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Gluten-free or false?

Visiting Europe is fascinating. Despite retaining their respective culture, the American influence is definitively visible in the music, dress, and of course, diet.

The “new thing” according to the locals here in Ireland, is the “gluten-free” diet. It has been adopted in the menus of most of the restaurants and is listed among the isles of the grocery stores (much like here in the United States).

The popularity of the gluten-free diet seemed to explode when pop-culture recognized it as a “healthier solution” to the regular American diet. Good or bad, it is here to stay. Is it healthier? Well, certainly if you have Celiac Disease (I will explain that later in the blog).

Stars like Miley Cyrus and Elisabeth Hasselbeck have encouraged the gluten-free diet for all their fans. Miley Cyrus claims she has had successful weight loss using the specially programmed diet. Unfortunately, promoting this diet is BAD advice for most of America (and Europe). The gluten-free diet is high in fats and sugar and generally results in weight gain. In addition, adherence to the diet may result in nutritional deficiencies in iron, zinc, B vitamins (folate, niacin).

Celiac Disease is a result of the “inappropriate response to the dietary protein glutein” according to the American Academy of Family Practice (AAFP), which results in inflammation of the small intestine. Specifically the inflammation affects the microscopic villi in the small intestines. ( These villi are like a “plush carpet” with each strand responsible for the absorption of food and nutrients from our digestive tract. ( Inflammation of the intestines damages the villi, which may result in diarrhea, abdominal pain, and weight loss. Additionally, Celiac Disease can cause abnormal physical findings.
1. Skin: rash (herpes dermatiformis)
2. Liver: abnormal liver enzymes as a result of inflammation of the liver cells
3. Nervous system: seizures or nerve damage (peripheral neuropathy)
4. Cancer: increased risk for lymphoma or bowel cancer
5. Bones: osteoporosis (thinning of the bones)

Celiac Disease (also termed “ celiac sprue”) occurs in approximately 1/100 to 1/200 people according to the web site. The cause is generally due to genetic predisposition (family history). Other causes are uncertain but there is a higher risk among people with:
Type 1 Diabetes
Autoimmune thyroid diseases (like Hashimoto’s Thyroiditis)
Downs Syndrome
Microscopic Colitis

Should you get screened for Celiac Disease? The AAFP and other medical web sites do NOT recommend screening if you have no uncomfortable gastrointestinal symptoms. Consider Celiac Disease testing if you have early-onset osteoporosis or unexplained indigestion or iron-deficiency.

Discuss testing options with your physician. Blood tests such as the IgA endomysial antibody test and the tTG antibody test together are generally performed. Additionally, your physician may choose to have you undergo a bowel biopsy if your symptoms are severe or there is a question regarding your diagnosis. Symptoms generally resolve or decrease in 5-6 months.

The Celiac Disease “fad” is going to be around for a while. Choose wisely when it comes to your health. Avoid over-treatment with the Celiac diet if possible and be careful with medical and nutritional advice from celebrities.

Know someone with celiac disease? Celebrate celiac awareness month

Recently, I received a call from my colleague

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Rachel Begun, MS, RD. She was headed to Dallas and needed a restaurant recommendation that would cater to her specific food restrictions. I wracked my brains and finally decided to point her to a well-known steakhouse. I was so relieved when her email came the next day saying that the restaurant had taken excellent care of her and that she enjoyed a delicious meal. You see, observing Rachel’s food restrictions is extremely serious business as is true for anyone who lives with celiac disease.

In celebration of Celiac Awareness Month, I asked Rachel (AKA the Gluten Free RD)a few questions about the disease, the recent rise in incidence and how living with celiac disease has made her more adventerous in her own kitchen.

What is celiac disease? How many people have it and how is it diagnosed

Celiac disease is an autoimmune disorder that affects 1% of the population or approximately 3 million Americans. When gluten is consumed, the body triggers an immune response that attacks and damages the intestinal lining. The damage prevents nutrients from being absorbed into the body, which often leads to nutrition deficiencies and their associated conditions and symptoms. Left untreated, celiac disease can lead to serious health conditions and complications, including osteoporosis, infertility, other autoimmune disorders and intestinal cancers. The only current treatment is adhering to a lifelong gluten free diet.

If celiac disease is suspected, the first step a physician will take is to do a blood test to test for antibodies to gluten. If blood testing for antibodies comes back positive, the second step is taken to confirm the diagnosis, which is an endoscopy with small intestine biopsy. While it seems counterintuitive, it is vitally important for patients undergoing testing to CONTINUE EATING GLUTEN. Removing gluten from the diet prior to or during testing may result in inaccurate test results.

Why has the incidence of celiac diagnosis risen so much in the last few years?

While increased awareness of celiac disease and improved diagnostic testing in recent years has enabled more people to get tested and accurately diagnosed, there is more to the story. A recent study shows that the rate of celiac incidence has increased about five-fold in the last 50 years. There are several theories as to why incidence may be rising. Here is a an article in which esteemed celiac researcher Dr. Alessio Fasano explains some of these theories.

As someone with celiac disease, what has been the hardest adjustment? The easiest?

The hardest adjustment for me was the social aspect of eating out. I like to try new foods and eat at different restaurants, especially when traveling. You can be educated to the nth degree about how to order gluten free at a restaurant, but you cannot control how much or little the foodservice staff knows about cross contamination. To eat out gluten free, you have to put time into picking the right restaurants, choosing your meals and communicating with the staff. I still do enjoy eating at many restaurants. At the same time, my eyes have been opened up to a whole new world of ingredients that I may not have tried before. My cooking skills and culinary knowledge have definitely improved and expanded!

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Gluten-free matzoh for Passover available locally

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It’s hard to celebrate Passover without matzoh and for those with celiac disease, who can’t consume gluten, that’s a real problem. Happily there’s now a gluten-free matzo made by Yehuda. Sue Rosen, a member of the Gluten Intolerance Group (GiG) of Greater Dallas, emailed me that she found it at the Tom Thumb on Coit and Legacy in Plano. You can also find it online on Amazon and on the Yehuda website here.

“Matzoh is something I have truly missed since being diagnosed with celiac disease about 7 years ago,” Sue wrote me. While it costs a lot more than regular matzoh, she says it’s worth it. She has also found Manishewitz gluten-free noodles which she says has a great recipe for noodle pudding on the back of the package.

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