What is celiac (coeliac) disease?
Celiac disease is a genetic disorder that causes damage to the digestive tract when it is exposed to gluten. This damage results in the decreased ability to absorb nutrients, which leads to long-term ill health effects. It can also lead to a host of other medical conditions, ranging from irritable bowel syndrome and dermatitis herpetiformis, to autoimmune diseases like diabetes and arthritis.
1 in 133 (or an estimated 2.8 million) Americans are thought to have celiac disease, with 95% of those being, so far, undiagnosed. This statistic is similar in the UK, Australia, New Zealand, and Ireland (each about 1 in 100), as well as in Italy (1 in 250), and presumably other European nations.
It is believed that the amount of people that have celiac disease is on the rise. Some studies have shown that four times as many people have the disease today than did 50 years ago.
What is gluten intolerance or gluten sensitivity?
Simply stated, if you have celiac disease, you have a “gluten intolerance” because your digestive system cannot tolerate gluten.
While celiac disease is the most notable form of gluten intolerance or gluten sensitivity (GS), it is not the only manifestation of GS. there is another group of people who exhibit Non-Celiac (Coeliac) Gluten-Intolerance (“NCGI”), which have been recognized for quite some time in the UK and Australia.
In February of 2012, an international panel of experts convened to agree that NCGI is a legitimate medical condition, which they are now calling Gluten Sensitivity (GS). While doctors are still learning about this newly recognized disorder, more and more people are converting to a gluten-free diet, based on self-diagnosis of gluten intolerance or sensitivity. People with GS exhibit symptoms similar to celiac disease after ingesting gluten, but blood tests and biopsies for celiac disease come back negative.
It is estimated that 8-12% of the world’s population has gluten sensitivity (compared to less than 1% being celiac). Some doctors believe the percentages are even higher. Doctors and scientists are still learning about Gluten Sensitivity and the many ways that gluten effects health.
What symptoms are manifested by eating gluten?
The problem with diagnosing celiac disease and gluten-intolerance, is that the symptoms manifest in a variety of ways, and vary from one individual to another. Many of the symptoms mimic other common diseases, such as irritable bowel syndrome and chronic fatigue syndrome. Therefore, celiac disease can often go undiagnosed for a very long time. In fact, the average time it takes to get diagnosed is 10 to 12 years.
Some people have gone decades without being properly diagnosed. If you know that something is wrong with your system, but can’t figure out what it is, it might be time to take a look at your diet.
Here are some common symptoms of Celiac Disease and gluten-intolerance.
- abdominal bloating and pain
- chronic diarrhea
- weight loss or weight gain
- bone or joint pain
- tingling or numbness in the hands and feet
- missed menstrual periods
- infertility or recurrent miscarriages
- canker sores
- dermatitis herpetiformis (an itchy, blistery skin rash)
- inability to concentrate.
This list is just the beginning of the many symptoms that patients experience, and in fact Braly and Hoggan have actually identified nearly 200 medical conditions associated with gluten.
Some of the diseases that have been associated with gluten intolerance include (but are not limited to):
- Down syndrome
- type 1 diabetes
- multiple sclerosis
- ulcerative colitis
- other autoimmune disorders
- irritable bowel syndrome
- pancreatic disorders
- rheumatoid arthritis
- non-Hodgkin’s lymphoma, and more.
There are also a number of studies showing that gluten-free diet does benefit some neurological disorders, and there is quite a number of peer reviewed, carefully structured studies (beginning in the late 1960s) showing that many schizophrenia patients benefit enormously from the GF diet. In addition, there is also much anecdotal evidence that a gluten-free diet can be beneficial to people with autism and ADHD.
What is a wheat allergy?
Some people experience an allergic reaction when eating wheat. Like other allergic reactions, the symptoms of a wheat allergy include rash, wheezing, lip swelling, abdominal pain and diarrhea. This is a different reaction than the digestive symptoms of gluten intolerance, and usually more immediate.
There is also a type of wheat allergy that manifests itself in a slower, digestive reaction similar to gluten intolerance. This is why many people use “intolerance” and “allergy” interchangeably. There is a grey area here, between what is actually an allergy, and what is an intolerance, and in some cases, people might exhibit immediate allergic reactions, as well as delayed digestive reactions. Doctors and scientists are still unraveling the myriad ways in which gluten and wheat affect a person’s health.
How is celiac disease and gluten intolerance diagnosed?
A blood test is used to determine if you have higher than normal gluten antibodies (tTGA and EMA). At the same time, a measurement of total IgA should be taken. If you have celiac disease, your body will send out extra antibodies to “fight” the gluten, each time you ingest it. This is why it is important to continue to eat gluten until this test can be taken. If you haven’t been eating gluten for some time, these antibodies will not show up, so the test will be negative. But this does not necessarily mean that you don’t have celiac disease.
An intestinal biopsy is another way to test for celiac disease. Because it is a more invasive procedure, this is often done after the results of a blood test come in. An endoscopy is performed, and pieces of the patient’s small intestine are sampled. If the tissue samples show damage to the intestinal “villi” than the patient is positive for celiac disease. Again, you would have to be eating gluten for some time (and in great quantities), for this damage to show up in a biopsy.
So if you haven’t had any of these tests performed yet, it is recommended that you continue to eat gluten until these tests can be performed. Even if your blood tests and biopsies come back negative, you can’t necessarily rule out celiac disease one hundred percent. Some doctors believe that the standards by which celiac disease is diagnosed should be expanded.
Instead of digestive symptoms, some celiac disease patients exhibit dermatitis herpetiformis (DH). A blood test and skin biopsy can be done to test for this skin disease, and if it comes back positive, then the patient is also positive for celiac disease.
Blood tests can often miss DH, however, so the blood test is not a good way of ruling out DH. Even intestinal biopsies will often miss DH. The best route is to get a skin biopsy but the biopsy should not be taken from a DH lesion. it should be taken from nearby tissues. DH is easy to recognize under a microscope if the biopsy is taken properly and from the correct location.
Up until recently, the only way to diagnose whether or not you had non-celiac gluten-intolerance, was through an elimination diet. However, there are some labs that now offer IgG testing for gluten antibodies, which will identify some form of non-celiac gluten intolerance.
Although there is still debate about IgG testing for anti-gliadin antibodies, and some believe that they are non-specific, others believe that since they indicate an immune reaction to gluten, they are a good marker for non-celiac gluten sensitivity. Still others only recognize innate reactions to gluten as non-celiac gluten sensitivity. Opinions are still quite diverse on this topic.
Should I take gluten out of my diet?
If you suspect that gluten is causing you problems, it is advisable to keep gluten in your diet until your doctor can perform blood tests and/or biopsies. It is much easier to detect gluten antibodies and damage to the small intestine if you are actually still eating gluten.
If you have been positively diagnosed with celiac disease, then you must take gluten out of your diet. This is the only cure for the disease.
If you have tested negative for celiac disease, and you are still not feeling well, then you can follow the elimination diet to see if eliminating gluten makes you feel any better. If it does, then following a gluten-free diet might be recommended for you. A gluten-free diet has been shown to be beneficial in helping chronic digestive disorders, chronic pain, autism, ADHD and much more.
Is a gluten-free diet a good way to lose weight?
People who choose a gluten-free diet, usually do so because they have a bad reaction to gluten and need to avoid it at all costs. While avoiding gluten has recently become easier, it is still hard work and the majority of us are on a gluten-free diet out of necessity.
It is true that if you go gluten-free, then you might miss out on office birthday cakes, team pizza parties, and many a pot-luck dish, which in turn might contribute to weight loss. It is also true that wheat has a higher glycemic index than sugar, so reducing your wheat intake may contribute to weight loss. However, replacing gluten dishes with gluten-free substitutes, may not ultimately result in weight loss. After all, a cupcake is still a cupcake, whether its gluten free or not.
Gluten-free substitutes can often be higher in caloric intake, and less dense in nutrients. In addition, there are many great desserts that contain no gluten, but are high in calories. Not to mention potato chips, French fries, etc. that are all naturally gluten-free but usually not recommended on a weight loss program.
However, if you do gluten-free the right way, you can lose weight!
Where can I get help?
If you think you are experiencing problems with gluten, please consult your health-care practitioner before making any drastic changes to your lifestyle.
If you don’t have celiac disease, but think you are having problems with gluten, seek the help of a functional MD or a naturopathic doctor. Unfortunately at this time, the majority of the conventional medical community in the US still does not recognize Gluten Sensitivity. We hope to change that.
What foods have gluten in them?
The following grains contain gluten:
- wheat (including durum, faro, kamut, semolina, spelt, bulgur, and einkorn),
- Some say that oats are naturally gluten-free but they are often processed in a wheat facility, so that you cannot consider oats to be gluten-free unless clearly labeled so. However, some people that are gluten-intolerant also exhibit a sensitivity to oats, even the gluten-free kind.
- Still others believe that all grains are harmful to celiacs and the gluten sensitive and advocate for a completely grain-free diet, including corn, rice, millet, teff, etc.
Most bread products are made with wheat. These include bagels, baked goods, pasta, pretzels. crackers, pizza, communion wafers and matzo.
Many sauces and condiments use wheat or gluten as a thickener. This includes soy sauce (but you can buy gluten-free versions), as well as bbq sauce, ketchup, cheese sauce, cream sauce, salad dressings, gravy, bouillon, etc. Its best to assume any sauce has wheat/gluten in it, unless you have specifically read the ingredients, it is specifically labeled gluten-free, or you have asked the chef about it.
Wheat can also be in seasonings and spice mixes. Watch out for those seasoned French fries! They probably have gluten in them. Also, if you are super sensitive to gluten, you probably need to steer clear of any fried foods that share a fryer with breaded fried foods. Even Smoke Flavoring might have gluten in it.
Most beer is made with barley, so also has gluten in it. There is still discussion as to whether distilled alcohol is gluten-free, so choose alcohol not derived from grains until we know for sure. Fermented alcohols (like cider) may add barley or other grain enzymes to induce fermentation. Never trust a cocktail “mix” to be gluten-free, unless you can read the ingredients for yourself.
Wheat is used in sautéing and restaurants offering sautéed chicken breast, for example, probably dusted the chicken with flour before sautéing it.
Other places where gluten can lurk include processed meats, candy, and soup (including miso).
Finally, wheat and gluten can be found under other names such as (not necessarily an exhaustive list):
- cake flour
- durum (also spelled duram)
- malt extract
- matzoh, matzah, matzo
- triticum aestivum
Gluten may or may not also be found in:
- artificial color
- artificial flavoring
- clarifying agents
- fat replacers
- glucose syrup
- hydrolyzed protein
- hydrolyzed vegetable protein (HVP)
- hydrolyzed plant protein (HPP)
- modified food starch or other type of starch
- natural colors
- natural flavoring
- texturized vegetable protein (TVP)
- texturized plant protein (TPP)
Always read the ingredient labels of the foods you buy in the store. And always ask your servers and restaurants managers about what goes into their dishes. If you don’t recognize the name of ingredient, be sure to check it out before ingesting it.
What can I eat?
While taking gluten out of your diet requires a big adjustment, there is no need to worry. There is a whole world of culinary options that are free of gluten. That’s what Stuffed Pepper is here for.
The most important aspect of maintaining a gluten-free lifestyle is to take control of your diet. The best way to do this is to cook for yourself, because you will have complete control over what goes into your meal. There are many simple, tasty gluten-free recipes on our site, for even the most timid of chefs to explore. You can even filter by other dietary restrictions that you may have.
While we believe that fresh, unprocessed, home-cooked food is the best, we understand that some store bought items are convenient to have on hand. Don’t forget: unless a product is clearly labeled Gluten Free, you must read every label on every food product that you buy, every time that you buy it. Even if you have come to rely on a product as being gluten-free because you have memorized the ingredient list, manufacturers do change their ingredients from time to time. Also, please consider take a moment to understand a little more about gluten-free labeling and what is or isn’t considered safe.