Question:

How long on average does it take the celiac numbers to start to drop after starting a gluten-free diet? My daughter’s 6-month blood test was still very high.

From,

Toni

Answer:

Hi Toni. According to Dr. Peter Green in his book, Celiac Disease, A Hidden Epidemic, follow-up celiac blood tests usually return to negative after 6-12 months following a gluten-free diet. He goes on to state that a downward trend is what you should be looking for, even if it takes more than a year to become negative.

If you are not seeing a downward trend after 6-12 months, it would be advised to reevaluate all possible sources of gluten exposure, including areas of cross contamination at home or in restaurants; recheck ingredient labels as formulations do change and there may be hidden sources of gluten; and evaluate if there has been any intentional consumption of gluten. On a personal note, my daughter’s blood tests took more than a year to become negative.

Sincerely,

Nancy Dickens, BS, RD, LDN

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Question:

Why do so many products say "may contain traces of wheat"? This is on boxes of plain rice, cans of plain beans, and so much more. Help!

From,

Suz

Answer:

Hi Suz. The claims “may contain traces of wheat,” “produced in a facility that manufactures wheat” and “produced on equipment that manufactures wheat” are all voluntary claims made by a manufacturer to let consumers know there is the possibility of wheat and, therefore, gluten cross-contamination in that product. What these claims mean is that the manufacturer is not using a dedicated gluten-free facility and that wheat products are made in the same facility as the product you are purchasing.

These claims are confusing, and it is hard for consumers to know what the risk of gluten contamination can be. When these claims are made, it is best to call the manufacturer to understand how the product is made, so you can determine for yourself the relative risk for gluten contamination. In the particular case of “may contain traces of wheat,” it is a good idea to err on the side of caution and not purchase products with this claim.

Be well,

Rachel Begun, MS, RD

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• New Research Draws Concern for Gluten-Free Grains
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Question

I just noticed for the first time yesterday on a label it said, "de-glutenized wheat." The same for corn. What does this mean? The label also said it was gluten-free. From, Joyce

Answer

Hi Joyce. Yes, you are likely to start seeing the term “de-glutenized wheat” and “de-glutenized wheat starch” on product ingredient labels. This means that the wheat or wheat starch ingredient used in the product has been refined to remove the gluten from it. However, buyer beware: this doesn’t necessarily mean that the product is safe to eat, as gluten can be present from other ingredients or cross-contamination. You should still do the following:

1. Read the remainder of the ingredient statement to see if all ingredients are gluten-free.
2. Determine if the product has been certified gluten-free by a third-party certifier.
3. Call the manufacturer to determine if they test for safe gluten levels of less than 20 ppm. If the company tests for gluten levels at less than 20 ppm or they use a third-party gluten-free certifier you can feel confident that the product is safe. However, if the company doesn’t test for gluten levels on its own or through a third-party certifier, you should be wary of the product’s safety. Many companies make a “gluten-free” claim very loosely, meaning the ingredients may not contain gluten, but they don’t test for gluten that may have entered the product through the shipping and manufacturing process.

Be well, Rachel Begun, MS, RD

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• • Is Modified Food Starch Gluten-Free?
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Question

My physician has advised me to go on a gluten-free diet and also switch to a low-glycemic diet. Are you aware of sugar causing problems for celiacs? I've seen nothing about that. From, Anita

Answer

Hi Anita. Assuming you have no other medical conditions that might warrant a low-glycemic diet, there is no reason sugar in the diet would be any more problematic for someone with celiac disease than for someone without. Some physicians and other healthcare professionals advise their patients to follow a low-glycemic diet as a means to keep blood sugar levels balanced to help promote weight loss and reduce the risk for certain chronic diseases, including cardiovascular disease and type 2 diabetes. While I certainly think it’s a good idea to minimize added sugars in the diet and keep blood sugar levels stable, in my opinion, simply following a low-glycemic diet is not necessarily the best choice. It excludes some otherwise healthy foods, such as watermelon and red potatoes, which are high on the GI scale. I suggest you ask your physician about their rationale behind having you follow a low-glycemic diet. Assuming you have no other underlying medical conditions, a healthy diet includes lots of vegetables and fruit; lean protein, including legumes; eggs, if desired; dairy products or non-dairy sources of calcium; healthy fats, such as nuts, avocados, and olive oil; and even some sweets in moderation. Consuming these foods and balancing your intake of carbohydrates, protein and fat at meals and snacks will promote good health, keep blood sugar levels stable, and should sustain your energy levels. In good health, EA Stewart, MBA, RD

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Question

Can someone who has loved carbs and gluten all their life have celiac disease or gluten intolerance? From, Givonne

Answer

Hi Givonne. Your question is a good one, and to answer it: Yes, someone who has loved carbohydrates and foods high in gluten, such as wheat, all their life can most definitely be diagnosed with celiac disease or gluten sensitivity/intolerance. When I was studying nutrition in college, I learned that celiac disease was very rare; that it presented in infants and young children; and that the symptoms were diarrhea and failure-to-thrive. Flash forward many years, and researchers now know that not only is there a wide array of symptoms attributed to celiac disease (many of them non-GI-related), but also that celiac disease and gluten sensitivity can occur at any age. Indeed, researchers are finding that celiac disease on the rise, and the rates are especially increasing in the elderly. To learn more about the incidence of celiac disease and gluten-sensitivity, please check out Celiac and Gluten-Free Fast Facts on the Beyond Celiac website. In good health, EA Stewart, MBA, RD

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Question:

When modified food starch is listed in the ingredients and the “contains” statement does not list wheat, is it okay to eat?

From,

Kelley

Answer:

Hi Kelley. Thanks very much for your question. Modified food starch is commonly found in foods where it is used as a texture stabilizing agent; a thickener; or an anti-caking agent.

While modified food starches can be made from a variety of foods, including corn, waxy maize, tapioca, potato, or wheat, in North America the most common sources are modified corn, waxy maize, and potato. Wheat is only occasionally used as the source for modified food starches in the U.S. If wheat is used as the source, it must be declared on the label as modified wheat starch or modified food starch (wheat).

So, to answer your question, if a food product manufactured in North America has modified food starch listed as an ingredient, but “wheat” is not listed on the label, then it is safe to eat.

In good health,

EA Stewart, MBA, RD

References

• Case, S. (2008) Gluten-Free Diet: A Comprehensive Resource Guide (pp. 51-52). Regina, Saskatchewan: Case Nutrition Consulting Inc.

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Question

What's the best way to rehydrate after a bout of diarrhea? Nutritional supplements, sports drinks, water, or something else?

Answer

This is a great question as diarrhea is one of the biggest contributors to dehydration and malabsorption of nutrients. The degree of dehydration will determine the best treatment for rehydration. It is important to respond quickly at the first signs of mild dehydration (i.e., dry mouth and thirst) by treating with consistent water intake and electrolyte replacement. In very mild cases, when there are no symptoms other than dry mouth and thirst, it is adequate to drink lots of water, non-caffeinated teas, 100% fruit juices and other beverages that don’t contain added sugars, alcohol or caffeine until symptoms disappear. Beverages containing alcohol, caffeine and added sugars should be avoided, as they contribute to dehydration rather than improve it. Electrolytes can be consumed by eating potassium, magnesium and sodium-rich foods that are tolerated. When more severe dehydration sets in, with symptoms such as thirst, lack of urination, dry skin, fatigue, light-headedness or inability to sweat, it is important to see a doctor immediately to seek their advice. If diarrhea persists for more than 3 days, with or without the above-stated symptoms, it is still a good idea to see a doctor, as dehydration can set in very quickly. While waiting for medical attention, it is best to drink as much as possible of water, sports drinks, fruit drinks and broth, as well as to salt food and beverages. If getting liquids down is hard to do, try sucking on ice cubes or fruit popsicles. When treating a dehydrated child, doctors often recommend over-the-counter replacement formulas, which have the ideal balance of water, sugar and salt for younger bodies. Please make sure to check the labels to ensure these products are gluten-free. In the most severe cases of dehydration, when an individual is experiencing low blood pressure, fainting, muscle contractions, rapid and/or deep breathing or a fast, weak pulse, take them to the emergency room immediately. Lastly, read all labels to be sure that what is being consumed is gluten-free. Diarrhea is one of the most common symptoms experienced by those with celiac disease and gluten sensitivity. Consuming a gluten-containing item will exacerbate the diarrhea in the short-term as well as trigger the autoimmune response that damages the intestines. Be well, Rachel Begun, MS, RD

Question:

Could you share a good source for restaurants that cater to celiacs? Also, is it common for celiacs to have no/limited appetite, nausea, and eat smaller meals? Thank you!

From,

Jean

Answer:

Hi Jean. Thank you for both of your questions! I’ll answer your second question first.

If you are just getting started on a gluten-free diet, it is certainly possible for you to experience a lessened appetite, along with nausea and a desire to eat smaller meals, especially if you are now eating a lot of foods you have never eaten before. A Registered Dietitian who specializes in celiac disease and gluten sensitivity can help ensure that you’re eating a well balanced gluten-free diet and can also help with meal planning frequency to make sure you are getting all your essential nutrients without having to feel full or nauseous.

If your nausea and limited appetite continue despite following a healthy, well- balanced gluten-free diet, I suggest you follow up with your physician to rule out any other medical conditions that may be contributing to your symptoms.

As far as your other question goes, I have several good resources for finding restaurants that cater to celiacs!

One of my “go-to” gluten-free dining out guides is The Essential Gluten-Free Restaurant Guide by Triumph Dining. The book has state-by-state listings of restaurants with gluten-free menu options. In addition, Triumph Dining also sells laminated dining cards that you can give to your waiter outlining the specifics of a gluten-free diet.

The National Foundation for Celiac Awareness (NFCA) also has a state-by-state listing of restaurants that completed gluten-free training through NFCA’s GREAT Kitchens program. See the list of GREAT Kitchens.

If you have an iPhone or smart phone, a couple of apps to check out include the Gluten Free Registry app, as well as the Gluten Free Ultimate Solution by G-Free Foodie. In addition, local celiac support groups often publish recommended restaurants for dining out gluten-free in your town. Check out the Celiac Disease Support Groups page by NFCA to find a gluten-free support group in your area.

And finally, always remember not to make any assumptions when dining out gluten-free. Call the restaurant ahead to inquire about their gluten-free menu options and food preparation techniques. Also, if your favorite restaurant isn’t listed on any of these guides, it doesn’t mean they can’t accommodate your gluten-free needs. You won’t find my favorite restaurants in San Diego listed in any gluten-free guides, yet I always have a fabulous (and safe) experience when I dine with them. I like to follow the motto, “You’ll never know unless you ask!”

In good health,

EA Stewart, MBA, RD

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Question

I am in the process of going gluten-free, and I am being tested for celiac disease now. I have been sick for 3 years now. How long will it take for me to feel better? Will I see some improvement right away? Help please. From, Colleen

Answer

Hi Colleen. Before I answer your question, it’s first important to ask: were you gluten-free before being tested for celiac disease? I ask because gluten must be in the diet in order for a celiac disease blood test to be accurate. If you had already eliminated gluten from your diet prior to being tested, I would suggest speaking with your physician about your test results. With that being said….yours is a great question and one that gets asked quite a lot. I can completely understand how eager you must be to start feeling better, fast! The bad news is that there is no definitive time period I can give you as to how soon you will start feeling better. However, the good news is that, in my experience, the majority of people who are found to have celiac disease or gluten sensitivity start to feel at least a little better very early on after adopting a gluten-free diet. Then, as time progresses and your GI tract heals, you should continue feeling much better as long as you remain on a strict gluten-free diet. In good health, EA Stewart, MBA, RD

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Question

Does gluten cause acne?

Answer

Although there's no published medical research showing a link between celiac disease, non-celiac gluten sensitivity and acne, many acne sufferers report their acne has cleared up after going gluten-free. However, because there is such a significant change in diet when going gluten-free, it is possible that the acne cleared up due to dietary reasons other than the elimination of gluten. Sincerely, Rachel Begun, MS, RD