Question:

I have had celiac disease for 4 years now and wondering if I can return to eating normal food yet. My doctor doesn't really tell me much except to keep eating the way I have been. You're supposed to lose weight doing this but I haven't. Why? I also have IBS and lactose intolerance. Fruits and veggies blow me up. What to do?

From,

Joni

Answer:

Hi Joni. Thanks so much for all your questions. I’ll address each concern individually below.

First, regarding your question about when you can return to “normal” eating, I’m guessing you’re referring to your “pre gluten-free” diet. If this is the case, the answer is that you must remain on your gluten-free diet for the rest of your life. While this may not be the answer you were hoping to hear, at this time the only treatment for celiac disease is 100% adherence to a gluten-free diet. The good news is that by following a gluten-free diet you should be able to live a very healthy life.

In regards to your question about weight loss, this is a very common misconception people have about the gluten-free diet. There is no evidence to suggest that a gluten-free diet, in and of itself, promotes weight loss. When you do hear about people losing weight (desired weight loss) while on a gluten-free diet, it usually occurs for one of two reasons. First, the person might simply be eating a healthier diet, consisting of more fruits and vegetables, lean proteins, and complex carbohydrates (i.e. quinoa, gluten-free oats, and sweet potatoes), and fewer sugars and simple carbohydrates (i.e. white bread, sugary desserts, and pasta). Second, when beginning a gluten-free diet, sometimes people will unintentionally consume fewer carbohydrates, often in conjunction with fewer calories, which can lead to weight loss.

Finally, in regards to your question regarding lactose intolerance, IBS, and symptoms with eating fruits and veggies, and assuming your doctor has ruled out other GI problems, it is possible you have some food sensitivities or intolerances in addition to celiac disease. Lactose intolerance is not uncommon in people with celiac disease. However, in many cases it resolves after several months on a gluten-free diet, as the villi in the gastrointestinal (GI) tract begin to heal.

If you have been following a strict gluten-free diet for 4 years, and are still having GI symptoms, you may want to consider working with a physician or registered dietitian who specializes in food sensitivities and intolerances. One approach I have used successfully for clients with constipation/bloating predominant IBS in my practice is the FODMAPs diet, which eliminates certain “fermentable” carbohydrates from the diet such as lactose (in dairy products), beans, and certain fruits and vegetables. You can read here to learn more about the FODMAPs diet for IBS and other functional gut disorders. You can also read these previous Q&As about FODMAPS:

• Gluten-Free But Still Having Symptoms?
• Still Having Symptoms When Eating Too Much Sugar

I hope you are able to find relief from your IBS soon.

In good health,

EA Stewart, MBA, RD

Question: My son's test results just came back and they show he is sensitive to gluten (as well as cow's milk, eggs and soy). I have been gluten-free for several years, but since neither of my children showed obvious signs, I didn't have them tested until now. My son will be 18 next month and off to college next year. I'd like help with how to best support him. I have tons of resources for myself and I do my family's cooking, but he eats at school, lives on cereal and bread and is off to his pre-season (basketball) pizza dinner tonight. Any suggestions for teens on navigating a gluten-free diet at this age? Thanks in advance. From, Dana Answer: Dear Dana, Thanks so much for your question! My first recommendation for gluten-free resources for your teenage son is right here on NFCA’s website. Although your son is not out of the house yet, it’s not too early for him to prepare himself for navigating a gluten-free college lifestyle. I encourage both you and your son to check out the new Gluten-Free in College section on NFCA’s website. It includes guides, blog posts and articles. In regards to what your son is eating now, it sounds like he is eating well at home, but could benefit from keeping some healthy snacks with him such as gluten-free protein bars (Larabars, Zing Bars, and Perfect Foods Bars are just a few of my favorites. Download a list of gluten-free energy bars), and trail mix with nuts, seeds, dried fruit, and some dark chocolate. That way, when he finds himself away from home right before a game or practice, he has something healthier to eat than simply gluten-free cereal or bread. He can even prepare a simple gluten-free cheese pizza at home using a pre-made gluten-free crust, such as Rudi’s or Udi’s, to take along to his team pizza party. Lastly, if your son uses a smartphone, as many teens do, he can definitely take advantage of today’s technology. There are numerous gluten-free apps on the market that help make gluten-free eating a lot easier (and safer) than in the past. A good one to check out is Find Me Gluten Free, a free guide to gluten-free restaurants in your area. In good heath, EA Stewart, MBA, RD Related Content:

• Going to College Gluten-Free
• Getting Started Guide
• Gluten-Free Quick Snacks

 

Question

Can gluten-containing ingredients irritate the skin (like wheat protein in shampoo, for instance)? From, Kathy

Answer

Hi Kathy. There is an autoimmune skin condition related to ingesting gluten called dermatitis herpetiformis. Not all people with celiac disease have this condition. It is not related to having skin contact with gluten; it is the consumptionof gluten that causes the symptoms. One caution I would like to mention is that when using products containing gluten ingredients, like the shampoo with wheat protein you mentioned, wash your hands thoroughly before eating to make sure no traces of the product accidentally get ingested. Many people with celiac disease avoid products like this to reduce the risk of accidental ingestion. See this link for further information: Celiac Disease and Skin Sincerely, Nancy Dickens, BS, RD, LDN Related Content:

• Dermatitis Herpetiformis
• Ask the Dietitian: Hidden Gluten in Dental and Cosmetic Products

Question

My daughter, age 2, was diagnosed 3 months ago with celiac. Just recently we are having a huge issue with constipation. Do you have any suggestions? From, Holly

Answer

Hi Holly. Thanks so much for your question. I’m sorry to hear your daughter has been having issues with constipation. I definitely have a few ideas that you can try with her to help alleviate things. You don’t mention if your daughter had constipation before her diagnosis. Constipation may occur as a symptom of celiac disease, and should start to resolve after some time on a gluten-free diet as the GI tract and villi begin to heal. Another, more common reason for constipation often occurs when first starting a gluten-free diet, and that is the removal of fiber-containing whole wheat from the diet. While more and more “whole grain” gluten-free products are on the market these days, there are still many highly processed gluten-free products (i.e. crackers, pasta, breads) whose main ingredients are tapioca flour, potato starch, and/or white rice, all of which contain very little fiber. Your best bet is to look for products containing fiber-rich gluten-free grains that are listed at the top of the ingredient list. These include amaranth, quinoa, buckwheat, millet, montina, sorghum and teff. In addition, fruits and vegetables, nuts, seeds, beans and legumes are excellent sources of fiber and should be a daily part of your daughter’s diet to help prevent constipation. Additionally, it’s also important for your daughter to drink adequate liquids throughout the day to help alleviate constipation, especially when consuming a higher-fiber diet. Water is best, but milk (cow’s or non-dairy alternative) and juice also count towards daily fluid requirements, and, again, the more fruits and veggies, the better, as they also are an excellent source of fluids. If your daughter’s symptoms persist, despite adding more fiber and fluids to the diet, I recommend you check with her physician to see if there are any other medical causes contributing to her constipation. In addition, you may want to work with a registered dietitian who specializes in celiac disease and gluten sensitivity, to help provide you with a high-fiber menu plan your daughter will enjoy eating. In good health, EA Stewart, MBA, RD

Question

We are doing a project on hypothetically creating a gluten-free restaurant. I was wondering if living a gluten-free lifestyle is good for people who do not suffer from celiac disease or gluten sensitivity? From, Alexandra

Answer

Hi Alexandra. A gluten-free diet can be quite healthful if choosing a variety of fresh, wholesome foods from all of the food groups, including gluten-free whole grains. However, a diet that relies mostly on highly processed gluten-free foods can be lacking in nutrients, particularly fiber, iron and B vitamins. Not only are highly processed gluten-free foods devoid of these nutrients, but they also are not required to be fortified with them. When choosing processed gluten-free foods, choose brands that are fortified. There is no evidence showing that a gluten-free diet leads to weight loss. If highly processed gluten-containing foods are taken out of the diet, and more fresh foods are consumed, this is more likely the reason for experiencing weight loss. Most health professionals recommend a gluten-free diet only for those who have adverse health effects when consuming gluten. Sincerely, Rachel Begun, MS, RD Source: Webinar Q&As under Food as Medicine for Celiac Disease: Nutrition Beyond the Gluten-Free Diet archives

Question

How many serving of vegetables and fruit should a celiac adult have a day? Is there a recommended daily allowance (RDA) chart that celiacs follow? From, Kathy

Answer

Hi Kathy. Adults with celiac disease should be eating the same amount of fruits and vegetables per day as the general population. The current recommendation is between 5 and 10 servings per day and should include a wide variety of fresh fruits and vegetables with different colors. The compounds in fruits and vegetables that give them their bright hues are antioxidants, the same nutrients that help to prevent various chronic diseases. The different colors represent different antioxidants, all of which we need for our bodies to age healthfully. That's why health professionals often give the advice to "eat the colors of the rainbow every day," so that your body obtains this wide variety of nutrients. To learn more, I recommend going to MyPlate.gov and scrolling down to the "Fruits" and "Vegetables" sections. The site offers a host of information about how to increase fruit and vegetable intake. Many people ask if frozen vegetables are okay to eat, and I say absolutely! Fruits and vegetables are often frozen right after being harvested, when they are at their peak of taste and nutrition. With freezing, there is little to no loss of flavor and nutrition over time and it can be an affordable and practical way to ensure fruit and vegetable intake. Sincerely, Rachel Begun, MS, RD

Related Content

• Gluten-Free Recipes
• 5 Ways to Get Your Gluten-Free Kids to Eat More Fruits and Veggies
• Nutrition for Mental Health and Emotional Wellness

Question

I recently found out I am allergic to oat bran, but not oats. Do rolled oats or oat flour contain oat bran? How do I know which oat products to avoid? Help please! From, Sara

Answer

Hi Sara. The anatomy of all grains, including oats, consists of three parts: the endosperm, germ and bran. Rolled oats and oat flour consisting of the whole grain will contain all three parts, including the oat bran. Some oat products are processed to remove the oat bran from the other parts of the oat and will be marketed with the title of "oat bran," meaning the endosperm and germ have been removed. If it is in fact the oat bran you are reacting to, you should avoid all whole oats and whole oat flour, because they contain all three parts, including the oat bran. I always recommend that specific food sensitivities such as this and the corresponding dietary treatment should be discussed with your doctor and a registered dietitian. Sincerely, Rachel Begun, MS, RD

Related Content

• New Research Draws Concerns for Gluten-Free Grains
• The Gluten-Free Diet

Question:

Is it OK to drink a scotch and water, one drink per night, with celiac disease?

From,

Mary Ellen

Answer:

Hi Mary Ellen. From a gluten-free standpoint, scotch is safe to drink for most of the celiac population. Even though whiskeys are commonly derived from barley, a gluten-containing grain, they are distilled alcohols, which means the gluten proteins have been removed to less than the proposed FDA standard of 20 parts per million.

There is always the potential that the distillation process doesn't completely remove the gluten. If you are ultra-sensitive, then it may be prudent to avoid scotch, but most celiacs tolerate distilled alcohols just fine.

Just like with all foods and beverages, it's important to check the ingredients statement to determine if any gluten-containing ingredients have been added, and to call the manufacturer should you have any concerns or uncertainty.

From a digestive health standpoint, for newly-diagnosed celiacs whose intestines may still be healing or other celiac patients with lingering gastrointestinal issues, sometimes alcohol can irritate the condition and be a cause for slower healing/recovery. If this applies to you, it's best to speak with your doctor so s/he can get a better understanding of what the issues are and provide a specific treatment protocol about whether it's necessary to reduce alcohol intake.

Sincerely,

Rachel Begun, MS, RD

Related Content:

• Ask the Dietitian: Painful Symptoms When Drinking Alcohol or Soda
• Anheuser-Busch Releases Gluten-Free Beer

Question

My tTG is 296—that’s strongly positive. I cannot digest rice. Please suggest some other grains that are easy to digest. From, Divya

Answer

Hi Divya. There are a wide variety of gluten-free grains to choose from. All are a good source of fiber and provide a range of vitamins, minerals and antioxidants, as well as have varying tastes, textures and culinary uses. A list of gluten-free grains commonly enjoyed by those who have to avoid gluten includes, but is not limited to:

• amaranth
• buckwheat
• corn/polenta
• certified gluten-free oats (if you can tolerate them--most with celiac disease can, but some cannot)
• millet
• quinoa
• sorghum
• teff
• wild rice (which is different from white and brown rice, so perhaps you can tolerate it)

Please note that inherently gluten-free grains can become unsafe if they come into contact with gluten, so it's a good idea to purchase from manufacturers that incorporate safe practices to prevent cross-contact from happening. Sincerely, Rachel Begun, MS, RD Related Content:

• The Gluten-Free Diet: Overview
• Getting Started Guide
• Is It Gluten-Free?

Question

I’ve been gluten-free for a while and I’m getting tested for celiac disease. How much gluten should I consume before getting the celiac blood panel?

Answer

As listed in Real Life with Celiac Disease, here are the guidelines for a gluten challenge:

1. Perform basic laboratory testing for IgA-tTG and total IgA level.
2. If tTG is elevated, proceed to step 5.
3. If tTG is within normal limits and there is a history of severe symptoms with gluten exposure, consider HLA-DQ2 or -DQ8 typing (genetic testing). Be cautious with gluten challenge if positive for HLA-DQ2 or -DQ8.
4. If tTG is within normal limits and there is no history of severe symptoms with gluten exposure, begin gluten challenge with one regular cracker or ¼ slice of regular bread. Double this every 1-3 days until significant symptoms develop or until you are eating the equivalent of 4 slices of bread or 2 cups/servings of pasta per day. Continue a full gluten-containing diet for 2 months before being tested for celiac disease. Note: The amount and duration of gluten ingestion can be altered depending on the severity of symptoms.
5. Perform endoscopy with duodenal biopsies and check IgA-tTG.
6. If biopsies are negative for celiac disease, continue a gluten-containing diet. Recheck tTG in 3-6 months or if symptoms develop. Repeat endoscopy with biopsy if tTG is elevated.

Sincerely, Melinda Dennis, MS, RD, LDN

References

Leffler, D. (2010). Chapter 8: Gluten Intolerance: You Mean I Don't Have Celiac Disease? In M. Dennis & D. Leffler. Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free. (p. 55). Bethesda, MD: AGA Press.

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• The Gluten Challenge
• Research News: Gluten Challenges May Need to be Increased
• Getting Tested for Celiac Disease