Straight Talk on Celiac Disease and the Gluten-Free Diet

ATTACHMENT DETAILS Celiac-Disease-on-Second-Opinion-TV.png December 7, 2017 256 KB 471 × 338 Edit Image Delete Permanently URL Title Celiac Disease on Second Opinion TVTranscript of a discussion on Celiac Disease on Second Opinion TV. On the panel were Louis J. Papa, MD, FACPAlice BastDaniel Leffler, MD, MS and R. John Looney, M.D.  This straight forward information offers an overall review about the disease and the diet and helps to dispel many of the common myths and misunderstandings. To watch the video, scroll down to the link at the bottom of the page.

When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats. Villi on the lining of the small intestine help absorb nutrients.

Celiac disease is both a disease of malabsorption—meaning nutrients are not absorbed properly—and an abnormal immune reaction to gluten. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. Celiac disease is genetic, meaning it runs in families. Sometimes the disease is triggered—or becomes active for the first time—after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

What are the symptoms of celiac disease?

Symptoms of celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include

  • abdominal bloating and pain
  • chronic diarrhea
  • vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss

Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may instead have one or more of the following:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss or osteoporosis
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • an itchy skin rash called dermatitis herpetiformis

People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition—which can lead to anemia, osteoporosis, and miscarriage, among other problems—liver diseases, and cancers of the intestine.

Why are celiac disease symptoms so varied?

Researchers are studying the reasons celiac disease affects people differently. The length of time a person was breastfed, the age a person started eating gluten-containing foods, and the amount of gluten-containing foods one eats are three factors thought to play a role in when and how celiac disease appears. Some studies have shown, for example, that the longer a person was breastfed, the later the symptoms of celiac disease appear.

Symptoms also vary depending on a person’s age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications.

What other health problems do people with celiac disease have?

People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may be genetic. They include

  • type 1 diabetes
  • autoimmune thyroid disease
  • autoimmune liver disease
  • rheumatoid arthritis
  • Addison’s disease, a condition in which the glands that produce critical hormones are damaged
  • Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed

How common is celiac disease?

Celiac disease affects people in all parts of the world. Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder. More than 2 million people in the United States have the disease, or about 1 in 133 people.1 Among people who have a first-degree relative—a parent, sibling, or child—diagnosed with celiac disease, as many as 1 in 22 people may have the disease.2

Celiac disease is also more common among people with other genetic disorders including Down syndrome and Turner syndrome, a condition that affects girls’ development.

1Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Archives of Internal Medicine. 2003;163(3):268–292.

How is celiac disease diagnosed?

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been underdiagnosed or misdiagnosed. As doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.

Blood tests

People with celiac disease have higher than normal levels of certain autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.

Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.

Intestinal biopsy

If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis. During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, the doctor eases a long, thin tube called an endoscope through the patient’s mouth and stomach into the small intestine. The doctor then takes the samples using instruments passed through the endoscope.

Dermatitis herpetiformis

Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with celiac disease.3 The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of celiac disease.

DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as dapsone. Because dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.


Screening for celiac disease means testing for the presence of autoantibodies in the blood in people without symptoms. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to 12 percent of an affected person’s first-degree relatives will also have the disease.4

3Rodrigo L. Celiac disease. World Journal of Gastroenterology. 2006;12(41):6585–6593.

How is celiac disease treated?

The only treatment for celiac disease is a gluten-free diet. Doctors may ask a newly diagnosed person to work with a dietitian on a gluten-free diet plan. A dietitian is a health care professional who specializes in food and nutrition. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.

For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.

To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.

Some people with celiac disease show no improvement on the gluten-free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.

Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. Researchers are evaluating drug treatments for refractory celiac disease.

The gluten-free diet

A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. In other words, a person with celiac disease should not eat most grain, pasta, cereal, and many processed foods.

Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from mainstream stores.

“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can freely eat these foods. In the past, people with celiac disease were advised not to eat oats. New evidence suggests that most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should work closely with their health care team when deciding whether to include oats in their diet. Examples of other foods that are safe to eat and those that are not are provided in the table.

The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with celiac disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they grab for a snack. Eating out can be a challenge. When in doubt about a menu item, a person with celiac disease should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.

Gluten is also used in some medications. People with celiac disease should ask a pharmacist if prescribed medications contain wheat. Because gluten is sometimes used as an additive in unexpected products—such as lipstick and play dough—reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature.


CCA Holiday Survival Guide WP

​Happy Holidays from the Canadian Celiac Association!

CCA Holiday Survival GuideThe Canadian Celiac Association is pleased to ‘gift’ you their Holiday Survival Guide. Please open BEFORE the holidays!

  • printed with permission from the Canadian Celiac Association 1

This guide contains tips and recipes from a team of passionate volunteers, who perhaps like you or a family member, face the challenges of celiac disease or non-celiac gluten sensitivity during a time of the year when food-centred activities take place.

  • “My CCA membership provided me the tools to find my way to the new normal in a gluten filled world. Now it gives me the most up to date information. If you are in this group and do not have a membership and asked “is this gluten free?” Perhaps it is time to ask Santa for a membership to support not only the peer review moderated information from the CCA in this group But support the research that assists with keeping you safe in Canada. AnD this CCA advocates to keep labelling laws simple. Thanks CCA for keeping me safe. Get educated, go to a meeting, peer support (in person) has been invaluable.” Christa

Anne Wraggett, President, CCA

Anne Wraggett, President, CCA

​If you have enjoyed the support, education and information from CCA over this past year, we hope that you will consider a donation towards our annual Festive Campaign. Donations allow our charity to continue to advocate on your behalf, increase access to safe foods and improve the quality of life of people with CD and NCGS through investing in research and education, and more. To make a secure online donation, please click this link to Canada Helps.

Wishing you all a fun and gluten-free holiday season!

Anne Wraggett, President

Anne’s Best Advice!

  • Are the holidays all about the food? It sometimes feels like it. This Holiday Survival Guide is CCA’s gift to you and is chock full of our experts’ best ideas to help you cope with a joyous season that can also be stressful and emotional as well as being a challenge for those who must eat gluten free. Right here I am I going to give you my personal, very best tip: Eat first! Yes, I’m serious. Unless you either control the food at the event you will be attending or have solid knowledge that safe gluten-free food will be available, eat first. If you find there are treats you can have – wonderful! If not, you won’t be hungry.

    CCA Holiday Survival Guide 2


  • You arrive at a holiday party and the host assures you the food is safe. Here’s what to ask to ensure you’re don’t get accidentally “glutened.”
  • It’s a situation that almost everyone with celiac has encountered. You arrive at a holiday party or dinner party with a meal brought from home, and the lovely, well-intentioned host informs you that she knows you can’t eat gluten, so she’s made a gluten-free meal for you!
  • Although it would be wonderful to not have to eat the meal you stashed in your purse, you probably should. Unfortunately, most people who don’t have celiac or non-celiac gluten sensitivity don’t know enough to prevent gluten from sneaking in their home-cooked meals.
  • Your best bet in this situation is to politely decline any food that you didn’t make yourself. Yes, someone might end up offended, but your health must be your top priority. But if your host insists, you can show her the risks involved by asking some, well, pointed questions. Here are a few to consider – and the reasoning behind asking them.

“Did the turkey have gluten-containing stuffing inside it?”

  • Why you need to ask: Some people don’t realize that if a turkey had stuffing inside, and the stuffing contains regular bread, then the turkey itself is almost certain to be contaminated. Your host may try to assure you that your portion never touched the stuffing, but the risk is too great. The turkey may have been basted with the juices from the pan that had gluten leached into them, and the bird was likely handled by your host’s contaminated hand.

“Mind if I see the seasoning mix you used?”

  • Why you need to ask: Some seasoning mixes contain wheat flour, wheat starch or wheat crumbs, according to an article by dietitian and celiac disease expert Shelley Case in Allergic Living. Your host may not have thought to read the ingredients, since spices and seasonings aren’t the most obvious sources of gluten.

“Did you prepare this meal using a cutting board that’s also used for gluten-containing foods?”

  • Why you need to ask: People don’t realize that some cutting boards, especially wood or plastic ones, can hold on to gluten in the grooves left by knife cuts, even after being washed.

“May I please see the packaging of the nuts used in the green beans?”

  • Why you need to ask: Many vegetable side dishes, such as green bean Amandine, contain almonds, and hosts may also serve mixed nuts as a pre-dinner snack. Your host will assume nuts are gluten-free, but in fact, wheat will often appear as a “may contain” in nuts’ ingredient list—which makes them unsafe for people with celiac disease. (It’s
    never worth the risk.)

“Did you strain the pasta using a plastic colander that’s also used for regular pasta?”

  • Why you need to ask: It’s difficult to clean plastic items well enough to completely rid them of gluten. Colanders are especially challenging to properly decontaminate, thanks to the many tiny holes.

“Did you use a wooden rolling pin to roll the cookies?”

  • Why you need to ask: Wooden items are difficult to properly clean—despite your host’s best efforts to clean the pin, it is likely still contaminated with gluten.

“When you added butter to the mashed potatoes, was it a fresh brick or stick?”

  • Why you need to ask: If your host previously used the butter for, say, a sandwich made with regular bread, then the crumbs from the bread could have contaminated the butter, making the mashed potatoes unsafe. Most people have no idea that just a couple of crumbs of gluten is more than any person with celiac should knowingly consume.
  • To avoid having to ask any questions at all, consider chatting with the holiday party host in advance to inform them that you’ll be bringing your own food. If you must have an awkward conversation about food preparation and ingredients, it’s better to have it in private, before the party begins.


The holidays can be a challenging time to stay gluten free. But, with a few strategies in your back pocket, the holidays can be confidently enjoyed gluten free! Here are three tips to try at your next holiday social.

Bring your own delicious GF dish to share.

  • This is a tried and true strategy that will ensure you have something safe to eat. Afraid the host may not approve?Communicate your concern by saying “I have celiac disease and even a tiny bit of gluten can cause me to feel extremely unwell. I have (an event, a presentation, a family outing etc) and it would be very unfortunate if I have to miss it because I’m ill. So, I brought my own dish just in case!” Something along those lines is always well received.

Be involved with the food preparation as much as possible.

  • Whether the event is close to home or far away, technology can be your friend! If someone else is taking the lead
    in preparing the food, make sure your voice is heard.
  • In a Kitchen: Physically help prepare the meal by showing up in advance of the event so you can have eyes on
    potential sources of cross contamination and ensure all ingredients being used are gluten free.
  • Away from the Kitchen: Talk to them on the phone ahead of time to help plan the meal, get family/friends to text you pictures of ingredient lists, Facetime with them in the grocery store, and let them know brand names of your favorite GF foods.

Be armed with confident communication skills.

  • Being able to politely decline food that has had so much love and eort put into it, is one of the hardest things to do as a celiac. Here are some example responses that you may want to try:
  • Comment: “What do you mean you can’t have these cookies, I made them special just for you!”
    Response: Thank you so much for thinking of me. I really appreciate it. But, I have to be so careful as even something as little crumb can make me very ill for days. And, with the holidays, I just can’t risk it. Maybe next time we get together, we can bake cookies at my house!
  • Comment: Come on, a little gluten won’t hurt!”
    Response: I wish that was the case, but unfortunately, even a little would cause my digestive system to be damaged. Just imagine one Smartie split into 4 pieces. Just one of those quarters still contains 25x too much gluten for me to safely ingest! It really is such a small amount. So, I do have to be very careful about the choices I make and really appreciate your understanding.


  • Are you using GF bread for stuffing, bread pudding or bread salad (panzanella, fattoush, etc.) or breakfast strata?
    • Be sure to dry it out thoroughly in a slow oven first to avoid ending up with a mushy, unpleasant texture.
  • Do you use suet for traditional holiday dishes like plum pudding and mincemeat?
    • Beware of packaged ground suet from the supermarket. It contains wheat. Ask a butcher to grind suet for you to order.
  • Not so confident in your GF baking skills?
    • Try making traditional candies like fudge, trues, nut brittles and chocolate bark and Christmas crack instead. Most do not contain gluten so there’s no need to substitute ingredients or search out unusual grains or xanthan gum. You still have the satisfaction of offering luscious homemade holiday treats to family and guests. Many of these keep well and making them ahead of time is convenient.
  • Are you or someone in your family new to the GF diet?
    • It can be very difficult to cope when faced with all the foods that are part of the traditional holiday celebrations but are now o the table. Even people who have been gluten free for decades are not immune to the sudden feeling of being left out or deprived. We all want to enjoy the traditions and food is a major part of the celebration. So, decide which particular family or cultural dish or treat is the most important one to you, or to your celiac child, and do your best to create or buy a fabulous GF version that will satisfy that inner need to share in the comfort and joy.


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CORN THINS – Pressed Popcorn Bursting with Flavour

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Organic Sesame CORN THINS: corn, sesame, sea salt



  • Real Foods ensures that every product manufactured is free from any Genetically Modified Ingredients.


  • Real Foods hold Organic Certification through Australian Certified Organic (ACO), a fully owned subsidiary of Biological Farmers of Australia (BFA). Certification ensures compliance with national organic production standards. Real Foods also hold USDA (USA) and JAS (Japan) Organic Certification through ACO.

Cross Contamination

  • Real Foods has implemented a Hazard Analysis Critical Control Point system (HACCP) to minimize any risk cross contamination of allergens.