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DESCRIPTION
Celiac disease, also known as celiac sprue, chronic digestive disorder that is caused by a hereditary intolerance to gluten. When a person with celiac disease consumes gluten, damage to the small intestine results.
This gluten-sensitive enteropathy (GSE), and non-tropical sprue is a once-thought rare disorder caused by an intolerance to gluten, a component of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains such as rye, barley, tritcale, and possibly oats. Gluten contains a protein called alpha-gliadin.
In persons with celiac disease, this protein causes a reaction in the mucous lining of the intestine. It is believed the body responds to gluten as if it was an antigen, and launches an immune attack when it is absorbed by the intestine. As a result, the villi (tiny, finger-like or hair-like projections, raised tissues) lining the small intestine create a large surface that absorbs vitamins, sugars, and other nutrients as food passes through the small intestine suffer damage and destruction. which impairs the body's ability to absorb vital nutrients.
When a person has celiac disease, the villi that line the small intestine flatten out, shrink, or disappear, decreasing the area of absorption, suffering damage and destruction by an immunologically toxic reaction to the ingestion of gluten. This destruction impairs the body's ability to absorb vital nutrients such as fats, proteins, carbohydrates, vitamins and minerals (calcium, iron, and folate), and in some cases, water, and bile salts. Malabsorption becomes a serious problem, and the loss of vitamins, minerals, and calories results in malnutrition and illness (such as iron-deficiency anemia, rickets, or osteoporosis) despite adequate diet. Diarrhea compounds the problem. Because celiac disease impairs digestion, food allergies may also appear.
In the United States, the exact number of people who have celiac disease is not known. Celiac disease is much more prevalent than was once believed, affecting at least 2.2 million Americans. Studies by the University of Chicago Celiac Disease Program indicate that as many as 1 in 133 apparently healthy people is affected. With newer screen tests it has been discovered that most people who have celiac disease do not have symptoms. For those with related symptoms, the incidence may be as high as 1 in 56. (The incidence may be even higher in may areas of Europe.)
FREQUENT SIGNS & SYMPTOMS
Celiac disease affects both adults and children, and can appear at any age. If often appears when a child is first introduced to cereal foods, at around 3 to 4 months of age, but is most often diagnosed around the ages 1 to 3 years old. Some people who actually have the disease may have been diagnosed with a different condition. Because of these and other factors, it is now believed that celiac disease is more common than previously though. Many adults may not develop signs of the condition until age 30 or older. In others, the disease can be triggered by emotional stress or physical trauma, such as surgery or pregnancy. Symptoms of celiac disease may vary from minor to severe. The severity of the symptoms depends on how much of the intestine has been damaged by the disease and how severe the damage is. Symptoms of celiac disease, if they occur, may come and go throughout a person's life.
The symptoms of untreated celiac disease may be the same in both children and adults. Intestinal symptoms may be more likely to occur in children who have untreated celiac disease than in adults. Children who have untreated celiac disease can become very ill. They may need to be hospitalized for treatment with fluids and medications to restore nutrients to the body. These treatments are usually short term, and most children recover completely. Many people, especially adults, who have celiac disease may not have any symptoms of the disease or may have less severe symptoms.
Since it is a relatively rare condition and many health care providers are not aware of the various symptoms associated with gluten intolerance, they may misdiagnose celiac disease. It is often misdiagnosed as irritable bowel syndrome or spastic colon, for example. There have been cases in which health care providers unable to diagnose the illness have referred their patients to psychiatrists. Many people go a long time before being diagnosed correctly, and often the correct diagnosis is arrived at only because of something they have heard or read that enables them to identify the disease themselves. Yet, if left untreated, celiac disease can be quite serious, even life-threatening.
Most common signs of celiac disease are:
- Diarrhea. Large (bulky), loose (or watery), and frequently pale and/or light-yellow-colored, frothy (bubbly), foul-smelling stools that float. The stools can contain a large amount of fat and may be oily (steatorrhea) and stick to the sides of the toilet bowel, making them hard to flush. Chronic diarrhea or constipation or both are common signs of celiac disease.
- Weight loss. Infants and children may exhibit stunted growth and may fail to gain weight as expected (failure to thrive), have an anemic, undernourished appearance even though he or she has a good appetite. A baby with celiac disease may gain weight more slowly than normal or may lose weight. Both adults and children may have unexplained weight loss despite having a normal appetite. Weight loss with large appetite, or in some cases a weight gain.
- Abdominal swelling, gas (flatulence), and bloating. When a person is not able to absorb nutrients from food, the small intestine and large intestine produce intestinal gas. This gas leads to bloating and swelling of the abdomen. A person may complain of mild stomach pain or a feeling of bloating but rarely complains of severe stomach pain.
- Nutritional deficiencies (anemia). A child is likely to have an anemic, undernourished appearance. Anemia is especially common in adults who have untreated celiac disease. This may be unexplained anemia, or due to folate, B-12, B-6, or iron deficiency or all. Anemia may lead to weakness and fatigue.
- Nausea and vomiting (rare) may also be signs of intestinal disturbances.
- Depression and/or irritability.
- Muscle cramps and wasting.
- Joint and/or bone pain.
- An intense burning sensation in the skin, and a red, blistering, intensely itchy skin rash called dermatitis herpetiformis (DH). The rash has a symmetrical distribution and is most frequently found on elbows, knees, and buttocks. People with DH can have gastro-intestinal damage without perceptible symptoms.
- Mouth ulcers.
- Frequent respiratory infections.
Long term maladies that can complicate celiac disease:
- Iron deficiency anemia or folic acid deficiency anemia. Serious vitamin and mineral deficiencies.
- Bone disease. Bone problems, such as osteoporosis or osteopenia, may develop because a person who has celiac disease may not absorb enough calcium from the food he or she eats.
- Central & peripheral nervous system impairment - usually due to unsuspected nutrient deficiencies. Problems with memory and concentration.
- Internal hemorrhaging, vitamin K deficiency associated with risk for hemorrhaging.
- Pancreatic insufficiency disease.
- Reproductive system problems. Gynecological disorders, such as infertility and the absence of menstrual periods (amenorrhea), may occur in women who have celiac disease. Miscarriages may also occur. Children who have untreated celiac sprue may experience a delayed onset of puberty.
- Increased risk of adults developing intestinal lymphoma (cancer) and other intestinal malignancies, cancer of the mouth, and the tube that connects the mouth to the stomach (esophagus). This has not been shown to be true for children who have celiac disease. However, it is possible that eating foods that contain gluten may make a child or an adult with celiac disease more likely to develop these tumors, although this has not been documented. Therefore, even if a child with celiac sprue does not have symptoms of the disease, he or she should stay on a strict gluten-free diet. Talk with your health care provider about how long a child should remain on a gluten-free diet.
Certain autoimmune disorders can be associated with celiac disease:
- Dermatitis Herpetiformis (DH) (more common in adults than but can occur in children). Dermatitis herpetiformis is a skin rash with many small fluid-filled skin sores (blister-like sores). It may improve if the person eats a gluten-free diet.
- Kidney disease (nephrosis), IgA nephropathy.
- Insulin-dependent diabetes mellitus (Type 1 diabetes).
- Systemic lupus erythematosus.
- Thyroid disease.
- Primary biliary cirrhosis.
- Selective antibody deficiency (immunoglobulin A or IgA deficiency).
Less commonly linked disorders to celiac disease:
- Chronic active hepatitis (rarely).
- Scleroderma.
- Sarcoidosis (the formation of lesions in the lungs, bones, skin, and other places).
- Myasthenia gravis.
- Addison's disease.
- Rheumatoid arthritis.
- Sjogren's syndrome.
- Down syndrome.
CAUSES
The cause of celiac disease is unknown, although it is known to affect mostly Caucasians of European descent.
The symptoms of celiac disease (such as diarrhea, weight loss, and abdominal bloating) are caused by eating foods that contain gluten. Why eating gluten triggers symptoms of celiac disease in some people is though to be related to:
Genetics: Celiac disease may be inherited. Current research indicates celiac disease is strongly associated with a group of genes on Chromosome 6. These genes (HLA class II antigens) are involved in the regulation of the body's immune response to the gluten protein fractions.
- Occurs more often in genetically susceptible Caucasians.
- Is rare in blacks, Japanese, and Chinese.
- Occurs at the same rate in male and female children.
- In adults, the disease is found twice as often in females than males.
- Occurs more often (about 5-15%) in first-degree relatives (brothers, sisters, parents, sons, daughters) of people who have the disease. In 70% of identical twin pairs, both twins have the disease. It is suggested that family members be tested for celiac disease.
Environment: Agents, such as bacteria, may play a role in triggering celiac disease in susceptible people who eat gluten. A virus that causes upper respiratory and stomach illness may also trigger celiac disease in people who are prone to developing the disease.
Immune System Problems: Problems with a person's immune system may increase the likelihood that eating gluten will trigger an immune reaction. This immune reaction may damage the lining of the small intestine, leading to symptoms of celiac disease.
The immune system is the body's natural defense system. A health immune system recognizes foreign substances, such as bacteria and viruses, as being different from body tissues. It then attacks and destroys them. When working properly, the immune system allows the body to fight off infections.
The immune system is also responsible for allergic reactions and allergies, which may occur when the immune system overreacts to a substance called an allergen (such as pollen, mold, chemicals, plants, and medications).
The body's immune system consists of:
- Special proteins called antibodies. Antibodies attach themselves to foreign substances, such as bacteria or viruses, and allow other immune system cells to attack and destroy them.
- Special types of white blood cells produced by the lymphatic, or lymph, system. When the body is fighting an infection, the lymph nodes may swell or become hard or tender.
- Many chemicals and proteins that help kill bacteria or viruses or remove unknown substances from the blood or tissues.
The health of the immune system can be affected by many factors, including age, medications, and medical conditions. If the immune system is weakened or impaired by disease or medications, the person will be at higher risk for infections.
Sometimes the body responds to its own tissues as if they were foreign substances. This is called autoimmune response.
COMPLICATIONSCHILDREN
Children who have untreated celiac disease may develop complications such as:
- Weight loss and failure to grow (failure to thrive). As a child gets older, he or she may be short; have small, undeveloped muscles of the buttocks, arms, and legs; and a large swollen belly. Even if a child eats well, his or her weight is usually below normal.
- Rickets or osteoporosis. These conditions may develop because the body does not absorb enough calcium and vitamin D.
- Iron Deficiency Anemia. Children and adults who have celiac disease are more likely to develop iron deficiency anemia because their intestines are not able to absorb enough iron.
- Loss of tooth enamel. Enamel may not form normally on the teeth, leaving them soft and yellow.
- Folic Acid Anemia.
TEENAGERS
Complications in teenagers who have untreated celiac disease may experience:
- Delays in growth. Teens may be short and underweight for their age.
- Delay of sexual development. Menstrual periods may start later than normal in girls. Facial hair growth and voice changes may occur later in boys.
ADULTS
Complications in adults who have celiac disease may develop:
- Refractory sprue, which means the person's symptoms persist even if he or she follows a gluten-free diet.
- Blockage or sores (ulcerations) in the small intestine.
- Iron deficiency anemia and folic acid deficiency anemia.
- Osteoporosis.
- Infertility, a miscarriage or repeated miscarriages and birth defects.
- Gynecological disorders such as the absence of menstrual periods (amenorrhea).
- Cancer (lymphoma) in the intestine, mouth, and the esophagus.
TREATMENT
DIAGNOSIS
Celiac disease is often difficult to diagnose because the symptoms are similar to those of other diseases, such as irritable bowel syndrome, gastric ulcers, and anemia. The average time it takes for a person to be diagnosed is 11 years. Advances in blood testing have made it easier to detect celiac disease. A diagnosis based on a blood test should be followed up with a biopsy of intestinal tissue, which is usually an out patient procedure. However, due to the fact that symptoms are so diverse, and that some people with celiac disease do not show obvious symptoms, many people go a long time before being diagnosed correctly. Because celiac disease is hereditary, if one family member is diagnosed with it, other family members should also be tested.
A person seeking preliminary diagnosis must be consuming gluten. Specific antibody blood tests are used to identify the possibility of celiac disease and are the initial step in screening individuals who are at risk (first degree relatives of biopsy diagnosed celiacs). Certain antibodies are produced by the immune system in response to substances that the body perceived to be threatening (i.e. gluten). Current research shows that people with celiac disease have higher than normal levels of these antibodies in their blood. It is recommended that people with positive antibody tests have a small bowel biopsy done to confirm the diagnosis and assess the degree of mucosal damage.
Dermatitis herpetiformis (DH) is diagnosed by a biopsy of a skin lesion and staining for IgA in the tissues. More than 85% of DH patients have small-bowel sensitivity to gluten. An experienced CD/DH pathologist is essential to establish these diagnoses. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet.
TREATMENT
There is no known cure for celiac disease, but it can be controlled by lifelong adherence to a gluten-free diet.
The only treatment for celiac disease and DH is the life-long adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improved. If people who have celiac disease stay on a gluten-free diet, they can lead normal lives. Medication is normally not required. However, if a child's growth has been stunted from lack of nutrients, the child may not be as tall as he or she would have been without the disease. Because osteopenic bone disease is common and may be profound in people with newly diagnosed celiac disease, bone density testing (densitometry) should be measured in adults at or shortly after diagnosis.
If gluten is eaten again, symptoms may return. Some people who have celiac disease may be able to eat foods that contain gluten without developing symptoms. This does not mean that the body is absorbing nutrients normally. Even without symptoms, if the small intestine is injured from gluten, the lack of absorption of nutrients may cause complications of celiac disease, such as delays in growth and sexual maturation. People with celiac disease should be monitored by their health care provider to ensure compliance with, and response to the gluten-free diet. Dietary compliance decreases the likelihood of osteoporosis, lymphoma, and other associated illnesses.
Adapting to the gluten-free diet requires some lifestyle changes. It is crucial to read labels which are often imprecise, and learn to identify ingredients that may contain hidden gluten.
Rarely a person thought to have celiac disease does not get better on a gluten-free diet. This may be caused by a condition called refractory sprue, which mimics celiac sprue. Some of these people may be treated with steroid medications to control the symptoms.
OTHER CONSIDERATIONS
Any child who is not thriving could have celiac disease. The disease manifests itself differently with each person. Symptoms include irritability, fatigue, and/or behavior changes; they do not always involve obvious digestive problems.
A child who gets blisters and sores all over his or her body should be checked for celiac disease.
Heredity is a vital factor in the development of the disease. Celiac disease often develops in childhood but may trail off in adolescence; in some cases reappearing in adults in their 30s and 40s. Factors that may trigger the onset of celiac disease are emotional stress, physical trauma, a viral infection, pregnancy, or surgery.
If celiac disease is suspected, an intestinal biopsy should be performed to make a definitive diagnosis.
Starting a gluten-free diet is challenging because gluten is present in so many foods, including most grains, pasta, cereals, and processed foods. However, people with celiac disease can still eat a varied, well-balanced diet that includes breads and pastas made from potato, rice, soy, or bean flour. Gluten-free products are available from may health food stores and specialty food companies. there are also many cookbooks available for those on a gluten-free diet. Grainaissance is an industry leader in providing wheat-, gluten-, and dairy-free products. Mochi bake-and-serve rice squares are wheat-, gluten-, and dairy-free, as are Amazake Rice Shakes. Enjoy Life Foods sells a number of foods that are ideal for a gluten-free diet, including breakfast cereals. Masuya has Rice Sembei Snacks in different flavors that are gluten-free. Mrs. Leepers carries a line of organic rice pastas and corn pastas that are gluten-, wheat-, and casein-free. Rizopia rice pasta is gluten-free. Nature's Path carries a number of gluten-free products. U.S. Mills offers wheat- and gluten-free cereals under the Erewhon and New Morning brands.
Several studies suggest that people with celiac disease can safely eat oats. However, since oats are frequently processed with other grains, it is difficult to determine whether oats are completely gluten-free. Follow your health care provider's or dietician's advice about including oats in a gluten-free diet.
It may be necessary to remove milk and milk products from the diet because of a secondary lactase deficiency.
MoonDragon's Health & Wellness: Lactose Intolerance
Vitamin K deficiency caused by celiac disease may lead to hypoprothrombinemia (a lack of clotting factors in the blood). One form of vitamin K is manufactured by "friendly" bacteria in the intestines; another is present in certain foods, especially leafy greens, alfalfa, tomatoes, strawberries, whole grains, and yogurt. Bacteria such as those found in yogurt and acidophilus can also help to restore the intestinal flora necessary for vitamin K production. Avoid commercially made yogurt products. Use homemade yogurt in place of commercially prepared yogurts.
Martin F. Kagnoff, M.D. of the University of California, San Diego, says that heredity is a vital factor in the development of this disease. He also says that celiac disease often develops in childhood but may trail off in adolescence; in some cases, reappearing in adults in their 30s and 40s. Factors that may trigger the onset of celiac disease are emotional stress, physical trauma, a viral infection, pregnancy, or surgery.
The British medical journal "The Lancet" reports that there may be a connection between celiac disease and epilepsy. Theories as to how the two might be linked include the possibility that endorphin-like substances may be created from wheat gluten and may affect brain metabolism. Another possible theory is that celiac disease increases intestinal permeability, which in turn allows the absorption of substances that may affect brain chemistry.
Schizophrenia has been observed to occur more often in those with celiac disease.
For more information about celiac disease, you can contact the following patient organizations provide information on celiac disease, gluten sensitivity and dietary treatment:
American Celiac Society-Dietary Support Coalition
58 Musano Court
West Orange, NJ 07052
(201) 325-8837
P.O. Box 23455
New Orleans, LA 70183
(504) 737-3293
E-mail: AmerCeliacSoc@onebox.com
williamshaffer.org/acs/about.htm
www.americanceliacsociety.org/
Celiac Disease Foundation (CDF)
13251 Ventura Blvd. #3
Studio City, CA 91604
(818) 990-2354
www.celiac.org
Celiac Sprue Association/USA, Inc.
P.O. Box 31700
Omaha, NE 68131-0700
(402) 558-0600
Toll Free: (877) CSA-4CSA
Fax: (402) 558-1347
www.csaceliacs.org/
celiacs@csaceliacs.org
Gluten Intolerance Group of North America
Cynthia Kupper, Executive Director
15110 10 Ave SW Suite A
Seattle WA 98166-1820
206-246-6652
FAX 206-246-6531
gig@accessone.com
www.gluten.net
DIETARY, HERBAL & HOLISTIC RECOMMENDATIONS
HERBS
Alfalfa supplies vitamin K, which is often deficient in those with celiac disease. Take 2,000 to 3,000 mg in tablet form daily.
HerbalRemedies: Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
HerbalRemedies: Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.
Olive Leaf Extract and/or Goldenseal is helpful for keeping infection down.
Caution:Do not take Goldenseal on a daily basis for more than one week at a time, and do not use it during pregnancy. If you have a history of heart disease, diabetes, or glaucoma, use Goldenseal only under a health care provider's supervision.
HerbalRemedies: Olive Leaf Herb, Nature's Way, 470 mg, 100 Caps
HerbalRemedies: Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
HerbalRemedies: Olive Leaf Extract Tincture, 100% Organic, 2 fl. oz.
HerbalRemedies: Goldenseal Root Tincture, 100% Organic, 2 fl. oz.
HerbalRemedies: Goldenseal Root, Nature's way, 570 mg, 100 Caps
HerbalRemedies: Goldenseal Herb, Nature's Way, 400 mg, 180 Caps
RECOMMENDATIONS
Eat fresh vegetables, legumes (such as lentils, beans, and peas), rice bran, nuts, sunflower seeds, raisins, figs, and "seedy" fruits, such as strawberries, raspberries, and blackberries. Include in the diet blackstrap molasses, which is high in iron and the B vitamins. People with celiac disease need fiber and foods rich in iron and the B vitamins.
Do not eat sugary products, processed foods, dairy products, bouillon cubes, chocolate, and bottled salad dressings.
Celiac disease causes malabsorption of the B vitamins and the fat-soluble (vitamins A, D, E, and K), so take these nutrients. Note that gluten is found in many nutritional supplements. Read labels carefully, and use supplements that are hypoallergenic, wheat-free, and yeast-free.
If a child develops any of the symptoms of celiac disease, omit all gluten-containing foods from the child's diet and see if the problem clears up. Eliminate milk, as lactose intolerance can occur with celiac disease. The disease can begin in the first few months of life, depending on the child's diet.
Avoid any and all foods that contain gluten. Do not eat any products that contain barley, oats, rye, or wheat. Rice and corn can be eaten. Substitute rice, potato, cornmeal, and soy flour for wheat flour. Read all labels carefully. Watch for "hidden" sources of gluten, such as hydrolyzed vegetable protein, textured vegetable protein, hydrolyzed plant protein, and all derivatives of wheat, rye, oats, and barley, including malt, modified food starch, some soy sauces, grain vinegars, binders, fillers, excipients, and "natural flavorings". Do not consume hot dogs, gravies, luncheon meat, beer, mustard, catsup, nondairy creamer, white vinegar, curry powder, or seasonings. Gluten-free products are available at health food stores or online.
Alcohol and vinegar that are properly distilled should not contain any harmful gluten peptides (or prolomines). Research indicates that the gluten peptide is too large to carry over in the distillation process. This leaves the resultant liquid gluten-free unless a gluten- containing additive is inserted after the distillation process. Alcohol and vinegars should be carefully investigated for additives before use. Malt vinegars are not distilled and therefore not gluten-free.
SUBSTITUTING INGREDIENTS FOR A GLUTEN-FREE DIET
(Adapted From: Living Gluten-Free For Dummies)
To convert a recipe that usually contains gluten into one that's gluten-free, you need to make some simple substitutions. For the most part, with the exception of flours you use when making baked goods, the substitutions are simple - just swap one for the other.
Beer: Some foods, especially deep-fried foods, may call for beer in the recipe. You can use either the gluten-free beers available online or try cider instead.
Binders: A binder is just something that holds foodstuff together. Because gluten provides elasticity and stretch to baked goods, adding binders to foods that don't have gluten-containing flours in them is a good idea. Binders include xanthin gum, guar gum, gelatin powder (this is cool, too, because it adds protein and moisture), and eggs.
Breadcrumbs: No-brainer here. Anyone who's ever eaten a piece of gluten-free bread (especially without toasting it) knows that breadcrumbs aren't hard to come by. You can buy gluten-free breadcrumbs from specialty stores or online, but if you can't or don't want to get those, consider using any gluten-free bread: Put the bread in a plastic bag and smoosh it into the size of crumbs you want. You can even toast the crumbs if you want added crunch or need dry breadcrumbs instead of fresh ones. Crushed cereals work well in place of breadcrumbs, too. Also consider using mashed potato flakes or quinoa flakes.
Bun: Consider using a lettuce wrap, corn tortilla, or of course, gluten-free bread. Some good gluten-free buns are available online and at specialty shops.
Coatings: If a recipe calls for some type of coating, you have several options. You can consider using a gluten-free flour, as well as any versatile gluten-free mix you have lying around, such as a mix for bread, muffins, or pancakes. Cornmeal or corn flour (masa) with seasonings mixed in adds an interesting texture, and crushed barbecue potato chips (gluten-free, of course) are awe-inspiring. You may also want to look into commercial brands of Cajun-style coatings, usually marketed as seafood seasonings. Many of those are just cornmeal with some spices added.
"Cream of" Soups: Use chicken broth and sour cream or half-and-half. Remember to add the food the soup is a cream of - mushroom, celery, potato, and so on - to complete the soup.
Croutons: Homemade croutons are actually very easy to make. Most recipes for croutons suggest you use stale bread, but that's not the best idea for gluten-free bread, because you'd probably end up with crumbled crouton crumbs instead. Cut fresh gluten-free bread into the size cubes you want and deep-fry them. After you drain and cool them, roll them in Parmesan cheese, spices, or any other flavoring you like.
Fillers: Filler is a highly technical culinary term for something that fills stuff in. Yum. Generally not something you hope to see on a label, fillers aren't always a bad thing; they may be in meatloaf, for example, where the recipe often calls for breadcrumbs, crackers, and other filler-type materials to add, well, filling. Gluten-free bread or breadcrumbs are obvious substitutions here, but also consider leftover corn bread, mashed potato flakes, or even an unsweetened cereal that you've crushed up.
Flour: Many recipes call for flour, usually to serve as a thickener (see the suggested thickeners in this list). Also consider using gluten-free flours such as rice flour, sweet rice flour (they're different), potato starch, sorghum flour, garbanzo/fava bean flour, and Montina (Indian ricegrass flour).
Flour Tortillas: The obvious substitution here is corn tortillas. Some new gluten-free flour tortillas are on the market now, and you can find recipes for homemade tortillas online or in cookbooks. Other wrap substitutions include rice wraps (found in Asian markets) or lettuce.
Pie crust: One easy way to make a pie crust is to take your favorite cereal and smash it into tiny crumbs, add some butter (and sugar, if the cereal isn't sweet enough), and then press the mixture into the bottom of a pie pan. Some good gluten-free crackers and cookies work well the same way. Some pie crusts are supposed to be cooked before adding the pie filling, and others aren't. The fact that the crust is gluten-free doesn't change whether you need to cook the crust before filling the pie. Also check out some of the gluten-free pie crust mixes available on the Internet and at specialty stores.
"Special" Sauce: You can make their "special" sauce with just mayo and ketchup, both of which are gluten-free!
Soy Sauce: Most soy sauce has wheat in it (and the label clearly indicates wheat), but you can find brands that are wheat-free. (By the way, tamari - a thicker, Japanese soy sauce - is not always wheat-free, so check the label.) Either use a wheat-free soy sauce or try Bragg Liquid Aminos. You may also want to get adventurous and try an Asian sauce like fish sauce (careful - it's really fishy!) or oyster sauce.
Teriyaki: Because most soy sauce has wheat in it, most teriyaki (which is made from soy sauce) does, too. A few brands of wheat-free teriyaki sauces are available, but don't be afraid to make your own.
Thickeners: Many recipes call for flour as a thickener, but lots of alternatives are available. For sweet things, try using a dry pudding mix or gelatin. ClearJel works well with acidic ingredients (unlike cornstarch), tolerates high temperatures, and doesn't cause pie fillings to "weep" during storage. Arrowroot flour, agar, tapioca starch, and cornstarch are also excellent thickeners. So is sweet rice flour, which comes from sticky or glutinous rice (despite the name, it really is gluten-free). And remember that muffin or cake mix you have lying around. Not only do mixes thicken the recipe, but the sweet flavor is a pleasant surprise.
If you have any concerns or doubts about any product or the product labeling isn't clear about the ingredients and whether or not it is gluten-free, don't use it. Be on the safe side.
Here are only a few good books to start with if you are looking for further information and recipes for a gluten-free diet:
GLUTEN-FREE DIET SIDE EFFECTS
For celiac patients - even those with no obvious symptoms - adhering to the gluten-free diet can prevent serious, life-threatening complications. But just avoiding gluten does not guarantee that your diet is completely healthy. Keep the following issues in mind as you shop and plan your meals.
You Will Probably Gain Weight: Many celiac disease patients were gaunt and sickly before they were diagnosed. Damage to the villi that line the small intestine meant that food (and calories) couldn't be absorbed. After some time on the gluten-free diet, when the intestines begin to heal, the nutrients (and the calories) in foods can be absorbed. Even though you may not be consuming any more calories now than you did when you were eating gluten, it's likely that you're going to gain weight. In fact, hard as it may be to imagine for people who were too thin before their diagnosis, studies have shown an increased risk for obesity on the gluten-free diet. It's important to start counting calories.
You're At Risk for Poor Vitamin Status: Patients with newly diagnosed celiac disease often have nutrient deficiencies. Complicating that problem, gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber. Few if any gluten-free products are enriched or fortified with these nutrients. When Swedish researchers studied adult celiac patients who had been gluten-free for 10 years, half of the patients had vitamin deficiencies, including low levels of vitamin B-6 or folate, or both, and high levels of homocysteine (a risk factor for heart attacks, vascular disease, and strokes). Before the study, all the patients had biopsies to prove their intestines were healed and healthy, so these vitamin deficiencies could not be explained by malabsorption. Italian researchers have found similar deficiencies in gluten-free adolescents. When it's time for an annual check-up, celiac patients should ask their health care provider whether their vitamin status needs to be measured, and whether they should be taking folic acid and vitamin supplements.
Your Cholesterol Levels Will Probably Rise: You may find that before going on a gluten-free diet, your cholesterol levels were fine and were in the low range. The intestines were not absorbing any of the cholesterol in the foods you were eating. Those days may be over with your new gluten free diet. Now you may have to watch your cholesterol levels along with everyone else since your intestines will start absorbing food nutrients, including cholesterol, as the intestines heal start working properly. You will need to check food nutrition labels for the presence of gluten and also check the fat and cholesterol content. It's very important to choose low-fat, low-cholesterol foods. Packaged gluten-free products are often higher in fat than their gluten-containing counterparts. This is especially true of packaged gluten-free cookies, crackers, and cakes.
You Might Experience Constipation or Diarrhea: If you replace the bread and pasta in your diet with only processed white rice, the low-fiber diet may lead to constipation. Conversely, if fiber-rich grains and beans are added to your diet in large amounts too quickly, you might develop gassiness and diarrhea.
Some People Actually Lose Weight: Dietary changes to eliminate gluten-containing foods can also lead to a decrease in caloric intake and weight loss.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
NUTRIENTS Supplement Suggested Dosage Comments Essential Essential Fatty Acids
(Flaxseed Oil, Primrose Oil are good sources.)As directed on label. Needed for the villi in the intestines.
Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels,
Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.,
Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps,
Barlean's Primrose Oil, With Gamma Linolenic Acid (GLA), 1300 mg, 120 SoftGelsOr
Kyolic EPAAs directed on label. Needed for the villi in the intestines.
Free-Form Amino Acid Complex As directed on label. Supplies protein in a form that is rapidly absorbed and assimilated. Use a sublingual form.
AMINO 1000 Complete, NOW Foods, 120 Caps,
Branched Chain Amino Acid Powder, NOW Foods, 12 oz.,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs,
Branched Chain Amino Acids, Free Form, 120 CapsL-Glutathione 500 mg 3 times daily. An amino acid needed for repair of the intestinal tract.
L-Glutathione, 250 mg, 60 CapsKyo-Dophilus As directed on label. A dairy- and yeast-free probiotic formula to replace the friendly bacteria.
Liquid Kyolic
With B-1 & B-12
WakunagaAs directed on label. Dramatically increases levels of vitamins B-1 and B-12 for immune enhancement. Multi-Vitamin & Multi-Mineral Complex As directed on label. All nutrients are necessary in balance. Use a wheat- and yeast-free product only.
Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption), Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)Vitamin A 15,000 IU. If you are pregnant, do not exceed 10,000 IU daily. An important antioxidant. Use a wheat- and yeast-free product only.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 SoftgelsNatural Beta-Carotene
Or
Carotenoid Complex (Betatene)10,000 IU daily.
As directed on label.Powerful antioxidant that promote healing. Use a wheat- and yeast-free product only.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 SoftgelsVitamin E 200 IU daily. Powerful free radical scavenger and oxygen carrier. Use a wheat- and yeast-free product only. Use d-alpha-tocopherol form, if available.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Vitamin B Complex 100 mg 3 times daily.
Injections: 2 cc weekly, or as prescribed by health care provider.B vitamins are essential proper digestion.
Injections are best because they bypass the digestive system. If injections are not available, use a sublingual form. Use a wheat- and yeast-free product only.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 CapsPlus Extra
Vitamin B-6 (Pyridoxine)100 mg daily. Injections: 1/2 cc weekly, or as prescribed by health care provider. Necessary for proper digestion. Injections are recommended because they bypass the digestive system.
Vitamin B-6 / Pyridoxine, Nature's Way, 100 mg, 100 CapsVitamin B-12 As directed on label. Malabsorption of vitamin B-12 results from celiac disease. Injections may be necessary. If injections are not available, use a lozenge or sublingual form. Use a wheat- and yeast-free product only.
Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.Plus Extra
Vitamin B-1 (Thiamine)as directed on label. B vitamins work best when taken together.
Vitamin B-1 / Thiamine HCl (Hydrochloric Acid), 100% Natural, Nature's Way, 100 mg, 100 CapsAnd
Folic Acid400-800 mcg daily. Malabsorption of folic acid results from celiac disease.
Vitamin B-9 (Folic Acid), 100% Natural, Nature's Way, 800 mcg, 100 CapsImportant Acetylglucosamine
(N-A-G from Source Naturals)As directed on label. Forms the basis of complex molecular structure of the mucous membranes of the intestinal lining.
N-Acetyl Glucosamine (NAG), Allergy Research Group / Nutricology, 90 Caps,
Vitamin K
Or Alfalfa2,000-3,000 mg daily or as direction on label. Fat-soluble vitamins are not absorbed well in this disorder. Alfalfa supplies vitamin K, which is often deficient in those with celiac disease. Use a wheat- and yeast-free product only.
Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps,
Full Spectrum Vitamin K, Allergy Research Group / Nutricology, 90 SoftGels,
Alfalfa, NOW Foods, 650 mg, (10 Grain), 500 Tabs.Zinc 75 mg daily.
For Lozenges: 1 15-mg lozenge 5 times daily. Do not exceed a total of 100 mg daily from all supplements.Needed for immunity and healing.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 CapsCopper 3 mg daily. Needed to balance with zinc.
Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.,Helpful Calcium 1,500 mg daily. Works with magnesium.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 GelcapsMagnesium 750 mg daily. Helps maintain the body's normal pH balance. Deficiency is common in people with celiac disease.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 CapsProteolytic Enzymes
With
BromelainAs directed on label, 3 times daily. Take between meals, on an empty stomach. Additional digestive enzymes may be needed to aid in breakdown and absorption of foods.
MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs,
Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps,
Enzymes, All Complete, 250 mg, 90 CapsVitamin C With Bioflavonoids 2,000-5,000 mg daily, in divided doses. Boosts immune function.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 TabsVitamin D 400 IU daily. Essential in for repair and healing of inflamed tissue.
Vitamin D, Nature's Way, 100% Natural, 400 IU, 100 CapsPsyllium Seed
Or
Flax Seed
Or
Aerobic Bulk Cleanse (ABC)As directed on label. Take separately from other supplements and medications. A fiber product not absorbed by the intestines. Drink large amounts of water because the fiber expands to several times its dry volume.
Psyllium Seed, Nature's Way, 610 mg, 100 Capsules,
Golden Flax Seeds, NOW Foods, Whole Bulk, 16 oz.,
CELIAC DISEASE SUPPLEMENTS
Information and supplements to help with Celiac Disease.
5 HTP Hydroxy Tryptophan, Vegetarian, NOW Foods, 100 mg, 120 VCaps.
5-HTP also known as Hydroxy Tryptophan is an Amino Acid and precursor to serotonin, a brain chemical responsible for regulating mood, appetite, behavior, and sleep. 5HTP may help elevate mood, control appetite, and promote better sleep.5 HTP Supplement Hydroxy Tryptophan, Natural Serotonin, With Vitamin B-6 & C, Nature's Way, 50 mg, 60 Tabs
Nature's Way 5 HTP Supplement is available in an easy to swallow enteric coated tablet.Alfa Max Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Nature's Way Alfa-Max Alfalfa Extract capsules is a 10x extract of fresh green Alfalfa leaves.Branched Chain Amino Acids, Free Form, 120 Caps
The branched chain amino acids (BCAA's) leucine, isoleucine and valine are three of the eight essential amino acids the human body must receive in food.Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.
WaterOz Ionic Calcium is a pure liquid Calcium supplement. Calcium is one of the most essential of the major biochemical elements needed in human nutrition. It is needed in every organ of the body, including the brain. Calcium is called the "knitter" because it promotes healing or knitting everywhere in the body. It is valuable for tone, power, strength, longevity, vitality, and endurance, healing of wounds, counter-acting acids, and helping regulate metabolism.Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin c oxidation and is integral in the formation of RNA.Instant Energy B-12, NOW Foods, 2000 mcg, 75 Packets
NOW® Vitamin B-12 Instant Energy is the perfect way to keep alert and energized, regardless of the situation. These convenient, fast-acting packets are perfect when traveling or for convenience.Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Lactobacillus Acidophilus Supplement taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora.L-Glutathione, 250 mg, 60 Caps
L-Glutathione is a tripeptide amino acid produced in the liver primarily from cysteine. L-Glutathione acts as a cellular antioxidant by inhibiting free radical proliferation.Multi-Vitamin Without Iron, Nature's Way, 100 Caps
The vitamins and minerals in this Multi Vitamin without Iron play many important roles in the body: antioxidants to protect fats, cells and DNA, coenzyme precursors for energy production and metabolism, and cofactors for hormones and enzymes which regulate body processes.Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels
Odorless Garlic supplement is extracted from Allum sativum and is a specially made Japanese product. Our Odorless Garlic yields high amounts of Scordiin, a unique sulfur compound which may be responsible for many of garlic's renowned benefits.ProstaClean, Prostate Herbs Balanceuticals, TCM Prostate Formula, 100% Natural, 60 Caps
Chinese medicine uses this well-known formula for its diuretic and immune supporting properties to clear the prostate and eliminate heat and toxins, and to rejuvenate.Protein From Rice Powder, Dairy Free, Vegetarian / Vegan, Hypoallergenic, Chocolate, 1 lb 6.9 oz.
A great tasting vegetable protein made from non-genetically modified California grown brown rice. Free of the common food allergens from soy, milk, egg, wheat and yeast.Protein From Rice Powder, Dairy Free, Vegetarian / Vegan, Hypoallergenic, Mixed Berry, 1 lb 5 oz.
A great tasting vegetable protein made from non-genetically modified California grown brown rice. Free of the common food allergens from soy, milk, egg, wheat and yeast.Protein From Rice, Powder, Dairy Free, Vegetarian / Vegan, Hypoallergenic, Plain, 1 lb 5 oz.
A great tasting vegetable protein made from non-genetically modified California grown brown rice. Free of the common food allergens from soy, milk, egg, wheat and yeast.Protein From Rice, Powder, Dairy Free, Vegetarian / Vegan, Hypoallergenic, Vanilla, 1 lb 5 oz.
A great tasting vegetable protein made from non-genetically modified California grown brown rice. Free of the common food allergens from soy, milk, egg, wheat and yeast.Selenium, 100% Natural, 200 mcg, 100 Caps
Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 SoftGels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-12 Liquid Supplement, 50 mcg, & vitamin B-9 (Folic Acid), 400 mcg, 1 fl. oz.
This liquid B-12 supplement with its combination of B vitamins can be a very effective revitalizer in supporting the nervous system, prenatal child health, vegetarians, and heart health.Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.
Vitamin B-12 Helps to maintain a healthy nervous system, and helps in the prevention of pernicious anemia. Folic Acid should be taken by all females of child bearing age to help prevent neuro-tube birth defects. Folic acid is also linked to heart health.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin E, Natural D-Alpha-Tocopherol, 400 IU, 100 SoftGels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.Zinc Lozenges With Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Nature's Way Zinc lozenge boosts cold season defense with zinc, widely recognized as an important nutritional support during the cold season, and echinacea pupurea, clinically shown to support the immune system, and Vitamin C, a vitally important vitamin for general health maintenance.
HerbalRemedies: Celiac Information
HerbalRemedies: Celiac supplements & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You lose weight unexpectedly.
Your child has diarrhea that lasts longer than 1 to 2 weeks.
Your child fails to grow or gain weight as expected.
Your child seems to be more tired than usual or has a change in mood, especially if it lasts more than 1 week and is not related to any other illness, such as the flu. This may be caused by iron deficiency anemia.
If you or your child has been diagnosed with celiac disease, call a health professional if:
Symptoms have not been occurring but they begin to occur again.
There is a change in symptoms, such as increased tiredness or increased stomach pain.
Your child has symptoms such as diarrhea or unexplained weight loss, and you know your child has not eaten gluten.
You cannot tell whether your child has eaten foods that have gluten, and his or her symptoms continue.
If you or your child has not been diagnosed with celiac disease but has symptoms such as diarrhea, use research to find out what to do about these symptoms. If you think your child may have celiac disease, watchful waiting is appropriate if your child has mild symptoms of diarrhea or vomiting if it lasts only for a few days. If your child continues to have diarrhea and does not seem to be gaining weight as expected even though he or she has a good appetite, talk with a health care provider.
If your child has celiac disease and has symptoms (after being without symptoms on a gluten-free diet), it usually means that he or she has eaten gluten. You need to ask your child what he or she has eaten when away from home. As children get older and more independent, it is more tempting to not follow a strict gluten-free diet. Check the labels of processed foods you child may be eating to see whether the foods contain hidden gluten. If your child's symptoms do not get better after removing foods with hidden gluten from his or her diet, talk with a health care provider.
It is recommended that consultation with a specialist in gastroenterology should be done if you are having symptoms to rule out other disorders.
RELATED LINKS
Gluten-Free Pantry - Foods Online Website Collection - Gluten-free Weblinks Celiac Disease & Gluten Sensitivity Celiac Disease Foundation Medline: Celiac Disease The Gluten-Free Mall Eating Well Gluten-Free Recipes, Menus and Tips
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