By: Emily Roberts MA, LPC
I am in an abusive relationship. Not with a man or a friend, but with bread. Yep, my old pal Gluten and I are not getting along these days, I recently found out that an intolerance or allergy may be to blame. Food allergy testing (via blood) will give me the results soon, but the likelihood is that I won’t be able to hang out with my “friends” pasta, pizza, or pretty much any refined carbohydrate, the way I used to. The news was heartbreaking, considering that the bread basket brings me as much joy as a shopping does for most women, but the worst part is I also was confused. What does this mean for my diet? Some professionals said “you may have a gluten allergy or intolerance,” Some said “you probably have celiac disease.” I thought to myself, “isn’t all the same?” Apparently not. I turned to Google to help me figure it out; overwhelmingly it popped out millions of results but the clear question remained, what are the difference in these intolerances and what on earth can I eat?
The American Celiac Disease Alliance was a very easy website to navigate. They said: “It’s important to know if you have celiac, a wheat allergy or gluten intolerance; as they are all vastly different. Celiac disease, wheat allergy and gluten-intolerance are treated similarly, in that patients with these conditions must remove wheat from their diet. It is important to note, however, that there is a difference between these three medical problems:
- Celiac disease is an autoimmune condition, where the body’s immune system starts attacking normal tissue, such as intestinal tissue, in response to eating gluten. Because of this, people with celiac disease are at risk for malabsorption of food, which cause nutritional deficiencies and may result in conditions such as iron deficiency anemia, osteopenia, and osteoporosis.
- Persons with a wheat or gluten-intolerance usually do not have severe intestinal damage, and therefore are not at risk for these nutritional deficiencies. They also are not at increased risk of developing other autoimmune conditions.”
The American Celiac Association also goes on give the following distinctions between Celaic, intolerance, and allergy. “CELIAC DISEASE can be defined as a permanent intolerance to the gliadin fraction of wheat protein and related alcohol-soluble proteins (called prolamines) found in rye and barley. CELIAC DISEASE occurs in genetically susceptible individuals who eat these proteins, leading to an autoimmune disease, where the body’s immune system starts attacking normal tissue. This condition continues as long as these food products are in the diet.
- The resulting inflammation and atrophy of the intestinal villi (small, finger-like projections in the small intestine) results in the malabsorption of critical vitamins, minerals, and calories. Signs and symptoms of the disease classically include diarrhea, short stature, iron-deficiency anemia and lactose intolerance. However, many patients will also present with “non-classical” symptoms, such as abdominal pain, “irritable bowel”, and osteoporosis.
- Patients may also be screened for celiac disease because of the presence of another autoimmune disease, such as type I diabetes or thyroid disease, or a family history of celiac disease, without having any obvious symptoms. Serum antibodies can be utilized to screen for celiac disease. However, the key to confirming the diagnosis remains a small intestinal biopsy, and the patient’s subsequent clinical response to a gluten-free diet. Clinicians in the United States must maintain a high index of suspicion for this disease, as it is significantly under-diagnosed in this country. Interstingly enough, Rates of certain cancers of the gastrointestinal tract are much higher in people with celiac sprue, and there is evidence that this risk is decreased with a gluten-free diet.
- People with active celiac disease are at increased risk for other auto-immune conditions, (such as diabetes mellitus type 1, Graves’ disease and Hashimoto’s thyroiditis) especially those with continued gluten exposure.
Great alternative for Crackers
People can also have other medical problems, besides celiac disease, when they eat wheat and related proteins. Wheat allergy is one of the top 8 food allergies in the United States. Allergic reactions after eating wheat may include reactions in the skin, mouth, lungs, and even the GI tract. Symptoms of wheat allergy can include rash, wheezing, lip swelling, abdominal pain and diarrhea. The branch of the immune system activated in allergic reactions is different from the branch thought to be responsible for the autoimmune reactions of celiac disease.
Gluten Intolerance: People can also experience ‘intolerance’ to gluten. Food intolerances are not thought to be immune mediated. GI symptoms with wheat or gluten intolerance may include gassiness, abdominal pain, abdominal distension, and diarrhea. These symptoms are usually transient, and are thought NOT cause permanent damage.
Unlike a food allergy or food intolerance, celiac disease is an inherited condition. This means family members may have it, too. For this reason, if someone in your family is diagnosed, it is recommended that first degree relatives (parents, children, siblings) are screened as well. Finally, celiac disease involves the activation of a particular type of white blood cell, the T lymphocyte, as well as other parts of the immune system, which may increase the risk of developing GI cancers, in particular lymphomas, in persons with celiac disease. Since food allergies and intolerances do not involve this particular immune system pathway, these patients are not at increased risk for these cancers.
While celiac disease, wheat allergy, and gluten-intolerance may be treated with similar diets, they are not the same conditions. Due to the genetic component, and risk of nutritional deficiencies, other autoimmune diseases, and GI cancers, it is very important for a person to be properly diagnosed.
So what contains gluten? Gosh, what doesn’t but the wonderful thing is that we now have so many options for gluten-free breads, pastas, and sweets that it may not be too difficult to avoid. The website “What Contains Gluten” has simple and amazing information on living gluten-free. Here is what they say:
Following is a list of foods containing gluten. Avoid these foods at all costs, unless you can find a gluten-free version of them:
• Bulgar wheat
• Barley water drinks
• Pie crust
• Anything made of breadcrumbs
• Sponge puddings
• Malted drinks
• Yorkshire pudding
• Crumble toppings
• Some varieties of breakfast cereals
• Breaded meat
• Breaded vegetables
So here I wait for my results, with the holidays coming up and a sweet tooth that is longing for a slice of pumpkin pie. By then I should know if I should avoid it at all costs (for my health) or give in and have some temporary discomfort. Fingers crossed the pie and I can remain friends. However, if the results come back in the red I am optimistic that there are other options out there or ways to indulge occasionally. I spoke with Champane Frias at Neurogistics who said there are many enzymes and supplements you can take to help improve digestion with Gluten sensitive’s “You can use digestive enzymes such as Bioset Chewable Digestion enhanced with gluten digestive for those times that you just can’t avoid it, like Aunt Suzie’s famous apple pie, that you only get to have once a year on Thanksgiving.”She said. This will help with the enzymes that I am not producing.
There are some great alternatives to gluten and many companies who are capitalizing on this. Whole Foods and local natural health food stores have gluten-Free pie crust, pies, and deserts. Recently I have switched to Udi’s gluten free bread instead of my old favorite whole-wheat. Rice pasta has become a staple; although it tastes a little different it is worth it by the end of the meal. The discomfort and pain of a big bowl of ravioli or pasta primavera can only be tolerated for so long. I having been finding great blogs and webistes that have recepies that make life with out gluten feel luxurious rather than deprivation. Gluten Free Hot Products is a great blog with coupon and great recipe ideas. With this new insight I will be creating a new healthy relationship with food; restaurants that have gluten free options, as well as digestive enzymes, to support me in times of “need”. Armed with the supplements in hand, this Thanksgiving I will be visiting my old, delicious, friends Stuffing and Pumpkin Pie. I am aware that it could be a painful and possibly abusive exchange; however, I’m hopeful that the supplements doing their job, and the new education I will embark on once I find out what is really going on with my relationship with Gluten.
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