Gluten-Free in the 21st Century

(This excerpt is taken from a book on gluten-free living I've been working on recently. Check back for more follow-ups, including "How to Stock a Gluten-Free Pantry")

More than two million people in the U.S. have been diagnosed with Celiac Disease (Celiac Sprue) or Gluten Intolerance (gluten-sensitive enteropathy). Celiac Disease is a life-long, immune-mediated disease of the small intestine that is caused by eating gluten. Gluten is a composite of the proteins gliadin and glutenin. These exist, conjoined with starch, in the endosperms of some grass-related grains, notably wheat, rye and barley. Gliadin and glutenin comprise about 80% of the protein contained in the wheat seed.

When a person with Celiac ingests glutens the proteins found within them damage the tiny villi that line the small intestine, causing them to essentially lie flat along the intestinal wall. These villi perform the necessary function of picking up the various food molecules passing through the small intestine, but in order to do this they must be active and standing at attention, so to speak. Once damaged, these villi can no longer perform this function and only the most easily digestible molecules, glucose and fat, are absorbed. Often patients with Celiac Sprue are underweight and malnourished, but because their small intestines are still able to absorb glucose and fat molecules, it is not uncommon for a Celiac patient to be both overweight AND malnourished!

According to the University of Chicago Celiac Disease Center…”recent prevalence studies have shown that Celiac [Disease ]is much more common than previously believed, affecting one in 120 to 300 people in Europe and North America. A recent large epidemiologic study in the U.S. found that the overall prevalence of Celiac [Disease] is one in 133.” Though this number could be much higher since so many U.S. citizens are descended from European haplogroups in which the incidence is significantly higher. However, for every American diagnosed with Celiac Disease another four are currently undiagnosed or misdiagnosed.

Some symptoms of Celiac Disease are:

Abdominal cramping/bloating		Feet (Reduced fat padding)
Abdominal distention		Flatus (Passing gas)
Acidosis		Gluten ataxia
Appetite (Increased to the point of craving)		Mouth sores or cracks in the corners
Back pain (Such as a result of collapsed lumbar vertebrae)		Muscle cramping (Especially in the hands and legs)
Constipation		Night blindness
Decreased ability to clot blood		Skin (Very dry)
Dehydration		Stools (anything inconsistent could be a symptom)
Diarrhea (See Stools below)		Tongue (Smooth or geographic - looks like different continents)
Edema		Tooth enamel defects
Electrolyte depletion		Weakness/ Fatigue
Energy loss		Weight loss

There are currently two methods of diagnosing Celiac Disease, blood tests and intestinal biopsies. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Before testing it is important to eat a normal, gluten-containing meal otherwise the results may be a false negative. If the result is negative and Celiac is still suspected, the next step is to have an internal biopsy of the small intestine. During the endoscopy the doctor will remove tiny pieces of tissue from the small intestine to check for damage to the villi. This test is about as accurate as one can get, but depending on exactly where the damage may be located and where the endoscope finds and takes a sample, it is still possible, though much more rare, to receive a false negative. If this occurs and the patient still strongly believes that he/she has Celiac Sprue, the surest test is to simply avoid all glutens for a minimum of 30 days and simply see how they feel.

The current treatment for Celiac Disease is a strict adherence to a gluten-free diet…permanently. In many ways this is a blessing, as there is no need for regular medications, though there is ongoing research into the effectiveness of certain supplemental enzymes. And while this may sound like a simple enough task, adhering to a gluten-free diet requires a complete paradigm shift in how one perceives food. It’s not enough to simply read labels or make a list of foods to avoid, or just substitute non-gluten forming foods in your favorite recipes.

In addition to avoiding all gluten containing foods, it is also necessary to try to avoid all gluten containing non-food products. And believe it or not, there are many! It is impossible to list ALL of the products that may have hidden glutens, but some of the more common are the adhesive on both lick-able stamps and envelopes as well as some self-sticking stamps, stickers and envelopes. The dusting powder used to line latex or rubber gloves are often made from wheat. Glutens can hide in some shampoos, hair dyes, lip balms, soaps, lotions, etc. They may also be found in art supplies, play-dough and glues. Unfortunately, one insidious place glutens hideis in medications and supplements, both over-the-counter and prescription!

Fortunately, now that Celiac Disease and gluten sensitivities are becoming more well known, many manufacturers are getting much more diligent about labeling their products “gluten-free” and “wheat-free”. For a more detailed list of foods, ingredients and products to avoid please refer to www.celiac.com.