Nutrition Corner: The 411 on Celiac Disease and a Gluten-Free Diet

The 411

By Carleton Rivers, RD

May is National Celiac Disease Awareness Month, and in honor of this we would like to educate everyone on the ins and outs of celiac disease. Celiac disease is a genetically based sensitivity to certain amino acid sequences found in the prolamin fraction of wheat, barley, and rye. Prolamins are storage proteins found in the endosperm of grain (1).

What does that mean exactly?
When a person with celiac disease consumes wheat, barley or rye, their body has an immune response that causes damage to the mucosa of the small intestine, leading to the malabsorption of macronutrients and micronutrients like calcium, vitamin D, iron, and folate (1).

So what is gluten and how does it relate to celiac disease?
Gluten makes up part of the prolamin gliadin, but the term “gluten-free” is used as a general term to describe the nutrition prescription of persons with celiac disease. What is important to know is that those with celiac disease must follow a lifelong, gluten-free diet. Even a miniscule amount of gluten in the diet can cause damage to the small intestine. Reduced bone mineral density and lymphoma may result if celiac disease is left untreated (1).

What are the signs and symptoms of celiac disease?
Individuals with celiac disease usually present with signs and symptoms of malabsorption including diarrhea, weight loss, and fatigue. Other gastrointestinal symptoms that may occur consist of flatulence, constipation, bloating, indigestion, steatorrhea (fat in the stools), and abdominal pain. It is possible to not have any gastrointestinal symptoms but still suffer from celiac disease. Other symptoms include unexplained, chronically high levels of transaminases, unexplained short stature, unexplained delayed puberty, unexplained iron-deficiency anemia, repeated fetal loss, and infertility. Those who present with these signs and symptoms should see a physician immediately for testing (1).

Why is there such a wide range in signs and symptoms?
The amount and degree of damaged intestine varies greatly between individuals with celiac disease. Those who have more severe damage will present with more severe symptoms (1).

What tests are done to diagnose celiac disease?
Serologic tests are one way to diagnose celiac disease. These tests include immunoglobulin A (IgA), antihuman tissue transglutaminase, and IgA endomysial antibody immunofluorescence. The gold standard, however, is a biopsy of the small intestine which allows doctors to view mucosal abnormalities. Testing for genetic markers is also a way to determine the likelihood that a person has celiac disease (1).

Can you have celiac disease and be lactose intolerant?
Yes, because when there is damage to the lining of the small intestine there can be a subsequent decrease in lactase levels (lactase is the enzyme that breaks down lactose). Many times the lactose intolerance resolves once the person follows a gluten-free diet and the intestine is able to heal (1).

What foods should people with celiac disease avoid?
They should not eat any foods containing wheat, barley, rye, malt, and oats (unless specified gluten free). These ingredients are mostly found in flours, bread products, pasta, breakfast cereals, cakes, and cookies. However, many of these products have a gluten-free version which is acceptable for people with celiac disease. It is important to avoid cross-contamination when preparing food for a person with celiac disease. Any amount of gluten could cause damage to the intestinal wall. All utensils and surfaces that have come in contact with wheat, rye or barley should be thoroughly cleaned to prevent cross-contamination (1).

What grains can a person with celiac disease eat?

Gluten-free grain options include rice, corn, amaranth, buckwheat, quinoa (my favorite), soy, and legumes to name a few (1). The market for gluten-free products has expanded drastically in recent years, allowing those with celiac disease to consume foods that may typically contain gluten. It is important to continue to consume whole grains since those with celiac disease are commonly deficient in thiamin, riboflavin, niacin, folate, and iron (2).

Is it beneficial to consume a gluten-free diet even if you do not have celiac disease?
Within the past decade, a gluten-free diet has been linked to boosting health and energy, weight loss, or coping with ADHD, autism, and headaches (3). Research has shown that the number-one reason why consumers buy gluten-free products is that they think that these products are healthier than their gluten-containing counterparts.  Celebrity endorsements have put a spotlight on using the gluten-free diet to lose weight; however, there is no published experimental evidence to support these claims for the general population. Actually, greater whole grain intake has been associated with lower body mass index (BMI). This means that those who eat more whole grains tend to weigh less. Gluten-rich grains, especially wheat, create a healthy composition of colon bacteria which may protect the gut from some cancers, inflammatory conditions, and cardiovascular disease. Gluten has also been linked to blood pressure control and immune function. Studies have indicated that a gluten-free diet is only beneficial for those with celiac disease, gluten sensitivity, psoriasis, rheumatoid arthritis, and type 1 diabetes (2).

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