They’re there for a good reason: Celiac disease, a chronic, inherited digestive disorder that can lead to malnutrition if not treated, may affect more than two million Americans who have an abnormal reaction to gluten, a protein in certain grains. Then there are plenty of others who have allergies or sensitivities to gluten and wheat, one of the eight modern food allergens.
The Right Diet
Initially cutting out gluten and wheat may seem overwhelming. Omit barley (including malt), rye, triticale (a cross between rye and wheat), and wheat in all types (durum, einkorn, emmer, kamut, semolina, and spelt) and forms (bran or germ, cracked or crushed, farina, graham flour, hydrolyzed wheat protein). A number of processed foods can also contain gluten: bouillon cubes, brown rice syrup, candy, chips, cold cuts and other processed meats, Communion wafers, French fries, gravy, imitation bacon and fish, marinades, matzo, panko and other breadings, pasta, rice mixes, and packaged vegetables in sauce to name a few. Some people who can’t tolerate this wheat protein may also have trouble digesting dairy.
Enjoy a wealth of foods: amaranth, buckwheat, corn, flax, legumes, millet, quinoa, rice (brown or white), sorghum, teff, wild rice (a grain unrelated to rice), and flours made from these foods. Substitute rice cakes for breads and crackers. Cook cream of rice or eggs for breakfast.
Eat lots of brightly-colored fruits and veggies. Besides providing needed vitamins and minerals, they’re high in fiber that supports healthy digestion. For example, 1/2 cup of fresh raspberries has 4 grams (g) of dietary fiber and 1/2 cup of cooked artichokes hearts have 4.5 g. Consume iron-rich poultry, eggs, seafood, and soy, too. The Food and Drug Administration permits voluntary labeling, so look for the gluten-free label. In addition to stocking up on the growing number of gluten-free products available, try the recipes here.
Malabsorption is common for those with celiac disease and food allergies, so consider digestive enzymes (several multivitamin-mineral formulas contain these helpful supplements). Even after going Gluten-Free, some people may be low in calcium, folic acid, iron, and zinc, so consider supplements. A small double-blind, placebo-controlled trial also shows that B vitamins improve the health of celiac patients on gluten-free diets.
What’s Celiac Disease?
Symptoms vary greatly from individual to individual. Children may experience abdominal bloating and pain, chronic diarrhea, constipation, vomiting, and weight loss, while adults may also complain of arthritis, bone or joint pain, canker sores, depression, fatigue, infertility or recurrent miscarriages, itchy skin rash (dermatitis herpetiformis), missed menstrual periods, tingling numbness in their extremities, or unexplained iron-deficiency anemia.
Blood testing (for high levels of certain autoantibodies) and a biopsy of the small intestine (to check for damage to the villi, which are tiny, finger-like protrusions lining this part of the gastrointestinal tract) are needed to diagnose celiac disease. It’s very important though, NOT to avoid gluten before testing; otherwise, test results may be negative, even when disease is present.
Unfortunately, it can take as long as 13 years to diagnose celiac disease. This is in part due to the fact that symptoms resemble irritable bowel and other digestive disorders like lactose intolerance, and in part because physicians are not trained to consider this condition. That’s too bad, since celiac disease not only causes malabsorption but also damages the small intestine. Absorption problems can lead to iron-deficient anemia and osteoporosis.
People with this disease tend to have other autoimmune conditions: Addison’s disease, autoimmune liver or thyroid diseases, rheumatoid arthritis, Sjogren’s syndrome, or Type 1 diabetes. A recent French study suggests that celiac disease may be a potentially treatable cause of stroke, particularly in the young, even without gastrointestinal complaints.
The good news is that, although celiac disease is incurable, it can be treated with a gluten-free diet. In most cases avoiding gluten will heal the intestine.
What About Oats?
“If you were diagnosed with celiac disease several years ago, you were probably told not to eat oats,” notes nutrition consultant Tricia Thompson, MS, RD, due to cross contamination with barley, rye, or wheat. But today several brands of oats available in natural markets appear safe to eat in moderation. Look for gluten-free oats tested by groups like the Food Allergy Research and Resource Program and the Gluten-Free Certification Organization.
A number of medications, as well as some dental care products, supplements, and even lip balm, contain gluten, especially if starch is on the ingredients list. However, corn, rice, potato, and tapioca starch are safe. Since not all pharmacists are experienced with celiac disease or gluten intolerance, call the manufacturer to ask if a drug (over-the-counter or prescription) contains gluten. A common response is “We don’t use gluten in manufacturing,” but that doesn’t mean a products’ raw materials don’t contain gluten. To learn more, visit www.glutenfreedrugs.com.