Gluten Intolerance
Celiac Disease: An American Autobiography
By Lindsey Howell
An oedematous, swollen intestinal mucosa with short, thick, blunt villi and deeper than normal crypts [results], and the reduced epithelial surface area and compromised epithelial digestive and absorptive capacity leads to malabsorption (Keshav 80).
Celiac is a disease in which people are unable to tolerate gluten, a protein found in wheat, rye, barley, and possibly oats. The ingestion of gluten by a celiac patient results in painful symptoms and destruction to the inner digestive organs. Celiac disease mostly damages the small intestine and interferes with nutrient absorption, making it a malabsorption syndrome. Diseases often compared to and confused with Celiac include: irritable bowel syndrome, Chrons disease, ulcerative colitis, stomach ulcers, diverticulosis, and chronic fatigue syndrome.
The concentration of dietary gluten is highest proximally in the intestine and therefore celiac disease affects the duodenum and proximal jejunum most severely (Keshav 80).
Amongst the many symptoms of Celiac, one may experience, for example, nausea, sudden weight gain/loss, and severe abdominal bloating and pain, along with other gastrointestinal problems. Psychological issues may arise as well, including: depression, irritability, inability to concentrate, and mood changes. Contrastingly, a person of Celiac disease may live his whole life never displaying symptoms other than the damage being done to his digestive tract.
The criterion for diagnosis of celiac disease should be the demonstration of an unequivocal improvement of any mucosal abnormality in response to a gluten free diet, or deterioration in response to gluten (Cooke 11).
There is no definitive trial for Celiac, although through many tests and procedures one may come to an educated assumption of the disease. Among the tests generally performed upon suspicion of the disease are: Upper GI, Small Bowel Follow Through, Anti-body blood tests or an elimination diet. A biopsy of the small intestine may also show if there is damage being caused to the small intestine. However, any of these tests may produce a false negative result if the patient had been maintaining a gluten-free diet and therefore the damage to the intestine (tentative proof of the disease) would have already healed. Because little is known about the disease, one must generally go through an array of misdiagnoses before a proper one is made.
After a lifetime of sickness and digestive problems, at the age of 19, I was diagnosed with Celiac disease. The diagnosis was made through many tests and elimination diets which showed the prevalence of a malabsorption syndrome in which I could not process gluten and lactose. If left untreated, symptoms would be persistent and painful, and the disease would cause permanent damage to my digestive tract. Although a potentially serious disease with no cure, if dietary restrictions were followed, I could cope and live symptom free. Dramatic changes had to be made to my diet and lifestyle. Because I was diagnosed with Celiac after my eating habits had already been established, altering my diet would prove to become a complicated process. Celiac disease would come to be an important, routine-altering milestone in my social and personal life. My food, in fact, was a way of life as much as it was sustenance for my physical being.
Beyond merely nourishing the body, what we eat and with whom we eat can inspire and strengthen the bonds between individuals, communities, and even countries. The Meaning of Food is an exploration of culture through food. What we consume, how we acquire it, who prepares it, who’s at the table, and who eats first is a form of communication that is rich with meaning (www.pbs.org).
Foods that I had once taken for granted had suddenly become forbidden. A simple dinner-and-a-movie date became so complicated that the romantic ideal was even lost. While my friends were wolfing down a seductively and deliciously scented pizza, I watched with a resenting glare. I would give anything to once again savor the deliciousness of any of the foods in which I had once found comfort and familiarity. I became irritable and suffered constant waves of depression as I forgot how much good I still had in my life. I went through periods of cheating and binge-eating foods which were making me sicker inside and out. After the initial shock, and with some level of comprehension and realization, I stopped feeling sorry for myself. I desperately began to search for gluten-free foods and recipes decent enough to replace what I was being forced to give up.
GF Buttermilk pancakes
1 egg
.75
c GF baking mix
1.5 t baking soda
1 T corn oil
1 t GF baking powder
1 c lactose-free milk
.25 c tapioca flour (www.csaceliacs.org)
Already being a bit of a cook myself, baking was taken to a whole new level. Searching for sufficient gluten-free recipes before each meal was a regular task. It was certainly an interesting process of trial and error. While some foods turned out dry, tough and resembled the texture and flavor of cardboard, others were even more delectable than your typical gluten-enriched foods. I learned to make mouth-watering cookies, brownies, chicken parmesan, and risotto of any variation. Although my wallet was sad to spend twice as much on a specially made cake-mix, my intestines were healing and feeling good.
Eating makes a social statement – we eat with our family and our friends. Eating makes a political statement – what we eat affects what other people will and won’t have to eat. Eating makes a moral statement – what we eat affects how the earth is treated, and thus, reflects our personal ethics (Ikerd).
Eating is a task shared by everyone; therefore food plays a major role in shaping our culture. Every culture regards food in a different light: the preparation, the mealtime, and the social, political, and moral aspects. Recently in America, the amount of citizens showing particular concern for the foods they ingest has begun to rise. More and more, consumers are looking for fresh, organic foods that look good and will possibly even alter their appearance for the better. Concern is also focused around the expenses of foods. Although a small portion of the population cares for the wellbeing of the producers, mostly Americans just want better food for a cheaper price, whether it means personally dealing through smaller businesses or with larger corporations.
This year Americans will spend over $110 billion on fast food; that’s more than they'll spend on movies, books, magazines, newspapers, videos, and recorded music combined....Fast-food has so dominated our culture, that, in fact, children often recognize the McDonald's logo before they recognize their own name (www.cbsnews.com).
The characteristics of America’s dominant food culture are cost, convenience, and appearance (www.cbsnews.com). At the realization of my need for a new diet, all possibilities of these luxuries were lost. The convenience of splitting a pizza among friends was a distant memory. Instead, I would have to order a salad or something bland and incomparable because of my condition. I could no longer experience American’s most prized fast-food restaurants which so many casually take pleasure in. When deciding where to go for dinner as a group, my limitations had to be considered. Even worse was that the mere idea of affording a meal or snack at the same price as most Americans was also blown out the window. More and more I found specially-made gluten-free foods to be much higher priced. Also, as discussed before, the gluten-free foods I came across seemed to be consistently less tasty than normal brands. Therefore, flavor was something else I could no longer afford to be picky about.
Anyone who has a consistent, three-meal a day relationship with food knows it does more than meet physical needs. We were designed to enjoy food, and food has an undeniable impact on mind, body and soul (www.kansan.com).
It was certain that a major adjustment had to be made. I not only had to change my eating habits, but my overall attitude and outlook on life as well. I had gained an appreciation for those who’ve had to overcome greater obstacles. In my case, it would be a challenging, lifelong adjustment, but it was also a chance to learn and come out a stronger person in the end. Unfortunately, given that I have previously known the pleasures of a freshly baked, warm loaf of cinnamon bread, or a large plate of pasta, I might always suffer a craving for these foods. However, the important point was that I was finally becoming healthy and no longer suffering from the intolerable symptoms.
In spite of intensive research over the last 30 years it would appear that we are still some way off from naming the specific factor or mechanism responsible for causing celiac disease (Cooke 273).
Not much about the actual disease is commonly known, including the cause, making Celiac difficult to identify. In fact, nearly 1/133 people are victims to celiac, while only about 3% of that population has been properly diagnosed (celiac.com). The age onset of symptoms of the disease is also a mystery. Some may show symptoms at the first taste of gluten, and others may not show signs until late in adulthood, while some may never experience symptoms. What does seem to be fairly apparent, however, is that there is a strong genetic tendency for the disease to run in families. Researchers, however, still have not found a way to alter this gene, nor have they been successful in finding a cure.
The exact way in which damage to the intestinal mucosa, typical of celiacs, occurs-whether through an aberrant immune reaction to gluten, through a peptidase deficiency, or in some other way-remains unknown (Kretchermer 180).
Without treatment, people with celiac disease can develop complications like cancer, osteoporosis, anemia, and seizures. There has also been evidence pointing to a connection between other autoimmune diseases, and Celiac. Unfortunately, the only relief is a strict, lifetime commitment to a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage.The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults. (http://digestive.gov). In making this transition, a dietitian can teach important information regarding reading food labels, and balancing a healthy diet. Furthermore, many support groups exist where not only patients alike of Celiac disease attend, but doctors and psychiatrists as well.
Regarding my personal and social life, I would soon learn to overcome the challenge of adapting to a new lifestyle. Where at first I would focus on the negative aspects and all the things which were suddenly hindered by the disease, I had learned to steer my attention elsewhere. My life never really completely revolved around food, and there was still so much to be thankful for. I quickly became more educated on the topic of health in general, and I even took up yoga as a daily activity. I could still enjoy the company of friends and family at suppertime while I would eat my special bowl of gluten-free pasta. I was gradually learning to overcome my disease, and successfully maintaining my social life, despite foods major impact on the American culture. In actuality, just as Americans hold food in such high regard, they seem to be equally as concerned with different forms of dieting. And, after all, I could still eat; I just followed a different diet!
Works Cited
1. Celiac.com. 1995. Celiac Disease and Gluten-Free Diet Support Center. 4
February 2007 .
2. Celiac Disease. October 2005. National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health. 4 February 2007.
3. Celiacs Helping Celiacs: Recipes. 2004. Celiac Sprue Association. 13 February
2007.
4. Cooke, W.T. and G.K.T. Holmes. Coeliac Disease. New York, New York:Churchill Livingstone Inc., 1984. 5. Dotevall, Gerhard, M.D., Ph.D. Stress and Common Gastrointestinal Disorders.New York, New York: Praeger Publishers, 1985. 6. Ikerd, John. The New American Food Culture. 2000. Three Rivers Press. 11
February 2007.
7. Keshav, Satish. The Gastrointestinal System at a Glance. Malden, Massachusetts:Blackwell Science Ltd, 2004. 8. Kretchermer, Norman, M.D., Ph.D. Food, Nutrition and Evolution: Food as anEnvironmental Factor in the Genesis of Human Variability. Chicago, Illinois: Masson Publishing USA, 1981. 9. Marks, Jay W. M.D. Celiac Disease.1996. MedicineNet Inc. 4 February 2007.
10. The Meaning of Food. 2005. Pie in the Sky Productions. 18 February 2007.
11. Schlosser, Eric. Americans Are Obsessed with Fast Food: The Dark Side of
the All American Meal. 2001. CBS. 15 February 2007.
12. Wisdom, Erin. Comfort Food Cravings. 2006. The University Daily Kansan. 16
February 2007.
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