•  Digestive Disorders Center

Just about everybody loves the smell of freshly baked whole-wheat bread, but not everyone can afford to take a bite. For anyone with celiac disease, this treat is practically poison. People with this condition are extremely sensitive to gluten, a class of proteins found in all foods made with wheat, rye, or barley. Even small amounts of these proteins can damage the intestines and block the absorption of vital nutrients.

Gluten doesn't harm the intestines directly. Instead, the proteins set the immune system into attack mode. The body releases powerful antibodies to fight the "intruder." Finding no germs to destroy, the cells turn against the lining of the intestine.

People with celiac disease have inherited genes that make them sensitive to gluten. However, not everybody with such genes shows signs of the disease.

Scientists believe the disease needs to be "turned on" before it can cause any problems. Large amounts of gluten during infancy and early childhood seem to help set the disease in motion. Some adults first notice symptoms after injury, infection, childbirth, or period of severe stress.

The symptoms of celiac disease can vary widely from person to person, and tend to change with age. Infants often have stomach pain and diarrhea (possibly bloody) and may be slow to gain weight.

In toddlers and older children, common symptoms are nausea, stomach pain, a lack of appetite, anemia, mouth sores, and a blistering rash. The rash, most often found on the elbows, knees, or buttocks, may be the only indication of the disease. Children who don't absorb enough nutrients can show signs of malnourishment. They may become pale and thin with a bulging stomach. The disease may delay puberty and slow down growth in the teenage years. Experts speculate that about 10 percent of people who are unusually short for no obvious reason have a hidden case of celiac disease.

Adults who develop celiac disease may have only mild intestinal problems, but most don't get off easy. Adult patients often feel tired, irritable, and depressed. And because celiac disease can block the absorption of calcium and iron, many adult patients develop osteoporosis and anemia. Untreated celiac disease can raise the risk of many other conditions, including an inflamed liver (hepatitis), an inflamed thyroid (thyroiditis), infertility, lymphoma, diabetes, and rheumatoid arthritis.

Tests that measure the levels of certain antibodies in the blood are good screening tools for diagnosing celiac disease. Since current tests aren't 100 percent accurate, however, you probably won't know for sure if you have celiac disease until you start avoiding gluten. If your symptoms go away quickly, the diagnosis is still more certain. The gold standard of diagnosis, however, is a biopsy of the small intestine.

There's only one sure cure for celiac disease: Give up gluten. It's simple advice that can be very difficult to follow. Gluten can lurk in strange places, from soy sauce to luncheon meat. To protect yourself, you'll have to learn to avoid gluten in all its forms.

With a little planning, people with celiac disease can enjoy varied diets. Several types of grain are perfectly safe, including rice, corn, flax, and sorghum. Oats were long considered a forbidden food, but recent studies suggest some people with celiac disease can safely eat them. Be cautious with oats, though; they can be contaminated with gluten during harvesting or milling.

Many stores now carry gluten-free flour, breads, and snack foods. And feel free to indulge in potatoes, fruits, vegetables, aged hard cheese, meat, poultry, and eggs (well-cooked). Of course, any of these foods can be risky if they are combined with additives or other foods containing gluten.

People with celiac disease soon become experts at reading labels. Watch for any mention of the forbidden grains. Also look out for hydrolyzed vegetable protein, textured plant protein, or hydrolyzed plant protein. These can be made of either corn or soy (safe foods) or corn or soy mixed with wheat (unsafe). Contact the manufacturer if you have any questions or concerns.

Eating a gluten-free diet may be a hassle, but the rewards are tremendous. Your symptoms should quickly disappear, your intestines will heal, and your risk of developing other digestive diseases drops dramatically. Not even the taste of fresh whole-wheat bread can beat that.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Further Resources

Celiac Disease Foundation

13251 Ventura Boulevard, #1

Studio City, CA 91604

818/990-2354

818/990-2379 (fax)

Celiac Sprue Association

PO Box 31700

Omaha, NE 68131-0700

402/558-0600

402/558-1347 (fax)

References

First published August 27, 2001
Last updated September 22, 2008
Copyright © 2001 Consumer Health Interactive

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