Test Your Gluten and Celiac Knowledge

by Melissa Diane Smith

Awareness of celiac disease and gluten sensitivity has grown so much in recent years that more and more people are avoiding gluten and “gluten-free” is one of the hottest and most in-demand labels placed on foods today. Yet, despite the popularity in “gluten-free,” many people have sketchy information about gluten, gluten-related illness and gluten-free foods.

There is no better time than now, National Celiac Awareness Month, to clear up common misconceptions and raise awareness, So, take my quiz, test your knowledge, and find out how gluten-savvy you really are.

TEST YOUR KNOWLEDGE

On Gluten

1. True or False: Gluten is a type of carbohydrate that people with celiac disease or gluten sensitivity react to.

2. True or False: People who follow a gluten-free diet don’t eat wheat, rye, and barley, but they can eat foods made with spelt.

3. True or False: There is controversy about whether certified gluten-free oats are a safe food for all people with celiac disease and gluten sensitivity.

4. True or False: “Gluten-free” listed on a food label is a term that is clearly defined and regulated by the FDA.

On Celiac Disease and Gluten Sensitivity

5. True or False: Celiac disease is an autoimmune disease.

6. True or False: The symptoms of celiac disease are always lower gastrointestinal symptoms, such as diarrhea, constipation, gas, and bloating.

7. True or False: In both gluten sensitivity and celiac disease, the innate immune system reacts to gluten.

8. True or False: Gluten sensitivity can cause symptoms similar to those experienced in people who have celiac disease.

ANSWERS TO THE QUIZ

On Gluten:

1. False. People with celiac disease or gluten sensitivity react to gluten, but gluten is a protein, not a carbohydrate.

2. False. People who avoid gluten need to avoid wheat, rye and barley but they also should avoid spelt. It’s a common misconception that spelt is okay for those on a gluten-free diet. But it is not. Spelt is a type of wheat and contains gluten just like wheat does.

3. True. There are conflicting studies and opinions about the safety of pure, uncontaminated oats in the diet. One study found that pure oats can be accepted and tolerated by the majority of children with celiac disease, but another study found that people who ate oats experienced significantly more frequent diarrhea and more severe constipation than those on a gluten-free diet who did not. The Celiac Sprue Association recommends against eating pure oats because some celiacs develop immune responses and symptoms to them and there are no indicators right now to determine which celiacs may have such a response. Overall, there are still too many questions, so making a blanket statement that oats are safe for all people with celiac disease or gluten sensitivity is premature, explains Ron Hoggan and Scott Adams, authors of the new book Cereal Killers: Celiac Disease and Gluten-Free A to Z.

4. False. An act passed in 2004 required the Food and Drug Administration (FDA) to develop an official definition of the term “gluten-free” for the purpose of labeling gluten-free foods. So far the FDA has completed a proposed rule on that but not a final rule. Right now it is up to manufacturers of “gluten-free” food items to define and make the gluten-free claim. That means it is up to consumers to beware of the gluten-free claim on packages of food, to ask questions, and to be knowledgeable about hidden sources of gluten and processing techniques that may contaminate the foods with gluten. Consumers also can look for two different symbols on product labels that indicate stricter standards than what the FDA proposes. They are a Certified Gluten-Free trademark symbol by the Gluten Intolerance Group or a CSA (Celiac Sprue Association) Recognition Seal. To learn more about these symbols, visit www.gfco.org and www.csaceliacs.org .

On Celiac Disease and Gluten Sensitivity:

5. True. In celiac disease, the immune system attacks both gluten and the small intestine, leading to the damage in the small intestine that characterizes celiac disease. Celiac disease is classified as an autoimmune disease because the immune system attacks part of the body.

6. False. Symptoms of celiac disease sometimes show up as lower gastrointestinal symptoms but not always. A growing percentage of people diagnosed with celiac disease actually either have no symptoms or nongastrointestinal symptoms such as bone disease, anemia, neurologic symptoms, or fatigue.

7. True. In people who have either gluten sensitivity or celiac disease, the innate immune system, the most ancestral form of defense we have against “invaders,” reacts to gluten. In people who have celiac disease, the adaptive immune system also reacts, setting off the autoimmune process in the small intestine that characterizes celiac disease.

8. True. Even though people with gluten sensitivity do not have the damage to the gut that characterizes celiac disease, they can have similar or sometimes identical symptoms to those that people with celiac disease experience.

References:

Celiac Sprue Association Defining the Term “Gluten-Free” web page,

CSA Recognition Seal Program web page.

Ford, Rodney P. Which serological tests best identify gluten reactions? Journal of Pediatric Gastroenterology and Nutrition, 2009;Vol. 49, Suppl 1, p. E14.

Gluten-Free Certification Organization website.

Hogberg L, Laurin P, Falth-Magnusson K, et al. Oats to children with newly diagnosed coeliac disease: a randomized double blind study. Gut. 2004 May;53(5):649-54.

Hoggan, Ron, and Adams, Scott. Cereal Killers: Celiac Disease and Gluten-Free A to Z. Charleston, SC: Watersideworks and Celiac.com, 2010.

Lapid, Nancy. “The Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA): What FALCPA Means for Gluten-Free Food Shopping,” CeliacDisease.About.com.

Peraaho M, Kaukinen K, Mustalahti K, et al. Effect of an oats-containing luten-free diet on symptoms and quality of life in coeliac disase. A randomized study. Scandinavian Journal of Gastroenterology, 2004 Jan;39(1):27-31.

Personal phone interview with Alessio Fasano, M.D., director of the Center for Celiac Research, January 13, 2010.

Rampertab SD, Pooran N, Brar P, et al. Trends in the presentation of celiac disease. American Journal of Medicine, 2006;119;355.e9-14.

Sapone A, Lammers K, Casolaro V, et al. Gluten sensitivity is associated to activation of the innate but not Th1/Th17 immune response to gluten exposure. Journal of Pediatric Gastroenterology and Nutrition, 2009;Vol. 49, Suppl 1, p. E14.

Copyright © 2010 Melissa Diane Smith

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