Everyday Tips for Living with Celiac Disease

May is Celiac Awareness Month, a month-long campaign that offers an opportunity to focus national attention on how to identify, treat, and live with celiac disease. May is the month dedicated to celiac-consciousness but, in my practice as a registered dietitian, I am made conscious of concerns about gluten sensitivity almost every day.

What is celiac disease?

Celiac disease is an autoimmune disorder in which the body attacks the intestines. Such attacks are triggered by the ingestion of gluten, a protein found in wheat, barley, oats, and rye. As a result, the intestines become inflamed and cannot absorb nutrients satisfactorily.

Since the intestines are damaged by this disease, symptoms include abdominal pain, chronic constipation and diarrhea, growth stunting in children, and fatigue. Deficiencies in iron, folic acid, calcium, and vitamin D are often found in people with celiac disease, due to the small intestine’s compromised ability to properly absorb nutrients from food.

Diagnosis

Diagnosing celiac involves the use of a blood test for certain antibodies that the immune system produces in response to gluten. This test, called the IgA antibody test, is not completely accurate, but  it does correctly predict the presence of celiac disease on intestinal biopsies roughly 90 percent to 95 percent of the time. Celiac disease is still somewhat under the radar in the U.S.—even though about one in every 141 Americans has the disease, 83 percent of those who have it are still either undiagnosed or misdiagnosed.

What Is gluten sensitivity?

Sometimes a patient will test negative for the IgA antibody, and yet will still be unable to tolerate gluten. These people often experience an innate immune response that is similar to full-blown celiac disease; however, their intestines do not suffer damage. This scenario is called non-celiac gluten sensitivity (NCGS) and these patients are required to stick with the same level of gluten-free eating as celiac patients.

Eating gluten free

What is a gluten-free eating style? Such a plan includes an abundance of fruits, vegetables, yogurt and milk, beans, nuts, oils, meats, poultry, and fish. (Doesn’t sound that bad, does it?) Wherever possible, the patient focuses on natural GF (gluten-free) foods rather than on the many pre-packaged, commercial alternatives that some manufacturer claims are GF.

So someone with celiac disease will want to maximize their mouthfuls with nutrient-dense foods that will help remedy any deficiencies and heal their body as fast as possible. People with celiac need to focus particularly on foods rich in antioxidants and vitamins A and C; this means citrus fruits, as well as all the fruits and vegetables that are dark green and bright orange.

Starches that can be tolerated

The following starches are all gluten free and therefore perfectly safe: rice, corn, potatoes, yucca, buckwheat, quinoa, millet, and teff. I teach my patients how to improvise and substitute with these gluten-free stand-ins. For instance, a stuffing made with nuts, rice, and quinoa is a great substitute for a bread-based stuffing. Or a baked potato is a suitable replacement for sandwich bread when it’s wedged with tuna or poultry.

Don’t corrupt your kitchen

Avoid gluten corruption in the kitchen, sometimes referred to as “dip contamination.” When supplies such as nut butters, condiments, catsup, and mustard are routinely spread on both breads with and without gluten, these spreads can get cross-contaminated. Therefore, you’ll have to use separate squeeze containers for butter, mayo, catsup, mustard, syrup—anything that you dip into. Also color-code the following and keep them separate: cutting boards, colanders, serving utensils, and so forth. Keep a separate toaster for gluten-free breads as well.

Be a supermarket sleuth

Keep an eye out for gluten buzz-words such as rye, oats, barley, malt, brewer’s yeast, and wheat. Be aware that “wheat free” does not always mean “gluten free.” Be sure to read labels carefully. Obviously, food manufacturers must adhere to the Food Allergen Labeling and Consumer Protection Act (FALCPA), and disclose if a product contains wheat. Traces of wheat, however, may be hidden in foods containing ingredients such as modified food starch, starch, or dextrin.

Some of the manufacturers that offer trusted gluten-free products are Ener-G, Food for Life, Glutino, Schar, Udi’s, Arrowhead Mills, and KIND Snacks. Beware that not all products from these manufacturers are gluten-free. Be sure to check each manufacturer’s website for the individual product lists.

Restaurant dining

Many restaurants post their menus online. Before dining out, take a moment to review these and check out what your gluten-free strategies will be. Common culprits for gluten contamination in eateries are croutons in a salad, cross contamination with serving utensils, and co-mingling of foods in the deep-fat fryer. Whenever possible, call ahead to make a reservation and specify that you will be requesting a gluten-free meal.

There’s an app for that!

Supermarket chains and recipe websites lead the way with gluten-free information. For example, both Wegman's supermarket and the website epicurious.com offer gluten-free product options. And for gluten-free dining apps for your smart phone, check out the Triumph Dining website

Don’t forget vacations!

Gluten-free dining establishments are popping up in every city these days.

  • Best gluten-free destinations: New York City, Disney World, Washington D.C., San Francisco, Australia/New Zealand, Italy, and Ireland .
  • Best gluten-free cruises: Disney Cruises, Celebrity Cruises, Royal Caribbean Cruises, Princess Cruises, Norwegian Cruise Lines, Cunard.

Last, if you go to CeliacTravel.com, you can print out handy (and free) “Gluten-Free Restaurant Cards” in 54 languages, so no matter where you travel, you can simply hand one to your waiter, who will then take it back into the kitchen and alert food preparers anywhere in the world about celiac.

©1996-2013, Johns Hopkins University. All rights reserved. Disclosure: The information provided here is compiled by The Johns Hopkins University School of Medicine with editorial supervision by one or more of the members of the faculty of the School of Medicine pursuant to a license agreement with Yahoo! Inc. under which the School of Medicine and its faculty editors receive licensing fees and payment for services rendered within the scope of the License Agreement. Johns Hopkins subscribes to the HONcode principles of the Health on the Net Foundation.

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