Dermatitis herpetiformis

Autoimmune disorders, barley, bowel disorders, CD, celiac, celiac disease, celiac sprue, dermatitis herpetiformis, DH, gluten intolerance, gluten-intolerance, kamut, rye, small intestine, triticale, vegetarian diet, wheat, wheat-free diet.

A gluten free diet is a diet completely free of ingredients containing gluten, a protein found in wheat (including kamut and spelt), barley, rye and triticale. Gluten constitutes about 80% of the proteins contained in wheat and is responsible for the flexibility of kneaded dough. Those with celiac disease (CD) and dermatitis herpetiformis (DH- the skin manifestation of CD characterized by chronic, extremely itchy rash consisting of bumps and blisters), who are gluten intolerant, must strictly follow this diet.

Celiac disease is a genetic disorder that affects one in 133Americans. The disease seems to most affect people of European (especially Northern European) descent, but recent studies show that it may also affect Hispanic, Black and Asian populations. Those affected suffer damage to regions of their intestines if they consume gluten. Oats have traditionally been considered to be toxic to celiacs, but recent scientific studies have shown otherwise. This research is ongoing and it is too early to draw any firm conclusions.

A gluten free diet may also be helpful for persons with multiple sclerosis (MS) and other autoimmune disorders, although currently there are no high quality human trials available to support this claim.

Gluten intolerance is the result of an immune-mediated response to the ingestion of gluten that damages the small intestine, usually through inflammation and/or swelling. Nutrients quickly pass through the small intestine rather than being absorbed. To develop celiac disease, three conditions must be present: an individual must inherit the gene, the individual must consume gluten and the gene must be triggered. Common triggers may include stress, trauma (surgeries, pregnancy, etc.) and viral infections. Approximately 1 in 20 first-degree relatives could have celiac disease triggered in their lifetime. The disease is permanent and damage to the small intestine will occur every time gluten is consumed, regardless if symptoms are present.

Celiac disease (CD): Following a strict, gluten free diet is the only known treatment for celiac disease. Celiac disease may appear at any time in a person's life. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often imitate other bowel disorders. Infants, toddlers, and children often exhibit growth failure, vomiting, bloated abdomen and behavioral changes. Some people with CD report no symptoms at all. Physical symptoms may include: abdominal cramping/bloating, abdominal distention, acidosis, appetite (cravings), back pain, bloating, bone or joint pain, constipation, decreased ability to clot blood, dehydration, diarrhea, distention, dry skin, edema, electrolyte depletion, energy loss, fatigue, gas, gluten ataxia (lack of coordination or unsteadiness), infertility, mouth sores, muscle cramping, night blindness, osteopenia, osteoporosis, steatorrhea (fatty stools), tooth enamel defects, weakness and weight loss. Emotional symptoms may include: depression, concentration issues, disinterest, irritability or moods swings.

When working with a physician to diagnose and/or confirm CD, three steps are taken. First, a thorough physical examination is conducted including a series of blood tests sometimes referred to as the Celiac Blood Panel. Second, a duodenal biopsy is performed with multiple samples from multiple locations in the small intestine. Third, a gluten free diet is followed. A person seeking initial diagnosis must be consuming gluten. Specific antibody blood tests are used to identify the presence of CD and are the initial step in screening. Blood tests include: anti-Gliadin (aGa) IgA, (aGa) IgG, anti-Endomysial (EMa) IgA, anti-tissue transglutaminase (tTG) and total serum Iga.

Dermatitis herpetiformis (DH): The skin manifestation of celiac disease. It is diagnosed by a biopsy of a skin lesion and staining for Iga in the tissues.

The legal definition of the phrase "gluten free" varies from country to country. Current research suggests that for persons with celiac disease, the maximum safe level of gluten in a finished product is probably less than 0.02% and possibly as little as 0.002%. Ordinary wheat flour contains approximately 12% gluten.

This information has been edited and peer-reviewed by contributors to the natural Standard Research Collaboration (www.naturalstandard.com).

Annibale B, Severi C, Chistolini A, et al. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol 2001;96(1):132-137.

Addolorato G, Parente a, De Lorenzi G, et al. Rapid regression of psoriasis in a coeliac patient after gluten-free diet. a case report and review of the literature. Digestion 2003;68(1):9-12.

Addolorato G, De Lorenzi G, Abenavoli L, et al. Psychological support counselling improves gluten-free diet compliance in coeliac patients with affective disorders. Aliment Pharmacol Ther 2004;20(7):777-782.

Bardella MT, Fredella C, Prampolini L, et al. Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. Am J Clin Nutr 2000;72(4):937-939.

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Caution: The gluten free diet requires individuals to read food labels that are often vague and to learn how to identify ingredients that may contain hidden gluten. Selected foods are listed below. A qualified health professional and nutritionist should be consulted before starting any new diet, as they can help dieters determine individual food tolerances.

Gluten free foods may include: Acacia gum, acorn quercus, adipic acid, adzuki bean, agar, alfalfa, algae, algin, alginate, allicin, almond nut, aluminum, amaranth, annatto, annatto color, apple cider vinegar, arabic gum, arrowroot, artichokes, ascorbic acid, aspartame, aspic, Astragalus gummifer, balsamic vinegar, beans, benzoic acid, besan, beta carotene,betaine, bha, bht, biotin, buckwheat, butter (check additives), butylated hydroxyanisole, butyl compounds, calcium carbonate, calcium caseinate, calcium chloride, calcium disodium, calcium phosphate, calcium silicate, calcium stearate, calcium sulfate, camphor, canola oil, caprylic acid, carrageen chondrus crispus, carboxymethylcellulose, carnauba wax, carob bean, carob bean gum, carob flour, carrageen, casein, cassava manihot esculenta, castor oil, cellulose gum, cetyl alcohol, cheeses (check ingredients), chestnuts, chickpea, chlorella, chymosin, citric acid, collagen, corn, corn flour, corn meal, cornstarch, corn syrup, corn syrup solids, corn sweetener, cortisone, cotton seed oil, cowitch, cowpea, cream of tartar, demineralized whey, desamidocollagen, dextrose, dioctyl sodium, distilled vinegar, eggs, elastin, ester gum, ferrous gluconate, fish (fresh), flaked rice, flax, folic acid-folacin, formaldehyde, fructose, fruit (including dried), fumaric acid, gelatin, glutamate (free), glutamic acid, glutamine (amino acid), glycerides, glycerol monooleate, glycol, glycolic acid, glycol monosterate, gram flour (chick peas), grits (corn), guar gum, hemp, herbs, honey, hyacinth bean, hydrogen peroxide, hydrolyzed soy protein, inulin, invert sugar, iodine, job's tears, kasha (roasted buckwheat), keratin, kudzu root starch, lactic acid, lactose, lanolin, lecithin, lentil, lipase, locust bean gum, magnesium carbonate, magnesium hydroxide, maize, malic acid, maltitol, manioc, masa, masa flour, masa harina, meat (fresh), milk, millet, milo, mineral oil, mineral salts, monopotassium phosphate, monosodium glutamate [MSG] (made in the United States), mung bean, musk, niacin-niacinamide, nuts (except wheat, rye & barley), oils and fats, oleyl alcohol/oil paraffin, pea (cow), pea flour, peas, pepsin, Peru balsam, petrolatum phenylalanine, pigeon peas, polenta, polyethylene glycol, polyglycerol, polysorbates, potassium citrate, potassium iodide, potassium sorbate, potatoes, potato flour, prinus, pristane, propolis, propylene glycol, propylene glycol monosterate, propyl gallate psyllium, pyridoxine hydrochloride, quinoa, ragi, rape, rennet, reticulin, rice, rice flour, rice vinegar, rosin, royal jelly, sago flour, sago palm, saifun (bean threads), scotch whisky, seaweed, seeds (except wheat, rye & barley), sphingolipids, soba (100% buckwheat), sodium acid pyrophosphate, sodium alginate, sodium ascorbate, sodium benzoate, sodium caseinate, sodium citrate, sodium erythrobate, sodium hexametaphosphate, sodium lauryl sulfate, sodium nitrate, sodium phosphate, sodium silacoaluminate, sodium stannate, sorbic acid, sorbitol-mannitol, sorghum, sorghum flour, soy, soybean, soy lecithin, spices (pure), stearates, stearamide, stearamine, stearic acid, sunflower seed, succotash (corn and beans), sucrose, sulfosuccinate, sulfites, sulfur dioxide, sweet chestnut flour, tallow, tapioca, tapioca flour, tarrow root, tartaric acid, tea, tea-tree oil, teff, teff flour, tepary bean, thiamine hydrochoride, tofu-soya curd, tolu balsam, tragacanth, tragacanth gum, tri-calcium, phosphate, turmeric, tyrosine, urad/urid beans, urad/urid dal (peas), urad/urid flour, vanillin, vegetables, vitamin A (retinol), waxy maize, whey, white vinegar, wild rice, wines, wine vinegars, xanthan gum, yam flour, yogurt (plain, unflavored).

Gluten-containing foods may include: Abyssinian hard (wheat Triticum durum), amp-isostearoyl hydrolyzed, barley grass (may contain seeds), barley hordeum vulgare, barley malt beer, bleached flour, blue cheese (made with bread), bran, bread flour, brewer's yeast, brown flour, bulgur (bulgar wheat/nuts), bulgur wheat, cereal binding, chilton, club wheat (Triticum aestivum subspecies compactum), common wheat (Triticum aestivum), couscous, dextrimaltose, disodium wheatgermamido peg-2 sulfosuccinate, durum wheat (Triticum durum), edible starch, einkorn (Triticum monococcum), emmer (Triticum dicoccon), farina, farina graham, filler, flour (normally this is wheat), fu (dried wheat gluten), germ, graham flour, granary flour, groats (barley, wheat), hard wheat, hydrolyzed wheat gluten, hydrolyzed wheat protein, hydrolyzed wheat protein pg-propyl silanetriol, hydrolyzed wheat starch, hydroxypropyltrimonium hydrolyzed wheat protein, kamut (pasta wheat), macha wheat (Triticum aestivum),malt, malt extract, malt flavoring, malt syrup, malt vinegar, matzo semolina, mir, oriental wheat (Triticum turanicum), pasta, persian wheat (Triticum carthlicum), poulard wheat (Triticum turgidum), polish wheat (Triticum polonicum), rice malt (if barley or koji are used), rye, seitan, semolina, semolina triticum, shot wheat (Triticum aestivum), small spelt, sprouted wheat or barley, stearyldimoniumhydroxypropyl hydrolyzed wheat protein, strong flour, suet in packets, tabbouleh, teriyaki sauce, textured vegetable protein (TYP), timopheevi wheat (Triticum timopheevii), triticale x triticosecale, Triticum vulgare (wheat) flour lipids, Triticum vulgare (wheat) germ extract, Triticum vulgare (wheat) germ oil, udon (wheat noodles), unbleached flour, vavilovi wheat (Triticum aestivum), vegetable starch, wheat, wheat germ extract, wheat grass (may contain seeds), wheat nuts, wheat protein, whole-meal flour, wild einkorn (Triticum boeotictim), wild emmer (Triticum dicoccoides).

May also contain gluten: cereals, condiments, creams and cosmetics, envelopes and other gummed labels, fried restaurant food (gluten-contaminated grease), grilled restaurant food (gluten-contaminated grills), ground spices, lotion, rice paper, sauce mixes, rice and soy beverages (production may use barley enzymes), stamps, toothpaste and mouthwash, and wheat-bread crumbs.