Last updated on June 2nd, 2023
What is Celiac Disease?
Celiac disease is an autoimmune disorder triggered by gluten—a combination of proteins in wheat, rye, and barley. Small intestinal damage leads to malnutrition and then further health complications.
Celiac disease is genetic but not inherited. Susceptibility runs in families, but CD develops when a person’s genes interact with environmental factors.
When people with celiac disease eat gluten their immune system tries to destroy it, damaging their small intestines at the same time. Sort of like knights busting up the very castle they’re trying to defend ⚔️
Villi are finger-like projections that create more surface area in the small intestines to absorb nutrients from food. Exposure to gluten causes inflammation that flattens out the villi, leading to malabsorption in people with CD 😬
The only treatment for celiac disease is food-based:
- No barley
- No rye
- No wheat
- No "cheats"
(Oats are often out too 🥴)
Interesting Facts about Celiac Disease
Doctors once thought bananas cured celiac disease. Patients improved on a banana diet (including dairy, meat, and veggies). However, the omission of gluten, not the addition of bananas, lead to healing!
About 1% of the world’s population has celiac disease. Chances are if you're reading this you know at least one person affected by it.
It’s estimated that 4 out of 5 people living with celiac disease are undiagnosed.
Celiac diagnosis is usually a 2-step process, starting with a blood test. If it comes back positive, then an endoscopic biopsy of the small intestine is next.
After a celiac diagnosis it can take a year or more of a 100% gluten-free diet for the gut to fully heal.
A celiac diagnosis often comes with secondary lactose intolerance due to intestinal damage from gluten exposure. This intolerance might be temporary, but it's helpful to avoid dairy for a while after diagnosis to allow the gut to heal.
Celiac disease is a life-long diagnosis. No cheat days. No growing out of it.
What is Gluten?
Gluten is a combination of storage proteins in cereal grains 🌾 Proteins in corn and rice are sometimes called gluten, but only those found in wheat, rye, and barley trigger celiac disease (okay, often oats, too!).
A single crumb can cause intestinal damage and set off other symptoms of celiac disease.
Most grains and pseudo-grains are gluten free, including:
Like so many things with celiac disease, oats are complicated. They’re usually cross contaminated in the field or during harvest/storage/milling.
What about GF oats? At least 20% of celiacs react to certified gluten-free oats 🤷♀️
Food labeled "gluten free" must contain less than 20 parts per million (ppm) gluten. Not because this is the safest level, but because this is the lowest level reliably detected.
Many plant-based meat alternatives depend on vital wheat gluten for protein and texture. That means they're off the menu for people with celiac disease.
Eggs are naturally gluten free, BUT some restaurants have a secret ingredient for fluffy omelets and scrambles: pancake batter 🥞 People with celiac disease need to check with their server if the eggs are gluten free.
Although generally gluten free, french fries become cross contaminated when fried in the same oil as gluten food. People with celiac disease need to find out if restaurants use a shared deep fryer.
👀 Look out for barley malt in cereal, candy, milkshakes and other sweetened milk drinks.
Barley also shows up in some unexpected places thanks to malt vinegar.
Watch out for malt vinegar in:
- BBQ sauce
- Cocktail sauce
- Malt aioli
- Steak sauce
- Brown sauces
- Worcestershire sauce
Whether traditionally fermented traditionally or industrially made, most soy sauce contains gluten from wheat berries. If you don’t have access to the bottle, assume that soy sauce includes gluten.