Zeroing In On Gluten

An article in the Cleveland Plain Dealer, Zeroing in on Gluten, offers a good basic overview on the subject of celiac disease, the better and more modern name for gluten intolerance.

An estimated 3 million Americans have celiac disease. The medical community doesn't define celiac disease as an allergy but an autoimmune disorder in which nutrients aren't properly absorbed in the small intestine. The culprit is gluten, a variety of grain-based sticky protein found in a vast array of natural and manufactured ingredients and food products -- including wheat, barley and rye flours that provide the tender, elastic texture in that slice of bread.

It is estimated that the condition affects one in every 130 people worldwide, and it is undiagnosed in about 90 percent of Americans who have it.

Normally, nutrients are absorbed in the small intestine, which is lined with tiny fingerlike projections called villi. Villi add to the intestine's surface area, increasing its ability to absorb nutrients. But in celiac disease, gluten appears to flatten the villi and damage them, reducing the body's ability to take in nutrients properly. Inflammation of the intestine results.

Celiacs don't only suffer discomfort or serious pain when they consume gluten. The condition can lead to a wide range of symptoms and ailments, says Dr. Lori Mahajan, a pediatric gastroenterologist at Cleveland Clinic Children's Hospital.

"When infants and children develop celiac disease, it's typically when solid foods are introduced," she says. "They can exhibit abdominal pain, diarrhea, vomiting, bloating and gassiness. They can test positive for anemia. In older kids, there may be delayed puberty, or elevated liver enzymes, which can be misdiagnosed as hepatitis. Type 1 diabetes can occur."

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In adults, common symptoms can include abdominal distention -- a "bloated" feeling -- and intestinal discomfort ranging from bouts of flatulence to chronic severe pain. Weight loss can accompany the disease because of the body's inability to absorb nutrients, and fatigue and exhaustion often result.

"If the villi have fallen off the intestinal walls, you can't easily absorb carbohydrates," Mahajan says. Milk sugars become a problem for the patient who becomes lactose intolerant, which can be misdiagnosed as irritable bowel syndrome, she says.

Be Free For Me - Coupons for Special Foods

Photo by John Wilcox

Kathleen Reale discovered that she had celiac disease in 1994. As with so many others of us who have to turn to a special foods diet, she became frustrated with the lack of appropriate information and variety.

As Donna Goodison wrote for The Boston Herald, Reale has now created BeFreeForMe.com.

Her free Web site is targeting the country’s estimated 3 million celiacs and 12 million-plus people who have food allergies. It has signed more than 1,000 members since it launched last week amid Celiac Awareness Month. Reale’s goal is to have 5,000 members by the end of the year.

Those who join BeFreeForMe.com - which also will include online links to savings and samples as well as recipes, articles, product reviews and a blog by Reale - will receive a monthly newsletter and quarterly coupon books. Reale hopes to have offers from 48 product manufacturers, retailers and restaurants in the first book that will be sent by mail early next year.

The savings should be an enticement for prospective members, because many gluten- and allergen-free foods tend to be expensive, according to Reale. A box of gluten-free cereal can cost up to $5.50, and a loaf of gluten-free bread can be upward of $6.

There's a sign-up page at the site where you can agree to receive Reale's materials.

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Hasn't Australia Heard of Lactose Intolerance?

OK, I admit that in 1978, when I was first diagnosed, I had never heard the term lactose intolerance. That was a full 30 years ago. I thought it was common knowledge everywhere on the planet.

Then I saw this article on coeliac disease in the Australian newspaper, The Age.

Coeliacs have an auto-immune disorder of the small intestine; they comprise about 1% of Australia's population. A further 1% to 2% of adults suffer allergic reactions to products such as cow's milk, wheat, peanuts, eggs, soy, fish and seafood. And then there's the fast-growing, if less easily quantified, group who are intolerant of substances such as fructose and lactose, but whose symptoms fall outside the medical definitions of food allergy.

I imagine that the percentage of people in Australia who are lactose intolerant hasn't changed much in decades. Awareness of it may have grown, but not the underlying condition.

In addition, the symptoms of both fructose and lactose intolerance overlap those of food allergies. They are entirely different conditions - both from allergies and from each other - so they are indeed outsiders in that sense, but that is hardly the understanding you would get from that article.

My work is never done.

Food to Some, Poison to Others

With a husband an children who have celiac disease and a child who is lactose intolerant, Terry Traub has all the motivation of the author who writes a food book out of her experiences.

A press release on her, Beating the Back-to-School (Gluten-Free) Lunch Box Blues: Sanity-Saving Advice and Yummy Recipes for Moms of Kids with Food Allergies, has this to say:

Terry's first book, The Food Allergy Detection Program, was written in response to the trauma the family went through trying to detect what her boys were allergic to. Their predicament made her aware that other children and adults may have problems similar to her sons. Terry developed an elimination diet to isolate the allergens causing these problems. However, unlike other elimination diets, her method was in recipe form, not just a list of foods to avoid. Also, unlike the elimination diets of the time, she stayed away from any saturated fats during the diet as these can be difficult to digest.

Terry's new book, Food to Some, Poison to Others, is an expanded version of the first book. While primarily it is still an elimination diet, more has been added to the book. The book recognizes the problems with GERD (Gastro Esophageal Reflux Disease) and IBS (Irritable Bowel Syndrome), and changes the way the food is prepared to help with these diseases. The new book also has a chapter entitled "On the Road," which gives tips and advice on eating out.

The full title of the book is Food to Some, Poison to Others: The Food Allergy Detection Program.

Three Reasons to Avoid Wheat

Naomi Coleman of the The Daily Mail tries to sort out the various ways that wheat and gluten can affect systems. Here's a shortened version.

What is gluten intolerance?

Gluten intolerance - otherwise known as coeliac disease - is an inflammatory condition of the digestive tract, caused by gluten - a protein found in wheat, rye, barley and oats. It is not a contagious illness but is often genetic.

Coeliac disease affects one person in every thousand. Most people are diagnosed between the ages of 30 and 45. Classic symptoms include lethargy, weight loss, vomiting and diarrhoea.

The condition causes Gluten to damage the lining of the small intestine which greatly reduces the ability of the gut to absorb adequate nutrients from food. In the worst cases, this can lead to severe malnutrition. ... The only treatment available to sufferers of Coeliac disease is a gluten-free diet.

What is a wheat allergy?

A sensitivity or allergy to wheat can produce a variety of symptoms in the body such as sneezing itching, rashes, watery eyes, runny nose, coughing, hay fever, headaches, nausea, digestive problems, swollen limbs or general aches and pains.

When someone is allergic to a certain food, their immune system reacts as if the food were an invader and produces antibodies. ...

Unlike classic allergies, if you are allergic to wheat you will usually be allergic to more than one food. On average, sufferers react to four or five different foods.

Sufferers are advised to eliminate wheat from their diet altogether and replace with rice, corn, millet, buckwheat or potatoes.

What is wheat intolerance?

Wheat intolerance does not involve an immune response. The reasons why people suffer from wheat intolerance are not entirely understood. Some experts believe it occurs when some people are short of the enzymes necessary for the proper digestion of wheat.

Symptoms of wheat intolerance can include bloating, headaches and joint pains. ...

The only proper diagnosis for wheat intolerance is a test called a food challenge, carried out in a hospital. The patient is blindfolded and tested for wheat under controlled conditions.

The patient is then monitored over three days to see if they develop any symptoms. Depending on which foods they react to, a food elimination programme is carried out under strict supervision.

Intolerance Foods Market No Longer Niche

There's a huge potential market of foods for people with food intolerances and allergies that is being met, according to the global market research firm, Euromonitor International.

An article by Melissa Suggitt, Food intolerance products have massive growth potential in the UK, said:

Food allergies or “sensitivities” are on the rise in the UK, but the food industry is struggling to meet consumer demand for ever more specialised food intolerance products. As a result, many sufferers remain uncatered for or have to hunt around for highly priced items in specialist outlets. According to market analyst, Euromonitor International, now is the time for food manufacturers and retailers to realise that food intolerance products are no longer niche and hold massive growth potential in the UK.

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The UK is the third-biggest market for gluten-free foods (after the US and Italy), amounting to GBP47 million in 2006. Value sales of lactose-free products (dairy products, ice cream, baby foods) have increased by 29% since 2002, reaching GBP23 million in 2006.

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However, there is still much room for improvement. In an interview with Euromonitor International, a Food and Drinks Advisor at Coeliac UK confirmed that, although it was now much easier to get hold of specialist products, people resented having to pay such high premiums, and that most sufferers would like to see more “normal” products, such as gluten-free jaffa cakes, pitta breads, pizzas, sausage rolls or maybe even a pork pie. Such products do exist, but availability is limited to large stores.

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Euromonitor International suggests that food manufacturers would do well to further their investment in products that can be confidently labelled as free from wheat, gluten, cows milk, lactose, egg, soya, nuts and ominous additives, such as sulphites. Now would be a good time for larger players to acquire small specialist companies, who can provide uncontaminated products from their custom-built production facilities. Such companies can blossom once provided with adequate resources, as demonstrated by organic companies such as Rachel's Dairy (acquired by Dean Foods) and Green & Blacks (acquired by Cadbury Schweppes).

Euromonitor International wants to sell its pricey marketing reports and databases, of course, but the above is accurate. The UK has always lagged behind the North American market in the easy availability of specialty foods. And the US and Canadian markets could do with more and more affordable foods as well.

I hope some manufacturers are listening.

Doctors: Learn to Diagnose Celiac Disease!

Once a rare and virtually unknown disease in the U.S. celiac disease, or gluten intolerance, has become fairly well known and understood. Even better, there are many resources available for dealing with it, including many foods that are gluten-free as well as lactose-free. The lactose-free foods part is necessary because celiac disease destroys the villi, the tiny projections on the insides of the intestines where the lactase enzyme is made.

I've covered this topic in several recent posts, including Gluten-Free, Casein-Free (GFCF) Diet Helps Autistic Children, The Gluten-Free Restaurant Awareness Program (GFRAP), and New Gluten-Free, Casein-Free Diet Cookbook.

Apparently, celiac disease, or as they spell it coeliac disease, is not as well known in the U.K.

It's absolutely chilling to read Family's battle to have disease diagnosed by Lucia Clifford on the Warwick Today website.

To see her now, Summer Wareing is like any other active five-year-old.

She began to suffer with the symptoms of coeliac disease, but doctors put her ill health down to a reaction to her recent MMR booster.

Summer continued to suffer with severe diarrhoea and her condition was so bad, her mum Ruth took her to the doctor every couple of weeks. She was told to stop being 'neurotic' and that children pick up all manor of bugs.

As the weeks passed, the three-year old was losing more and more weight and had her tummy had become extremely bloated.

Ruth, of Burton Green, said: "After one particularly bad night, I took Summer to our local A and E department where the doctor just laughed and said: "It's the weekend, what do you want me to do about it?"

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Out of sheer desperation, they turned to private medical care. However, even this was not straightforward and the family had to persist before Summer finally had a blood test for coeliac disease.

When the results came back positive, her family were just relieved to finally have an answer, a diagnosis. However, unfortunately they couldn't begin to help their daughter by starting her on a gluten-free diet until she had had a biopsy to confirm the diagnosis. By the time biopsy was performed, Summer had no villi left in her intestines, which had led to an intolerance to lactose and she weighed less than when she was 18 months old.

Ruth added: "Trying to feed her on a gluten-free diet was a nightmare, she had become so afraid of food, all she knew was that when she ate her tummy hurt. Her doctors told me she was becoming a fussy eater and that we were making her worse because we were being sympathetic to her."

Eventually Summer did begin to trust again and did begin to eat but it wasn't easy trying to find gluten-free foods, while also omitting milk (due to her lactose intolerance), that would entice a three-year old.

Now five years old, Summer is thriving and according to her mum 'has way too much energy'.

It's hard to know whether this is an indictment of Britain's National Health Service (NHS), or just a general lack of knowledge among U.K. doctors.

Either way, the government doesn't come out very well.

People diagnosed with coeliac disease can be prescribed an NHS prescription for basic food including bread, pasta and flour.

Due to current funding considerations within the NHS, some PCTs have sought to restrict or stop prescriptions for gluten-free foods. Due to the comparatively high cost of gluten-free food for many people on lower incomes the prescriptions are essential to ensure they maintain a healthy diet. Coeliac UK has opposed measures to restrict prescriptions where it effects staple foods.

Coeliac UK is "the charity for people with coeliac disease and dermatitis herpetiformis*." Looks to be lots of good information and lists of gluten-free food on the site.

And try to make doctors aware of the problem so that no future Summers are so dark and stormy.


*"Dermatitis Herpetiformis (DH) is an important associated disorder or complication of celiac disease which is manifested in the form of a skin rash. There is strong evidence that the changes in the intestinal mucosa and the immunologic findings in the majority of patients diagnosed with DH are identical with those found in celiac disease. Gluten has been found to have a close relationship with this skin rash. DH is often referred to as "celiac disease of the skin" while CD is referred to as "celiac disease of the gut."
from the Celiac Sprue Association.