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Coping with celiac disease

Gluten-free diet can help in avoiding intestinal pain

Gluten-free diet can help in avoiding intestinal pain
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Learn more about celiac disease

Recipe: Quinoa Salad

Winnipeg Health Region
Wave, March / April 2011

Most people love the bakery - that warm and inviting place where the magic of flour, yeast and sugar work to make the wonderful taste and smell of breads, buns and special occasion fare. After all, what birthday is complete without a cake?

This same bakery has far less appeal for people with celiac disease, a stomach disorder that can be triggered by gluten, a substance found in baked goods.

A genetically based, lifelong condition, celiac disease can lead to poor absorption of all nutrients: carbohydrates, proteins, fats, vitamins and minerals. People with celiac disease that is not well-controlled are at risk for nutritional deficiencies.

A wide range of symptoms of varying severity may be present in people who have not yet been diagnosed with celiac disease. These symptoms are mainly abdominal in nature and can be mild or severe. The symptoms can also include weight loss, anemia and fatigue.

If you or someone you know suspects that they have celiac disease, the first step is to make an appointment with a primary care provider (doctor or nurse practitioner). A relatively simple blood test can be used to screen for markers of this condition. If this test is positive, then the second step is to have a small bowel biopsy. In this test, a specialist doctor removes a miniscule piece of bowel tissue and examines it under a microscope. If the doctor sees the damage on the absorptive surface of the intestine that occurs in people with celiac disease, then the diagnosis is made. The small bowel can return to normal function, but only if the person with celiac disease strictly avoids all forms of gluten.

If it were only so easy to check food labels and stay away from foods that list wheat, rye, triticale and barley in the ingredients, then people with celiac disease would have a much easier time shopping for food and eating away from home.

Unfortunately, gluten is found in many different products, including some unlikely candidates. Foods such as soy sauce and canned soup, for example, may contain gluten in the form of malt or hydrolyzed vegetable/plant protein, which should be avoided by people with celiac disease. It is important that people with this condition check the list of ingredients on food packages every time to ensure it is truly gluten-free. The pocket dictionary available from the Canadian Celiac Association is an invaluable resource when shopping for food or eating out.

Gluten-free products are often more expensive than those that contain the substance. The Manitoba chapter of the Canadian Celiac Association can be contacted for information on how you may be able to claim medical expenses on your income tax return for the cost difference when purchasing gluten-free products.

While many foods are off-limits for those with celiac disease, many are not. These include all fruits and vegetables, fresh meats and fish, and milk and milk products, as long no gluten-containing foods have been added (such as breading and sauces).

People with celiac disease are advised to work closely with their health-care team, including a registered dietitian, to make sure that their diet provides adequate nutrients for good health. Common nutritional concerns for people with celiac disease include getting enough fibre, iron and calcium in their diet, and managing temporary lactose intolerance. These concerns are best addressed with a registered dietitian who can make recommendations based on an individual assessment. Dietitians can also direct people to vendors who provide gluten-free products.

The Canadian prairies produce some of the world's highest quality grains, and we are indeed fortunate to be able to call them local foods. Fortunately, for people with celiac disease, our well-developed agri-foods industry is working to find ways to make affordable, acceptable flours from locally produced beans, peas, corn and legumes so that people with celiac disease have better quality foods and more of them to choose from.

March is Nutrition Month in Canada, and the 2011 theme is "Celebrating Food . . . From Field to Table." For those who have special dietary concerns, it is truly a celebration when the scientific successes in the field produce new and exciting products on the menu.

Colleen Rand is Regional Manager, Clinical Nutrition - Community for the Winnipeg Health Region.

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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