Gluten Free or Celiac?

More and more people are making the switch to gluten-free living. For some, it is because they notice a discernible difference in how they feel and for others, simply because they’ve come to believe it is a healthier choice. Fortunately, more and more dining establishments are accommodating the gluten-free lifestyle and have even created the distinction of celiac friendly and gluten free friendly choices. This has some people lost at what the difference really is between the two.

Celiac disease is a genetically linked auto-immune condition. It is not a food allergy. There is an inability to breakdown the proteins in certain grains and consequently an immune response is activated. This response causes damage to the small intestine and can ultimately lead to compromised nutrient absorption. This is different than an immune IgE response normally associated with a food allergy. Blood tests for celiac disease will often test IgA levels. Celiac is not always present in childhood and can be triggered at any age. Possible triggers for celiac are severe illness or infection, surgery, pregnancy & childbirth and severe or prolonged emotional stress. It is now estimated there are more than 3 million Americans with Celiac and greater than 90% of those suffering are undiagnosed.

Symptoms of celiac disease can include diarrhea, constipation, bloating, weight gain or loss, abdominal pain, fatigue, irritability, inability to concentrate and headache. In children, poor growth and poor weight gain may also be present. People affected by celiac can have many complications of poor nutrient absorption. These include but are not limited to osteoporosis, arthritis, joint pain, anemia, infertility, peripheral neuropathy, depression, dementia and behavioral changes.

It is the glutenin and gliadin in wheat, the secalin in rye, the hordein in barley and for some the avenin in oats that creates the immune response. We have come to collectively refer to these as “gluten”, but really it is a certain type of protein in each grain.

Gluten sensitivity or intolerance are terms used for people who experience similar symptoms to those with celiac but without the autoimmune response or consequent tissue damage. It is clear for those with NCGS (non-celiac gluten sensitivity), that they feel better on a diet without gluten and that there is definitely an inflammatory response when gluten is consumed. They do not have the same IgA response however. There are also those who have a specific wheat allergy. Wheat allergies do activate an immune response but without being an autoimmune condition. It is conservatively estimated that 18 million Americans have NCGS. Those with celiac, wheat allergies and NCGS appear to produce more zonulin than the average person. Zonulin production is increased anytime wheat is consumed with or without sensitivities. Zonulin is a protein produced in the intestine that helps regulate intestinal permeability. It impacts the tight junctions in the intestines and can cause them to loosen. Ingesting wheat creates a higher production of zonulin, directly impacting gut integrity and function. This is ever more pronounced in those with celiac, NCGS and wheat allergies.

Recent research is finding that many people suffering from NCGS may actually be having problems digesting FODMAPS. FODMAPS are a specific group of carbohydrates, they are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. When these are insufficiently broken down, the excess travels to the intestine and is food for anaerobic bacteria. This contributes to the gas and discomfort people experience. Adhering to a low FODMAPS diet for 2-8 weeks can help reduce discomfort and improve gut function for those suffering with NCGS & SIBO. Click here for a list of high and low FODMAPS foods.

Navigating restaurants is a part of life with celiac disorder. There are apps that can help simplify the selection process, one such app is Find Me Gluten-Free. There are more considerations though for those with Celiac than just finding gluten free. Two other concerns are cross contamination and cross reactive foods. Many establishments upon ordering will offer the option of celiac or gluten free. The distinguishing difference between the two is the sensitivity to cross contamination. In true celiac disease, any exposure whether through skin, spray or a contaminated cutting board, can cause a flare up. In celiac friendly restaurant kitchens, they have separate utensils they use when it is a celiac order. They will use different pots, pans and baking sheets. This prevents even a trace of gluten from touching someone’s order. Choosing the gluten-free or intolerant option means you will not be served anything containing gluten, but your food may have been prepared with or touched something that had gluten residue.

Cross reactivity is an altogether different concern. During digestion, the body looks at sections of amino acid chains (proteins) to identify them. There are some occasions where although a food contains no gluten whatsoever, its amino acid chain sequence resembles that of a gluten containing food. This can contribute to cross reactivity, where someone will react to a non-gluten containing food as though it had gluten. Some of the most common cross reaction foods for gluten are:

• Oats
• Buckwheat
• Sorghum
• Millet
• Corn
• Quinoa
• Amaranth
• Potato
• hemp
• rice
• teff
• yeast
• chocolate
• eggs
• soy
• dairy
• coffee
• sesame
• tapioca

It is valuable to remember to look for these ingredients not only in foods and beverages, but also in skin care products and cosmetics.

Avoiding gluten is a great choice for most people to reduce irritation and inflammation and improve gut integrity and function. Whether you have tested positive for celiac disease or not, try cutting out gluten and notice any changes it makes for you. Let it be an adventure or a discovery process about what makes your body thrive vs. survive. Be wary of gluten-free products that are over processed or contain too many sweeteners. Be inventive in introducing more whole foods into your diet rather than substituting processed foods for gluten containing foods. Remember that “wheat free on a label does not mean gluten free. The list of names of gluten ingredients is long, but here are just a few to look for:

• Modified food starch
• White vinegar
• Semolina
• Spelt
• Kamut
• Malt
• Malt vinegar
• Seitan
• Hydrolyzed or texturized protein
• Maltose
• Triga
• Bulgur
• Couscous
• Farina
• Durum
• Einkorn

 

Resources:

https://www.csaceliacs.org/label_reading_101.jsp

http://knowgluten.me/2012/03/31/other-names-for-gluten/

http://nourishinghope.com/

http://ed.ted.com/lessons/what-s-the-big-deal-with-gluten-william-d-chey

https://www.ted.com/talks/heribert_watzke_the_brain_in_your_gut