Questions & Answers about Gluten
What is gluten?
Gluten is the protein found in grains. The gluten that is the offending substance for people diagnosed with celiac disease or gluten-intolerance is contained within wheat, rye, oats, and barley, and all related grains such as kamut, spelt, and triticale. Gluten is the substance that makes a flour sticky or gooey and holds product together, such as breads and cakes, and it also keeps cookies from crumbling. Gluten can be found in all baked items, including cookies, cakes, pies, pastas, cereals, cheeses, snack crackers, pretzels, many forms of candy, croutons, pizza shells, condiments, many processed foods, as well as vitamins and pharmaceuticals. Wheat is used as a filler, or as a cohesive in medicines. Barley is used as an enzyme to process many foods, including tamari sauce and rice products. Wheat is an abundant and versatile grain, so many food producers adapt it for a variety of uses.
What is celiac disease or gluten intolerance?
Celiac disease or gluten intolerance is a genetic autoimmune disease. It occurs in every one of 250 people in the United States. It's genetic, meaning it's inherited, but symptoms will not necessarily develop until some physical or emotional trauma triggers its onset. It's an autoimmune disease, meaning the body attacks itself. In the case of celiac disease, the body sees gluten as a poison and tries to eradicate the gluten. In the process of doing so, the body also attacks and damages the finger-like projections in the small intestine called "villi." Damage is also done to the lining of the small intestine called the "mucosa." This damage results in the malabsorption of nutrients. Eventually, if untreated, symptoms related to nutrient malabsorption develop, such as osteoporosis due to the malabsorption of calcium. Also, continual damage will result in more permanent and less treatable diseases, such as lymphoma, colon cancer, and pancreatitis.
What are the symptoms of celiac disease?
Persistent gastrointestinal distress, including diarrhea, constipation, gas, bloating, acid reflux (this is sometimes diagnosed as Irritable Bowel Syndrome); weight loss; obesity; nutrient deficiencies, especially of iron, calcium, folic acid or fat-soluble vitamins, including D, E, K, and A; mental distress, such as depression, especially when medications do not help; chronic fatigue; bone pain; loss of bone density (osteoporosis). And in children, there may be a failure to thrive, a distended abdomen, dental enamel defects,and unusual behavior changes. Children may also be short of stature.
Is there a cure for celiac disease?
Unfortunately, there is no cure for celiac disease, but a 100% gluten-free diet will restore your health and your body will heal. Strict adherence for life is mandatory, because even a small ingestion of gluten will cause damage to the small intestine and increase the risk factors. Even though the gluten-free diet is a challenge at first, once a celiac stops eating gluten, great health and well-being will be achieved. Plus, many celiacs acknowledge celiac disease is a lot less threatening than other possible diagnoses which are less manageable and treatable that were attributed to them by doctors whom they've seen throughout the course of trying to figure out what was causing their symptoms.
Why would someone need to be on a gluten-free diet?
The diagnosis of celiac disease or gluten-intolerance is one reason for a strict gluten-free diet. This diagnosis can only be made when a person suspected of having celiac disease continues to ingest gluten-containing foods and follows a course of testing. This is very important because sometimes a gluten-free diet will make a person feel better when what is truly causing their symptoms may be something else and will make diagnosis all that much more difficult for the doctor. This could result in a worsening of a more serious illness. Also, there is a form of gluten sensitivity called dermatitis herpetiformis (DH), where antibodies related to the gluten sensitivity are deposited in the skin and come out as itchy, blistering rashes found on the elbows, knees, buttocks, scalp or back. There is a medication called Dapsone to treat DH, but a strict gluten-free diet must also be followed. Another reason for being on a gluten-free diet is because of some mental disturbance. It has been found that autism can be greatly ameliorated by a strict gluten-free and casein-free diet. Casein is a protein found in cow’s milk. There are also studies showing an improvement for schizophrenics and manic depressives on a strict gluten-free diet.There is also a theory that people with the Blood Type O should avoid wheat, which is only one of the offending gluten-containing grains for celiacs, but many Type O people enjoy better health with the exclusion of gluten from their diet. Our Information Section, which includes Medical Sites and Support and Information Sites contains many references about celiac disease.
Why can't people on a restricted diet, such as a gluten-free diet, shop at
a regular grocery store?
They can, but they can only buy whole foods without worry of it possibly containing gluten. Labeling laws are such that manufacturers of food products are not required to list a substance if there is only a very small amount. Therefore, when a manufacturer "dusts" the conveyor belt with wheat flour to prevent sticking, the product will have enough gluten on it to poison a celiac, but wheat flour is not required to be listed as an ingredient. The same is true for barley when used as an enzyme, but enough gluten will remain in that product to cause a reaction in a celiac. Then there are the "hidden" glutens, such as maltodextrin, which by law must be made from corn, but is not regulated. Other hidden glutens are modified food starch and hydrolized vegetable protein. Another surprise hidden gluten is citric acid. When citric acid is made in the United States, it is made from sugar cane, sugar beets or corn; however, when it is produced in China, it may be made from wheat. A celiac must be ever-vigilant and call manufacturers of commercial products before consumption. There is also the concern for cross-contamination in the factories where gluten-containing products are also manufactured and/or packaged on the same production lines. If you have any doubt whether a particular food is safe, do not consume it until you confirm its gluten-free status with the manufacturer.
How does one know if they are gluten-intolerant or have celiac disease?
Celiac disease is an extremely difficult disease to diagnose. This is because everyone will have different symptoms, depending on the severity of malabsorption. Blood tests have been developed to screen for specific antibodies to gluten which are present only when one has celiac, but one must continue to consume gluten for these tests to be valid. These blood tests must be conducted by a laboratory experienced in this specific testing.Please check out our Links section and look at the bottom where we list a couple laboratories that claim to specialize in testing for celiac. Then if that blood test comes back positive (saying you have celiac), to confirm the diagnosis, you should undergo a small bowel biopsy performed by a gastroenterologist specializing in celiac disease. Then once the diagnosis is made and a gluten-free diet is begun and the symptoms disappear, the diagnosis is confirmed.
What are the risks of having celiac disease and not maintaining a
gluten-free diet?
The risk is certain that damage will occur to the small intestine, resulting in more extensive malabsorption, possibly leading to disease. For example, it has been definitely established that celiacs have a 40 to 100 times increased risk of developing non-Hodgkin’s lymphoma. There is also an increased risk of developing colon cancer, pancreatitis, and reflux disease.
If the grains wheat, rye, barley, and oats are eliminated from the diet,what is there to eat?
There is an amazing array of nutritious and delicious foods for the celiac to eat. Along with whole fruits, vegetables, eggs, soy, dairy, nuts, legumes, and all meats, there are highly nutritious foods for a celiac to eat. They include all forms of rice, potatoes, buckwheat, amaranth, and quinoa. There are some delicious pastas made from rice, corn, or legumes. Gluten-free bread is a bit tricky to make, but once it is mastered and a favorite recipe or brand is found, good bread can be enjoyed. Some celiacs are not only sensitive to gluten in wheat, rye, oats, and barley, but they develop sensitivities to other foods, as well, such as quinoa, eggs, soy, or canola oil. It has been established that these "other" food sensitivities are separate and apart from celiac disease, and none of those substances contain the offending gluten. Some celiacs are also lactose intolerant because the area where damage to the small intestine is done by the antibodies to gluten is the same area where lactose is digested. For some celiacs, this lactose intolerance may go away after being on a gluten-free diet.
