As a nutritionist quite often people will ask me what the difference is between celiac disease and gluten intolerance. They seem confused and wonder if some people are just faking it or maybe it is just a health food trend. It may be a trend and maybe some people are wishy washy on their conviction however I am here to dispel the myths. Read below for the facts and some ways to cope if you or someone in your family is avoiding gluten in their diet for whatever reason it may be.
Celiac disease is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages. It is a reaction to gliadin (a protein in wheat) which causes inflammation in the small intestine thereby decreasing the bodies’ ability to absorb food. Other glutinous grains include rye and barley. Oat are to be avoided due to tendency for cross contamination unless they are certified gluten free.
Some symptoms of Celiac disease could include the following although everyone is quite different in their expression: pain and discomfort in the digestive tract, chronic constipation and diarrhea or alternating, failure to thrive (in children), anemia and fatigue. These symptoms may be absent however and symptoms in other organ systems have been described such as a skin condition known as dermatitis hepataformis.
Celiac disease is diagnosed with a blood test and or biopsy scheduled by your health care provider. You can also be genetically tested for celiac disease however this is not the first line of detection and a really new procedure. The most important thing is to continue to eat gluten until you have the testing done otherwise it may not be detected properly if at all.
Gluten Intolerance on the other hand is a gluten sensitivity and describes those individuals who cannot tolerate gluten and experience symptoms similar to those with celiac disease but lack the same antibodies and intestinal damage as seen in celiac disease. The cause is a general immune response to gluten as oppose to an antibody specific response as in celiac disease.
Gluten sensitivity shares many symptoms with celiac disease however individuals with gluten sensitivity may have extra intestinal or non-GI symptoms, such as headache, “foggy mind,” joint pain, and numbness in the legs, arms or fingers. Symptoms typically appear hours or days after gluten has been ingested.
Gluten sensitivity is diagnosed by process of exclusion. Experts recommend that you first get tested for a wheat allergy and for celiac disease. If both of those are negative, then your doctor may recommend a gluten elimination diet. If symptoms improve on a gluten-free diet, then you likely have a gluten sensitivity.
Just to make things messier there is a third condition to consider; wheat allergy. People who are allergic to wheat — actually, truly allergic to it — sometimes also experience gastrointestinal symptoms and rashes, but they also experience more "typical" allergy symptoms, like a runny nose. People occasionally refer to a wheat allergy as a "gluten allergy," but true wheat allergy doesn't necessarily involve gluten — it's possible to be allergic to many different components of the wheat plant. The cause is an over active immune system to a component of wheat. Some of the symptoms include nasal congestion, itchy, red, watery eyes, hives and/or itchy rashes, swelling of lips, tongue and/or face nausea, vomiting and/or abdominal pain diarrhea, difficulty breathing. The diagnosis is through skin prick testing if the celiac disease has been ruled out.
There, does that clarify a few things? So you have been through the testing and you know what you have. If the diagnosis leaves you turning to a gluten free diet; what now? Below are more details and some ways to cope with this new way of life.
What You Can’t Have - Based on the available scientific evidence, Health Canada considers gluten-free foods, prepared under good manufacturing practices that contain levels of gluten not exceeding 20 ppm is considered safe on a gluten free diet. What you can’t have is wheat, rye and barley, triticale, kamut and spelt. Also oats if you cannot find gluten free oats. (Certified are difficult to find in Canada)
Benefits of a Gluten Free Diet - There are actually a lot of benefits to eating a gluten free diet (I think this is where the trend part comes in). Without gluten you naturally eat less sugar especially if you are choosing whole grain gluten free foods. It also means you are going to eat less desserts in general which reduces your overall caloric intake. You naturally tend to eat healthier in that you eat more vegetables and salads since you can’t have sandwiches and other foods involving breads. You will be focusing on whole foods since a lot of processed foods contain wheat/gluten as a filler.
Cooking for a gluten free diet - It is important to watch out for cross contamination in your kitchen. For instance using different pans if you are making a gluten and non-gluten version of a meal or making sure to wash the pan very thoroughly in between gluten and non-gluten foods. Have a separate toaster for gluten and non gluten toast. Make sure to have separate butters and spreads so crumbs do not cross contaminate. Keep food items separate in the fridge if you can or label them well so know which is gluten free and which is not if you put anything in the freezer.
Grocery shopping – Most grocery stores have a strategy for making it easier to shop for gluten free. Some stores have a separate section for gluten free and some will incorporate them into the aisles throughout the store. At CNF we incorporate but also have a gluten free labeling system for easier identification. Click here to learn more about what we offer
Feeding your family – In general you can have the same meals you did before with some basic substitutes. Pasta, bread, wraps, cereal etc all come in alternate varieties appropriate for gluten free. I personally cook gluten free for both my daughter and myself. She is used to it and likes it. Some people may not be so lucky or have picky eaters. Some things can be pretty straight forward such as cooking two types of pasta but only one sauce. Other times you will have to avoid that type of meal all together or make two meals.
Eating out -It has never been easier to eat out at restaurants in Calgary. Lots of menus will even have the items marked especially to make them easy to identify. More and more people want gluten free options so restaurants are offering. With that being said I would make sure to go to restaurants that you trust. If the server doesn’t know what gluten free is you shouldn’t eat there. The staff should be well versed. Plan ahead and check menus before you go. Make sure to tell the server at the beginning of the meal about eating gluten free.
With friends (at their homes) – I have a list of items I can’t eat and some suggestions of easy items I can have to provide to the host. I also offer to bring something which I of course make gluten free. This makes it easier for everyone involved.
While traveling – Depending on where you are travelling to makes a difference. Certain cities and countries are really in tune with gluten free. Small towns are not so much. If it is a country where you don’t speak the language it can be challenging. You can download free translation cards on the internet that you can take with you when you travel to provide the server or restaurant. You can always look ahead and plan where you will be eating but also to find ideas of where you can eat as well.
Supplements – It is important to work with a health professional if you have celiac disease and or a wheat allergy for sure. Celiac disease leads to malabsorption issues so supplementations may be necessary. Your health care provider can test you for certain key issues such as anemia, Vitamin D deficiency, osteopenia or osteoporosis etc.
To be honest it can be a bit rough for sure when you are starting out eating a gluten free diet. There are the ups and downs of feeling sorry for yourself and being frustrated. The good news is with a few helpful tips, practice and a positive attitude you will be living the new normal really soon. You will most likely be healthier for it too!