Some Americans—as many as 1 in 133—can’t digest gluten, a combination of proteins found in wheat, rye, and barley. The reason is celiac disease, a genetically based autoimmune condition. In this condition, the body reacts to the proteins in gluten as though they were dangerous instead of nourishing. The immune system sounds the alarm and responds by producing inflammation within the small intestine.
This can lead to symptoms such as bloating, gas, abdominal pain, chronic diarrhea and/or constipation, bone or joint pain, depression and irritability, fatigue, canker sores inside the mouth, and tooth discoloration or loss of enamel, among hundreds of other symptoms.
Inflammation is normally a healthful way for the body to fight off harmful invaders, but in the case of celiac disease, it is misdirected. The inflammation damages or destroys villi, the tiny, fingerlike protrusions lining the walls of the intestines whose job is to pass nutrients into the bloodstream. Without healthy villi, malnourishment results—no matter how much good food one eats. And the malnourishment caused by celiac disease is serious: it can lead to serious problems such as anemia, infertility, or cancer.
If your doctor suspects you have celiac disease, diagnosis may take place in three separate steps. The first is usually a simple blood analysis that tests for high levels of certain antibodies typical of celiac. If the results of the blood test warrant looking further, your doctor may recommend an intestinal biopsy, an outpatient procedure that removes a small amount of intestinal tissue for evaluation. Should the biopsy reveal damaged villi, then the last and conclusive test is undertaken: the gluten-free diet.
A celiac patient who follows a gluten-free diet—and avoids wheat, rye, and barley in all their forms—stands an excellent chance of preventing further damage to the intestine wall. The villi will heal or grow back and nutritional deficiencies can be corrected.
Other Kinds of Gluten Sensitivity
What if the diagnosis is negative, yet you still feel uncomfortable after eating bread, cereals, or pasta? As many as one person in seven experiences a wheat intolerance. Unlike celiac disease, the symptoms of wheat intolerance may not appear for two or three days after ingestion, and that makes the condition hard to diagnose. Symptoms may include bloating, cramping, diarrhea, flatulence, or constipation. Skin rashes are a possibility too, as well as food cravings, tiredness, chronic fatigue, or just feeling generally unwell. Even depression can stem from wheat intolerance. But remember: Other food allergies can also produce uncomfortable symptoms. An elimination diet recommended by your doctor will help you sort out the possibilities.
Where to Start
If you decide to go gluten free, what’s the best way to begin? The general rule is to remove from your diet all wheat, barley, and rye. All other foods are safe, with the possible exception of oats. Some researchers believe that moderate consumption of oats is allowable on a gluten-free diet, although there does remain the issue of cross-contamination—that is, gluten finding its way into oats during harvesting, shipment, or processing. (For that reason, several producers of oats certify their products to be “gluten free.”)
Giving up wheat leaves lots of tasty alternatives that can be made into a host of delicious meals. Consider, for example, corn, millet, rice, sorghum, amaranth, quinoa, buckwheat, wild rice, and teff, a grain native to Ethiopia. (In this country, it’s possible to find teff in the form of either grain or flour.) Also give puffed rice, cream of rice, rice flakes, cornmeal, hominy, and grits a try.
If you’re looking for packaged gluten-free meals or snacks, food labels are your allies. If a food product contains wheat or wheat protein, the word “wheat” must be clearly visible on its label. You’re also wise to look out for the following ingredients, which may contain traces of wheat: modified food starch, dextrin, maltodextrin, caramel, and glucose syrup. Wheat can also exist in such products as beer, bouillon cubes, candy, hot dogs, sauces, seasoned tofu, and soy milk.
Enjoy the ever-expanding variety of gluten-free foods now available in supermarkets. Be sure to take a look at the breads, flours, cakes, cookies, cereals, and baking mixes labeled “gluten free” that are becoming more popular. Many national brands are now carrying gluten-free products that make life easy for consumers wishing to remove gluten from their diets.