Whether a celiac sufferer or just observing a gluten-free diet, there are many places where gluten can be hiding in plain sight.
Celiac disease is an autoimmune disorder which affects approximately 1 in 133 people in Canada. It occurs when the body is unable to break down and use a protein called gluten. When gluten cannot be used by the body it stays in the small intestine and begins to damage the absorptive surface which results in an inability to absorb nutrients.
The grains that affect people with celiac disease include the different species of wheat (e.g., durum, spelt, kamut), malt, barley, rye, and their cross-bred hybrids (e.g., triticale, which is a cross between wheat and rye). Currently, the only treatment for celiac disease is to continually maintain a strict gluten-free diet.
Common symptoms include anemia, chronic diarrhea, weight loss, fatigue, cramps and bloating, irritability and abdominal pain, but celiac can affect just about every system in your body, including the skin, hormones, bones and joints.
Although some or all of these symptoms occur in celiac disease, some can also occur in other common diseases.
Until recently, physicians had to rely on clinical signs to suggest the diagnosis and to select which patients should have further investigation to prove the diagnosis. Since signs may be vague or of varying severity, this may be difficult. Now, simple blood screening tests are becoming available to help this process.
Testing for the disease should take place before an individual starts a gluten-free diet, since removal of gluten from the diet would interfere with the ability to detect the disease. Celiac disease can be diagnosed through a combination of:
· Blood tests (you can now buy home tests)
· Small-bowel biopsy
· Recovery from the symptoms while following a gluten-free diet
Small-bowel biopsy remains the 'gold standard' test for celiac disease detection. After 6 to 12 months of maintaining a strict gluten-free diet, symptoms should disappear, blood tests for the disease should become negative, and any small bowel injury should heal completely. It will be important for celiac patients to regularly follow up with their health care practioner on the progress in treating the disease.
The treatment of celiac disease is strict adherence to a gluten-free diet for life. It requires knowledgeable nutritional counseling and frequent updates as commercial food contents change.
Celiacs must be alert to hidden sources of gluten such as HVP/HPP (hydrolyzed vegetable/plant protein). Today's processed and packaged foods have many hidden sources of gluten, which can be unintentionally ingested. To be safe, a person with celiac disease wanting to avoid flare-ups, should read ingredients on labels every time they purchase food as manufacturers frequently change ingredients.
Here are 10 of the most common hidden sources of gluten:
1) Scrambled eggs, omelets. When you make them at home, scrambled eggs and omelets typically contain just eggs, butter, vegetables, and perhaps a little milk. But some restaurants, in an effort to add a little extra "fluff" to their eggs, add flour or other gluten-containing additives. Always be sure to inquire about the ingredients in egg-based foods when eating out.
2) Soup. Many traditional soup recipes contain roux, a mixture of flour and fat that serves as a thickening base. Unless clearly delineated as being free of gluten, many soups likely contain added wheat flour.
3) Ground meat. Hamburger patties, meatloaf, meatballs, and other foods made from ground meat products are thickened similar to soup, using breadcrumbs. This can also include luncheon meats and sausages. Be sure to look for 100 percent pure beef labels, for instance, and always ask your waiter or waitress when dining out whether or not flour or breadcrumbs are added to the restaurant's meat dishes.
4) Vitamins, dietary supplements and pharmaceutical drugs. Believe it or not, some vitamin and supplement manufacturers use casings, fillers, and other ingredients that may contain gluten. According to a recent U.S. News & World Report investigation, vitamins, supplements, and even pharmaceutical drugs can contain wheat-based "modified food starch" and other inactive ingredients with gluten.
5) Chinese food. Many of the dishes served at Chinese restaurants may appear to be gluten-free, containing just meat, rice and vegetables. But hidden inside many Chinese food dishes are condiment ingredients like soy, oyster and bean sauces that contain wheat-based ingredients. Unless it is specially prepared in a dedicated gluten-free environment with wheat-free ingredients, Chinese food is almost always a no-go.
6) French fries. Many people assume that French fries are just potato slices deep fried in oil. But in some cases, the French fries served at restaurants or sold frozen at the grocery store have been coated in a flour batter to make them crispier when cooked. And even when they haven't been coated, deep frying oils in general can be contaminated with breading from other foods that have already been cooked in them.
7) Diet soda, artificially-sweetened foods. Though it does not actually contain gluten, the artificial sweetener aspartame is recognized as a serious offender for those with a gluten intolerance or celiac disease. Since it often triggers similar allergic symptoms, including severe stomach pain and bloating, aspartame and other artificial sweeteners might as well be gluten.
8) Vegetables. When you can't prepare them yourself, vegetables are another possible source of gluten contamination. Restaurants that serve pasta dishes may reuse the same water to cook vegetables, for instance, causing wheat ingredients and residue to soak directly into these vegetables. Again, always inquire about how foods are cooked whenever eating out, including seemingly unlikely offenders like vegetables.
9) Household appliances. Unless they are specifically used just for heating gluten-free foods, chances are your toaster and baking oven are hotbeds of gluten residue. Bread crumbs, spilled sauces, and other loose ingredients can easily contaminate other cooked foods, which is why it is important that people with celiac disease use dedicated cooking appliances whenever possible.
10) Cosmetics, lip balms. The things we put on our bodies can be just as threatening as the things we put in our bodies, especially when gluten allergies are a factor. In 2011, researchers found that many popular cosmetics, including foundations, body lotions and other beauty products, contained gluten ingredients that may pose a threat. Similarly, some lip balms are offenders as well, which means it is always important to look for cosmetics and lip balms specifically labeled as being free of gluten.
As for oats, recent studies have shown that pure uncontaminated oats may be used in the gluten-free diet with care.
It can be difficult to follow a truly gluten-free diet, so it's important to make a definite diagnosis of celiac disease. If celiac disease is diagnosed, a gluten-free diet must be followed for the rest of your life. Some people find it helpful to speak with a nutritionist to learn how to adopt a gluten-free diet.
Read more about eating gluten-free food while traveling
Canadian Celiac Association. (2011). About Celiac Disease. Available: . Last accessed 1 May 2013.
Benson, J. (2013). Watch Out For These 10 Hidden Sources of Gluten. Available: http://www.naturalnews.com/039235_gluten_hidden_sources_vitamins.html. Last accessed 10th May 2013.