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GLUTEN
FREE INFORMATION
CELIAC
DISEASE-HIDDEN &
DANGEROUS
Celiac disease Is a genetically-based
autoimmune disorder in which specific peptides from wheat, rye, barley,
spelt, kamut, and triticale [collectively called gluten] trigger
progressive destruction of the villi of the small intestines. Gluten
consumption can result in deficiencies of certain vitamins and
minerals.
DERMATITIS HERPETIFORMIS is an expression of
celiac disease characterized by a blistering, intensely itchy skin rash, found
most frequently on the elbows, knees, buttocks and upper back. Patients with DH
often present with mild or no gastrointestinal symptoms, but villous atrophy occurs
in the majority of cases.
Celiac disease is now recognized as one of
the most common inherited diseases; therefore first and to a lesser extent
second-degree relatives are at a higher risk of having unrecognized celiac
disease.
SYMPTOMS
The symptoms of Celiac Disease can occur at
any age and the number and severity of symptoms associated with untreated
celiac disease vary greatly from person to person. In many cases the disease is
silent and is discovered only by blood screening. The presence of obesity or
constipation does not exclude the diagnosis of celiac disease.
The following symptoms may occur singly or in combination:
-anemia-iron,
folate/vitamin B12 deficiency
-recurrent canker sores
-deficiency
of Vitamins A, D, E,
K
-easy bruising
-abdominal
pain, bloating/cramping/gas
-bone/joint pain
-recurring/persistent
diarrhea
-edema of feet & hands
-constipation
-menstrual irregularities
-extreme
weakness and
fatigue
-infertility in men and & women
-weight
loss
-indigestion &
nausea
-lactose
intolerance
-migraines
-dermatitis
herpetiformis
-depression
-elevated
liver
enzymes
-recurrent miscarriages
-peripheral
neuropathy, ataxia, epilepsy with occipital
calcifications
Additional symptoms in children:
-vomiting -delayed
puberty -dental
enamel
abnormalities
-irritability
and behavioral
changes -delayed
growth -short
stature
CELIAC DISEASE FREQUENTLY OCCURS IN COMBINATION
WITH OTHER CONDITIONS,such as -type
1 diabetes
mellitus -osteoporosis -Downs
Syndrome
-lymphoma -Turner
Syndrome
-Other autoimmune diseases-e.g. autoimmune
hepatitis or thyroid disease.
Screening for Celiac Disease should be
considered if there is a family history of celiac disease or if there are symptoms of
celiac disease with any of the above diseases. There is a 10-15% chance of
having celiac disease if it is in your family
DIAGNOSIS
The similarity of the symptoms with those of
other diseases often leads to misdiagnoses such as irritable bowel syndrome,
lactose intolerance, chronic fatigue syndrome and diverticulosis, resulting in
even further delays. Blood tests-According to Celiac News 2010, the
IgA-based tissue transglutaminase antibody (TTG)is a highly sensitive and
specific teat and is currently the recommended screening test for celiac
disease. Both the IgA and IgG are now considered redundant. False negative
results can occur with these tests. False positive results can occur but are
rare.
An intestinal biopsy, while
an individual is on a gluten-containing diet,
is required to establish the diagnosis.
A GLUTEN-FREE DIET SHOULD NOT BE STARTED
BEFORE A BLOOD TEST AND BIOPSY HAVE BEEN COMPLETED, since it can interfere with
making an accurate diagnosis.
TREATMENT
The ONLY TREATMENT for celiac disease,
including those patients with DH, is a STRICT GLUTEN FREE DIET FOR
LIFE. This enables the gut to recover and can reduce the risk of
developing many of the complications of untreated celiac
disease. The services of a qualified dietician and regular
follow-ups with a physician are recommended. Join the CANADIAN CELIAC ASSOCIATION and
their local chapter for valuable practical information and ongoing support:http://www.celiac.ca
The safety of oats in celiac disease has been
extensively investigated. Clinical studies have shown that small amounts
of pure, uncontaminated oats are safe for most adults and
children. Most commercially available oats are contaminated with wheat, rye, or
barley; however pure, uncontaminated oats are now being produced in
Canada.
Being diagnosed with celiac disease today is
not as bad as it was a few years ago. Foods today are delicious and are varied
and abundant. With the help of the experts at your local health food store, you
can live a normal and happy life with great-tasting foods. It’s also a great
place to pick up information about celiac disease and mouth watering
recipes.
________________________________________________________________________________________________________________________________
HIDDEN GLUTENS
It is
assumed that, patients with celiac disease, once diagnosed, can eliminate
glutens from their diet safely by reading all the labels. For the
most part, this is true; however there are some disguised glutens to be aware
of.
MODIFIED
STARCH: if it is corn, tapioca, or potato starch, it is safe.However we as a
consumer do not know if the manufacturer has used wheat starch. Therefore, it
is wise to avoid anything made with modified starch.
DEXTRIN:
can be made from corn, rice, tapioca, or wheat. Avoid dextrin unless
the label clearly indicates from what source its from.
CARAMEL
COLOUR: can be made from dextrose(corn sugar), lactose(milk
sugar), molasses, invert sugar, or sucrose(beet or cane sugar).These are
all safe, but it could be made from malt syrup or starch hydrolysates which may
contain wheat.
FLAVOURINGS,
EXTRACTS & TINCTURES: Many of these contain grain alcohols. Read
labels carefully.
TRITICALE:
a grain found in some cereals and flour mixtures. This is a cross between wheat
and rye and contains gluten.
SIRIMI:
an imitation seaweed containing starch. Be sure to find out where the starch
comes from.
CANDY:
although companies are required to list all ingredients in their products, they
are not required to list anything under 1%. This can lead to problems with
celiacs as many candies found may be dusted with wheat flour to prevent
sticking.
PRESCRIPTION
DRUGS: many prescription and over the counter drugs contain gluten as a
filler.Be sure your doctor is aware of this. The best way is to talk to your
pharmacistfor this very important information. He is a much better source for
this info as many doctors still do not have a full understanding of Celiac
disease.
SOYA
SAUCE: Don't be fooled by its name. Most contain wheat. Choose
BRAGG'S Liquid Soy Seasoning or LifeMax Tamari Soy Sauce (comes in 4
flavours).
ICING
SUGAR: Many commercial brands contain wheat starch. REDPATH & LANTIC are
gluten free.
PEANUT
BUTTER: Many brands contain icing sugar. Unfortunately. The
companies do not list what starch is used. Choose a brand without icing sugar
or make your own at a Health Store that has their own Peanut Butter Machine.
Dry Roasted Peanuts are used with no additives. Great tasting and better for
your Health.
BAKING
POWDER: Some brands contain wheat starch. Choose a brand made from cornstarch.
There are Gluten Free Brands on the market. Rule of thumb with some is to use
50% more if the recipe calls for regular Baking Powder. ex.1 tsp.
Reg.=11/2 tsp G/F
House Call
Feb/Mar 2010 Issue
Too Much Iron
Celiac disease is linked to a
very rare genetic disease of iron overload, called hemochromatosis. (Symptoms
include chronic fatigue and abdominal pain, among others.) People with celiac
disease who also have hemochromatosis may not know it because the malabsorption
of celiac protects them from accumulating too much iron—until they go gluten
free. As they change their diet, their intestines heal and their iron levels
can rise dangerously. Serum ferritin is the best test to screen for iron
overload.
By Christine Doherty, ND
Iron
Deficiancy and Celiac Disease
This mighty mineral fights
fatigue
Iron deficiency is the most
common nutritional deficiency in the world. The World Health Organization
estimates that up to 700 million people suffer from lack of this important
mineral. Could you be one of them?
If you have celiac disease, you
are at risk. (A common manifestation of celiac disease is iron-deficiency
anemia.) Vegetarians are also at risk. (People on a strict vegetarian diet have
a difficult time maintaining healthy iron levels because vegetable sources of
iron are more difficult to absorb than animal sources.) Heavy menstrual
periods, pregnancy, any kind of internal bleeding (like ulcers) and certain
kidney conditions can also set you up for iron deficiency. Lack of vitamin K
can indirectly contribute because it can lead to poor blood clotting, which
causes increased bleeding and iron loss.
With its profound impact on
energy and even mood, iron has a major influence in determining your quality of
life. If your body lacks iron, it has too-few red blood cells and the blood
cells it does have are pale and small. Depletion symptoms range from pale skin,
light nail beds, brittle nails and rapid heart rate to lack of stamina, depression,
cognitive confusion and overall fatigue. In cases of severe deficiency, people
develop intense cravings, called pica, driving adults to crunch on ice cubes,
for example, and children to eat non-food items like chalk, dirt or paint
chips.
A simple blood test checks for
iron deficiency, usually diagnosed as anemia. However, if you’ve been iron
depleted for a long time (often the case for people with undiagnosed celiac
disease), you may be suffering from very low iron levels that won’t be detected
by the usual blood test. In this scenario, doctors can assess iron levels with
a more sensitive blood test, called serum ferritin. Celiac patients should
specifically ask for this test if they continue to have low-iron symptoms after
a blood test rules out anemia.
The foods richest in iron are
meat, specifically beef, dark chicken and turkey, and lamb. Molasses is a good
vegetable source (one tablespoon contains more iron than a 3-ounce steak), as
are teff, amaranth, pumpkin seeds, raisins and prune juice. Absorption is
enhanced by eating these items along with foods that contain vitamin C, like
citrus juice.
Studies reveal that many celiacs
are still iron deficient up to a decade after going gluten free. If you have
celiac disease, ask your health care practitioner to monitor your ferritin
level. Aim for a serum ferritin of at least 45. (Many labs use 10 as a bottom
range but people often continue to have symptoms at this level.) If tests
reveal your numbers are low, include more iron-rich foods in your diet. You may
also want to talk with your doctor about taking an iron supplement.
Supplements are often required to
reverse long-standing deficiency, especially in at-risk populations. Many iron
supplements contain ferrous sulfate, which can cause stomach pain, nausea and
constipation, particularly if taken on an empty stomach. Look for iron
bys-glycinate, which is better tolerated. In severe cases of deficiency, iron
can be administered at your doctor’s office via a series of injections or IV.LW
Christine
Doherty, ND, is a licensed naturopathic doctor who specializes in food
allergies and celiac disease. She lives in the Boston area.
Note that
iron excess increases the risk of heart disease and organ damage. Most people,
particularly men and post-menopausal women, should not take iron supplements
unless prescribed by their doctor. Consult your health care practitioner before
taking supplements.
Is Barley
(or Malt) Gluten Free?
By Marla Hingley
on November 22, 2014 .
Gluten is
a protein that is found in wheat (which includes; spelt, kamut, khorasan,
einkorn, faro, and emmer), rye, triticale (a rye/wheat hybrid), and barley.
Under no circumstance should people on a gluten free diet eat any of the above
grains, including barley.
Foods
Made From Barley
The
following foods are made from barley, or have a high likelihood of
containing barley, so be sure to read the ingredient label:
Another
product you need to be aware of that is made from barley, is malt.
Malt is
made using barley grains. The dried grains are soaked until germination begins,
at which point they are dried again. This process, known as ‘malting’, allows
the enzymes within the barley to turn the starches into sugars (maltose). These
sugars are further refined into malt syrup and malt extract, which can be added
to a number of edible products and is used to enhance flavor.
Foods Containing
Malt
Foods
that always contain malt, and therefore are never safe to consume
are:
Malt
syrup added to bagel recipe
Foods
that can contain malt, so be sure to check the label, are:
A form of
malt, maltodextrin, can be made from barley or wheat, as well as corn,
potato, or rice.
So how do
you know if maltodextrin is made from one of these safe ingredients, or
from a gluten containing grain like barley or wheat?
With the
new US Food Labeling laws, if maltodextrin is made from wheat it must state
that on the product label. Maltodextrin made in the US and Canada is always
made from potatoes or corn, however in other parts of the world it can still be
made with barley or wheat.
Reading
Labels - Words to Watch Out For:
*barley
*malt
*malt
syrup,flavouring or vinegar
*wheat
or barley maltose
*wheat or
barley maltodextrin
Diagnosing Celiac In People
With IgA Deficiency
There has
been significant progress in the development of good blood tests for celiac
disease. The same blood tests can be used to screen people at risk as well as
help make the diagnosis. The tests are accurate enough that some experts
believe small bowel biopsies may not be needed to diagnose CD in children.
The tests
measure antibodies in the blood that are targeting specific substances called
antigens. One antigen is tissue transglutaminase (tTG), which is present on
intestinal cells, and is an “autoantigen” or normal part of the intestinal
tract that stimulates antibodies in people with CD. Large amounts of
immunoglobulin A (IgA) to tissue transglutaminase (IgA anti-tTG) almost always
mean a person has celiac disease.
Antigliadin
antibodies tests are not reliable enough to screen people or make the diagnosis
of celiac disease
In the
past, tests measured antibodies against gliadins, which are parts of gluten.
However, antigliadin antibodies tests are not reliable enough to screen people
or make the diagnosis of celiac disease. Researchers learned that people with
CD make antibodies against modified gliadins, called deamidated gliadin
peptides (DGP). Other blood tests now measure IgA antibody to DGP (IgA
anti-DGP).
These are
both good tests. There are different commercial kits used to measure the
antibodies, and there can be slightly different results from different labs.
Some doctors use both tests, some only one, to screen for celiac disease. Not
only can these tests help make the diagnosis, but they can also be used to
follow progress. IgA anti-tTG levels come down when people with CD follow a
gluten-free diet.
However,
there is one group of people who cannot be screened for CD with these tests.
This is the group of people who have low levels of IgA, called IgA deficiency.
Because they do not make a lot of IgA, they do not make enough IgA anti-tTG or
IgA anti-DGP to test.
How big
of a problem is this? By some estimates, one in 600 people of European descent
is IgA deficient. It is also estimated that approximately 1% of this population
has celiac disease. These two conditions are related. People with IgA
deficiency are more likely to have asymptomatic celiac disease than people
without the deficiency. Compared to people who have normal levels of IgA, they
are 10 to 20 times more likely to have celiac disease. Research has also shown
that IgA deficient individuals and people with celiac disease have similar HLA
types, the underlying gene groups that predispose people to develop CD.
These two
conditions are closely enough related that many experts recommended checking
total IgA levels when doing celiac blood testing. If the results show IgA
deficiency and neither of the celiac tests are positive, further evaluation
must be done.
There are
a number of different kinds of immunoglobulins, or antibodies. IgA is made in
the intestine. IgG is made by blood cells that have been activated against an
allergen or infectious agent. People who are IgA deficient usually still make
IgG.
The only
tests being used right now to diagnose celiac disease in people with IgA
deficiency are IgG levels to the same antigens. IgG to tTG and IgG to DGP are
the two levels that are measured.
A
recently published study presented data about these tests from research done in
Sweden. The researchers were able to look at information from 488,156 people
screened for CD. Of these, there were 1,414 IgA deficient individuals, and of
these, 356 agreed to participate in further study. 47 blood donors who were IgA
negative served as control subjects; they had no symptoms of celiac disease.
Not every study participant had all data collected, including lab tests and
surveys, so the information is partially incomplete.
18.8% of
the IgA deficient subjects (67) with suspected celiac disease had IgG anti-tTG
antibodies, and from 15.7% (56) to 21.3% (76) had IgG anti-DGP, with one brand
of test kit finding a higher number. 54 had celiac disease confirmed on
intestinal biopsy.
There
were also some individuals from the blood donation group who had positive IgG
tests, and four went on to have biopsy-proven celiac disease. There were 58
total patients in the study with definite CD. 63% (34) were IgG anti-tTG positive.
52% (28) were positive for IgG anti-DGP with one test kit and 65% (35) with the
other test kit. There was no one test guaranteed to give a positive result in
patients who actually did have celiac disease and IgA deficiency.
Blood
tests for the diagnosis of celiac disease in people with IgA deficiency are not
as accurate as those for people who have normal IgA.
One other
type of blood test can be done, which is HLA typing, looking for the genes that
make a person susceptible to CD. If someone does not have either types HLA-DQ2
or DQ8, they almost certainly do not have celiac disease. Someone with one of
these genes, IgA deficiency and negative IgG tests with symptoms or signs of
celiac disease may still need small bowel biopsies.
This
study confirms that at the current time, blood tests for the diagnosis of
celiac disease in people with IgA deficiency are not as accurate as those for
people who have normal IgA. In addition, the researchers looked at the IgG
levels when people with CD were on a gluten-free diet. They were just as high
in some of the individuals on the gluten-free diet as those not on the diet.
The researchers noted that this has been seen in other studies. While IgA
antibody levels are useful in following people with celiac disease and
correlate with their dietary adherence, the same cannot be said of IgG
antibodies.
Physicians
should order these IgG tests on patients with suspected CD who have IgA
deficiency.
It is
very likely that better blood tests will be developed in the future, but at
this time, all the available information must be considered carefully in IgA
deficient individuals with possible celiac disease.
Reference
Ning Wang, Lennart Truedsson, Kerstin Elvin, et al. Serological Assessment for
Celiac Disease in IgA Deficient Adults. PLOS ONE. www.plosone.org 1
April 2014 | Volume 9 | Issue 4 | e93180
LIVING WITHOUT’S GLUTEN FREE & MORE
Fortify & Enrich That
Gluten-Free Diet
Many conventional processed foods are fortified;
gluten-free processed foods aren't. Does it matter?
By
Kirstin Boncher
After I
switched my family to a gluten-free diet, I noticed that the processed foods we
had given up were fortified and enriched, while our gluten-free equivalents
were not.
Despite
their healthier diets, my children were not getting these micro-doses of extra
vitamins and minerals throughout the day that kids on typical diets get.
Given my
children’s problems with malabsorption, they were missing out on nutrients they
very much needed. Fortified and enriched products help those eating processed
foods get important vitamins and minerals. For people on gluten-free or
dairy-free diets, the lack of fortification or enrichment in equivalent
products can be an issue.
Why Fortify?
Fortification
is the process of adding certain vitamins and minerals to processed food
products. For example, cow’s milk, a widely consumed staple, is fortified with
vitamin D, which aids in calcium absorption. Table salt, another household
staple, is fortified with iodine, critical for thyroid function. Many
mainstream dry breakfast cereals are fortified with a slew of extra vitamins
and minerals.
Enrichment
is the practice of adding nutrients back into processed food that are lost
during processing. White wheat flour is an example of a staple food that’s
enriched. Nutrients lost during the removal of the wheat bran, typically iron
and B vitamins like folic acid, riboflavin, niacin and thiamin, are replenished
in the flour. Gluten-free flours are not similarly enriched.
“We know
that specific nutrients are vital to our health but there doesn’t seem to be a
way to get enough of what we need in the typical modernized American diet,”
says registered dietitian Geri Brewster, RD, MPH, CDN of Mount Kisco, New York.
“That’s why fortification and enrichment become necessary.”
If your
special diet has you giving up processed products that are fortified and
enriched, make sure the foods you choose are nutrient dense. Eating a wide
variety of wholesome, single-ingredient, unprocessed foods is the best way to
ensure you’re getting adequate nutrients.
People
who obtain the majority of their calories from gluten-free processed products
should be vigilant about getting adequate nutrients from other sources and that
includes vitamin and mineral supplements.
“Ideally,
all our nutrients would come from whole food sources,” says Brewster. For those
who must forgo fortified staples (like enriched wheat flour and vitamin-D
fortified milk) due to food allergy or sensitivity, she recommends a whole
foods diet along with appropriate supplements.
“If
you’re eating processed foods, make sure they are as clean and nutrient dense
as possible,” Brewster says. “The goal should be to get your nutrients from
highly nutritious whole foods and then use targeted supplementation based on
one’s bio-individuality to maximize health and minimize the risk of disease.”
Consult a
knowledgeable dietitian or physician about supplements and proper dosages.
Freelance
writer Kirstin Boncher blogs at ourGFfamily.com MyLifeWithFoodAllergies.co
I'm a celiac and I take a supplement to give me a fairly steady daily intake of needed vitamins and minerals. Most of the food I eat is basic, simple stuff-- fruits and vegetables, grains, roots and legumes, meat and dairy products-- but some of it, like the wine I drink probably a bit too much of, doesn't provide much in the way of nutrition. And I don't think xanthan gum and tapioca flour are high in nutrients, either. For a while, coming off a pre-diagnosis diet, and on recommendation of my doctor, I took an iron supplement as an aid to getting me out of the celiac-induced anemia that lingered after I went gluten free. I think a good approach is to eat nutrient rich foods, and supplement as necessary. To find out what is necessary, it's probably advisable to talk to your doctor about getting the necessary testing done on a periodic basis.
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PRODUCTS AVAILABLE IN OUR BAKED GOODS SECTION: SPECIAL ORDERS ON REQUEST.
PIES:
-Pecan-G.F.
& G.F./D.F.
-Pumpkin-
as above
-Apple-only
in the fall & By order
-Lemon Sponge & Lemon Meringue-by special order and they don't freeze[but I will make them for you fresh if you let me know the week before.]
CAKES:
-Flourless
Chocolate Quinoa- G.F. & G.F /D.F.
-Chocolate
Oatmeal -as above-special order(great cake if you want a large cake)
-Banana-as
above; with white or chocolate icing
-Carrot-
as above
SQUARES:
-date
-pecan
-butter tart -lemon -lemon coconut
-hello
dollies[chocolate, butterscotch]
-cherry squares
-grasshopper-mint
nanaimo
-brownies-with or without nuts -raspberry squares
COOKIES:
-chocolate
chip
-peanut butter chocolate chips
-peanut
butter
-gingersnaps
-oatmeal raisin -oatmeal chocolate chip
-hermits
-chocolate
chunk shortbread-at Christmas
-shortbread-at Christmas
We also make a MONSTER cookie which is no flour, but uses oats and nut butters.
QUICHES - broccoli, ham,tomato,shrimp,crab,mushroom....all with cheese
This is a list
that may be expanded over the Christmas season to include CHRISTMAS
CAKES, CARROT PUDDINGS,-----SPECIAL ORDERS ARE NEEDED FOR OUR PUDDINGS.
