What is celiac disease?
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in products we use every day, such as stamp and envelope adhesive, medicines, and vitamins.

 When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging the small intestine. The tiny, fingerlike protrusions lining the small intestine are damaged or destroyed. Called villi, they normally allow nutrients from food to be absorbed into the bloodstream. Without healthy villi, a person becomes malnourished, regardless of the quantity of food eaten. Villi on the lining of the small intestine help absorb nutrients.

Because the body’s own immune system causes the damage, celiac disease is considered an autoimmune disorder. However, it is also classified as a disease of malabsorption because nutrients are not absorbed. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.

Celiac disease is a genetic disease, meaning it runs in families. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.
What are the symptoms of celiac disease? Celiac disease affects people differently. Symptoms may occur in the digestive system, or in other parts of the body. For example, one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children.

Symptoms of celiac disease may include one or more of the following:

gas recurring abdominal bloating and pain chronic diarrhea constipation pale, foul-smelling, or fatty stool weight loss/weight gain fatigue unexplained anemia (a low count of red blood cells causing fatigue) bone or joint pain osteoporosis, osteopenia behavioral changes

tingling numbness in the legs (from nerve damage) muscle cramps seizures missed menstrual periods (often because of excessive weight loss) infertility, recurrent miscarriage delayed growth failure to thrive in infants pale sores inside the mouth, called aphthous ulcers tooth discoloration or loss of enamel itchy skin rash called dermatitis herpetiformis

A person with celiac disease may have no symptoms. People without symptoms are still at risk for the complications of celiac disease, including malnutrition. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anemia, delayed growth, and weight loss are signs of malnutrition: The body is just not getting enough nutrients. Malnutrition is a serious problem for children because they need adequate nutrition to develop properly.

The Gluten-free Diet
A gluten-free diet means not eating foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. The foods and products made from these grains are also not allowed. In other words, a person with celiac disease should not eat most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including gluten-free bread and pasta. For example, people with celiac disease can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from regular stores.
Checking labels for “gluten free” is important since many corn and rice products are produced in factories that also manufacture wheat products. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers. Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods.
“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Recommending that people with celiac disease avoid oats is controversial because some people have been able to eat oats without having symptoms. Scientists are currently studying whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician’s or dietitian’s advice about eating oats.
The gluten-free diet is challenging. It requires a completely new approach to eating that affects a person’s entire life. Newly diagnosed people and their families may find support groups to be particularly helpful as they learn to adjust to a new way of life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, or what they grab for a snack. Eating out can be a challenge. If a person with celiac disease is in doubt about a menu item, ask the waiter or chef about ingredients and preparation, or if a gluten-free menu is available.
Gluten is also used in some medications. One should check with the pharmacist to learn whether medications used contain gluten. Since gluten is also sometimes used as an additive in unexpected products, it is important to read all labels. If the ingredients are not listed on the product label, the manufacturer of the product should provide the list upon request. With practice, screening for gluten becomes second nature.

The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. Please feel free to contact our Registered Dietician: Katherine Musgrave 947-8658.  People with celiac disease should always read food ingredient lists carefully to make sure that the food does not contain gluten.

Allowed Grains / Foods
Amaranth	Job’s Tears	Sago
Arrowroot	Legumes	Seeds
Buckwheat	Millet	Soy
Cassava	Nuts	Sorghum
Corn	Potatoes	Tapioca
Flax	Quinoa	Teff
Indian rice grass	Rice, Wild Rice	Yucca
Foods To Avoid
Wheat	Barley	Rye
Including: einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein	Pasta	Triticale (a cross between wheat and rye)
Other Wheat Products
Bromated flour	Graham flour	Self-rising flour
Durum flour	Phosphated flour	Semolina
Enriched flour	Plain flour	White flour
Farina	Pasta – wheat or white
Processed Foods That May Contain Wheat, Barley, or Rye*
Bouillon cubes	French fries	Sauces
Brown rice syrup	Gravy	Seasoned tortilla chips
Chips/potato chips	Imitation fish	Self-basting turkey
Candy	Matzo	Soups
Cold cuts, hot dogs	Rice mixes	Soy sauce
Communion wafer	Salami, sausage	Vegetables in sauce
* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.

Helpful Links:

http://www.celiac.com/

http://www.celiac.org/

http://allrecipes.com/Recipes/Healthy-Living/Gluten-Free/Main.aspx

http://www.recipezaar.com/recipes/gluten-free

*DISCLAIMER
This site is not meant to diagnose your condition. The information here does not necessarily pertain to all individuals and should not replace the advice of your physician. Please contact your doctor with any questions.
**Information derived from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm** -- 6/1/07