What is gluten?
Gluten is a protein found in wheat, rye and barley. When a person with celiac disease, (sometimes called coeliac disease or non-tropical sprue) consumes gluten, it damages their small intestines and causes them to suffer digestive disorders and malnutrition. Historically, doctors only tested patients with chronic diarrhea and weight loss for celiac disease, yet many patients present seemingly unrelated symptoms and many are actually overweight. This is why it often takes celiac patients several years to get a proper diagnosis. A proper diagnosis is made through blood tests for antibodies and is confirmed with an intestinal biopsy. It is important to get tested BEFORE going on a gluten-free diet to avoid a false negative test result.
What is a gluten-free diet?
A celiac disease diet, or gluten-free diet, means avoiding ALL gluten-containing ingredients and avoiding cross contamination. This can truly be challenging! Food companies are coming out with new gluten-free foods, but not all taste as good as their wheat-containing counterparts. Many home recipes can be made gluten-free by simply substituting gluten-free flour and grains for gluten-containing ingredients. Oats are considered gluten-free and safe for celiac patients, but choose oats that are labeled gluten-free to avoid cross contamination with gluten during grain processing. Processed foods that contain less than 20 ppm of gluten are considered safe for celiac patients and can be labeled gluten-free in the US. Pure meat, dairy, fruit and vegetables are naturally gluten-free and are safe to consume.
Most importantly, always read labels to avoid inadvertently ingesting gluten-containing ingredients! A really great resource for grocery shopping is called Cecelia’s Marketplace, a small book listing common grocery items that are gluten-free.
What are the symptoms of Celiac Disease?
According to the University of Chicago’s Celiac Disease Center, there are over 200 symptoms of Celiac Disease. Many symptoms seem unrelated to intestinal damage, often making diagnosis difficult. Some common symptoms include the following:
- Recurring abdominal bloating and pain
- Chronic diarrhea/constipation
- Liver and biliary tract disorders
- Weight loss
- Pale, foul-smelling stool due to undigested fat
- Iron-deficiency anemia that does not respond to iron therapy
- Failure to thrive/short stature
- Delayed puberty
- Unexplained infertility and recurrent miscarriages
- Osteoporosis or osteopenia
- Anxiety & depression
- Dermatitis Herpetiformis (DH)
What is Dermatitis Herpetiformis?
Dermatitis Herpetiformis is an itchy, blistery skin rash usually found bilaterally on the elbows, knees and buttocks that will go away with a strict gluten-free diet. Interestingly, people with DH may not have any digestive disorders, and only about 40% of these patients have positive antibody blood tests, yet they often have the same intestinal damage due to eating gluten. DH is diagnosed with a skin biopsy.
What is the treatment for Celiac Disease?
Currently, the only treatment for Celiac Disease and DH is a strict life-long gluten-free diet free from food containing wheat, rye, barley and ingredients made from these foods. Even tiny particles of gluten can cause intestinal damage and/or a flare-up of DH within hours, which is why is it important to avoid cross-contamination with gluten when preparing food. This means using separate cutting boards, different knives for spreads, and different serving utensils for gluten-free foods.
Are there other reasons people should avoid wheat or gluten?
Gluten-intolerance and wheat allergies are different than celiac disease, but people with these disorders often need to follow a gluten-free diet or a wheat-free diet, too. Although these disorders can cause digestive problems and even “brain fog,” these patients don’t get intestinal damage when consuming gluten or wheat. Some people choose to avoid wheat and gluten-containing foods based on cardiologist William Davis MD’s book called Wheat Belly, where he states these foods cause spikes in blood sugar and thus removing them will help with weight loss and improve health.
Science is just starting to understand the benefits of a wheat-free diet or gluten-free diet for non-celiac patients, so most Registered Dietitian Nutritionists (RDN) support using these diets if you feel better after eliminating these foods. However, wheat and rice are currently the only fortified grains in our country, so it is important to work with a RDN to make sure you are eating a balanced diet that includes all food groups to promote optimal health.
There are many wheat-free and gluten-free recipes available nowadays on the Internet, but here a couple of recipes to get you started.
Starter Gluten-Free Recipes
All-purpose Gluten-free Flour
4 ¼ cups brown rice flour
4 ¼ cups white rice flour
4 ¼ cups sweet rice flour
4 ½ cups tapioca flour
2 ½ Tbsp. xanthan gum
Blend ingredients thoroughly in a large bowl. Store in an airtight container, and use in place of all-purpose flour.
¾ cup gluten-free flour (add ½ tsp. xanthium gum if your flour mix doesn’t contain it)
1½ tsp. baking powder
½ tsp. salt
1 tsp. sugar or sugar substitute
⅔ cup milk
2 eggs, beaten
2 Tbsp. coconut oil
In a large bowl, combine first four ingredients. In a separate bowl, combine next three ingredients. Whisk milk mixture into dry ingredients until well blended. Let rest for 5 to 10 minutes.
Oil a griddle and preheat over medium heat. Make pancakes by pouring batter by ¼ cup increments onto griddle. Turn pancakes once bubbles begin to form and pop open on top. Brown the other side and enjoy with fresh berries and maple syrup.