Celiac disease is an autoimmune disease and those affected are unable to tolerate gluten. In those with celiac disease, gluten causes the immune system to attack its own bowel tissue and damages the small intestines. The villi that line the small intestine are eroded. This may lead to malabsorption and malnutrition as the villi are where nutrients are absorbed. Continued intake of gluten can cause irreversible damage, nutrient malabsorption, osteoporosis, and anemia in people with celiac disease. Research suggests approximately 1 in every 100 Americans may have celiac disease; however, nearly 80% are undiagnosed.
Symptoms of celiac disease and gluten intolerance can vary from person to person and many symptoms resemble those of other diseases. Symptoms can include bloating, diarrhea, constipation, weight loss or gain, sleep issues, and depression. Other common symptoms include fatigue and/or trouble concentrating (brain fog). These two symptoms are typically the first to disappear and resolve once a gluten-free diet is started. Some people may have no symptoms at all, which can be very dangerous as the small intestines are under constant attack.
Due to the fact that symptoms for celiac disease resemble symptoms of other diseases, it can be difficult to diagnose celiac disease. The only true means for diagnosis is a biopsy of the small intestine. Blood test of tTG-IgA (tissue transglutaminase antibodies) can also be used to help diagnose. This may provide a false positive though if there is an associated autoimmune disorder, such as type 1 diabetes, autoimmune liver disease, Hashimoto’s thyroiditis, psoriatic or rheumatoid arthritis, or heart failure. It is important to note that if a gluten-free diet has been started prior to any testing, the results may reveal a false negative.
Non-celiac gluten sensitivity (NCGS) is another issue characterized by the intolerance to gluten. It is estimated that approximately 18 million Americans have NCGS. There are no actual diagnostic tests for gluten sensitivity, so it is difficult to know the actual number of people affected. Symptoms for NCGS are similar to those of celiac disease and typically diminish or resolve with a gluten-free diet.
There is no cure for celiac disease or NCGS; however, a strict gluten-free diet and lifestyle can greatly reduce, and even resolve the associated symptoms. Even trace amounts of gluten may be damaging, so it is important to follow a gluten-free lifestyle and avoid cross-contamination in order to avoid complications.
What exactly is gluten? Gluten is the protein found in the endosperm/flour of wheat, barley, rye, and triticale (a cross between wheat and rye). It is made up of the two proteins gliadin and glutenin. Gluten is often referred to as the “glue” and affects the elasticity of bread and other baked goods. One food to be cautious with when following a gluten-free diet is oats. Oats are naturally gluten-free; however, they are often contaminated during processing. It is important to avoid oats, unless they are certified gluten-free.
Other than the obvious sources of gluten, such as breads and pastas, gluten is also hidden in many products. Certain medications and vitamins/supplements may use gluten as a binder. Beauty products, include lipsticks and moisturizers may contain gluten as it can be used as an emulsifier or stabilizer. It is imperative to be an avid label reader when choosing foods, medications/supplements, and beauty products to ensure there are no hidden sources of gluten.
The good news for those with celiac disease and NCGS is that there are many foods that are naturally gluten-free. These include:
- Beans and legumes
- Nuts and seeds
- Fruits and vegetables (avoid extra sauces, spice packs, etc.)
- Most dairy products
- Fresh meats, poultry, fish/seafood (avoid breaded, batter coated, marinated, and imitation)
- Grains and starches
- Amaranth
- Arrowroot
- Buckwheat
- Corn/cornmeal
- Rice and rice flour
- Millet
- Quinoa
- Sorghum
- Soy
- Tapioca
- Teff
It is important to be aware of cross contamination when following a gluten-free diet. Many products say “may contain gluten” if cross contamination is likely, as it may occur during the processing of the product. When cooking, it is important to have separate toasters, cutting boards, and to clean utensils/dishes thoroughly to minimize the chances of cross contamination.
Following a gluten-free diet and lifestyle may seem daunting and may require trying new foods, products, and recipes. For those with celiac disease and NCGS, this is the only way to reduce symptoms and avoid future complications.
References:
“Celiac Disease.” MedlinePlus. https://medlineplus.gov/celiacdisease.html. 24 May 2017. Date accessed: 16 June 2017.
“Non-Celiac Gluten Sensitivity.” Beyond Celiac. https://www.beyondceliac.org/celiac-disease/non-celiac-gluten-sensitivity/. Date accessed: 16 June 2017.
Sapone A, Leffler DA, Mukherjee R. “Non-celiac gluten sensitivity: Where are we now in 2015?” Practical Gastroenterology. 2015 June; 142:40-48.
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