Dietary Changes for Celiac Disease
Celiac disease is a disorder that damages your small intestine and keeps it from absorbing the nutrients in food. The damage to your intestinal tract is caused by your immune system's reaction to gluten. Gluten is a protein found in wheat, barley, and rye. Some oats contain gluten.
When you have celiac disease, gluten causes your immune system to damage or destroy villi. Villi are the tiny, finger tubules that line your small intestine.
The villi’s job is to get food nutrients to the blood through the walls of your small intestine. If villi are destroyed, you may become malnourished, no matter how much you eat. This is because you aren’t able to absorb nutrients.
Complications of the disorder include anemia, seizures, joint pain, thinning bones, and cancer.
Lifestyle changes to cope with celiac disease
A gluten-free diet is the only treatment if you’ve been diagnosed with celiac disease. You’ll have to avoid gluten for the rest of your life. Even the slightest amount will trigger an immune system reaction that can damage your small intestine. Eating a gluten-free diet requires a new approach to food.
A gluten-free diet generally means not eating most grains, pasta, cereals, and processed foods. The reason is that they usually contain wheat, rye, and barley. You’ll need to become an expert at reading ingredient lists on packages. Choose foods that don’t contain gluten.
You can still eat a well-balanced diet with many different foods, including meat, fish, rice, fruits, and vegetables, along with prepared foods that are marked gluten-free.
Gluten-free bread, pasta, and other products have long been available at organic food stores and other specialty food shops. Today, you can find gluten-free products in just about every grocery store. Gluten-free dishes are on menus at all kinds of restaurants.
Tips for following a gluten-free diet
Here are steps to take when getting gluten your diet.
Rethink your grains:
- Avoid all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour, including self-rising and durum, not labeled gluten-free.
- Be careful of corn and rice products. These don’t contain gluten, but they can sometimes be contaminated with wheat gluten if they're produced in factories that also manufacture wheat products. Look for such a warning on the package label.
- Go with oats. Recent studies suggest you can eat oats as long as they are not contaminated with wheat gluten during processing. You should check with your healthcare provider first.
- Substitute potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour for wheat flour. You can also use sorghum, chickpea or Bengal gram, arrowroot, and corn flour, as well as tapioca starch extract. These act as thickeners and leavening agents.
Become a label expert:
- Know terms for hidden gluten. Avoid einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, and hydrolyzed wheat protein. Stay away from emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors because they can contain gluten.
- Check the labels of all foods. Gluten can be found in food items you’d never suspect. Here are some ly to contain gluten:
- Beer, ale, and lagers
- Bouillon cubes
- Brown rice syrup
- Chips, potato chips
- Cold cuts, hot dogs, salami, and sausage
- Communion wafers
- French fries
- Imitation fish
- Rice mixes
- Seasoned tortilla chips
- Self-basting turkey
- Soy sauce
- Vegetables in sauce
More strategies for a gluten-free lifestyle
Here are ideas to better make the transition to a gluten-free diet:
- Separate all kitchen items used for preparing gluten and gluten-free foods. These include cooking utensils, cutting boards, forks, knives, and spoons.
- When eating out, if you’re not sure about the ingredients in a particular dish, ask the chef how the food was prepared. You can also ask whether a gluten-free menu is available. Most restaurants have a website where you can review the menu in advance.
- Ask your pharmacist if any of your medicines contain wheat or a wheat byproduct. Gluten is used as an additive in many products from medicines to lipstick. Manufacturers can provide a list of ingredients on request if they are not named on the product. Many herbals, vitamins, supplements, and probiotics contain gluten.
- Watch your portion sizes. Gluten-free foods may be safe and good for you, but they're not calorie-free.
If you still feel symptoms on your gluten-free diet, double check that you're not still consuming small amounts of gluten hidden in sauces, salad dressings, and canned soups or through additives, such as modified food starch, preservatives, and stabilizers made with wheat. Even some medicines can contain gluten. Tablets and capsules can be sources of gluten contamination. The risk of your medicines containing gluten is very small but, if you are concerned, you should discuss this with your healthcare provider.
As you and your family become experts in reading food and product labels, you’ll be able to find hidden sources of gluten before they can cause a problem.
You might also get more ideas from joining a support group, in person or online, that can help you adjust to your new way of life.
These are great forums for learning a wealth of delicious recipes for everything from gluten-free cookies and banana bread to biscuits, trail mix, and grits.
You Asked: Do I Have a Gluten Allergy?
People tend to conflate the terms allergy, intolerance, and sensitivity when they talk about food-related reactions, and especially gluten. The first two refer to well-understood digestive disorders with predictable symptoms, says Dr. Robert A. Wood, division chief of allergy and immunology at Johns Hopkins.
If you have a true allergy, your immune system produces antibodies designed to protect you from something it sees as a threat—be it nuts or shellfish. Even a little nibble can cause cramping or stomach pain, a runny nose, skin rashes, or swelling and breathing issues, Wood says.
An intolerance is an inability to properly digest or absorb specific foods or nutrients, often due to a lack of one or more digestive enzymes.
(For example, people who are lactose intolerant don’t have the enzymes required to break down lactose.) This inability can lead to gastrointestinal problems stomach pain, vomiting or diarrhea.
Wood says food intolerances, un allergies, tend to be “dose dependent”—meaning the more of the food you eat, the worse you feel.
Take gluten, a type of protein found in grains wheat, rye and barley. When it comes to gluten-related health concerns, says Dr.
Alessio Fasano, director of the Center for Celiac Research at Massachusetts General Hospital, roughly 1% of the population has celiac disease—a condition that causes a sufferer’s immune system to attack the small intestine whenever gluten is present. A smaller percentage of people, maybe 0.5%, have a related wheat allergy.
“We can verify each of these through blood tests and screening,” Fasano adds. Blood tests are the first step in identifying the underlying condition; to get a definitive diagnosis, a gut biopsy is usually required. For people with these conditions, cutting gluten or wheat is an absolute necessity.
But un allergies and intolerances, food sensitivities occupy a gray zone. an allergy, they may be related to immune reactions. But they’re poorly understood and symptoms are hard to pin down, says Fasano. “If you believe reports, a food sensitivity could cause a stomachache one time, then a headache, then joint pain or even cognitive problems,” Fasano says.
Because the mechanisms underlying sensitivities aren’t known, Fasano says there’s no way to test and validate them. That ambiguity has led to a lot of confusion and disagreement among researchers, while creating ideal conditions for spurious health “experts” to push food elimination diets that may do more harm than good, he says.
Eliminating gluten is the most common (and some would say trendy) example of this, Fasano says. Some estimates suggest a third of Americans are trying to avoid or altogether ditch gluten. “There’s this misconception that gluten-free foods are healthier or somehow linked to weight loss,” Fasano says. “But for most people, going gluten-free probably will not be beneficial.”
There may be another category of people who suffer from a sensitivity to wheat or gluten. Some popular books have suggested, in the words of Grain Brain author David Perlmutter, that gluten “represents one of the greatest and most under-recognized health threats to humanity.
” But there’s not much data to support such claims. Fasano says what data there is point to stomach or abdominal pain as the most common symptom of gluten sensitivity, followed by skin conditions eczema.
While foggy thinking and fatigue are tied to gluten, there’s no agreed-on explanation for these symptoms, Fasano says.
Aside from celiac disease, Johns Hopkins’s Wood says that the medical science community is so convinced gluten isn’t a major health issue that there’s very little funding or interest in studying the subject further. “I think the bulk of people avoiding gluten are avoiding it unnecessarily,” he says. “Most doctors or people who’ve looked into it think it’s more of a lifestyle choice than a valid health issue.”
And when people claim to feel healthier after ditching wheat or gluten? “Lots of junk foods and snack foods contain gluten,” Fasano says.
Some estimates show one-third of all grocery store items contain gluten—many of them the additive-stuffed, overly processed packaged foods nutritionists would love for you to eighty-six from your diet.
“If you cut out those things, of course you’ll feel better,” Fasano says. “But it’s not because your body has a problem with gluten.”
While he doesn’t believe gluten is the health villain many have made it out to be, Fasano says food-related reactions are common, from gastrointestinal issues stomachaches or cramps to non-GI issues headache and joint pain. Fruit, beans, alcohol and many other common foods have been linked to symptoms of allergy or intolerance.
If you feel certain foods, including gluten or wheat, may be triggering pain or another type of physical reaction, Fasano recommends visiting a gastroenterologist or an expert dietitian—someone who can help you identify the source of your problem without putting you at risk for a nutritional deficiency.
“You wouldn’t take antibiotics or insulin without seeing a doctor first,” he says, “and you should take the same precautions when it comes to making changes to your diet.”
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