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GLUTEN IS BAD |
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[[File:Gluten Sources.png|right|thumb|upright=1.30|Sources of gluten: Clockwise from top: high-gluten [[wheat flour]], European [[spelt]], [[barley]], rolled [[rye flakes]]]] |
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'''Gluten''' (from Latin ''[[:wikt:gluten#Latin|gluten]]'', "[[glue]]") is a composite of [[storage protein]]s termed [[prolamin]]s and [[glutelin]]s<ref name=FDAlabeling2007>{{cite web |url= https://www.fda.gov/OHRMS/DOCKETS/98fr/05n-0279-npr0001.pdf |title= Food Labeling ; Gluten-Free Labeling of Foods |date= January 2007 |author= Food and Drug Administration }}</ref> found in [[wheat]] and related grains, including [[barley]], [[rye]], [[oat]], and all their species and hybrids (such as [[spelt]], [[Khorasan wheat|khorasan]], [[emmer]], [[Einkorn wheat|einkorn]], [[triticale]], etc.).<ref name=Biesiekierski2017>{{cite journal| author=Biesiekierski JR| title=What is gluten? | journal=J Gastroenterol Hepatol | year= 2017 | volume= 32 Suppl 1 | pages= 78–81 | pmid=28244676 | doi=10.1111/jgh.13703 | url= http://onlinelibrary.wiley.com/doi/10.1111/jgh.13703/full | type=Review | quote= Similar proteins to the gliadin found in wheat exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as “gluten.” Derivatives of these grains such as triticale and malt and other ancient wheat varieties such as spelt and kamut also contain gluten. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, coeliac disease.}}{{open access}}</ref> Gluten is appreciated for its [[viscoelasticity|viscoelastic]] properties.<ref name=shewry1/><ref name=LamacchiaCamarca2014>{{cite journal | vauthors = Lamacchia C, Camarca A, Picascia S, Di Luccia A, Gianfrani C| title = Cereal-based gluten-free food: how to reconcile nutritional and technological properties of wheat proteins with safety for celiac disease patients | journal = Nutrients | volume = 6| issue = 2| pages = 575–90| date = Jan 29, 2014| pmid = 24481131|pmc= 3942718| doi = 10.3390/nu6020575 |type= Review | quote= the distinctive feature that makes wheat unique is, precisely, the visco-elasticity of gluten. When the grain is milled and mixed with water, storage proteins form a dough, capable of retaining gas bubbles. These properties make wheat suitable for the preparation of a great diversity of food products }}</ref> It gives elasticity to [[dough]], helping it [[leavening agent|rise]] and keep its shape and often gives the final product a [[chewiness|chewy]] texture. |
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Gluten is conjoined with [[starch]] in the [[endosperm]] of various [[Triticeae glutens|grassrelated]] [[cereal|grains]]. Wheat [[Prolamin|prolamins]] are called [[Gliadin|gliadins]], barley prolamins are [[Hordein|hordeins]], rye prolamins are [[Secalin|secalins]] and oats prolamins are [[Avenin|avenins]], which are collectively named gluten.<ref name=Biesiekierski2017 /> [[Oat#Celiac disease|Oat avenin toxicity]] in people with [[gluten-related disorders]] depends on the oat [[cultivar]] consumed because the [[immunoreactivity|immunoreactivities]] of toxic prolamins are different among oat varieties.<ref name=PenaginiDilillo>{{cite journal | vauthors = Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV| title = Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet | journal = Nutrients | volume = 5| issue = 11| pages = 4553–65| date = Nov 18, 2013| pmid = 24253052|pmc= 3847748| doi = 10.3390/nu5114553| type=Review}}</ref><ref name=DeSouzaDeschenes2016>{{cite journal| vauthors=de Souza MC, Deschênes ME, Laurencelle S, Godet P, Roy CC, Djilali-Saiah I| title=Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. | journal=Can J Gastroenterol Hepatol | year= 2016 | volume= 2016 | issue= | pages= 1576360 | pmid=27446824 | doi=10.1155/2016/1576360 | pmc=4904650 | type= Review }}</ref><ref name=CominoMoreno2015>{{cite journal | vauthors = Comino I, Moreno Mde L, Sousa C | title = Role of oats in celiac disease | journal = World J Gastroenterol | volume = 21 | issue = 41 | pages = 11825–31 | date = Nov 7, 2015 | pmid = 26557006 |pmc= 4631980 | doi = 10.3748/wjg.v21.i41.11825 |quote= It is necessary to consider that oats include many varieties, containing various amino acid sequences and showing different immunoreactivities associated with toxic prolamins. As a result, several studies have shown that the immunogenicity of oats varies depending on the cultivar consumed. Thus, it is essential to thoroughly study the variety of oats used in a food ingredient before including it in a gluten-free diet.}}</ref> Also, many oat products are cross-contaminated with other gluten-containing cereals.<ref name="DeSouzaDeschenes2016"/> |
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The fruit of most [[flowering plant]]s have endosperms with stored protein to nourish [[Plant embryogenesis|embryonic plants]] during [[germination]]. True gluten is limited to the grains listed above.<ref name=FDAlabeling2007 /> The stored proteins of [[maize]] and [[rice]] are sometimes called glutens, but their proteins differ from true gluten.<ref name=FDAlabeling2007 /> |
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==Preparation == |
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Gluten is a protein complex that accounts for 75 to 85% of the total protein in bread wheat.<ref name=shewry1/><ref name=cgc/> Gluten is prepared from [[flour]] by kneading the flour under water, agglomerating the gluten into an elastic network, a [[dough]], and then washing out the [[starch]].<ref name=shewry1/><ref name="cgc">{{Cite web |url=https://www.grainscanada.gc.ca/fact-fait/gluten-eng.htm |title=Gluten's role in bread baking performance |publisher=Canadian Grain Commission |publication-date=29 March 2016}}</ref> Starch granules [[suspension (chemistry)|disperse]] in cold/low-temperature water, and the dispersed starch is [[sedimentation|sedimented]] and dried. If a [[salt|saline]] solution is used instead of water, a purer protein is obtained, with certain harmless [[impurity|impurities]] departing to the solution with the starch. Where starch is the prime product, cold water is the favored solvent because the impurities depart from the gluten. |
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In home or restaurant cooking, a ball of wheat flour dough is kneaded under water until the starch disperses out.<ref name=cgc/> In industrial production, a [[slurry]] of wheat flour is kneaded vigorously by machinery until the gluten agglomerates into a mass.<ref name="sakhare">{{cite journal|pmc=4252461|year=2013|author1=Sakhare|first1=S. D.|title=Effect of flour particle size on microstructural, rheological and physico-sensory characteristics of bread and south Indian parotta|journal=Journal of Food Science and Technology|volume=51|issue=12|pages=4108–4113|last2=Inamdar|first2=A. A.|last3=Soumya|first3=C|last4=Indrani|first4=D|last5=Rao|first5=G. V.|doi=10.1007/s13197-013-0939-5}}</ref> This mass is collected by [[centrifugation]], then transported through several stages integrated in a continuous process. About 65% of the water in the wet gluten is removed by means of a [[screw press]]; the remainder is sprayed through an [[atomizer nozzle]] into a [[drying]] chamber, where it remains at an elevated temperature a short time to evaporate the water without denaturing the gluten.{{citation needed|date=December 2016}} The process yields a flour-like powder with a 7% moisture content, which is [[Air cooling|air cooled]] and [[Pneumatics|pneumatically]] transported to a receiving vessel. In the final step, the processed gluten is [[Sieve|sifted]] and [[Mill (grinding)|milled]] to produce a uniform product.<ref name=sakhare/> |
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== Uses == |
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[[File:Wheat field.jpg|thumb|[[Wheat]], a prime source of gluten]] |
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===Bread products=== |
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Gluten forms when glutenin molecules cross-link to form a submicroscopic network attached to [[gliadin]], which contributes [[viscosity]] (thickness) and extensibility to the mix.<ref name="shewry1">{{cite journal|pmc=1692935|year=2002|author1=Shewry|first1=P. R.|title=The structure and properties of gluten: An elastic protein from wheat grain|journal=Philosophical Transactions of the Royal Society B: Biological Sciences|volume=357|issue=1418|pages=133–142|last2=Halford|first2=N. G.|last3=Belton|first3=P. S.|last4=Tatham|first4=A. S.|doi=10.1098/rstb.2001.1024|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692935/pdf/11911770.pdf}}</ref><ref> |
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{{cite web | last1=Woychick | first1=JH | url=http://www.friedli.com/research/PhD/gluten/chap2.html |
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| title=The Gluten Proteins and Deamidated Soluble Wheat Protein |
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| accessdate=8 September 2009|display-authors=etal}} |
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</ref> If this dough is [[Leavening agent|leavened]] with [[yeast]], [[fermentation (food)|fermentation]] produces [[carbon dioxide]] bubbles, which, trapped by the gluten network, cause the dough to rise. [[Baking]] [[denaturation (biochemistry)|coagulates]] the gluten, which, along with starch, stabilizes the shape of the final product. Gluten content has been implicated as a factor in the [[staling]] of bread, possibly because it binds water through hydration.<ref> |
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Sahlstrom, S. & Brathen, E. (1997). "Effects of enzyme |
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preparations for baking, mixing time and resting time on |
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bread quality and bread staling". ''Food Chemistry'', 58, 1, |
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75-80. Effects of wheat variety and processing conditions |
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in experimental bread-baking studied by univariate and |
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[[multivariate analysis]].</ref> |
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The development of gluten (i.e., enhancing its elasticity) affects the texture of the baked goods.<ref name=shewry1/> Gluten's attainable elasticity is proportional to its content of glutenins with low molecular weights as this portion contains the preponderance of the sulfur atoms responsible for the cross-linking in the network.<ref>{{cite journal |
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| last = Edwards | first = N. M. |author2=Mulvaney, S. J. |author3=Scanlon, M. G. |author4=Dexter, J. E. |
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| year = 2003 |
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| title = Role of gluten and its components in determining durum semolina dough viscoelastic properties |
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| journal=Cereal chemistry | volume=80 | issue=6 | pages=755–763 |
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| url = http://cat.inist.fr/?aModele=afficheN&cpsidt=15273405 |
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| accessdate = 2007-08-14 | doi = 10.1094/CCHEM.2003.80.6.755 |
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}}</ref><ref>{{cite journal |
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| last = Tosi | first = Paola |
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|author2=Masci, Stefania |author3=Giovangrossi, Angela2 |author4=D'Ovidio, Renato |author5=Bekes, Frank |author6=Larroque, Oscar |author7=Napier, Johnathan |author8= Shewry, Peter |
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|date=September 2005 |
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| title = Modification of the Low Molecular Weight (LMW) Glutenin Composition of Transgenic Durum Wheat: Effects on Glutenin Polymer Size and Gluten Functionality |
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| journal=Molecular Breeding | volume=16 | issue=2 | pages=113–126 |
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| url = http://www.ingentaconnect.com/content/klu/molb/2005/00000016/00000002/00005912 |
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| accessdate = 2007-08-14 | doi = 10.1007/s11032-005-5912-1 |
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}}</ref> |
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More refining (of the gluten) leads to chewier products such as [[pizza]] and [[bagel]]s, while less refining yields tender baked goods such as [[pastry]] products.<ref name="Baking Technology, Bread">{{cite web |
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| url = http://www.bakersassist.nl/processing5-2.htm |
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| title = Baking Technology, Bread | publisher = Bakersassist |
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| accessdate = 2007-08-14}}</ref> |
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Generally, [[bread]] flours are high in gluten (hard wheat); pastry flours have a lower gluten content. [[Kneading]] promotes the formation of gluten strands and cross-links, creating baked products that are chewier (in contrast to crumbly). The "chewiness" increases as the dough is kneaded for longer times. An increased moisture content in the dough enhances gluten development,<ref name="Baking Technology, Bread"/> and very wet doughs left to rise for a long time require no kneading (see [[no-knead bread]]). [[Shortening]] inhibits formation of cross-links and is used, along with diminished water and less kneading, when a tender and flaky product, such as a pie crust, is desired. |
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The strength and elasticity of gluten in flour is measured in the baking industry using a [[farinograph]]. This gives the baker a measurement of quality for different varieties of flours in developing recipes for various baked goods.<ref name=shewry1/><ref>{{cite web |url=http://www.ndsu.edu/ndsu/simsek/wheat/farinograph.html |title=Farinograph |date=22 September 2014 |website=Wheat Quality and Carbohydrate Research |publisher=North Dakota State University |accessdate=8 December 2014}}</ref><ref>{{cite journal |last=Oliver |first=JR |last2=Allen |first2=HM |date=January 1992 |title=The prediction of bread baking performance using the farinograph and extensograph |url=http://www.sciencedirect.com/science/article/pii/S0733521009800581 |journal=Journal of Cereal Science |publisher=Elsevier |volume=15 |issue=1 |pages=79–89 |doi=10.1016/S0733-5210(09)80058-1 |accessdate=5 December 2014}}</ref> |
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====Added gluten==== |
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Gluten, when dried and milled to a powder and added to ordinary flour dough, improves a dough's ability to rise and increases the bread's structural stability and chewiness.<ref>{{cite book|author1= Amendola, J.|author2= Rees, N.|author3= Lundberg, D. E. |year=2002|title=Understanding Baking}}</ref> Gluten-added dough must be worked vigorously to induce it to rise to its full capacity; an automatic [[bread machine]] or [[food processor]] may be required for high-gluten kneading.<ref>{{cite book|author1=Eckhardt, L.W.|author2=Butts, D.C. |year=1997|title=Rustic European Breads from your Bread Machine}}</ref> Generally, higher gluten levels are associated with higher amounts of overall protein.<ref>{{cite web |url=http://www.newyorker.com/magazine/2014/11/03/grain |title=Against the Grain |date=3 November 2014 |website=The New Yorker |accessdate=8 December 2014}}</ref> |
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===Imitation meats=== |
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[[File:Wheat gluten (vegetarian mock duck) 2007.jpg|thumb|Gluten is often used in imitation meats (such as this mock "duck") to provide supplemental protein and variety in vegetarian diets.]] |
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{{details|topic=the use of gluten in cooking|Wheat gluten (food)}} |
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Gluten, especially [[wheat gluten (food)|wheat gluten]], is often the basis for [[Meat analogue|imitation meats]] resembling [[beef]], [[Chicken (food)|chicken]], [[Duck (food)|duck]] (see [[mock duck]]), [[Fish (food)|fish]], and [[pork]]. When cooked in [[broth]], gluten absorbs some of the surrounding liquid (including the flavor) and becomes firm to the bite.<ref>Bates, Dorothy, R.; Wingate, Colby. 1993. "Cooking with Gluten and Seitan." Summertown, Tennessee: The Book Publishing Co. 128 p</ref><ref>{{cite web |url=http://vegannomnoms.net/2011/03/how-to-make-seitan-an-illustrated-guide.html |title=How to Make Seitan: An Illustrated Guide |last=Abramowski |first=Nicole |date=11 March 2011 |website=Vegan Nom Noms |accessdate=8 December 2014}}</ref> |
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=== Other consumer products=== |
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Gluten is often present in [[beer]] and [[soy sauce]], and can be used as a [[food additive|stabilizing agent]] in more unexpected food products, such as [[ice cream]] and [[ketchup]]. Foods of this kind may raise a problem for a small number of consumers because the hidden gluten constitutes a hazard for people with [[Coeliac disease|celiac disease]]. |
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Gluten is also used in [[cosmetics]], hair products, and other [[Dermatology|dermatological]] preparations.<ref>{{cite journal|journal=Eur J Dermatol|year=2006|volume=16|issue=1|pages=4–11|title=Gluten intolerance and skin diseases|author1=Humbert P|author2= Pelletier F|author3= Dreno B|author4= Puzenat E|author5= Aubin F|pmid=16436335}}</ref> |
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===Animal feed=== |
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The protein content of some [[pet food]]s may also be enhanced by adding gluten.<ref>{{cite web |
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| title = Pet Foods | accessdate = 14 August 2007 |
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| publisher = International Wheat Gluten Association |
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| archiveurl = https://web.archive.org/web/20071007175039/http://www.iwga.net/04_pet.htm <!-- Bot retrieved archive --> |
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| archivedate = 2007-10-07| url = http://www.iwga.net/04_pet.htm <!-- Bot retrieved archive -->}}</ref> |
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== Adverse reactions == |
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{{Main article|Gluten-related disorders|Gluten-sensitive enteropathy-associated conditions|Gluten-sensitive idiopathic neuropathies}} |
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Gluten-related disorders is the umbrella term for all diseases triggered by gluten, which include [[celiac disease]] (CD), [[non-celiac gluten sensitivity]] (NCGS), [[wheat allergy]], [[gluten ataxia]], and [[dermatitis herpetiformis]] (DH).<ref name=LudvigssonLeffler2013>{{cite journal |vauthors=Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, Hadjivassiliou M, Kaukinen K, Kelly CP, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C |title=The Oslo definitions for coeliac disease and related terms |journal=Gut |volume=62 |issue=1 |pages=43–52 | date=January 2013 |pmid=22345659 |pmc=3440559 |doi=10.1136/gutjnl-2011-301346|type=Review}}</ref> Currently, their incidence is increasing in most geographic areas of the world.<ref name=TovoliMasi>{{cite journal | vauthors = Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L| title = Clinical and diagnostic aspects of gluten related disorders| journal = World J Clin Cases| volume = 3| issue = 3| pages = 275–84| date = Mar 16, 2015| pmid = 25789300|pmc= 4360499| doi = 10.12998/wjcc.v3.i3.275|type=Review}}</ref><ref name=LionettiGatti2015>{{cite journal|vauthors=Lionetti E, Gatti S, Pulvirenti A, Catassi C|title=Celiac disease from a global perspective |journal=Best Pract Res Clin Gastroenterol |volume=29 |issue=3 |pages=365–79 |date=Jun 2015|pmid=26060103|doi=10.1016/j.bpg.2015.05.004|type=Review}}</ref><ref name=SaponeBai2012>{{cite journal |vauthors=Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, Kaukinen K, Rostami K, Sanders DS, Schumann M, Ullrich R, Villalta D, Volta U, Catassi C, Fasano A |title=Spectrum of gluten-related disorders: consensus on new nomenclature and classification |journal=BMC Medicine |volume=10 |issue= |pages=13 |year=2012 |pmid=22313950 |pmc=3292448 |doi=10.1186/1741-7015-10-13 |type=Review}} {{open access}}</ref> It can be explained possibly by the growing westernization of diet,<ref name=TovoliMasi /> increasing use of wheat-based foods included in the [[Mediterranean diet]],<ref name=VoltaCaioQuestionsQuotation>{{cite journal|vauthors=Volta U, Caio G, Tovoli F, De Giorgio R|title=Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness|journal=Cellular and Molecular Immunology|volume=10|issue=5|year=2013|pages=383–392|issn=1672-7681|doi=10.1038/cmi.2013.28|pmid=23934026|type=Review|pmc=4003198}}</ref><ref name=GuandaliniPolanco>{{cite journal|vauthors=Guandalini S, Polanco I|title=Nonceliac gluten sensitivity or wheat intolerance syndrome?|journal=J Pediatr|volume=166|issue=4|pages=805–11|date=Apr 2015|pmid=25662287|doi=10.1016/j.jpeds.2014.12.039|type=Review|quote=The increase in world-wide consumption of a Mediterranean diet, which includes a wide range of wheat-based foods, has possibly contributed to an alarming rise in the incidence of wheat (gluten?)-related disorders.1, 2 }}</ref> the progressive replacement of rice by wheat in many countries in Asia, the Middle East, and North Africa,<ref name=TovoliMasi /> the development in recent years of new types of wheat with a higher amount of [[Cytotoxicity|cytotoxic]] gluten [[peptide]]s,<ref name=VoltaCaioQuestions>{{cite journal |vauthors=Volta U, Caio G, Tovoli F, De Giorgio R |title=Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness |journal=Cellular & Molecular Immunology |volume=10 |issue=5 |pages=383–92 | date=September 2013 |pmid=23934026 |pmc=4003198 |doi=10.1038/cmi.2013.28 |type=Review}}</ref><ref name=Belderok>{{cite journal|author=Belderok B|title=Developments in bread-making processes |journal=Plant Foods Hum Nutr |volume=55 |issue=1 |pages=1–86 |date=2000 |pmid=10823487|doi=10.1023/A:1008199314267|type=Review}}</ref> and the higher content of gluten in bread and bakery products, due to the reduction of dough fermentation time.<ref name=VoltaCaioQuestions /><ref name=GobbettiGiuseppe2007>{{cite journal|vauthors=Gobbetti M, Giuseppe Rizzello C, Di Cagno R, De Angelis M |title=Sourdough lactobacilli and celiac disease |journal=Food Microbiol |volume=24 |issue=2 |pages=187–96 |date=Apr 2007 |pmid=17008163 |doi= 10.1016/j.fm.2006.07.014|type=Review}}</ref> |
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=== Celiac disease === |
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{{Main article|Celiac disease}} |
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[[Celiac disease]] (CD) is a chronic, immune-mediated mainly intestinal process, caused by the ingestion of wheat, barley, rye, and derivatives, that appears in [[genetic predisposition|genetically predisposed]] people of all ages. CD is not only a gastrointestinal disease, because it may involve several organs and cause an extensive variety of non-gastrointestinal symptoms, and most importantly, it may often be completely asymptomatic. Added difficulties for diagnosis are the fact that serological markers ([[Anti-transglutaminase antibodies#Anti-tissue transglutaminase|anti-tissue transglutaminase]] [TG2]) are not always present<ref name=NEJM2012>{{cite journal|last1=Fasano|first1=A|last2=Catassi|first2=C|title=Clinical practice. Celiac disease.|journal=The New England Journal of Medicine|date=Dec 20, 2012|volume=367|issue=25|pages=2419–26|pmid=23252527|doi=10.1056/NEJMcp1113994}}</ref> and many people may have minor mucosal lesions, without atrophy of the [[intestinal villi]].<ref name=BoldRostami>{{cite journal | vauthors = Bold J, Rostami K| title = Gluten tolerance; potential challenges in treatment strategies | journal = Gastroenterol Hepatol Bed Bench | volume = 4| issue = 2| pages = 53–7| date = 2011 | pmid = 24834157|pmc= 4017406}}</ref> |
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CD affects approximately 1–2% of the general population,<ref name=LundinWijmenga2015>{{cite journal|vauthors=Lundin KE, Wijmenga C|title=Coeliac disease and autoimmune disease-genetic overlap and screening|journal=Nat Rev Gastroenterol Hepatol|volume=12|issue=9|pages=507–15|date =Sep 2015|pmid=26303674|doi=10.1038/nrgastro.2015.136}}</ref> but most cases remain unrecognized, undiagnosed and untreated, and at risk for serious long-term health complications.<ref name=LionettiGatti2015 /><ref name=LundinWijmenga2015 /><ref name=Fasano2005Pediatric>{{cite journal | author = Fasano A| title = Clinical presentation of celiac disease in the pediatric population | journal = Gastroenterology | volume = 128| issue = 4 Suppl 1| pages = S68–73| date = Apr 2005| pmid = 15825129 |pmc= | doi = 10.1053/j.gastro.2005.02.015}}</ref><ref name=ElliBranchi>{{cite journal | vauthors = Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, Roncoroni L, Bardella MT| title = Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity | journal = World J Gastroenterol | volume = 21 | issue = 23 | pages = 7110–9 | date = Jun 2015 | pmid = 26109797 |pmc= 4476872 | doi = 10.3748/wjg.v21.i23.7110}}</ref> People may suffer severe disease symptoms and be subjected to extensive investigations for many years, before a proper diagnosis is achieved.<ref name=LudvigssonCard>{{cite journal | vauthors = Ludvigsson JF, Card T, Ciclitira PJ, Swift GL, Nasr I, Sanders DS, Ciacci C| title = Support for patients with celiac disease: A literature review | journal = United European Gastroenterol J | volume = 3 | issue = 2 | pages = 146–59 | date = Apr 2015 | pmid = 25922674 | pmc = 4406900 |doi = 10.1177/2050640614562599}}</ref> Untreated CD may cause [[malabsorption]], reduced quality of life, [[iron deficiency]], [[osteoporosis]], an increased risk of intestinal [[lymphoma]]s, and greater mortality.<ref name=LebwoholLudvigsson>{{cite journal | vauthors =Lebwohl B, Ludvigsson JF, Green PH | title = Celiac disease and non-celiac gluten sensitivity | journal = BMJ | volume = 351 | pages = h4347| date = Oct 2015 | pmid = 26438584|pmc= 4596973 | doi = 10.1136/bmj.h4347|type= Review }}</ref> CD is associated with some other autoimmune diseases, such as [[diabetes mellitus type 1]], [[thyroiditis]],<ref name=LundinWijmenga>{{cite journal | vauthors = Lundin KE, Wijmenga C| title = Coeliac disease and autoimmune disease-genetic overlap and screening| journal = Nat Rev Gastroenterol Hepatol| volume = 12| issue = 9| pages = 507–15| date = Sep 2015 | pmid = 26303674 | doi = 10.1038/nrgastro.2015.136}}</ref> [[ataxia|gluten ataxia]], [[psoriasis]], [[vitiligo]], [[autoimmune hepatitis]], [[dermatitis herpetiformis]], [[primary sclerosing cholangitis]], and more.<ref name=LundinWijmenga /> |
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CD with "classic symptoms", which include gastrointestinal manifestations such as chronic diarrhea and abdominal distention, malabsorption, loss of appetite, and impaired growth, is currently the least common presentation form of the disease and affects predominantly small children generally younger than two years of age.<ref name=Fasano2005Pediatric /><ref name=LudvigssonCard /> |
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CD with "non-classic symptoms" is the most common clinical type<ref name=LudvigssonCard /> and occurs in older children (over 2 years old),<ref name=LudvigssonCard /> adolescents, and adults.<ref name=LudvigssonCard /> It is characterized by milder or even absent gastrointestinal symptoms and a wide spectrum of non-intestinal manifestations that can involve any organ of the body, and very frequently may be completely asymptomatic<ref name=Fasano2005Pediatric /> both in children (at least in 43% of the cases<ref name=VriezingaSchweizer>{{cite journal |vauthors=Vriezinga SL, Schweizer JJ, Koning F, Mearin ML |title=Coeliac disease and gluten-related disorders in childhood |journal=Nature Reviews. Gastroenterology & Hepatology |volume= 12 |issue= 9 |pages= 527–36 |year= Sep 2015 |pmid=26100369 |doi=10.1038/nrgastro.2015.98 |type=Review}}</ref>) and adults.<ref name=Fasano2005Pediatric /> |
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=== Non-celiac gluten sensitivity === |
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{{Main article|Non-celiac gluten sensitivity}} |
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Non-celiac gluten sensitivity (NCGS) is described as a condition of multiple symptoms that improves when switching to a [[gluten-free diet]], after celiac disease and wheat allergy are excluded.<ref name=NijeboerBontkes>{{cite journal|last1=Mooney|first1=P|last2=Aziz|first2=I|last3=Sanders|first3=D|title=Non-celiac gluten sensitivity: clinical relevance and recommendations for future research|journal=Neurogastroenterology & Motility|date=2013|volume=25|issue=11|pages=864–871|doi=10.1111/nmo.12216|pmid=23937528}}</ref><ref>{{cite journal|last1=Nijeboer| |
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first1=P|last2=Bontkes|first2=H|last3=Mulder|first3=C|last4=Bouma|first4=G|title=Non-celiac gluten sensitivity. Is it in the gluten or the grain?|journal=Journal of gastrointestinal and liver disorders|date=2013|volume=22|issue=4|pages=435–40|pmid=24369326}}</ref> Recognized since 2010,<ref name=CatassiBai /><ref name=FasanoSapone2015>{{cite journal | vauthors = Fasano A, Sapone A, Zevallos V, Schuppan D| title = Nonceliac gluten sensitivity | journal = Gastroenterology | volume = 148| issue = 6| pages = 1195–204| date = May 2015| pmid = 25583468 | doi = 10.1053/j.gastro.2014.12.049|url=http://www.clinicalnutritionjournal.com/article/S0261-5614(14)00218-0/fulltext}}</ref> it is included among [[gluten-related disorders]],<ref name=CatassiBai /> but its [[pathogenesis]] is not yet well understood.<ref name=FasanoSapone2015 /> NCGS is the most common syndrome of [[gluten intolerance]],<ref name=CatassiBai /><ref name=CzajaBulsa>{{cite journal | author = Czaja-Bulsa G | title = Non coeliac gluten sensitivity - A new disease with gluten intolerance | journal = Clin Nutr | volume = 34| issue = 2| pages = 189–94| date = Apr 2015| pmid = 25245857 | doi = 10.1016/j.clnu.2014.08.012}}</ref> with a prevalence estimated to be 6-10%.<ref name=MolinaInfanteSantolaria>{{cite journal | vauthors = Molina-Infante J, Santolaria S, Montoro M, Esteve M, Fernández-Bañares F| title = [Non-celiac gluten sensitivity: a critical review of current evidence] [Article in Spanish] | journal = Gastroenterol Hepatol | volume = 37| issue = 6 | pages = 362–71 | date = 2014 | pmid = 24667093 | doi = 10.1016/j.gastrohep.2014.01.005}}</ref> |
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People with NCGS may develop gastrointestinal symptoms, which resemble those of [[irritable bowel syndrome]] or [[wheat allergy]],<ref name=CatassiBai>{{cite journal | vauthors = Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A| title = Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders | journal = Nutrients | volume = 5| issue = 10| pages = 3839–53| date = Sep 2013 | pmid =24077239 |pmc= 3820047| doi = 10.3390/nu5103839}}</ref><ref name=ElliRoncorni>{{cite journal | vauthors = Elli L, Roncoroni L, Bardella MT| title = Non-celiac gluten sensitivity: Time for sifting the grain | journal = World J Gastroenterol | volume = 21| issue = 27| pages = 8221–6| date = Jul 2015 | pmid = 26217073 |pmc= 4507091 | doi = 10.3748/wjg.v21.i27.8221|type= Review }}</ref> and/or a wide variety of non-gastrointestinal symptoms, such as [[headache]], chronic [[fatigue (medical)|fatigue]], [[fibromyalgia]], [[atopy|atopic diseases]], [[allergy|allergies]], [[neurological disorder|neurological diseases]], or [[mental disorder|psychiatric disorders]], among others.<ref name=LebwoholLudvigsson /><ref name=FasanoSapone2015 /><ref name=VoltaCaio2015>{{cite journal | vauthors = Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE| title = Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders | journal = Best Pract Res Clin Gastroenterol | volume = 29| issue = 3| pages = 477–91| date = Jun 2015| pmid = 26060112 | doi = 10.1016/j.bpg.2015.04.006}}</ref> |
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Besides gluten, additional components present in wheat, rye, barley, and their derivatives, including other proteins and short-chain [[carbohydrates]] called [[FODMAP]]s, may cause NCGS symptoms. The effects of FODMAPs are only limited to gastrointestinal discomfort.<ref name=FasanoSapone2015 /> |
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=== Wheat allergy === |
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{{Main article|Wheat allergy}} |
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People can also experience adverse effects of wheat as result of a [[wheat allergy]].<ref name=ElliBranchi /> As with most allergies, a wheat allergy causes the immune system to abnormally respond to a component of wheat that it treats as a threatening foreign body. This immune response is often time-limited and does not cause lasting harm to body tissues.<ref>{{cite web|url=http://www.cureceliacdisease.org/archives/faq/what-is-the-difference-between-gluten-intolerance-gluten-sensitivity-and-wheat-allergy|publisher=The University of Chicago Celiac Disease Center|title=What’s the difference between celiac disease, gluten intolerance, non-celiac gluten sensitivity and wheat allergy?|date=2015|accessdate=4 January 2015}}</ref> Wheat allergy and celiac disease are different disorders.<ref name=ElliBranchi/><ref>{{cite web |url=http://www.food.gov.uk/multimedia/pdfs/allergyfactsheettwo.pdf |title=Food intolerance and coeliac disease |publisher=Food Standards Agency |date=September 2006 |format=PDF |accessdate=8 September 2009}}</ref> Gastrointestinal symptoms of wheat allergy are similar to those of celiac disease and non-celiac gluten sensitivity, but there is a different interval between exposure to wheat and onset of symptoms. An allergic reaction to wheat has a fast onset (from minutes to hours) after the consumption of food containing wheat and could include [[anaphylaxis]].<ref name=NEJM2012 /> |
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==Labelling== |
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===International standards=== |
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The ''[[Codex Alimentarius]]'' [[international standard]]s for [[food labelling]] has a standard relating to the labelling of products as "gluten-free". It only applies to foods that would normally contain gluten.<ref>{{cite web|url=http://www.codexalimentarius.org/download/standards/291/cxs_118e.pdf|publisher=[[Codex Alimentarius]]|title=Codex Standard For "Gluten-Free Foods" CODEX STAN 118-1981|date=February 22, 2006|format=PDF}}</ref> |
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===Brazil=== |
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By law in Brazil, all food products must display labels clearly indicating whether or not they contain gluten.<ref>{{cite web |
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|url=http://e-legis.anvisa.gov.br/leisref/public/showAct.php?id=32 |
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|date=July 2014 |
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|title=General labeling for Packaged Foods (free translation) |
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|publisher=[[ANVISA]]}}</ref> |
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===Canada=== |
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The Canadian Celiac Association estimates that one in 133 Canadians experiences adverse symptoms from gluten in celiac disease.<ref>{{cite web|url=http://www.celiac.ca/?page_id=882|title=About celiac disease|date=2014|publisher=Canadian Celiac Association}}</ref> Labels for all food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 20 parts per million.<ref>{{cite web|url=http://www.hc-sc.gc.ca/fn-an/securit/allerg/cel-coe/gluten-position-eng.php|title=Health Canada's Position on Gluten-Free Claims|date=29 June 2012|publisher=Health Canada|accessdate=28 January 2015}}</ref> |
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===United Kingdom=== |
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In the United Kingdom, all prepackaged foods and non-prepacked foods from a restaurant, take-out food wrapped just before sale, or unpackaged food served in institutions must be identified if gluten-free.<ref name="fsa2016">{{cite web |
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|url= https://www.food.gov.uk/business-industry/allergy-guide/labelling-of-gluten-free-foods |
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|date=31 October 2016 |
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| title=Labelling of 'gluten free' foods |
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| publisher=[[Food Standards Agency]] |format=PDF}}</ref> "Gluten-free" is defined as 20 parts per million of gluten or less and "very low gluten" is 100 parts per million of gluten or less; only foods with cereal ingredients processed to remove gluten can claim "very low gluten" on labels.<ref name=fsa2016/> |
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===United States=== |
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In the United States, gluten is not listed on labels unless added as a stand-alone ingredient. Wheat or other allergens are listed after the ingredient line. The [[US Food and Drug Administration]] (FDA) has historically classified gluten as "[[generally recognized as safe]]" (GRAS). In August 2013, FDA issued a final rule, effective August 2014, that defined the term "gluten-free" for voluntary use in the labeling of foods as meaning that the amount of gluten contained in the food is below 20 parts per million.<ref>{{cite web|url=http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm|publisher=US Food and Drug Administration|title=Questions and Answers: Gluten-Free Food Labeling Final Rule|date=5 August 2014|accessdate=4 January 2015}}</ref> |
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== See also == |
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* [[Gluten-free diet]] |
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* [[Gliadin]] |
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== References == |
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{{Reflist|2}} |
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== Further reading == |
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* {{Cite web |
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|last1 = Curtis |first1 = B.C. |last2 = Rajaram |first2 = S. |last3 = Macpherson |first3 = H.G. |
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|title = Bread Wheat, Improvement and production — FAO Plant Production and Protection Series No. #30. |url = http://www.fao.org/DOCREP/006/Y4011E/y4011e05.htm |accessdate = 2007-08-21 |
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|postscript = <!--None--> |
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}} |
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* {{Cite web |last = Pfluger |first = Laura |
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|title = Marker Assisted Selection in Wheat, ''Quality traits. Gluten Strength'', Coordinated Agricultural Project (funded by USDACREES) |url = http://maswheat.ucdavis.edu/protocols/gluten/index.htm |accessdate = 2007-09-29 |postscript = <!--None--> |
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}} |
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{{Barley}} |
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{{Wheat}} |
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[[Category:Gluten| ]] |
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[[Category:Nutrition]] |
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[[Category:Seed storage proteins]] |
Revision as of 17:42, 15 May 2017
GLUTEN IS BAD