Wheat Free For Life
by Dana Denis, MSPH., RD (topic expert: nutrition)

Have you noticed more foods in the grocery store labeled "wheat free" or "gluten free"? What does this mean and who needs these products? It is intended for people with either a wheat allergy or celiac disease.

Celiac disease used to be a disease diagnosed in children who had symptoms of diarrhea, bloating and failure to grow. Not any more. There has been a steady rise in the diagnosis of celiac disease in adults, primarily due to increased screening and knowledge of the disease. Currently 1% of the US population has a form of celiac disease.

Many individuals can go years without being diagnosed. Similar to children, symptoms in adults include diarrhea and bloating. Other symptoms include gas, weight loss, weakness, vomiting and abdominal pain. Some individuals have no gastrointestinal symptoms but have a skin disease, dermatitis herpatiformi. Lesions develop most often around the knees, elbows, buttocks or back. Yet others, diagnosed through screening, have no symptoms of the disease. No matter what the symptom, when celiac disease is diagnosed, there is only one treatment - strict adherence to a gluten-free diet.

Gluten is a protein found in wheat, barley and rye. All foods and medications containing gluten must be eliminated from the diet of anyone diagnosed with celiac disease. This is not an easy task as gluten is also hidden in many foods. The only way to tell is by reading the ingredient labels. Some of the foods or ingredients that must be avoided include: wheat, barley, rye, bulgar, couscous, flour (typically this is wheat), farina, faro, graham flour, malt, maltose, pastas, oats, semolina, and beer. In their place, celiac sufferers can eat corn, rice, potato, soy, nuts, beans, tapioca, flax, quinoa, and uncontaminated oats.

Other hidden sources of gluten can be found in items like soy sauce, teriyaki and other sauces, flavor packets that accompany rice mixes, stock or bullion cubes and pastes, as well as artificial colorings. Individuals must purchase special flours to make their own breads and pastas, or purchase special pre-made products which can be quite costly. As you can imagine, it can be very challenging to dine out or travel and adhere to this diet.

Depending on how long someone has had celiac disease prior to its diagnosis, he or she can also suffer from malnutrition of various vitamins and minerals. There is usually anemia present, related to either an iron, folate or vitamin B-12 deficiency. Other potential deficiencies are vitamins A, D, E and K, as well as calcium. The low calcium levels often result due to a lactose intolerance. These deficiencies usually resolve, including the lactose intolerance with the gluten-free diet, but some will need gluten-free vitamin and mineral supplements. But beware, gluten can also be found in some vitamin supplements.

As you can tell, this can be a very difficult process for anyone. For that reason individuals usually must seek several consultations with a dietitian as well as access to a support group, where additional information and support can be obtained by people living well with celiac disease.

Celiac disease is a genetic disorder, so if you have family members with this disease it is a good idea to be screened. There may also be environmental factors involved; for example foods containing gluten should not be introduced to infants until 4 months of age. Prior to 4 months, breastmilk or formula should be the only food given. Gradual introduction of gluten between 4 to 6 months of age, while being breastfed, could reduce risk.

Current research is focusing on treatments that would allow those with celiac disease to consume small amounts of gluten. Although it seems like a small step forward, it would greatly enhance the quality of life of these individuals.

References:

1. Niewinski, MM. Advances in celiac disease and gluten-free diet. J Am Diet Assoc. 2008; 108:661-672.
2. Unsafe gluten-free food list. Celiac Disease and Gluten-Free Diet Support Center. www.celiac.com. Accessed September 2008.
3. Ferroli C. Gluten-free diets - help for gluten intolerance. American Dietetic Association. www.eatright.org. Accessed September 2008.