Celiac Disease

Plus Sugo Di Cinghiale

A conversation about celiac disease, plus a delicious dinner of gluten-free pasta with wild boar sauce

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Why are so many people avoiding gluten nowadays? What exactly is gluten and is it really bad for you? What’s the difference between gluten sensitivity, gluten intolerance, gluten allergies, and celiac disease? What does wild boar taste like?

Dinner Table Doctor and I recently shared a fabulous meal with DTD’s sister, Lanore, and her husband, Matt. Usually I don’t reveal who we enjoy a dinner with for confidentiality reasons, since the health-related discussions can get a little crazy, but Lanore and Matt have given me permission to share their story. Matt has celiac disease and came close to death before being properly diagnosed. This story comes up a lot in our family, because we all love Matt, and it’s one more example of how smart DTD is, so we probably should listen to his advice!

For a long time we have wanted to make pasta with a wild boar sauce, or sugo di cinghiale. There is a recipe in David Rocco’s cookbook, and we suspected we had the perfect bottle of wine to go with the meal. Every time we thought about having this wine with something else, we would research pairings online and would find comments about how it went “perfectly with wild boar.” We often stared longingly at the beautiful photo with the recipe of this delectable dish, but never could find wild boar. As luck would have it, one day DTD’s coworker mentioned she had some wild boar in her freezer. Her husband had gone on a hunting trip. She was kind enough to part with some so we could finally drink that bottle of wine!

Matt is a foodie and wanted to partake in this experience, even though he’s a vegetarian and has celiac disease. Lanore explains that he is truly a flexitarian at heart, because he does eat meat on certain occasions such as Thanksgiving and Christmas. Apparently the chance to have wild boar was too tempting to resist, so Lanore and Matt visited us on a Saturday afternoon to create the meal. While Lanore and I were chatting and DTD and Matt were cooking, we all enjoyed an appetizer and wine and conversation naturally led to Matt’s celiac disease.

My Brother-in-Law’s Harrowing Tale

Around 15 years ago Matt experienced a lot of health issues. A very active guy in his 30’s, Matt noticed that he was increasingly running low on energy. He also complained of his stomach bothering him almost every time he ate. Over the course of a few years, he would mention this to his doctor. Tests would not show anything wrong, and he continued to struggle. He was working a lot and had two small kids at the time, so he thought maybe this is just the way it is. As time went on, though, he could barely get through a day of work and his ankles were swelling. Eventually it became clear that this was not normal, and he made yet another appointment with his primary care doctor. This time, Matt was so anemic that the doctor sent him directly to the emergency room. The ER doctors were stunned that he could actually be walking and talking considering how anemic he was. Honestly they were surprised he was alive.

DTD received a frantic call from his sister explaining what was happening. After hearing all Matt had been experiencing and how anemic he was, DTD said she should tell the doctors to test Matt for celiac disease.

Matt learned that he had been anemic for some time, but his regular doctor never mentioned it to him because Matt is a vegetarian. Mistakenly, this old school doctor assumed Matt just needed to eat some meat. At that time, the levels weren’t so low, so there wasn’t much concern. Now that he was in the hospital, a barrage of tests and blood transfusions were necessary to stabilize Matt’s condition and to diagnose the problem.

Back then, celiac disease and gluten were not well-known terms. The testing was not as advanced and the condition often misdiagnosed. Doctors in this hospital kept looking for other answers, until they finally did a biopsy of Matt’s small intestine and he was told he had celiac disease. DTD was right! A week in the hospital undergoing testing and blood transfusions and being close to death was truly a harrowing experience for Matt.

What is Celiac Disease?

Celiac is an autoimmune disease. Your immune system is the network of cells and tissues designed to defend your body from viruses, bacteria, and infection. Autoimmune disorders are when the body mistakenly targets and attacks healthy tissues. With celiac disease, the ingestion of gluten damages the small intestine. In genetically sensitive people, gluten triggers the immune response, which tries to destroy the intestine. It is hereditary, meaning it runs in families, and it can be diagnosed at any age. As in any autoimmune disorder, some people have mild symptoms and some severe.

Left untreated, a person becomes malnourished which can lead to very serious health problems, including weight loss, infertility and miscarriage, intestinal lymphomas and other gastrointestinal cancers, central and peripheral nervous disorders, and many more issues. Matt’s intestines were so damaged, he could no longer absorb calories or nutrients such as iron and B12, which is why he was anemic and malnourished.

Symptoms of Celiac Disease

People with celiac disease can have many different symptoms, and some people have none. Symptoms can include:

• diarrhea or constipation
• bloating and cramping
• nausea and vomiting
• rashes or unusual skin conditions
• flatulence
• acid reflux
• anemia
• vitamin deficiency
• weight loss
• fatigue
• depression
• joint pain
• brain fog
• menstrual irregularities

Diagnosing Celiac Disease

Many more people are diagnosed with celiac disease now, because the blood tests are much better. Once thought extremely rare, we now know this disease is pretty common. If after describing your symptoms, your doctor suspects celiac disease, you will be tested for celiac-specific antibodies (referred to as a celiac panel). These antibodies are proteins in the blood that are produced in response to gluten ingestion. The next step is an endoscopy of the small intestine, where several biopsy samples are taken to check for inflammation and damaged villi.

Living With Celiac Disease

A person with celiac disease can lead a very normal life on a gluten-free diet. Gluten is the general name for proteins found in wheat. It acts as a binder, holding food together. Most people think wheat, rye, or barley when they think gluten, but it is actually found in a surprising amount of foods. You not only find gluten in bread and pasta, but also in processed foods like salad dressings, in beer, as a flavoring in sauces and soups, etc. Luckily, nowadays there are gluten free options readily available. (Matt was very happy when he found gluten free beer!)

Ever since Matt was diagnosed, the entire family has researched and created gluten free fare. Because he typically following a vegetarian diet, it adds an extra layer of complexity, and we enjoy the challenge. Honestly, we spoil him, but we all agree he’s worth it!

If you ever need advice on living with celiac disease, Matt and Lanore are experts. DTD’s sister is the kind of person who will truly give anyone the shirt off her back, so when her husband had his near death experience, she dove right in and learned everything she could about celiac disease and following a strict gluten free diet. Matt, who was rail thin and pale looking for most of the first 15 years we knew him, suddenly put on pounds and had a lot more color in his face. His energy levels skyrocketed and his appreciation for food did too, even with a more limited diet. Long before all the current gluten free options existed, Lanore would travel far and wide for gluten free ingredients, seek out delicious recipes, experiment in the kitchen, and find restaurants where Matt could enjoy a gluten free meal. Lanore is also an excellent baker and has made the most delicious gluten free desserts through the years. Usually her creations taste better than the gluten version, especially her cookies and chocolate cakes! Luckily, today you can easily find wheat flour substitutes such as almond, chick pea, and rice flour.

Is Gluten Bad for Me?

Certain people cannot eat gluten for a variety of reasons:

• Celiac Disease
• Wheat allergy, which is common in children and is a reaction to any of the proteins in wheat, including but not limited to gluten.
• Non-celiac gluten sensitivity, also known as gluten intolerance, where a person might experience many of the symptoms of celiac disease, but not have intestinal damage or elevated levels of antibodies. There is no definitive test for this. Most people with this condition just recognize that they feel some symptoms after eating gluten.
• Dermatitis Herpetiformis, where a person develops a rash after eating gluten. While this is common in someone with celiac disease, it can also happen to those without celiac.

As the plethora of gluten free options grows, it’s obvious that many people who do not have any of the above conditions are still in the market for gluten free foods. DTD says there is absolutely nothing wrong with gluten, unless you have a medical reason to avoid it. Even Matt, who almost died from celiac disease, can now cheat by eating a little bit of gluten. As long as he’s not eating it regularly or in abundance, he’s fine, but might get an upset stomach or have gas.

People who choose to avoid gluten often feel better, probably because they are largely avoiding carbs and processed foods. DTD has explained many times that carbohydrates convert to sugar in our bodies and can cause a host of health issues. You can be very unhealthy on a gluten free diet, because there are some carbohydrates with no gluten. Consuming too much rice or gluten free desserts won’t do you any favors. As DTD has reminded us in several dinner conversations, the key to a healthy diet is lots of fruits and veggies and legumes and limited carbohydrates, meat, and sugar.

Pasta with a Wild Boar Sauce, or Sugo di Cinghiale

If you are lucky enough to get your hands on some wild boar, here is the link to David Rocco’s recipe, which can also be found in one of our favorite cookbooks, Made in Italy. DTD and Matt had a great time creating this sauce, which was actually quite easy and so delicious! The wild boar does not have a gamey taste after simmering with all the other ingredients. It tastes sweet, reminiscent of lamb, but I think even better. It was also even more fabulous the next day.

We made an Italian broccolini recipe, which we found on homemadeitaliancooking.com and was the perfect side dish. Because Lanore is also a vegetarian, and was not in any way tempted to eat wild boar, we made a pesto sauce for her pasta. This meant there were three bowls of pasta on the table: one with gluten free noodles and wild boar; one with regular noodles and wild boar; and one with regular noodles and pesto. See if you can tell the difference between the noodles!

The outstanding wine DTD paired with this meal was a bottle of 2014 Pakravan Papi Montescudaio Campo del Pari, a Tuscan red. It is a blend of Merlot and Cabernet Sauvignon/Franc. The beautiful Pakravan Papi winery has an interesting history. Amineh Pakravan was born in Iran and studied in New Delhi, Pakistan, and France. She came to Italy in 1966 to assist in the rescue of art and books when Florence was hit by catastrophic floods. She met her husband, Enzo Papi, and settled in Tuscany permanently. She says they would watch the wild boar on the first parcel of land they purchased, so it seems meant to be that we enjoyed their wine with our special dinner. The Pakravan Papi label has won many awards.

DTD and Matt had a great time preparing our fantastic meal while Lanore and I “supervised,” AKA “drank wine.” There was plenty of food and wine to go around, and we all toasted the fact that we are grateful Matt is now living a healthy life despite having celiac disease.

Do you or someone you know have celiac disease? How do you/they cope? What are your favorite gluten free recipes? Would you try wild boar if given the opportunity? Let me know! Find me on Facebook, Instagram, Twitter, Pinterest, or leave a comment here.