Celiac Disease Feeds Gluten-Free Need

By Marie Spano, M.S., R.D., C.S.C.S., Contributing Editor

The incidence of celiac disease is four times higher today than 50 years ago. This increase isnt solely due to advances in detection; on the contrary, many people live with celiac disease for years before being diagnosed. In addition to the increase in incidence, consumer awareness has also grown, boosting the demand for gluten-free foods.

Approximately 2 million Americans have celiac disease, making it more prevalent than Crohns disease, cystic fibrosis and ulcerative colitis combined. This genetic disease affects the digestive system, leading to damage in the small intestine and malnourishment. For those with celiac disease, the protein gluten, found in wheat, rye and barley, causes an immune reaction that destroys villi, the fingerlike projections in the small intestine that help us absorb nutrients from the food we consume. This can lead to anemia, osteoporosis, miscarriages and other complications from long-term malabsorption.

More celiacs coming

Unfortunately, many people with celiac disease are misdiagnosed, or it may take up to 11 years to get an accurate diagnosis, according to Shelley Case, R.D., celiac researcher and co-author of The Canadian Celiac Health Survey (Digestive Diseases and Sciences, 2007; 52(4):1,087-95).

Scientists believe only 5% to 10% of those living with celiac disease are diagnosed. Those with celiac disease may have no symptoms, gastrointestinal issues or vague symptoms that are common in many other ailments and illnesses. People with Graves disease, type 1 diabetes and Hashimotos disease have a greater incidence of celiac disease than the rest of the population.

Wheat is a major staple of the North American diet and accounts for a large portion of the gluten we consume. Gluten is also naturally found in foods that contain rye and barley, and in a number of other foods due to cross-contamination. Cross-contamination can occur during growing, harvesting, transporting and processing of various crops and food items.

Gluten-free designs

The only treatment is to stick to a gluten-free diet. In most cases, this will reverse existing intestinal damage, although this process could take a few years in adults. Following a gluten-free diet means steering clear of most traditional grain-based foods, including pasta, cereals, breads and crackers. Naturally gluten-free foods, such as fish, poultry and meats, as well as fruits and vegetables, are OK in their natural state. However, celiac patients need to become astute label readers, looking for words such as wheat starch, wheat bran, graham flour, Kamut and hydrolyzed wheat protein. They may also need to check with food manufacturers or restaurant chefs to determine if a meal contains sources of gluten. Studies indicate that the tolerable daily gluten threshold varies, but as little as 10 to 50 mg of gluten can cause problems in some people with celiac disease.

Codex Alimentarius allows the term gluten-free on products containing wheat starch, as long as the gluten does not exceed 20 ppm in the food. This definition of gluten-free has been proposed to FDA, but it has yet to be finalized, in part because FDA is looking at the tolerable dose. Although there is no formally accepted definition for gluten-free at this time, the Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that labels clearly identify wheat (as well as other common food allergens) in the ingredient list.

A variety of grains, seeds and starches can be gluten-free alternatives: corn, sorghum, potato, rice, amaranth, quinoa, arrowroot, buckwheat, millet, tapioca, teff, mesquite flour, flax and bean flour. Food scientists are also researching gluten-free replacements for gluten functionality, such as egg and other proteins, gums, and specialty starches. Wheat-based starch hydrolysates, such as glucose syrups and maltodextrin, contain low to insignificant amounts of residual gluten and are considered safe for celiac patients. Wheat starch varies in the amount of gluten in the final product, but can be processed in a manner that removes the maximum amount of gluten.

Marie Spano, M.S., R.D., C.S.C.S., is a nutrition communications expert whose work has appeared in popular press magazines, e-zines and nutrition-industry trade publications. She has been an expert guest on NBC, ABC and CBS affiliates on the East Coast. For more information, visit mariespano.com.