Food allergies can wreak havoc on our lives, especially gluten allergies. Gluten is a substance found in wheat, barley, rye, spelt and sometimes oats. What makes it even more ubiquitous is that besides bread products, it is used as filler in many processed foods, or can be a contaminant of normally gluten-free foods in the same processing facility.
Why is gluten a problem? Unlike peanut allergies, which can cause sudden near-death reactions, gluten creates slow destruction in our bodies over time. Dr. Fred Williams with Gateway Gastroenterology says that although the symptoms of bloating, gas and diarrhea can be distressing to people intolerant to gluten, that’s not a true allergy. The danger comes in the autoimmune form of gluten intolerance, celiac disease, also called celiac sprue. In celiac disease, the consumption of gluten causes the body’s immune system to attack and damage the small intestine. The inside of the small intestine, some 20 feet long, becomes inflamed and the hair-like projections (villi) become flattened and damaged.
“When a patient comes in with irritable bowel syndrome (IBS), we always think of celiac disease. The symptoms can be the same: diarrhea, gas, bloating, although some people with celiac have constipation, and many others have no GI symptoms,” Williams says. “What we pick it up on are other symptoms of celiac: premature osteoporosis in the 30s, iron-deficiency anemia, migraines and chronic fatigue.” Williams says the list of symptoms goes on to include depression, infertility and ADD-ADHD, delayed puberty, short stature and delayed growth in children. All of these symptoms are caused by malabsorption of key nutrients in the inflamed small intestine. Long term, untreated celiac disease also can markedly increase the risk of developing small intestine lymphoma, which when diagnosed is often fatal.
“Research estimates that one in 130 Caucasians have celiac disease, fewer in other ethnic groups,” he notes. “An Italian study found that three-fourths went undiagnosed. Diagnosis is made through a blood antibody test that is 95 percent sensitive in picking up the disease. If that’s negative, we stop there. If positive, we do an upper endoscopy to snip a small piece of the small intestine for biopsy to determine the extent of the damage.” The main treatment for both celiac disease and gluten intolerance is the same: lifelong adherence to a gluten-free diet. It takes only a relatively small amount of gluten in the diet of a celiac to keep the inflammation going. It’s important to make sure a nutritionist trains you in the diet.
Ellen Stein is a nutritionist who deals with clients facing gluten problems all the time. “There are many people diagnosed, and others just wondering,” she says. “It’s a developing science, and very tempting to diagnose yourself.” If a client doesn’t know for sure whether he has a gluten intolerance or celiac disease, she recommends he or she see a gastroenterologist for a diagnosis, because the difference is crucial. People with intolerance symptoms from gluten are not doing their bodies real harm if they occasionally fall off the wagon. With celiac disease, the diet is critical. People must be sure to get the B-vitamins, fiber, minerals, healthy fatty acids and other nutrients they usually get from gluten grains.
“I help people design a diet to both meet their nutritional needs and satisfy their tastes without gluten,” explains Stein. “I take into account the foods they have available, their eating schedule and preferences, trying to approximate as closely as possible their original diet.” One of her tricks is to give clients a list of basic foods to keep in stock so they can put together a nutritious meal in 10 minutes. “The fresher the better, and the least likely to be adulterated. The best way to know what’s in your food is to make it yourself,” she says.
Susan Rahn is the clinical manager of Endoscopy Center of St. Louis, and although she is not a true celiac disease patient, she has gluten intolerance severe enough that she eats a gluten-free diet. “It’s not that hard, and it’s really a healthy diet,” Rahn says. “I focus on what I can eat: unprocessed meats, frozen or fresh fruits and vegetables, and non-gluten grains. I have a combination of flaxseed, rice flour, and corn flour that makes a good baking mix. And I use sour cream or applesauce to help hold baked goods together. I made my son’s birthday cake this way—and he liked it.”
Going to restaurants is tricky, but she has become a pro at knowing what to order. “You can get cookbooks and other support at celiac.org, and if you become a member, they will send you a card you can use at restaurants to help select your order,” says Rahn. Dr. David Cort, who works with Rahn, says the small intestine, the target of celiac disease, if it were laid out, would be as big as a tennis court. That’s a lot of absorptive surface impaired when the small intestine is inflamed. “You can’t absorb iron, calcium, fat-soluble vitamins, vitamin B-12, and many micro and macronutrients,” Cort says. “We also see celiac patients with dermatitis; and some of them have only the rash and not the intestinal symptoms. Diagnosis is critical, as it tends to run in families.”