gluten-freeCeliac Disease and the Gluten-Free Diet

Celiac disease is a lifelong autoimmune digestive disease that affects 1 in 133 adults and children. When individuals with celiac disease eat gluten-containing foods, their immune system responds by damaging the small intestine and preventing nutrients from being properly absorbed. Gluten is a protein found in wheat, rye, barley and oats. Celiac disease is not a food allergy. At this time the cause of celiac disease is unknown, though a strong genetic link has been identified. It is strongly suggested that family members of someone with celiac disease be tested, even if they display no symptoms. The onset of celiac disease may be also triggered by surgery, viral infection, severe emotional stress, pregnancy or childbirth. There is also an increased incidence of celiac disease seen in individuals with a history of autoimmune illness such as:

  • Type 1 diabetes
  • Autoimmune thyroid or liver disease
  • Addison’s disease
  • Sjogren’s syndrome
  • Rheumatoid arthritis

Symptoms

The symptoms of celiac disease are extremely varied and are often confused with other intestinal disorders. In some cases, individuals experience no symptoms at all. Damage can occur to the small intestine even when symptoms are not present. Digestive symptoms are more common in infants and young children and may include:

  • Abdominal bloating and pain
  • Chronic diarrhea
  • Vomiting
  • Constipation
  • Pale, foul-smelling, or fatty stool
  • Weight loss

Other symptoms seen in children may include:

  • Irritability
  • Behavior change
  • Concentration/learning difficulties
  • Failure to thrive
  • Delayed growth or short stature

Adults with celiac disease are less likely to have digestive symptoms and may instead experience one or more of the following:

  • Unexplained iron-deficiency anemia
  • Fatigue
  • Bone or joint pain
  • Arthritis
  • Bone loss or osteoporosis
  • Depression or anxiety
  • Tingling numbness in the hands and feet
  • Seizures
  • Missed menstrual periods
  • Infertility or recurrent miscarriage
  • Canker sores
  • An itchy skin rash called dermatitis herpetiformis
  • Lactose intolerance

 

Diagnosis

In celiac disease, the immune system recognizes gluten as a foreign substance and produces elevated levels of antibodies to get rid of it.

  • Blood test – A blood test, also referred to as an IgE test, measures your immune system’s response to gluten by counting the number of specific antibodies in your blood.
  • Biopsy – If certain antibody levels are high, a biopsy, or tissue sample, is taken from the small intestine to determine the extent of or absence of tissue damage in order to confirm a diagnosis.

If you suspect that you or a loved one may have celiac disease or gluten sensitivity it is necessary to undergo testing before starting a gluten free diet regimen for the test results to be accurate. Testing may produce a "false negative" result if a gluten-free diet is followed before testing occurs.  

Survival Skills

The only treatment available for celiac disease is to follow a strict gluten-free diet for life. While this lifestyle change may seem overwhelming, the good news is that many foods are naturally gluten-free and safe to eat. Foods to Eat on a Gluten-Free Diet:

  • Fresh fruits & vegetables
  • Plain, unseasoned meat, poultry, fish, eggs, nuts, peas, tofu, and beans
  • Plain milk and yogurt, cream cheese, cottage cheese, and cheese
  • Naturally gluten-free grains like amaranth, buckwheat, rice, corn, flax potato, tapioca, bean, sorghum, soy, arrowroot, quinoa, teff, nut flours, or wild rice
  • Butter, margarine, and vegetable oils
  • Plain pickles, relish, olives, ketchup, mustard, pure herbs and spices, apple, cider or distilled white vinegar

*These foods are generally considered safe to eat, however it is extremely important to thoroughly evaluate the ingredients listing prior to consumption. You should also consider if the food is produced in a facility where gluten-containing ingredients are handled. Foods to AVOID on a Gluten-Free Diet:

  • Wheat (durum, semolina, bran, germ)
  • Rye
  • Barley
  • Bulgur
  • Graham flour
  • Spelt
  • Triticale
  • Kamut
  • Farina
  • Oats*

*Many people with celiac disease can tolerate small amounts of pure oats in their diet. However, gluten can get into oats used in commercial food during growing, harvesting and processing. Look for the “gluten-free” claim on foods that contain oats. Questionable Sources of Gluten AVOID the following ingredients unless you can verify they are gluten-free:

  • Brown rice syrup (frequently made with barley)
  • Dextrin or maltodextrin (usually made from corn, but may be derived from wheat)
  • Flour or cereal products
  • Hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP) or textured vegetable protein (TVP)
  • Malt or malt flavoring (usually made from barley; okay if made from corn)
  • Modified food starch
  • Natural and artificial flavors
  • Soy sauce (most soy sauces contain wheat)
  • Blue cheese (may be cultured on rye or dusted with flour)

*These ingredients may be found in processed meats, sauces, bouillon, selected condiments, salad dressing, baking powder, sour cream, ice cream, processed cheeses, etc.   Food Handling: Cross-contamination may occur when a gluten-free product comes into contact with a food or surface that is not gluten-free. To prevent cross contamination at home:

  • Store all gluten-free products in separate labeled containers and away from gluten-containing foods in the refrigerator and pantry.
  • Buy squeeze bottles of condiments like ketchup, mustard and relish.
  • Use labeled utensils and cutting boards that are for preparation of gluten-free foods only.
  • Use a separate toaster or a toaster oven where the rack can be removed and thoroughly washed between uses.
  • Make sure kitchen surfaces, cooking equipment and utensils are washed thoroughly between uses.

To prevent cross contamination outside the home:

  • Avoid purchasing foods from bulk bins
  • Be aware that fried foods may have been cooked in the same oil as battered with gluten-containing ingredients have been fried.
  • Request that the grill be cleaned preparation of your meal when dining out and keep the meal away from meals that may contain gluten.
  • At a buffet or salad bar, request a clean spoon prior to use.
  • When purchasing deli meats, request that the slicer be thoroughly cleaned and sanitized before fulfilling your order. You may also consider shopping early so your deli order is the first of the day.

Shopping: It is extremely important to carefully read labels while shopping. If a package bears the "gluten-free," claim, the manufacturer has tested the product to ensure the ingredients meet the FDA’s criteria in order to voluntarily make this statement. Keep in mind that food products may have traces of gluten if it is produced in a facility that also produces gluten-containing foods. If a food does not have a "gluten-free" claim on the package, check directly with product manufacturers for more information. Ingredients and manufacturing and plant conditions can change frequently so make label reading a habit.

gluten-chart

Eating Out: When dining out, ask detailed questions about ingredients and how the food was prepared – your health and safety are at stake! Fortunately many restaurants are now offering gluten free selections that are either marked as such on the menu or on the restaurant’s website. You may also consider calling ahead in order to evaluate menu options or alert the chef of your dietary needs.  

Don’t Go it Alone

A new diagnosis can be scary. Be sure to build a support system of family, friends and healthcare professionals to help you manage your diagnosis of celiac disease. Talk to a doctor or registered dietitian when eliminating foods from your diet about possible vitamin and mineral deficiencies. They may recommend an adjustment in your meal plan or a supplement to replace nutrients lost by eliminating the offending food and food ingredients. Vitamin and Mineral Supplementation Gluten-free diets may be lacking essential nutrients like folate, thiamin, niacin, riboflavin, iron, calcium and fiber. When coupled with poor nutrient absorption, supplementing your diet with a daily multivitamin is generally necessary to prevent malnutrition. Discuss all supplements with your doctor or registered dietitian to determine which one is right for you. Remember to read the label thoroughly before purchasing dietary supplements as some may use fillers that have been made from wheat or rye. Medications Talk to your doctor about all medications prior to use as some may use fillers that have been made from wheat or rye.

Additional Resources

American College of Allergy, Asthma and Immunology http://www.acaai.org
American Academy of Allergy, Asthma and Immunology http://www.aaaai.org
Asthma and Allergy Foundation of America http://www.aafa.org
The Food Allergy & Anaphylaxis Network http://www.foodallergy.org
The Food Allergy Initiative http://www.faiusa.org