By EatingWell Editors
One in 133 Americans has celiac disease (also known as celiac sprue), an autoimmune disease that damages the small intestine and interferes with the absorption of nutrients. People with celiac disease can’t tolerate a protein called gluten, which is found in wheat, rye and barley. If they eat foods or use products containing gluten, their immune system responds by damaging the lining of the small intestine, where nutrients from food are absorbed. This damage to the small intestine decreases the absorption of all nutrients—resulting in an overall poor nutritional status. If not treated, a person with celiac disease can develop more severe nutritional deficiencies, such as osteoporosis (because of poor calcium absorption), iron-deficiency anemia or multiple other vitamin and mineral deficiencies.
Although the specific causes of celiac disease are still unknown, it is genetically inherited: if someone in your family has it, there’s up to a 15 percent chance you could have it as well. Many times, for reasons that aren’t clear, celiac disease is triggered by pregnancy, viral infection or emotional stress. The disease often goes undiagnosed for years because it causes broad and nonspecific symptoms, such as diarrhea, constipation, gas, irritability, tiredness and weight loss, which are easily confused with symptoms of other ailments. Some people with celiac disease also have a painful skin rash known as dermatitis herpetiformis (DH), and they may not have gastrointestinal symptoms.
Some people may be sensitive to gluten without having celiac disease. This condition, known as “gluten intolerance,” isn’t well understood: people with gluten intolerance experience symptoms when eating gluten-containing foods and they usually feel better after removing gluten from their diet, but they don’t have the damage to their small intestines seen in celiac disease. Current research has not established if there is a clear link between gluten intolerance and celiac disease.
If you are experiencing unexplained gastric distress or other symptoms of celiac disease you should talk to your doctor before you begin eliminating all gluten-containing foods. Your doctor should first determine whether you have celiac disease or whether your symptoms are caused by some other food intolerance or allergy. You’ll need a full medical workup and, to definitively diagnose celiac disease, a blood test and a biopsy of the small intestine.
If you and your doctor decide that you have gluten intolerance or celiac disease, a lifelong commitment to a gluten-free diet is currently the only available treatment. This specialized diet can seem like a miracle for those who need it, but it is only beneficial to people who truly have gluten intolerance or who have been diagnosed with celiac disease; it provides no nutritional benefit to people without these conditions. It takes a lot of know-how to manage celiac disease and to follow a gluten-free diet.
To treat your celiac disease, you must avoid any food containing gluten—namely, anything that contains wheat, rye or barley. You’ll have to give up a lot of grains, pastas, cereals and processed foods unless you find them in “gluten-free” versions (luckily becoming more and more available these days).
There are also a variety of foods you can eat. For example, instead of wheat flour, you can use potato, rice, soy or bean flour. There are also many gluten-free types of bread, pastas and other products in stores, and many websites that offer them; click here for online sources for gluten-free foods. And of course, plain meat, fish, rice and fruits and vegetables don’t contain gluten.
The diet is lifelong—and cheating isn’t an option: even eating a tiny amount of gluten can damage the small intestine. But the good news is that, for most people, following this diet will stop symptoms, heal existing intestinal damage and prevent further damage. Improvements begin within days of starting the diet, and the small intestine is usually completely healed in three to six months for children and young adults and within two years for older adults.
People with celiac disease can safely enjoy a variety of grains and starches including amaranth, arrowroot, buckwheat cassava, corn, flax, legumes, millet, potatoes, quinoa, rice, soy, sorghum, tapioca, wild rice, yucca and nut flours. Click here for a list of safe grains and starches.
Foods to avoid include wheat (including einkorn, emmer, spelt, kamut), wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein, barley, rye and triticale (a cross between wheat and rye). Click here for a list of starches to avoid and other terms for wheat.
People with celiac disease are often counseled to avoid oats, due to the concerns of health professionals that most oats are cross-contaminated with grains containing gluten. But research indicates that pure, uncontaminated oats consumed daily in moderation (1 cup cooked, or about ½ cup or 2 ounces uncooked) are tolerated by most adults with celiac disease. It’s worth trying to work oats into your diet: besides being delicious, they add soluble fiber and other nutrients that are often lacking in the gluten-free diet. But the Gluten Intolerance Group of North America suggests you work closely with your health-care team before deciding to introduce oats into your diet.
Wheat and wheat products are often used as thickeners, stabilizers and texture enhancers in foods that might otherwise seem wheat-free, like some salad dressings. Since the term "gluten" is rarely used on product labels, it is vital that a person on a gluten-free diet learn the typical places that gluten can hide. Thanks to the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), it is easier now to identify wheat-containing ingredients: if a food or an ingredient contains wheat or protein derived from wheat, the word “wheat” must appear clearly on the food label.
But processed foods may also contain other off-limits grains, such as barley or rye. Foods that may be made with gluten-containing grains include bouillon cubes, rice mixes, potato chips, hard candy, licorice, jelly beans, cold cuts, hot dogs, salami, sausage, communion wafers, French fries, gravy, imitation fish, matzo, sauces, seasoned tortilla chips, self-basting turkey, soups, soy sauce, vegetables in sauce, salad dressings and many low- or nonfat products. See a more extensive list of unsafe foods on celiac.com.
Some medicines and mouthwash also contain gluten, usually as an inactive ingredient. Look for the words 'starch' or 'stabilizer' in the inactive-ingredients list, and consult with a pharmacist if you’re not sure. If ingredients aren’t listed, you can check with the manufacturer of the product. The Wheaton Gluten-Free Support Group, based in Wheaton, Illinois, maintains a list of gluten-free medications.
It is important to not contaminate gluten-free foods with foods that contain gluten during cooking and food preparation. Contamination can occur if foods are prepared on common surfaces or with utensils that are not thoroughly cleaned after preparing gluten-containing foods. Spreadable condiments in shared containers may also be a source of contamination--when someone dips into a mayonnaise jar a second time with the knife used to make a sandwich, the condiment becomes contaminated with breadcrumbs. Likewise, deep-fried foods cooked in oil shared with breaded products will become contaminated and should not be eaten.
Having gluten intolerance or celiac disease doesn’t mean you can’t enjoy a meal out; you just have to use caution and plan ahead. It’s best to allow extra time to discuss your needs with your host or the restaurant before you go. Many restaurants, including many national chains, now offer gluten-free options, so it’s worth doing a little research online or making a telephone call first.
Fast-food, quick-service restaurants and those with a standard menu may have little time to thoroughly check ingredients, and the styles of food preparation can present a particular challenge to those following a gluten-free diet. You may have to bring your own bread/rolls/pizza crust as a backup, to be confident that your food does not contain gluten.
The chefs at finer-dining restaurants are generally aware of gluten and can be very helpful in accommodating your needs. Call the restaurant the day before or earlier the same day and speak to the chef to discuss your meal options. It also helps to time your meal earlier or later than the busiest meal time, so you’ll have more time and easier access to the people who can help you.
Distilled alcoholic beverages, such as vodka, gin and whiskey, are gluten-free (as, by the way, are distilled vinegars). Even though they may be made from gluten-containing grains like barley, research suggests that the harmful peptide portion of the gluten is too large to carry over in the distillation process. Wines are also gluten-free but beers, ales and lagers and malt vinegar are not; all contain small amounts of gluten and must be avoided.