Both gluten sensitivity and celiac disease require the avoidance of foods that contain gluten. Gluten sensitivity involves you having negative reactions towards gluten-containing foods; though, these negative reactions are not triggered by immune responses. In fact, the cause of these reactions remains unclear. Alternatively, celiac disease is an auto-immune disorder that manifests as intestinal atrophy, and mostly affects the duodenum. After the intake of foods containing gluten, both gluten sensitivity and celiac disease cause certain symptoms that cause you discomfort.
The gluten-free diet
The gluten-free diet is normally recommended for the management of gluten sensitivity and celiac disease. Several symptoms of gluten sensitivity and celiac disease are similar including wasting, diarrhoea, bloating , abdominal cramping and malabsorption.
The symptoms of celiac disease however vary since not all individuals present with similar symptoms. Others can have fatigue , anaemia , neuropathy or osteoporosis.
Types of celiac disease
There are 4 major types of celiac disease including:
Latent Celiac Disease – It is confirmed by positive serologic assessments. It does not present with any symptoms and there lacks any intestinal atrophy. However, symptoms may develop later.
Classical celiac disease- Manifests predominantly with gastrointestinal symptoms including weight loss , diarrhoea, malabsorption, abdominal cramping and bloating. Laboratory tests confirm the presence of the disease.
Celiac disease with atypical symptoms– It is characterized by other symptoms not gastro-intestinal related such as osteoporosis, fatigue, neuropathy, anaemia, etc.
Dermatitis herpetiformis – This type of celiac disease affects the skin and manifests as rashes that could develop to blisters. Its diagnosis is determined by performing a skin biopsy near the blisters. Patients with dermatitis herpetiformis usually lack gastro-intestinal symptoms though when an intestinal biopsy is performed it usually confirms the presence of the intestinal mucosa atrophy.
Silent celiac disease-Lacks any clinical symptoms despite a positive confirmation of assessment results along with damage to the intestinal mucosa.
There is also Refractory sprue- a type of celiac disease, which is not responsive to a gluten free diet.
Nutrition assessment and diagnosis
To diagnose celiac disease, an intestinal biopsy is usually conducted. Clinical assessment may further confirm the presence of the disease.
Depending on the extent of damage to intestines , the severity of malabsorption may vary in turn impacting the deficiency of certain nutrients including iron, folate, Vitamin D and calcium. Moreover, after the gluten -free diet is implemented certain nutrients e.g. thiamine (mainly obtained from gluten-containing foods) become increasingly deficient.
Certain individuals with gluten-sensitivity may also identify that they are lactose -intolerant because lactose intolerance can manifest secondary to celiac disease.
How you can manage gluten sensitivity
To manage gluten sensitivity and celiac disease, the gluten-free diet is recommended. The supplementation of nutrients likely to be deficient, is also recommended although under a qualified dietitian’s guidance.
What is a gluten- free diet?
The basis of this diet is the elimination of foods containing gluten including grains, cereals and associated ingredients. Foods containing barley, wheat, ale, rye etc are avoided. Even the derivatives of the mentioned foods are avoided including semolina and alcohol.
However, certain grains not related to wheat , for example , maize, sorghum , millet , cassava, flax, legumes, rice and quinoa can be consumed .
Oats can also be consumed but by persons on gluten -free diet who can tolerate them.
Overall, if you are on gluten-free diet, aim to consume adequate amounts of whole -grains as opposed to refined grains. This should ensure that you obtain adequate amounts of varied nutrients. Also ensure that you opt for non-cereal sources of nutrients that are likely to be limited in a gluten-free diet , e.g. thiamine, Vitamin B2 , Vitamin B3 , and folate. This should also ensure that you meet the recommended intakes of these nutrients.
Foods to be omitted include:
- Cereals and grain products-Breads and flour made from either wheat, rye ,barley or oats. Wheat germ, noodles or spaghetti from the excluded foods e.g. rye , barley and bran.
- Beverages- beer, ale distilled spirits from cereal and malted milk among others with the excluded foods.
- Vegetables- vegetables coated with either flour from wheat , rye, barley etc.
- Soups- soups containing noodles, barley etc.
- Fats-cream sauces thickened with flour, or commercial sauces.
Symptoms of celiac disease are likely to subside after about an year if you adhere to a gluten-free diet. The long-term compliance to the diet even after the symptoms have subsided should continue to prevent relapses.
Additionally, if you suspect that you have symptoms associated with gluten-sensitivity, you should seek medical assistance because the delayed treatment or a lack of compliance to a gluten-free diet may predispose one to increased likelihood of developing complications such as osteoporosis and Type 1 diabetes. You can receive guidance on how to plan your gluten-free diet from a qualified dietitian.