Julie Whittington, RD

Healthy tips from a Registered Dietitian

Celiac disease managed by gluten free diet

Celiac disease – a genetically inherited digestive and autoimmune disease – affects an estimated 2 million people in the US. It is the only autoimmune disease where the trigger is known. That trigger is dietary.

An autoimmune disorder, by definition, is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. There are more than 80 different autoimmune disorders. Examples of other autoimmune disorders include Type 1 Diabetes, Lupus, Multiple Sclerosis and Rheumatoid Arthritis.

In the case of celiac disease, if someone with the condition never ate any sources of wheat, rye or barley (in particular, the proteins in these grains called prolamins), then this person might not ever know he or she had the disease. However, a life without eating these grains is hardly the norm since they are in most types (especially mainstream versions) of spaghetti, bread, cereal, crackers, flour, beer, imitation fish, seasoned chips, soups, soy sauce, French fries, communion wafers, cookies, pizza crust and more. There are many obvious sources of prolamins, while others may be more hidden such as in vitamins, medicines, envelope adhesive and condiments.

On a side note, you will likely hear the word “gluten” used, rather than “prolamin”, when it comes to celiac disease. Gluten is a prolamin in wheat, but the term is collectively used to identify the prolamins in wheat, rye, barley and triticale (a cross between wheat and rye) which are responsible for triggering celiac disease. When the gluten source is from an unsafe grain, it must be avoided by those with celiac disease. It can be confusing to see a food label list “corn gluten” or some other safe grain with the word gluten after it. Corn gluten is safe for celiacs.

In the case of celiac disease, when a person eats a food containing gluten, an immune response is triggered which in turn damages the lining of the small intestine. This damages the integrity of the intestine, interfering with the proper absorption of nutrients such as carbohydrates, proteins, fats, vitamins and minerals. Side effects can include but are not limited to malnourishment, weight changes, diarrhea, constipation, gassiness, fatigue, iron-deficiency anemia, infertility/miscarriage, muscle cramps, osteoporosis, itchy rash and possibly even lymphoma (cancer of the lymph tissue).

On the positive side, if a person is able to identify that he/she has celiac disease (with lab tests from a doctor’s office) rather than another digestive condition such as irritable bowel syndrome, the solution is simple. Living a life on a gluten free diet will allow the intestine to heal and side effects to subside.

Luckily, more food manufacturers are offering gluten free food items in local grocery stores. Whereas, it used to be necessary to grocery shop at natural markets or online to find these products, it is now a lot easier. Plus, under new product labeling requirements (in effect January 1, 2006), products must specifically indicate if they contain wheat or wheat proteins. It will either be listed in the ingredients list or in the separate “Contains” statement, listed after the ingredients. However, it will not list barley or rye so just because it does not contain wheat does not necessarily mean it does not contain gluten.

You may hear that you need to avoid oats on a gluten free diet. Oats contain a prolamin different from wheat, rye and barley that may affect some people with celiac disease. Research shows that individuals with celiac disease can usually include up to ½ cup of dry, whole grain, rolled oats or ¼ cup of dry, steel cut oats per day if the oats are listed as gluten-free oats. If the oats are not identified as gluten-free, there is a high likelihood that they have been contaminated by other grains processed on the same equipment. For example, regular Quaker oats are not gluten free.

If you have celiac disease or if you have a wheat allergy and choose to simply follow the gluten free diet, listed below are some suggestions to ensure that you still consume enough grains (especially whole and enriched grains). Always remember to check food labels to ensure the products you choose are safe. Remember, it is never a good idea to eliminate all carbohydrates from your diet out of fear of celiac symptoms. Your body needs to have enough carbohydrates to function properly and prevent other diseases.

Safe grains: Amaranth, buckwheat, corn, Finger millet (Ragi), Job’s tears, millet, montina (Indian rice grass), quinoa, rice, sorghum, tef/teff and wild rice.

Recommended foods/use of safe grains: Plain brown rice, plain enriched white rice, plain basmati or jasmine rice, rice cakes (check the label), rice crackers (check the label), plain rice noodles, corn tortillas, taco shells, unseasoned corn tortilla chips, grits, plain popcorn, polenta, quinoa, buckwheat, millet.  Aim to select the “super six”, nutritional powerhouse gluten-free grains: amaranth, buckwheat, teff, millet, quinoa and sorghum, since many other gluten-free grains are lower in fiber and B vitamins.  Also, consider eating more “celiac-friendly” cuisines such as Thai, Indian, Ethiopian and Mexican – but always still be sure to know or ask which menu items are safe.

Recommended brands/sources (not a complete list): Bob’s Red Mill (www.bobsredmill.com), Nature’s Path/Lifestream/EnviroKids (www.naturespath.com), Van’s International Foods – yummy frozen waffles (www.vansintl.com), Eden Foods (www.edenfoods.com), Barbara’s Bakery – great cereals (www.barbarasbakery.com), Arrowhead Mills – great baking mixes (www.arrowheadmills.com), Health Valley (www.healthvalley.com), Nature Made (www.naturemade.com), Amy’s Kitchen (www.amys.com), Gluten Free Pantry (www.glutenfree.com), Gluten Free Mall (www.glutenfreemall.com)

Unsafe grains/products (not a complete list): Wheat, rye, barley, triticale, flours (including bromated, durum, enriched, gluten, graham, phosphated, plain, self-rising and white flours) bulgar, farina, semolina, beer, ale, porter, stout, malt & malt products, many candies, many deli meats, bouillon cubes, brown rice syrup, communion wafers, French fries, gravy, imitation fish, matzo, rice mixes, many sauces, seasoned chips, self-basting turkey, many soups, soy sauce, envelope adhesive

Recommended websites: www.celiac.org, www.celiac.com, www.csaceliacs.org, www.glutenfreeliving.com, www.livingwithout.com, www.eatright.org, http://digestive.niddk.nih.gov/index.htm, http://www.triumphdining.com (Restaurant & Grocery Guides)

With proper planning and grocery shopping, the individual with celiac disease can master the gluten free diet and achieve better gastrointestinal health! It may take time to do so, but working with your doctor and a registered dietitian will be your best path.

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