Celiac disease: an elusive 'iceberg'

Fatigue, weakness, joint pain and migraines are frequently overlooked as symptoms of the disorder

Although as many as 300,000 Canadians suffer from celiac disease, many of them don't know it.
Celiac disease, a lifelong, genetically based disorder, occurs when gluten - a protein found in wheat, rye and barley - triggers an abnormal immune response that damages the lining of the small intestine interfering with the absorption of nutrients. Often the condition goes undiagnosed.


Experts commonly refer to it as an "iceberg" disease. Visible at the tip are individuals whose symptoms include diarrhea, abdominal pain, weight loss and, in children, delayed growth. The rest of the iceberg consists of those with more subtle symptoms, such as bloating or excess gas. Although these may go unrecognized as signs of celiac disease, the damage continues.
While most people think celiac disease afflicts mainly children, it can occur at any age. In fact, two-thirds of those diagnosed are adults. Later in life, the disease can be triggered by pregnancy, surgery, gastrointestinal infection or severe emotional stress.



According to a 2007 survey of the Canadian Celiac Association's more than 5,000 members, the average time it took to get diagnosed was 12 years. Many respondents had consulted three or more doctors before getting their diagnosis.


While stomach pain, abdominal distention and diarrhea are considered the classic symptoms of celiac disease, in adults they're often not present. Constipation and bloating may be the only outward signs. Symptoms such as fatigue, weakness, joint pain and migraines - ones typically not recognized as gut-related - are commonly reported, and the diagnosis is often anemia, stress, irritable bowel syndrome or chronic fatigue syndrome.


If left untreated, celiac disease increases the risk of osteoporosis (because of poor absorption of calcium and vitamin D), infertility, certain digestive tract cancers and other autoimmune disorders such as Type 1 diabetes and thyroid disease.

Screening tests that measure the level of antibodies in the blood are available. (People with celiac disease have higher than normal levels of antibodies to gluten.)


Health Canada recently approved the Biocard Celiac Test Kit, an at-home test that measures gluten antibodies from a fingertip blood sample. The Biocard is currently available in British Columbia and is expected to be available for $50 in pharmacies across the country by the end of this year.

A blood test, however, is only the first step in diagnosing celiac disease; it's used to detect people who are likely to have the condition. Confirming a diagnosis requires a small bowel biopsy in which an endoscope is passed through the mouth into the stomach and upper intestine so that the lining can be examined and a biopsy taken.



The only treatment for celiac disease is a gluten-free diet for life. That means eliminating all foods and food ingredients made from wheat, rye and barley. Included in the wheat family are spelt, kamut, semolina, durum, einkorn and faro. The main sources of gluten are breads, cereals, crackers and pastas, but it's also found in luncheon meats, yogurt, seasonings, salad dressings, sauces, marinades, soy sauce, soups and beer.

Even if you think you are following a gluten-free diet, you may be unknowingly consuming gluten as a hidden ingredient in food products, medications or vitamin supplements. Ingredients to question or avoid include graham flour, malt, dextrin, modified food starch, hydrolyzed vegetable protein, MSG, emulsifiers, stabilizers, caramel colour and natural flavour.

Oats, previously on the list of gluten-containing foods to avoid, have now been given the green light for people with celiac disease. The Canadian Celiac Association maintains that eating pure, uncontaminated oats - up to ¾ cup dry oats a day for adults and ¼ cup for children - is safe.
The problem is that oats may become contaminated with other gluten-containing grains during processing. Pure, uncontaminated oats are trademarked "Pavena" to ensure accurate identification. Still, a small number of people may not be able to tolerate oats and should follow up with their doctor when adding them to a gluten-free diet.

(People with untreated celiac disease may also have difficulty digesting lactose in milk products. That problem usually disappears when gluten is removed from the diet, allowing the gut to heal.)
Today, it's getting easier to follow a gluten-free diet with the influx of products in supermarkets and natural food stores. Manufacturers of gluten-free products include El Peto, Glutino, Kinnikinnick, Enjoy Life, Kaybee, Rizopia and Tinkyada. And it's important to consult with a registered dietitian who can advise you on gluten-free alternatives and the need for vitamin and mineral supplements.

If you suspect you have celiac disease, don't put yourself on a gluten-free diet until you are properly diagnosed. If you do have the disease, the Canadian Celiac Association (celiac.ca) can provide more information and support.



July 9, 2008. Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV's Canada AM every Wednesday. Her website is lesliebeck.com.

GF Toronto - Big Momma's Boy

The last restaurant I am going to spotlight is Big Momma's Boy. This restaurant is in the Cabbagetown district of Toronto I would recommend spending at least a whole day in this area, it is fun, vibrant and you can find many things to do. The restaurant is situated in an old Victorian house and the decor is absolutely beautiful. There is seating indoors and outdoors, but this place is very popular and I would get there early before the rush hits. The staff was very nice and very educated in the GF arts. Being it our first time, we asked for the gluten-free menu and he informed us that the entire menu is gluten-free. Again, Tommie and I just stared at each other. Now that I look back, most of the chefs and restaurant staff we encountered must have though we were a couple sandwiches short of a picnic by the way we reacted in their restaurants. It's not everyday you travel to a city that has countless gluten-free options, unless you live in Toronto of course. Needless to say, this restaurant is the real deal folks, everything (except the spring rolls) on the menu can be done gluten-free and let me tell you, I think we ordered at least half of the menu.

We had spent the day sightseeing and were exhausted and starving by the time we entered Big Momma's Boy. We didn't know the next time we'd be in Toronto so we figured we'd order a bunch of food and take the extra back to the hotel with us for the next day. We ordered pulled pork sandwiches, pizza (again) with Canadian sausage, chocolate cake, ...I don't want to make this blog too long so I'll stop there. Everything was delicious and even though we had managed to not hug or kiss any chefs or wait staff to this point, I couldn't handle it anymore - so I hugged the waiter. He just laughed and smiled, it appears they get a lot of people from outside of Toronto and their website even boast that their pizza is so good, people from other provinces come to Toronto just to eat at their restaurant. I believe it. Our bill only came up to around $65 and believe me, we ordered a TON of food, enough for at least four people (let me remind you there are only 2 of us). Next time you're in Toronto, make this restaurant a 'must' on your list because I guarantee a wonderful time and absolutely fabulous food!

http://www.bigmammasboy.ca/index.html

GF Toronto - The Creperie

Now I'm not one for crepes, it's a texture thing really, but you do not turn down an opportunity to go to a GF restaurant. The Creperie is located in the Distillery District of Toronto and when we were there in August it was a little hard to get to due to construction. If you are taking local transportation (such as the bus and subway) I would leave plenty of time in your schedule if you choose to venture to this restaurant. That being said, it is worth it. The whole area was an experience, not only were there restaurants, but art galleries and shops have also made their home in the old Distillery district. The setting is very casual and modern, your order food at the counter and they'll call your name when it is ready. It was lunch time when we got there so we both had a savory crepe and then shared a cinnamon and sugar crepe - which was so yummy! The portions were large and our lunch cost us around $23. I recommend not only The Creperie, but the entire experience of the Distillery District - good food, great art, nice people and an overall great time.
www.lacreperie.ca/

GF Toronto - The Cafe Next Door

Feel Good Food...That is the motto of the Café Next Door, which is exactly the café next door to The Magic Oven on Broadview Ave. When the guys at The Magic Oven sparked up a conversation about gluten-free foods we told them we were from Indiana and that we were amazed by the GF selection they had. They then invited us over to the café to try their breakfast options. Don't you just hate it when people twist your arm? Needless to say the next morning we jumped on the subway and walked into the Café Next Door. I had a yummy fruit salad and multi-grain BLT sandwich, but who cares about what I ate, right? Tommie had a bagel with butter and a 'Perfect Grilled Cheese Sandwich' with Swiss cheese of course. He absolutely loved the food! He kept smiling the whole time he ate and it, it definitely started our day of touristy fun off on the right foot. Another great GF place to try when you're in the area.

GF Toronto - The Magic Oven

When Tommie and I decided to go to Toronto as part of our honeymoon we made sure to do our GF homework. The first thing I 'googled' was pizza restaurants and was amazed to find that not only did Toronto offer such a thing, but that it was a franchise and would deliver! The Magic Oven we went to was on Broadview St. and was extremely easy to access since the subway had a stop right across the street! Magic Oven makes a commitment to serve as many natural and organic products as it can, as well as giving their customers a wide array of choices, from vegan to gluten-free. Now I must say that the Oven offers items such as soups and salads...la la la...but we were there for pizza only. We kept it simple, a sausage pizza with some sodas. When the pizza was brought to our table we were amazed; it looked like a Noble Roman's pizza! Tommie and I just looked at it, then poked it, and then picked it up and looked at the bottom. The chef thought we were crazy and asked if everything was okay...we just smiled. When we tried the pizza we were blown away by the texture and the taste. Who would have known that gluten-free pizza could be this good? I thought Tommie was going to run up to all of the employees and give them a big kiss on the cheek. It was by far the best gluten-free pizza we have had to date! Needless to say we returned to the Oven one more time before we left Toronto. I highly recommend for you to try this when you're in that neck of the woods, it is definitely worth it. Next time we find ourselves in Toronto we're definitely stopping by and maybe next time we'll try some of the pasta and desserts. They have a tandoori chicken pasta that sounds out of this world! http://www.magicoven.com/home.php

Other great things about the Oven: "Our restaurants reflect our commitment to respecting our resources.We use bio-degradable packaging wherever possible, our menus are printed on recycled paper, our pizza boxes are made of recycled cardboard, and we use bio-degradable plastic bags.Magic Oven restaurant locations are all reclaimed sites, saved from demolition crews and featuring recycled furniture and fixtures.We are a family-run business with a commitment to the environment and the community."

Pizza Pizza - Toronto

KEITH BEATY/TORONTO STAR
Gluten-Free Food Goes Mainstream
Choices for celiacs and those with sensitivity are slowly improving

Apr 16, 2008 04:30 AM Barbara Turnbull LIVING reporter. On Friday night, Janet Dalziel did what thousands of Torontonians do every day: she picked up the phone and called 967-1111. Her pepperoni and mushroom pizza came with a gluten-free crust, which the Pizza Pizza chain introduced in 50 Toronto restaurants last month. That was a big deal for the school vice-principal, who was diagnosed with celiac disease in 2001 and can't consume regular wheat products. "It put me back in the real world," she says. The fast food chain is the latest in a long line of manufacturers to acknowledge the growing demand for products made without gluten, a protein found in wheat, rye and barley. It's also used in many foods to add texture or flavour.
"Gluten is hidden everywhere – salad dressings, soya sauce, chicken broth, for heaven's sake," Dalziel says.

While Toronto celiacs have long had options such as gluten-free crust and pasta at a smaller pizza chain called Magic Oven, you know it's gone mainstream when Pizza Pizza jumps on the bandwagon. Celiac disease, also known as gluten intolerance, is the most common chronic autoimmune disease in the world, affecting one out of every 133 Canadians, says Dalziel, who became president of the Canadian Celiac Association last year. In celiac disease, gluten triggers the body's immune system to attack the lining of the intestine, which impairs its ability to absorb nutrients.
But many other people are seeking food products without gluten to deal with a real or perceived food sensitivity, resulting in a gluten-free boom at mainstream grocery stores and restaurants.
Pizza Pizza's chief marketing officer, Pat Finelli, says the trial at 50 GTA locations has been so successful the company will expand it across the country. The reaction has been even stronger than with the launch of whole-wheat and multi-grain crusts, he notes. Last week they sold 2,100 gluten-free pizza crusts with no advertising, other than word-of-mouth and a mention on their website.

Gluten-free products are also cropping up at stores, bakeries and cafés all over the GTA. O'Doughs is a new North York bakery that's totally gluten-free, but also supplies health food stores throughout the GTA. Hilary Davidson, the travel writer behind the Frommer's Toronto guidebook, has started a blog for people with celiac or gluten intolerances who want to dine out and travel (glutenfreeguidebook.com). Civilized societies have been growing wheat and making bread with it for thousands of years. The gluten left after rinsing out the starch in wheat is also known as seitan and is used by the Chinese and vegetarians as a "wheat meat."
Many people think they are sensitive to gluten without having celiac disease, says Dr. David Jenkins, the Canada Research Chair in Nutrition and Metabolism at the University of Toronto.
In clinical research training, Jenkins, 65, learned that many people with gastrointestinal problems other than celiac disease appear to benefit from a gluten-free diet. But that can't be scientifically validated, due to the fluctuating nature of the conditions, says Jenkins, who is also director of the risk factor modification centre at St. Michael's Hospital.
The link between gluten and celiac disease was discovered during World War II, when the supply of wheat was disrupted. Some children with the condition improved, but after the war, their health deteriorated as wheat consumption rose.
No one knows exactly why gluten causes the reaction, but in celiacs it inflames of the lining of the small intestine, leading to chronic diarrhea, weight loss, fatigue, anemia, cramps and bloating.
A lot of other people feel that bloating and other symptoms disappear after cutting out wheat and gluten, but there are no diagnostic criteria for it, Jenkins says. He cautions against cutting all gluten out of the diet, with the exception of celiacs, for fear of eliminating foods that may contain gluten but are still good for the body.

Grocery shopping is still a multi-store marathon for Dalziel. She drives all over the city to get the best specialty products. "Even a product that was safe the last time I went grocery shopping I have to check again, because formulations will change very often," she says.
Among her favourite stops is the Montmartre Bakery in Scarborough, which makes more than 40 kilograms of rice-based dough into loaves, buns and pizza shells each Thursday, strictly by preorders and cash sales. They're working on a chocolate chip cookie, says owner Ralph Lang. Dalziel hesitates to recommend the bakery to celiacs, because it also makes regular bread and she says anyone who's hypersensitive may react to flour in the air. She's also afraid the bakery won't be able to keep up with demand once the secret gets out.
As it happens, Dalziel's cherished rice bread comes from a mix and even that bag carries a warning "May contain traces of wheat." But Lang uses separate pans and utensils for wheat and gluten-free products and no one has ever reported a reaction, he says.
Jenkins advises everyone, celiac or not, to branch out and try bread made with different grains such as quinoa, oats, corn or kamut.
"People have to be careful in deciding whether they feel better or not, because we may not be able to measure anything (to indicate) whether they are better or not," he says. "You've got to have a very good reason for cutting (gluten) out."