Eating Against the Grain: How to Control Celiac Disease
Madison, Wisconsin - In the last 50 years, many grocery stores, restaurants, and cookbooks have modified their offerings to accommodate people with celiac disease, an autoimmune disorder triggered by the foods they eat.
Celiac disease is an inflammation of the small intestine that may cause bloating, diarrhea, constipation, malabsorption of vitamins, osteoporosis, weight loss, fatigue, weakness and possibly lower blood counts. Foods containing the protein gluten are responsible for causing these problems in the digestive system. Foods with gluten include wheat, barley, rye and possibly oats.
According to the National Institutes of Health, Caucasians, people of northern European descent, and people with Type 1 diabetes and fibroid conditions are commonly diagnosed with celiac disease. It may also be passed on to family members through genetics.
Diagnosis can be determined by a blood test and with an endoscopy, in which tissue removed from the small intestine is biopsied to determine if a patient is sensitive to foods containing gluten.
There is no cure for celiac disease, but according to Dr. John Williams, a gastroenterologist and assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health, its symptoms can be kept under control with proper diet.
"The primary treatment is eliminating gluten compounds from your diet," he said. "That requires a consultation with your nutritionist and a look at where you might be getting gluten in your diet."
Some foods acceptable in a gluten-free diet include eggs, meat, fish, fruit, vegetables, and grains such as rice, millet, quinoa, and buckwheat. Normally, within two weeks of starting the diet, the symptoms of celiac disease start to diminish.
Jackie Sullivan, a gastrointestinal nutritionist at UW Health, says people with the disease should always check food labels to avoid products associated with gluten, such as modified food starch and hydrolyzed vegetable protein.
"Modified food starch can be derived from corn, tapioca, potato, or wheat starch," she said. "The Food and Drug Administration (FDA) states that the label should say if the source is wheat. If the label lists starch with no disclaimer that the food contains wheat, then it is cornstarch and is safe to eat. Hydrolyzed vegetable protein and textured vegetable protein can be made from soy, corn, rice, peanuts, casein, or wheat. Only if the food label states 'contains wheat' does it contain gluten."
Sullivan said people with celiac disease also need to pay close attention to medicines and vitamin supplements that may also contain gluten even though many drug makers have stopped using it.
"The label lists the ingredients, and wheat starch is commonly used in drugs as filler," she said. "But medications may also contain dextrin, malt, maltodextrin, modified food starch, natural flavoring and hydrolyzed vegetable protein. People with celiac disease should assume that products listing starch on the label contain wheat starch unless they know the exact source of the starch. Patients need to tell their physician and pharmacist they have celiac disease. Most stores carry gluten-free supplements, which are stated on the product labels. Otherwise, read the ingredients list."
Sullivan adds that in August 2013, the FDA modified its ruling on what should be defined as gluten-free for voluntary labeling, and the new requirements go into effect in August 2014.
"A food labeled gluten-free cannot contain a grain with gluten such as spelt wheat, an ingredient derived from a gluten-containing grain such as wheat flour, or an ingredient processed to remove gluten such as wheat starch, if the use of that ingredient results in greater than 20 parts per million gluten (20 mg/kilogram of the food)," she explained.
Williams said in very rare cases, steroids and other medications may be required to control celiac disease, but a proper diet will normally keep it in remission. But, certain myths claiming that a gluten-free diet is healthy and promotes weight loss are not true.
"People don't want to embark on a gluten-free diet without a formal diagnosis of celiac disease," he said. "It can be hard to maintain and lead to nutritional deficiencies if not closely monitored. It's become somewhat of a fad diet in some quarters, and some people believe it is a path to weight loss when it's actually the opposite. In some gluten free foods, there are more calories present than in the gluten containing alternatives. This adds back some of the taste lost by removing gluten, but will not help with losing weight."
Date Published: 10/16/2013