Complied by Don Lyon. (Nov. 2008)
Celiac Disease is an auto-immune condition which is triggered by eating gluten. Gluten occurs in wheat (and all its variations), barley and rye grains, and foodstuff prepared from them. Approximately 1% of the population is celiac, although only a small percentage of them have been diagnosed. CD is passed on genetically and is not contagious. There is a 10% to 12% likelihood of immediate family members also being celiac. A simple blood test called “anti-tissue transglutaminase” is about 92% accurate, and after a positive blood test, a follow-up gastroscopic biopsy provides a conclusive diagnosis. CD tends to occur with younger people, but can occur at any age. In adults, it is often triggered by stress, childbirth or menopause. Three-quarters of these with CD are female. While it cannot be cured, it can be controlled with an appropriate diet. If not controlled, several serious bodily conditions can follow.
Most of the food we eat is absorbed in the small intestine, through the intestinal villi. In celiacs, these villi are destroyed by gluten, although the villi normally will gradually regenerate on a gluten-free (GF) diet. Since most foods are absorbed through these villi, a celiac cannot absorb normal amounts of nutrition, vitamins or minerals. Until a celiac goes onto a comprehensive and pure gluten-free diet, he/she can have deficiencies like anemia (iron deficiency), and low bone density (including osteoporosis), as well as weight loss or slow growth, simply because these nutrients “went straigh through” without being absorbed.
Why is gluten-free a diet is required? Eating as little as 1/8th a teaspoonful of flour causes visible intestinal damage! One area of concern is called cross-contamination, occurring where a variety of foods are prepared without thorough food-equipment cleaning before gluten-free food is processed – two examples: gluten-containing crumbs from kitchen surfaces or a food- prep knife, toasters etc. get transferred to otherwise gluten-free food; and food manufacturing facilities contaminate by processing a variety of products without careful batch separation etc.
Celiacs generally prefer plain food items to avoid unintended cross-contamination from non-GF sauces, breaded meats, or inclusion of hydrolyzed vegetable protein (unless it is specified as from a non-gluten grain) tea, coffee milk and juice – for example: beer (barley malt) is out, but wine is OK; any vinegar but malt vinegar is OK; and many soya sauces are made with wheat, but not all. VH brand is GF.
So what do celiacs eat? A fairly normal diet, actually, but you need to read all the ingredients in detail, brand-by-brand, and variety-by-variety. Meat, fish, poultry, corn, rice, potatoes, all vegetables and fruit are good, but desserts can be tricky. And yes, there is rice and corn pasta (processed in Italy!). Breakfasts are quite manageable with care, although most cornflakes and rice crispies etc. usually have wheat/malt as a major ingredient. GF Oats are usually OK. Gluten-free bread is available at supermarkets and some health-food stores, usually frozen and not very local. Since GF bread is gluten-free and gluten is a binder, it tends to be crumbly but toasts well. Lunches are the most challenging meal. Almost all “prepared” foods (including dry and tinned soups) and processed meats have gluten components. Sandwiches and wraps with gluten-free bread or tortillas are useful. Items like potato skins, a GF meat sauce over rice or GF pasta, local soups made gluten-free etc. add variety. GF foods are often also organic and cost 2-1/2 to 3 times “regular” food items.
Eating out can be a challenge, but many restaurants are quite helpful. Fast-food and chain eateries are the poorest option. At least theoretically, the more upscale the restaurant, the more all meals will be individually prepared, and therefore the better possibility of getting a safe GF meal.
Buffets can be good choices, too! Celiacs need to carefully explain their needs to the server, and sometimes the chef. Some restaurants have special diet menus (request them), or it may be possible to have components from various menu items combined for a special meal (eg. a cut of meat from one menu choice, steamed veggies from a second menu item, and rice or potato from a third). Deep-fried potatoes are a poor choice, because battered fish or meats etc. are probably cooked in the same fat. And sometimes a celiac just shouldn’t eat there!