What Is Celiac Disease?

Gluten-free is still going strong. Every day it seems like there’s some new recipe to try, medical report to consider, or news item about to break the Internet.

Chains like Panera and Starbucks are testing out new product lines that are set to launch any day now. Students of beer (yes that’s a real degree) are researching the best compliant brews. A woman even sued a popular restaurant for tacking on a surcharge to her gluten-free meal. Who knew wheat could cause such hysteria?

The truth, though, is that gluten-free eating is not just a trendy diet to shed the pounds and look great in a swimsuit by summer. It originated as a medically necessary way of life for those with gluten sensitivities and the more serious Celiac disease, an autoimmune disorder that attacks the digestive system even when the tiniest trace amounts are eaten. In fact, a new report in the Journal of Pediatrics finds that giving up gluten is actually more harmful to non-Celiacs than good.

In honor of Celiac Disease Awareness Month, we take a closer look at the condition, its symptoms, and the treatments that can help create a better quality of life.

Defining Celiac disease

According to the Celiac Disease Foundation, the condition is defined as “an autoimmune disorder that can occur in genetically-predisposed people where the ingestion of gluten leads to damage in the small intestine.”

Gluten is a naturally occurring protein found in wheat, rye, and barley that acts as a kind of glue to hold food like bread and baked goods together. When people with Celiac disease eat these commonplace goodies, however, their body triggers an immune response that attacks the small intestine and damages the villi organisms in the interior lining of the gut that are responsible for nutrient absorption. With damaged villi, nutrients will not be absorbed properly in the body, which can lead to a whole host of health problems.

Foods that contain gluten

Unfortunately for those with Celiac disease, gluten is found in many of the popular foods that have become staples in the American diet, and are just plain enjoyable to eat. Some examples include:

• Pastas of all kinds, including spaghetti, ravioli, dumplings, and gnocchi
• Noodles, such as ramen udon, soba, chow mein, and egg noodles
• Breads and baked goods (croissants, pita, naan, bagels, flatbreads, cornbread, potato bread, muffins, donuts, rolls, cakes, cookies, pie crusts, and brownies)
• Crackers and pretzels
• Cereals and granolas, including some corn flakes and rice puffs that contain malt extract/flavoring and granola made with regular oats
• Breakfast favorites like pancakes, waffles, French toast, crepes, and biscuits
• Breading and batter commonly used with meats and vegetables
• Sauces and gravies that use wheat flour as a thickener
• Flour tortillas
• Beer and malt beverages
• Soy sauce

Those with Celiac disease will also need to regularly check labels for the following ingredients that are known carriers of gluten:

• Wheat and wheat flour
• Other varieties of wheat, like semolina, farro, and wheat berries
• Rye
• Barley
• Triticale
• Malt in all forms (malted barley flour, malted milk or milkshakes, malt extract, malt flavoring, and malt vinegar)
• Brewer’s yeast

Adhering to a gluten-free diet is no small task, and includes being stringent about making proper food choices and being choosier about restaurants, but thankfully there are a range of options that make substituting foods you love both easy and affordable.

Celiac disease symptoms

Celiac disease is often a hereditary condition, so if you have a family member who has been diagnosed, there is a greater probability you will also have it. In fact, people with a first-degree relative, such as a parent, sibling, or child, have a 1 in 10 chance.

If no one in your family has Celiac disease, you can still have it. Here are what some of the symptoms look like:

• Bloating
• Chronic diarrhea
• Constipation
• Gas
• Stomach pain
• Nausea and vomiting

In children, there can also be developmental issues due to lack of nutrient absorption, which is common with Celiac disease. Some of the signs to look out for include:

• Failure to thrive in infants
• Slowed growth and smaller stature
• Weight loss
• Irritability or mood swings
• Delayed puberty

Adults also experience a wide range of separate issues that stem from malnutrition. These can include:

• Bone or joint pain
• Canker or cold sores
• Headaches or lightheadedness
• Itchy skin rashes
• Depression and/or anxiety
• Fatigue
• Infertility or miscarriage
• Missed periods
• Seizures
• Tingling or numbness in appendages
• Weak, brittle bones and/or osteoporosis

It’s important to remember that Celiac disease affects everyone differently. Age alone can play a factor, but symptoms can also be dependent on how much damage has already been done to the small intestine. This could range from a slight upset stomach to more severe cases that include infertility or seizures.

Celiac disease testing

While it can be tempting to self-diagnose, the best course of action is to make an appointment with a doctor if you feel you could have Celiac disease. He or she will run one or more tests to make a diagnosis.

Blood test

The first (and most routine) option is a blood test, which will look for the presence of antibodies. This allows the doctor to gauge your body’s response to gluten since antibodies normally indicate an allergic response.

Endoscopy

If the tests are inconclusive, or there is a need for more specific testing, an endoscopy will likely be recommended. This involves a very thin tube with attached camera that travels through your mouth to your intestines and takes a closer look at the internal structure to identify any inflammation and possible damage, which can be dead giveaways of Celiac disease. A biopsy might also be taken. The procedure is brief (about 15 minutes) and relatively painless with sedation. It’s one of the best ways for your medical team to determine an official diagnosis.

A common mistake that some people make before testing is automatically switching to a gluten-free diet. While this will be a prescribed treatment if you do in fact have Celiac disease, jumping the gun could effectively alter test results and provide a false negative diagnosis.

If you’ve already chosen to go gluten-free and have yet to be tested, however, you can try a gluten challenge in order to get more accurate results. This requires eating a certain amount of gluten daily to build antibodies back up so that they show in pathology reports. Although, don’t try this without first checking with your doctor as he or she will need to monitor the process to ensure your safety.

A diagnosis (or not)

Even if your test results come back negative, gluten could still be to blame. Many people live with gluten sensitivity or a gluten intolerance, a less severe response that has many of the same symptoms as Celiac disease but does not damage the intestines. Currently, it is undetectable through testing.

On the other hand, test results may confirm suspicions and you might end up with a formal Celiac diagnosis. While this probably won’t come as good news, it can be a relief to know the source of health issues and get started on a treatment plan to get healthier.

Celiac disease treatment

The only real treatment for Celiac disease is the complete elimination of gluten from the diet—that means no cheat days or “I’m just going to try a bite.” Even the smallest amounts can trigger a reaction. It can be challenging at first, but there are a few useful tips that can make the transition easier:

• Build a support system. Managing Celiac disease doesn’t have to be something you do alone. Work with your doctors and a reputable dietitian or nutritionist who can provide guidance on how to shop, cook, and eat gluten-free long-term. It also can be helpful to find a support group (there’s a number of them online), and reach out to loved ones to help you through the life changes. When you’re ready, tell people you know—from close friends to colleagues—so the can help support you, too!
• Read labels. This might mean spending a little more time at the grocery store at first, scanning ingredient lists and examining packaging, but it will become more intuitive and help you in the long run to make healthier, more informed choices. You can also refer to the CSA Gluten-Free Product Listing for a handy roundup of commercial products that are gluten-free.
• Find good swaps. Eating gluten-free doesn’t mean you have to give up everything you love. There’s a ton of great tasting substitutes that let you still enjoy chocolate cupcakes, granola, and crunchy tortilla chips.

Gluten-free diet

Though it may sound limiting, eating gluten-free actually offers a wide range of options that are both satisfying and fulfilling. All of these foods are naturally gluten-free and can be go-tos when grocery shopping or eating out:

• Rice
• Cassava
• Corn
• Soy
• Potato
• Quinoa
• Flax
• Chia
• Nut-based flours
• Beans
• Millet
• Yucca

Gluten-free recipes

Switching up your diet can also provide the chance to get creative in the kitchen. Try these tasty gluten-free recipes that the whole family will love.

Gluten-Free Spaghetti With Bagna Cauda

You don’t have to say “basta” to pasta on a gluten-free diet. Simply combine chickpea spaghetti with everyday staples for this easy but tasty gluten-free pasta that combines garlic and EVOO with wild sardines and capers.

Spicy Tofu Bowl

Yes you cayenne make tofu flavorful! Top soba noodles with tofu marinated in a vibrant blend of spices, sweet maple syrup, and orange juice for a zesty dish that will wake up your tastebuds.

Raw Carrot Pad Thai

Oh hi, Pad Thai! Swap shaved carrot strips for traditional rice noodles (though rice noodles are A-OK on a GF diet), and you’ve got a lighter, brighter take on this Thai favorite that’s totally gluten-free and 100 percent delicious.

Green Spring Rolls

Need a new spin on gluten-free wraps? Roll herbs, veggies, and creamy avocado into Vietnamese rice paper rounds for a healthy but hearty bite.

Stuffed Sweet Potatoes

What can’t you do with a sweet potato? For a gluten-free quick lunch, try stuffing our favorite root vegetable with sautéed greens, top with sliced avocado, and drizzle with a tahini-turmeric dressing.

Gluten-Free Fish Sticks

If you still have childhood longings for fish sticks, here’s a quick and easy recipe that uses potato chips, corn flakes, and ghee to make the delicious breaded coating.

Gluten-Free Coconut Cake

Baked goods are not off limits when you use coconut. This recipe takes it to a whole other level with coconut oil, milk, and shredded coconut, plus oat flour, and raspberries.

Coconut Flour–Fried Chicken Wings

The party staple goes gluten-free when you use coconut flour for breading and season with cayenne pepper, sea salt, oregano, and other spices.

Gluten-Free Ramen Burger

Foodies can go gluten-free, too, with this ramen burger that is all the rage in the culinary scene and gets modified with millet and brown rice ramen and tamari.

Gluten-Free Blueberry Muffins

Breakfast is easy to do with this traditional recipe that uses almond flour, ghee, a bunch of tasty spices, and of course blueberries.

Illustration by Foley Wu