Celiac Disease

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Picture of villi in the intestines

 May is Celiac Awareness Month
By: Hannah Chapeskie, Dietetic Intern 2021
Did you know that 1 in 133 people live with celiac disease? It affects people of every age, sex, and ethnicity and is not the same as a gluten intolerance or gluten sensitivity.
What is Celiac Disease?
Celiac disease (CD) is an autoimmune disorder that impacts the digestive system. For people living with CD, consuming gluten (a protein found in grains such as wheat, barley, and rye) triggers the body to attack the lining of the small intestine. This damages the intestinal villi that line the small intestine and are essential for absorbing nutrients. As a result, people with unmanaged CD can become deficient in many vitamins and minerals. Have you or a loved one recently diagnosed with celiac disease? Are you looking for nutrition support?

Picture of blood test

Signs and Symptoms:
There are more than 300 symptoms associated with CD and every individual can experience CD differently. Some individuals with CD experience no outward symptoms at all which makes diagnosis difficult.
 Some of the more common symptoms include:

  • Anemia
  • Anxiety
  • Bloating and abdominal pain
  • Delayed growth (in children)
  • Depression
  • Dermatitis herpetiformis (blistery and itchy skin rash commonly on the elbows, knees, and buttock or entire body)
  • Fatigue
  • Headaches
  • Irregular bowel movements (constipation, diarrhea, or both)
  • Joint pain
  • Steatorrhea (pale, foul smelling, fatty stool)
  • Tingling/numbness in the limbs
  • Unexplained weight loss

Risk Factors:
It is unknown what exactly causes the development of CD, however, you are at higher risk if you are female, have a family history of CD or dermatitis herpetiformis, have type 1 diabetes, and/or have another autoimmune disorder. Research has shown that CD tends to become active following a surgery, pregnancy, infection, or severe stress.
Diagnosis begins before one starts a gluten-free diet to avoid false negatives. A blood test is performed to look for specific antibodies that are produced in someone with CD. These tests include IgA-TTG, IgA-EMA or a combination of both. Total serum IgA can be tested as well as an IgA deficiency can lead to false negatives in the previous tests. If blood tests are positive, a biopsy of the small intestine is performed to look for damage and inflammation due to CD and confirm the diagnosis.
Undiagnosed Celiac Disease:
With a wide range of symptoms, around 83% of sufferers go undiagnosed, or misdiagnosed with other conditions such as IBS, lactose intolerance, chronic fatigue, and/or ulcers. Undiagnosed CD can lead to the development of other autoimmune disorders such as type 1 diabetes and multiple sclerosis (MS) as well as other health complications. Many complications are attributed to prolonged nutrient deficiencies due damage of the intestines and can include anemia, lactose intolerance, osteoporosis, infertility, heart disease, intestinal cancers, peripheral neuropathy (pins and needles/numbness in limbs), epilepsy and more.

Currently, the only treatment for CD is to adhere to a gluten-free (GF) diet for life. Going gluten-free allows the small intestine to repair itself and can reduce symptoms. A gluten-free diet avoids all grains that contain the protein gluten including wheat, rye, barley and sometimes oats. Although many foods may appear to be gluten-free, CD sufferers need to watch for items that are often contaminated with gluten, such as:

  • Lentils
  • Rice
  • Cornstarch
  • Flax and hemp seeds

Many cosmetic and personal hygiene products also contain gluten but typically there is not enough to trigger a reaction in someone with CD. Overall, it’s important that individuals living with CD learn how to read labels and identify ingredients that contain gluten, in order to avoid them. Have you or a family member been diagnosed with Celiac Disease? We can help ensure that all nutrient needs are met on a gluten-free diet.

Picture of bulk bins

Cross-Contact and Celiac Disease:
Cross-contact refers to when a gluten-free food is exposed to a gluten-containing food, making it unsafe for those with CD to consume. Being aware of how and where cross-contact can occur is essential in maintaining a strict, gluten-freediet and managing CD.
Outside of the home, avoiding cross-contact can be difficult to control. Here are some places where cross-contact can occur, and caution is adv
ised for those with CD:

At the Grocery Store

  • Bulk Bins – scoops may be used in multiple bins
  • Deli Counter – slicer may be used to slice both GF and gluten-containing meat
  • Packaged Foods – can be contaminated in processing, packaging and/or transport. Search for the “may contain gluten” or “contains gluten” statements on labels

Eating Out

  • Buffets – thermometers and serving spoons may be shared between dishes
  • French Fries – may be cooked in the same oil as battered or breaded foods
  • Meat – may be cooked on a gluten contaminated grill
  • Rice – may be cooked in a gluten-containing broth

In your own home, avoiding cross-contact can be easier to control but requires the entire household to be onboard. Here are some tips for ensuring a household member with CD stays safe:

  • Spreads – keep separate jam, butter, peanut butter etc. for the individual with CD
  • Toaster – have a separate toaster or use a toaster bag when preparing GF toast
  • Kitchenware – have a separate cutting board and wooden utensils. Clean shared kitchenware
  • and counter spaces well with separate sponges
  • The Air and Surfaces – be cautious of flour dust in the air and on surfaces. Always complete GF baking first
  • Food Storage – store GF foods and goods on the top shelf of the fridge and pantry in a designated area to avoid gluten-containing crumbs falling into GF foods

Are you finding the gluten-free diet overwhelming? The dietitians at For the Love of Food can help.

​Tips for Gluten Free Baking:

With so many gluten-free replacements and recipes available today, cooking gluten-free gets easier with time and practice. However, making gluten-free baked goods with the right texture and flavour can be difficult at first.
Here are some tips and tricks for baking better gluten-free favourites at home:

  • GF flour blends give the best texture and flavour and can be substituted for gluten containing flours cup-for-cup. We recommend GF flours by Cup4Cup, Robin Hood, Bobs Red Mill, GoGo Quinoa, and Anitas.
  • When recipes call for eggs, separate the eggs, adding the yolk to the batter and whip the egg whites to stiff peaks before adding to improve texture.
  • Use brown sugar instead of white to increase moisture.
  • Don’t be afraid of over-mixing as it can improve the texture when there is no gluten.
  • Allow batter to sit and absorb moisture for a few minutes after combining wet with dry.
  • Rely on a thermometer and bake times, not colour to test doneness.
  • Cook past the point where a toothpick comes out clean.

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