There are lots of people who know about foods or drinks that make them sick. For my son, eating shrimp resulted in severe vomiting as a child. However, he loved to eat shrimp and apparently “grew out of” this reaction since he has been eating shrimp for the past few years with no bad effects.
There are other reactions to food, which may result in life-threatening problems, like your tongue swelling up or your blood pressure dropping to nearly nothing. In these cases, the food in question must be avoided completely.
Celiac disease is one of those life-threatening, food-related problems. However, it does not give us the dramatic, sudden reactions described above. It seems to cause a problem in the immune system of the afflicted person such that the cells that line the intestine are damaged, as well as skin reactions and other problems.
The past two columns have been about gluten and the health problems associated with gluten, namely celiac disease and gluten intolerance. Gluten is the generic name for certain types of proteins contained in the common cereal grains wheat, barley, rye and their common derivatives.
When the diagnosis of celiac disease or gluten intolerance is made, or at least suspected, a gluten-free diet is needed. Books have been written about this complicated topic. Therefore, it would be foolhardy for me to suggest that I can tell you all you need to know in a column (or two or three).
That said, I will try to give you the highlights of a gluten-free diet as follows:
Not allowed in any form: Wheat (durum, graham, kamut, semolina, spelt), rye, barley and triticale.
Allowed: Rice, corn, soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina® and nut flours.
Suspect all of these foods: Breading, coating mixes, Panko, broth, soup bases, brown rice syrup, candy, croutons, flour or cereal products, imitation bacon, imitation seafood, marinades, pastas, processed luncheon meats, sauces, gravies, self-basting poultry, soy sauce or soy sauce solids, stuffing, dressing, thickeners (roux), communion wafers, herbal supplements, drugs and over-the-counter medications, nutritional supplements, vitamins and mineral supplements, play dough (a potential problem if hands are put on or in the mouth while playing with play dough or are not washed after use).
Recent research shows that pure, uncontaminated oats used in moderation (1 cup cooked) are safe for most persons with celiac disease. Consult your dietitian or physician if you want to include oats in your diet.
If in doubt, go without.
If the label does not specifically say “Gluten Free” and, by reading the label, you are unable to verify ingredients or the ingredient list is unavailable — DO NOT EAT IT. Regardless of the amount eaten, it is not worth triggering your immune system and the damage to the small intestine that occurs every time gluten is consumed, whether symptoms are present or not.
When preparing gluten-free foods, they must not come into contact with food containing gluten. Contamination can occur if foods are prepared on common surfaces, or with utensils that are not thoroughly cleaned after preparing gluten-containing foods. Using a common toaster for gluten-free bread and regular bread is a major source of contamination. Flour sifters should not be shared with gluten-containing flours. Deep fried foods cooked in oil shared with breaded products should not be consumed. Spreadable condiments in shared containers may be a source of contamination. When a person dips into a condiment a second time, with the knife (used for spreading), the condiment becomes contaminated with crumbs (e.g. mustard, mayonnaise, jam, peanut butter, and margarine).
Wheat flour can stay airborne for many hours in a bakery (or at home) and contaminate exposed preparation surfaces and utensils or uncovered gluten-free products. Likewise, foods not produced in a gluten-free environment have the potential to be contaminated with gluten. This may occur when machinery or equipment is inadequately cleaned after producing gluten-containing foods. Food manufacturers are required to abide by Good Manufacturing Practices outlined in the FDA's Code of Federal Regulations, to reduce the risk of contamination in manufacturing. Let common sense be your guide.
Products labeled wheat-free are not necessarily gluten-free. They may still contain rye, barley-based ingredients.
Not all adverse reactions are due to celiac disease: lactose intolerance, food sensitivities or allergies to soy, corn, or other foods or even the stomach flu, are common causes of symptoms similar to celiac disease. Newly diagnosed patients may have trouble digesting certain foods, especially fatty foods, until the small intestine has had a chance to heal and start absorbing normally. If necessary, keep a diary of foods eaten. Read labels, remember what you ate, and listen to your body.
Attitude is everything: Stay focused on all the foods you can eat. Fresh fruits and vegetables are delicious and healthy. Fresh poultry, fish, meat and legumes provide protein and are naturally gluten-free. Most dairy foods can also still be enjoyed providing you are not lactose intolerant. Gluten-free substitutes for foods commonly made with wheat are available at health food stores and from gluten-free food manufacturers.
For the celiac disease patient, the gluten-free diet is a lifelong commitment. Starting the diet without complete testing is generally not recommended and makes diagnosis more difficult. For a valid diagnosis, gluten may need to be reintroduced. Therefore, if you suspect you have problems related to gluten consumption, consult your doctor for testing and/or referral.
Dr. Terry Gaff practiced family medicine in Albion for 17 years and is now medical director of the emergency department at Parkview Noble Hospital in Kendallville and the Noble County EMS. He welcomes your questions. He can be reached at
terrygaff@pol.net
