Celiac disease is an immune reaction that people can have when eating gluten, a natural protein found in wheat, barley, and rye. When consumed, the gluten protein inhibits nutrients from being absorbed by the small intestine by damaging the finger-like villi. This can cause problems over time. The damaging of the intestine’s lining and prevention of nutrient absorption can lead to malnutrition as well as other cancers, infertility, osteoporosis, and other diseases1,2. Supplements such as drinkable probiotics and probiotics capsules are known as good bacteria and can help combat the bad bacteria in your body if you have Celiac. Is Celiac disease and gluten intolerance the same thing? Before continuing, it’s important to distinguish the difference between Celiac disease vs gluten intolerance. While very similar in symptoms, Celiac disease and gluten intolerance are not the same thing. Abdominal pain and fatigue can be present in both Celiac disease and gluten intolerance, but the small intestine is not damaged with gluten intolerance. Gluten intolerance will not lead to Celiac disease because Celiac disease is a serious, genetic autoimmune disease1. If you are experiencing diarrhea, bloating and gas, abdominal pain, and/or constipation, these might be the first signs of gluten intolerance2. What Foods Trigger Celiac Disease? Just as it can be the best diet for Crohn’s disease, a gluten free diet is important to follow for those with Celiac disease. There are three main grains that contain gluten. These grains can be found in numerous different forms and food products. Here are the celiac disease foods to avoid. Wheat is not gluten-free and is one of the three grains that can trigger the autoimmune response in people with Celiac disease. Wheat contains a type of gluten protein called gliadin3. Wheat is required by the U.S. Food and Drug Administration (FDA) to be labeled on all food products monitored by them4. Barley is another grain that is not gluten-free and should be avoided if you have Celiac disease. Barley contains a type of gluten protein called hordein3. Barley can be found in numerous foods, but it is not required by the FDA to be stated on the food label. The top eight allergens are the only ones required to be declared. Wheat is the only grain containing gluten, out of the three, that is required to be put on a label. If there is a question if a product has barley in it or not, ones labeled ‘Gluten Free’ are the safest bet. Barley malt, barley malt extract, barley flour, and pearl barley are not gluten free. Barley grass can be gluten free, only if the plant is picked before sprouting and producing seeds, but it is considered a high-risk ingredient.4 Rye is the last of the three grains that is not gluten free and can trigger Celiac disease symptoms in people with the disease. Rye contains a type of gluten protein called secalin. Rye is not required to be disclosed on labels from the FDA4. Labels that include rye, Secale (the Latin name for rye), or triticale (a hybrid of wheat and rye), should be avoided. But what about whiskeys and other alcohols made with rye? Due to the distillation process, these liquors are gluten free and can be consumed5. Gluten can also be naturally found in bulgur, dinkel, durum, einkorn, emmer, farina, farro, freekeh, graham, Kamut/Khorasan (a hybrid), malt, semolina (durum wheat), spelt, triticale (a combination of wheat and rye), and wheat derivatives such as wheat berries, wheat germ, whole wheat, cracked wheat, and wheat bran6. Here are some common products in the grocery store that contain gluten unless they explicitly specify that they are gluten-free: baked goods such as bagels, bread, biscuits, croissants, and donuts, flatbreads, flour tortillas, muffins, pancakes, rolls and waffles, desserts such as brownies, cakes, and cookies, pastries, any form of pasta, crackers, pretzels, and even beers and malted beverages. Why malt and beer? Malt is a partial hydrolysate of barley prolamins and can be toxic for those with Celiac disease. Any malt syrups, extracts, and flavorings should be avoided in a Celiac disease diet. Beer usually contains hordein (barley gluten prolamin) and can be problematic6. Low-gluten, gluten-free, and gluten-removed beers have grown in the market and can be a good alternative. When shopping through the grocery store, make sure to carefully read the food label on each item before placing them in your cart. Gluten tends to be a sneaky additive to many pre-packaged foods. Sauces (BBQ, soy, etc.), brown rice syrup, chips, lunch meats, meat substitutes for vegetarians, soups, ice cream, and seasoning packets are some common products that gluten tends to hide. Most labels will disclose the information with “Contains Wheat,” but it would be prudent to read each item on the ingredient list to know for sure. Again, this is because wheat is the only gluten-containing grain that is required to be listed on the product by the FDA. The safest bet is to choose products that are certified as gluten free foods7. When eating out, keep an eye out for fried foods. Even if a restaurant serves a gluten-free option of fried food, oftentimes the gluten-free food can be fried in the same vat of oil as the glutinous food. More often than not, those with a gluten intolerance won’t notice a difference, but it can be devastating to someone with Celiac disease. When notifying a server of Celiac disease, most restaurants take extra care in the preparation of food and will use separate utensils, surfaces, and gloves when preparing food. While avoiding foods containing gluten, people with Celiac disease should also make sure to take a probiotic. Drinkable probiotics or probiotic pills will help ease the Celiac disease symptoms on top of avoiding glutinous foods. Probiotics are also a common component in a SIBO diet plan because they are considered “good bacteria,” are made up of different strains or combinations of strains, and can help alter the balance of bacteria that already exist in the gut, the gut microbiota. The gut microbiota is home to over 2,500 different species of bacteria8. The gut microbiota plays a large role in our health functions such as metabolism, food digestion, and immune response development. If the balance of gut microbiota contains more “bad bacteria” than “good”, it can cause the instigation and continuation of intestinal inflammation in numerous chronic conditions. Probiotics can help even out the balance of “bad” to “good” bacteria in the gut microbiota. This is why probiotics are popular among those following a leaky gut syndrome diet as well. Research suggests that probiotics may be useful in Celiac disease. Probiotics can produce materials that obstruct pathogens from invading the body, block the adhesion sites of gluten proteins on the small intestine, synthesize certain nutrients, reduce toxin receptors, and regulate immunity, all of which can have positive effects on gut health. It has also been observed that some probiotics digest or alter gluten polypeptides, decreasing their toxicity9. Adding a probiotic like Bio-K+ ® is an important step you can take to improving your Celiac symptoms and overall health. Probiotics can help protect your gut microbiota and small intestine from the accidental gluten ingestion and products that have cross-contamination. Common food questions: Can you eat rice with celiac disease? Absolutely! Rice, in its natural form, is gluten free. This includes brown rice, white rice, and wild rice. Even sticky rice or Asian rice that is sometimes referred to as “glutinous rice,” is gluten free. These kinds of rice are referred to as glutinous because of the stickiness of the rice and not because of the gluten protein. Rice is a common replacement in many gluten-free packaged foods and even as a pasta replacement. While rice is naturally gluten-free, it can still come in contact with gluten during growing and harvesting; this is called cross-contact. Make sure to double-check labels and look for labels that say “certified gluten free”!10 Are bananas gluten free? Yes, bananas are gluten free. A Celiac diet called the “banana diet” was an experiment in the early to mid-1900’s when Dr. Sidney Haas was looking for a cure for Celiac disease. For over fifty years, Dr. Haas’ researched the elimination of carbohydrates and found it brought a significant improvement in Celiac disease. The only carbohydrate added to the celiac disease diet was bananas, which showed that this carbohydrate could still be added to a Celiac diet to hasten recovery and provide beneficial nutrients to the diet. In the study, some children were eating more than eight bananas a day. Bananas are full of calories, potassium, and can be a great nutritional source for those with Celiac disease11,12. It is important to discuss with your health care professional if you want to start this type of diet to avoid any nutritional deficiencies. A gluten-free diet can be really restrictive- it is always better to be well informed before starting any new diet. - Sources: 1“Celiac Disease: Info, Symptoms, Treatment.” Beyond Celiac, www.beyondceliac.org/celiac-disease/. 2“Celiac Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Sept. 2019, www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220. 3“Intestinal Microbiota and Probiotics in Celiac Disease.” Clinical Microbiology Reviews, American Society for Microbiology, July 2014, Intestinal Microbiota and Probiotics in Celiac Disease - PMC (nih.gov). 4“Is Barley Gluten-Free?” Beyond Celiac, www.beyondceliac.org/gluten-free-diet/is-it-gluten-free/barley/. 5“Is Rye Gluten-Free?” Beyond Celiac, www.beyondceliac.org/gluten-free-diet/is-it-gluten-free/rye/. 6Saturni, Letizia, et al. “The Gluten-Free Diet: Safety and Nutritional Quality.” Nutrients, Molecular Diversity Preservation International, Jan. 2010, The Gluten-Free Diet: Safety and Nutritional Quality - PMC (nih.gov). 7“Reading Food Labels.” Beyond Celiac, www.beyondceliac.org/gluten-free-diet/reading-food-labels/. 8“Cultured microbes represent a substantial fraction of the human and mouse gut microbiota.” NCBI, Cultured microbes represent a substantial fraction of the human and mouse gut microbiota - PMC (nih.gov) 9“Microorganisms with Claimed Probiotic Properties: an Overview of Recent Literature.” International Journal of Environmental Research and Public Health, MDPI, 5 May 2014, Microorganisms with Claimed Probiotic Properties: An Overview of Recent Literature - PMC (nih.gov). 10“Is Rice Gluten-Free?” Beyond Celiac, www.beyondceliac.org/gluten-free-diet/is-it-gluten-free/rice/. 11“Early Dietary Treatment for Celiac Disease: The Banana Diet.” Gluten Free Watchdog, 1 May 2017, www.glutenfreewatchdog.org/news/early-dietary-treatment-for-celiac-disease-the-banana-diet/. 12“About Dr. Sydney Valentine Haas.” Sydney Valentine Haas - Biography, www.scdiet.net/scdarchive/1about/haasbiblio.html.
