NUTRITION Q&A
Celiac Disease: The Good, the Bad and the Gluten
BY:HELEN RASMUSSEN, MS, RD, FADA
Q: After months of feeling lethargic and suffering through waves of stomach bloating and cramps, my doctor told me, "I have good news and bad news. The good news is you have celiac disease. The bad news is you must give up eating that homemade wheat bread you love." Why is celiac disease "good news," and how do I replace my homemade bread?
A: In this case, "good news" is a relative term. The myriad physical symptoms and complaints that manifest from celiac disease make it a challenge for a doctor to diagnose. These symptoms-including bone and/or joint pain, anemia, recurring abdominal bloating, tingling and numbness in the legs, muscle cramps, exhaustion, depression and unexplained weight loss-are similar to those found in more debilitating diseases. Unlike other potential diseases you could have with this constellation of symptoms, celiac disease has a treatment that usually makes your symptoms disappear.
Celiac disease is an autoimmune disease of the digestive tract, with the small intestine bearing the brunt of the damage. People who have celiac disease cannot tolerate gluten, a protein found in wheat, rye and barley. When you eat that homemade wheat bread, your immune system reacts by damaging the small intestine. A healthy small intestine has tiny finger-like projections called villi, which absorb nutrients from food into the bloodstream. With enough damaged villi from the immune response against gluten, your body becomes malnourished even though you may be eating properly. A celiac diagnosis is usually made by blood tests that look for antibodies participating in the body's autoimmune reactions to gluten, and a small bowel biopsy to document the condition of the villi.
If diagnosed early, celiac disease responds very effectively to dietary treatment, which entails avoidance of foods containing gluten, including wheat, rye and barley. Oats are also usually restricted, however some people can tolerate this grain. A gluten-free diet is challenging because you have to be very knowledgeable about where gluten can be found. Foods at restaurants and parties need to be carefully screened. Hidden sources of gluten can be found in additives for processed foods, medicines and dental products. Very often the ingredients are not obvious enough on the label for you to identify gluten; a label may only say a food contains an emulsifier (identified as wheat starch) and caramel color (which is made from barley).
People with celiac disease can eat a well-balanced, varied diet. Potato, rice or soy flour can be substituted for wheat. Meats (without breading), fruits and vegetables are okay, as are milk and milk products. Flavored or malted milks or frozen yogurts should be avoided. There are many gluten-free products available at larger supermarkets, and some stores even devote entire aisles to gluten-free products.
As for the "bad news" about your homemade bread, many celiac patients invest in a bread machine to make homemade breads with rice or potato flour.
Finally, to get you started on the right track, your doctor should refer you to a registered dietitian who is experienced in treating celiac patients.