A British physician named Samuel Gee is considered the modern father of celiac disease; in 1887, he called the condition a "chronic indigestion" likely caused by diet, though his suspicions of what those dietary factors were proved to be wrong [source: Fasano]. After World War II, a Dutch pediatrician named Willem-Karel Dicke noted that fewer children died during the war when there was no bread, while their mortality rate rose again once bread was available. Scientists used that observation to pinpoint gluten, a protein found in wheat, barley and rye grains, as the culprit behind celiac disease.
When a person with celiac disease consumes gluten, the protein destroys the lining of the small intestine, leaving the intestine unable to absorb nutrients. The person can experience a wide array of symptoms on the road to malnutrition, including diarrhea, abdominal pain, muscle cramps, fatigue, depression and a skin rash. The only solution for this condition is to adopt a strict gluten-free diet. Any cheating, and the gluten could further damage the small intestine.
To many, the thought of a gluten-free lifestyle is intimidating and depressing. The diet can immediately impact a person's social life; children must deal with being unable to partake in the pizza parties and cupcake celebrations that occur throughout the school year, while a young adult may be frustrated by limited options when dining out with friends. Gluten-free products tend to be much more expensive than their regular counterparts. Lastly, a gluten-free diet can be difficult for shy people, who may have to call manufacturers, quiz chefs or ask a bride about the ingredients of her wedding cake before enjoying a meal.
In some places in the world, particularly in Europe, gluten-free diets are much more common. In Finland, for example, a person can walk into a McDonald's and order a gluten-free Big Mac. But for those who need a little more guidance on where to start, turn the page for a list of foods that can -- and can't -- be eaten.
The first step to eating a gluten-free diet is to swear off all wheat, rye and barley grains, as well as their derivatives. It's essential to read labels carefully to ensure these flours and grains aren't an ingredient. Unfortunately, wheat flour is commonly used in baking, as the gluten serves as an elastic thickening agent that gives baked goods their light and airy texture. That means that most breads, cereals, pastas, crackers, cookies and cakes fall on the restricted list.
However, gluten is found in some less obvious sources as well, including beer, candy, processed cold cuts, soups, sauces, soy sauce and salad dressings. Gluten is also often present in Communion wafers, vitamins, medications, lipstick, Play-Doh and toothpaste. Again, all labels must be read with a careful eye, and when in doubt, customers should contact manufacturers to ensure that a product is safe. If one of these products comes with a "gluten-free" label, it's not exempt from the investigative treatment, either; restrictions about what can earn the "gluten-free" label are fairly new and in some cases still being worked out.
So what foods can be safely consumed? Dieticians often recommend shopping along the perimeter of a supermarket, where fresh fruits and vegetables can be found, along with unprocessed beef, pork, poultry and seafood. Eggs, milk, unprocessed cheese and yogurt and butter are also OK. There are some gluten-free finds to be had in the middle of the store as well, including unflavored potato chips, popcorn, plain nuts, packaged fruits and veggies, and sugar. And all grains aren't forbidden; rather, those eating a gluten-free diet can still enjoy grains that are naturally gluten-free, including corn, potato flour, quinoa, rice and soy. Eating out with celiac disease involves working with restaurants to determine which ingredients are safe and where substitutions can be made; an increasing number of restaurants are popping up to serve those with celiac disease exclusively.
These restaurants, along with the increasing number of products labeled gluten-free, have allowed many who can't eat gluten to partake in their beloved bagels or pastas. But as this niche market explodes, many are wondering whether a gluten-free diet could benefit more than just those with celiac disease. Should everyone go gluten-free?
Adopting a Gluten-free Diet
Since many gluten-free products are sold in health stores, some people have come to the conclusion that eliminating gluten from their diets is a healthy move. These people may put themselves on a gluten-free diet, but doctors caution that no research shows the benefits of gluten-free eating to anyone but those suffering from celiac disease. Those who have adopted the gluten-free life may think there's no need for research; they can tell that they feel better and possess increased stores of energy. That's likely because processed wheat products cause a spike in blood sugar levels, and the resulting drop makes a person feel lethargic. Rather than going completely gluten-free, those people may just want to eliminate processed foods.
Many with gastrointestinal discomforts might self-diagnose themselves as having celiac disease, but doctors ask that they not begin eating gluten-free until they receive a firm diagnosis. Eating gluten-free will affect the levels of antibodies in the blood that reveal celiac disease, and the current thinking is that people shouldn't begin eating celiac-free until they absolutely have to. For one thing, just because a gluten-free food product is in a health food store doesn't mean it's completely healthy. Some gluten-free foods are higher in fat and contain higher amounts of sugar, which aids those with celiac disease who may be underweight and malnourished from years of not receiving proper levels of nutrients. Those eating a gluten-free diet also usually need to meet with a dietitian to ensure they get enough nutrients through supplements; gluten-free foods are low on B vitamins, for example.
There's also a concern that as more people adopt a gluten-free diet, it will minimize the efforts of those who must eat gluten-free to fend off the evils of celiac disease. While it's helpful for more gluten-free products to be available, it may also increase the risk that product manufacturers become less vigilant at preventing cross-contamination.
Cross-contamination is a key issue for those trying to go gluten-free. As an example for how cross-contamination works, consider this: A mother is making sandwiches for her children, one with celiac disease and one without. If she spreads jam on gluten-containing bread and then uses the same knife to spread jam on gluten-free bread, there is a chance that gluten particles will make it into the sandwich intended for the child with celiac disease. In restaurants, chefs should prepare gluten-free items at a completely different workstation with separate utensils, and food labels should denote whether a food item has shared processing equipment with something containing gluten.
For more on celiac disease, see the links on the next page.
Related HowStuffWorks Articles
- Brody, Jane E. "With this Disorder, No Cheating on the Diet." New York Times. April 23, 2002. (July 20, 2009)http://www.nytimes.com/2002/04/23/health/personal-health-with-this-disorder-no-cheating-on-the-diet.html
- "Celiac disease." Mayo Clinic. Dec. 13, 2008. (July 20, 2009)http://mayoclinic.com/health/celiac-disease/DS00319
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- Fasano, Alessio. "Surprises from Celiac Disease." Scientific American. August 2009.
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- Huntington, Anna Seaton. "A Debilitating Disease That is Often Unknown." New York Times. Oct. 10, 2008. (July 20, 2009)http://www.nytimes.com/2008/10/10/sports/othersports/10celiac.html
- Mann, Denise. "Learning to Live with Celiac Disease." WebMD. Oct. 1, 2008. (July 20, 2009)http://www.webmd.com/digestive-disorders/celiac-disease/features/learning-to-live-with-celiac-disease
- Murphy, Kate. "Jury Is Still Out on Gluten, the Latest Dietary Villian." New York Times. May 8, 2007. (July 20, 2009)http://www.nytimes.com/2007/05/08/health/08glut.html
- Nardiello, Carolyn. "Restaurants Offering Gluten-Free Options." New York Times. July 20, 2008. (July 20, 2009)http://www.nytimes.com/2008/07/20/nyregion/nyregionspecial2/20dineli.html
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