What is Celiac Disease and how is it treated?
Celiac disease is a medical condition in which the absorptive surface of the small intestine is damaged by a substance called gluten. This damage results in an inability of the body to absorb nutrients the protein, fat, carbohydrates, vitamins and minerals that are necessary for good health. CD is quite sneaky however, and it presents as a multi-system problem rather than primarily an intestinal disease. The most common symptoms are: fatigue, joint pain, bloating, gas, headaches, migraines, cramping, diarrhea, constipation, and in children – failure to thrive or stunted growth is a common symptom. Some celiacs have milder reactions although with continued consumption of products containing gluten, they run the risk of more serious consequences, including cancer.
For every one person diagnosed with CD, there are more than a thousand people who suffer from some degree of gluten intolerance, which we will refer to as “Non-Celiac Gluten Sensitivity” (“NCGS”). NCGS is CD’s weaker, but more prevalent brother affecting up to 10% of the population. There are over 250 documented symptoms of NCGS ranging from bloating to weight gain, and from diabetes to arthritis. The truth is, we really don’t much about NCGS at this point, except that it is a serious problem in today’s society.
The treatment for both CD and NCGS is fairly simply - avoid products containing gluten. The damage done will for the most part repair itself and a patient can live a normal life without gluten.
Naturally, many people think of CD and NCGS as “wheat allergies” but that is incorrect. A body with a wheat allergy will have a histamine response to wheat, much like a peanut allergy or hay fever, versus gluten intolerance symptoms generally manifest themselves more like a nutritional deficiency, with symptoms that sometimes arise slowly over time.
How is Celiac Disease and Non-Celiac Gluten Sensitivity diagnosed?
As far as NCGS, there is no test. The only way is to experiment with a gluten-free diet and see if it alleviates the issues you suspect are being caused by the gluten sensitivity.
As for CD, there are two tests commonly used - a blood test and a biopsy. The blood test has a fairly high margin of error so most gastroenterologists rely on the biopsy test. For a biopsy the doctor will put a scope down the esophagus and look at the stomach and duodenum and take a sample of the small intestine. The tests are only conclusive if the patient has been consuming gluten for some time prior to testing. If the patient has been avoiding gluten, then the cells will likely be healthy and will not indicate any problem. This makes a conclusive diagnosis sometimes difficult. A new development in dental research has indicated your dentist can possibly spot CD. Patients with CD may have dental enamel defects and recurring mouth ulcers. If this is spotted early, a follow-up with a physician can assist in arriving at a diagnosis.
Why has there been such an alarming increase in the rate of CD and NCGS?
There are numerous theories to explain the astounding increase in gluten sensitivity. One interesting theory – the “hygiene hypothesis” suggests that the modern environment is so clean, and antibiotics are so overused, that our immune systems have little to attack and turns on itself or is simply weaker. A related hygiene theory suggests that cleanliness in industrialized societies have fundamentally changed the composition of digestive bacteria contained within the gut. Yet another theory says that we are exposed to far more gluten through a myriad of processed foods that we did not consume 50 or more years ago.
Perhaps the most interesting theory is that we are not consuming the same wheat today as we were 50 years ago or for that matter 5000 years ago. In a new book entitled “Wheat Belly”, William Davis, MD argues that wheat changed little from the strains consumed by the Natufians in the Pleistocene period, around 8500 BC, all the way to the first half of the twentieth century, but then “an upheaval in hybridization methods” and crossbreeding transformed grain into something entirely unique, nearly unrecognizable compared to the original and yet still called by the same name: wheat. “Modern commercial wheat production has been intent on enhancing features such as increased yield, decreased production costs, and large-scale delivery of a consistent commodity product. All the while, virtually no questions have been asked about whether these features are compatible with human health.” “The result: A loaf of bread, biscuit, or pancake of today is different than its counterpart of a thousand years ago, different even from what our grandmothers made. They might look the same, even taste much the same, but there are biochemical differences. Small changes in wheat protein structure can spell the difference between a devastating immune response to wheat protein versus no immune response at all.”
Nobody knows for sure why gluten has become such a devil. Likely all the popular hypothesizes have a degree of validity and combined form the answer.
What is gluten and where is it found?
Gluten is a protein naturally found in certain grains such as wheat, barley, and rye. It gives elasticity to dough, helping it to rise and to keep its shape, and often giving the final product a chewy texture. The seeds of most flowering plants have endosperms with stored protein to nourish embryonic plants during germination.
Wheat can have a confusing array of aliases:
Bran; Bulgur; Couscous; Durum; Einkorn; Emmer; Farina; Farro; Graham Flour; Kamut; Matzo Meal; Orzo; Panko; Seitan; Semolina; Spelt; Udon; Beer (some beer contains wheat).
Rye has a higher fibre content than wheat but lower gluten content. It can be found in many types of bread, beers, vodka and some whiskies.
Barley is very commonly found in foods. Look for these ingredients: Barley grass; Barley malt, Barley groats, Pearl Barley, Malt and Malt flavouring, Malt Vinegar; Caramel colour, and Beer.
Hidden sources of gluten are some deli meats, some sausage, some burgers, fried foods (also because of cross contamination), some blue cheese, (mold originates with bread), croutons, gravy, hydrolyzed vegetable protein, and hydrolyzed plant protein, imitation crab, licorice, soy sauce, soup base, communion wafers, marinades, dressings, seasonings (usually agents to prevent clumping contain wheat starch), brewer’s yeast (other yeast is considered safe), prescription and over the counter medications.
Many are under the mistaken impression that by purchasing breads or other wheat products made from “whole grains”, they will avoid the problems with gluten. Although whole wheat flour, or whole grains, are unquestionably better for you than white flour, they still contain gluten.
What foods are gluten-free?
For many years, Celiacs had the choice of consuming rice, rice or rice. Recently, gluten-free products have exploded in popularity. Some safe substitutions for wheat are: Quinoa, Oats, Amaranth, Millet, Buckwheat, Sorghum, Rice (white or brown), Potato, Bean, Tapioca, Corn, Chickpea, and so many more. Baking techniques for breads have come a long way to making breads that have a fluffier (albeit somewhat cake-like) texture.
Many facilities that process oats, also process gluten grains. The possibility of cross contamination is the only reason that oats would be considered a risk to a celiac. Processed in a gluten-free facility, oats are perfectly safe to consume.
We’re often asked, “If the animal consumes grains containing gluten, does this mean the meat has gluten?” Absolutely NOT! We have confirmed this with the Canadian Celiac Association, as well as having done research in this regard and there is no gluten-related risk with consuming animals whose diet contained gluten. So go ahead and get that Chicken breast (just make sure it isn’t breaded), beef, pork, lamb or game meat. The only risk is in how it is prepared or if it is treated in anyway for commercial freezing or bulk packaging. It is important to check those labels, or ask the staff to check ingredients and preparation methods.
At The Healthy Butcher, there is no doubt that gluten-free products have exploded in popularity. If you're shopping in our store, here is a small checklist of gluten-free:
All fresh cuts of meat and fish
About 50+ varieties of sausage made in-house without any wheat products
Several of our handmade burgers, the best selling being the “Meadow Beef Burger”
A myriad of prepared foods made by our team of chefs, from quinoa salads to Pulled Pork
Jars and jars and jars of awesome soups made from scratch
Bread made by a few bakers using gluten free ingredients
Cereals, with our current best seller being a Dragons' Den success story – called “Holy Crap”
Organic frozen foods such as pizzas, burritos, lasagnas, pastas, and appetizers
Condiments, including The Healthy Butcher’s Original BBQ Sauce
All fruits and vegetables are gluten-free so go nuts… oh and nuts are gluten free too!
Many desserts… brownies, cookies, baking mixes and a LOT more.
There is a new certification standard for “Certified Gluten-Free”. Recently the Canadian Celiac Association has created a certification process that requires compliance in several areas to become Certified Gluten-Free. This is a new standard and we expect to see more companies participating in this process. Until now, in Canada no such standard has existed; the manufacturers themselves policed it. Many manufacturers who produce wheat products have simply labeled their non-gluten products “gluten-free” putting some more sensitive individuals at risk from exposure to cross contamination.
For a disease with such an alarming increase in occurrences, it is surprising that so little research has gone into “cause” other than genetics. We know one thing for sure: Something is wrong somewhere with the wheat we consume, and how our bodies digest it. Celiac disease has been found in all ages, genders, and ethnicities. Arm yourself with the knowledge that gluten sensitivities exist and if undiagnosed can cause severe damage to your body. If you feel bloated after having a plate of pasta, question the reason – don’t just accept it. Your health is at stake.
Sources and Further Reading
Hasselbeck, Elisabeth, The G-Free Diet – A Gluten-Free Survival Guide . Centre Street .2009. Print.
www.celiacdiseasecenter.org Columbia University N.p. Web.., n.d.
Patrick, Sarah. “Gluten Intolerance Symptoms” http://gluten-intolerance-symptoms.com N.p. Web. 2012
Gluten Freely,LLC. http://www.glutenfreely.com/liveglutenfreely/what-is-gluten N.p.., Web. n.d.
Davis, William.MD. “From Natufian Porridge to Donut Holes”. http://health.abc4.com/provider_article.php?ar=963&pr=0&geo=ut. CitiHealth.., Sept.20,2011.,Web.
Fillion, Kate. “On the Evils of Wheat” http://www2.macleans.ca/2011/09/20/on-the-evils-of-wheat-why-it-is-so-addictive-and-how-shunning-it-will-make-you-skinny/. Macleans .ca ., Sept.20, 2011. Web.
Canadian Celiac Information. “Gluten Intolerance Statistics” . http://www.celiac-association.ca/celiac-disease-symptoms/gluten-intolerance-statistics/ . N.p., 2012. Web.
Canadian Celiac Association. http://www.celiac.ca/ N.p.., 2011.Web.