Myth: Gluten is Poison

This simple E-learning module will explore the myth 'gluten is poison'. You will be taken through a series of slides and activities that explore the common misconceptions of gluten, dieting perspectives as well as gluten intolerance vs coeliac disease. 

With the gluten free diet becoming increasingly popular, this module seeks to clarify the facts about the role of gluten in our diet. 

This learning module can be viewed in PDF format, and is mobile friendly. Enjoy!

What is gluten?

Meet 'gluten'

What is Gluten?

Gluten is made up of 2 proteins (Gliadin and Glutenin) found in some grains. It makes food elastic and gives it a doughy and chewy texture. The small intestine digests and absorbs gluten.  

Gluten is found in...

Gluten is found in products which contain

  • Wheat
  • Barley
  • Rye

Common foods containing gluten include

  • Pizza, pasta, bread, muesli, beer, soy sauce


What foods contain gluten?

  • Rice
  • Pumpkin
  • Bread
  • Pasta
Select all answers that contain gluten

Why is gluten important?

Benefits of gluten

Grains that contain gluten add to your intake of whole grains. These are a key source of dietary fibre. Whole grains:

  • Help to lower cholesterol 
  • Improve digestive health 
  • Are rich in antioxidants, which may help prevent disease

Gluten is hidden in products you may not suspect. Spices, sauces, flavourings, and dietary supplements contain gluten. Therefore eating gluten allows you to enjoy a broad range of food choices. This makes eating out easier. 

Gluten is often combined with important vitamins and minerals. So cutting out gluten without needing to may decrease the level of nutrients in the body.

 

Risks of going gluten free

Consider these risks before following a gluten free diet: 

  • Lower carbohydrate intake can decrease the body's main source of energy. Remember not all carbohydrates contain gluten!
  • Lack of fibre from reduced whole grain intake can lead to digestive issues. Fibre assists with healthy bowel movements. 
  • Possible weight gain from eating gluten-free products. These often contain higher levels of saturated fat & sugar.
  • Possible weight loss & nutrient deficient diet from eliminating too many foods.  

What foods are naturally gluten free?

Many sauces contain gluten - if you have coeliac disease or gluten sensitivity, be sure to read the food labels before consumption. 

Vegetables and fruits are naturally gluten free, as well as some grains (e.g. quinoa, buckwheat, rice)

Beer is made with hops, barley & other ingredients containing gluten. Some beer is specifically brewed as 'gluten-free', otherwise cider is a gluten free alternative. 

  • Beer
  • Rice
  • Soy sauce
  • Quinoa
  • Vegetables
  • Banana bread

Times when gluten is poison

Who should have a gluten free diet?

People who suffer from coeliac disease or are gluten intolerant should follow a gluten free diet. 

What is coeliac disease?

Coeliac disease is an autoimmune disease where the body has an allergic reaction to gluten. The immune system begins to act against the body, and attack it's healthy cells. 

The small finger-like structures in the small intestine are known as villi. These become inflamed and flattened making it harder for nutrients to be absorbed. This can lead to uncomfortable symptoms and a lack of nutrients in the body. 

Healthy villi of small intestine


Unhealthy villi of small intestine

Common symptoms of coeliac disease

  • Stomach pain
  • Bloating 
  • Lots of gas
  • Vomiting
  • Dizziness 
  • Diarrhoea 
  • Constipation
  • Tiredness
  • Weight loss
  • Mouth ulcers

What is Gluten Intolerance?

People who have an intolerance to gluten can have small amounts of it before symptoms start to show. These symptoms are similar to those present in coeliac disease. These include: stomach pain, diarrhoea, gas, bloating, nausea and fatigue. 

Unlike coeliac disease, gluten intolerance is not linked to an immune response. The villi of the small intestine are not damaged. The cause for this remains unknown. 

Have a guess at how many people in Australia are effected by coeliac disease

  • 1 in 70,000
  • 1 in 7000
  • 1 in 700
  • 1 in 70

Now have a guess at how many people who have coeliac disease remain undiagnosed

  • 5%
  • 20%
  • 80%
  • 30%

Which of these is NOT a typical symptom of coeliac disease?

  • Bloating
  • Stomach pain
  • Vomiting
  • Hair falling out

Next Steps

Help! I think I have coeliac disease!

If you believe you may be experiencing symptoms of coeliac disease please follow this step by step guide.

Step 1 - See your doctor

They will assess your symptoms and make a judgement of what to do next. They will tell you to continue your normal diet. You need to keep gluten in your diet so they can test how it reacts in your body. 

Step 2 - Blood test

This will test to see if your body is having a reaction to gluten. Your doctor will inform you of your test results.

Step 3 - Endoscopy 

If you have a positive blood test result you will need an endoscopy (performed by a specialist) to assess your gut function. If your small intestine is inflamed you may be diagnosed with coeliac disease. 

Step 4 - Follow a gluten free diet

This is the only known treatment for coeliac disease. You may also find it helpful to discuss your symptoms with another health professional, such as a Dietician. Our list of further resources may also be helpful.

Where can I find more information?

Find a GP or Dietician

Royal Australian College of General Practitioners

www.racgp.org.au

Dieticians Association of Australia

https://daa.asn.au/

Media

What is Gluten? (Khan Academy)

www.youtube.com/watch?v=25mxf_xUqDQ

Gluten Intolerance & Coeliac Disease (Catalyst)

www.abc.net.au/catalyst/stories/4358631.htm

Gluten Intolerance (The Feed)

www.sbs.com.au/news/thefeed/story/gluten-intolerance

What's the big deal with gluten? (TedEd)

www.youtube.com/watch?v=uEM2iDT-VAk

The Gut (Giulia Enders)

www.youtube.com/watch?v=zFhCJZfZpAk

Recap of what we have covered so far!

Short video

Short Video - What the heck is gluten!?

Please watch until the 2 minute point.

Summary

Brief Summary

  • Gluten is found in food products made up of wheat, barley and rye 
  • Gluten is present in a wide range of food products (such as breads, pasta, cereals etc). So cutting it out can restrict your fibre and nutrient intake 
  • Processed gluten free foods often contain higher amounts of sugars and fats 
  • A gluten free diet is only recommended for people with coeliac disease or gluten intolerance 

Test Your Knowledge

Word Match

  • Glutenin & Gliadin
    Proteins that make up gluten
  • Wheat, Rye & Barley
    Grains that contain gluten
  • Tests to diagnose Coeliac Disease
    Blood test and possible endoscopy
  • If you suspect you have a reaction to gluten the first step is to
    See your doctor
  • Coeliac Disease
    Autoimmune disease that results in damage to the villi of the small intestine
  • Gluten Intolerance
    Non immune response to gluten often resulting in bloating, stomach pain and diarrhoea

Fill in the blanks!

Gluten is made up of the proteins and .

Foods that contain gluten are often combined with important  and .

Some risks associated with going gluten free if you are not a coeliac can be:  and  

Gluten is found in....

Why is gluten important for our diet?

  • Because gluten is found in all carbohydrates
  • Because gluten is found in a wide variety of foods
  • Because gluten promotes weight loss

About the creators

Group photo!

From left: Eloise Defina, Stefanie Dingnis, Matthew Poad, Mikhala Antonino, Vincent Essibrah 

We are Master of Nursing Science first year students at the University of Melbourne. 

Any feedback regarding this module can be directed to [email protected]

Appendix

Appendix

Aim:

The aim of the module was to educate and deconstruct misinformation about gluten free diets.  Care was taken to present the facts surrounding gluten/gluten-free in a non-judgmental way. Focus was centred around the body's physiological response to gluten and priority was given to scientific facts, rather than social conjecture.

Target audience:

This module is aimed at individuals between the ages of 16 – 35. Specifically, individuals interested in health, and who may be confused about the increased discussion in society and media surrounding the gluten free diet. These people may also be considering or already adhering to a gluten free diet. This age group is assumed to be techno-savvy, so will be able to appropriately interact and understand the electronic platform.

Materials and resources:

  • The University of Melbourne Library portal was used for research purposes.
  • A Google search was conducted to locate appropriate government materials.
  • The platform, 'EasyGenerator', was used to construct this learning module.

Process of creating the module:

  • Brainstorm: General myths that exist within the medical field were discussed to determine which were the most prevalent and interesting to focus the assignment on. The myth ‘gluten is poison’ was selected due to its topical nature within contemporary society. 
  • Research: An area of research was allocated to each group member. The library portal and Google were utilised to find suitable references, such as academic articles and government websites. A reasonable research timeframe was established and weekly meetings were agreed upon.
  • Collating information: Information was grouped according to themes and a structural flow was established. The following sections were decided upon: what is gluten, why is gluten important, times when gluten is poison, next steps and further resources. A ‘test your knowledge’ section was included in order to motivate readers to engage with the module and to ensure they understood the content.
  • Input of information  into the  e-module: The program had various tools (diagrams, true/false, fill-in-blanks, pictures, etc.) which were used to ensure information was portrayed in an interactive manner, with our target in mind.
  • Editing: The module was reviewed from start to finish to ensure the delivery of content flowed. Adjustments were made to the sequence to improve the clarity of information. A spelling and grammar check was also conducted.
  • FOG Index: As part of the editing process, the FOG index was applied to all content sections to determine the level of readability. Question sections were excluded in this process. An initial average of 11.1 was calculated for the module, which is significantly above the recommended index of 7 - 8. After reducing the word count, sentence length, number of sentences and number of big words (3 or more syllables), the FOG index was reduced to 7.9 - which is within the ideal range. This indicates the module is readable for the target audience. 

Means of dissemination: 

'EasyGenerator', the platform used to create the module, creates a direct weblink to the E-health learning module. A PDF version is also accessible. This link can be distributed across various media platforms such as Facebook, Instagram and Twitter. This target audience often uses Facebook as a means to connect with others and share information. Therefore, Facebook is thought to be the most convenient platform for the dissemination of the module. Twitter and Instagram are also popular social media websites that are used rather extensively in today's society. On all of these platforms, the link can be shared among peers which further broadens the reach of the module. 

The module could also be shared through discussion forums on health, nutrition and lifestyle websites or blogs. 

Additionally,  the online module and the PDF format could be a valuable resource for education. It may be incorporated as part of a nutritional learning activity within the secondary school curriculum. 

Means to evaluate effectiveness:

The effectiveness of the module would be evaluated by monitoring participants' answers and identifying any questions that are too challenging or require clarification. 'EasyGenerator' allows participants to leave comments, provide feedback on content and to rate the module out of 100. A contact email address has been provided for participants to send through any further feedback they may have.



References

Australasian Society of Clinical Immunology & Allergy. (2014). Food Intolerance. Retrieved from www.allergy.org.au/patients/food-other-adverse-reactions/food-intolerance

Better Health Channel. (2016). Coeliac disease and gluten sensitivity. Retrieved from www.betterhealth.vic.gov.au/health/conditionsandtreatments/coeliac-disease-and-gluten-sensitivity.

Coeliac Australia. (2017). Coeliac Disease. Retrieved from http://www.coeliac.org.au/coeliac-disease/.

Coeliac Australia. (2017). Gluten Free. Retrieved from http://www.coeliac.org.au/gluten-free/.

Celiac Disease Foundation. (2017). Villi. Retrieved from https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms/celiac/

Curtain, S. (2015). Five myths about gluten free eating. Retrieved from https://www.medibank.com.au/livebetter/5-gluten-free-food-myths/.

Chey, W. D. (Presenter). (2015). What’s the big deal with gluten? [Video]. Stretch Films, Inc. Retrieved from www.youtube.com/watch?v=uEM2iDT-VAk.

Demasi, M., & Branscombe, M. (Producers). (2015). (Television series episode). Gluten: a gut feeling. Catalyst. Melbourne, Australia. ABC Television. Retrieved from http://www.abc.net.au/catalyst/stories/4358631.htm. 

Department of Health (2013). Nutrition publications. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-resources.htm.

Dieticians Association of Australia. (2017). Retrieved from https://daa.asn.au/

Enders, G. (Presenter). (2017). The Gut [Video] In Sydney Opera House, All about women. Sydney, Australia: Ideas at the House. Retrieved from https://www.youtube.com/watch?v=zFhCJZfZpAk.

EatForHealth.gov.au. (2015). Food essentials. Retrieved from https://www.eatforhealth.gov.au/food-essentials.

HealthDirect.gov.au. (2016). Gluten free diet. Retrieved from www.healthdirect.gov.au/gluten-free-diet

Khan Academy Medicine. (2015). What is gluten? [Video]. Retrieved from www.youtube.com/watch?v=25mxf_xUqDQ.

Moffit, M., & Brown, G. (2015). What the heck is gluten? [Video]. Retrieved from https://www.youtube.com/watch?v=DXjpb7SFi3s. 

Pruimboom, L., & de Punder, K. (2013) The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients, 5(3), 771-787. doi:10.3390/nu5030771.

Royal Australian College of General Practitioners. (2017). Retrieved from www.racgp.org.au

The Feed. (2014). (Television series episode). Gluten Intolerance. Retrieved from www.sbs.com.au/news/thefeed/story/gluten-intolerance.

Walter & Eliza Hall Institute of Medical Research. (2016). Coeliac disease. Retrieved from www.wehi.edu.au/research-diseases/immune-disorders/coeliac-disease.