Download Dietary Recommendations for Celiac and NCGS

Dietary Recommendations for
Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS)
Lisa Helffrich Hudson, RDN
Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS) are similar conditions in that they both
have food, and specifically gluten, as the common factor that elicits a significant immune
response. Celiac disease is an autoimmune disorder that affects genetically susceptible
individuals when they ingest gluten, a protein found in many foods in our diet. The gluten
protein is detected by the immune system as “foreign” and triggers an autoimmune response.
The result is inflammation and damage of the small intestines ultimately leading to severe
nutritional deficiencies and chronic health challenges. NCGS is also an autoimmune disorder
triggered by gluten ingestion but these individuals do not have the genetic predisposition. The
inflammation may occur in the small intestines, but not always, and is systemic so symptoms
can be diverse and difficult to track. Both conditions are often undiagnosed leading to malabsorption, nutritional deficiencies and chronic inflammation. The good news is once gluten is
identified as the problem these individuals can make the necessary dietary changes to promote
healing and restore their health. The purpose of this article is to provide an overview of the
dietary recommendations for celiac and NCGS patients and also supply a list of resources for
further learning.
Regardless of the health condition your patient presents with, the food they consume, their
nutrition, is the foundation of their recovery. Persons with celiac and NCGS are certainly not
exempt. In fact, nutritional deficiencies are two fold in this patient population. Before these
individuals realize gluten is the trigger of the inflammation, the damage to the small intestines
has already occurred leading to mal-absorption of key vitamins and minerals such as iron,
calcium, B12, folate, magnesium, phosphorus, zinc and vitamin D. Secondarily, once they are
aware of their inability to tolerate gluten, the avoidance of grains and fortified foods may lead
to further deficiencies and impaired healing. Luckily with the help of a Registered Dietitian or
nutrition professional, it is very easy to learn how to eat a nutrient dense, whole foods diet that
is gluten free and contains all the vitamins and minerals necessary to restore the integrity of the
gut and overall health.
First let’s identify where gluten is found in the diet? Gluten is a protein found in wheat, barley
and rye. It sounds simple enough to remove these three grains from our diet. However, the
challenge is gluten is not only found in the obvious foods where flour is the key ingredient such
as breads, cereals, pasta and baked goods. It is also used as a filler, a binder and a processing
aide in many other processed foods like condiments, soups, gravies, luncheon meats and so
many other foods. And it is not just food we have to be concerned about. Supplements,
prescription medications and even skin care products often contain gluten. Furthermore, while
wheat, barley and rye are three grains known to contain gluten, many gluten-free advocates
include oats in this list as well. Oats, while technically gluten free, may be contaminated during
manufacturing so it is important to look for oat products specifically labeled gluten free.
Receiving a diagnosis of celiac disease or learning that you are NCGS can be very overwhelming
and is only amplified by all the information available for eating gluten free. As a dietitian one of
my biggest challenges is telling my clients what they cannot eat. So, I prefer to focus on what
they can eat. Persons with celiac disease and NCGS can eat all fresh fruits and vegetables, all of
them! They are loaded with vitamins, minerals, antioxidants, phyto-nutrients, fiber and
naturally occurring anti-inflammatory compounds. The more color the better. My preference is
organic when possible, or purchase from a local farmer who uses sustainable agriculture
practices with no harmful herbicides or pesticides.
The gluten free diet allows for all fresh or frozen (not processed) animal proteins such as beef,
poultry, pork and seafood. Proteins supply vital amino acids necessary for growth and repair of
damaged tissue. Again organic when possible or ask for grass fed, free range, wild caught
animals with no growth hormones or antibiotics. Eggs, plain unflavored milk and yogurt, and
aged hard cheeses such as cheddar, Swiss, Edam, and Parmesan are naturally gluten free as
well. Check the ingredient list on cottage cheese, cream cheese, and all pasteurized, processed
cheese. Note, eggs and dairy are common allergy foods so you will want to confirm there are no
sensitivities to these foods.
Healthy fats will supply the necessary fat soluble vitamins and essential fatty acids that are also
anti-inflammatory. These include olive oil, coconut oil, avocado, nuts, seeds and butter from
grass fed cows.
Last on the list are whole naturally gluten free grains such as brown or wild rice, quinoa,
amaranth, millet and teft. These grains are a good source of B vitamins, minerals and fiber
essential for the restoration of gut health. Because they are naturally gluten free these grains
are not always labeled as such. If the grains are no longer whole and have been processed into
flour or meal, be sure they are specified gluten free. Again, unless the oat product is specifically
labeled gluten free there is the possibility of cross contamination.
With this extensive list of foods to choose from what are some of the challenges I see and how
can they be addressed?
1. How can we help our patients learn how to read labels and identify the hidden gluten.
This can be a daunting task as most often it does not simply say “gluten”. The following
is a modified list of the names for how gluten may appear in the “other ingredients”
section of a label. These ingredients should be avoided as they contain the gluten
protein: any form of wheat, barley or rye, Brewer's yeast, bulgur, durum, dinkel,
farro/faro, graham flour, hydrolyzed wheat protein, kamut, malt extract, syrup or
flavoring, malt vinegar, malted milk, matzo, modified wheat starch, seitan, semolina and
triticale. As mentioned earlier, whole oats, oatmeal, oat bran or oat flour should not be
eaten unless they are from pure, uncontaminated oats.
So, while I am a label scrutinizer, I find the easiest way to avoid hidden gluten when first
learning is to choose from the list of naturally gluten free foods provided above. I
encourage my clients to choose fresh, whole foods as they most likely have no other
ingredients so they do not have to worry about hidden gluten and “other ingredients”. It
is the processed, pre-packaged foods that they have to be more cautious with. When
purchasing processed or packaged foods you will want to look for gluten free on the
label.
2. How can I eat out and still remain gluten free? This can be difficult and for the newly
diagnosed it might be best to avoid eating out until you have your diet under control
and your gut is on the mend. Fortunately, the awareness of gluten free is growing and
there are more restaurants providing gluten free options on their menu. The concern is
cross contamination. This means a naturally gluten free food is prepared in a kitchen
where breads, pasta and other gluten products are prepared and gluten can easily
contaminate the gluten free food. Some restaurants will dedicate an area gluten free to
avoid cross contamination so I suggest making a phone call ahead of time to find out.
Other situations may arise, such as a sleep over or friend’s dinner party, where I
encourage my clients to prepare their own food and take it with them or eat ahead of
time. Being prepared is always best.
3. How do I get my child to adhere to a gluten free diet? This is a real challenge mainly
because kids do not want to be “different” and they want to fit in. They are also at a
time where they are exerting their independence. The key is educating the child on the
benefits of gluten free for their health and the consequences of not following the diet. I
have seen the best success when the whole family goes gluten free so while at home
there is no perceived difference. For lunch at school or sleep overs with friends, the
food needs to be prepared at home. Again, the prevalence awareness of gluten free is
on the rise so more and more schools and families are familiar with the importance of
eating gluten free.
As with anything new there is a learning curve and a period of changing old habits and learning
new ones. The first step with celiac and NCGS is being properly diagnosed. Once gluten is
identified, the dietary modifications and adherence to a gluten free lifestyle is the number one
priority to reverse the damage and restore health. There are other treatments (acupuncture,
chiropractic, digestive enzymes and probiotic supplements) that I also recommend, but nothing
works optimally until the gluten is removed. The gluten free diet is paramount to recovery.
The information provided in this article is an introduction to the importance of diet and
nutrition for celiac and NCGS patients. For more comprehensive information I recommend the
following list of resources. (www.CeliacNow.org is at the top of the list because it is a very
extensive educational website).
Registered Dietitians:
Melinda Dennis, MS, RD, LDN, www.CeliacNow.org
Tricia Thompson, MS, RD, www.glutenfreedietitian.com
Shelley Case, RD, www.glutenfreediet.ca
Marlisa Brown, MS, RD, CDE, CDN, www.glutenfreeeasy.com
American Dietetic Association's Client Education Booklet: Celiac Disease Nutrition Guide,
www.eatright.org/Shop/Product.aspx?id=5052
American Dietetic Association's Easy Gluten-Free: Expert Nutrition Advice with More than 100
Recipes, www.eatright.org/Shop/Product.aspx?id=6442459392
National Organizations and Support Groups:
American Celiac Disease Alliance
www.americanceliac.org
Canadian Celiac Association
www.celiac.ca
Celiac Disease Center at Columbia University
www.celiacdiseasecenter.org
Celiac Disease Foundation
www.celiac.org
Gluten Intolerance Group of North America
www.gluten.net
National Foundation for Celiac Awareness
www.celiaccentral.org
North American Society for the Study of Celiac Disease
www.nasscd.org
Raising Our Celiac Kids (ROCK)
www.celiackids.com
WEBSITES:
www.celiac.com
www.glutenfree.com
www.glutenfreedrugs.com
www.glutenfreemd.com
www.glutenfreewatchdog.com
www.livingglutenfreely.com