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Publix GreenWise Market Magazine
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Publix GreenWise Market Magazine - Spring 2012

The Facts About Gluten-Free
Marsha McCulloch, M.S., R.D., L.D., C.L.T.

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Giving up gluten—the grain protein that makes bread dough stretchy—is critical for the health of people with celiac disease. New studies show millions more may face health risks too.

Going gluten-free (GF) isn't an option for people with celiac disease. It could be a matter of life or death. An estimated 3 million Americans have the condition—and millions more haven't been diagnosed yet. An even larger number may have gluten sensitivity, a condition whose symptoms often mimic those of celiac disease. Here's what you need to know about these conditions and some tips for living with them.

When someone with celiac disease, a hereditary autoimmune condition, consumes gluten, their body misinterprets it as a foe. That triggers the immune system to attack the lining of the small intestine, often resulting in digestive problems. The treatment? Eliminating wheat, rye, barley and related gluten-containing grains.

What to watch for
Don't dismiss the possibility of celiac disease just because you don't have diarrhea or stomach troubles. Ultimately gluten can harm any tissue or organ in the body—causing about 300 possible symptoms.

The most frequent way the disease shows up in both children and adults is iron-deficiency anemia and related fatigue, according to Alessio Fasano, M.D., a renowned celiac disease expert and medical director of the University of Maryland Center for Celiac Research in Baltimore. Even seemingly unrelated symptoms such as recurrent miscarriages and infertility may signal the disease in adults, he says. Children may have stunted growth or changes in school performance and behavior.

If you suspect gluten is a problem, request a blood test. But wait to change your diet until after you're tested, or you'll risk skewing the results. If your doctor has ruled out a wheat allergy and nothing turns up in celiac tests—yet your symptoms subside when you go gluten-free—you may have nonceliac gluten sensitivity. (See Gluten sensitivity below.)
Finer points of eating GF
Sneaking a bite of gluten-containing birthday cake isn't an option for people with celiac disease. Ingesting mere crumbs of gluten can cause harm, even if the person doesn't feel sick. So it's crucial to avoid obvious sources as well as gluten contamination. For example, use separate colanders, toasters and other difficult-to-clean kitchen equipment, says Melinda Dennis, M.S., R.D., coauthor of Real Life with Celiac Disease (AGA Press, 2010). Similarly, use squeezable mustard and other condiments and separate jars of peanut butter to avoid crumbs from knives, she says.

With an ever-growing array of gluten-free baked goods and mixes on store shelves, a potential pitfall of the diet is overdoing these packaged items. "When gluten-free food manufacturers try to mimic the texture of regular wheat bread, cakes and cookies, they often add more fat and sugar, which can double the calories," Dennis says. Additionally these goodies often are made with nutritionally poor refined starches. Instead she recommends these "super six" grains: amaranth, buckwheat, millet, quinoa, sorghum and teff.

Dennis also teaches her patients to eat plenty of naturally gluten-free vegetables, fruits, nuts, seeds, lean meats, fish and poultry. These foods help people get nutrients that can fall short on a gluten-free diet, including fiber, iron and B vitamins.

Adjusting to the diet
Going gluten-free requires effort, and it can take time to get used to the flavor and baking properties of alternative grains. "Some gluten-free flours work better than others in certain recipes," says Nicolette Dumke, author of gluten-free cookbooks available at food-allergy.org. "For example buckwheat flour makes good yeast bread, while quinoa flour paired with sesame seeds makes tasty crackers."

The gluten-free diet also can be expensive. One nationwide study found swapping regular bread with gluten-free versions doubles the cost. To save money Dumke suggests making gluten-free breads with a bread machine that has programmable cycles for kneading, rising and baking times. (Note: Use the machine exclusively for gluten-free baking.) Preparing gluten-free main dishes in large batches and freezing them also stretches your dollar.

"Cooked meats, beans and vegetables freeze very well," Dumke says. With a little planning you'll not only save time and money, but you'll likely be eating more nutritiously too.
Gluten sensitivity
If tests fail to show you have celiac disease but going gluten-free is the only thing that relieves digestive issues or other symptoms (which often mimic those of celiac disease), you might have gluten sensitivity. "Between 5 and 7 percent of the U.S. population has nonceliac gluten sensitivity," says Alessio Fasano, M.D., based on a groundbreaking study his team completed in 2010. There's not yet a validated test for gluten sensitivity that you can ask your doctor for, but Fasano and his colleagues have begun a carefully controlled study to help pinpoint blood markers of the condition. He says it could be three to five years before a diagnostic test is available. For more information visit celiaccenter.org 

Gluten patrol
These common items often contain gluten that's easy to overlook. Always read product labels, even if you've bought the item before. When in doubt, ask the manufacturer.
  • Beer
  • Broth or bouillon
  • Communion wafers
  • Fast-food French fries
  • Imitation crab
  • Licorice
  • Luncheon meats
  • Medications
  • Rice pilaf mixes
  • Salad dressings
  • Scalloped potatoes
  • Soy sauce
  • Supplements


Marsha McCulloch, the author of this article, has been a dietitian for 15 years and has completed specialized training from the Celiac Sprue Association. She is also a Certified Lifestyle Eating and Performance (LEAP) Food Sensitivity Therapist and a Certified Gluten Coach.
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