In the movie This Is the End, Seth Rogen gave us the perfect pop culture definition of gluten:

“Whenever you feel sh---y, that’s because of gluten . . . Gluten is a vague term. It’s something that’s used to categorize things that are bad. Ya know? Calories: that’s a gluten. Fat: that’s a gluten.”

Here at The Family Thrive, we’re going to give you the perfect evidence-based definition of gluten, and explain what you as a parent need to know about it.

What is gluten?

Gluten (or “gliaden”) is a protein found in the germ of the grains of wheat, barley, and rye.

Why should parents care about gluten?

Up to 6% of the population in Western countries have a gluten-related disorder (GRD), which means that their bodies have some level of an abnormal response when they eat food with gluten.

By understanding what the symptoms of GRDs are and how best to respond to milder cases, parents can manage symptoms that are too mild to get a diagnosis of a serious GRD like celiac disease.

What are gluten-related disorders (GRDs) and how are they each different?

Non-celiac gluten sensitivity (NCGS) isn’t an allergy and can’t be diagnosed like other GRDs because there’s not detectable immune system response in the blood. You or your child could have some of the same gastrointestinal symptoms that a person with wheat allergy or celiac has, but damage doesn’t usually appear in the small intestine and blood tests come back negative.

Wheat allergy (WA) is the result of an immune reaction to proteins in wheat and can be diagnosed by finding antibodies in the blood called “Immunoglobin E (IgE).” There are 18 different proteins in wheat that can cause a problem, gluten being just one of them. An antibody tags the wheat as a foreign item so that the immune system can remember it, attack it, and ward off any future invasion. With Wheat Allergy, the body mistakenly thinks that the wheat protein is an invader that needs to be attacked. The reaction happens within minutes to hours after wheat protein is consumed.

Celiac disease (CD) is an inherited autoimmune disorder. This means that the body’s immune system attacks its own healthy tissues. The immune system attacks gluten, the protein found in wheat, barley, and rye, but it also mistakenly attacks the body’s own healthy tissue in the gut. This involves a different part of the immune system than the antibody IgE related to wheat allergy. However, a person can have both Wheat Allergy and Celiac and actually test positive for both. This autoimmune reaction can cause harm to the otherwise healthy small intestine tissues anywhere from days to weeks after ingestion.

What are the signs and symptoms of a GRD?

For all three conditions, nausea, vomiting, diarrhea, bloating, abdominal pain, and constipation may be present. Joint pain can also be implicated in these disorders.

Additional symptoms:

• NCGS: In addition to nausea, vomiting, and other GI complaints, fatigue, and mental cloudiness (including ADHD-like behavior) are often reported.
• WA: Immediate reactions that range from mild (rashes, hives, itching, swelling, etc.) to severe (trouble breathing, wheezing, loss of consciousness, etc.) and can even be fatal.
• CD: There are many body systems affected including the brain and nervous system (recurring headaches, decreased sensation in hands and feet, anxiety, panic attacks, depression), itchy skin rash, and arthritis may occur as well (FASANO, 2012).

How Are GRDs diagnosed?

• NCGS: As of now, the best method available to determine this sensitivity is to withhold gluten products, with a monitored re-introduction to evaluate for return of symptoms.
• WA: A food allergist may use skin prick tests to help diagnose. Usually, the skin on the back is pricked and a small amount of the protein is inserted. If redness and swelling happen at the site, they are measured for significance.
• CD: As of now, the gold standard for diagnosing Celiac Disease is a small bowel biopsy where damage to the small intestine can be seen under a microscope. A newer proposed diagnosis includes genotyping as well.

What’s the chance that I or my kids have a GRD?

We know that gluten-related disorders have a global prevalence of about 5% of the population. We also know that all GRDs are on the rise. For example, researchers estimate that in the last 22 years, the rates for celiac disease have risen from 5.9 in 100,000 people to 19.1, close to tripling. Diagnosis is twice as high in females than in males, and it is hereditary; if a parent has it, their child has a 1 in 10 chance of getting it too.

Other risk factors for GRDs include the association between celiac disease and other autoimmune disorders including type 1 diabetes and thyroid conditions. About 25% of patients with autoimmune diseases have a tendency to develop additional autoimmune diseases. There is also a high association between the genetic variances HLADQ2 and HLADQ8 and the incidence of celiac.

What can we do about GRDs?

Right now, gluten avoidance is the only established method to treat any of the GRDs. Those with true celiac disease must be very strict about gluten avoidance including avoiding all forms of cross-contamination and lowering exposure all the way down to less than 20 parts per million.

Eating out

Allergy Eats and Celiac.org are helpful guides to dining out and social eating, and this app is a gluten-free restaurant locator. Today, any large restaurant chains have come up with dedicated gluten-free menus including PF Chang’s, BJ’s, Outback Steakhouse, and Bonefish Grill.

Grocery shopping

Thankfully, there are now entire aisles devoted to allergy-friendly foods in most grocery stores, along with third-party agencies who are providing their “stamp of approval” to protect consumers (see the Gluten-Free Certification Organization for examples of stamps).

In addition to the basic grocery stores that carry allergy-friendly manufacturers (like Sprouts, Whole Foods, and Trader Joe's), there is also an online grocery store called “Thrive Market” that seeks to fill the gap for the allergenic community and provide allergen-friendly brands at attractive prices.

Find what works for your situation

NCGS sufferers likely have a more individualized response and differ in their ability to handle different amounts of gluten, or even find that they can tolerate fermented gluten-containing products (such as a three-day fermented sourdough). Some varieties of wheat also have a much lower gluten protein content than others (such as ancient wheat hybrids like Emmer, Kamut, and Einkorn).

Healing the gut

GRDs can damage the small intestine, which can result in poor absorption of fat-soluble vitamins (A, D, E, K) and B Vitamins. Healing and repairing the gut with probiotics, fiber, and possibly L-glutamine or mucilaginous herbs is one tool to aid recovery from the damage caused by these disorders. Following a Fierce Foods eating pattern with plenty of fruits, vegetables, and high-quality protein and healthy fat is another important part of the healing process.

Making gluten-free delicious

The key to successfully avoiding gluten is finding delicious alternatives to gluten-containing kid-favorites. Check out these gluten-free recipes from Yes Collective:

• Instead of wheat crackers: Grain-Free Seed Granola Bars or Grain-Free Cheese Crackers
• Instead of chips: Try cassava chips or cut veggies and use flavorful dips like Avocado Pepita Dip to add flavor
• Instead of pasta: Cauliflower Mac'N’Cheese, Vegetable Zoodles in Pesto, or Zucchini Ravioli (or try Trader Joe's Cauliflower Gnocchi)
• Instead of bread and tortillas: use apple slices (Apple Almond Butter Sandwiches) or lettuce wraps (Vietnamese-Inspired Chicken Lettuce Wraps) (or try cassava or coconut fiber wraps)