What is celiac disease? Symptoms, Dietary restrictions, Foods containing gluten,

What is celiac disease?

Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. The exact cause of celiac disease is not clear, however, the outcome is well established. This disease effects the small intestine and its ability to absorb nutrients, resulting in deficiencies and health complications. 

Gluten is a protein found in wheat, rye, and barley. When you have celiac disease your body reacts to gluten as if it were toxic. This reaction occurs in the small intestine and ends up damaging the mucosal surface (the inner lining of the small intestine). When the mucosal surface is damaged the small intestine is not able to absorb nutrients properly. These nutrients include vitamins, calcium, carbohydrates, protein, and fats.

The symptoms of Celiac disease include:

• Gas
  
• Recurring stomach pain and bloating
  
• Diarrhea
  
• Constipation
  
• Weight loss/weight gain
  
• Fatigue
  
• Change in mood
  
• Pale, foul-smelling, or fatty stools
  
• Bone or joint pain
  
• Unexplained anemia
  
• Very itchy skin rash with blisters called dermatitis herpetiformis
  
• Muscle cramps
  
• Tingling numbness in the legs
  
• Pale sores in the mouth, called aphthous ulcers
  
• Osteoporosis
• • Tooth discoloration or loss of enamel
    
  • Failure to thrive in infants
    
  • Delayed growth

  What are the dietary restrictions for celiac disease (gluten)?

  Omitting gluten from the diet is the key to controlling celiac disease. In patients with celiac disease, strict dietary gluten elimination will heal the small intestine over time (weeks to months). It is imperative that your diet remains gluten-free. Any gluten in your diet will cause the damage to your intestine to reoccur. Learning to follow a gluten-free diet can be very daunting, but with time you will see that there are many options available.
  Foods containing gluten
  To begin with, you will need to become an expert in reading the ingredients on food labels and become a detective for gluten in the food that is not labeled.
  These are the foods and products of gluten containing ingredients to AVOID:
  • Barley
    
  • Bran
    
  • Bromated flour
    
  • Bulgur
    
  • Couscous
    
  • Durum flour
    
  • Enriched flour
    
  • Farina
    
  • Faro
    
  • Graham Flour
    
  • Matzo meal/flour
    
  • Malt or malt flavoring (can be made from barley)
    
  • Malt vinegar (made from barley)
  • • Orzo
      
    • Panko
      
    • Phosphated flour
      
    • Plain flour
      
    • Rye
      
    • Seitan
      
    • Self-rising flour
      
    • Semolina
      
    • Triticale (a cross between wheat and rye)
      
    • Udon
      
    • Wheat
       
      • Einkorn
        
      • Emmer
        
      • Spelt
        
      • Kamut
        
      • Wheat starch
        
      • Wheat bran
      • • • Wheat germ
            
          • Cracked wheat
            
          • Hydrolyzed wheat protein 
           
        • White flour
        There are many other products that contain gluten that you will also need to avoid. Read the labels on each of these:
        • Beer and other grain-based alcohol
          
        • Breading
          
        • Brown rice syrup
          
        • Caramel color
          
        • Communion wafers
          
        • Couscous
          
        • Croutons
          
        • Dairy substitutes
          
        • Dextrin
          
        • Dry roasted nuts
          
        • Gravy
          
        • Herbs
          
        • Hydrolyzed vegetable protein 
        • • mitation seafood
            
          • Licorice
            
          • Lipstick, lip gloss, chapstick
            
          • Luncheon meats
            
          • Malt flavoring
            
          • Matzo
            
          • Modified food starch
            
          • Play clay
            
          • Postage stamps
            
          • Salad dressings
            
          • Seasonings
            
          • Soups, bouillon, broths
            
          • Soy sauce
            
          • Supplements
            
          • Toothpaste
            
          • Vitamins
          • • Wheat-free products - this does not mean gluten-free so you still need to read the list of ingredients
              
            • Medications - gluten containing fillers can be found in some prescription and over-the-counter medications. You can check the list of ingredients, ask the pharmacist or your doctor, and/or use the resource at the end for more information.
            There is some controversy surrounding whether or not it is safe to consume oats. Studies have shown that it is safe for people with celiac disease to consume oats. Unfortunately, oats are frequently contaminated with wheat, rye, or barley.
            There are many oat products that are gluten-free, but without the testing to ensure that they have not been contaminated it is best to avoid oats.
            Cross-contamination is a potential problem in other areas that needs to be monitored. Whenever products containing gluten touch a bowl, utensil, or cutting board there is a risk of it getting into the gluten-free food. Other possibilities for cross-contamination are:
            • Toaster/toaster oven - use a separate toaster
              
            • Crumbs being left in jams, butter, condiments - use squeeze containers
              
            • Storage - make a separate space in cabinets and refrigerator
            • Double dipping - make sure that no one sticks utensils or food in gluten-free foods.

            • Are there any dietary deficiencies associated with celiac disease?

              Patients with celiac disease are at risk for some nutritional deficiencies. A recent study evaluated the nutritional status of over 400 patients who had been diagnosed with celiac disease within the past 3 months. They found that 12% had folate deficiency, 5% had B12 deficiency and 33% of the men and 19% of the women had iron deficiency. Celiac disease patients are also at risk of developing low bone mineral density (osteoporosis).
              There are two reasons for nutritional deficiencies in celiac disease patients;
              1. the diseased small intestine causes lack of absorption of vitamins and nutrients, and
                  
              2. strict gluten restriction can also lead to nutritional deficiencies.
              Many of the gluten-free foods are not fortified or enriched with vitamins or minerals. Studies have also shown that gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber.
              Fortunately, there are blood tests that your physician can do to determine if you are deficient in any of the above. It's important to be aware of what deficiencies you are at risk for, and make every effort to avoid these deficiencies.
              The deficiency in nutrients does not mean a deficiency in calories. There is an increased incidence of obesity in persons with celiac disease following a gluten-free diet. The dietary goal is to follow a well-balanced diet, with appropriate supplements when needed, and an adequate amount of calories for a healthy weight.

              What foods are safe to consume with celiac disease?

              There has been much advancement to assist with complying with a gluten-free diet. The Food Allergen Labeling and Consumer Protection Act (FALPCA) requires manufacturers to provide more information about the ingredients used to make their food products, by specifying the presence of allergens on the product label, including wheat. Wheat-free does not mean gluten-free so you will still need to read the rest of the ingredients.

              Gluten-free foods

              It's a good idea to get into the habit of keeping a food record. You can use the record to make sure that you are reaching your required nutrients and avoiding gluten containing foods.
              These are the foods that are SAFE to consume:
              • Amaranth
                
              • Arrowroot
                
              • Buckwheat
                
              • Cassava
                
              • Corn
                
              • Flax
                
              • Garbanzo beans (chickpeas)
                
              • Indian rice grass
                
              • Job's tears
                
              • Legumes
                
              • Millet 
              • • Nut flours
                  
                • Potatoes
                  
                • Quinoa
                  
                • Rice
                  
                • Sago
                  
                • Seeds
                  
                • Soy
                  
                • Sorghum
                  
                • Tapioca
                  
                • Teff
                  
                • Wild rice
                  
                • Yucca
                The other foods that you are able to eat are:
                Meats
                • Plan meat, poultry, fish, shellfish, and eggs
                  
                • Dry peas and beans, nuts, peanut butter, and soybeans
                  
                • Tofu
                Fruit
                • Fruit juice
                Vegetables
                • Fresh, frozen, and canned vegetables
                Dairy
                • Milk
                  
                • Plain yogurt
                  
                • Cottage cheese
                  
                • Cheese
                Beverages
                • Pure instant or ground coffee
                  
                • Tea
                  
                • Carbonated beverages
                  
                • Alcohol - wine, vodka, gin, rum
                Fats
                • Butter
                  
                • Margarine
                  
                • Vegetable oils
                  
                • Lard 
                • • Shortening
                  Miscellaneous
                  • Sugar
                    
                  • Honey
                    
                  • Jelly
                    
                  • Jam
                    
                  • Olives
                    
                  • Black pepper
                  There is a way to convert recipes that contain gluten into gluten-free recipes. You will need to experiment with the ingredient substitution, length of time, and temperature used for baking. Here are some substitutions that you can make in your recipes:
                  For 1 tablespoon of wheat flour, substitute one of these:
                  • 1 1/2 teaspoons cornstarch
                    
                  • 1 1/2 teaspoons potato starch
                    
                  • 1 1/2 teaspoons arrowroot starch
                    
                  • 1 1/2 teaspoons rice flour
                    
                  • 2 teaspoons quick-cooking tapioca
                  • For 1 cup of wheat flour, substitute one of these:
                    • 3/4 cup plain cornmeal, coarse
                      
                    • 1 cup plain cornmeal, fine
                      
                    • 5/8 cup potato flour
                      
                    • 3/4 cup rice flour
                    A panel convened by the National Institutes of Health assessed all of the available scientific evidence on celiac disease and identified six elements essential to treating celiac disease once it is diagnosed:
                    C: Consultation with a skilled registered dietitian
                    E: Education about the disease
                    L: Lifelong adherence to a gluten-free diet
                    I: Identification and treatment of nutritional deficiencies
                    A: Access to an advocacy group
                    C: Continuous long-term follow-up.
                    You are going to need time, patience, persistence, and support with making these changes. These changes will affect you and everyone in your life, but it will get easier as you all get used to it. You are not alone in this so reach out to those who know what you are going through. The important thing to remember is that your body needs this diet to function correctly.