Gluten Free Holidays

Writing a blog at the end of October regarding health seems to almost beg me to write about insulin resistance, but instead I resist the cliché. However, as obvious by the amount of food that has begun to circulate the workplace, Halloween is the start of the holiday binges. Because my stomach was focused on food today, I thought I would write something about gluten.

Gluten is now the dominant protein in wheat, about 80% thanks to genetic grain breeding. Gluten is composed of a mix of gliadin and glutenin and is now one of our most common food allergens. Celiac disease is a genetic disorder where individuals are unable to digest the gluten protein. As a result, the small intestinal lining may become flattened; losing it's villi and it's absorptive qualities. The immune dysfunction caused by patients with celiac disease eating gluten is also profound, increasing the risk of liver disease, autoimmune diseases as well as a higher risk of cancer. The exact cause of celiac disease is unknown, but new research suggests that it requires a genetics situation combined with an environmental trigger. Two genetic phenotypes tend to have celiac - HLA DQ - 2 (95%) and HLA DQ-8 (5%). It is estimated that 1 out of every 90 individuals in the US has celiac disease and the incidence is thought to be growing significantly. It is also estimated that only about 1% of those individuals know they have the condition.

Some individuals don't have celiac, but instead have a wheat allergy or a wheat intolerance. An allergy means that you activate your immune system usually with IGG or IGE immunoglobulins. With celiac a different part of the immune system is effected and many patients will not have an IGG or IGE reaction to wheat. However, a number of people with celiac may also have an allergy to wheat as well. The third wheat problem is someone with a wheat intolerance. These people also feel better not eating wheat even though they don't have a true allergy. For them, there maybe multiple factors involved in their reactions. It's important to note that because celiac disease is a combination of genetics + environment, many people may have the genetic potential their entire lives, but not activate that potential until adulthood.

Getting diagnosed:
It is said that in the US it will take 10 years and 10 doctors in order to be diagnosed with celiac - in Europe the average time to diagnosis about 6 months. In certain countries, doctors are more aware of celiac disease and so it is diagnosed at younger ages or faster on symptom output.

So how do people escape diagnosis? I think that comes from a combination of several factors:

1. The US is a gluten-loving society - we start on wheat cereal from infancy and until recently it was on the bottom of our food pyramid. We can't imagine (either patients or doctors) that bread could be bad for us.

2. Doctors and Individuals think of gluten-free as a deprivation diet - gluten-free for celiac is LIFELONG even if symptoms resolve. But, eating poison everyday isn't good for you and if you have celiac then gluten equals poison.

3. US physicians are not well trained in celiac disease - they know what it is, but many don't acknowledge the high incidence. They think of it as a zebra diagnosis; something that they are unlikely to see in their office. It is thought to be 1/90 people according to new research.

4. Celiac mimics other things. Although it has a classic symptom picture, it actually can produce a number of low-grade symptoms or even neurological symptoms without any intestinal symptoms. You do not have to have GI symptoms to have celiac disease. Symptoms may change throughout the years and may not even show any symptoms.

5. The lab testing is commonly negative even with people with severe symptoms.

One thing to know is that you can be diagnosed several ways. Blood work may be helpful - if it's positive, it's positive. This test does have a high false negative rate. So your lab work may be negative even though you may have horrible celiac disease. You can do a screening for the HLA type: http://www.kashilab.com/. This can tell you whether you are in the 30% of the population that is at risk (you may still have a wheat allergy or intolerance). If negative, you may still have a wheat allergy or intolerance. You can do a fecal test: http://www.enterolab.com/
The gluten free diet - FOR LIFE
Being gluten free today is not the same as it was 10-15+ years ago. Today, it is easy to be just as "bad" in your diet gluten-free as gluten-filled. It is also easier as major food manufacturers also announce gluten free options. Just this week Betty Crocker announced gluten free mixes: http://www.bettycrocker.com/products/gluten-free! Our local grocery store carries a large assortment of gluten free products and flours and Bob's Red Mill http://www.bobsredmill.com/ has flours that we can make things from scratch. Almost every restaurant here in Portland has a gluten free menu as do many of the national chain restaurants (you may have to ask). The internet has also allowed us to exchange and post recipes and support for people struggling gluten free. That's not to say that being gluten-free isn't without challenges. Products commonly post wheat-free where they may not be, restaurants don't realize that their spice mix contains gluten, and friends don't realize that using their wooden cutting board to cut the gluten free bread may contaminate the sample. A 1/4 of a cracker per day may be enough to completely keep the small intestinal tract malabsorptive. Becoming truly gluten-free is an exercise in label reading, self confidence in demanding answers and perhaps a few baking disasters. BUT, the results can be absolutely miraculous. Imagine, trying new grains, avoiding gluten and not being in pain, being in GI distress, growing (children), getting stronger, not getting autoimmune disease. It's worth it! See http://www.celiac.org/lifestyle.php - I haven't tried anything of Shauna James Ahern's that hasn't worked out. Her oven is clearly better than mine leading to me having to cook longer, but fabulous. I always end up doubling the recipes. I highly recommend her biscotti: http://glutenfreegirl.blogspot.com/2009/01/lemon-pecan-biscotti-gluten-free.html - home of Gluten Free Gobsmacked. Home too of gluten free cast iron pizza - yum http://glutenfree.wordpress.com/2007/08/06/gluten-free-cast-iron-skillet-pizza-2/
http://glutenfreemommy.com/ - very nice article on the different grains and how to play with them.

My next experiment is gluten-free Fruit cake (not kidding it's a family tradition). Happy baking everyone!
Alison

For more about celiac see:
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
http://www.blogger.com/www.celiac.org