The New Glucose Revolution Low GI Gluten-Free Eating Made Easy

PART 1

1
Who Really Needs a
Gluten-free Diet and Why

Some people can’t tolerate gluten. If you have celiac disease or dermatitis herpetiformis (a gluten-sensitive chronic skin condition) you need to eat a gluten-free diet. For life. If you have a gluten intolerance (non-celiac gluten sensitivity) you will need to reduce the amount of gluten in your diet.

Gluten is the protein found in the grains wheat, rye, barley, and triticale. Oats are frequently grown, harvested, milled, and processed alongside gluten-containing grains, so they may be contaminated with gluten. They also contain a glutenlike protein that some people with celiac disease react to. So, although research is ongoing, oats are currently not recommended for people with celiac disease.

UNDERSTANDING CELIAC DISEASE

We don’t know how or why celiac disease occurs, but it seems clear that both the environment and genes play a part. For example, we do know that around 10 percent of all parents, brothers, sisters, or children (first-degree relatives) of someone with celiac disease will also have it. And if one identical twin has celiac disease, there is about a 70 percent chance the other twin will be affected.

We also know that it mainly affects Caucasians (people of European origin), but it occurs in India and some Middle Eastern countries, too. It is rarely diagnosed in Asian, African, and Native American populations.

We also now know it’s not just an early childhood problem. Celiac disease affects children and adults of any age. Many people develop symptoms only as adults, and others have no obvious symptoms at all, making diagnosis very difficult. It is the most common and one of the most underdiagnosed hereditary autoimmune diseases.

In the United States and Canada, celiac disease affects up to one in every hundred people. On top of this, for every person diagnosed with celiac disease, there’s likely to be six undiagnosed people with symptoms or complications attributable to it.

If you have celiac disease and you eat something that contains gluten, you will get an immune reaction in your small intestine. This damages your intestinal wall, reducing its ability to absorb nutrients from food and leading to deficiencies of the essential vitamins and minerals your body needs for growth, health, healing, and energy. In children, if it’s not diagnosed and treated, celiac disease can affect growth and development. In adults, it can lead to long-term health problems including osteoporosis (due to calcium malabsorption), infertility, miscarriage, tooth decay, and an increased risk of cancers of the digestive system.

Celiac disease never goes away.

The good news is that you don’t need drugs to deal with it; you can manage it effectively by following a strict gluten-free diet. By doing this, your intestinal wall will heal so nutrients can be absorbed, your symptoms will be resolved, and long-term health problems may be prevented.

Diagnosing It

Symptoms vary widely and some are very mild and nonspecific. Some people have all or many of the symptoms while others may have only a few or none at all. Typical symptoms include:

• Fatigue, weakness, and lethargy
• Low iron levels or unexplained anemia that does not improve or recurs after taking iron supplements
• Gas, bloating, and abdominal distension
• Stomach cramps
• Diarrhea
• Constipation
• Nausea and vomiting
• Weight loss
• Poor weight gain, delayed growth, and delayed puberty in children

Some less common symptoms in adults include:

• Easy bruising of the skin
• Mouth ulcers
• Infertility and miscarriages
• Muscle spasms/cramps due to low calcium levels
• Deficiencies of vitamins B₁₂, A, D, E, and K
• Dental problems
• Poor memory and concentration
• Bone and joint pains

If you have one or more of these signs or symptoms, make an appointment with your doctor for a checkup. He or she should refer you to a gastroenterologist who specializes in celiac disease.

Although blood tests that measure antibodies to gluten can be used to screen for celiac disease, you actually need to have a small bowel biopsy to diagnose it. This test looks at whether the lining of the small intestine shows the typical damage known as villous atrophy (inflammation of the villi, which line the surface of the small intestine) seen in those with celiac disease. A word of warning: It is important you don’t jump the gun and start on a gluten-free diet before you have this test. If you do, the lining of your intestinal wall will repair and may not show any damage when the biopsy is taken, thus preventing a proper diagnosis.

UNDERSTANDING DERMATITIS HERPETIFORMIS

Dermatitis herpetiformis (DH) is also a genetic autoimmune disease caused by sensitivity to gluten. It causes an intensely itchy skin rash that looks like watery blisters or pimples. It generally presents in adult life and is more common in men than women and in people originally from some parts of northern Europe.

DH tends to appear over the kneecap, on the outer surface of the elbows, on the buttock area, around the ears, on the shoulder blades, and in the hairline and eyebrows. It usually occurs symmetrically (on both sides of the body).

As with celiac disease, you never get over it, but you can manage it with a gluten-free diet.

Diagnosing It

If you have DH, eating a food containing gluten triggers an immune response that deposits a chemical called immunoglob-ulin A (IgA) under the top layer of skin. Your dermatologist will need to take a skin biopsy to determine the presence of IgA deposits. Villous atrophy also occurs in people with DH.

It can take a year or two on a gluten-free diet for the IgA deposits under the skin to clear completely. But don’t despair; medication can provide immediate relief from the itching and burning rash.

UNDERSTANDING GLUTEN INTOLERANCE

Gluten intolerance is a broad term, covering all kinds of sensitivity to gluten. In addition to those with celiac disease and DH, many people have a sensitivity to gluten but do not test positive for celiac disease. These people have what is called non-celiac gluten sensitivity, a condition in which the body does not tolerate large amounts of gluten.

If you have gluten intolerance you will generally need to reduce the amount of gluten in your diet, but you probably won’t have to follow a strict gluten-free diet.

Diagnosing It

Symptoms may be similar to celiac disease and commonly include digestive symptoms such as diarrhea or constipation, gas, and bloating.

The most accurate way to diagnose gluten intolerance is by doing an elimination diet—this involves removing foods containing gluten for a specified time to see if symptoms resolve, then reintroducing foods containing gluten to see if the symptoms recur. This should be done under the guidance of a registered dietitian (RD) who specializes in food allergies and intolerance. However, it is important to establish whether you have celiac disease before you remove gluten from your diet.

UNDERSTANDING WHEAT INTOLERANCE

In addition to gluten intolerance, some people have an intolerance to wheat but are able to tolerate other gluten-containing grains such as barley, rye, and oats. Symptoms are similar to gluten intolerance and often include gas, bloating, and constipation or diarrhea.

Diagnosing It

The most accurate way to diagnose wheat intolerance is by doing an elimination diet—this involves removing foods containing wheat for a specified period of time to see if the symptoms go away, then reintroducing foods containing wheat to see if the symptoms recur. This should also be done under the guidance of a registered dietitian who specializes in food allergies and intolerances and, again, you should rule out celiac disease before starting an elimination diet.

2
Gluten-free Ground Rules

Our ground rules cover what’s in, what’s out, what tends to be missing from a gluten-free diet, and what you need to do about it.

Although it may seem like mission impossible to suddenly change the way you shop, cook, feed the family, and eat out, it’s not the end of the world. There are plenty of great gluten-free foods to choose from. However, it may take more work and planning to start with.

In this chapter, we give you an idea of the sorts of foods you can enjoy to your heart’s content, plus the ones you should leave off the menu. However, if you need to follow a strict gluten-free diet, we suggest as step one that you join your local celiac support group and take advantage of the up-to-date and comprehensive information it provides for members on shopping, cooking, and eating gluten-free. As for step two, it won’t go amiss to brush up on your food-label reading skills (see page 12).

WHAT’S IN?

There are many more foods you can eat than those you can’t. For starters, some foods are naturally gluten-free, such as fruit and vegetables, legumes and nuts, many grains, meat, chicken, and fish (providing they haven’t been processed or breaded). An increasing number of packaged gluten-free foods, such as breads, pastas, cookies, and crackers in supermarkets and health food stores, also make following a gluten-free diet much easier. Some major supermarkets have a gluten-free section where you can shop with confidence, although if you have diabetes you will still need to check nutritional labels for things like fats and total carbs.

The following foods are suitable for those on a gluten-free diet:

• Rice, corn, buckwheat, millet, sorghum, quinoa, amaranth, polenta, tapioca, sago
• Gluten-free breads and breakfast cereals
• Gluten-free pasta, rice noodles and vermicelli, buckwheat noodles, bean thread noodles
• Pure corn taco shells and tortillas
• Legumes (dried peas, beans, and lentils)—check canned varieties for gluten
• Plain nuts