Gluten. A protein that occurs naturally in grains, including wheat, barley and rye, it is what gives dough its delightfully elasticity and bread its addictively chewy texture.
It is also the enemy of the estimated three million Americans who suffer with celiac disease, an autoimmune disorder that has their bodies overreacting to gluten by interfering with the proper function of the small intestine, creating havoc in their intestinal tract.
According to Web MD, when people with celiac disease eat gluten, their body’s inability to properly process the protein mistakenly causes the immune system to attack the villi, small projections on the wall of the small intestine that aid in nutrient absorption. That inability to properly digest food can lead to serious health concerns including malnutrition, osteoporosis, miscarriages, infertility, neurological diseases and even cancer, and can also trigger a veritable smorgasbord of unpleasant side effects.
With so many serious health risks associated with celiac, it is crucial for those with the disease to avoid all foods containing gluten, because even if they have minimal or no symptoms, the damage may still be taking place. It is estimated that the vast majority of people with celiac are never even diagnosed because their symptoms are so mild, while others can experience diarrhea, gas, constipation, headaches, fatigue, nausea, abdominal pain, joint pain, weight loss or heartburn after eating gluten. The fact that the range of symptoms for celiac sufferers is so wide is another reason why many people are completely unaware that they have the disease – their symptoms are attributed to other health problems. Although there is no cure for celiac, those who adhere to a lifelong gluten-free diet can reverse the damage to their small intestines, experiencing relief within a matter of days.
While in some cases celiac, which is not uncommon in Jews with Eastern European roots, can be genetic, other confirmed cases can seem completely random. Celiac can be diagnosed at any age, as Leah Reich* found out when she was 49 years old.
“My doctor noticed that I had an iron deficiency and they did blood work that indicated that I might have celiac,” said Reich, whose diagnosis was confirmed through an endoscopy.
While some say their doctors have been tremendous sources of support, Reich’s experience was far less positive.
“He handed me a piece of paper saying I had to change everything I eat and then sent me home,” recalled Reich.
Taking matters into her own hands, Reich turned to her computer to research celiac, finding a wealth of information and numerous blogs, although none that catered to Jewish celiac sufferers. Over the years the sudden popularity of gluten-free items, particularly in the kosher food business, has been a boon for people like Reich, who makes her own rolls out of a gluten-free flour blend developed by a Le Cordon Bleu trained pastry chef whose own husband was diagnosed with celiac in 2007.
“I really don’t feel deprived,” remarked Reich. “Eating a gluten-free diet is so much easier today than it was even five years ago. There are Chex cereals and Cheerios for people who can tolerate them. There are all kinds of crackers, cookies and pretzels, and Barilla makes pasta that tastes amazing. I do miss real pizza, fabulous desserts and challah, but other than that there are so many great products out there.”
Reich said she cooks mostly gluten-free food for her family, including gluten-free hamantaschen and kreplach. She finds eating out to be extremely difficult, although a recent trip to Israel was a pleasant surprise.
“Israel is incredibly ahead when it comes to gluten-free,” said Roth. “There were so many options for gluten-free pizza and Ben Ami on Emek is fabulous. They actually have a separate gluten-free menu.”
While it can appear relatively simple to avoid obvious sources of gluten, the protein can show up in expected places. Oats can often be contaminated with gluten and many processed foods including candies, chips, cold cuts, deli meats, French fries and sauces can all contain gluten, making it crucial for those with celiac to be vigilant when it comes to reading labels. The many relatively unfamiliar or lesser known items that pop up on supermarket shelves can make it tough to determine which contain gluten and which are best avoided. Spelt, durum, semolina, farro, kamut and triticale all contain gluten and should not be included in a celiac diet, while amaranth, buckwheat, arrowroot, quinoa, millet, tapioca and flax are all gluten-free. The jury is still out on whether or not gluten in products such as cosmetics and toiletries can cause trouble for celiacs and beauty giant Sephora currently offers 507 gluten-free items, including Too Faced eye shadows, Bare Minerals liquid lipsticks and Boscia facial care products, on its website.
Cross contamination can be a serious issue when it comes to celiac. Because some people are sensitive to even the most minute traces of gluten, eating food that was prepared in the same cookware that was used for foods containing gluten can cause a reaction. Reich confessed to being “obsessive” about covering her plate to avoid cross contamination and said that her husband knows never to pass regular challah over her plate to other family members. The Academy of Nutrition and Dietetics suggests being extra vigilant to avoid cross contamination by purchasing a dedicated gluten-free toaster, using separate cutting boards and utensils for gluten-free foods and storing all gluten-free items above other items so that gluten particles don’t fall or settle onto gluten-free foods.
Ironically, Pesach, with all of its associated efforts, is an opportunity for many with celiac to heave a sigh of relief. In recent years, the market has been flooded with a torrent of gluten-free products to accommodate those who don’t eat gebrokts, including flat breads, granola bars, soup croutons and even matza and matza meal substitutes made out of potato and tapioca starches.
While celiac can be challenging for adults, it can be even harder for children. School snacks, birthday parties and summer camp can all pose logistical challenges and kids who have grown up eating pizza, doughnuts and pretzels may find themselves feeling deprived when everyone else is enjoying a particular treat that is off limits to them. Experts suggest placing a greater emphasis on permitted foods and including your child in meal planning and food preparation so that he or she develop both the skills and the confidence needed to make right choices.
Most important is teaching your child to be an informed eater. Kids who are old enough to read should check food labels and be on the lookout not just for wheat, barley or rye, but also hidden sources of gluten like malt syrup or brewer’s yeast. And children who are in school and going to friend’s houses shouldn’t just be taught to ask if a food has gluten, they should learn to ask what ingredients are in a particular item because people who aren’t informed about celiac may be unaware which foods can be problematic.
Like children with severe food allergies, kids with celiac can’t always eat everything their friends can, but that is a fact of life that has to be dealt with as positively as possible. By making sure that kids know that celiac is part of their lives but doesn’t define who they are, they can rise above the difficulties of their disease and go from being happy and well adjusted kids to well rounded teens and adults who take responsibility for their health as they go about their day to day lives.
*Name changed for reasons of privacy