For many people living with Celiac Disease, having Celiacs and being an advocate for awareness often times are synonymous. We are a demographic of people who cannot eat one of the most commonly consumed foods: bread. So, naturally, when people come across a Celiac for the first time they have a lot of questions. Wheat has played an incredibly large role in our political, religious and culinary histories. As a result, it may seem pretty odd or even unbelievable when you encounter a person biologically designed to reject it. Whenever I meet someone who has not heard of Celiac Disease or the gluten free diet I am unfailingly asked one of three questions:
- What is gluten???
- So…what happens to you if you eat bread?
- Celi-what disease?
It is important to be able to answer these questions coherently and knowledgeably. Why? Because otherwise the gluten free diet gets a bad rap! If people living with Celiacs or gluten intolerance do not speak up, the media and fad-dieting celebrities control the narrative about what it means to be “gluten free”. That being said, if you have Celiac Disease or gluten intolerance, what should you know??
A Celiac in the know should have a basic and celiac-specific understanding of Physiology, Plant Biology, Biochemistry, Immunology and Genetics. As a Science teacher and GF blogger it is about time I merged my two favorite things into a blog post! I won’t be offended if you simply skim the rest of this post because things are about to get a bit nerdy :)
Physiology is the study of biological functions eg how the digestive system functions. Given that Celiac Disease is a digestive disease it is important for us to know how the digestive system works! The purpose of the digestive system is to digest and absorb. There is a common misconception that people with Celiac Disease struggle with digestion but this isn’t really true: we struggle with absorption.
For example, someone who is lactose intolerant cannot digest dairy products, their body cannot break it down. Celiacs are great at breaking things down, in fact, we have a whole class of biological soldiers (antibodies) that attack gluten. If this were merely a matter of digestion, the symptoms of Celiac Disease would not be so varied and at times debilitating.
Digestion is the process of breaking down food into biologically usable parts. Your cells don’t need pepperoni pizza, they need glucose, amino acids, vitamins and minerals etc. The digestive process transforms food into these usable components. Once the food is broken down (aka digested) it will reach your small intestine, which is where the absorption takes place.
Your small intestine is lined with villi, finger-like projections that absorb those usable components from the food into the body/blood stream. When the villi are damaged they look stub-like and can longer efficiently absorb nutrients. Someone with Celiac Disease may eat an incredibly healthful diet and yet not receive the benefits of those foods because their villi are damaged! Luckily, the villi can repair themselves overtime which is why living gluten free can often reverse almost all of the pre-diagnosis symptoms. For example, I went from being severely anemic to having normal iron levels about five months into being gluten free.
How many times have you answered the “what is gluten” question with “You know…bread, pasta, cookies, anything with flour…basically.” Although that simplification may be best in some contexts, it is still nice to know what it really is! Gluten is a group of proteins that is responsible for the elasticity of dough aka the chewy goodness that I sometimes miss so much. Gluten is made up of two proteins: gliadin and gluteninin (gluten = gliadin + glutenin). Interestingly, Celiacs are only sensitive to “gliadin” but for whatever reason we use the term “gluten-free” to describe a diet that is not harmful to people with Celiac Disease.
Did you know that wheatgrass is gluten free? The wheatgrass is immature wheat. Though the same origin, Triticum aestivum L., the grass forms before the grain and does not contain the harmful proteins we discussed above. NOTE: if you buy wheatgrass make sure it is labelled gluten free because otherwise there is a risk that the grass has been contaminated with the mature grain.
The very first day of my Biochemistry class in college my professor warned me that I would have to memorize the structure and names for all 20 amino acids used in the body to form proteins. Don’t worry, these structures didn’t make my list of things Celiacs should know but the basic concept that proteins are made up of a string of amino acids definitely made the list.
We know if you are Celiac you need to be gluten free. We know that gluten is made up of two proteins and Celiacs are mostly sensitive to gliadin. So what is it about the protein called gliadin that is harmful?
A protein is made up of a string of amino acids. The sequence, or order, of these amino acids is what determines what type of protein it is. There is a specific part of gliadin, a sequence of 19 amino acids, that trigger the autoimmune response in Celiac patients. Proteins with similar sequences, even if not exact, can cause reactions as well. This is why people with Celiac Disease typically cannot eat rye, barley, malt and sometimes even oats because the amino acid sequences can cause a reaction!
The immune system has two parts: innate immunity, the body’s first and more generic line of defense, and adaptive immunity, our specific response. When it comes to Celiac Disease we are mostly interested in adaptive immunity because it is this part of the immune system that is triggered by gluten.
In someone with Celiac Disease, the body perceives gluten as a threat and produces antibodies to attack and eliminate it called Anti-gliadin antibodies (also called AGA). You probably recognize that word from the tests you were given for your diagnosis. Some doctors will test the blood for the presence of AGA in order to determine if someone has Celiac Disease.
Why does it matter if the body creates an antibody specific for gluten? Doesn’t that just mean that the gluten is attacked? The immune system is very complex and yet imperfect. Autoimmune diseases are conditions where the body’s defense systems begin to attack healthy cells. In Celiac Disease, the Anti-gliadin antibodies end up attacking the lining of the small intestine (among other areas in the body), damaging the ability of the villi to absorb nutrients.
In short, the immune system creates specific proteins that target foreign and unwanted invaders in the body. People with Celiac Disease develop antibodies in response to consuming gluten that attack and destroy healthy cells in the body causing damage, inflammation and symptoms of Celiacs.
The reason it is important to understand the genetic aspect of Celiac Disease is all about getting people tested. If you or a family-member are diagnosed with Celiac Disease it is really important that the rest of the family get tested as well. If a family-member has Celiac Disease, your chances of having it are much higher than the average person in the general population. Family-members may be asymptomatic or may have symptoms that have been misdiagnosed (I used to have a juvenile arthritis diagnosis on file before going gluten free).
I can’t tell you how many of my readers have told me that they found out they needed to be gluten free because a family-member was diagnosed first. My grandmother found out she had Celiac Disease after I was diagnosed and has experience improved health since going gluten free! There is no way to get around the fact that Celiacs is genetic. I know many families that are resistant to getting tested because they do not realize that they have a risk of having or developing Celiac Disease.
Being in the know is not just important for spreading accurate awareness, it can actually help you stay motivated. When you understand what happens to the body on a molecular level in response to even trace amounts of gluten you may find yourself even more committed to taking those extra steps like avoiding cross contamination to be completely gluten free.
Have a great rest of the weekend, readers!