Birthday cake. Pizza. Chocolate chip cookies. For people with
celiac disease, a lifelong disorder of the digestive system, these
foods aren't always the treats that most people think they
are. Why? Because they usually contain a type of protein called
gluten, which causes problems for people with celiac disease.
What Is Gluten?
Gluten is the common term for a group of proteins found in wheat
(durum, kamut, semolina, or spelt), rye, barley triticale, and
farina. Grains are so common in our diet that gluten is second only
to sugar as our most commonly consumed ingredient.
What Is Celiac Disease?
is the set of organs that digest food and absorb the important
nutrients the body needs to stay healthy and grow. One important
part of the digestive system is the small intestine, which is lined
with millions of microscopic, finger-like projections called
-lye). Nutrients are absorbed into the body through the villi.
People who have celiac (pronounced:
-lee-ak) disease have a disorder that makes their bodies react to
gluten. When they eat gluten, an immune system reaction to the
protein gradually damages the villi in the small intestine. When
the villi are damaged, the body is unable to absorb the vitamins,
minerals, and other nutrients it needs to stay healthy. People with
celiac disease are therefore at risk of
and can develop anemia (a decreased number of red blood cells due
to lack of iron) or osteoporosis (brittle bones from lack of
The body's inability to absorb nutrients can also mean that
young people with untreated celiac disease may not grow properly
and may have weight loss and fatigue. In addition, people who have
celiac disease may be prone to developing other diseases, such as
, type 1
, and gastrointestinal cancer.
What Causes It?
Experts don't know exactly why people get celiac disease,
which is also called gluten intolerance, celiac sprue, nontropical
sprue, or gluten-sensitive enteropathy. The disease has some
genetic background, which means that it may run in families. Just
like eye or hair color, people inherit the genes that make them
more likely to get celiac disease from their parents and
grandparents. If an immediate family member, such as a parent,
brother, or sister has celiac disease, there's about a 5% to
10% chance that you could have it, too. Celiac disease affects
people of all heritages and backgrounds.
In the past, experts believed celiac disease to be somewhat rare
and it was usually diagnosed only in very young children.
It is estimated that 1 in 133 people in the United
States has the condition. Many people who have celiac disease
don't know that they have it.
Signs and Symptoms
It's important to diagnose celiac disease early before it
causes damage to the intestine. But because it's easy to
confuse the symptoms with other intestinal disorders, such as
irritable bowel syndrome
, teens with celiac disease may not know they have it.
Some common symptoms of celiac disease are diarrhea, abdominal
pain and bloating, and weight loss. People with the disease may
feel tired, and they could be irritable or depressed. Some have
skin rashes and mouth sores. Teens with undiagnosed celiac disease
may go through
Sometimes a person who has celiac disease may not show any
symptoms until he or she goes through an emotionally or physically
stressful event, such as going away to college, illness, or an
injury or pregnancy.
How Is Celiac Disease Diagnosed?
Because the symptoms of celiac disease are similar to some other
digestive conditions, only a doctor can tell for sure if a person
has the disease. First the doctor will do a
, where he or she will ask you about any concerns and symptoms you
have, your past health, your family's health, any medications
you're taking, any allergies you have, and other issues. In
addition to doing a medical history, your doctor will do a
If a doctor suspects a person has celiac disease, he or she will
probably order a blood test as a first step in diagnosing the
disease. If the results of the blood test show the person has a
high level of antibodies to gluten and to certain other proteins in
the intestinal lining - a sign that the person could have celiac
disease - then the doctor may order a biopsy of the small
intestine to confirm the diagnosis.
In the case of celiac disease, doctors take a tissue sample from
the small intestine by inserting a long, thin tube called an
through the mouth and stomach into the small intestine. A person is
always moderately sedated during this procedure. In some cases, a
doctor may put a person to sleep with general anesthesia. The
sample is sent to to a laboratory for testing.
How Is It Treated?
Once a doctor has a diagnosis, he or she will help treat the
condition. Although there is no cure for celiac disease, it can be
managed successfully by following a gluten-free diet. People with
celiac disease need to follow this diet for life. Because
gluten can be found in everything from breakfast cereals to
prepared luncheon meats, people with celiac disease need to be very
aware of what's in the foods they eat. If you've been
diagnosed with celiac disease, a doctor or dietitian who
specializes in celiac disease can help you develop an eating plan
that works with your lifestyle.
Luckily, the small intestine can heal. Although this process may
take up to a year, many people start to feel better after just a
few days on a gluten-free diet. But feeling better doesn't mean
that people with celiac disease can resume eating foods containing
gluten. Because the genes that cause the disease are present in the
body and the immune system continues to react to gluten, the
symptoms and problems will return if a person with celiac disease
starts eating gluten again.
Taking Care of Yourself
The good news about celiac disease is that the foods mentioned
at the beginning of this article, including birthday cake and
pizza, can be prepared without gluten. So if you have celiac
disease, you can still find ways to enjoy most of your favorite
foods - you just need to do some research and be aware of
what's in the foods you eat.
Here are four things you should do if you have celiac
- Learn to read labels to find out if a food contains
- Learn which foods are gluten free.
- Find alternatives to flour and other grain ingredients for
- Find a support group where you and other people with the
condition can share up-to-date information.
If you have celiac disease, you don't have to limit yourself
to eating at home. With experience and knowledge, you'll be
able to figure out which dishes at restaurants or friends'
homes contain gluten. You may even have some restaurants in your
town that offer gluten-free dishes on their menus. Ask at
restaurants or consult your dietitian or a celiac disease support
group for this type of information. Sometimes, no matter how well
prepared you are, you might not be able to find out if a particular
food is gluten free.
When in doubt, leave it out!
Here are some tips to remember when choosing foods for celiac
Start with the foods you
Foods and ingredients that you can eat and use in cooking include:
foods made with the flours of corn, rice, buckwheat, sorghum,
arrowroot, garbanzo beans (chickpeas), quinoa, tapioca, teff, and
potato (provided other ingredients in your recipe do not contain
gluten). You can also eat all
meat, fish, chicken, legumes, nuts, seeds, oils, milk, cheese,
eggs, fruits, and vegetables.
Be on the lookout for possible
Even when eating or preparing foods that are gluten free, if these
foods come into contact with foods that contain gluten, you run the
risk of something called
. For example, crumbs from regular wheat bread can find their way
into jams, spreads, or condiments if people aren't careful to
use a fresh knife or utensil each time. Keeping condiments in
squeezable bottles or using separate jams and spreads is a great
idea for people with celiac disease. It's also a good idea to
keep a separate toaster for gluten-free bread.
If someone in your family bakes with products that contain
gluten, you need to thoroughly clean appliances, utensils, and work
surfaces before preparing your gluten-free products. Remember to
wash your hands thoroughly and often.
If the food manufacturing environment is not a dedicated
gluten-free environment, there is the potential for contamination.
For example, gluten-free bread prepared in a bakery that also
produces regular products may be contaminated. This can happen
when machinery is not properly cleaned between the
production of gluten-containing and gluten-free products. Some
manufacturers are now producing products in gluten-free
Foods and Ingredients to Avoid
A U.S. law helps make checking labels for gluten a bit
easier. Since January 2006, all food labels are required to clearly
state if the food contains any of the top eight food
allergens, including wheat. However,
wheat free doesn't mean gluten free
. Lawmakers are also working to make labels easier for people
with celiac disease by requiring companies to identify other
components, such as hidden ingredients and barley and rye. Still,
it helps to know the foods to avoid. These include:
- beer and other grain-based alcohol products
- bouillons and broths
- breading (such as the coating on breaded chicken cutlets,
- brown rice syrup (frequently made from barley)
- cake flour (made from wheat)
- caramel color (occasionally made from barley)
- communion wafers
- creamed or breaded vegetables
- dextrin (a rare ingredient, which may be made from wheat;
maltodextrin is OK for people with celiac disease to
- dry roasted nuts (processing agents may contain wheat
flour or flavorings)
- fried chicken
- french fries (if they've been coated in flour)
- gravies and sauces (including some tomato and meat
- imitation bacon, crab, or other seafood
- luncheon and processed meats
- malt or malt flavoring (usually made from barley)
- modified food starch (most food manufacturers will now
specify the source of this ingredient; e.g., modified
, which is OK, or modified
starch, which is not)
- nondairy creamer
- salad dressings
- seasonings (pure spices are OK, but check seasoning mixes for
- some herbal teas and flavored coffees
- soup mixes and canned soups
- soy sauce and soy sauce solids (they may be fermented with
wheat; don't eat them unless you verify they're OK with a
- spreads, soft cheeses, and dips
- udon noodles
- wheat-free products (wheat free does not mean gluten free;
many wheat-free cookies and breads contain barley or rye flour,
which contains gluten and other gluten-containing
- yogurts with wheat starch
Finding Gluten-Free Foods and Ingredients
Most grocery stores carry a few gluten-free products these days.
You may be able to find gluten-free bread, cereal, baking mixes,
cookies, and crackers at your local market. For a wider selection,
make a trip to a health food store. Be aware that lots of natural
markets and health-food stores keep foods in bulk bins. It's
not a good idea to use even gluten-free products from these bins
because the risk of cross contamination is very high. Many
specialty shops online also sell a range of gluten-free
products, such as bread, pizza crusts, and pastas. Many regular and
online shops even sell gluten-free flour blends that you can use to
make your own pancakes and waffles, pizza dough, cookies, and
Eating a gluten-free diet is a lifelong commitment. But if
you have celiac disease, you are not alone. There are lots of
support groups, cookbooks, and websites dedicated to living a
gluten-free life. A word of caution, though: What experts know
about celiac disease is developing so rapidly that many books and
sites are out of date. To make sure you always have the most
current and accurate information, consider joining one of the
national celiac organizations. There are even gluten-free summer
camps and special support groups just for kids and teens.
Karoly Horvath, MD, PhD
Date reviewed: January 2006
Originally reviewed by:
Margaret Braae, MHSc, RD, CD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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