Living Gluten Free

Celiac disease is also known as gluten sensitive enteropathy. Most people think of this as an allergy but it is actually an autoimmune condition in which the body mounts an immune response against the protein gluten. Glutens are primarily found in wheat, and most people relate this condition to eating wheat products, but the proteins are also found in barley, rye and spelt. Other cereal grains can be a problem as well.

The gluten proteins provoke an immune response with the antibodies attacking the lining of the small intestine. Symptoms can include abdominal pain, diarrhea, weight loss, fatigue and anemia. Interestingly, many people with undiagnosed celiac disease have no symptoms at all. The main issue becomes one where the body can’t absorb nutrients as a consequence of the damage to the lining of the intestine. As a result the celiac disease can affect many other parts of the body, including the heart as well as nervous and endocrine systems.

Celiac disease is one of the most common immune disorders. There’s a high prevalence with the estimates being 1 in every 133 people having the disease. Here’s the potential risk for different groups:

Group Prevalence
First degree relatives (mother, father, sister, brother) 1 in 22
Second-degree relatives (grandparents, aunts, uncles) 1 in 39
Symptomatic patients 1 in 56
Not-at-risk individuals (overall prevalence) 1 in 133

Celiac disease is associated with two genes, the HLA-DQ2 gene and HLA-DQ8 gene. Interestingly, Type 1 diabetes is associated with the same DQ molecules, but in the opposite order. There are genetic tests for these genes and a mouth swab or blood test are both options. The test is negative more in men (especially older men) but the definitive diagnosis is biopsy of the small intestine.

Doctors evaluate celiac disease in a variety of ways. The definitive diagnosis is made by biopsy of the small intestine with the aid of endoscopy (a fiber optic scope). There are, however, blood tests to help guide whether such invasive screening is indicated. However, often these tests can be negative and a biopsy of the small intestine is required for definitive diagnosis. The diagnosis is also confirmed by removing all gluten containing foods from the diet. If the small intestine repairs itself, it is clear that a person has celiac disease.

Following a gluten free diet is the only treatment for this condition. This means avoiding all products that contain wheat, barley or rye. Adherence to a gluten free diet can be a challenge as there so many foods that contain gluten. Often the gluten is hidden in foods that might not obviously contain wheat, barley or rye. There can be some confusion about oats. While oats don’t contain gluten there can be cross contamination of oat products by gluten containing foods as they are often made in the same factories. As a result many people are best off to avoid oat products, at least during the early period of treatment.

Substituting with foods made from corn, rice, buckwheat and quinoa is the key strategy and the less processed the food the safer. This applies to eating in general – the closer the food is to its natural state, the healthier it will be, dietary restrictions or not. Fresher is just better, not only for health, but also for taste. Fresh food satisfies the body, senses and is a huge step toward taking control of your diet.


Celiac Disease: Health and Nutrition Bites