by Elizabeth Helgans, PA-C (and Celiac)
As a Physicians Assistant in Gastroenterology and person with Celiac Disease, I am always exploring ways to enjoy life to its fullest while staying healthy. Here a few things I’ve learned and some tips for living well with Celiac Disease:
What is Celiac Disease?
Celiac disease is an autoimmune (body attacking itself) condition. When gluten is eaten the body attacks the lining of the small intestine. The small intestine is lined with a fuzzy carpet like layer called villi. Villa are where nutrients from food are absorbed. When a person with Celiac disease eats gluten, the body attacks the villi of the small intestine. This impacts absorption of nutrients. Often when Celiacs are first diagnosed they are very vitamin deficient. This is what causes some of the symptoms that include fatigue, paresthesias (pins and needles), anemia, body aches, and headaches.
When Will I Feel Better?
Your body is stressed, vitamin deficient, and lacks functioning villi to digest food and absorb nutrients. That’s the bad news. The good news is that your small bowel can fully recover on a gluten-free diet. Many people will feel better within weeks, but don’t be discouraged if it takes months to a year. Full villi recovery takes 6 to 9 months. Also, while healing you may have trouble digesting other foods, as many enzymes needed for digestion come from the tips of the villi.
As you heal, you will digest food better and be less “intolerant” of certain foods. I often tell people to omit dairy from their diets for a few months when initially diagnosed, as it can be very hard to digest with lots of villi damage. In most cases, after you are healed your intolerances will go away.
What Can I Do to Heal?
The most important step you can take to support healing is a gluten-free diet. With a gluten-free diet you cannot eat wheat, barley or rye. This task may seem daunting at first, but you will find that its possible to adjust to a gluten-free diet as time goes by. Fortunately, the last decade has seen a flood of gluten-free products introduced in the market. Colorado is a great state for gluten-free eating and Boulder County is one of the best places in the world to be a Celiac. In addition to an abundance of delicious, gluten-free offerings in local grocery stores, most local restaurants are able and happy to accommodate a gluten-free diet. In fact, many national restaurant chains have gluten-free choices as well.
Can I Cheat?
The short answer is no. The long answer is also no, but let me explain. Some people will not “react” when they accidentally or purposely eat gluten. Most people will, however, and it won’t be pretty. It could be just belly pain or it could be accompanied with diarrhea. Some people will have joint aches and “brain fog” for a few days. Either way, whether you react or not, you are inflicting damage inside your small intestine.
Untreated or undiagnosed Celiac disease can increase your risk of other autoimmune diseases such as rheumatoid arthritis, thyroid disease, multiple sclerosis, diabetes and some cancers. There has also been some suggestion in research that it can lead to dementia if not treated with a gluten-free diet.
That being said, you have to live. The cross-contamination issue is a tough one. It is hard to eat out and not have any cross-contamination unless you go to a 100% gluten-free restaurant. I eat out all the time and most of the time I feel great and don’t have any consequences (belly pain/diarrhea) from the likely cross-contamination that I am getting here and there. I refuse to let the disease control everything in my life.
- PF Changs
- Pei Wei
- Mod Market (pizza, salads and meals)
- Chipotle (everything gluten-free except flour tortillas)
- Outback Steak House
- California Pizza Kitchen
- Yellow Belly (gluten-free chicken in Boulder)
- Lark Burger (gluten-free buns)
- Protein Bar
- Mad Greens
- Zoe’s Kitchen
- Beaujos pizza
100% GF restaurants in the Boulder Area
- Blooming Beets
- Fresh Thymes
- Julia’s Kitchen
- 5 on Black
- Zeel (nearly 100%)
- Kim and Jakes Cakes (bakery of your dreams!)
- Purple Door market in Hygiene is an adorable gluten-free market/bakery
Brands I Like
- Canyon Bakehouse multigrain bread- soft gluten-free bread for sandwiches
- Glutino pretzels
- Ancient Harvest pasta (corn/quinoa blend)
- Annies creamy deluxe Mac n cheese
- Kim and Jakes cookies and baguettes
- WOW cookies
Beware: Surprise Sources of Gluten
Remember to always read the ingredient labels. Here are a few tips about surprise sources of gluten.
- Soy sauce is made from wheat. Use Tamari instead.
- Imitation crab meat is made from wheat.
- Candy bars such as Reese’s Cups, Snickers, etc are gluten-free, but their smaller sized, holiday-shaped ones are not. I don’t know why.
- “Natural Flavors” are usually okay but sometimes barley is used as a carrier. No way to tell.
- Maltodextrin is okay, as it’s usually made from corn or potato. If made with wheat, the ingredient label must specify this.
- A new gluten-free labeling law passed a few years ago. Things labeled gluten-free must be less than 20 parts per million.
- Caramel coloring is said to contain gluten, but not in the United States. International products with caramel coloring in them can be a problem.
- If you stick to whole foods you will be okay. Choose whole rather than processed foods.
- celiac.com – Celiac disease and gluten-free diet support
- Celiac Support Association
- The “Find Me Gluten Free” App – a great tool for traveling that uses GPS to find gluten-free options
- Yelp with the gluten-free filter
- Zomato with the gluten-free filter
Exciting Developments on the Horizon
- Drug in final stages of testing that will allow you to get a little gluten in your diet (from cross contamination) without “reacting” or causing damage to your intestines
- Possible vaccine is testing in Australia
Elizabeth Helgans is a Physicians Assistant in the Gastroenterology Department at Boulder Medical Center. Click Here to learn more about the Gastroenterology Department or call 303-440-3216 for an appointment.