Gluten-Free Guide

By Angela Bristow

If you walk down the aisles of any grocery store you’ll no doubt notice the plethora of Gluten-free products. This way of eating is not necessarily a choice but a necessity for those who have celiac disease or celiac sprue. These are autoimmune diseases that prevent the small intestine from absorbing nutrients and the body from breaking down gluten. This happens when the gluten damages the villi, small finger-like projections, of the small intestine.

“This is a permanent adverse reaction in the body. Once you’ve been diagnosed you have to follow a gluten-free diet for life,” said Lisa Musician, a bariatric dietitian for St. Luke’s University Health Network in Allentown.

The Details

Gluten is a gray, sticky, nutritious mixture of proteins, including gliadin, found in wheat and other grain: it gives dough its tough, elastic quality. Gluten makes up 80 percent of the protein in wheat called glutenin.

One out of 133 Americans has celiac disease and follow a gluten-free diet. Seventeen million Americans could be gluten sensitive. Celiac disease can occur at any age, but is usually diagnostically missed early in children. Generally, adults are diagnosed more readily. If a child is diagnosed and follows a gluten-free diet their healing time in the gastrointestinal tract is about six months. In adults, it’s one to two years.

Some noteworthy improvement has been seen in children with autism and attention deficit hyperactivity disorder (ADHD) that follow a gluten-free and casein-free diet. Casein is found in milk. Musician advises parents to work along with a medical specialist when considering this type of diet for their child.

The Diagnosis

Generally individuals will see a gastrointestinal doctor to be clinically diagnosed. A celiac disease diagnosis is achieved through blood work, with the possible addition of genetic testing and biopsy of the small intestine. A biopsy is considered the full-standard test, but if the blood work comes back positive usually there is no need to go on with the biopsy. With the blood work the doctor is testing for the total serum IgA and tTG. Genetic testing is usually not done because of the high cost and is generally not covered by medical insurance. To receive an accurate reading on the blood test the patient should not alter their diet prior to the test being done. After positive blood test result and symptom relief from a post-test gluten-free diet, diagnosis is generally confirmed.

Since celiac disease is a genetic disorder, children have a higher chance of having it if their parent has it. Medical professionals are still unsure how to systematically diagnose non-celiac disease gluten sensitive patients.

Those with celiac disease often become lactose intolerant, so monitoring is needed.

“Certainly if you go undiagnosed you are prone to other diseases because you’re not absorbing nutrients. So they could develop infections and gastroenteritis,” said Musician.

What to Look For

Symptoms occur mainly in the gastrointestinal tract and include abdominal pain, gas, diarrhea after eating a meal, and bloating. Some other less obvious symptoms are achy joints, generalized fatigue, headache, skin rash usually between the fingers, and weight loss.

Some of the main food culprits are wheat, rye, barley and possibly oats because of cross-contamination. So, in addition to the obvious problem with most bread, gluten is also used as a thickener, a binder, and a flavor-enhancer in foods. Protein supplements, soy sauce, salad dressings, soups, cosmetics, beer, cola, and caramel color because it sometimes contains barley malt, are all everyday items that may contain gluten.

Musician recommends getting familiar with other names used on packaging for wheat, such as couscous, farina, semolina and spelt. While labeling may say that something includes wheat, manufacturers are not required by law to say that something contains gluten. To be labeled gluten-free the product has to meet Food and Drug Administration (FDA) standards.

When eating out, people with celiac disease are beginning to find more restaurants offering gluten-free options. At restaurants avoid menu items with any breading, sauces, gravies or marinades. The cross-contamination in a restaurant and at home most often happens in the cooking oil and the toaster.

What Else Should You Know?

Beyond food and cosmetic items, an often-overlooked area with potentially hidden gluten is medications and supplements. The Web site provides a list of medications that are free of gluten.

When in doubt, Musician advises calling a manufacturer and specifically asking, “Does this product contain gluten?” The manufacturer has to answer “yes” or “no.”

While a gluten-free diet may sound restrictive there are safe alternatives. Suitable substitutes include the grains corn and rice, as well as potatoes. “You want to look for enriched flours because when any grain goes through a refining process the nutrients are lost during the milling process and this is where the B vitamins are, so you want to get enriched flours to get the B vitamins back,” said Musician.

She adds, “Anything that someone is eating in the wheat, barley and rye products, you can get in the safe grains.” Fruits, vegetables and legumes are great mainstays to any diet.

Buckwheat, quinoa and amaranth are also acceptable foods for those on a gluten-free diet.

“There are a lot of gluten-free products out there and people are eating them because they feel it’s a healthier way to eat. The products are usually higher in fat and sugar, so it’s not necessarily healthier. It would be better for people to bake their own breads and crackers,” said Musician.

Those with celiac disease can receive practical ideas for living with the disease through support groups such as the two mentioned by Musician – the Celiac Disease Foundation (CDF) at and Celiac Sprue Association and Gluten Intolerance Group at

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