Unravel The Complexities Of Celiac Disease and Gluten-Free Nutrition

In the U.S., it’s estimated that 3 million people have celiac disease (1,2). Celiac disease is a reaction that occurs mainly in the digestive system when a particular—yet all too common—protein is ingested.

The good news is that celiac disease, and all of the pain and anguish that goes along with it, can be managed using the power of nutrition. The main strategy is to avoid gluten-containing foods and beverages. The tricky thing is that gluten is in some of the most popular foods, and can be hidden in ingredient lists and product labels.

This article is full of information that you need to know in order to determine if you have celiac disease, and how to successfully manage it using nutrition. You’ll also learn which foods often hide gluten, which ingredients to avoid, and the plethora of nutritious foods that are naturally gluten-free.

What is celiac disease?

Celiac disease is a gastrointestinal autoimmune condition where someone cannot tolerate the protein known as gluten. Celiac disease has other names, such as celiac sprue, gluten intolerance, and gluten-sensitive enteropathy (3). Gluten is naturally found in wheat, rye, barley, and triticale.

Celiac disease can be inherited, tends to run in families, and is often seen in people with a Northern European background (3,4). People with celiac disease are more likely to develop other autoimmune conditions such as thyroid disease, type 1 diabetes, rheumatic diseases, and liver diseases (3,4).

Celiac disease occurs when the body’s own immune system, particularly the part located in the small intestine, reacts to gluten after it is consumed (3). This immune response causes inflammation which can damage the lining of the intestine, impairing its ability to absorb nutrients (3). This malabsorption can lead to malnutrition within the body, even when consuming adequate nutrients (3,5). Some long-term health concerns of malnutrition include slow growth, anemia, miscarriages and infertility, osteoporosis, intestinal cancers, nerve damage, and seizures (1,3).

Both the gastrointestinal inflammation and malnutrition can cause people to struggle with many common symptoms (3).

How do I know if I have celiac disease?

Some of the common symptoms of celiac disease include abdominal pain, bloating, gassiness, nausea, vomiting, diarrhea, constipation, canker sores, and tooth discoloration (3,6,7). Sometimes symptoms go beyond the gut to include headaches, seizures, itchy or scaly skin, bone or joint pain, changes in menstruation, miscarriages, infertility, fatigue, and weight loss (3,6). There may also be some mental health symptoms, as people with celiac disease may experience irritability, mood changes, or even depression (3).

Celiac disease is different from having a gluten sensitivity or wheat intolerance, as those conditions do not damage the small intestine (4).

It can be difficult to diagnose celiac disease using symptoms alone because it has much in common with other digestive conditions (7). Diagnosing celiac disease can involve blood tests and biopsies of the small intestine (7). These tests are more accurate if they’re done before starting a gluten-free diet (7), so it’s important to speak with your healthcare professional as soon as celiac disease is a concern.

The good news is that symptoms of celiac disease can be prevented by avoiding gluten (3). According to the American Gastroenterological Association, “A strict gluten-free diet is the only treatment available for celiac disease” (8).

After removing gluten from your diet, celiac disease symptoms may improve within a few weeks, and damage to the lining of the gastrointestinal tract can be reversed within a few months (3).

What do I eat if I have celiac disease?

Because celiac disease is an immune response, any exposure to gluten can trigger the symptoms and damage, so avoiding gluten in foods and other products is a long-term commitment (3,5).

The challenge in avoiding gluten is that it’s found in very common foods and ingredients that are used to make a wide variety of prepared foods (3). Some of the most common grains are a huge source of gluten (wheat, rye, barley, and triticale) (2,3). This means that gluten is found in cereals and white and whole wheat flours, and therefore is in most breads and other baked goods, as well as pastas (2,3). Gluten is the protein that gives baked goods some of their texture and shape (2). In the case of celiac disease, it’s best to choose products that are labeled to be “gluten-free” or “without gluten.” 

According to the U.S. FDA, a “gluten-free” claim is “a voluntary claim that can be used by food manufacturers on food labels if they meet all the requirements of the regulations” (1). These regulations state that foods must not contain any detectable traces of gluten (no more than 20 parts per million) (2).

In addition to avoiding the most common grain-containing foods, gluten may also be found in some unexpected places:

  • Dairy products that contain fillers
  • Prepared soups, sauces, dressings, and gravies
  • Processed or cured meats
  • Creamed vegetables
  • Flavored coffee
  • Some french fry and potato chip seasonings
  • Soy sauce
  • Many cereals, granolas, and bars may use regular (not gluten-free) oats or malt extract
  • Beer, flavored liquors, malt beverages

There may even be gluten in lip balms, lipsticks, toothpaste, dietary supplements, and some medicines (4,5,9). 

Always read your labels!

Nutrition (pro) tips if you have celiac disease

Beyond simply looking for foods labeled to be gluten-free, and avoiding white or whole wheat, rye, barley, and triticale, below are some specific examples of ingredients to avoid, as well as naturally gluten-free foods to enjoy.

One thing to note is that cross-contamination is possible. If a gluten-containing food is packaged, stored, prepared, or served and comes into contact with a gluten-free food, some of the gluten may cross over and contaminate the gluten-free food (10). This can happen through the use of shared utensils, cutting boards, containers, and even toasters used for regular bread (9). It’s important to keep the possibility of cross-contamination in mind when eating at a restaurant, so look for ones that offer gluten-free menus, and let the server know if you have celiac disease (10). This also applies when attending social events or eating at someone’s home (10). 

Here are examples of ingredients used in packaged and prepared foods to avoid (because they may be made from wheat, rye, barley, or triticale):

  • Flours (durum, emmer, kamut, semolina, spelt)
  • Food starches and thickeners
  • Hydrolyzed vegetable protein
  • Malt flavoring, extract, or vinegar
  • Brewer’s yeast
  • Preservatives and stabilizers

To be certain that a food does not contain any of these gluten-containing ingredients, check the ingredient listing on the label or contact the company directly.

Here are examples of naturally gluten-free foods to enjoy at your leisure:

  • Fresh, frozen, or canned fruits and vegetables (without sauce)
  • Fresh fish, poultry, or meat
  • Eggs
  • Plain, natural dairy products 
  • Plain nuts and seeds
  • Rice and rice flour
  • Gluten-free grains such as amaranth, buckwheat, quinoa, teff*
  • Flours made from gluten-free foods (cassava, coconut, corn, potatoes, tapioca)
  • Oats that are labeled as being gluten-free**
  • Soybeans and edamame (but not soy sauce)

*Choose gluten-free grains that have been fortified with essential vitamins and minerals [K].

**Oats may come into contact with gluten-containing grains during processing or packaging, so look for a gluten-free label (10,11).

Your grocery store may have a gluten-free section. You can also look for gluten-free baked goods (made with alternative flours) in the freezer section (11).

Consider avoiding the bulk section when choosing gluten-free foods, as these may have become cross-contaminated (11).

Bottom Line

The good news about celiac disease is that it can be successfully treated by avoiding gluten. Even though gluten is commonly found in pre-made, processed, and packaged foods, there is a growing number of options for gluten-free alternatives. Plus, knowing which foods are naturally gluten-free empowers you to manage your gluten intake and prevent distressing symptoms of celiac disease.

Do you need help choosing or preparing gluten-free foods? As a Physicians Assistant, I’d love to help.

Want support to eliminate gastrointestinal symptoms of celiac disease? Need personalized recommendations for recipes, meal plans, and other ways to ensure you’re getting all of the necessary nutrients? Ready to start working with a professional who is invested in seeing you thrive, despite celiac disease? Book an appointment with me today to see if my program can help you.

References

(1) U.S. Food and Drug Administration (2022, March 7). Gluten-Free Labeling of Foods. https://www.fda.gov/food/food-labeling-nutrition/gluten-free-labeling-foods

(2) U.S. Food and Drug Administration. (2018, July 16). Gluten and Food Labeling. https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling

(3) Harvard Health Publishing. (2023, April 7). Celiac disease (non-tropical sprue). https://www.health.harvard.edu/a_to_z/celiac-disease-non-tropical-sprue-a-to-z

(4) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Definition & Facts for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts

(5) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Treatment for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment

(6) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Symptoms & Causes of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes

(7) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Diagnosis of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis

(8) Adelsberg, R. (2021, March). Gluten-free diet: nutritional value. American Gastroenterological Association, AGA GI Patient Center.  https://patient.gastro.org/gluten-free-nutritious-diet/

(9) Celiac Disease Foundation. (n.d.). Sources of gluten. https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/

(10) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Eating, Diet, & Nutrition for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition

(11) Celiac Disease Foundation. (n.d.). Gluten-Free Foods. https://celiac.org/gluten-free-living/gluten-free-foods/

Leave a Comment

Your email address will not be published. Required fields are marked *