Navigating through a sea of information can be tricky. This is especially true when it comes to celiac disease, where there seems to be a constant flow of new studies and research. To help you with the latest developments, we’ve answered some common and not-so-common queries.

Common Questions About Celiac

I was recently diagnosed with celiac disease. Do I need to worry about gluten-containing ingredients in the body care and makeup products that I use?

Research has shown that gluten molecules are too large to penetrate intact skin. However, there are some people with celiac or gluten sensitivities who avoid any skin care items or makeup products that contain gluten on the chance that it may irritate their skin or accidentally be swallowed. (This is a particular concern with lip balms, lip glosses, and lipsticks.) Fortunately, there are many natural skin care and makeup manufacturers that avoid gluten as well as other common allergens in their product lines. Be sure to check labels every time before purchasing, as formulations may change.

If I have celiac disease, do I need to worry about feeding gluten to my baby girl? Will her avoiding it help prevent the disease?

It was believed that if gluten was introduced later on in a genetically susceptible child, the risk of developing the disease could be reduced. However, new data from randomized clinical trials shows that children who are genetically susceptible to celiac disease who were introduced to gluten later on simply developed the disease later on.

Michelle Pietzak, MD, a pediatric gastroenterologist at Children’s Hospital of Los Angeles, advises that genetic testing be considered before introducing gluten to infants with a celiac sibling or parent. While not all experts agree on delaying gluten if the baby has a high genetic risk, you may want to wait to introduce it—or avoid it altogether. Delaying gluten until the child is 2 won’t prevent the disease, but it will delay its onset during important growth periods.

It’s interesting to note that if a baby has high-risk genes for celiac disease, breastfeeding won’t protect her. It can help protect against a wheat allergy, however, as babies who are breastfed tend to have fewer allergies.

Are there new tests coming out to determine if someone has celiac disease? What about testing for non-celiac gluten sensitivity?

There’s a new blood test being developed at Norway’s University of Oslo for celiac disease. It will work even when individuals are on a gluten-free diet by detecting special gluten-reactive T-cells in the body. Those with celiac disease have greater numbers of these T-cells, even when they eat gluten free. Later this year a preliminary clinical trial on the testing should be complete.

Researchers are getting closer to identifying markers for gluten sensitivity in the body. A study from the University of Bologna in Italy indicates that those who are gluten-sensitive may have high levels of zonulin—a molecule linked to inflammation. Preliminary results find that levels of zonulin in gluten-sensitive individuals nearly match those who have celiac disease. This is a promising start for developing tests to diagnose non-celiac gluten sensitivity in the future.

Should I be taking probiotics if I have celiac disease? Which ones would work best?

When unresolved issues are present (abdominal discomfort, bloating, occasional constipation or diarrhea), a probiotic may help, according to Stefano Guandalini, MD, an expert in celiac disease and founder and medical director of the University of Chicago Celiac Disease Center. Research suggests that the strain Bifidobacterium breve may reduce inflammatory markers in children with celiac disease. Bifidobacterium infantis may lessen some symptoms of the disease in adults. 

Carefully read labels or contact the manufacturer, as not every product is gluten- or allergen-free. Inquire with the manufacturer whether any of the bacterial strains in the probiotic supplement were grown on a gluten-containing grain such as wheat or barley. Instead of—or in addition to—probiotics, you may also want to consume fermented foods containing live cultures (yogurt, kefir, miso, sauerkraut, kombucha, and kimchi). These items can be good gluten-free sources of probiotics.

Avoiding gluten isn’t just about monitoring what you eat. It’s also about making sure there are safe areas where you store, prepare, and eat food.

You don’t need to renovate your kitchen to ensure it’s free of gluten. Here are some helpful steps to make the area a safe zone for all—whether some or all of your family are gluten free.

Steps to a Gluten-Free Kitchen

1. Get Rid of Products

   If you’re going for a completely gluten-free kitchen, start by getting rid of the obvius.

   • Donate Unopened Products

     Donate any unopened gluten-containing foods to a food bank. Or give them away to friends, family, or co-workers.

     Common foods include:

     • flours
     • mixes
     • pastas
     • cereals
     • breads
     • cookies
     • crackers

   • Discard Opened Products

     Discard any gluten products that have already been opened.

     Handle items with care, so flour particles won’t become airborne and potentially swallowed.

   • Beware Cross-Contamination

     Keep in mind that opened gluten-free pantry items like sugar, baking powder, and baking soda may have been contaminated at some point with a measuring cup or spoon.

2. Clean Away Gluten

   This step is crucial for making a space safe for celiacs and gluten-intolerant individuals.

   Even a single lurking bread or cracker crumb contains harmful gluten proteins and can inadvertently end up on someone’s plate.

   To rid the area of gluten:

   1. Clear Out The Kitchen

      Remove all items from the cupboards, pantries, silverware and utensil drawers, and the freezer and fridge.

   2. Wipe Down Surfaces

      Wipe down surfaces with a mild soap solution. Rinse and then dry.

      Pay special attention to spots that are sticky or greasy, as flour and crumbs tend to stick to these areas.

      Don’t forget to clean the tops of kitchen cupboards and light fixtures as well as cupboard and drawer handles.

   3. Do The Kitchen Laundry

      Launder aprons, dish towels, and cloth napkins. Scrub the oven—including the racks and oven drawer.

   Mind Your Sponges

   Sponges can be a problem if they’re used to wipe up areas where there’s gluten.

   To safely mop up spills, assign one color sponge for gluten-containing messes and another for gluten-free zones.

3. Maintain It

   • Keep Items Isolated

     • Purchase a toaster that will be used only for gluten-free foods, since it’s almost impossible to clean an old toaster of all its crumbs. Store and use the gluten-free toaster in a separate area.
     • Use separate butter dishes, flour sifters, pasta colanders, and cutting boards for those eating gluten free.
     • You may also want to consider another set of roasting and baking pans, measuring cups and spoons, utensils, and can openers.
     • Be sure to purchase and label brand-new storage containers for all gluten-free flours.

   • Keep Appliances Clean

     Appliances such as bread makers and food processors can contain hidden gluten. Clean paddles, blades, and crevices very carefully.

     If possible, have a second set of blades or—even better—different machines.

   • Avoid Using Plastic

     Be wary of using old plastic bowls and utensils. They scratch easily, and the scratches can harbor tiny amounts of gluten.

     It’s best to discard or donate these items. Replace with stainless steel or glass bowls that are washed carefully between between uses.

Tips for Kitchens with Gluten

• Storage

  • Label Containers

    If it seems that some family members are (still!) dipping their gluten-containing utensils back into condiment jars, put Post-it notes or a label maker to use.

    Label which condiments are gluten safe and which aren’t.

    Label gluten-free flours and grains, whether they’re stored in the pantry, fridge, or freezer. Mark with the date of purchase and the expiration date.

  • Use Squirt Bottles

    Squeeze-top or squirt bottles of condiments make a good choice for avoiding cross contamination, and they’re some-thing every family member can use safely.

    Just remind everyone not to touch the bottle tips to gluten-containing foods.

  • Separate Items

    If some family members eat gluten, be sure to put their items on a separate, labeled shelf. Better yet, store these foods in a separate cabinet.

    Make sure everyone knows where their own snacks are kept, and make sure they return items to their proper place.

• Gluten-Free Kids

  For a fun family activity, let youngsters choose stickers of their favorite color or animal. Use these to label packaged items that are safe for them.

  When there’s a visitor or babysitter in the house who doesn’t understand the gluten-free diet, the stickers will help them identify snack items that are safe for each child.

• For Pet Owners

  Most pet food (including fish food) contains wheat, and if it’s stored and portioned out in the kitchen, particles can end up on counters.

  Keep it safe by storing it in a separate area away from where meals are prepared and enjoyed.

Gone are the days when dining away from home was a near impossibility for those avoiding gluten. Today restaurants are stretching their options for those who follow all sorts of special diets—including gluten free.

But before you go, here’s some guidance on dining out safely.

Eating Out Gluten-Free

• Assess what being gluten free means to you. If you have celiac disease, know exactly what grains and hidden sources of gluten you must avoid, and be aware of cross contamination concerns. If you are gluten intolerant, know your limits on how much (if any) gluten-containing foods you can ingest.

• Use websites to locate restaurants that cater to those eating gluten free. Some sites offer downloadable smart phone apps for convenience away from home. Here are a few to browse:

  • http://allergyeats.com
  • http://findmeglutenfree.com
  • http://glutenfreepassport.com
  • http://glutenfreetravelsite.com

• Research dining establishments ahead of time. Call the kitchen manager or chef when the restaurant’s not busy. Ask which dishes can be made without gluten-containing ingredients. Inquire if there’s a separate menu with gluten-free options. 

• Carry a dining card that explains what you can and cannot eat. Some come in different languages for international travel. Try finding printable versions from these sites:

  • http://celiactravel.com
  • http://specialgourmets.com

• Eat a small snack before heading to a restaurant. Your hunger pangs will be quelled, and you won’t be tempted when the bread comes or someone orders a fried appetizer.

• After your party has been seated, let your server know you are gluten intolerant. Be sure they comprehend the situation. If they don’t seem like they do, ask to see the manager or chef.

• Never assume how a dish is prepared. An order of poached salmon may be covered in a wheat-thickened sauce. A scoop of ice cream could have a cookie wedged into it. If the mashed potatoes come from a mix, they might contain gluten. Salads are often topped with croutons or dressing containing wheat. Flour is sometimes added to the skins of baked potatoes to make them crispy. For light and fluffy omelets, some dining establishments add pancake batter. Always ask! 

• Inquire about cross-contamination practices. Does the restaurant have a separate work area for making gluten-free items? Do they clean the grill before making items for a gluten-free patron? Does the kitchen staff use a dedicated fryer, or will the oil be replaced when making gluten-free food?  Ask if gluten-free pasta is cooked in its own water, not that which held wheat-containing pasta. Also, is a separate and clean colander used to drain the gluten-free pasta?

• Avoid getting attached to your first choice. Pick back-up entrees in case your favorite is not gluten free. If nothing seems safe, ask the chef to saute plain meat or fish in oil or butter with some steamed vegetables. It may not be the most memorable meal, but at least you won’t get ill.

With any type of diet, it’s best to focus on what you can eat—not on what you can’t. Eating gluten free is no exception. 

Those who follow this type of diet know to avoid gluten-containing grains such as wheat, farina, farro, graham flour, kamut, semolina, spelt, triticale, rye, and barley. But there’s a whole other world of gluten-free grains (and seeds!) to focus on. 

Meet the Grains

Most individuals eating a gluten-free diet can tolerate small amounts of oats—if they’re labeled gluten free. This means that during harvesting and processing, the oats were not cross-contaminated with any grains containing gluten. Consuming oats may help reduce LDL, or “bad,” cholesterol in the body. Keep only a small quantity on hand as oats have may have a tendency to turn rancid. 

Not technically a grain, quinoa is the seed of a plant related to amaranth. The flaked variety is often used in baking and for making breakfast dishes. Quinoa is a complete source of protein. Store it in the fridge in a well-sealed container for no more than six months.

Rice is a gluten-free cereal grain. While it contains less protein than other grains, the long-grain brown variety offers folate, manganese, and selenium. For best results when cooking basmati rice, refrain from lifting the lid before steaming time is complete.

Fun to prepare, colorful, and surprisingly yummy doused with your favorite sauces, these new-fangled plant-based noodles will become a family staple.

Types of Plant Pasta

• Carrot-Zucchini Noodles

  With their skins on, use a vegetable peeler to make ribbon noodles from peeling these carrots and zucchini.

  Enjoy them raw with your favorite sauce for a pasta salad or immerse the ribbons into boiling water for one minute before serving.

  For finicky kids, try adding some of the vegetable ribbons to your regular pasta before going all veggie.

• Spaghetti Squash

  So many people get scared off by squash because they don't know what to do with it.

  Preparing a spaghetti squash pasta is truly as easy as 1-2-3.

  1. Slice the squash in half, place face down on a buttered or oiled baking sheet.
  2. Bake at 350 degrees for 35 minutes or until soft throughout.
  3. Simply scoop out the "spaghetti" and serve with your favorite sauce.

  Kids love this with butter and Parmesan cheese.

• Kelp Noodles

  Ever eaten rice noodles? They are very close to this seaweed "pasta" in texture and flavor.

  A touch more rubbery than traditional pasta, kelp noodles are flavorless and lend themselves to showing off a vibrant sauce, and they are surprisingly high in calcium.

  Find kelp noodles at natural food stores and Asian markets.

When a person with this autoimmune disease ingests gluten (a protein found in wheat, barley, rye, and triticale), the immune system responds as if the body is in danger and attacks the lining of the small intestine. The damaged intestine is no longer able to properly absorb nutrients, which can lead to many health problems including malnutrition, anemia, premature bone loss, multiple sclerosis, and even cancer.

About one in 133 people has celiac disease, but most—about 97 percent—remain undiagnosed. Unfortunately, it takes an average of nine years to get a correct diagnosis, partly because the disease mimics other conditions such as irritable bowel syndrome, spastic colon, thyroid disease, colitis, and gastric ulcers. Symptoms include diarrhea and/or constipation, abdominal pain, gas, irritability, anemia, bloating, joint pain, mouth sores, depression, fatigue, and tingling in the feet and legs.

If the lining of the gastrointestinal tract becomes damaged enough, large food molecules can escape and cause problems associated with leaky gut syndrome, including allergies and a taxed liver. Although rare, severe liver damage or even liver failure can develop.

Those most at risk for celiac disease are people with a family history of it, those with Down syndrome, anyone with Type 1 diabetes, people with endocrine disorders (such as thyroid and Addison’s diseases), men and women with fertility issues, and those with other autoimmune disorders, including lupus and rheumatoid arthritis. The disease can manifest at any time in the life cycle—from childhood to old age—and is sometimes triggered by stressful situations such as pregnancy, childbirth, and surgery.

What to Do

If you think you have celiac disease, ask your doctor for a blood test. Keep consuming food containing gluten before the test so that the results don’t come back as normal. If you’ve gone gluten-free for a long period already and are reluctant to reintroduce gluten, genetic testing may be a better option.

If your blood test is positive, a small-bowel biopsy should be arranged to confirm the diagnosis and determine intestinal damage. Continue to eat a diet containing gluten until the biopsy, after which you can embark on a gluten-free diet. Also, be sure to have your blood levels tested for iron, folic acid, vitamin B12, and calcium deficiencies that may have resulted from the disease. 

Sometimes testing shows no signs of intestinal damage. Such people may be diagnosed with non-celiac gluten sensitivity (NCGS).

Surviving & Thriving with Celiac Disease

There’s no known cure for celiac disease, but it can be managed by adhering to a strict, gluten-free diet. Mills that process oats may handle gluten-containing grains. Always buy oats certified as gluten free. A small subset of celiac patients experience inflammatory reactions to pure oats and must avoid even certified gluten-free oats as a result. Additionally, some people with celiac disease may be lactose intolerant, so avoiding cow’s milk may reduce symptom flare-ups.

Children with celiac disease often experience short stature and delayed puberty, but studies show that adopting a gluten-free diet usually leads to a rapid catch-up in growth. One study of Turkish children with the disease reveals that going gluten free leads to quick gains in weight and height, but early diagnosis and adherence to a gluten-free diet are essential for long-term growth.

Research shows that people with celiac disease have less beneficial bacteria (which aid in digestion) in their systems than control groups, and it appears that a gluten-free diet may result in a further reduction of beneficial gut flora.

The antioxidant capacity of celiac patients has also been found to be significantly reduced, mostly because of a depletion of the enzyme glutathione. More research needs to be done to pinpoint food and supplement regimens such as probiotic therapies that might be beneficial for those with celiac disease.

Sudden Increase?

Some people write off as hype the recent media flurry about gluten-free issues as well as the influx of gluten-free products now available. But celiac disease is increasing worldwide—and it’s not just because more doctors are aware of the disease and test for it more frequently.

One study compared blood samples taken from 9,133 young adults stationed at Warren Air Force Base between 1948 and 1954 with 12,768 recent blood samples from gender-matched subjects in Minnesota. Only .2 percent of the blood samples collected 50 years ago indicate undiagnosed celiac disease. In the more recent samples, the incidence was more than four times greater.

Experts don’t know why celiac disease is becoming more common. Some believe it may be due to changes in the way wheat is grown and processed. “The reasons for the increasing prevalence of celiac disease over time will need further study,” researcher Alberto Rubio-Tapia, MD, told Reuters Health. “The most likely explanation may be environmental.”

It may also be because gluten—present in so many processed foods—now saturates our diets. Another explanation is that the increasingly germ-free environment of modern life may be causing more allergies, asthma, and abnormal immune system reactions, although this doesn’t explain the growth of celiac disease in developing countries.