Celiac Disease Awareness–May 2021

Happy Celiac disease Awareness Month! To celebrate, let’s talk about how to eat gluten-free and healthy.

Gluten-free and Healthy

Going gluten-free can be a big turning point to greater awareness and eating healthier.  All of a sudden, people need to start reading labels, and many begin to wonder why there are all of these ingredients they can’t pronounce and why high fructose corn syrup seems to be in everything.  Or maybe after years of eating anything and staying slim, the pounds have started creeping upward, or blood pressure, blood sugar or cholesterol numbers are moving in the wrong direction.

Are you getting the nutrients you need?

Nutrition is important for everyone, but particularly for people who have food restrictions.  While a gluten-free diet is absolutely necessary for everyone with Celiac Disease, there’s an abundance of highly processed, sugary foods out in the gluten-free aisle—often even more than conventional foods.

Years ago, the Food and Drug Administration realized that many people weren’t getting enough vitamins like thiamin, riboflavin, folate and iron.  So they added a variety of nutrients to the foods supply in everyday foods like flour, bread, pasta, cereal, etc.  However, gluten-free breads and cereals are considered specialty products, and very few are enriched with these vitamins.  Not only that, but many gluten-free breads are filled with things like tapioca, potato and cornstarch to give a light texture, and these foods often are high in carbohydrates, but lower protein, vitamins and minerals.  So when people switch from eating regular packaged foods to eating gluten-free processed foods, they don’t realize that they’re actually eating a lot fewer vitamins, minerals and fiber and usually more calories, too.

This is not inevitable! The good news is that that many healthy foods are naturally gluten-free, like fruits, vegetables, beans, many whole grains, nuts, seeds, and plain fish and poultry.

Also, for many people, untreated Celiac disease leads to nutrient deficiencies.  Absorption of many nutrients happens through the villi in the small intestine.  When these villi are damaged and flattened, fewer nutrients are absorbed.  Because of this, people recently diagnosed with Celiac may even need more nutrients to make up for this.  Iron, B vitamins, Vitamin D, calcium and magnesium are particularly important.

It’s awesome that there are now gluten-free brownies, donuts and beer. But just because they are gluten-free does not automatically mean good for you!  Often in the beginning, people want to try anything that’s gluten-free, and are just focusing on getting through the day.  The focus is on finding replacements for old favorites and learning all of the new rules.  That is definitely a great short-term strategy but it’s only the first step!

Here are some suggestions to make your diet healthier:

  • Go for healthy fats. Increase the amount you eat of fatty fish, like salmon, trout, flounder, sole, rockfish, sardines and more.
  • Calcium is key! This can be from Greek yogurt, cheese, or milk, or if you avoid dairy, choose sardines, collards or turnip greens, beans, nuts, etc.
  • Switch to a GF baking blend using sorghum, garbanzo beans, almond or coconut, brown rice or other whole grains.
  • Have fruit or vegetables with every meal—5-9 servings a day.  That can be as easy as an orange with breakfast, a veggie soup and a salad with lunch, dried fruit for snack and 2 servings of veggies along with dinner.
  • Include legumes (i.e., dried beans and peas) with your meals regularly; increase your intake of these foods gradually to limit gas.
  • Drink your water!  8 glasses a day are important to stay hydrated, especially when you increase the amount of fiber you eat.
  • Include nuts and seeds several times a week, which also contain monounsaturated fats and can help control blood cholesterol levels.
  • Find a way to reduce stress: acupuncture, meditation, deep breathing, talking to a friend, dancing, walking the dog, or whatever works for you. This under the umbrella of nutrition, because most people don’t reach for Brussels sprouts when they get stressed.
  • Use healthy oils, like olive, avocado, etc. and eliminate trans fats.
  • Limit sugar and high fructose corn syrup.
  • Take care of yourself. This includes sleeping well, reducing stress, and doing things you enjoy.  You’re worth it.

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May is also Ehlers-Danlos Awareness Month. If that’s a new term to you, it’s a connective tissue disorder that’s actually linked to Celiac and other digestive conditions. I recently did a presentation for the DC Metro EDS/HSD Support group on Digestive Disorders in EDS and HSD and How Nutrition Can Help.

  • I’m excited about a new cookbook, Gluten-free Baking for Beginners by In Johnna’s Kitchen. It’ll be released on May 18th, but I got to preview a copy and it looks fantastic, and delicious, especially for people with multiple food restrictions.
  • Gluten-free and kosher? There are upcoming (online) classes on baking GF breakfasts…and upcoming dates for picnics, BBQs & more.

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Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA (currently, remotely!)  She helps people with a range of dietary issues, including Celiac Disease, GI digestive issues and more. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

 

Celiac disease & Ehlers-Danlos: What’s the Connection?

May is Celiac awareness month. It’s also Ehlers-Danlos awareness month. And if you’re really genetically blessed like me, you may be personally aware of the link between the two. If not, indulge me in a quick discussion of the research, because it’s too rarely discussed.

The Ehlers Danlos Society Logo

There was a 2011 paper which indicated that Celiac was much more common than expected in people with hypermobile EDS. [1] 19% had positive Celiac serology (bloodwork), and 16% agreed to a biopsy, and those 16% were confirmed to have Celiac disease. Notably, the sample size for this study was small—it was only 31 people—however, 16% is much higher than the expected prevalence of Celiac disease, which is ~1%.

2015 paper also indicated a potential link between Celiac disease and hypermobility, with found that 30% of people with Celiac met the criteria for Joint Hypermobility Syndrome (JHS), which is now known as Hypermobility Spectrum Disorder (HSD). [2]

Most recently, in 2021, a case control report looked at people with all types of EDS, and found that Celiac disease was one of the most common GI conditions associated with EDS, and the association was much stronger than in controls. The study did not break out EDS subtypes, however. [3]

So, while the percentages and the details may still be a question, clearly there is some link between Celiac disease, EDS and Hypermobility Spectrum Disorders. And it is worth noting that while EDS is quite rare, HSD is common; 2-3% of the population.

Of course, testing is always essential before dietary changes because a proper diagnosis is critical. Other people may simply respond poorly to FODMAP content of wheat, so a much larger portion may feel better gluten free, even though they don’t have Celiac.

For more of the research on digestion and hypermobility and EDS, I do have more fun stuff on nutrition for GI issues and all things hypermobility here.

Footnotes

  1. Danese C, Castori M, Celletti C, Amato S, Lo Russo C, Grammatico P, Camerota F. 2011. Screening for celiac disease in the joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type. Am J Med Genet Part A 155:2314–2316.
  2. Fikree A, Aktar R, Grahame R, Hakim AJ, Morris JK, Knowles CH, Aziz Q. Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study. Neurogastroenterol Motil. 2015
  3. Rachel S Brooks, James Grady, Thomas W Lowder, Svetlana Blitshteyn, Prevalence of gastrointestinal, cardiovascular, autonomic and allergic manifestations in hospitalized patients with Ehlers-Danlos syndrome: a case-control study, Rheumatology, 2021.