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Publix GreenWise Market Magazine - August 2007

Against the Grain
People with celiac disease focus on food to find relief.

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Against the GrainVanessa Maltin, 24, loves to cook. But three years ago, when she was diagnosed with celiac disease, she thought her days in the kitchen might be over. "I cried about how I would never eat like a normal person again," Maltin says. But instead of getting angry, she got creative, and today Maltin regularly whips up gluten-free dishes such as polenta lasagna, brown rice casseroles, and butterscotch cookies. She even teamed up with the National Foundation for Celiac Awareness to write a guide to gluten-free cooking and eating called Beyond Rice Cakes (iUniverse, Inc.).

Like Maltin, 2 million people in the United States - one of every 133 - may have celiac disease, according to the National Institutes of Health website. The disorder is characterized by inability to tolerate foods containing a protein called gluten, which is found in wheat, rye, and barley. Scientists don't know exactly what causes celiac disease, but research suggests its origins lie with genes involved in the body's immune system, according to the National Institute of Diabetes & Digestive & Kidney Diseases, which conducts research on celiac disease.

Normally, the immune system defends the body against foreign invaders such as viruses or harmful bacteria. But when a person with celiac disease eats a gluten-containing food, the immune system goes after normal tissue, attacking the small intestine. The off-kilter response damages tiny projections in the intestine called villi, which help the body absorb nutrients from foods. As the villi become damaged, the intestine starts to lose the ability to absorb nutrients. Left untreated, celiac disease can lead to anemia, bone loss, malnutrition, and other conditions.

Celiac disease runs in families, and can strike at any time of life. Some people develop symptoms during childhood. For others, the disease doesn't surface until later in life. According to the Celiac Disease Foundation, symptoms vary as well, and may include gas, chronic diarrhea, fatigue, depression, muscle cramps, infertility, bloating, or an itchy skin rash. Maltin suffered chronic migraines.

The only known treatment for celiac disease is to follow a gluten-free diet. Some people take vitamins and supplements, such as vitamins C and E and calcium, but there are no across-the-board recommendations because each person has different vitamin and mineral deficiencies depending on the severity of the disease. The Celiac Disease Foundation recommends that people diagnosed with celiac disease talk with their doctor about which supplements they may need.

People with celiac disease must avoid foods that contain wheat (including spelt, kamut, einkorn, durum, faro, graham, and semolina), rye, barley, and triticale (a hybrid of rye and wheat). This means abstaining from traditional pastas, cereals, and many processed foods. And although some sufferers can eat oats without experiencing symptoms, the scientific jury is still out on whether oats are "safe" because they are processed in the same facilities as wheat products. Until more research is complete, your best bet is to follow a doctor's or dietitian's advice.

With so many trigger foods, people with celiac disease spend a lot of time reading food labels. In addition to the foods listed above, gluten is used in some food additives that serve as thickeners, stabilizers, and texture enhancers. Earlier this year, the Food and Drug Administration proposed that food manufacturers begin to voluntarily label foods that are gluten-free. Currently, there is no federal regulation for labeling foods gluten-free. For now, the Celiac Disease Foundation suggests being on the lookout for the following label ingredients, which may contain hidden gluten:

  • Modified food starch or any unidentified starch
  • Hydrolyzed vegetable protein (often abbreviated as HVP)
  • Hydrolyzed plant protein (HPP)
  • Texturized vegetable protein (TVP)
  • Fillers
  • Excipients
  • Extenders
  • Malt (beer, lager, and malt vinegar contain gluten)
The good news is that there is a wide variety of gluten-free flours that can be used in your favorite recipes. Look for flours made from potatoes, rice, soy, amaranth, quinoa, buckwheat, tapioca, beans, garfava, sorghum, millet, arrowroot, teff, Montina, flax, and nuts.

People with celiac disease also can eat plain meats, fish, rice, fruits, and vegetables. "Everything in the produce aisle is gluten-free," Maltin says, "and the number of gluten-free foods available in supermarkets has grown astronomically in the past several years." Your neighborhood Publix sells a variety of gluten-free breads, pasta, and other products.

With guidance from a doctor and dietitian, the vast majority of people with celiac disease can enjoy life free of the disease's symptoms. For Maltin, going gluten-free was well worth it. "I had so much more energy," she says. "It was amazing the first day when I didn't wake up with a headache," a symptom that had plagued her for 21 years.

LEARN MORE: Visit the National Institutes of Health (, the Celiac Disease Foundation (, or the National Foundation for Celiac Awareness (

Watch Out!
The American Celiac Disease Alliance points out that the following foods are frequently overlooked sources of gluten:
  • Breading or coating mixes
  • Croutons
  • Flour or cereal products
  • Imitation seafood
  • Pastas
  • Sauces, gravies
  • Soy sauce or soy sauce solids
  • Stuffings, dressing
  • Communion wafers
  • Brown rice syrup
  • Energy bars
  • Imitation bacon
  • Marinades
  • Processed luncheon meats
  • Self-basting poultry
  • Soup bases
  • Thickeners (roux)
  • Herbal, vitamin, or mineral supplements
  • Play-Doh (a potential problem for little ones who put their hands in their mouths after playing with it)

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