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Celiac
sprue (wheat allergy)
What
is the difference between wheat allergy and intolerance to wheat?
Wheat allergy and wheat intolerance are conditions that can result in
excessive gas, bloating and diarrhea. Wheat allergy disease called celiac
sprue is a disease that needs to be considered when there is weight loss,
foul smelling stool, osteoporosis or a family history of this illness.
A number of people are concerned that wheat makes them sick. Whether or
not they are truly allergic requires specific testing.
What
is the disease called celiac sprue (wheat allergy)?
In celiac sprue, the wheat protein called gluten comes in contact with
the small intestine and allergic white blood cells are attracted to the
surface lining and cause tissue damage. As a result, the absorptive corrugated
lining becomes blunted or flat. The small intestine is then not able to
absorb nutrients and vitamins. Diarrhea, abdominal discomfort, malnutrition,
weight loss and diseases caused by vitamin deficiency occur.
Why
do people get sprue and how is it diagnosed?
There is a genetic predisposition to developing celiac sprue. This condition
is particularly common in people of Irish descent. A similar gene that
predisposes someone to wheat allergy also occurs in insulin-dependant
diabetic people and, consequently approximately 5% will develop sprue.
The disease is diagnosed by biopsies of the small intestine obtained during
upper endoscopy. A blood test called the endomyseal antibody is also a
good test to diagnose sprue. An upper GI barium small bowel x-ray is not
a sensitive test.
How
is celiac sprue treated?
The treatment is a strict, life-long elimination of all wheat protein
from the diet. Tiny amounts of wheat can appear in a variety of sources
(pills, prepared foods, other grains when the processing factory uses
the same equipment). It is rare that people need steroids or immunosuppressants.
What
are the main principles of a gluten free diet?
Gluten is the protein part of wheat, rye, barley and other related grains.
It is contained in many commercial food products. Many foods, beverages
and food products must be omitted in order to stay compliant with a gluten-free
diet. Celiac sprue patients must be 100% gluten-free to stay healthy.
Labels on any packaged food needs to be carefully examined.
What
is safe to eat and drink?
These foods are healthy and safe: Meat (all non-processed meat
and some hot dogs), fish, poultry, most soy products, eggs, dairy products
(most cheese see next page), vegetables, beans, nuts, peanut butter,
fruit, white rice, brown rice, and rice-based cereals.
These beverages can be consumed: Water, coffee, tea, milk, soda (and some root beer), juice, certain protein shakes, fruit smoothies, wine, and vodka.
These grains can be consumed: Amaranth, arrowroot, corn, millet, quinoa, sorghum, and tapioca. The safety of oats and oatmeal is controversial.
These flours can be consumed: cornmeal, garfava, nut, potato, quinoa, rice, soybean.
These seasonings and condiments are safe: Salt, pepper, rice vinegar, wine vinegar, oil, butter, cooking spray, margarine, mayonnaise, some mustards, a few ketchups, a few soy sauces, herbs, food coloring, most spices (except for curry powder, some cinnamon, some alcohol-based flavoring extracts), jelly, jam, most molasses, honey and sugar.
What
are substitutes for my favorite foods that I can’t have?
Breakfast ideas: Rice cereals (including sugar pops, corn pops,
puffed rice, hot rice cereal (cream of rice), eggs, egg white omelets,
yogurt and fruit, cottage cheese and grapefruit.
Gluten-free bread alternatives in St. Louis: Available at Schnucks (Mason/Olive), Whole Foods, Wild Oats, Breadsmith (10031 Manchester; 314-822-8200: call to order on the first Thursday each month) or bake fresh with Betty Hagman: Gourmet Gluten Free Baking Bread Cookbook.
Gluten-free pasta alternatives: A variety is available at Wild Oats and Whole Foods. Oriental rice and bean thread noodles are available there and at Oriental markets.
Snack and dessert options: Rice and popcorn cakes, popcorn, some potato chips, rice crackers and wafers, soy chips, pure corn tortillas, cold veggies, fruit, trail mix, nuts, seeds, some protein bars, some ice creams, sorbets, some sherbets, frozen yogurt, meringue cookies, mousse, chocolate, marshmallows, and some candy.
What
food, beverages and ingredients need to be avoided?
Omit all gluten-containing foods: Breading, bread crumbs, certain
blue cheeses (stilton, Roquefort, gorgonzola and some that contain oat
gum), most cereal products, coating, communion wafers, croutons, most
flour, imitation bacon and seafood, commercial marinades, pasta, processed
meats, roux, sauces with thickening, self-basting poultry, soup base,
stuffing, thickeners, tuna canned in vegetable broth and white vinegar.
Omit all gluten-containing grains: Wheat, barley, farina, kamut, rye, spelt, durum, and semolina.
Omit any prepared foods with the following ingredients: Emulsifier, flavoring, all gluten-containing thickening agents, some vegetable gums, hydrolyzed plant protein, stabilizer, starch, some brown rice syrup, caramel color, and dextrin.
Omit all gluten-containing beverages: Beer, gin, rye, whiskey, scotch, malt-containing drinks, some non-dairy creamers, some commercial chocolate milk, and some root beer.
Examples of gluten-containing commercial products: creamed vegetables, some canned vegetables and beans, thickened or prepared fruits, some salad dressings, bouillon, certain candies, some corn syrup, yeast, certain medicines using gluten-fillers, and many ketchups and mustard (in part because of use of white vinegar).