I just bought something today from the grocery store that prominently displayed “Gluten Free” on the package. I am not sure if I noticed it because I knew I was writing an article about gluten sensitivity or if it was so obvious, I couldn’t miss it. Either way, in the past few years, I have heard “Celiac disease,” “gluten sensitivity,” “gluten-free,” and “does not contain gluten” more times than I can count.
What does this all mean? How is Celiac disease different from gluten sensitivity? Can you live a gluten-free life and still enjoy all the foods you love?
I spoke with Emily Van Walleghen, Ph.D. and bariatric program dietitian at Georgia Health Sciences Medical Center, about the distinction between Celiac disease and gluten sensitivity.
Celiac Diseas vs. Gluten Sensitivity
“Celiac disease is an inherited autoimmune condition where eating foods containing gluten causes damage to the lining of the small intestine, which results in malabsorption of nutrients,” she says. Alternately, if someone is gluten sensitive, they may experience gastrointestinal symptoms when eating food with gluten, but the gluten doesn’t cause intestinal damage.
Some classical signs of Celiac disease include weight loss due to malabsorption and fatigue due to anemia, according to Van Walleghen. Some symptoms of Celiac disease overlap with gluten sensitivity such as diarrhea, gas, bloating and constipation.
“It is important for a person with symptoms to be properly diagnosed because of differences in treatments between Celiac disease and gluten intolerance,” says Van Walleghen. If you have the disease, a strict gluten-free diet must be maintained for life. It is also crucial to be tested before starting a gluten-free diet because the screening test for the disease is only valid if the person is eating gluten at the time of testing.
Ashlyn Hutto, an Augusta mother of two, was diagnosed with Celiac disease in August 2010. She learned she had the disease through a biopsy of the small intestines, which is said to be the “gold standard,” as the biopsy reveals the damage (flattened villi) of the small intestine. Since then, she has dove right into a 100 percent gluten-free diet.
So, What Is Gluten?
“Gluten is a protein found in some grain products such as wheat, rye and barley,” says Kim Beavers, University Hospital Dietitian and producer/developer of Eating Well with Kim on WRDW. Also, oat products that are made in factories that produce wheat, rye and barley products may contain gluten.
These grain products are found in everyday foods such as cereals, bread and pasta as well as liquids such as gravy, soup bases and beer. “It can also be present in over-the-counter drugs and non-food items such as Play-Doh and cosmetics,” says Van Walleghen.
When diagnosed, Hutto looked on Web sites, purchased cookbooks and guides and relied on the Gluten Intolerance Group (www.gluten.net) to help her understand her condition. “There is a ton of information out there and not all of it is correct,” she says.
Navigating a Gluten-Free Lifestyle
Going “gluten-free” can be confusing, as products that are listed wheat-free are not necessarily gluten-free. “For instance, foods containing spelt are not gluten-free,” says Van Welleghen. Also, foods with oats are not necessarily gluten-free because they are grown or processed with wheat and may have become contaminated.
Beavers warns that being gluten-free can be tricky for Americans due to the amount of processed foods in our diet. She says some key words to look for on labels include:
• Wheat, barley and rye—these grains contain gluten so avoid them!
• Malt—contains varying levels of gluten.
• Hydrolyzed protein—used as flavoring agents in many foods such as soups, sauces, gravies and seasoning mixtures. Most are made from corn, soy or wheat. In the U.S., the common name of the protein hydrolysate should be specific to the ingredient and shall include the identity of the food source where the protein was derived (e.g. hydrolyzed wheat gluten).
• Seasonings—blends of flavoring agents and an anti-caking agent (e.g. calcium silicate) which are often combined with a carrier agent (e.g. salt, sugar, lactose, starches, etc.). The carrier agents in seasoning mixtures such as gravy, sauces and snack foods often contain wheat flour or wheat starch. If the seasoning mixture is sold separately, the components of the ingredients must be labeled. (e.g. taco seasoning packet).
• Starch—a variety of starches can be used in foods such as corn, waxy maize, potato, tapioca, rice, wheat, etc. Wheat starch must be avoided. Note: the single word “starch” on a food label refers to “cornstarch.” If it is another starch, such as potato, tapioca or wheat used in food products, the source of the starch must be declared.
A Market Full of Gluten-Free Products
Today there are more than 2,000 gluten-free products in grocery stores, says Beavers. “There are gluten-free creamed soups, baking mixes, cookies, crackers, broth, noodles, waffles, frozen pizzas, cereals and many more gluten-free products available.”
Hutto says she is thankful that Betty Crocker has come out with a good chocolate chip cookie and Redbridge makes a beer that is gluten-free. She is also glad that gluten-free pizza (Mellow Mushroom or Udi’s pizza crust) is now available. “I have been able to simply substitute a brand on most things to convert anything to gluten-free,” she says. “I am a label reader!”
Even with a completely gluten-free diet, it is important to consume whole grains such as brown rice, corn, quinoa, millet and buckwheat to get your needed nutrients. Be aware of commercial gluten-free specialty foods such as breads, pretzels and cereals because they may be made with nutrient-poor starches and not fortified with vitamins and minerals like wheat-based foods, advises Van Walleghen. Monitor your intake and if need be, take a vitamin and mineral supplement.
Beavers agrees and says many gluten-free processed foods can be high in fat, calories and sugar. Just because it says gluten-free does not necessarily mean it is healthy. Read the labels.
To improve nutrients in your baked goods, Beavers suggests replacing 1/4 to 1/3 cup of gluten-free baking mix with the same amount of one of these whole grain flours: amaranth, buckwheat, quinoa or gluten-free oat flour.
You can also get your nutrients through most plain, unprocessed foods that do not contain added gluten such as plain vegetables, plain fruits, plain meats (including beef, poultry, fish and shellfish), plain dairy products, eggs, soy, nuts and seeds, according to Beavers.
For someone who has just found out they have Celiac disease or are gluten sensitive, Hutto adivises to be patient since mistakes will be made. “Find a gluten-free buddy to help you navigate the grocery store and restaurants and join a support group,” she says. “Above all else, stick with it—you will feel much better and healthier than you probably ever have, making it well worth the inconvenience.”
Cammie Jones is an Augusta freelance writer and mother of three.