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Bread and wheat with a warning sign

Bread and wheat with a warning sign (udra, iStockphoto)

STEM in Context

Celiac Disease: When You Really Need to Stay Gluten-Free

Kate Williams

Summary

Celiac disease is an autoimmune disorder. Gluten triggers an immune system response, seriously affecting nutrition.

Have you ever seen the words “gluten free” on a menu? And have you ever wondered why so many people avoid gluten? After all, gluten is found in all kinds of popular foods, such as many types of bread and pasta. And for most people, gluten is harmless and easy to digest. But for many other people, eating gluten leads to a range of gastrointestinal problems. The most severe problems are caused by a condition called celiac disease. Let’s learn what celiac disease is. Then, let’s learn why people with celiac disease need to stay away from gluten. And finally, let’s look at why some people without celiac disease stay away from gluten, too.

Did you know?

The word “celiac” most likely comes from the Greek word “koiliakos,” which means “suffering in the bowel.”

What is gluten?

Gluten made up of two different proteins. These proteins are called gliadin and glutenin. When mixed with water, these proteins combine to form gluten. 

Gluten is found in wheat, barley and rye. Its structure makes it very elastic. This helps to keep bread dough flexible when rising.

Molecular formula and ball-and-stick model of gliadin, one of the proteins that makes up gluten
Molecular formula and ball-and-stick model of gliadin, one of the proteins that makes up gluten (Source: ermess via iStockphoto).

 

Gluten-related disorders can range from a mild sensitivity to all-out celiac disease. If you have mild sensitivity, you’ll feel okay as long as you only eat small amounts of gluten. If you eat too much gluten, you might notice symptoms like bloating, diarrhea or constipation, and even mood changes.

But if you have celiac disease, any amount of gluten will make you sick.

Misconception Alert

If you think you have gluten insensitivity, talk to your doctor. Studies show that most people who believe they have a gluten sensitivity can actually digest gluten without any health problems. 

What is celiac disease?

Celiac disease is a genetic autoimmune disease. The word “autoimmune” means “immunity against yourself.” When your immune system works properly, it protects you from disease. It recognizes foreign substances, like bacteria and viruses, in your body. And it attacks them. But when you have an autoimmune disease, your immune system attacks you, damaging your healthy cells and tissues.

If you suffer from celiac disease, gluten entering your small intestine triggers an autoimmune response in the villi. Villi are small, finger-like projections that line the inside of your small intestine. They help increase the surface area of your intestine. This improves your ability to absorb vitamins, minerals, fats, and other nutrients.

Inside of the small intestine, showing the villi
Inside of the small intestine, showing the villi (Let’s Talk Science using an image by wildpixel via iStockphoto)

 

In people with celiac disease, gluten triggers the autoimmune response. This response damages the villi. As a result, the villi can’t absorb nutrients very well. This means people with celiac disease can struggle with malnutrition and weight loss.

Did you know?

A person’s small intestine is about seven metres long. The villi lining the small intestine gives it a surface area of 250 square meters. That’s similar to the area of a tennis court!

Is there a celiac disease treatment?

Unfortunately, there is no cure for celiac disease. When a person has celiac disease, their immune system will always react to gluten. But there is a way to manage the disease: going gluten-free. A celiac diet involves cutting out gluten completely. This can prevent any future damage from the immune response. In fact, over time, a gluten-free diet can actually reverse damage done to the villi.

Following a gluten-free diet can be difficult. But it’s getting easier. Many restaurants and grocery stores now offer lots of gluten-free options. For example, more than 60% of fast-food restaurants in Canada have committed to providing gluten-free options!

Gluten-free foods include foods made from corn, wheat, almonds, walnuts, beans, peas, sunflower seeds, etc.
Gluten-free foods include foods made from corn, wheat, almonds, walnuts, beans, peas, sunflower seeds, etc. (Source: Janine Lamontagne via iStockphoto).

Why do so many people follow gluten-free diets?

Estimates suggest that less than 1% of North Americans suffer from celiac disease. In Canada, that’s approximately 350 000 people. But as many as 97% of these people are undiagnosed. 

Still, though, approximately 2.5 million people in Canada shop for gluten-free products! And up to 30% of the population are on a gluten-reduced or gluten-free diet! Why? 

Well, some people may have symptoms similar to a celiac sufferer. But these symptoms may actually be due to a wheat allergy. Others have a non-celiac gluten sensitivity. Other people may get an autoimmune response to a different protein in wheat. If these people stop eating gluten, their symptoms usually stop, too.

Did you know?

Celiac disease and other gluten-related disorders were rare 50 years ago. Researchers think the increase may be related to a general increase in wheat consumption. Others believe that it may be linked to genetic modification in wheat.

Should we all eat gluten-free food?

People are more and more aware of gluten-related disorders. In many ways, this is a good thing. It’s part of the reason that restaurants are offering more gluten-free options. But there’s a downside to all of this awareness. People are starting to see wheat as a “bad” food. Many people now either eat less wheat, or no wheat at all. The media has even made going gluten-free trendy. Can you think of any celebrities that endorse gluten-free diets?

Doctors fear that many people are diagnosing themselves with celiac disease, rather than seeking professional medical advice. That’s a problem. Remember, we should always get health information from a medical professional, not from the latest headlines!

 

Starting Points

Connecting and Relating

  • Have you ever had an allergic reaction? If so, describe how you felt.

  • What do you think would be the two greatest challenges in following a strict diet?

Connecting and Relating

  • Have you ever had an allergic reaction? If so, describe how you felt.

  • What do you think would be the two greatest challenges in following a strict diet?

Relating Science and Technology to Society and the Environment

  • Should the availability of gluten-free food options be mandated by public policies or laws? Explain.

  • Do you think it is possible to develop a cure for food allergies? Why/why not?

  • What impact would a cure for food allergies have on the economy?

  • How might the increasing demand for gluten-free food items affect the agricultural industry?

Relating Science and Technology to Society and the Environment

  • Should the availability of gluten-free food options be mandated by public policies or laws? Explain.

  • Do you think it is possible to develop a cure for food allergies? Why/why not?

  • What impact would a cure for food allergies have on the economy?

  • How might the increasing demand for gluten-free food items affect the agricultural industry?

Exploring Concepts

  • Is there a difference between an allergic reaction to food and an infectious reaction in an autoimmune disorder? Explain.

  • How can celiac disease affect the digestive system and the health of a person with the disease?

  • Celiac disease is an autoimmune disorder, not an allergy. How does this affect the treatments available?

  • What is the difference between food allergies and environmental or respiratory allergies (such as hay fever)?

Exploring Concepts

  • Is there a difference between an allergic reaction to food and an infectious reaction in an autoimmune disorder? Explain.

  • How can celiac disease affect the digestive system and the health of a person with the disease?

  • Celiac disease is an autoimmune disorder, not an allergy. How does this affect the treatments available?

  • What is the difference between food allergies and environmental or respiratory allergies (such as hay fever)?

Nature of Science/Nature of Technology

What role should scientists play when health advocates make use of research data to promote diets? Explain.

Nature of Science/Nature of Technology

What role should scientists play when health advocates make use of research data to promote diets? Explain.

Media Literacy

  • To what degree has the general public’s knowledge of Celiac disease been informed by various media outlets?

  • What role should media outlets play in reporting on relationships between diet and public health concerns? Explain.

Media Literacy

  • To what degree has the general public’s knowledge of Celiac disease been informed by various media outlets?

  • What role should media outlets play in reporting on relationships between diet and public health concerns? Explain.

Teaching Suggestions

  • This article can be used to support teaching and learning of Biology, Anatomy and Health related to autoimmune diseases, digestive system, immune system, nutrition and proteins. Concepts introduced include gluten, proteins, gliadin, glutenin, celiac disease, autoimmune disorder, immune system, small intestine, villi and allergy.

  • To activate prior knowledge before reading this article, teachers could have students complete an Admit Slip learning strategy. Download ready-to-use Admit Slip reproducibles for this article in [Google doc] and [PDF] formats.

  • To go further after reading the article, teachers could have students consider the consequences of having more and more people following a gluten-free diet using a Consequence Mapping learning strategy. Download ready-to-use Consequence Mapping reproducibles for this article in [Google doc] and [PDF] formats. Download the Consequence Mapping sample student responses to this article [PDF].

  • To consolidate learning, teachers could have students complete an Exit Slip learning strategy. Download ready-to-use Exit Slip reproducibles for this article in [Google doc] and [PDF] formats.

Teaching Suggestions

  • This article can be used to support teaching and learning of Biology, Anatomy and Health related to autoimmune diseases, digestive system, immune system, nutrition and proteins. Concepts introduced include gluten, proteins, gliadin, glutenin, celiac disease, autoimmune disorder, immune system, small intestine, villi and allergy.

  • To activate prior knowledge before reading this article, teachers could have students complete an Admit Slip learning strategy. Download ready-to-use Admit Slip reproducibles for this article in [Google doc] and [PDF] formats.

  • To go further after reading the article, teachers could have students consider the consequences of having more and more people following a gluten-free diet using a Consequence Mapping learning strategy. Download ready-to-use Consequence Mapping reproducibles for this article in [Google doc] and [PDF] formats. Download the Consequence Mapping sample student responses to this article [PDF].

  • To consolidate learning, teachers could have students complete an Exit Slip learning strategy. Download ready-to-use Exit Slip reproducibles for this article in [Google doc] and [PDF] formats.

Learn more

The Number Of Americans Going Gluten-Free Has Tripled Since 2009 (2017) 

Article from Forbes discussing the rise in people following a gluten-free diet, includes stats and an infographic.

Is a gluten-free diet good for your health? (2018) 

Article from Medical News Today discussing celiac disease, non-celiac gluten sensitivity, foods and other products that contain gluten, and some of the risks associated with a gluten-free diet when you are not celiac. Note that this resource was also used as a reference.

References

Bake Info. (n.d.). Gluten.

Celiac Disease Center at The University of Chicago Medicine. (n.d.). Celiac disease facts and figures.

Government of Canada. (2017, November 10). Agriculture and agri-food Canada.

Government of Canada. (2012, April 6). Celiac disease - The gluten connection.

Gulli, C. (2013, September 10). The dangers of going gluten-free. Maclean's.

University of Chicago Medicine. (n.d.). Treatment of celiac disease.

Watson, J. (2017, May 16). Celiac disease’s millennia-long rise to prominence. Celiac Disease Foundation.