Celiac disease is generally an inherited disease that affects nearly 1% of the Canadian population. The immune system of a person suffering from this condition reacts negatively to gluten, the protein found in wheat and its derivatives. Before diagnosis, adults have symptoms such as unintentional weight loss or weight gain, diarrhea, constipation, and gas. (Government of Canada, 2018). This disease is diagnosed by the doctor using blood tests (IgA-tTG) and using a duodenal biopsy (Cœliaque Quebec).
Pathophysiology
When a person with celiac disease eats foods with gluten or contaminated with gluten, the inner lining of the intestine is damaged. This creates inflammation in the villi on the inner wall of the intestine and these villi atrophy. So the absorption of many nutrients is reduced such as iron, folic acid, calcium, vitamin D, protein etc. This increases the risk of suffering from anemia, osteoporosis, lymphomas, infertility, malnutrition etc. The only way to treat this disease is to completely exclude gluten from your diet.
What to consider when eating gluten-free?
● Possible food intolerance: lactose
● Vitamin and mineral supplementation possibly necessary.
● Severity of the situation: Even flour dust containing gluten can be harmful. It can be deposited on uncontaminated food and harm a person with celiac disease (Canadian Celiac Association).
● Know the sources of gluten
○ Barley, oats, rye, triticale, wheat (eg, durum wheat, kamut and spelled) and others.
Cross-contamination: When suffering from this disease, you should avoid bulk grocery stores (Ex: Bulk Barn), check labels, have a gluten-free space for cooking, etc.
● Eating outside
○ Ideally, you should contact the restaurant before going. The chef or director must be questioned about the measures put in place for gluten-free meals.
● Read nutrition labels (Canada)
○ The inscription of the words "Contains" and "May contain" on the packaging is not always compulsory. On the other hand, when the mention is present, the 10 most common allergens must be listed, including wheat (gluten).
○ When a food contains sources of gluten (no cross-contamination origin), it is required to declare it on the list of ingredients or it can be in the "Contains" part of the label. It is essential to know all the sources of gluten and its derivatives.
○ So if the food is prepared in an establishment where there are other foods that contain wheat, our food may be contaminated without it being listed on the label.
○ A mention gluten free one day is not permanent. The company can decide to change its labels according to its production.
○ If in doubt, call the company.
Additional Resources
Canadian Celiac Association: http://celiac.ca/pdfs/lien_gluten-eng.pdf
Quebec Celiac Disease Association: https://www.coeliaque.quebec/fr/
Book by Shelly Case (Dietitian): Gluten-Free Diet - A Comprehensive Resource Guide
Until next time,
Karine Drouin RD
Références
Association canadienne de la maladie cœliaque. (n.d.). Entamer un régime alimentaire sans gluten. Retrouvé le 23 avril 2021 au https://www.celiac.ca/fr/vivre-sans-gluten/diagnostic-recent/
Cœliaque Québec. (n.d.) Dépistage et diagnostic. Retrouvé le 23 avril 2021 au https://www.coeliaque.quebec/fr/diagnostic
Gouvernement du Canada. (Mai, 2018). Maladie cœliaque. Retrouvé le 15 avril 2021 au https://www.canada.ca/fr/sante-canada/services/aliments-nutrition/salubrite-aliments/allergies-alimentaires-intolerances-alimentaires/maladie-coeliaque.html
Gouvernement du Canada. (Août, 2012). Questions et réponses au sujet de la nouvelle réglementation visant l'amélioration de l'étiquetage des aliments au chapitre des allergènes, des sources de gluten et des sulfites ajoutés. Retrouvé le 15 avril 2021 au https://www.canada.ca/fr/sante-canada/services/aliments-nutrition/etiquetage-aliments/etiquetage-allergenes/questions-reponses-sujet-nouvelle-reglementation-visant-amelioration-etiquetage-aliments-chapitre-allergenes-sources-gluten-sulfites-ajoutes-sante.html#q19