Celiac Disease and Gluten Free Diets
Written by: Tracy Pritchard (MS, CNS, LDN)
September 13 is National Celiac Disease Awareness Day. This day is named after Dr Samuel Gee (born September 13, 1839) who was the first researcher to link celiac disease to the diet. It wasn’t until 1952 when scientists in England linked celiac disease with gluten specifically for the first time. Prior to this discovery, Aretaeus (a Greek physician) gave a description of this disease in AD100 calling it “koiliakos,” an abdominal infection. Bringing awareness to this condition is so important because many cases go undiagnosed in the United States. Researchers estimate that up to 83% of Americans with celiac disease are undiagnosed or misdiagnosed with other conditions.
Celiac disease is diagnosed through a combination of blood tests and an intestinal biopsy. Most people with celiac disease will have certain antibodies in their blood, but the test is only reliable if gluten has been regularly eaten. This can be a challenge for those who already gave up gluten and feel better, and have to weigh the pros and cons of reintroducing gluten for several weeks in order to get an accurate diagnosis.
Celiac disease is a chronic genetically based autoimmune disease where gluten triggers antibodies to attack the villi of the small intestine. It effects approximately three million Americans, or about 1% of the population. Over time these exposures damage the lining of the small intestine. This often leads to the malabsorption of nutrients resulting in anemia, fatigue, bone/joint pain, headaches, low vitamin D and vitamin B12, osteoporosis, and others. Celiac disease has been called “an invisible illness” due to the major impact it has on health. People with celiac disease have reported sacrificing major life events because of their dietary requirements, social anxiety and isolation, and symptoms of depression and brain fog.
Approximately thirty eight percent of the population carries genes for celiac disease but only a small percentage develop it. The most common age to be diagnosed is age forty to sixty. It may seem confusing why “all of a sudden” someone can no longer consume gluten without feeling ill. Sometimes it becomes active after surgery, pregnancy, childbirth and may be triggered by a viral infection or severe emotional stress.
There are many people who complain that they do not feel well after consuming gluten who do not have celiac disease. This sensitivity has been called Non-Celiac Gluten Sensitivity (NCGS) and must be differentiated from celiac disease. People with NCGS may complain of bloating and diarrhea after consuming gluten, but they do not experience the compromised immune system of those with celiac disease. NCGS typically does not have the same negative impact on health like celiac disease; someone with NCGS may find some relief and symptom improvement simply by reducing gluten intake. Many are unaware that celiac disease can cause symptoms in parts of the body other than digestive system. Symptoms can vary from person to person, and some may not experience symptoms while gluten is damaging their small intestine. Symptoms other than digestive symptoms may include unintentional weight loss, skin symptoms, nervous system symptoms, and variety of other seemingly unconnected symptoms such as delayed puberty and infertility.
We all know someone who has tried a gluten free diet, yet many misunderstand why those with celiac disease can’t consume any gluten, a protein found in wheat, rye, oats, and barley. Celiac disease is different than a food allergy such as a wheat or peanut allergy when the immune system overreacts to a specific protein in a food resulting in symptoms such as itching, hives, or even anaphylaxis. (Those with celiac disease do not get anaphylaxis). While both those with celiac disease or a food allergy need to avoid certain ingredients, that is the only thing they share in common. Celiac disease and wheat allergy are very different conditions with different health effects and treatments. Those with celiac disease need to completely avoid gluten for their entire life – even a crumb of gluten will produce symptoms that can last for hours or days.
“Gluten free” products seem to be everywhere these days; they are often higher in refined carbohydrates and sugars and are not always a better choice for those without celiac disease. It is important to understand that gluten free does not mean “grain free” or “healthy”. There are many gluten-containing whole grains that are suitable for those without celiac disease. There are also many inherently gluten-free whole grains that can be part of a healthy diet. It is important to learn how to read labels for gluten containing ingredients since they can go by many names.
Gluten containing: barley, bulgur, cereal (whole wheat), couscous, crackers (rye), kamut, spelt
Gluten free: amaranth, buckwheat, grits (corn/soy), millet, oats (GF), quinoa, rice (basmati, black, brown, purple, red, wild, white), sorghum, teff
There are many common foods that contain gluten. These include baked goods such as cookies and muffins, beer, bread, cereal, crackers, flour tortillas, granola, pancakes pasta, and pastries such as pies and rolls. It has become easier to find gluten free pastas made from lentils or chick peas that include fiber and protein rather than just carbohydrates associated with traditional gluten-free pasta made with corn and rice. You can also find gluten free tortillas that do not contain glutenous flour – these are typically made with almond flour, rice flour, corn, or a gluten-free flour.
Challenge:
If you know someone who has celiac disease, consider hosting a gluten-free bake off. This is a tasty way to learn about safe food options. They will undoubtedly be grateful for the opportunity to participate in this event. Other friends who choose to avoid gluten for other reasons will also appreciate this!
When contributing food to a pot luck consider a gluten free version and label it accordingly so those with celiac disease know it is safe for them to eat.
Extra Resources:
National Celiac Association: https://nationalceliac.org/
Celiac Disease Foundation: https://eat-gluten-free.celiac.org/recipes/
Beyond Celiac: https://www.beyondceliac.org/
University of Chicago Celiac Disease Center: https://www.uchicagomedicine.org/conditions-services/gastroenterology/celiac-disease
