The term “gluten” is, in a sense, a generic term for the storage proteins that are found in grains. The “gluten” in wheat, barley, rye, and a much lower amount in oats* (WBRO), contain particular amino acid sequences that are harmful to persons with celiac disease. It is important to note that the gluten found in corn and rice does not cause harm to those with CD. (Note: In order to avoid confusion, the term “gluten” used in this web site refers to only that gluten found in WBRO, not that found in corn and rice.)
* Inconclusive information exists concerning the inclusion of oats in the gluten-free diet. Some clinical studies indicate that uncontaminated oats may be tolerated by some people with CD. Other studies indicate that some people with CD have an immune response to oats (avenin). Currently, there is no way to identify which people with CD may tolerate oats. Therefore caution is advised when considering the use of uncontaminated oats in a gluten-free diet.
While one would expect to find gluten in places like breads, pastas, cookies and other obvious grain products, gluten is also “hidden” in many processed foods such as frozen French fried potatoes, soy sauce and rice cereal. Even many non-food items like cosmetics, and household cleansers contain gluten. Any product that is made with WBRO or any of their derivatives will contain varying amounts of gluten. Refer to the Grains and Flours Glossary for a list of gluten-free and gluten-containing grains.
Beside the fact that WBRO are present in many foods and other non-food items, the clinical gluten-free diet also recommends the elimination of gluten that comes from cross contamination or contact with gluten-containing items. Care must be taken during food preparation and storage to insure that cross contamination and contact does not occur.
Since the term “gluten” may not be used on product labels, it is imperative that a person on a gluten-free diet learns the typical places that gluten can hide. Label reading must become a habit in order for the celiac consumer to have the confidence to make informed choices.
Since 2013, the FDA has required that foods labeled “gluten free” must be certified to meet a standard of 20 ppm gluten or less. The FDA website contains helpful information, including answers to common questions, about the labeling requirements for gluten free foods.
Self-management is vital to living a full life with celiac disease. It means making safe and healthy choices at home and away from home. It means adopting a lifestyle that is free of WBRO. It means taking responsibility for one’s own health and well-being. It means living life to the fullest!
The move to gluten free living brings a number of important changes to life. The return to health and well-being is the greatest among them. The disease can be “controlled” simply by a change in one’s diet – no risky surgeries, no life-long dependence on expensive medication. And, best of all, the gluten-free diet is a risk-free diet! Gluten, as a protein, is not essential to the diet and its amino acid components are replaced many times over by other foods. For a person with celiac disease, living gluten free can only result in improved health and wellbeing!
It is important when adopting a lifestyle change to be patient and understanding, both with one’s self and with others. Educating loved ones and friends is an important part of treatment. The positive attitudes and understanding of the people closest to the patient make the dietary transition easier.
Gathering information from physicians, dietitians, home economists, and celiac organizations like CSA is essential.
Changing long-established habits – for the rest of your life – can seem like a daunting task. It need not be faced alone, however. Membership in an organization like ours provides information, encouragement, and support that will help the transition go more smoothly. Working with a dietitian or nutrition professional will also aid in learning to shop, cook and eat gluten-free.
It is important to remember that there is no such thing as a “typical celiac.” Not only do the symptoms vary widely, so do the related medical conditions. Diet and treatment needs are unique to each individual. Therefore, it is absolutely VITAL that a relationship is established with a gastroenterologist or other physician who is knowledgeable in the diagnosis and care of CD. Partnering with a doctor will help an individual make the most appropriate decisions regarding the GF diet and any supplementation that may be necessary.
Celiac disease prevents the body from absorbing nutrients properly. There are no longer as many functioning “holes in the sieve” for nutrients to get through to the blood stream. Even after the villi in the small intestine are described as being “back to normal,” there remains the potential of some nutrients being absorbed at lower levels. Because of this, the monitoring physician may recommend a blood test analysis to learn if selected vitamins or nutrients are being absorbed at adequate levels.
Once a determination is made, supplementation of the GF diet may be advised. This recommendation may include selected intake of iron and folate and, in a few cases, one of the B vitamins. Occasionally there is need for replacement of fluids and electrolytes, including calcium, potassium and magnesium. Both men and women with low bone density may require vitamin D replacement. If there are associated conditions, such as lactose intolerance or diabetes, a series of additional treatment elements may apply.
It is important to remember that the immune system of a person with celiac disease is weak. The auto-immune system functions at a lower-than-normal level. Infections may not be handled as well as in other people. Stamina and resilience may not be at the level they once were. Most vitamins, food supplements and over-the-counter medications are based on and measured for persons at full-functioning, full-absorbing levels. A person with CD may need less or perhaps more of a particular vitamin, mineral or medication. Again, working with a monitoring physician will help determine what and how much is the appropriate allowance of a particular medical or supplemental product.
If symptoms persist after adopting a GF diet, further refinement may be necessary.
Even after the GF diet is well established, one or more of the original symptoms may persist. If this occurs, it is important to again consult the monitoring physician as there may be additional food sensitivities or other health considerations involved.
One generally transient condition that is common in those with CD is lactose intolerance. If lactase is not present to facilitate digestion of the milk sugar, lactose, the body reacts with symptoms such as bloating, gas and/or diarrhea. A simple test for lactose intolerance can be administered during a routine physician visit.
A lesser number of celiacs report that one or more food allergies also affect them. Approximately 90% of food-based allergies in the U.S. are linked to eight major categories: milk, soy, eggs, fish, crustacean shellfish, tree nuts, peanuts and wheat. It is important to note that one can have an allergy to wheat and not have celiac disease.
For each of these conditions, appropriate dietary changes and related adjustments will need to be made with the help of the monitoring physician. However, for the majority of celiac patients, the gluten free diet is the entire treatment.