IMAGINE what life would be like if eating wheat made you very sick, and you had to avoid not just bread, but even processed foods that had tiny amounts of wheat such as hot dogs, canned soups and ice cream.
Millions of Americans face this problem every day--it's called celiac disease.
Years ago, celiac disease was thought to be extremely rare. It was diagnosed only in severe cases, such as people who were malnourished despite eating normal amounts of food, and who had chronic diarrhea or
Nowadays, doctors can diagnose celiac disease when it has milder symptoms, such as fatigue, bloating, anemia and infertility (or in some cases, no symptoms at all). This is important, because mild symptoms can slowly and silently progress to serious problems such as osteoporosis and increased risk of lymphoma.
About 1 in 133 Americans has celiac disease, and the only cure is a strict diet avoiding gluten--a protein found in wheat, rye and barley. People also have to avoid oats that are milled in the same facilities that process wheat and thus get contaminated.
Even invisible amounts of gluten can cause a reaction in these folks. The problem is, the condition is hard to identify, because people can have vague symptoms that can be delayed by hours or even weeks, making it hard to connect them with wheat.
Unlike food allergies, which cause immediate symptoms like hives or trouble breathing, celiac disease slowly damages the small intestine. This makes it harder to absorb nutrients, which can lead to broken bones due to not absorbing calcium, anemia from not absorbing iron, and many milder problems that make a person feel run-down and tired.
If you think you have celiac disease, the National Institutes of Health now recommends the TTG and EMA blood tests--your doctor will know what they are and whether you need them. (It's important not to avoid wheat and gluten before the test, as that can make celiac disease harder to detect.) If a blood test is positive, the next step is a biopsy of the small intestine.
Celiac disease runs in families, so parents, siblings and children of people with celiac disease should get tested, even if they don't have any symptoms. Celiac disease also is more common in people with Type 1 diabetes and Down syndrome.
For folks who test positive for celiac disease, the only treatment is a lifelong gluten-free diet, avoiding wheat, rye, barley and oats. It takes three to six months on the diet for the intestines to heal.
As you may imagine, this requires a lifestyle overhaul. The first step is visiting a registered dietitian to learn to decipher hidden sources of gluten on food labels, as well as to discover new foods and strategies to avoid nutrient deficiencies.
Instead of traditional wheat bread, pasta, cakes, cookies, pizza crusts and the like, people can use combinations of gluten-free flours, such as soy, rice, corn and potato flours, among others.
Plain fruits, veggies, meats, chicken and fish are all safe. Many lunch meats and canned and frozen foods, however, have wheat byproducts added to sauces and seasonings. Often, innocent-sounding ingredients like starch, malt or vegetable protein are actually made from wheat.
Celiac disease affects not just people with the disease, but the lifestyle of their families and friends as well. That's because a person with celiac disease has to guard against cross-contamination. For instance, they will need a separate toaster for gluten-free bread, so as not to be exposed to crumbs of wheat bread. Similarly, they often need separate or squirtable containers of buttery spreads and jelly to avoid contamination by the crumby knife of someone who has been eating regular wheat bread.
Eating out is particularly challenging, because many waiters and chefs aren't familiar with gluten-free cooking.
Despite all the challenges, people with celiac disease can live well and usually feel dramatically better on the gluten-free diet.
Jennifer Motl welcomes reader questions via her Web site, brighteating.com, or mailed to Nutrition, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401.| For more information about celiac disease, contact the nonprofit Celiac Sprue Association at csaceliacs.org or toll-free at 877/272-4272. Also helpful is dietitian Shelley Case's book "Gluten-Free Diet." |
| Jennifer Motl is a registered dietitian. Formerly of Fredericksburg, she now lives in Wisconsin. |