We Americans are obsessed with what we eat, when we eat, where we eat and how much we weigh, and despite all of that, 33.3% of us who are 20 years of age or older are overweight and 35.9% are considered obese. It seems there is always a trendy new diet to try if we want to take a short cut to losing weight, instead of concentrating on good nutrition that will result in our maintaining a healthy weight the common sense way. Unfortunately, some trends are not based in solid nutritional science and can actually pose risks to our health. Other diets are just misunderstood…when applied inappropriately, they can be less than advisable, but when applied under the right circumstances can be lifesaving. A gluten-free diet is a perfect example of just such a nutritional misunderstanding.
What is gluten?
Before we can address who should or should not consider a gluten-free diet, it’s important to understand what gluten is. Gluten is a protein naturally found in certain grains such as wheat, barley, rye, malt and some oats. Foods that are made with these grains also contain gluten – that includes many kinds of breads, bagels, cakes, cereals, cookies, crackers, pasta, pizza and more.
Who should avoid gluten?
People with a serious medical condition called celiac disease should follow a strict gluten-free diet. For someone with celiac disease, foods that contain gluten cause damage to the lining of the small intestine. This damage makes it very difficult for the body to absorb nutrients from foods and, with time, can lead to malnourishment and other complications. While there is no cure for celiac disease, the good news is that eating gluten free is the best way to heal and prevent further damage to the small intestine. Some people who have a sensitivity to gluten but do not have celiac disease may avoid gluten as a personal choice.
The trouble comes when people who do not have a sensitivity to gluten or celiac disease decide to switch to a gluten-free diet as a method of weight loss. While avoiding products containing gluten may support weight loss to some extent because the dieter is consuming fewer products such as breads, cookies, cakes, and crackers, they may not be receiving enough fiber and other important nutrients such as iron, folate, niacin, thiamine, calcium, vitamin B12, phosphorus and zinc.
What you should know about celiac disease.
Approximately one percent of the U.S. population has celiac disease, but many go undiagnosed because the symptoms may vary so widely. We know that people who have a family member with celiac disease are at greater risk for developing the condition.
Well-Being spoke with Sara Waller Rippel, M.D., Pediatric Gastroenterologist with GI Associates & Endoscopy Center, about what someone faces if they have celiac disease.
According to Dr. Rippel, some common symptoms of celiac disease include abdominal pain, bloating, diarrhea and weight loss. Other symptoms include gas, indigestion, constipation, decreased appetite, lactose intolerance, nausea and vomiting.
“The key difference in the symptoms for celiac disease is the persistency of gastrointestinal symptoms,” notes Dr. Rippel. “If symptoms include abdominal pain, we start with a blood test to look for special antibodies that can indicate celiac disease.”
“In the case of a positive blood test we may conduct an upper endoscopy to take a sample of tissue from the small intestine,” Dr. Rippel adds. “The endoscope is really the gold standard for reaching a diagnosis of celiac disease.”
Genetic testing is also available to identify people who may be at risk of celiac disease, but not everyone with genetic markers for the disease will contract it.
A gluten-free diet can be a challenge.
For someone who has celiac disease, a gluten-free diet is crucial, but creating a gluten-free environment can be quite daunting. The best way to know if a product is gluten free is to read the ingredients. To determine if a product contains gluten, there are five main words you need to know – wheat, barley, rye, malt, and oats. The tricky part is, that you must not only avoid eating products with gluten, but you must also avoid cross contamination from utensils or containers used for items containing gluten. Even airborne wheat flour, can cause a person with celiac disease to have a severe reaction. There are also many processed foods such as broths, breading mixes, imitation bacon and seafood, marinades, processed meats and sauces and gravies that contain gluten.
The best way to know if a product is gluten free is to carefully check all food labels for the ingredients.
What foods are acceptable for a gluten-free diet?
The good news is that all of the foods, and there are many, that are safe to include in a gluten-free diet are also foods that are important to any healthy diet. Unprocessed fruits, vegetables, meats, eggs and dairy products are naturally gluten-free and can be eaten freely as long as they have not been cross-contaminated with gluten. While it is important to avoid any foods with wheat; barley; rye; malt; or oats, there are other grains, meals and flours derived from nuts, seeds, or beans that are naturally gluten-free and can be included in a healthy gluten-free diet. Many grocery stores now feature a gluten-free section, where these foods may be found.
For a tasty gluten-free family favorite, check out Gluten-free Mac & Cheese immediately following this article on the Well-Being website www.wellbeingmag.com.
More facts about celiac disease and a gluten-free diet.
• Do not start a gluten-free diet until you have been tested for celiac disease. Testing will not be accurate if you are already eating gluten-free.
• Celiac disease is an autoimmune disease, not an allergy. It is not part of food allergy testing.
• Eating gluten-free is not a weight loss diet. Many gluten-free breads and other baked goods are not only expensive (as much as 3x more), but are high in fat and calories.
• Eating foods that are naturally gluten-free is cheaper and healthier than eating processed gluten-free foods.
97% of people with celiac disease don’t know they have it.
“We see patients who have suffered with celiac disease for years, but have never been diagnosed,” states Dr. Rippel. “When gastrointestinal symptoms persist, talk to your doctor. While there is no cure for celiac disease, the sooner we can get a definite diagnosis and switch a patient to a gluten-free diet, the less long-term damage there will be to the small intestine. We also can identify risk of celiac disease for close family members so they can be tested as well.”
Look for gluten-free product certification.
The National Foundation for Celiac Awareness (NFCA) is proud to partner with Quality Assurance International (QAI) to provide a credible, verified and science-based gluten-free certification program, with a label consumers can trust. Products bearing this seal have met stringent standards to ensure gluten-free safety and are certified to contain under 10 parts per million (ppm) of gluten.
Sara Waller Rippel, M.D., Pediatric Gastroenterologist with GI Associates & Endoscopy Center, received her Doctor of Medicine degree at the Medical College of Georgia in Augusta, and served a residency in pediatrics at the University of South Florida. She completed a fellowship in Pediatric Gastroenterology and a Masters of Clinical Investigation at Vanderbilt University. Dr. Rippel is board certified in Pediatrics.