For this French/Italian girl that grew up on bagels and loaves of bread, it wasn’t easy to read the lab results telling me gluten was the source of all my problems (digestive anyway). Thank goodness I was on the path to pursue my degree in nutrition, this ought to be pretty easy to figure out, right? I’m here to break the news that it’s far from easy, not just for me, but the unfortunate waiter, the distressed party hostess, or the sibling that doesn’t quite understand why you are no helping devour the Oreos.

This blog is for anyone with a new diagnosis, those just coming to terms with an old diagnosis, and those that think thatgluten intolerance might be a possibility. It’s also for the friends and family of those affected by celiac disease or gluten intolerance, and for those that just want to learn more about it.

What is Gluten?

Gluten is a protein found in wheat, rye and barley.

Celiac Disease

What is it: Not an allergy, but a genetic autoimmune disorder (onset can be triggered by severe stress, surgery, trauma, pregnancy, or viral infection) that causes damage to the small intestine. We all have tons of little fingerlike-projections lining our small intestine that convene to significantly increase the intestinal surface area, therefore assisting in absorption of nutrients. Normally as nutrients are passing through the small intestine, they are absorbed through the walls of the villi and into the bloodstream. However, when a person with celiac disease is exposed to gluten, their immune system responds by attacking and destroying their own villi. The result is malabsorption of nutrients.

Symptoms: Vary by individual (and can actually be “silent” and present with nothing at all), but classic symptoms may include:

Constipation
Diarrhea
Bloating
Cramping, abdominal pain
Abnormal stools (If you’re reading this on your lunch break, I will refer you to some other sites rather than go into detail here. Check out Celiac Disease Foundation Celiac Disease Foundation and National Digestive Diseases Information Clearinghouse)

Diagnosis: If you or your doctor suspects Celiac disease, the first step is blood tests (TTG-IgA/IgG and EMA-IgA/IgG). If these come back positive, then a definitive diagnosis is to complete a biopsy of the small intestine.

Treatment: The only treatment is complete lifelong elimination of gluten.

Gluten Intolerance

What is it: An inability to tolerate gluten, however not an autoimmune disorder or an allergy.

Symptoms: Similar to celiac disease (constipation, bloating, diarrhea, vomiting).

Diagnosis: You likely will complete a blood test for celiac disease (it would be negative). The next step to confirm gluten intolerance would be to complete an elimination diet, where all gluten is avoided and symptoms are recorded. If there is improvement in symptoms, then intolerance to gluten can be assumed

Treatment: Avoidance of gluten. There is likely no damage to the small intestine if gluten is ingested, however the presentation of undesirable symptoms can be expected shortly following exposure. Is that bagel really worth it?

What to Avoid (if you have Celiacs or gluten intolerance)

Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt), rye, barley and triticale.

Beers, ales, lagers and malt vinegars that are made from gluten-containing grains that are not distilled.

Frequently overlooked foods that may contain gluten and need to be verified:

Brown rice syrup
Breading & coating mixes
Croutons
Energy Bars
Flour or cereal products
Glucose syrups
Imitation bacon
Imitation seafood
Marinades
Panko (Japanese bread crumbs)
Pastas
Processed luncheon meats
Sauces, gravies
Self-basting poultry
Soy sauce or soy sauce solids
Soup bases
Stuffings, dressing
Thickeners (Roux)
Communion wafers
Herbal supplements
Drugs & over-the-counter medications
Nutritional supplements
Vitamins & mineral supplements
Play-dough (I hope you aren’t eating it, but if kids are playing with it and then put their hands in their mouth then you might have a problem).

What to Include (if you have Celiacs or gluten intolerance)

Rice, corn (maize), soy, potato, tapioca, beans, fava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina®, flax, and nut flours.

Distilled alcoholic beverages (wine/hard liquor) and vinegars are gluten-free.

What to Ask your Doctor or Dietitian About

Oats- These are controversial and you may or may not react to oats. Some research has shown that pure, uncontaminated oats up to ½ cup daily may be tolerated.

Suggestions

The list of foods to avoid can be overwhelmingly long. Remember that consuming whole foods that have been minimally processed may be one approach. Whole fruits, vegetables, meats, legumes, nuts and seeds should be safe, but always check (sometimes even plain salted nuts may have flour on them).

Do you need to go out and buy only gluten-free cookbooks? No! If you know how to make appropriate substitutions for gluten-containing recipes, then go ahead and adapt any recipes you like. From my own experience, it’s not really intuitive how to substitute flours. The elasticity and rising actiongiven from gluten is hard to replicate and usually requires a number of ingredients in place of one (example of a current substitution for whole wheat flour is a combination of: white rice, brown rice, tapioca, sorghum, amaranth, quinoa, and potato starch). Therefore, I would encourage gluten-free baking cookbooks to start as baking tends to be a bit of a challenge!

So… you’re allergic to wheat?

No!!!! Gluten intolerance, celiac disease and wheat allergy are three separate things. For people with gluten intolerance or Celiac Disease, in addition to wheat, both rye and barley (and sometimes oats) must be avoided.