By Sidney Stohs, PhD, FACN, CNS, ATSF, Dean Emeritus, School of Pharmacy and Health Professions, Creighton University Medical Center
Submitted by Pamela Klim, Independent Advocare Distributor
Celiac disease is an autoimmune disorder that has immunologic, environmental, and genetic components. It is one of the most common immune-mediated disorders characterized by a response to ingested wheat gluten and related proteins from rye and barley, leading to inflammation and damage to the intestinal lining (mucosa). The incidence of celiac disease in the United States is believed to be about 1 percent of the population. Characteristic symptoms include diarrhea, chronic malabsorption, anemia, occasional constipation, abdominal cramps, gas and bloating. However, not all individuals suffer from abdominal distress. Some individuals may experience fatigue, headache, neurological problems, distress, infertility, weakness, and skin conditions such as dermatitis herpetiformis.
The eight food allergens that account for 90 percent of known food allergies include milk, eggs, fish, shellfish, tree nuts, peanuts, wheat (gluten), and soy beans. Gluten intolerance disorders bear the names celiac disease, sprue, and gluten enteropathy. The incidence of gluten intolerance is much greater than 1 percent in conjunction with diabetes, neurological disorders, skin diseases, digestive disorders including irritable bowel syndrome (IBS), joint disorders, infertility, chronic fatigue syndrome and fibromyalgia. Individuals with gluten intolerance have required an average of 9 years from the onset of symptoms until a firm diagnosis was obtained. This has been due in part to the lack of sensitive and rapid immunologic assays for gluten proteins. Recently developed immunologic assays are becoming more available, and health care providers are slowly learning to recognize that gluten intolerance is widespread and much more common than had been previously recognized. A recent study suggests that over one-fourth of the population in the United States is gluten sensitive based on immunologic assays, while approximately 1 percent may have progressed to a serious symptomatic disease state.
The treatment for gluten intolerance–related conditions is a gluten-free diet, and if one wishes to remain symptom free, the gluten-free diet must be maintained for life. Gluten is a mixture of several proteins found primarily in wheat, barley, and rye. Oats contain a related protein that the vast majority of individuals with gluten sensitivity can tolerate. However, oats are frequently milled using the same equipment for wheat, barley, and rye, and may therefore be contaminated with these grains. As a consequence, it may be prudent to avoid oat-based products.
One should avoid any ingredient derived from wheat, barley, and rye including such ingredients as malted barley, hydrolyzed proteins from these grains, filler flour, graham flour, barley extract, hydrolyzed wheat starch, wheat bran and germ, wheat protein, wheat-derived amino acids, oat extract, oat flour, and vegetable starch. Products such as soy and Brewers yeast should also be avoided because they may contain extracts from wheat, barley, or rye.
Unfortunately, gluten is used in the manufacture of virtually all packaged, canned, and boxed processed foods to improve palatability and texture. Gluten is in essence a glue that may hold products together. Common processed foods that contain hidden gluten include breads, cereals, cookies and cakes, flavored potato chips, frozen dinners, pastas, pies, sauces and gravies, some salad dressings, soy sauce, teriyaki sauce, dried and canned soups, barbecue sauce, breaded meats (fish, chicken, shrimp, steak, etc.), crackers, and couscous.
Frequently, symptoms can be relieved in gluten-sensitive individuals by going gluten-free for two weeks. However, in severe cases, a longer period of time may be required. Some individuals may have a concurrent sensitivity to other proteins in addition to gluten, as for example, casein and whey found in milk-derived products, tomatoes, white potatoes, eggplant, peppers, tobacco, peanuts and soy.
Flour substitutes that can be used in lieu of gluten-containing flours include corn flour and corn meal, almond flour and almond meal, buckwheat (soba) flour and groats, flax seed flour, millet, fava bean flour, besan (chickpea or garbanzo bean) flour, potato flour, quinoa, rice and rice flour, sorghum (milo), soy flour, tapioca flour, teff and amaranth flour.
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