Food Sensitivities and Celiac Disease
If you have celiac disease and you are struggling to find relief, it might be because you have unaddressed food sensitivities or intolerances (learn why following a gluten-free diet isn’t enough to support someone with celiac disease here). So if your body is telling you something still isn’t right after living gluten-free, here are some other food sensitivities to monitor if you have celiac disease.
I want to emphasize that these are just potential food sensitives to be aware of when you have celiac disease and might not be the cause of your continued symptoms. As always, if you’re concerned about your symptoms, be sure to consult your doctor or dietitian to help rule out other causes and certainly don’t attempt elimination diets on your own. Because a gluten-free lifestyle is already so restrictive, you don’t want to unnecessarily restrict further if you don’t have to.
What is Celiac Disease
Celiac disease an autoimmune disease that causes damage to the small intestine when gluten is consumed. Specifically, when someone with celiac disease eats gluten, the body attacks and damages the villi in the small intestine.
Yes, you read that right, the body attacks itself when gluten is consumed in people with celiac disease.
It’s important to note that celiac disease is not a gluten allergy (though some people might explain it as such for the sake of time). Food allergies involve an IgE immune response where Celiac involves a IgA immune response.
Additionally, celiac disease is not the same as non-celiac gluten sensitivity. Again, it involves different body responses.
Essentially, celiac disease an autoimmune disease that requires those diagnosed to live a gluten-free life. Living gluten-free is not limited to just eating gluten-free but also includes avoiding cross-contact.
What is a Food sensitivity
A food sensitivity is when the body has trouble digesting certain foods. This can be because of multiple reasons but the mechanisms of food sensitivities are mostly poorly understood.
Additionally, food sensitivities aren’t always permanent. Some people might find that they can tolerate foods after eliminating and reintroducing them, it depends.
The key point here is that food sensitivities involve the body having trouble digesting certain foods.
What’s tough about food sensitivities is that their symptoms often can present like celiac disease, making it hard to tell if it’s gluten exposure or something else.
Sometimes someone might mistake a symptom to be related to their celiac disease rather than unaddressed food sensitivities (or other problem).
This is why it’s important to keep food sensitivities on your radar just in case they might be the missing puzzle piece to your lingering problems.
It’s also important to note it is incredible important to consult your doctor or dietitian if you think your have an unaddressed food sensitivity or intolerance.
The path to identifying food sensitivities and intolerance is complicated and many of the interventions are very restrictive and require professional guidance.
Trust me, trialing elimination diets or going on a food “witch” hunt alone can lead to a wide array of problems like disordered eating, nutrient deficiencies, and more.
Your celiac specialzed doctor and/or your dietitian can be a great resource in helping you find out what is really going on.
What's the difference between a Food sensitivity and Food Allergy?
The difference between a food sensitivity and a food allergy is that a food allergy is an IgE immune mediated response to a food that could result in hives, trouble breathing, or even immediate death. A food sensitivity is not deadly and note IgE mediated but still is stressful to the body and mind.
Risk of food sensitivities in people with celiac
As discussed in the “What is Celiac” section, when gluten is consumed the small intestine is damaged. This damage includes damage to the villi and the microvilli on the villi.
This is important to understand because the villi and microvilli are involved in absorption, but more importantly the brush border on the microvilli assist in digestion by releasing some digestive enzymes.
Specifically, the brush border releases enzymes that help break down complex sugars like lactose, maltose, sucrose.
So when the small intestine is damaged, absorption is impaired and digestion of complex carbs can be impacted as well, all of which can lead to food sensitivities.
Common Food Sensitivities in Celiac
Now that we have a little background in the potential pathophysiology of food sensitivities in celiac, let’s talk about some of the common ones seen in celiac.
- Lactose Intolerance or Dairy Intolerance: Lactose intolerance is incredibly common in people newly with celiac because of their small intestinal damage. As discussed, the brush border is where lactase is released in digestion and it’s often damaged with celiac thus making lactose intolerance common with celiac. The good news is this often resolves as the small intestine heals.
- Soy Sensitivity: often people with celiac will report a soy sensitivity (I myself included) and it can again, be related to a multitude of things from impaired digestion to increased risk of cross-contact. Nonetheless, something to pay attention and bring up with your dietitian if you’re concerned.
- Corn Sensitivity: another common food sensitivity seen in people with celiac is corn. This, just like soy, can be due to a variety of reasons but again should be discussed with your dietitian.
- Oat Sensitivity: again, an oat sensitivity or intolerance can be related to digestion issues, cross-contact during processing, IBS, and more. Read more about oat safety here.
When it comes to food sensitivities, there are a few other things to discuss that are often brought up with celiac.
- Foods with “Gluten Cross-Reactive Proteins” – I wrote a whole blog post about gluten cross-reactive proteins and whether or not people with celiac disease should avoid them. Essentially the idea is that certain foods have proteins so similar to gluten that they trigger a similar immune response. Ultimately, there isn’t a lot of evidence to support these ideas, but if you’re concerned, definitely discuss this with your dietitian.
- FODMAPS: FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polysaccharides. Essentially these are sugar that are found in certain foods that can cause digestive upset in some people. If you’re considering a low-FODMAP route, it is important to discuss this and make a plan with your dietitian. This is a highly restrictive diet with very specific steps that need to be taken to get accurate results.
- Nightshades: I wrote a whole post on whether or not people with celiac disease should also avoid nightshades. With that said, nightshade foods are foods that belong to the nightshade family. Despite these foods being absolutely safe to eat, some people find that they react poorly to them. Thus, you might want to keep this sensitivity on your radar to discuss with your dietitian.
This is just a list of a few food sensitivities to monitor if you have celiac disease. Keeping a food journal or following an elimination diet (with the help of a registered dietitian) can be helpful in helping you identify what might be triggering uncomfortable reactions. Not only can a food journal help, but so can eating intuitively.
Eating intuitively can help you be mindful of what your body is asking for and how those foods make you feel. Definitely, a helpful tool to use on your journey to finding out the source behind your continued symptoms.
If you think you might be struggling with food sensitivities and need help, let’s chat!