Frequently Asked Questions About Celiac Disease

Frequently Asked Questions About Celiac Disease

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How much gluten is in a normal diet, and how much damage does it cause to the intestine?

       To give you an idea, one slice of wheat bread has 4.8 grams of gluten, and one serving of pasta has 6.4 grams of gluten. These are just components of the gluten-containing diet, which usually includes about 40-60 grams of gluten per day. As small as 0.1 gram of gluten can cause damage to the lining of the small intestine in an individual with celiac disease. This means that 1/48th of a slice of bread can damage the lining. So, even a little bit of gluten can be dangerous to the individual with celiac disease. It's important to completely eliminate gluten from your diet, once you've been diagnosed with celiac disease by a physician (Celiac.com). 

If gluten-containing products touch my skin, can that be dangerous as well?

       This is unlikely. Gluten is only dangerous to the gut of an individual with celiac disease, so if it does not directly contact the gut, it is unlikely to cause damage. Only people who have had an anaphylactic reaction to gluten before should avoid any topical contact with the substance, although this is extremely rare (Celiac.com).

How accurate are the blood tests for celiac disease?

       The blood tests are very accurate, so long as the individual is on a gluten-containing diet at the time of testing. The gluten autoantibodies will only be detected by the blood test when the person has consumed gluten recently (Massgeneral.org). 

Is celiac disease an allergy?

      No. Celiac disease is an autoimmune disorder that is triggered by the consumption of gluten. It is not an allergy to wheat or to gluten. An allergy is when an individual's immune system overreacts to a substance and produces symptoms as a result. An autoimmune disorder is much more severe, because in this case, the body's immune system malfunctions and reacts incorrectly to its own bodily tissues. This is what happens in the case of celiac disease, when the body produces immunoglobulins that attack it's own small intestine lining's villi (About.com). 

Can you grow out of celiac disease?

     No. Celiac disease is a condition that follows the individual for the rest of his or her life. This is why it is important to adapt to a gluten-free diet and lifestyle, to protect one's small intestine's longevity and health. If an individual were to stray from his or her gluten-free diet later on in life, the body would react to the consumption with the same negative autoimmune reaction as before the diagnosis (Coeliac.com).

The following is a link to a Dr. Oz video about Celiac Disease that may answer some other potential questions you may have regarding celiac disease: Dr. Oz: Celiac Disease. 

Resources:

Celiac Disease & Gluten-free Diet Information at Celiac.com. (n.d.). . Retrieved June 12, 2014, from http://www.celiac.com/

Massachusetts General Hospital Home. (n.d.). . Retrieved June 12, 2014, from http://www.massgeneral.org/ 

Celiac Disease - Gluten-Free Diet. (n.d.). About.com Celiac Disease & Gluten Sensitivity. Retrieved June 12, 2014, from http://celiacdisease.about.com

Home - Coeliac UK. (n.d.). Home - Coeliac UK. Retrieved June 12, 2014, from https://www.coeliac.org.uk

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Talking to Your Family About Celiac Disease

Talking to Family about Celiac Disease

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       After being diagnosed with celiac disease, it's easy to feel alone in the matter. All of a sudden, you have to give up so many foods that you've always loved, while everyone else gets to go on with their lives eating all the bread and pasta their hearts desire. However, you are not alone. Your family members play a crucial role in your condition. First of all, you can tell them how to help you manage your gluten intolerance. Second of all, your first- and second-degree family members actually have a significant chance of having celiac disease, as well, and it is important that you encourage them to get tested, and pay attention to any symptoms. 

      It's important to explain celiac disease to your family members, so that they can help you make healthy choices for yourself. Tell them something like, "Being gluten-free is somewhat like a food allergy -- I cannot eat food containing gluten, or I will get sick." Explain to them that gluten-containing foods are bread, spaghetti, and even some beer, among countless other foods that contain gluten. Make sure you explain to them that sometimes, gluten-containing ingredients can "sneak" into food items that seem safe, on the surface. Tell your friends and family about how foods can be contaminated with gluten, and they can help you have a more watchful eye on what you eat! Explain to them that if something containing gluten even touches your food, that you can become sick, so you have to be extremely careful. Explaining your condition in this thorough and helpful way to a friend or family member can help them to help you manage it effectively (Celiac Central). 

Process of determining a celiac disease diagnosis.

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      Additionally, it is important to recognize, and to help your family members recognize, that not only are you diagnosed with celiac disease, but they are also at risk, because they are a close relative to you, and celiac disease tends to run in families. 1 in 22 first-degree family members (such as a parent, brother, sister, or child), and 1 in 39 second-degree family members (such as an aunt, uncle, niece, nephew, granddaughter or grandson) are at risk for celiac disease (Celiac Central). A simple genetic test, called a H.L.A. DQ2/DQ8 test, can be given to see if an individual possesses the genes necessary to have celiac disease. If positive for these genes, the individual should look into a blood test to further see if the individual is affected. It is important to encourage family members to get tested for celiac disease, so that if they do have it, they can stop eating gluten immediately as to not cause further damage to their small intestine (NY Times). 

Resources:

National Foundation for Celiac Disease Awareness. (n.d.). Talking to Your Friends. Retrieved June 5, 2014, from http://www.celiaccentral.org/kids/talking-to-friends/

Genetic Testing for Celiac Disease. (n.d.). Consults Genetic Testing for Celiac Disease Comments. Retrieved June 5, 2014, from http://consults.blogs.nytimes.com/2010/01/13/genetic-testing-for-celiac-disease/?_php=true&_type=blogs&_r=0

Screening and Diagnosis of Celiac Disease

Screening and Diagnosis of Celiac Disease

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Screening

       The first step of the screening process for celiac disease is a genetic test. This can be a blood, saliva, or cheek swab test, that looks to see if the genes necessary for celiac disease to develop are present in the individual's body. Individual's with first-degree relatives who had the disease have been shown to be likely to develop it as well, so this test is a good starting point (University of Chicago Celiac Disease Center). 

        The next step in the screening process is a blood test. This simple blood test is called a tTG-IgA test, short for Tissue Transglutaminase Antibodies, and it will most likely be positive if you have celiac disease. However, it is crucial that you are on a gluten-containing diet at the time of the test, because otherwise, the test will be inaccurate. There is a chance that your test results may reflect a false positive if you have autoimmune diseases such as chronic liver disease, type 1 diabetes, rheumatoid arthritis, and heart failure (Celiac Disease Foundation). 

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        Other antibody tests include an EMA test (IgA Endomysial antibody test), which is still effective, but not as sensitive as the tTG-IgA test, because 5-10% of people who have celiac disease will have a negative result on this test. A total serum IgA test can be used to check for an IgA deficiency, which is a condition that is relatively harmless that is associated with celiac disease. Finally, a deaminated gliadin peptide test can be given to test people for celiac disease who have an IgA deficiency (Celiac Disease Foundation).

Diagnosis

        An intestinal biopsy can be performed to test for celiac disease, in order to confirm the diagnosis suggested by the blood test. An endoscope is used in this process, which is a long skinny tube inserted through the mouth, all the way down to the intestines of the patient. The doctor will take a sample of the small intestine's lining, and observe to see if damage to the villi (projections on in the inner surface of the lining, responsible for nutrient absorption) has occurred (National Digestive Diseases Information Clearinghouse). 

        The biopsy procedure is usually an outpatient one. Sedatives and local anesthetics are used, and the process takes about 30 minutes total (Celiac Disease Foundation). The patient will be assigned a Marsh classification which will explain the severity of the intestinal damage. Stage 0 is when the internal mucosa of the lining of the small intestine is normal, and celiac disease is extremely unlikely. This stage is also called the "pre-infiltrative stage". Stage 1 is when the surface cells of the inside of the small intestine are being infiltrated by lymphocytes (a white blood cell that is part of the body's immune system). Stage 3 shows a larger amount of lymphocytes, and a lining of the small intestine that is shrinking and flattening out. Stage 4 is when the the villi on the inside of the small intestine are completely flattened out, rendering them relatively ineffective (About.com). 

Resources

Screening - Celiac Disease Foundation. (n.d.). Celiac Disease Foundation. Retrieved June 3, 2014, from http://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/http://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/

National Digestive Diseases Information Clearinghouse (NDDIC). (n.d.). Celiac Disease. Retrieved June 3, 2014, from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#diagnosis

Celiac Disease Screening – Univeristy of Chicago Celiac Disease Center. (n.d.). . Retrieved June 3, 2014, from http://www.cureceliacdisease.org/living-with-celiac/guide/screening

Celiac Disease Marsh Stage - Celiac Disease Marsh Score. (n.d.). About.com Celiac Disease & Gluten Sensitivity. Retrieved June 3, 2014, from http://celiacdisease.about.com/od/diagnosingceliacdisease/ss/MarshScore.htm

        

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Eating Gluten-Free

How to Begin a Gluten-Free Diet 

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            Your doctor just told you that you have Celiac Disease and that you have to begin a gluten-free diet immediately, for the rest of your life. Now what? First, it is important to understand what “gluten-free” really means. Because the gluten protein is found in barley, wheat, and rye, you must avoid all foods containing these ingredients. You should also avoid a grain called triticale, which is used in bread, cereal, and distilling, because it is the result of the crossbreeding of wheat and rye. Additionally, oats do not contain gluten in themselves, but are often contaminated with wheat, so they should not be considered gluten-free. This may seem like a daunting task at first, but it is not as bad as it may sound, and there are plenty of gluten-free options (Gluten-Free Living).

            Additionally, there are some grains that are naturally gluten-free. These include amaranth, arrowroot, buckwheat, corn (maize), corn starch, flax, millet, quinoa, rice, sorghum, soy, tapioca, and teff. Unless mixed with any of the previously mentioned gluten-containing ingredients, these grains are safe for you to eat. Other food and ingredients that are gluten-free include:

• Butter

• Beans

• Canola oil

• Cheese

• Citric acid

• Dextrin

• Dextrose

• Eggs

• Fruit

• Glucose syrup

• Hydrolyzed vegetable protein

• Maltodextrin

• Plain meat

• Nuts

• Sesame

• Spices

• Vegetables

• Whey

• Food processed with Certified Gluten Free Oats

• Wine

• Hard liquor/distilled beverages

• Caramel coloring

• MSG

• Baking powder

• White wine vinegar

(Gluten Free Mom)

Looking for Gluten-Free Products?

The above video offers suggestions of gluten-free products from 

an individual affected with Celiac Disease. 

(KRCA News)

            As you can see, there are still plenty of foods that a gluten-free individual can safely consume. Please be advised, however, that as a gluten-free individual, it is important to be aware of the places that gluten hides. For example, beers, ales and lagers are made from grains that contain gluten, and therefore are not gluten-free (Gluten-Free Girl). Additionally, various medications may contain gluten, so it is very important to tell your doctor or pharmacist that you need gluten-free medications (Gluten-Free Living). The following is a list of foods to make sure you check for gluten:

• Miso

• Soy sauce

• Licorice

• Chocolate

• Fish sauce

• Malt vinegar

• Broth

• Ice cream

• BBQ sauces

• Seasoning packets

• Licorice

• Yogurt

• Sour cream

• Salad dressings

• Hard candies

           Additionally, there are several non-food items that could contain gluten. This includes lipstick, Chapstick, makeup, shampoo, and the filler in medications, as previously mentioned (Gluten Free Mom). 

Recipes for Gluten-Free Meals

           Take heart! There are many delicious meals that can be made form non-gluten-containing food items and ingredients. The following are several examples of such meals. Each recipe was obtained from AllRecipes.com, which has an entire Gluten-Free section of their website that you may find useful.

Gluten-Free Pancakes

Ingredients:

1 cup rice flour

3 tablespoons tapioca flour

1/3 cup potato starch

4 tablespoons dry buttermilk powder

1 packet sugar substitute

1 ½ tsp baking powder

½ tsp baking soda

½ tsp xanthan gum

2 eggs

3 tablespoons canola oil

2 cups of water

Directions:

1. In a bowl, mix or sift together the rice flour, tapioca flour, potato starch, dry buttermilk powder, sugar substitute, baking powder, baking soda, salt, and xanthan gum. Stir in eggs, water, and oil until well blended and few lumps remain.

2. Heat a large, well-oiled skillet or griddle over medium high heat. Spoon batter onto skillet and cook until bubbles begin to form. Flip, and continue cooking until golden brown on bottom. Serve immediately with condiments of your choice. Makes 12 pancakes (AllRecipes.com).

Blackened Chicken

Ingredients:

                      
1/2 teaspoon paprika

                      
1/8 teaspoon salt

                      
1/4 teaspoon cayenne pepper

                      
1/4 teaspoon ground cumin

                      
1/4 teaspoon dried thyme

                      
1/8 teaspoon ground white pepper

                      
1/8 teaspoon onion powder

                              
2 skinless, boneless chicken breast halves skinless, boneless chicken breast halves

Directions:

1. Preheat oven to 350 degrees F (175 degrees C). Lightly grease a baking sheet. Heat a cast iron skillet over high heat for 5 minutes until it is smoking hot.

2. Mix together the paprika, salt, cayenne, cumin, thyme, white pepper, and onion powder. Oil the chicken breasts with cooking spray on both sides, then coat the chicken breasts evenly with the spice mixture.

3. Place the chicken in the hot pan, and cook for 1 minute. Turn, and cook 1 minute on other side. Place the breasts on the prepared baking sheet.

4. Bake in the preheated oven until no longer pink in the center and the juices run clear, about 5 minutes (AllRecipes.com).

Resources:

Nutrition and healthy eating. (n.d.). Gluten-free diet: What's allowed, what's not. Retrieved June 3, 2014, from http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530

Is it Gluten Free? A Basic Diet Guide. (n.d.). GlutenFree Living. Retrieved June 3, 2014, from http://www.glutenfreeliving.com/nutrition/the-basic-diet/

Gluten Free Mom :: Starting a Gluten Free Diet. (n.d.). Gluten Free Mom :: Starting a Gluten Free Diet. Retrieved June 3, 2014, from http://glutenfreemom.com/starting_gluten_free/

New to Gluten-Free? - Gluten Free Girl and the Chef. (n.d.). Gluten Free Girl and the Chef RSS. Retrieved June 3, 2014, from http://glutenfreegirl.com/new-to-gluten-free/

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