Celiac Disease: Behind the Scenes
The Science
Celiac disease is becoming increasingly prevalent in the world today. In fact according to Health Canada (2012) it is the most common chronic disease in the world, affecting 1% of North Americans (Fedorak et al., 2012).
Celiac disease is an autoimmune disease where the body has an abnormal reaction to the protein gluten (Health Canada, 2012). When gluten is ingested the body triggers an inflammatory process which causes damage to the mucosal lining of the small intestine (Health Canada, 2012). Basically, when you eat gluten your body damages your small intestine which limits the digestive and absorptive capabilities of the organ. With these now limited capabilities, it is common for those with celiac disease (not following a gluten-free diet) to present with nutrient deficiencies and weight loss. Common symptoms of celiac disease are abdominal cramping and bloating, diarrhea, anemia, the list goes on (Health Canada, 2012). People can present with some or all of the symptoms described. This makes diagnosing celiac disease tough, as these symptoms can be related to many gastrointestinal problems.
The only treatment for celiac disease is following a strict gluten free diet. This not only includes eliminating all sources and contamination of wheat, but also: Barley, Bulgar, Couscous, Durum, Einkorn, Emmer, Farro, Kamut, Malt, Malt Extract, Malt Flavouring, Malt Syrup, Malt Vinegar, Oat Bran, Oats, Rye, Semolina, Spelt (Dinkel), and Triticale.
A full list of what needs to be eliminated from the diet can be found on the Canadian Celiac Association Website (https://www.celiac.ca/). Eliminating these foods can be very hard for many reasons, including: a lack of understanding, cross-contamination, not being the primary cook or grocery shopper in the household, etc. Education is a key piece to the treatment and management of this condition and from my experience even being a dietitian doesn't eliminate all challenges.
Following a strict gluten free diet will reduce the risk of developing any further complications from the disease. Complications such as nutrient deficiencies and GI cancers (Health Canada, 2012).
Social: Living with Celiac Disease
Now that we've covered the basic science behind celiac disease I wanted to provide a little insight into what it's like to live with this condition. Although when properly managed celiac disease isn't life threatening it still changes the way that an individual interacts with food and the world around them. This requires people to overcome mental, physical, social, and possibly economic barriers.
I was diagnosed with celiac disease two years ago. At first I was in complete shock and disbelief. How could this be possible? I'm Italian, I grew up on pasta and bread! I was in denial. As a Dietitian food is a huge part of my life and I knew that this diet change was going to alter my relationship with food, and be a challenge. Let's face it, I just didn't want to do it. It was really hard at first, I craved everything I couldn't have and was not interested in trying to make my favorite recipes a new way. I was finally starting to see what my clients must be going through when making any type of change to their diet; it sucks, it's hard, and sometimes you just want to quit. Over the past two years I have had my fair share of frustrations and failures. Some of which are:
1- Eating out is hard: I LOVE trying new restaurants, but I feel self-conscious because I am always 'that' person. The person who has to customize their order or even has to avoid certain restaurants. This is still something that haunts me and I am still working on being less self-conscious when going out.
2- It is hard to eat when others cook for you: People try really hard, but sometimes there is still contamination (even trace amounts of gluten will cause damage to your precious small intestine). I went through a phase where I would eat contaminated food to be polite but got to a point where I was just making myself sick. Taking control of your health is hard, especially when you don't want to disappoint anyone.
3- It is hard to eat when travelling to other countries and you don't speak the language: When I was travelling in Europe this summer I found myself (as embarrassing as it was) crying at a dinner table because I was just so frustrated that I couldn't speak Italian and tell them what I needed. I have come to terms with the fact that I can't eat the signature dish of some countries and have learned it is essential to take protein bars everywhere you go since sometimes you just can't find something to eat. I am now more prepared and have learned that there are little cards you can bring with you that explain gluten free in a variety of languages (which I will 100% be bringing with me next time I leave the country).
4- It is hard to try new things: Some things you just can't eat no matter what - RIP beef and barley soup.
5- You want to scream when people eat gluten free just because or to lose weight: Many people believe that gluten free products are healthier and will eat these products when they don't have to. When I hear this I lose my mind... Fun fact: a lot of gluten free products are actually full of fat and sugar to make them more palatable - not a healthier choice. Yes eating more fruits and veggies is healthier, but grains are not the enemy people!
(Strawberry Roll from Bunner's Gluten Free Bakery in Toronto)
Celiac disease is becoming increasingly prevalent in the world today. In fact according to Health Canada (2012) it is the most common chronic disease in the world, affecting 1% of North Americans (Fedorak et al., 2012).
Celiac disease is an autoimmune disease where the body has an abnormal reaction to the protein gluten (Health Canada, 2012). When gluten is ingested the body triggers an inflammatory process which causes damage to the mucosal lining of the small intestine (Health Canada, 2012). Basically, when you eat gluten your body damages your small intestine which limits the digestive and absorptive capabilities of the organ. With these now limited capabilities, it is common for those with celiac disease (not following a gluten-free diet) to present with nutrient deficiencies and weight loss. Common symptoms of celiac disease are abdominal cramping and bloating, diarrhea, anemia, the list goes on (Health Canada, 2012). People can present with some or all of the symptoms described. This makes diagnosing celiac disease tough, as these symptoms can be related to many gastrointestinal problems.
The only treatment for celiac disease is following a strict gluten free diet. This not only includes eliminating all sources and contamination of wheat, but also: Barley, Bulgar, Couscous, Durum, Einkorn, Emmer, Farro, Kamut, Malt, Malt Extract, Malt Flavouring, Malt Syrup, Malt Vinegar, Oat Bran, Oats, Rye, Semolina, Spelt (Dinkel), and Triticale.
A full list of what needs to be eliminated from the diet can be found on the Canadian Celiac Association Website (https://www.celiac.ca/). Eliminating these foods can be very hard for many reasons, including: a lack of understanding, cross-contamination, not being the primary cook or grocery shopper in the household, etc. Education is a key piece to the treatment and management of this condition and from my experience even being a dietitian doesn't eliminate all challenges.
Following a strict gluten free diet will reduce the risk of developing any further complications from the disease. Complications such as nutrient deficiencies and GI cancers (Health Canada, 2012).
Social: Living with Celiac Disease
Now that we've covered the basic science behind celiac disease I wanted to provide a little insight into what it's like to live with this condition. Although when properly managed celiac disease isn't life threatening it still changes the way that an individual interacts with food and the world around them. This requires people to overcome mental, physical, social, and possibly economic barriers.
I was diagnosed with celiac disease two years ago. At first I was in complete shock and disbelief. How could this be possible? I'm Italian, I grew up on pasta and bread! I was in denial. As a Dietitian food is a huge part of my life and I knew that this diet change was going to alter my relationship with food, and be a challenge. Let's face it, I just didn't want to do it. It was really hard at first, I craved everything I couldn't have and was not interested in trying to make my favorite recipes a new way. I was finally starting to see what my clients must be going through when making any type of change to their diet; it sucks, it's hard, and sometimes you just want to quit. Over the past two years I have had my fair share of frustrations and failures. Some of which are:
1- Eating out is hard: I LOVE trying new restaurants, but I feel self-conscious because I am always 'that' person. The person who has to customize their order or even has to avoid certain restaurants. This is still something that haunts me and I am still working on being less self-conscious when going out.
2- It is hard to eat when others cook for you: People try really hard, but sometimes there is still contamination (even trace amounts of gluten will cause damage to your precious small intestine). I went through a phase where I would eat contaminated food to be polite but got to a point where I was just making myself sick. Taking control of your health is hard, especially when you don't want to disappoint anyone.
3- It is hard to eat when travelling to other countries and you don't speak the language: When I was travelling in Europe this summer I found myself (as embarrassing as it was) crying at a dinner table because I was just so frustrated that I couldn't speak Italian and tell them what I needed. I have come to terms with the fact that I can't eat the signature dish of some countries and have learned it is essential to take protein bars everywhere you go since sometimes you just can't find something to eat. I am now more prepared and have learned that there are little cards you can bring with you that explain gluten free in a variety of languages (which I will 100% be bringing with me next time I leave the country).
4- It is hard to try new things: Some things you just can't eat no matter what - RIP beef and barley soup.
5- You want to scream when people eat gluten free just because or to lose weight: Many people believe that gluten free products are healthier and will eat these products when they don't have to. When I hear this I lose my mind... Fun fact: a lot of gluten free products are actually full of fat and sugar to make them more palatable - not a healthier choice. Yes eating more fruits and veggies is healthier, but grains are not the enemy people!
6- You can't just eat things: The amount of times I have gone to grab a sample and then realized I can't eat it has been far too many to count. When events are catered or there are samples, chances are you should bring your own food. I have a fear of being hungry so I am always packing some sort of snack.
All frustrations aside, being diagnosed with celiac disease has also had several positive impacts on my life and really is manageable (and not that bad). I have been able to explore new food and recipes I would have never otherwise tried, and I have found new places to eat that accommodate gluten free diets. Most importantly, I have become a better Dietitian. I can now empathize with people that have to make life changes that alter the way they interact with food, and I am able to better help people overcome barriers that get in the way of their progress. This has allowed me to become a better Dietitian as I can actually relate to what people are going through - genuine empathy goes a long way in improving creativity and problem-solving.
I do believe that everything happens for a reason. Although I don't know if I would go so far to say this is the best thing that has happened to me, it has certainly added new adventure and many benefits to my life. I am glad to have improved my practice as an RD and to have these new adventures in the kitchen. Eating gluten free is actually tasty (despite what some might have you believe) and not that hard once you get into the swing of things. Although it is a pain in the butt for those eating with me it has been a new way for many people in my life to discover new food. This just shows how food has the potential to heal, to discover and to bring people together - the theme of Nutrition Month 2018 could not have been more accurate!
My Gluten Free Favorites Across the Globe
- Bunners Gluten Free Bakery (Toronto, ON) - Baked goods
- Wooden Monkey (Halifax, NS) - Many GF options and very accommodating
- Envie: A Vegan Kitchen (Halifax, NS) - Many GF options and very accommodating
- Edna (Halifax, NS) - Many GF options and very accommodating
- Odell's Gluten Free Bakery (Halifax, NS) - Deli, baked goods
- Schoolhouse Gluten Free Bakery (sold in many cafes in Halifax, NS) - Baked goods and Breads
- Samuel's Coffeehouse (Summerside, PEI) - Many GF options and very accommodating
- Simply Raw Bakery (Vienna, Austria) - Everything GF
- Spiga Amica (Madalloni, Italy) - Everything GF
- Joylato (Rekjavick, Iceland) - Ice Cream
- Cesare Gelato (Reggio di Calabria, Italy) - Gelato on GF Brioche Bun
- La Figlia del Presidente (Naples, Italy) - Pizza
References:
Health Canada (2012). Celiac disease: The gluten connection. Retrieved from https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html
Canadian Celiac Association www.celiac.ca
Fedorack, R., Switzer, C., & Bridges, R. (2012). Canadian digestive health foundation public impact series 4: Celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Canadian Journal of Gastroenterology. 26(6):350-352.
All frustrations aside, being diagnosed with celiac disease has also had several positive impacts on my life and really is manageable (and not that bad). I have been able to explore new food and recipes I would have never otherwise tried, and I have found new places to eat that accommodate gluten free diets. Most importantly, I have become a better Dietitian. I can now empathize with people that have to make life changes that alter the way they interact with food, and I am able to better help people overcome barriers that get in the way of their progress. This has allowed me to become a better Dietitian as I can actually relate to what people are going through - genuine empathy goes a long way in improving creativity and problem-solving.
I do believe that everything happens for a reason. Although I don't know if I would go so far to say this is the best thing that has happened to me, it has certainly added new adventure and many benefits to my life. I am glad to have improved my practice as an RD and to have these new adventures in the kitchen. Eating gluten free is actually tasty (despite what some might have you believe) and not that hard once you get into the swing of things. Although it is a pain in the butt for those eating with me it has been a new way for many people in my life to discover new food. This just shows how food has the potential to heal, to discover and to bring people together - the theme of Nutrition Month 2018 could not have been more accurate!
My Gluten Free Favorites Across the Globe
- Bunners Gluten Free Bakery (Toronto, ON) - Baked goods
- Wooden Monkey (Halifax, NS) - Many GF options and very accommodating
- Envie: A Vegan Kitchen (Halifax, NS) - Many GF options and very accommodating
- Edna (Halifax, NS) - Many GF options and very accommodating
- Odell's Gluten Free Bakery (Halifax, NS) - Deli, baked goods
- Schoolhouse Gluten Free Bakery (sold in many cafes in Halifax, NS) - Baked goods and Breads
- Samuel's Coffeehouse (Summerside, PEI) - Many GF options and very accommodating
- Simply Raw Bakery (Vienna, Austria) - Everything GF
- Spiga Amica (Madalloni, Italy) - Everything GF
- Joylato (Rekjavick, Iceland) - Ice Cream
- Cesare Gelato (Reggio di Calabria, Italy) - Gelato on GF Brioche Bun
- La Figlia del Presidente (Naples, Italy) - Pizza
References:
Health Canada (2012). Celiac disease: The gluten connection. Retrieved from https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html
Canadian Celiac Association www.celiac.ca
Fedorack, R., Switzer, C., & Bridges, R. (2012). Canadian digestive health foundation public impact series 4: Celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Canadian Journal of Gastroenterology. 26(6):350-352.
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