what is gluten intolerance
Gluten intolerance is also known as Celiac disease, celiac sprue, coeliac sprue, non-tropical sprue, and gluten-sensitive enteropathy. Gluten intolerance is an autoimmune disorder with a genetic predisposition. Patients suffering from Celiac Disease cannot digest the protein gluten found in wheat, barley and rye.
Gluten intolerance should not be confused with a wheat allergy. In a gluten intolerance, the body cannot digest gluten. The intestines become damaged and cannot absorb vitamins, minerals and nutrients. A wheat allergy is an allergic reaction or hypersensitivity to a protein in wheat. The immune system reacts by treating the protein as a foreign substance, in other words, a “threat.” The allergic symptoms result from the immune system releasing certain chemicals to attack the protein.
What is Gluten?
Gluten is a protein found in grains such as, wheat, kamut, rye, spelt, tricticale and barley. It acts as a binding agent or “glue” in wheat flour. In wheat flour, it traps bubbles created by leavening agents and causes the bread to rise. In order for bread to rise, gluten helps keep the gases in the dough that are being released during fermentation. When it is cooked it becomes firm and works with starch to allow bread to keep its shape. It also gives bread a chewy texture and the ability to be absorbent.
Gluten intolerance occurs when the body cannot digest gliadin (a protein) and other proteins found in wheat, barley, rye and other grains in those that are genetically predisposed. In a gluten intolerant individual, digesting gluten actually damages their intestines and prevents the body from absorbing vital nutrients. The lining of the small intestine is covered with villa, tiny hair-like projections that help the body absorb vitamins and nutrients from food. When gluten is consumed, the inability to digest gluten damages the villa by smoothing them along the surface of the intestine.
Because there is a genetic component, people who suspect they may have Celiac disease should obtain a complete family history
Itchy, dry skin
Neuropathy (tingling in legs and feet)
Symptoms of malnutrition from celiac disease:
Osteoporosis (loss of bone density)
Stools may be gray, fatty, oily
Abdominal cramps, bloating, gas
Conditions related to Gluten intolerance:
Deficiency in B-12, folate, and iron
Loss of calcium and vitamin D leading to osteoporosis, osteomalacia (softening of the bone, also called rickets), oxalate stone (certain type of kidney stone)
Cancer (at greater risk if gluten free diet is not followed)
Neurological complications (celiac disease is also associated with seizures and nerve damage)
how to test and diagnose
Food Diary: If you think you have a gluten intolerance track your diet and symptoms. Keep a diary of the foods you are eating and what signs and symptoms you are experiencing after eating those foods.
Elimination Diet: Remove all food that contains gluten from your diet for 2-3 weeks. After 2-3 weeks gradually reintroduce those foods into your diet and see how your body reacts. You can use www.foodfacts.com as a guide for foods that will contain gluten. There are many hidden sources of gluten so be extra careful when reading food labels. If your symptoms are relieved during the time the food is eliminated, you may be allergic to that food. See your doctor for proper diagnosis. Note: If you decide to get a blood test to determine if you have a gluten intolerance, be sure to keep gluten in your diet in order for results to be accurate. Removing it before the test may give a negative result.
Dermatitis Herpetiformis: Often people with celiac disease experience a skin reaction called Dermatitis herpetiformis, (DH). DH is a severely itchy blistering red rash on the elbows, knees and/or buttocks. A skin biopsy and blood test can test for antibodies of DH. Antibiotics can be used to control the rash, but a gluten-free diet should still be followed.
Blood Test: A blood test will be used to test for high levels of anti-tissue transglutaminase antibodies (tTGA), anti-gliadin (AMA), or anti-endomysium antibodies (EMA). When a person has celiac disease, there are proteins that react against his or her own cells and tissues. These proteins are called auto-antibodies and are higher than normal in a person with celiac disease. If you have decided to get this test done be sure to keep gluten in your diet in order for test results to be accurate. Removing it before the test may give a negative result.
Intestinal Biopsy: A biopsy is performed by placing a tube called an endoscope in the patient’s mouth and through to the intestines. Tools remove a tissue sample through the endoscope. The removed tissue from the small intestine is then examined to see if the villi are damaged.
how to manage
Avoidance is the only way to prevent the symptoms of Celiac Disease. Be careful to read food labels in order to avoid gluten; become educated on the names of the ingredients and hidden ingredients that may have gluten in them. Patients often have difficulty digesting dairy products due to the damaged villa of the small intestine.
Carry an epinephrine autoinjector as directed by your doctor. If you have a severe allergy, and in the event that anaphylaxis occurs, this is advisable. This requires a prescription from your doctor. Your doctor may also prescribe other antihistamines. Antihistamines may be used; however, it is not as effective.
ingredients to avoid
Oats (recent studies have shown that oats are safe for the gluten intolerant, however, there is a risk of cross contamination in commercial oats. The safest oats are pure-uncontaminated oats. If you are gluten intolerant, talk to your clinician before trying oats)
Triticale (a cross between wheat and rye)
Foods products that Contain or May Contain Gluten:
Brown rice syrup
Seasoned tortilla chips
Cakes and pies
Imitation meat or seafood
Processed lunch meats
Fried or breaded foods
Flour from: rice, soy, corn, potato, beans, seeds, nuts, chestnut, tapioca
Buckwheat (make sure it is labeled gluten-free)
Kettle One Vodka
Complex carbohydrates: sweet potatoes, yams, white and red potatoes, parsnips, turnips, winter squash, yucca, spaghetti squash, taro, Jerusalem artichoke
suggestions for gluten-free cooking
Gluten-free flours cannot be easily used to make yeast breads, but baking powder can be used instead of yeast. Substitution for gluten is easiest in cakes, pie crusts, and pancakes. When you try gluten-free bread, it is difficult to duplicate the shape and texture. In smaller muffins and cakes; however, rice or potato flours may be substituted for wheat with baking powder as the leavener. Baking powder’s ability to hold the rise is related to the size of the pan, so use smaller pans in gluten-free baking.
- Polenta French toast with berry syrup
- Organic corn flakes, puffed rice, or puffed millet with choice of milks or juice
- Cream of rice, cream of buckwheat, amaranth, or corn grits with appropriate milk, sweetener, or fruit
- Miso soup with vegetables and rice
Lunch and Dinner
- A non-gluten grain (wild or brown rice, corn, buckwheat, millet, or quinoa) with vegetables
- (sautéed, stir-fried, or steamed) with dressing if desired
- Any variety of bean soups (split peas, lentils, chickpeas) or chili with alkaline vegetables
- Fish with vegetables and a baked root crop or a non-gluten grain
- Hummus, rice and alkaline vegetables
- Corn tacos with refried beans
- Baked or oven-fried sweet potatoes/yams
- Fresh nuts and seeds
- Fruit and crunchy raw vegetables with bean dip or yogurt
- Nut butters like almond and cashew with gluten-free crackers like rice
- Hummus or baba ganoush with vegetables or gluten-free chips or pretzels
- Products made with corn like tortilla chips and salsa
To help repair the damaged intestines and to help with better digestion overall, drink at least 20 minutes prior to eating and don’t drink any fluids while eating, then wait 2 hours after your meal to have a drink..
Try eating more solid foods like meat or poultry, rice or quinoa. Foods like salads that are water based pass right through your system.
You may also want to avoid dairy . Dairy tends to coat the intestines so digestion takes longer and many people have trouble digesting dairy in general. You can try the elimination diet with dairy and see if it helps with your symptoms and discomfort from celiac disease. There are plenty of dairy alternatives. Use www.foodfacts.com to see a complete list of foods that contain diary.
Some people think that gluten intolerance means you can’t eat carbohydrates. This is a misconception. A person with celiac disease can enjoy rice, baked potatoes, sweet potatoes and an occasional not-so-healthy choice – french fries.
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Tiffany Gale, Ceritfied Health Counselor
JeanMarie Ceravolo, Certified Health Counselor
Content written Feb. 2009, JeanMarie Ceravolo, CHC