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May 22, 2014

Gluten intolerance or allergy?

Commonly found in prepared foods, gluten is for some a source of many woes. Is it an intolerance or an allergy? Let’s learn more about celiac disease.


Gluten is a plant protein found in wheat (including spelt and kamut), rye, barley and triticale (a cross between wheat and rye). Its visco-elastic properties are what give baked goods their soft, chewy texture. Gluten also serves as a binding and thickening agent in sauces and other products.


Intolerance or allergy?

Gluten can trigger an abnormal immune response in certain people. This results in inflammation and damage to the lining (villi) of the small bowel, which, in turn, reduces the body’s ability to absorb iron, calcium, vitamins A, D, E and K and folate. The condition is known as celiac disease (CD) or gluten intolerance.

To avoid serious long-term complications, people with CD must eliminate all gluten-containing foods from their diets
The Canadian Celiac Association and Health Canada  have found, however, that most gluten-intolerant individuals are able to consume moderate* amounts of pure oats, uncontaminated with gluten-containing cereal grains.
*¼ cup dry oats per day for children and  ½ to ¾ cup dry oats per day for adults.

Given the involvement of the immune system and the need to avoid all traces of gluten, some specialists recommend treating this severe intolerance as an allergy.


Celiac disease presents a variety of different symptoms, which can be associated with several other diseases, making it difficult to diagnose. The nature, number and intensity of symptoms vary from one person to another. Here are a few:

In adults

  • Chronic diarrhea or constipation
  • Abdominal bloating, gas
  • Indigestion, nausea
  • Weakness and extreme fatigue
  • Muscle spasms
  • Skin rashes
  • Deficiencies of iron, folate and (or) vitamin B12
  • Vitamins A, D, E and K deficiencies
  • Weight loss or weight gain
  • Bone and joint pain
  • Mouth ulcers and cancer sores
  • Infertility in both sexes, miscarriages
  • Depression
  • Migraines and headaches


Additional symptoms noted in children

  • Vomiting
  • Poor growth or small stature
  • Dental enamel defects
  • Irritability, mood swings
  • Delayed puberty


Diagnosis and treatment

Celiac disease is diagnosed using special blood tests and a small-bowel biopsy.

The only available treatment for CD is to continuously follow a strict, gluten-free diet. In most cases, this diet will enable the intestinal wall to heal and resolve the related deficiencies and symptoms.

A gluten-free diet should include fresh food, which has undergone as little processing as possible, grains, such as rice, millet, buckwheat, corn and quinoa and flour made from rice, corn, potato, chickpea and soy.

Ingredients to avoid

Grocery shopping with a gluten intolerance is not always an easy task. Here is a list* of foods/ingredients to avoid.

Category Foods to Avoid
Sources of Gluten ale, All Bran, barley flour, barley malt extract, barley, beer on tap, beer, bock beer, bulgar, bulghur, bulgur wheat, common wheat, couscous, cracked wheat, croutons (bread), soluble toasted wheat extract,  flour (white, enriched), gluten, gluten flour, Graham flour or Graham, Job’s tears, kamut, lager, malt extract, malt flavouring, malt flour, malt liquor, malt powder, malt syrup, malt vinegar, malt, malted milk powder, malted milk, noodles, nutrim (fat substitute derived from barley), oat bran, oat flakes, oat flour, oat gum, oatrim (fat replacement product from oats), oats, pasta, porter, rye flour, rye, seitan (mix of algae, soy, herbs and a source of gluten), semolina, spelt flour, spelt, stout, triticale (wheat + rye), vermicelli, wheat bran, wheat meal, wheat flour, wheat germ oil, wheat germ, wheat semolina, Wheat starch, wheat, whole wheat
Possible Sources of Gluten* baking powder, bread crumbs, croutons, dextrimaltose (carbohydrate made from starch that may contain wheat), dextrin, hydrolyzed plant protein, hydrolyzed vegetable protein (HVP), hydrolyzed vegetable protein derivatives, hydrolyzed vegetable protein extract, invert syrup, maltitol, maltodextrine (carbohydrate made from starch that may contain wheat), maltose, modified starch, noodles, pasta, rice syrup (some rice syrups are made with a barley-based enzyme), semolina, soya sauce, soyhu, starch, vegetable protein, wheat bran


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Do you have more questions on the topic? Talk to your family pharmacist for helpful advice!

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