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What is Celiac Disease?
Celiac disease (CD) is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. The tiny, fingerlike protrusions lining the small intestine are damaged or destroyed. Because the body’s own immune system causes the damage, celiac disease is considered an autoimmune disorder and can also be classified as a disease of malabsorption because nutrients are not absorbed.
What is Gluten Intolerance?
It is a non-allergic and non-autoimmune digestive condition in which the consumption of gluten can lead to symptoms similar to those experienced in Celiac Disease or a wheat allergy. Most people have general complains of bloating, abdominal pain or diarrhea, as well as headaches, fatigue, and/or bone or joint pain.
What is Gluten?
Gluten is a protein found in wheat, barley, and rye. It is the substance in flour that forms the “glue” that holds the product together. In someone with Celiac Disease damage can be done to the intestine, which can then lead to decreased absorption of essential nutrients. If left untreated, possible conditions can develop such as decreased bone density, iron deficiency anemia, unintentional weight loss, vitamin B12 and folate deficiency, and other autoimmune diseases.
Where is Gluten Found?
The grains containing gluten include wheat, rye, barley and all their derivatives. These grains are used in items such as: pies, pasta, cereals, pizza, cakes, cookies, and breads.
Avoid the following grains:
Food Labeling Laws
Companies must identify in “plain English” the eight most prevalent food allergens including, fish, milk, peanuts, eggs, soybeans, tree nuts, shellfish, and wheat. If wheat protein or a protein derived from wheat is used as an ingredient it must be declared in the allergy statement. The law does NOT declare oats, rye, barley (malt) or gluten. If the label does not indicate in the allergy statement that wheat has been used, you must still read the list of ingredients for other gluten containing grains.
Be sure to read all labels carefully. Avoid all questionable products until the manufacturer confirms that the product is gluten-free (GF). All food-manufacturing companies have a 1-800 phone number to call with questions about gluten. Ingredients in a product can change at any time. The following questions may be helpful in determining if a specific product contains gluten:
Some companies cannot guarantee if the product is gluten-free if other gluten-containing foods are processed in the same manufacturing plant. This is due to cross-contamination within the plant.
What about Oats?
The protein found in oats may not be harmful to most people with CD but there is a concern as the oats may be contaminated with wheat during the milling and processing. Please consult your physician or dietitian before adding oats to your child’s diet.
What Can the Patient with Celiac Disease or Gluten Intolerance Eat?
There are many foods that will fit into your child’s diet that are naturally gluten-free and taste good.
Recipe for Peanut Butter Cookies
1 cup sugar
1 large egg, slightly beaten
1 teaspoons baking soda
1 cup peanut butter
Combine and shape into 1-inch balls, place on ungreased cookie sheet and crisscross top with fork. Bake at 350 degrees for about 10 minutes.
Celiac Sprue Association
Gluten-free grains and starches
NOTE: Distilled vinegars are gluten-free, as all distilled products do not contain any harmful gluten proteins. Malt vinegar is not distilled and does contain gluten.
How do I start a Gluten Free Diet?
Start the new diet by looking at the foods you already have in your home. Many of your favorite brands may already be gluten-free. Begin to plan your meals to include naturally gluten-free foods. Make a grocery list to help you stay on track at the store. Try the following meal suggestions:
Lunch and Dinner
At the Grocery Store
Shop the perimeter of the store. This is where you will find most foods that are naturally gluten-free. Stock up on nutrient rich, low, fat, low-sodium fruits and vegetables. Fresh meats are normally gluten-free so buy fresh, seafood, poultry and meat. Luncheon meat and other processed meats may contain gluten as filler or flavor enhancers. Be sure to read labels carefully. The dairy section contains many gluten-free items such as yogurt, pudding, and milk.
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At the Grocery Store (continued)
Within the inner aisles of the grocery store, look for:
Check out the “health food” or “organic” section of your grocery store for items such as GF baking products, flours and pasta. Specialty health food stores also offer larger varieties of GF foods. Look in the Asian section for rice noodles and crackers.
Meet with key school employees, such as the teacher and the school nurse. Provide them with written material about CD and GFD. Let them know the symptoms your child has when he/she eats gluten.
Provide a list of GF foods/snacks to the school and other caretakers. Remind them not to change from the list unless they check with you first.
Eating Away From Home
With a little effort, you can continue to enjoy dining out in restaurants. Here are a few tips to avoid getting sick.
Bring your own GF bread or crackers.
Food Preparation and Cross-Contamination
To avoid contaminating your food at home with gluten, follow these suggestions:
Overlooked gluten sources:
Possible sources of gluten in medications include:
Damage done to the intestinal lining can lead to decreased absorption of B-vitamins, iron, folate, and calcium. A vitamin/mineral supplement may be necessary. Many gluten-free foods are not fortified with B-vitamins and iron like their gluten-containing counterparts. Be sure to select a vitamin/mineral supplement that is gluten-free and meets 100% of the recommended daily allowance (RDA). Most nutrients can be obtained through a well-balanced diet.
Gluten Free Does NOT Mean it’s Good for You!
There are many specialty companies that produce good gluten-free foods. Although they taste good, the ingredients may not be a healthy alternative. Good nutrition includes foods that are:
Family support is very important. All family members should be aware of GF dietary requirements and become involved in both grocery shopping and meal preparation. For younger children, have only their gluten-free foods accessible. Encourage non-CD children to not share their food. Parents must set a good example and be very supportive of their CD child.
Should Other Family Members Be Tested?
First-degree relatives of patients with CD should undergo serological testing and a gastroenterologist should further evaluate family members with positive blood test results.
Celi-ACT Support Group
The sudden dietary and lifestyle change may induce certain feelings of fear and confusion. Our practice sponsors a support group, which was established by Dr. Al-Tawil, for those with Celiac Disease. Families with children who have this disease benefit greatly from the support and information provided through this group. For more information contact Celiactgiforkids@gmail.com and review the information on the support group’s website: www.Celi-Act.com.
Sample one-day menu:
Click to enlarge/view: GLUTEN FREE FOODS