What is celiac disease really? Symptoms, prohibited and allowed foods

Let’s find out what celiac disease is and what foods are suitable for celiacs. Also learn how to cook them and where to get them, so that those who suffer from this disorder can still follow a balanced and healthy diet.

Celiac disease is an autoimmune disorder that causes malabsorption of nutrients; it can only be cured by avoiding eating foods containing gluten, a protein found in wheat, barley, rye and in various cereal types such as seitan (because it is made from gluten).

It is not an allergy, but a multifactorial, autoimmune disorder, in which the sufferer’s immune system, which should be defending his or her body, instead begins to attack it based on stimuli that may be varied.

More in detail, gluten is a lipoprotein substance, composed of fat and two proteins. And these two proteins are able to bend to receptors present only in the intestine of the celiac, because of a small genetic defect. A defect that does not affect significantly growth or development, but unfortunately affects the way one eats, and for the whole life.

And in case you are not celiac, you will also find here the risks of a gluten-free diet for those who are not allergic.

Celiac disease meaning and prevalence

Celiac disease is prevalent throughout the world and, despite being a largely underdiagnosed disease, data on its prevalence have increased significantly over the past 25 years. An increase linked both to the improvement of diagnostic tools and to a greater tendency to screen people considered at risk. Globally, the prevalence of celiac disease is 1%, with large local variations and regardless of age.

It is commonly defined as ‘a strong allergic-type immune reaction to the gluten protein found in many varieties of cereals and wheat’.

Celiac disease symptoms

This disease can manifest itself only through mild complaints, but in most cases the most noticeable reaction is inflammatory, localized in the small intestinal tract, which is responsible for nutrient absorption.

They can then appear:

• violent headaches
• chronic diarrhea
• sense of fatigue
• anemia
• weight loss
• slow growth in children, so much so that for a long time celiac disease was considered a typical childhood disease

Although it may seem strange, it is triggered not only by food factors. Sometimes it is caused by particular environmental conditions (as well as other intolerances and allergies) or by genetic predispositions.

More recently, it has been scientifically documented that celiac disease also occurs as a result of strong emotional or physical stress.

What celiac disease really is

In those with celiac disease, gluten is seen as an ‘enemy’ by the immune system, and this leads the gut mucosa to refuse to absorb it.

Specifically, the wall of the intestine has a series of protuberances called villi, which are responsible for the absorption of nutrients from the foods we ingest. Thanks to these protuberances, the surface area of contact with food is increased and we are able to absorb more of it.

When gluten arrives in the intestine and rests against its walls (the intestine is a tube, and the walls absorb nutrients and release them into the bloodstream, which will circulate them through the body), an immune response is triggered that normally should not be triggered.

Here it is that some cells of the immune system, the lymphocytes, recognizing this substance as harmful, begin to attack the very wall of the intestine and in particular the villi. Progressively they “atrophy” until they disappear, so that in the long run the ever-inflamed stomach wall becomes smooth.

It results in malabsorption of all the substances we eat, because nutrients (iron and other minerals, vitamins, sugars, proteins, fats) are not assimilated.

Celiachia symptoms in children

Villi malabsorption causes malnutrition and growth problems. The problem manifests itself most in children (which is why the symptoms are so severe) and begins the moment we switch from breast milk to “solid” food. This is where we realize that something is wrong.

In young children, celiac disease manifests as stunting of growth and significant weight loss. In addition, one can observe:

• vomiting
• irregular bowels
• chronic diarrhea
• swollen abdomen
• constipation
• irritability
• insomnia
• chronic fatigue
• joint pain
• marks on the enamel of the teeth
• dermatitis herpetiform
• recurrent oral infections
• low ferritin in blood and high transaminases.

Celiac disease diagnosis

Celiac disease is considered a genetic disease and a complex of genes (HLA-DQ2 and HLA- DQ8) is linked to those who suffer from this allergy, however having them in one’s genetic make-up is not acondition sine qua non for developing celiac disease, but simply a predisposition.

In fact, the molecules involved in the mechanisms that determine intestinal damage in celiac individuals would appear to be set in motion by stress.

This means that, although there must be a genetic predisposition and a concomitance of environmental factors, as well as particular interactions of endogenous and exogenous order, the gluten absorption alone may not be sufficient to trigger the disease. It tends to manifest itself only in situations of stress and infectious states that have not yet been exactly identified.

Unfortunately, to date to celiac disease there is no cure:the only way for symptoms not to worsen (also causing, among other things, intestinal lymphomas due to too much stimulation of lymphocytes) is to not eat gluten for life.

The diet allowsinjured intestinal tissues to heal and normalizes theunbalances derived from celiac disease (particularly bone parameters and vitamin deficiencies).

But avoiding eating gluten if you do not have this genetic problem (for which you do not heal and become celiac, you simply are for life) has no benefit. Only those who are truly affected by this allergy should control what they eat and avoid gluten.

Those who think they are intolerant or believe they have a hard time digesting gluten, based on personal beliefs related to an unhealthy condition, having perhaps only had a medical consultation or pharmacy test, will not benefit

Celiac disease testing

To determine whether one has celiac disease, there are specific tests, which are based on the contact of the intestinal mucosa with gluten, then the assay of antibodies (the “defense mechanisms” released by lymphocytes, which we mentioned earlier) to see whether or not there may be an immune reaction toward gluten.

There are two tests to find out if you have this disorder: a blood tests and the intestinal biopsy. Without having these done, you cannot be diagnosed as having celiac disease.

• The blood tests are for the detection of certain specific antibodies (anti-transglutaminase, anti-gliadin, anti-endomysium).

• The intestinal biopsy leads to the assessment of the stage of the disease; it is an invasive test, because tissue has to be taken from the small intestine and then analyzed.
  And this test is also used to obtain an exemption from the ASL for the purchase of gluten-free products within a monthly spending threshold that varies from region to region.

This disease is therefore unequivocally established with intestinal biopsy for adults and a genetic test for children. If you are not found to have celiac disease, you can continue to eat gluten and foods that contain it.

FOCUS: Healthy breakfast ideas and recipes

What a celiac can eat

So let’s see in case of celiac disease what can be eaten. Gluten is a substance produced by wheat, and other grains similar to it; it is one of the proteins necessary for the survival of wheat, so although there are varieties with less gluten, there is no wheat that has no gluten at all.

To be precise, gluten is not in the grain of the cereal or in the flour, but is formed when water is added to make dough. Therefore, it is the products derived from this dough that are dangerous for allergy sufferers.

Anything that is wheat flour, even processed (bread, pasta) must thus be avoided by a celiac. Gluten is also present in plants belonging to similar species, which are part of the same family:

• wheat (including ancient varieties and derivatives with wheat germ, wheat bran, bulgur and cous cous)
• rice and its derivatives (malt and drinks containing it)
• segal
• buckwheat,
• triticale (which is a cross between wheat and rye)
• kamut, which is still a wheat, which celiacs cannot eat.
• spelt
• oats: although it does not contain gluten, because in the fields there are ears of wheat hidden among those of oats, and since the ears are not evaluated one by one, and among the oats there may also be a few kernels of wheat.

Celiac disease: diet to follow

Wheat and other grains contain some of the most important nutrients the body needs and are found in the majority of foods and products we find in commerce.

Celiac disease can therefore become a limiting and conditioning condition,because the only cure is adopting an absolutely gluten-free diet.

Here are some foods that celiacs can eat safely:.

• gluten-free cereals and flours: corn, millet, sorghum, cassava, and bread made with the flours of these cereals, both bread and pasta, cakes and biscuits.
• honey and sugar, both semolina white and brown and whole grain are good.
• all dairy products of animal origin are allowed (except yogurt)
• vinegar, olive oil and butter are gluten free.
• meat and fish, shellfish and crustaceans are foods suitable for people with celiac disease but beware of processing, so cooked ham, salami and various sausages are best left alone.
• all fruits and vegetables are suitable for those with a gluten allergy.
• both teas and coffee, various carbonated drinks and juices, wine, superalcoholic beverages and various spices are allowed.

But be careful, because gluten is used as an excipient and thickener in an impressive number of ready-to-eat foods and preparations such as yeast, data, chips, etc. Let’s sort this out. Among those at risk, attention should be paid to:

• chocolate
• ice cream
• amaranth
• quinoa
• soybean and its derivatives
• egg

Recipes and foods suitable for people with celiac disease

Until a few years ago, the life of a celiac might have been impossible, considering the lack of information and knowledge on the subject. Today, the situation has markedly improved, thanks to the internet and the new food labeling rules and the associations, forums and discussion groups that have sprung up with the aim of providing support for people with the disease.

There are a lot of sites full of useful information, guides, educational paths and specific food directions precisely to enable people with celiac disease, as well as relatives and family members directly involved. Many sites list gluten-free foods on the market, divided by category. This also makes it easier to locate companies, supermarkets and restaurants where gluten-free food and beverages can be found.

In addition, several brands and manufacturers have decided to label and certify their products with a recognizable and simplified symbology for gluten-free foods (the classic green crossed-out ear of corn). And not all restaurants can provide food for those with celiac disease, but an increasing number of establishments have begun to equip themselves with the gluten free sign and offer specially designed menus and dishes.

Since January 1, 2012, the European Council has adopted legislative measures to regulate the food labeling system. Currently, the European legislation states that:

• the threshold of gluten present in products that can be defined as ‘foods gluten-free’ must not exceed 20 mg/kg in the finished product
• the gluten threshold for food products “with very low gluten content” shall not exceed 100 mg/kg

Beware of contamination!

Exacerbating the problem is the fact that contaminated food, at least for the celiac, is anything that has even comesimplyin contact with food containing gluten. Here’s a little vademecum to untangle yourself:

• You cannot cook pasta for celiacs in the same pan in which pasta with gluten was cooked, because some of the gluten is still present in the water and could stick to pasta that is free of it, contaminating it. The same applies to the pans where you have fried with flour, and also to the cutlery.
• Some foods do not contain gluten, such as meat, fish, shellfish, and crustaceans, but they can be prepared with a breading that contains it, so be careful with chops, sticks, fried fish, and breaded vegetables.
• Other foods may be cooked in condiments and sauces thickened with banned flours, e.g. burgers and meatballs
• Foods that do not contain gluten, but are processed and handled with flour that does contain it, such as dried fruits, some soluble coffees, enriched with barley malt, yeast and seitan.