Celiac disease is an autoimmune disorder that affects around 1 in 100 people worldwide. It causes damage to the small intestine when gluten, a protein found in wheat, barley and rye, is consumed. The only treatment for celiac disease is strict adherence to a gluten-free diet. This can be challenging, as gluten is found in many commonly consumed foods and products. For those with celiac disease, choosing a place to live with readily available gluten-free options can make day-to-day life much easier.
What is Celiac Disease?
Celiac disease is caused by an abnormal immune reaction to gluten. When someone with celiac disease consumes gluten, their immune system attacks and damages the small intestine. This damage can prevent the absorption of nutrients from food. Symptoms of celiac disease may include:
- Diarrhea
- Abdominal pain
- Bloating
- Gas
- Fatigue
- Unexplained weight loss
- Bone and joint pain
- Skin rash
Celiac disease is hereditary, meaning it runs in families. People with a first-degree relative with celiac disease, such as a parent, child or sibling, have a 1 in 10 risk of developing celiac disease themselves. Diagnosis involves blood tests and an endoscopy with intestinal biopsy. Adhering to a strict gluten-free diet allows the intestinal damage to heal. Medicine or surgery are not used to treat celiac disease.
Challenges of Living with Celiac Disease
Following a gluten-free diet can be challenging, as many common foods and products contain gluten. This includes breads, pastas, cereals, baked goods, malted beverages, soups, sauces, seasonings and more. Reading ingredient labels is essential to identify hidden sources of gluten. Cross-contamination is also a concern when eating out or buying packaged foods made on shared equipment with gluten-containing items.
Access to gluten-free specialty products can be limited based on where someone lives. Smaller grocery stores may have minimal options compared to larger chains. Restaurants offering gluten-free menus are less common outside of major cities. The availability and cost of gluten-free foods also varies regionally.
Social aspects of having celiac disease should be considered too. There is often a lack of awareness about the extent people with celiac disease must go to avoid gluten. Some restaurants still do not take requests for gluten-free meals seriously. Traveling or relocating for work while following a gluten-free diet also presents difficulties.
Best Places in the U.S. for Celiac Disease
Certain areas of the United States make it easier to manage celiac disease on a daily basis. Important factors to consider include access to gluten-free grocery stores, restaurants with gluten-free options, knowledgeable healthcare providers and supportive communities.
New York, New York
New York City has a reputation for being gluten-free friendly. As a major city, New York has dedicated gluten-free bakeries, restaurants and pizzerias to choose from. Almost all restaurant menus include gluten-free indicators or highlight gluten-free dishes. Major grocery store chains like Whole Foods and Trader Joe’s accommodate specialty diet needs.
Healthcare resources are abundant in New York. There are gastroenterology groups with expertise in celiac disease and many registered dietitians familiar with gluten-free needs. Support groups and gluten-free events are also easy to find in the New York area.
Boston, Massachusetts
The Boston area similarly provides ample gluten-free offerings. Boston was named one of the most accommodating U.S. cities for gluten-free dining. Nearly 700 establishments have been certified by the Gluten Intolerance Group for proper training on gluten-free preparation. The city also has dedicated gluten-free bakeries and pizzerias.
Numerous health providers in the Boston area specialize in celiac disease and gluten-related disorders. Boston Children’s Hospital has an internationally recognized Celiac Program that treats pediatric and adult patients. There is also an active New England Celiac Organization chapter running local support groups and events.
San Francisco, California
The San Francisco Bay Area offers a wide selection of specialty grocery stores catering to gluten-free diets. Chains like Whole Foods and Sprouts are easy to find, along with smaller natural food stores. The region is home to popular gluten-free brands, like Canyon Bakehouse and Sami’s Bakery, supplying baked goods.
Dining out gluten-free is feasible with ample restaurant choices. Many eateries feature gluten-free menus or can accommodate modifications. Several celiac disease and gluten intolerance support groups are active locally as well.
Portland, Oregon
Portland has developed into a top gluten-free friendly city over the years. Nearly 10% of restaurants offer gluten-free menus, earn gluten-free certifications or avoid gluten in food preparation. The city hosts an annual Portland Gluten Free Expo highlighting regional businesses.
Large grocery retailers like Fred Meyer and New Seasons Market cater to specialty diets, including gluten-free. There are also small gluten-free bakeries and home delivery services for gluten-free products. Portland is home to advocacy organizations like Gluten Free Watchdog providing consumer resources.
Seattle, Washington
The Seattle area provides ample gluten-free offerings similar to Portland. Seattle has been named one of the most celiac-friendly cities based on its dedicated gluten-free restaurants, bakeries and pizzerias. Most major grocery retailers offer specialty gluten-free products. There are multiple health clinics in the region with expertise in celiac disease as well.
Most Challenging Places for Celiac Disease
On the opposite end of the spectrum, there are areas of the U.S. that present more challenges for managing celiac disease. This is often due to poor availability of gluten-free specialty products, dining options and medical resources.
Rural Areas
People living in rural communities frequently have trouble finding gluten-free foods nearby. Smaller grocery stores lack specialty diet sections seen in bigger chain stores. There are also fewer dining options, and existing restaurants rarely offer gluten-free dishes or accommodations.
Accessing healthcare providers knowledgeable about celiac disease can be limited in rural settings. Patients may need to travel long distances to see gastroenterologists or dietitians familiar with gluten-free needs. Support groups are also scarce.
Midwestern States
Certain midwestern states like Nebraska, Iowa, Indiana and Kansas are challenging for gluten-free living. These rural states have lower numbers of dedicated gluten-free eateries and restricted grocery options outside major cities. Awareness and accommodations for gluten-free needs in restaurants and social settings lag behind more progressive coastal cities.
Southern States
The southern U.S. similarly provides fewer gluten-free resources. Heavily fried, breaded comfort foods are dietary staples in the South. While fast food chains may offer gluten-free buns, independent restaurants rarely accommodate restrictions. Grocery stores carry basic gluten-free products but lack the expansive options seen elsewhere.
Hawaii
Despite the health-focused island culture, Hawaii proves tricky for gluten-free lifestyles. Imports drive up the cost of specialty products considerably. While Honolulu has the most gluten-free offerings, resources on other islands are limited to military commissaries and natural food stores. Restaurant menus emphasize gluten-heavy dishes, often cooked in shared oil.
International Destinations for Celiac Disease
There are gluten-free friendly destinations to consider outside the U.S. as well. English-speaking countries with high awareness of celiac disease tend to be most accommodating. Important factors again include grocery and dining options, knowledgeable healthcare and disease prevalence.
Ireland
Ireland has the highest rate of celiac disease worldwide, around 1 in 100. This has driven widespread accommodation by restaurants, hotels and food companies. Most eateries offer gluten-free menus and training on avoiding cross-contamination. Major grocery retailers have dedicated free-from sections. Ireland also has an active celiac society and conferences.
United Kingdom
The UK similarly has high celiac disease rates and gluten-free awareness. London ranks alongside New York and San Francisco for gluten-free friendliness. Chains like Pret A Manger highlight allergen-free foods, and many pubs have gluten-free menus. Large supermarkets carry extensive gluten-free products at reasonable prices.
Canada
Canada is ahead of the U.S. in many regards for gluten-free accommodations. Standard 1 in 100 celiac disease rates drive demand for products and awareness. Canada’s restaurant chains are leaders in allergen training and gluten-free offerings. The country even has the world’s first gluten-free certification program for food services.
Italy
While less convenient than English-speaking countries, Italy offers ample gluten-free options. Basic foods like produce, meat, dairy and rice are naturally gluten-free. Restaurant staff understand various dietary needs. Pasta brands like Barilla produce certified gluten-free alternatives. Just beware of potential language barriers explaining your needs.
Important Considerations When Moving
Relocating when you have celiac disease takes preparation. Give thought to the availability of specialty grocery stores and local food brands. Vet restaurants beforehand online for gluten-free menus. Find nearby gastroenterologists in case you need follow-up care after moving. Joining local celiac disease support groups can provide community ties.
If moving overseas, consider language barriers explaining your gluten-free needs. Bring translations of common phrases describing your diet. Research gluten-free terminology used locally. European products are required to list major allergens on packaging, for example. When traveling, plan accommodations with kitchens so you can prepare some of your own meals.
Conclusion
Certain areas make living with celiac disease much smoother day-to-day. When evaluating where to live, look for cities with dedicated gluten-free restaurants and stores. Access to knowledgeable doctors and dietitians helps ensure quality care. Active local celiac communities provide important support networks as well. On the flip side, rural regions and certain states lag behind in accommodations. With proper planning and research, those with celiac disease can thrive wherever they choose to live.
