Gluten-Free in a Gluten-Filled World

Gluten-Free in a Gluten-Filled World

By Tarynne Mingione, RD
Registered Dietitian

For this French/Italian girl that grew up on bagels and loaves of bread, it wasn’t easy to read the lab results telling me gluten was the source of all my problems (digestive anyway). Despite a degree in nutrition, I’m here to break the news that it’s far from easy, not just for me, but the unfortunate waiter, the distressed party hostess, or the sibling that doesn’t quite understand why you are no help in devouring the Oreos.

This post is for anyone with a new diagnosis, those just coming to terms with an old diagnosis, and those that think that gluten intolerance might be a possibility. It’s also for the friends and family of those affected by celiac disease or gluten intolerance, and for those that just want to learn more about it.

What’s the deal with wheat, gluten, and these allergies?

Gluten is a protein found in wheat, rye and barley. You can be allergic to wheat, which is different than being gluten-intolerant (a broader category of things to avoid), which is different from having celiac disease. Here’s a little about each.

Celiac Disease

  • What it is: Not an allergy, but an autoimmune disorder that causes damage to the small intestine. We all have tons of little fingerlike-projections lining our small intestine that significantly increase the intestinal surface area, therefore assisting in absorption of nutrients. Normally as nutrients are passing through the small intestine, they are absorbed through the walls of the villi and into the bloodstream. However, when a person with celiac disease is exposed to gluten, their immune system responds by attacking and destroying their own villi. The result is malabsorption of nutrients.
  • Symptoms: Vary by individual (and can actually be “silent” and present with nothing at all), but classic symptoms may include: constipation, diarrhea, bloating , cramping, abdominal pain, or abnormal stools .
  • Here are some good resources to read more about celiac: Celiac Disease Foundation and National Digestive Diseases Information Clearinghouse

  • Diagnosis: If you or your doctor suspects Celiac disease, the first step is often blood tests (TTG-IgA/IgG and EMA-IgA/IgG). If these come back positive, then a definitive diagnosis is to complete a biopsy of the small intestine.
  • Treatment: The only treatment is complete lifelong elimination of gluten from your diet.

Gluten Intolerance

  • What it is: An inability to tolerate gluten, however not an autoimmune disorder or an allergy
  • Symptoms: Similar to celiac disease (constipation, bloating, diarrhea, vomiting).
  • Diagnosis: You likely will complete a blood test for celiac disease (it would be negative). The next step to confirm gluten intolerance would be to complete an elimination diet, where all gluten is avoided and symptoms are recorded. If there is improvement in symptoms, then intolerance to gluten can be assumed.
  • Treatment: Avoidance of gluten. There is likely no damage to the small intestine if gluten is ingested, however the presentation of undesirable symptoms can be expected shortly following exposure. Is eating gluten worth it?

What to Avoid (if you have Celiac or gluten intolerance)

  • Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt), rye, barley and triticale. Most flours in common processed foods contain wheat. If it simply says “flour”, don’t eat it! (There are many gluten-free flours (potato, rice, tapioca, etc.), but they’re usually written out. “Flour” can mean anything, so if in doubt, don’t eat it!)
  • Beers, ales, lagers and malt vinegars that are made from gluten-containing grains that are not distilled.

What to eat (if you have Celiac or gluten intolerance)

  • Rice, corn (maize), soy, potato, tapioca, beans, fava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, flax, and nut flours.
  • Distilled alcoholic beverages (wine/hard liquor) and vinegars are gluten-free. Or you may be able to find gluten-free beer.

What to Ask your Doctor or Dietitian About

  • Oats - These are controversial and you may or may not react to oats, and you and your doctor can decide whether to avoid them.

Tips for dealing with a gluten-free diet

The list of foods to avoid can be overwhelmingly long. Remember that consuming whole foods that have been minimally processed may be one approach. Whole fruits, vegetables, meats, legumes, nuts and seeds should be safe, but always check (sometimes even plain salted nuts may have flour on them).

Do you need to go out and buy only gluten-free cookbooks? No! If you know how to make appropriate substitutions for gluten-containing recipes, then go ahead and adapt any recipes you like. From my own experience, it’s not really intuitive how to substitute flours. The elasticity and rising action given from gluten is hard to replicate and usually requires a number of ingredients in place of one (example of a current substitution for whole wheat flour is a combination of: white rice, brown rice, tapioca, sorghum, amaranth, quinoa, and potato starch). Therefore, I would encourage gluten-free baking cookbooks to start as baking tends to be a bit of a challenge!

So… you’re allergic to wheat?

No! Gluten intolerance, celiac disease and wheat allergy are three separate things. For people with gluten intolerance or Celiac Disease, in addition to wheat, they also need to avoid both rye and barley (and sometimes oats).

Where to Get More Information

I absolutely love this group, and this page will direct you towards valuable information.

(Ed. Note – I, too, have celiac, and am so glad Tarynne wrote this post. I often get asked, “is the salad ok if I pick out the croutons first?” For me, the answer is no way! If someone you love or know has celiac or a food allergy, please take the time to learn about what they can eat - or simply ask rather than guess. I can only speak for myself, but when eating out or as a guest, I’m always willing to discuss the proposed menu to see if there’s an easy substitution, if it’s already naturally gluten-free, or plan to bring food so I’m not a burden! I’d much rather do that and enjoy the company and gathering than not eat or accidentally get sick! Also, if you’re looking for recipes that are naturally gluten-free, check out our gluten-free healthy recipes archive here.)

Comments
Dana Lewis | Swedish Blog Administrator
Hi Deborah, I checked with one of our living donor nephrologists and the transplant coordinator: they said having celiac disease does not automatically rule out a living kidney donor.
9/23/2012 3:49:17 PM
Deborah Hammond
I'm looking for information on the possibility of a celiac being a kidney donor. I'm the same blood type as a friend with polycystic kidney disease and don't want to get his hopes up about this if celiac disease means I'm not a good donor. And of course I wonder if this is unwise of me for my own health.
Thanks, Deb
8/4/2012 3:28:34 AM
medical careers
oh my goodness, this is me!!! i hate not being able to eat gluten:(
7/11/2012 7:58:44 AM
Tarynne Mingione, RD
Good question! I always recommend washing produce thoroughly, but there isn't anything in the film or glue that would contain gluten in these types of stickers.
7/10/2012 9:49:11 AM
Uma Pisharody
Wow, Tarynne, didn't realize you had celiac. But what a true help you can be to the children that need your guidance and counseling! Just the other day, a parent of a patient asked if the glue from the stickers on apples is gluten-free. Do you happen to know the answer?
7/9/2012 5:49:06 PM
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