Food Cures (66 page)

C
eliac disease tends to take people by surprise—not just those who receive the diagnosis, but also family doctors, who are shocked when a physically robust patient’s blood work comes back positive for the disease. That’s because a couple of decades ago the stereotypical celiac patient was a pale, malnourished child, someone who wouldn’t be out of place in a Charles Dickens novel eating gruel and wasting away in an orphanage. As screening tests became more sophisticated, we’re learning that celiac disease is surprisingly common—affecting about one in every 100 people in the United States—and it can begin at any time in a person’s life. There is no consistent set of symptoms—some people lose a tremendous amount of weight, others experience fatigue, joint pain, or seizures, but sometimes there are no symptoms at all and the disease is discovered quite by chance.

In my practice, clients often learn they have celiac disease when their doctors investigate possible causes for unexplained anemia. One minute you feel fine and you’re having blood drawn for tests during a routine physical examination, the next you’re facing nonnegotiable changes to your eating habits and the possibility of complications. If that scenario sounds familiar, you’re lucky. If celiac disease remains undiagnosed or untreated, it can lead to osteoporosis, reproductive problems, skin rashes, epilepsy, and even some cancers. The good news is that celiac disease is treated entirely with dietary changes, so feeling better is as simple as knowing which foods are toxic to your gut.

WHAT AFFECTS CELIAC DISEASE?

Celiac disease (also called
celiac sprue, nontropical sprue
, and
gluten-sensitive enteropathy
) is genetic, which means that, in some people, the disease lies dormant until it is triggered. No one knows exactly what causes celiac disease to erupt, but experts believe that times of extreme emotional or physical stress—including surgery, a viral infection, pregnancy, or childbirth—can set the stage.

It’s important to remember that celiac disease is NOT a food allergy. Some people call it an allergy as a short-hand way to explain why those with a diagnosis need to avoid certain foods, but that description is both misleading and dangerous. Celiac disease is an autoimmune disorder. The body’s own immune system reacts to a protein called
gluten
, which is found in wheat. Related proteins are also found in rye and barley. When even the smallest amount of gluten enters the digestive system, it sets in motion a cascade of inflammatory processes, resulting in damage to the small intestine.

The small intestine is not merely a smooth tube connecting the stomach to the colon. The inner lining of the small intestine is jam-packed with protruding ridges called
villi
, which absorb nutrients as food passes through. In celiac disease, inflammation damages and sometimes destroys the villi, which means they can’t do their job, and nutrients your body needs pass through your digestive system and are eliminated by waste. The outcome of this damage varies depending on the extent of the disease. In mild cases, there are no overt symptoms, but blood tests might reveal a deficiency in certain nutrients, especially folate, vitamin B
₁₂
, or iron (which can result in anemia). Over time, poor calcium absorption can lead to osteoporosis. In some people, celiac disease causes embarrassing and sometimes life-altering gastrointestinal symptoms, including gas, bloating, diarrhea or constipation, or weight loss. Other problems associated with celiac disease include nerve damage, migraines, seizures, infertility or miscarriages, joint pain, and even some cancers, including non-Hodgkin lymphoma and cancer of the esophagus or small intestine. The longer the disease goes untreated, the greater the risk of harm.

HOW FOOD AFFECTS CELIAC DISEASE

There is no cure for celiac disease, and the only treatment is to eliminate gluten from your diet. If you get a diagnosis early enough, your villi will eventually heal, and, with the right foods, you can replenish stores of the nutrients you’ve been missing. In terms of limiting damage, nutritional treatment for celiac disease is all about which foods to avoid. However, because the list of forbidden foods is so extensive, it is also critically important that you pay attention to the vitamins and minerals that most people normally get from gluten-containing foods, and be sure your diet is rich in other sources.

AVOIDING FOODS THAT CONTAIN GLUTEN

If you have an allergy to cats, or know other people who do, you’ve probably noticed that not every cat-allergy sufferer suffers in the same way. Some people start to sneeze if they are just in the same house with a cat, others remain sneeze-free until they bury their face in the animal’s fur. That’s not the case with celiac disease. Even the tiniest bit of gluten—the amount found in 1/8 teaspoon of wheat flour—can signal the body’s immune system to respond with a full attack. The tricky part of celiac disease is that damage can occur without you noticing much in the way of symptoms. But the longer you eat foods containing gluten, the greater the damage until eventually, you become sick.

I wish the guidelines for avoiding gluten were as easy as telling you to stop eating wheat, barley, and rye bread. That’s part of what you need to do——but it is much more complicated than that. There are many hidden sources of gluten, and beyond that, some common gluten-free products can be contaminated with gluten.

Here are lists of foods, ingredients, and additives to avoid. Photocopy the list—make more than one—and carry a copy in your wallet, and others your car and anywhere else you’ll be able to refer to one easily when you’re shopping for or eating a meal. Eventually, you’ll have the foods memorized.

COMMON FOODS THAT CONTAIN GLUTEN

Barley (and anything with the word barley in it, such as barley malt)

Beer (all types)

Bleached flour

Bleu cheese (sometimes made with bread mold)

Bran (also called wheat bran)

Bread flour

Bulgur

Communion wafers

Couscous

Durum

Farina

Faro

Flour (this usually means wheat flour)

Graham flour

Groats

Kamut

Malt (and anything with the word malt in it, such as rice malt, malt extract or malt flavoring)

Malt beverages

Matzo

Oats and oat bran (see FAQ, Chapter 18)

Orzo

Pasta (all varieties made with wheat, wheat starch, oats, barley, rye or any ingredients on this list)

Rye (and anything with the word rye in it)

Seitan

Semolina

Soy sauce (check ingredients, often made with wheat)

Spelt

Suet

Tabbouleh

Teriyaki sauce

Triticale

Triticum

Unbleached flour

Wheat (and anything with the word wheat in it, such as wheat grass, wheat starch; buckwheat is okay, and is the only exception)

Wheat germ

LESS COMMON FOODS THAT CONTAIN GLUTEN

Abyssinian hard (a wheat product)

Amp-isostearoyl hydrolyzed wheat protein

Brewer’s yeast

Cereal binding

Dextrimaltose

Disodium wheatgermamido Peg-2 sulfosuccinate

Edible starch

Einkorn

Emmer

Filler

Fu

Granary flour

Mir

Udon (wheat noodles)

Whole-meal flour

FOOD ADDITIVES THAT
MAY
CONTAIN GLUTEN

If a favorite food contains one of the following ingredients, contact the company and ask questions—depending on the manufacturing process, these suspect ingredients can sometimes be gluten-free.

Artificial color

Artificial flavoring

Bouillon cubes

Caramel color

Coloring

Dextrins

Dried fruit (may be dusted with wheat)

Flavored coffee

Flavored vinegar

Flavoring

Food starch

Glucose syrup

Gravy cubes

Ground spices (wheat is sometimes added to prevent clumping)

Hydrolyzed plant protein (HPP)

Hydrolyzed vegetable protein (HVP)

Maltodextrin

Maltose

Miso

Modified food starch

Modified starch

Mono- and diglycerides

Monosodium glutamate (MSG)

Mustard powder (some brands contain gluten, check ingredients)

Natural flavoring

Processed cheese (check ingredients)

Processed meats (cold cuts, hot dogs, sausages, and canned meats which contain wheat, barley, rye, oats, gluten fillers, or stabilizers)

Shoyu

Smoke flavoring

Soba noodles

Starch

Stock/boullion cubes

Surimi (imitation seafood)

Textured vegetable protein (TVP)

Vegetable starch

Vitamins

MORE THINGS TO KNOW ABOUT
HEALTHY EATING WITH CELIAC DISEASE

• Don’t cheat.
  I can’t say this strongly enough. A miniscule amount of gluten can cause real damage to the small intestine. If you cheat, even a little, you can’t help but get a toxic amount of gluten. A single cookie, half a slice a bread, even a single cracker is too much gluten for your system.
  
• Don’t cheat, part 2.
  Unless you make every meal at home using absolutely no packaged products except those labeled “gluten-free,” you will eat some gluten. If you ever eat in a restaurant or at a friend’s house, or if you cook with any jarred, canned, or packaged foods, you will get some gluten in your food. There is really nothing you can do about it. In my office, we call this unintentional cheating because we know you don’t mean to do it. But the bottom line is that you’re getting some gluten even when you’re doing your best to avoid it, so don’t expose your intestines to more toxic gluten by consciously cheating.
  
• Whenever possible, choose gluten-free (GF) packaged foods.
  The best choices are foods that are specifically labeled gluten-free. Do not make the mistake of assuming that
  wheat-free
  or
  yeast-free
  means the same thing as
  gluten-free
  . Read the labels carefully, using the list of suspect ingredients as your guide. Also, check out the list of resources on Chapter 18. You can order all sorts of gluten-free, safe products for delivery right to your door.
  
• Go easy on gluten-free baked goods.
  In order to make up for the lack of gluten and related proteins, many gluten-free baked goods contain unhealthy amounts of saturated fats or trans fats. Once your celiac disease is under control, your body will absorb more of these fats, leading to an increased risk of high cholesterol.
  
• Be a gluten sleuth.
  Everything that goes in your mouth or touches your tongue needs to be screened for gluten. Everything. Read labels on vitamin supplements, toothpaste, mouth rinses, cough medicine, and all over-the-counter medications. Talk with your pharmacist about avoiding gluten so that your prescription medications can be chosen with your special needs in mind (also, look up gluten-free medicines at www.celiac.com). Don’t lick postage stamps or envelopes—the glue can contain gluten.