ADA Publishes Revised GF Diet Guidelines

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Copyright 2001 by Gluten-Free Living
From GLUTEN-FREE LIVING, the Resource for People with Gluten Sensitivity. Write to Gluten-Free Living, PO Box 105, Hastings-on-Hudson, NY 10706.* Comments to GLUTEN-FREE LIVING Magazine

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These guidelines are consistent with those followed in the rest of the world! by Ann Whelan

The American Dietetic Association (ADA) has published an updated and revised edition (6th) of the "Manual of Clinical Dietetics" that offers an international perspective on the dietary treatment of many diseases. The chapter on celiac disease, written by a team of dietitians, includes diet guidelines that are consistent with international standards. Therefore the chapter's list of safe foods includes buckwheat, quinoa, millet, amaranth, teff, distilled vinegar and distilled alcoholic beverages such as rum, gin, whiskey, and vodka.

These guidelines, created through a partnership between American and Canadian dietitians, differ from those previously recommended in this country. The United States has been the only country where celiacs have been instructed by one or all US celiac support groups to avoid some or all of the ingredients listed above.

The team of dietitians included three Canadian dietitians: Shelley Case, RD, Mavis Molloy, RD, and Marion Zarkadas, M.Sc., RD. They are all members of the Professional Advisory Board of the Canadian Celiac Association. American dietitians who reviewed it included Cynthia Kupper, CRD, CDE, Executive Director of the Gluten Intolerance Group, and a celiac herself.

"I am pleased to see these new guidelines established by the ADA," Kupper says. "Dietetics, like medicine is a constantly changing field. As new information becomes available, dietary recommendations are adjusted to provide the best possible treatment options. The dietitians who developed these recommendations based them on a thorough review of the latest research."

The Manual of Clinical Dietetics is a well recognized source of information for the dietary treatment of different illnesses. "It is the most up to date source currently available, and is used by many hospitals and by practicing dietitians across the country," " says Betsy Hornick, RD, editor of the volume. "I think this sixth edition is special because it reflects both US and Canadian practices."

The dietitians from Canada were equally enthusiastic. "We are delighted to finally have standardized dietary guidelines in print in North America. They will assist dietitians in providing accurate information to those who must follow the gluten-free diet," Case says.

Basic Diet

These new guidelines offer freedom from avoiding products due to unidentified vinegar. They offer greater choice in alcoholic drinks should you choose to use them. Perhaps the most exciting change is the variety and nutrition buckwheat, quinoa, amaranth, millet and teff, bring to the GF diet.. One year ago, after careful research, Gluten-Free Living published a basic diet that is consistent with the recommendations now approved by the ADA. We did that to try to sort out the confusion here in this country and only after careful research. The GFL diet had been reviewed and approved by the Gluten-Free Living Medical and Dietitian Advisory Boards. The following information will help clarify why these ingredients can be safely used on the gluten-free diet. Then you will be better able to enjoy a new variety of GF foods without wondering if you are doing the right thing.

Vinegar

The concern in this country has been the possibility of gluten peptides surviving distillation and winding up in distilled vinegar when the source is a gluten-containing grain. Not only is this not possible, but wheat is seldom, if ever, used as a vinegar source. So gluten would not be found in distilled vinegar, which is the kind you will run into almost all of the time in this country. Rather than go into all the evidence again, we have included a reprint from Gluten-Free Living with this issue. But the vinegar issue continues to plague the American celiac community. Recently a reader contacted us saying she had heard some new things about vinegar and why it might cause problems for celiacs. The theory she heard went like this:

Since gluten is a protein, it is made up of amino acids that hang together in a kind of chain, almost like a necklace. It is the peculiar order of the amino acids that appears to cause problems for celiacs. When gluten is processed in some way, the chain breaks up into individual links called peptides. While one peptide (or several) may be safe, one or more of the peptides may be toxic. The test that can measure gluten proteins cannot measue the peptides and therefore cannot find them because they are broken down. But they would still be there and potentially toxic to celiacs.

This theory is neither correct nor up to date since wheat does not appear to be used for vinegar in this country. But if you are concerned, here's what you need to know.

Proteins are made up of 20 different amino acids that are linked together by peptide bonds to form what is called a polypeptide. They are like the beads of a necklace, where different amino acids correspond to different colored beads. The number of each type of amino acids in a protein, combined with their sequence in the chain, determines what the protein is.

Proteins are long polypeptide chains usually incorporating at least 50 amino acids, although some proteins have many hundreds of amino acids in their chains. Natural peptides are shorter chains that are frequently the result of breakage of a long protein chain into smaller pieces, which can be of varying lengths.

For example, if there are only two amino acids in the chain, it is called a dipeptide. Diepeptides are too small to be harmful to celiac patients. The smallest peptide that has been shown to be harmful has 12 amino acids linked in the polypeptide chain.

There are a number of chemical ways to break up the proteins into shorter chains or even into the individual amino acids that comprise the protein. Some food processing methods, hydrolyzation for example, do break proteins up into peptides. If the proteins came from a gluten-containing grain, some of the peptides could be toxic, as the above theory proposes.

When a protein like gluten is hydrolyzed (broken up), the degree of breakdown may vary. Although the polypeptide chains could be broken down to the constituent amino acids, which would be harmless, the process is seldom carried that far. If it were, the resulting ingredient might no longer have the properties the food processor desired. "Partial" hydrolysis might result in peptides large enough to be toxic. That's why celiacs are advised to avoid hydrolyzed wheat protein or other hydrolyzed ingredients for which the source is not stated. Some of the peptides could be toxic.

Since FDA regulations now require that processors state the source of hydrolyzed ingredients, which can be soy, corn or wheat, celiacs should be able to read the label and determine which hydrolyzed proteins to avoid and which would be safe. This was not the case when processors could simply declare hydrolyzed "vegetable" protein on the label, leaving the celiac in the dark as to the source of the ingredient. *

However, the theory described above about dangerous peptides would not apply to distilled vinegar. Distillation is a process that separates molecules using their different volatilities. Those that are highly volatile (turn readily to vapor when heated) go one way (into the distillate); those that are less volatile or not volatile at all will lag behind or stay with the starting mixture.

For example, table salt is not volatile. It will not turn to vapor if heated under distillation conditions. So you can't smell it. But you can smell alcohol, as you probably know if you've been near someone who has had too much to drink. That's because alcohol is highly volatile.

Gluten proteins and peptides (even amino acids) have so little volatility, they don't vaporize with the alcohol in distillation, and are left behind, as table salt would be, while the alcohol separates readily. This means toxic peptides would not be present in the distillate when pure grain alcohol is made. So even if a distilled vinegar was made from pure grain alcohol derived from wheat (if you were able to find some), it would still be gluten free. **

Distillation has been practiced for centuries. It is an easy process to understand and has withstood the test of time, if not the test of celiacs. Readers who prefer to continue to avoid distilled vinegar, which is almost always (if not always) made from something other than wheat, can comfortably do so,. But their individual reactions or choices have nothing to do with other celiacs.

Buckwheat and Quinoa

There are many reasons why buckwheat and quinoa are considered to be gluten free; recently this fact seems to have been agreed on by the support groups in this country. What is not agreed on is the possibility of contamination.

But those who are worried about contamination in buckwheat and quinoa have not checked it out. For a number of reasons (see the Sept./Oct 1998 and July/August 1999 issues of GFL), these two ingredients are no more likely to be contaminated than any "grain." In fact, they may be more unlikely to be contaminated than other "grains." (Botanically, both buckwheat and quinoa are fruits. They are sometimes referred to as "pseudograins" because they have grain-like properties and uses.)

Buckwheat may very well be mixed with wheat, which is not contamination but rather the creation of something else. The resulting mixture would be toxic for celiacs since it contains wheat. Even with safe ingredients, you must still check the label to make sure they are not mixed with toxic ingredients.

Quinoa, too, might be mixed with other grains, so you should check the label. In addition, quinoa does have a bitter tasting compound in the outer hull called saponin that must be washed off before the quinoa is used. If the saponin is not washed off, it can cause anyone to feel sick, celiac and non celiac alike.

And anyone can "react" to any food. If the food does not contain gluten, the reaction is not a gluten reaction and therefore not relevant for other celiacs. So unless you "react," for some reason, you can safely enjoy buckwheat or quinoa on the gluten-free diet -- as the ADA has indicated

As noted above, the same principles that apply to distillation of alcohol for vinegar apply to distillation of alcohol for alcoholic drinks. Distilled alcoholic drinks would be gluten free as long as no gluten is added back in after the distillation process. According to the ADA, rum, gin, whiskey and vodka should be safe for celiacs.

However, Nancy Patin Falini, RD, an advisor for this newsletter, reminds celiacs that everyone should use alcohol with caution. It too much alcohol is consumed too often, it can irritate the gastrointestinal tract and cause bleeding and ulceration. Falini says this caution would be especially important to the newly diagnosed celiac whose gastrointestinal tract is already inflamed and damaged.

So, we now have a new approach to the GF diet created by American and Canadian dietitians, sanctioned by the American Dietetic Association, and followed in other countries of the world. Celiacs should be able to safely consume buckwheat, quinoa, millet, amaranth, teff, distilled vinegar and distilled alcoholic beverages such as rum, gin, whiskey and vodka. There is no longer any reason to wonder why ingredients thought to be dangerous on one side of the US/ Canadian border are safe on the other! We have finally reached sanity. What is toxic here is toxic there -- and vice versa, as common sense would suggest.

Ann Whelan is editor/publisher or Gluten-Free Living. She has been gluten sensitive for eleven years and has studied the diet in depth and written about it for more than seven years.

* Current Canadian regulations do not require identification of the source of the protein in HVP. Some Canadian processors do voluntarily state the source, but it is not required that they do so.

** Malt vinegar is the only vinegar celiacs should avoid.

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This fact sheet has been designed to be a general information resource. However, it is not intended for use in diagnosis, treatment, or any other medical application. Questions should be directed to your personal physician. This information is not warranted and no liability is assumed by the author or any group for the recommendations, information, dietary suggestions, menus, and recipes promulgated. Based upon accepted practices in supplying the source documents, this fact sheet is accurate and complete. Products mentioned or omitted do not constitute endorsement.

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