Question

I have the "silent" version of celiac disease. I never had pain from eating gluten. I am told that oats are OK to eat as long as they are uncontaminated. However, eating the uncontaminated oats gives me gas that was typical of my "symptoms" before my celiac diagnosis. How do I know if oats are OK for me to eat? From, Leslie

Answer

Hi Leslie. Great question! I’m assuming that your “uncontaminated” gluten-free oats are certified gluten-free? If yes, then you may be in the small percentage of people who are sensitive to oats, whether certified to be gluten-free or not. If this is the case, the likely culprit causing your symptoms is avenin, a protein in oats that acts similar to wheat, rye, and barley in people with celiac disease. Indeed, it is estimated that 1 in 5 persons with celiac disease will also have a reaction to oats. Because of this, the current recommendation for all persons newly diagnosed with celiac disease is to stop eating oats until it can be clearly demonstrated that their celiac disease is under control. After that, and under the guidance of a physician, registered dietitian or another qualified healthcare professional well-versed in celiac disease, certified gluten-free oats can gradually be added to the diet, as long as the patient remains symptom free. In your case, it would be advisable to eliminate all oats from your diet for the time being, then follow up with your physician when you have resolution from your symptoms. At that point, your doctor may advise whether or not you can start a controlled trial of gluten-free oats. Speaking as someone who adores her gluten-free oatmeal, I understand this may be difficult, especially if you are used to consuming a lot of oats. The good news, however, is that there are so many wonderful gluten-free cereal grains you can still enjoy! A few of my favorite gluten-free breakfast options include:

• Warm brown rice topped with cinnamon, milk, fresh apples, and walnuts
• Hot polenta topped with ricotta cheese, fresh chunks of orange, and pecans
• Bob’s Red Mill Gluten-Free Mighty Tasty Hot Cereal topped with vanilla soy or almond milk, sliced bananas, fresh berries, and cinnamon

In good health, EA Stewart, MBA, RD

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Question

Is brie gluten-free? From, David

Answer

Hi David. Thanks for your question! In regards to cheeses, the question I get asked most is if blue cheese is gluten-free. (Answer: almost always, yes, but not 100% depending if the growth medium for the mold spores was grown on wheat or rye bread. Even then, it would be highly unlikely the final product would contain more than 20 ppm gluten.) As for brie, the creamy and delicious cheese itself should absolutely be gluten-free. The rind is also very likely to be gluten-free; however, some have questioned if the rind contains gluten due to the method of making it (i.e. if the mold spores used to make the brie were grown on wheat or rye bread.) As with blue cheese, even if this was the case, it would be very unlikely the brie would contain 20 ppm or more gluten. Indeed, a 2009 study conducted by the Canadian Celiac Association found no detectable levels of gluten (using three different ELISA test kits) on three samples of blue cheese that were made from mold grown in gluten-containing media. So, go ahead and enjoy some brie with some fruit and your favorite gluten-free crackers! In good health, EA Stewart, MBA, RD

References

• Tricia Thompson, MS, RD Gluten Free Dietitian: Blue Cheese, February 3, 2011
• Canadian Celiac Association: Blue Cheese in the gluten-free diet-A research update. 2009, Canadian Celiac Association

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Question:

I've just read the Q&A about de-glutenized wheat, which prompted another question: I have sometimes gotten sick after eating products that say they have tested to < 20 ppm. Can I believe any gluten-free labels?

From,

Brooke

Answer:

Hi Brooke. The < 20 ppm threshold is supported by renowned researchers, including Dr. Alessio Fasano of the University of Maryland’s Center for Celiac Research, as a safe level for consumption. However, some certifying organizations use a lower threshold. The GFCO tests and certifies for < 10 ppm, and the NFCA/Quality Assurance International partnership also established < 10 ppm as the threshold for certification. The CSA Recognition Seal is for 5 ppm or less.

If the gluten-free label is from a certified organization (ex. GFCO or the others listed above), you can trust the labeling as being less than 20 ppm. However, some people have a higher sensitivity and will still react to these low levels. If you are one of those people, you may need to consume only naturally gluten-free items: fruits, vegetables, plain dairy and meats, eggs, rice and other food items that have no potential for contact or cross-contamination with gluten. You also need to make sure you have removed all possible areas of cross-contamination in your home, especially if you are newly diagnosed or share a home with people who eat gluten.

Sincerely,

Nancy Dickens, BS, RD, LDN

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Question

Can a gluten-free diet help hypothyroidism? From, Melanie

Answer

Hi Melanie. There is a relationship between celiac disease and Hashimoto’s thyroiditis (autoimmune hypothyroidism) because they are both autoimmune diseases. However, once diagnosed with hypothyroidism, the standard treatment is to replace the thyroid hormone by taking a daily dose of a synthetic thyroid hormone (Synthroid or Levothyroxine). Following a gluten-free diet does not help with hypothyroidism, except that if celiac disease is diagnosed, absorption of nutrients and medications may improve with the initiation of a gluten-free diet. Sincerely, Nancy Dickens, BS, RD, LDN

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Question:

Last January, my EGD (upper endoscopy) & colonoscopy showed villi damage. Regarding the comments about leaky gut, wouldn't my doctor have been able to see if I had a leaky gut and told me then? He did not mention it, and with all the info on celiac I have learned about it. Now I'm wondering if that is why I still do not feel good a lot of the time. Thanks.

From,

Shirley

Answer:

Hi Shirley. I cannot find any reference that describes diagnosing leaky gut with an EGD or colonoscopy, so I personally cannot confirm that your doctor could tell you that you had "leaky gut." Celiac disease is diagnosed with blood work and an endoscopy, not a colonoscopy. If you have been diagnosed with celiac disease due to the villi damage seen in an endoscopy, then following a strictly gluten-free diet is the only way to heal your intestine.

If you are still having symptoms and have been following a gluten-free diet since January, it may be time to have a look at all areas of your diet. Have you checked labels on the food you are eating? You can call or email manufacturers to ask if their products are gluten-free. The top 8 allergens are required to be listed on ingredient labels which is very helpful in regards to identifying WHEAT in a product, however BARLEY and RYE are not required to be identified on food labels, and still can be included as a “hidden ingredient.” A quick email or phone call to a manufacturer can give you helpful information.

Have you considered areas of cross contamination in your home or when eating out? Sharing condiments, cutting boards, grills, and colanders are just some of the places where crumbs or tiny amounts of gluten may be getting into the food you eat.

While some people start to feel better immediately when they start a gluten-free diet, for others it takes 6 months or more. I would suggest you meet with your physician and request follow up blood work to see if the blood tests are returning to normal levels. You can also discuss your concerns regarding leaky gut with your physician at that time.

Sincerely,

Nancy Dickens, BS, RD, LDN

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Question

I am pregnant and worried that my gluten-free diet might be causing issues for me. Are there any resources for pregnant celiacs to ensure all dietary needs are met? From, Meghan

Answer

Hi Meghan. I’m glad to see you are paying attention to your gluten-free diet while pregnant. Yes, Beyond Celiac has great information about the gluten-free diet and proper nutrition before and during pregnancy. See: Maximizing Nutrition for Pregnancy. The article also includes a list of references to additional sources of information about important nutrition issues during pregnancy, including: common vitamin deficiencies; the Dietary Guidelines for Americans recommendations for pregnant and nursing women; mercury levels in fish and shellfish; and much more. Thank you for your question and be well, Rachel Begun, MS, RD Related Content:

• Celiac Disease and Women's Health
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Question

Coco was just diagnosed with celiac disease after battling tummy issues for years. She is 10. We have cut gluten from her diet, but are wondering if cross-contamination, even a crumb, can trigger a reaction? We are very careful but her tummy still hurts. She has been gluten-free for 3 weeks. From, Coco’s Mom

Answer

Hi Coco’s Mom. The good thing is that Coco was diagnosed young and can start her journey to health. If Coco has a confirmed diagnosis of celiac disease, then yes, even a miniscule amount of gluten can trigger a reaction. The recognized gluten threshold that current science shows to be safe for the majority of celiac patients is 20 parts per million (ppm). This won’t mean much to you now, but will help you as you shop for foods labeled “gluten-free.” Continuous exposure to small amounts of gluten over time will prevent the intestines from healing and can potentially lead to nutritional deficiencies and other long-term conditions, such as other autoimmune disorders and even cancers of the GI system. I don’t want to scare you with these facts, but do want to stress the importance of Coco avoiding gluten completely. If she is diligent about eating gluten-free, these diseases shouldn’t be a problem, especially since she was diagnosed so young. As you see, preventing cross-contamination is extremely important and, therefore, requires diligent label reading for packaged foods and diligent research and questioning when eating outside of the home. If her tummy still hurts after being gluten-free for 3 weeks, it is likely that she has been ingesting gluten due to cross-contamination incidents. Learning how to live 100% gluten-free is a learning process. I highly recommend limiting dining outside the home as much as possible until Coco’s intestines start to heal and you have a better handle on cross-contamination issues, both in and out of the home. Once she feels comfortable with living gluten-free at home, you can then tackle the harder issue of eating away from home. Beyond Celiac has great resources to help you get started: Check out the Resource Library. Thank you for your question and we wish you and Coco well. Rachel Begun, MS, RD

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Question

If I have been following a gluten-free diet for more than 2 years and am not having any digestive symptoms, would I benefit from taking probiotics other than what is in yogurt? From, Ann

Answer

Hi Ann. Great question. Nutrition science has shown probiotics to help improve GI symptoms, including constipation, diarrhea, gas and bloating. There is also preliminary research that taking probiotics can boost the immune system by improving GI health. The best sources of probiotics come from: cultured milk products like yogurt and kefir; pickled fermented vegetables, such as kimchi (Korean specialty food) and sauerkraut; and fermented soy products, including tempeh, miso and natto. Most would agree that cultured milk products offer the most probiotic power, but eating all of the above as part of a well-balanced diet provides probiotic as well as other nutrition benefits. There is a great article on this exact topic in Today’s Dietitian: A Healthful Dose of Bacteria. Thank you for your question and be well. Rachel Begun, MS, RD

Question:

Is there anything that can be done to make [gluten-free] cakes and breads fluffy as opposed to thick and sticky?

From,

Shannon

Answer:

Hi Shannon. The gluten in wheat-based products is what helps to keep the elasticity in them…making cakes and breads light and airy. When baking gluten-free, we need to find a way to add back in something to help give the texture we are looking for and also make it taste great.

There are many gluten-free cookbooks on the market today. I just did a quick search on Amazon.com for “gluten-free cookbooks” and 601 results popped up! My point is that, instead of trying to figure it out on your own, which can take a lot of time and be costly, turn to the experts. There are cookbooks dedicated to breads, meals, desserts, kids, and more. There are also many gluten-free cake and bread mixes on store shelves where you just add water, butter, eggs, etc. and achieve a terrific product.

Here are a couple of hints about gluten-free baking:

Some of the flours are denser than others, so using a combination of light flours (cornstarch, tapioca starch) with heavier flours (brown rice flour) will help. Sifting the flour can help, too. NFCA’s Getting Started Guide has some useful information regarding different flour mixtures (download it from the Printable Guides page).

Some ingredients that may help to create that fluffier and more elastic end result include: unflavored gelatin, xanthan gum, guar gum, and eggs.

NFCA’s website has a page listing gluten-free cookbooks and magazines. I also like the magazines Gluten-Free Living and Living Without, which include recipes in every issue.

Sincerely,

Nancy Dickens, BS, RD, LDN

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