Gluten Intolerance

People with gluten intolerance are sensitive to gluten, a protein found in grain products such as wheat, rye and barley, some alcohol beverages and many processed foods and baked goods. Gluten intolerance goes by many names: sprue, nontropical sprue, celiac sprue and gluten-sensitive enteropathy, but most doctors today call it celiac disease. Dermatitis herpetiformis is a related skin disease.

What causes celiac disease?

Celiac disease is an inherited autoimmune disease.When a person with celiac disease eats a food that contains gluten, their immune system responds by damaging the small intestine by flattening out the villi, tiny fingerlike projections that absorb nutrients. This can lead to severe digestive problems and malnutrition. Left untreated, celiac disease can lead to vitamin and mineral deficiencies such as anemia, rickets and osteoporosis, as well as chronic diarrhea, lactose intolerance, gastrointestinal cancers and lymphomas and other serious diseases.

Allergy or Intolerance?

Celiac disease is not an allergy.With an allergy, the body produces antibodies specific to the allergen (the substance you're allergic to), which cause a rapid allergic reaction such as hives, itching or breathing difficulties. Celiac disease is a food intolerance in which the body cannot tolerate gluten and responds by harming the small intestine. Digestive symptoms may not develop for several hours or days and some people may have no symptoms at all.

What are the symptoms?

• Diarrhea
• Cramping
• Bloating
• Gas
• Nutritional deficiencies
• Weight loss and symptoms of malnourishment

How is it diagnosed?

Several blood tests can indicate, but not confirm, celiac disease. The gold standard for diagnosis is a small intestine biopsy, or series of biopsies. Research is underway to find a noninvasive diagnosis method.

How is celiac disease treated?

Currently the only treatment for celiac disease is to completely eliminate gluten from the diet. This enables the small intestine to heal, relieving symptoms for most people with celiac disease. A person with celiac disease must follow a gluten free diet for life. Ingesting even small amounts of gluten can produce symptoms.

Safe Foods

Not all grains contain gluten, and "wheatfree" does not mean gluten-free. It's important to read labels and contact the manufacturer for information if there's a question about whether a food contains gluten. The National Digestive Diseases Information Clearinghouse offers these guidelines on safe foods:

• Grain, starches and flour products - buckwheat, rice, corn, potato, tapioca, bean, sorghum, soy, arrowroot, amaranth, tef, quinoa, millet, nut flours and breads made from these ingredients.
• Cereals - Hot cereals made from hominy, brown and white rice, buckwheat groats, millet, cornmeal and quinoa flakes. Cold cereals made with puffed corn, rice or millet, and other rice and corn made with allowed ingredients.
• Pastas - Pastas made from rice and other allowed ingredients.

Foods to Avoid

The following guidelines will assist you in avoidingproblematic foods. For more information, it may be helpful to consult a dietitian.

Avoiding Hidden Glutens

It's relatively easy to avoid breads and other products made with grains that contain gluten, but sometimes gluten hides in other food ingredients. Be cautious of foods that contain textured vegetable protein (TVP), hydrolyzed vegetable protein (HVP), caramel color, soy sauce, malt flavoring and modified food starch. Products like imitation seafood, vitamin supplements and even prescription medicines may contain fillers with gluten.

Wheat (durum, semolina)
Rye
Barley
Spelt
Oats (while oats do not contain gluten, they are sometimes contaminated with glutens during processing)
Triticale
Kamut
Farina

The Gluten-Free Kitchen

It takes a little creativity, but it's possible to convert recipes to gluten-free versions. Here are some substitution ideas. Instead of flour-based thickeners, substitute cornstarch, arrowroot or sweet rice flour. For flour in baked goods, substitute glutenfree flours such as rice, potato or bean flours with the addition of small amounts of xanthan gum for texture. In her book The Gluten-free Gourmet, author and celiac patient Bette Hagman suggests the following substitutions for one cup of wheat flour:

7/8 cup rice flour
5/8 cup potato starch flour
1 cup soy flour plus 1/4 cup potato
starch flour
1/2 cup soy flour plus 1/2 cup potato
starch flour
1 cup corn flour
1 scant cup fine cornmeal
1 cup of gluten-free flour mix:
2 parts white rice flour, 2/3 part potato
starch flour and 1/3 part tapioca flour

Gluten-Free Products at ShopRite

Listed below are a few of the brands and product lines available at ShopRite.

Glutano pastas, cookies, breads, cereals, snacks
DeBoles pastas
Tinkyada brown rice pastas
Country Choice cookies
Pamela's cookies, baking mixes
Nature's Path cereals
Lundberg Family Farms rice chips/cakes, noodle and rice mixes
Hain rice cakes
Health Valley cereals, rice crackers, soups
Pacific Organic soups
Hol-Grain rice crackers
Gluten-Free Pantry baking mixes
Bob's Red Mill baking mixes
Arrowhead Mills baking mixes, cereals
Edward&Sons rice snacks
Nature's Highlight snacks
Soy Dream nondairy beverages
Amy's frozen entrees
Fantastic Foods rices
Casbah rice pilafs

Support and Information

If you've just been diagnosed with celiac disease you should consider a consultation with a registered dietitian. Organizations such as the Celiac Disease Foundation and others offer tips on coping, recipes, sources for gluten-free products and information on local support groups.

Support Groups

Celiac Sprue Association
P.O. Box 31700
Omaha, NE 68131-0700
Telephone: 1-877-272-4272
www.csaceliacs.org

Celiac Disease Foundation
13251 Ventura Blvd., #1
Studio City, CA 91604
Telephone: 818-990-2354
www.celiac.org

Gluten Intolerance Group

15110 10th Ave. SW, Suite A
Seattle,WA 98166-1820
Telephone: 206-246-6652
www.gluten.net

The American Dietetic Association/ National Center for Nutrition and Dietetics
Consumer Nutrition Hotline: 1-800-366-1655
www.eatright.org

Sources for Medical Information

A variety of medical journals and sources for research are available on the Internet:
American Journal of Clinical Nutrition www.ajcn.org

Medscape, Inc.
www.medscape.com

National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov

healthfinder®: A service of the U.S. Department
of Health and Human Services
www.healthfinder.gov

National Foundation for Celiac Awareness

The Foundation's mission is to raise awareness and funding for celiac disease that will advance research, education and screening, and improve the quality of life of children and adults affected by this autoimmune disease through grant making and direct programming.

www.CeliacCentral.org