Getting Rid of Gluten - celiac disease

Vegetarian Times, April, 1999 by Ann Whelan

For many Americans, good health depends on avoiding this common protein

As my 50th birthday approached, I felt as if I was wearing out. I had little energy. Simple things seemed confusing and too difficult to handle. My body ached, and chronic diarrhea kept me close to the bathroom. No matter how much I ate, I still felt hungry. There were days when I was convinced I was dying. Yet my condition stumped doctor after doctor. Some actually suggested I was a hypochondriac.

I managed to drag myself around like this for several years, when one day something flashed through my head. Perhaps this mysterious collection Of symptoms was celiac disease. My younger sister had it. Maybe it ran in the family. After several doctors' visits and tests, I learned that I wasn't dying. My illness was indeed celiac disease and there was a cure for it. While this genetic intestinal disorder is often tough to diagnose, it's remarkably easy to manage through diet and lifestyle changes. Soon I was on my way to feeling healthier than I had in a long time.

WHAT IS CELIAC DISEASE?

Celiac disease (also known as celiac/sprue, gluten sensitive enteropathy or nontropical sprue) is a genetically based malfunction of the immune system. It occurs when the small intestine "attacks" certain glutens, which are proteins found in wheat and rye, as if they were invading viruses. The more gluten one consumes, the more the body rebels, until the lining of the intestine becomes damaged and the body is unable to properly absorb nutrients from food. The resulting deficiencies can lead to other conditions, such as depression, chronic fatigue, anemia, infertility and osteoporosis. "A healthy intestine has numerous ridges and folds," explains Peter Green, M.D., a gastroenterologist at Columbia-Presbyterian Medical Center in New York City and an expert on celiac disease. "But when I look at an intestine damaged by gluten, I often don't see them. In fact, we describe the damaged intestine as `flat.'"

Researchers estimate that 750,000 Americans have celiac disease, but that number could be much higher since the condition is so often misdiagnosed. Doctors are taught in medical school that celiac disease is a rare childhood condition that mainly affects Irish people, so they don't look for it. And because some symptoms of celiac disease (anemia, diarrhea, fatigue, weight loss, depression) are fairly common and often masquerade as other conditions (lactose intolerance, irritable bowel syndrome, chronic fatigue syndrome, food allergies), it can take a long time to get a definitive diagnosis. Doctors frequently dismiss patient complaints as psychosomatic.

Slowly, awareness about celiac disease is growing. We now know that it can afflict anyone though it seems more common in those with osteoporosis and insulin-dependent diabetes. Children usually develop celiac symptoms after cereal is introduced into their diet. Doctors aren't sure why adults who've eaten gluten all their lives suddenly develop the disorder, but researchers are exploring possible links to pregnancy, viruses, emotional distress or surgery.

A diagnosis of celiac disease can be confirmed by blood tests that screen for gluten antibodies, and by a small bowel endoscopy, a procedure in which a long flexible tube enclosing a fiber optic instrument is inserted through the mouth into the small intestine. This allows the physician to examine the lining of the intestine and then remove samples for examination under a microscope.

Once diagnosed, celiac disease is simply remedied by removing gluten from the diet and restoring depleted nutrients, such as iron, calcium, folate and vitamin D. Without the irritation from gluten, the intestine can repair itself and the individual is able to heal. "Usually there aren't any other problems when a gluten-free diet is rigorously followed," says Joseph Murray, M.D., a gastroenterologist at the Mayo Clinic in Rochester, Minn. "It's also important to correct any nutrient deficiencies with adequate supplements, and once they are restored, to maintain levels with a regular multivitamin.

Eliminating gluten is a challenge since so many American foods are made from wheat. But giving up gluten doesn't mean swearing off all grains. Rice and corn are great substitutes for wheat. You can also find ready, made gluten-free foods including pasta, baked goods and even bread in natural food stores and you can order them by mail. These products are generally made with flours from tapioca, soy, potato, bean, nut, amaranth, quinoa and buckwheat, which, despite its name, is actually a fruit, not a grain.

Gluten often hides out in unexpected places, like soy sauce, licorice and many processed foods. Avoiding it altogether means reading labels conscientiously and calling the manufacturer if an item contains ingredients that you're not familiar with (most have an 800 number). The same holds true in the drugstore, since over-the-counter and prescription drugs can also contain fillers made with gluten. In restaurants, staying gluten-free often involves quizzing servers or the chef about how dishes are prepared. And at home, it means preventing any trace of gluten-containing food from getting into gluten-free food by using separate toasters, containers and utensils.