I doubt you leapt for joy on last week’s news that quinoa may be safe for patients with celiac disease. In fact, it’s not improbable you’ve never even heard of the ailment, let alone its symptoms. But I bet you’ve heard of the gluten-free diet.
Celiac disease is an autoimmune and digestive disorder. It’s when the small intestine is sensitive to and damaged by gluten. The latter is a protein found in some grains that makes it difficult for people with celiac disease to absorb nutrients like fat, calcium, iron and folate.
Contrary to a long-standing belief in health circles, there is little evidence tying celiac to autism in children. Celiac appears to be increasing though, and given the health problems linked to the disorder, it’s all the more important to look for symptoms of celiac early in life.
Observers suggest that most people should not eat a gluten-free diet. That’s not an option for people with celiac disease, however, who must avoid foods with gluten or risk damage to their small intestine and further health issues if left untreated.
The immune system would normally protect the body from foreign invaders. But when a celiac patient eats food with gluten, their immune system forms antibodies to the protein that inflame the gut. Gluten damages their villi too – the hair-like structures on the lining of the small intestine that absorb nutrients. This leads to malnourishment, no matter how much the patient eats, and symptoms of celiac disease, which include:
Celiac disease can also disrupt the menstrual cycle, cause miscarriage and fertility problems. When untreated, it can morph into more serious health issues, like birth defects and osteoporosis. In rare cases, celiac can lead to cancers of the intestine.
Your body has a long memory. Some celiac patients won’t notice symptoms of the disorder for years and continue to eat glutens – all while damaging their small intestine. The longer this occurs, the more vulnerable the patient is to the serious health effects linked to celiac disease.
Celiac disease can be especially pronounced in children; the disorder can stunt growth and delay puberty. Symptoms can emerge later too, like in the late teenage years, during a stressful event such as a pregnancy or leaving home for college.
Adults may experience fewer gastrointestinal symptoms from celiac than children and teenagers. They might also have other autoimmune disease, including thyroid disease, type 1 diabetes, lupus and rheumatoid arthritis.
According to the Mayo Clinic, undiagnosed celiac disease can quadruple risk of death.
Refractory celiac disease, when the small intestine does not heal even after all gluten is removed, is rare, at no more than one patient in 50. But it’s more serious, and may kill up to half these patients within three years.
A doctor can diagnose celiac disease with a physical exam and review of your medical history. He may also do a blood test to scan for higher levels of the antibodies typically seen in celiac patients. He’ll probably do another blood test to look for iron deficiency.
As well, he may also look for fat in your stool with a stool test, or a biopsy from your small intestine to check for damaged villi. For that procedure, he will insert an endoscope – under mild sedation – through your mouth and into the small intestine. While invasive, this allows your doctor to take a sample of your small intestine to examine later with a microscope.
People with celiac disease cannot eat any foods with gluten. This includes many wheat foods like bread and oats. Celiac symptoms should improve after several days and eventually disappear. The downside is that they’ll have to maintain this regimen for life. Any gluten can damage the small intestine and start the cycle again.
Some celiac patients may have intestinal damage, particularly if it’s diagnosed later in life, and require nutritional supplements fed through an IV.
With doctor-approval, it’s usually possible to manage celiac disease with simple changes to diet. Yes, that’s the gluten-free diet you’ve heard so much about and it’s big. You’ll need to rethink daily habits like lunch snacks and party foods (gluten-free Superbowl party!). Celiac patients may have to skip ‘staple’ foods like pasta and cereal, and avoid packaged foods, many of which are high in glutens.
Having said this, the gluten-free diet is hardly a death sentence. Most celiac patients find it’s still possible to eat a well-balanced diet, even with bread and pasta, assuming they’re made with gluten-free flour. Fresh foods, like fruit, vegetables, meat and fish have not been processed artificially and should be fine as well.
The gluten-free diet is a lifestyle, of the foods you eat and the habits you practice. So check food labels if you have celiac disease and prepare for changes including:
Look For Hidden Gluten – Wheat, barley and rye are obvious. Malt and hydrolyzed vegetable protein not so much, yet they’re both sources of hidden gluten. Watch out for oats too, which don’t have gluten, but may cause digestive problems in celiac patients regardless.
Avoid Most Wheat Products – Most wheat products are off-limits. That’s most – including white, wheat, marble and rye along with most other wheat products, like bagels, muffins and even pizza.
Buy Gluten-Free Bread – Gluten-free is a growing movement, with a variety of products available in health stores and even a few major supermarkets. They’re often made with rice or potato flour. Look for “100% gluten-free” on the label.
Watch Out for Gluten in Cereals – Sorry Cheerios. Adios Frosted Flakes. They’re both among the many cereals with gluten, which typically shows up as wheat, barley, rye or malt on the ingredient label.
Try Corn and Rice Cereals – Check the health section of your favorite supermarket and you may find gluten-free corn and rice cereals. Try them – assuming they don’t contain malt.
No More Traditional Pasta – Another casualty of the gluten-free diet, pasta is off-limits, unfortunately, because it’s typically made of wheat. Of course, you’re more than welcome to try gluten-free pasta, which is typically made of rice.
Indulge in Rice and Potatoes– Celiac patients can find some consolation in knowing they’re free to indulge in foods that diabetic and hypoglycemic folks can’t eat. Rice noodles, anyone?
Most Crackers Are Out – They’re made of wheat. Look for their non-gluten options or search for another vehicle on which to spread your favorite cheese.
Try Rice Cakes – Now, about that “other vehicle”. Rice cakes are a great snack food for people with gluten sensitivities – and yes, they work with cheese.
Avoid Breaded Foods – The breading that makes chicken nuggets crunchy are made primarily of wheat flour. The same goes for fish sticks.
Go For Lean Meat – Who needs to sugarcoat food in breading when you can have the real deal? Opt for lean meat, fish and chicken without additives. Watch out for hot dogs and deli meats, though, because they’re processed. Check their ingredients for gluten.
Say Good-Bye to Cookies and Cakes – Your inner sweet tooth might cry a little when it learns that most cookies, cakes, pies and other dietary sin bins are made of wheat flour.
Say Hello to Sweet and Chewy Treats – More catharsis for celiac patients. Marshmellows, gumdrops and hard candies are usually gluten-free – and specialty bakeries can sometimes make cakes, pies and other goodies without glutens too.
Beer is a No-Go – Folks with gluten-sensitivities might do their Superbowl party without beer this weekend because the latter is typically made of barley wheat.
Wine is Fine – Now the good news. Wine and liquors are usually gluten-free. The former is better for your heart than beer too.
Remember, celiac disease is a way of doing things different. That means eating gluten-free options over wheat-heavy foods. Keep an open communication with your doctor too. Plan ahead before you go to a restaurant. Watch for symptoms of celiac disease, especially in young people. With a little knowledge and the right attitude, you can live and even thrive with celiac disease.