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Family Health Magazine - NUTRITION

Celiac disease
When, how and why a gluten-free diet is important

Today, both celiac disease and gluten-free diets are common topics of conversation. Celiac disease is more commonly diagnosed and gluten-free products are appearing in grocery stores more often. Perhaps you know someone with celiac disease or have been diagnosed with it yourself. Understanding why gluten-free food is important can help in managing this food-related condition.

What is celiac disease?

diagram: how celiac disease affects absorption of nutrientsPeople with celiac disease cannot tolerate eating gluten, a protein found in wheat, rye and barley. Celiac disease is an autoimmune disorder, meaning that the body attacks itself. Hair-like structures (or finger-like structures) called villi line the small intestine, allowing nutrients to be absorbed into the bloodstream. When gluten is eaten, villi become inflamed and flattened. In people with damaged villi, vitamins, minerals, carbohydrate, protein and fat are poorly absorbed. The health of the body is affected.

Celiac disease is the main reason for using a diet that does not contain gluten. Those with celiac disease who continue to eat gluten are more likely to develop osteoporosis, infertility and cancers of the gut. They are also at risk for other autoimmune diseases such as hypothyroidism.

Before blood screening tests for celiac disease were developed, this condition was considered uncommon. Now that tests are available, it is diagnosed in about one in 133 people.

Research shows that relatives (parents, brothers, sisters and children) of someone with celiac disease have a greater chance (one in 22) of also having this disease.

How is it diagnosed?

Although blood tests can screen for celiac disease, they are not completely reliable. For accurate diagnosis, a small piece of tissue must be removed from the intestine and examined (biopsy).
Anyone being checked for celiac disease should continue eating foods containing gluten until a blood test and biopsy are done. If gluten is removed from the diet before this point, test results may not be accurate.

Dermatitis herpetiformis (DH) is another type of celiac disease affecting skin. It causes a blistering, intensely itchy rash. This rash is symmetrical and found on both sides of the body (bilateral), most on the elbows, knees, buttocks, and upper back. A skin biopsy is used to diagnose DH.

Symptoms of celiac disease

One or more of the following symptoms may appear:

  • Anemia
  • Infertility in women and men
  • Bloating, cramping, gas
  • Recurrent miscarriages
  • Indigestion, nausea
  • Migraines
  • Diarrhea
  • Depression
  • Constipation
  • Poor growth or short height in children
  • Weight loss
  • Delayed puberty
  • Dermatitis herpetiformis
  • Abdominal pain
  • Recurring canker sores
  • Bone and joint pain

Adapted from Celiac Disease – Hidden and Dangerous fact sheet, Canadian Celiac Association.

What are the symptoms?

Celiac disease causes a wide variety of symptoms that vary from one person to another. For some, it can take years before a correct diagnosis is made. The Canadian Celiac Survey is the largest study ever done on celiac disease. More than 5,000 people were surveyed, with 65 per cent responding.

The survey revealed that anemia, stress, irritable bowel syndrome and chronic fatigue syndrome are often diagnosed before celiac disease is identified as the true problem.

The most common symptoms include bloating, abdominal pain, and diarrhea. Almost a third of people surveyed suffered from constipation before diagnosis was made. Others had few symptoms and were only diagnosed when tested for another condition.

You may wonder about celiac disease if you experience gastrointestinal (stomach and intestines) or other symptoms listed in the table above. However, it is important to talk with your doctor before removing gluten from your diet.

How is celiac disease treated?

The only treatment for celiac disease or DH is a diet with no gluten. No medication is required, just a strict gluten-free diet. With this diet, those diagnosed with celiac disease or DH can stay healthy. They are at less risk of developing other health problems.

Gluten-free means banning wheat, rye and barley, and all foods or ingredients made from these grains.

NUTRIENT-RICH
GLUTEN-FREE GRAINS

OTHER GLUTEN-FREE GRAINS

amaranth arrowroot
buckwheat corn flour
flax cornstarch
millet potato flour and starch
quinoa white rice
brown rice sago
black rice sorghum
wild rice tapioca
teff  
bean or legume flours  

GRAINS AND INGREDIENTS
CONTAINING GLUTEN

WHEAT
Bulghur Einkorn Hydrolyzed wheat protein
Kamut Semolina Tritcale
Couscous Emmer Matzoh, matzoh meal
Spelt (also known as fariba faro, dinkel) Wheat flour

Wheat bran

Durum Graham flour

Wheat starch

Seitan Wheat germ  
BARLEY
Barley flakes Beer, ale, lager Malt flavouring
Barley flour Malt Malt vinegar
Pearl barley Malt extract Malted milk
Pot barley Malt syrup  
RYE
Rye bread Rye flour  
OATS (regular or commercial oats)
Oatmeal Oat bran Oat flour
Oats    

Adapted from Gluten-Free Diet - A Comprehensive Resource Guide, Shelley Case, 2006, www.glutenfreediet.ca

What foods contain gluten?

Grain products used to make bread, pasta, noodles, cakes, cookies and pastries are the major source of gluten in a North American diet. Vegetables, fruit, milk products, and meat and alternatives may also have added ingredients which contain gluten.

Food that is thickened, breaded, coated, marinated, sauced, seasoned or held together with flour or crumbs usually includes an ingredient that contains gluten. Some seasoned French fries contain gluten. Many soy sauces contain wheat, and most sausages, hot dogs and luncheon meats also include gluten containing ingredients.

Time and care must be taken to select and prepare gluten-free foods. Following a diet without gluten can be challenging. However, it means better health and quality of life for those with celiac disease or DH.

The gluten-free diet

A wide variety of gluten-free products are now available in the marketplace, including gluten-free bread, pizza, pasta, cookies and baked goods. Gluten-free whole grains and products containing flour made from legumes are very nutritious and should be eaten regularly. They are excellent sources of vitamins, minerals and fibre.

Refined gluten-free flours are lower in nutrients. Some manufacturers now enrich gluten-free products with thiamin, riboflavin, niacin, iron and folate to improve the nutritional quality.
Healthy eating on a gluten-free diet also means getting enough daily servings from each food group in Canada’s Food Guide. Each day, eat a variety of vegetables, fruit, grain products, milk products, and meat and alternatives. This will provide the nutrients needed to heal the intestine and achieve good health.

Preventing contamination

Gluten-free food must be handled properly to prevent contamination from foods containing gluten. Care must be taken when preparing or cooking gluten-free foods to prevent such contact.

This means using different cutting boards and toasters than those used to prepare regular breads that contain gluten. Spreads such as butter, margarine, jam, jelly, honey, peanut butter, mayonnaise and relishes must be free of crumbs. Make certain French fries are not cooked in the same oil used to make battered or breaded food, such as onion rings, zucchini sticks and chicken nuggets. Ask deli staff to clean the meat slicer before slicing gluten-free luncheon meat. Even prescription and over-the-counter medications, including vitamin and mineral supplements, must be checked to ensure they are free of gluten.

If people with celiac disease do not remove all gluten from their diet, the intestine continues to be damaged. If villi are not healthy, nutrients will be poorly absorbed.

More information on the gluten-free diet

Canadian Celiac Association
(28 chapters across Canada) offers information and support. 1-800-363-7296
www.celiac.ca

Books

Acceptability of Foods & Food Ingredients for the Gluten-Free Diet – Pocket Dictionary of Ingredients
Canadian Celiac Association, 2005

Gluten-Free Diet: A Comprehensive Resource Guide
Shelley Case, 2006 www.glutenfreediet.ca

125 Best Gluten-Free Recipes
Donna Washburn and Heather Butt, 2003

The Best Gluten-free Family Cookbook
Donna Washburn and Heather Butt, 2005

Complete Gluten-Free Cookbook: 150 Gluten-Free, Lactose-Free Recipes, Many with Egg-Free Variations
Donna Washburn and Heather Butt, 2007

Websites

Download a copy of Canada’s Food Guide from Health Canada’s website
www.hc-sc.gc.ca
or call 1-800-622-6232
TTY 1-800-926-9105 for a copy.

The scoop on oats

Pure oats are free of gluten. However, not everyone with celiac disease can tolerate them. Most commercially prepared oats and foods containing oats should be avoided as they are contaminated with wheat. Pure oat products are now available. Do not add them to the gluten-free diet until the disease is well controlled and there are no gastrointestinal symptoms.

People with celiac disease should discuss adding pure oats to their diet with their physician and their dietitian. Arrangements should be made for follow-up assessments to ensure that pure oats are tolerated and cause no damage to the intestine. Adults with celiac disease can include one-half to three-quarters of a cup (125 to 175 ml or 50 to 70 grams) of dry pure rolled oats daily. For children, the amount is one-quarter of a cup (65 ml or 20 to 25 grams) per day.

Support on a gluten-free diet

It can be challenging to follow a gluten-free diet. Accurate information and support is key. It is essential to see a registered dietitian (RD) or registered nutritionist (RDN) with expertise in celiac disease who can provide accurate information and ideas. With help, a gluten-free diet can be developed that is well balanced, healthy, and free of gluten.

Learning how to read food labels is also important. Food manufacturers may need to be contacted to ensure foods and ingredients are free of gluten. Friends and family, as well as restaurants must be told of the diet, to ensure that all foods are safe.

Joining a support group will help in learning more about and better following the strict diet. The Canadian Celiac Association provides members with excellent information booklets, education and support. Their website includes information sheets written by health care professionals who specialize in the treatment of this disease. Local chapters offer support, such as listing stores carrying gluten-free products or celiac-friendly restaurants.

By eating food free of gluten, those diagnosed with celiac disease or DH can enjoy better health.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
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Alberta College of Family Physicians
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