At last, now serving the gluten-adverse.

According to research published in the Archives of Internal Medicine, celiac disease, also known as gluten intolerance, is a genetic disorder that affects 1 in 133 Americans. Yet since that 2003 report, awareness of the disorder--whose effects are lifelong and if untreated, devastating--might be described as peripheral at best. But new innovations in the kitchen have led to a recent spate of restaurants in major metropolitan areas where those with strict dietary limitations can enjoy their dream foods without consequence.

What is Celiac Disease?

Celiac disease is an inherited autoimmune disorder that causes intestinal damage in people who consume wheat, rye, barley or their byproducts. Gluten is a storage protein found (combined with starch) in these cereals. Even though celiac disease is genetic and generally runs in families, it can sometimes become active for the first time after surgery, pregnancy, childbirth, viral infection or severe emotional stress. A lifelong disorder that is managed rather than cured, symptoms of celiac disease include weakness, bone pain, chronic diarrhea, abdominal bloating, progressive weight loss and malnutrition. If left undiagnosed, celiac disease can cause impaired growth in children and delayed maturation in teens and young adults.

When people with celiac disease eat foods or use products containing gluten, the response from their immune system damages the villi, which are the tiny protrusions lining the small intestine that allow nutrients from food to be absorbed into the bloodstream. When the villi are damaged, vital nutrients go unabsorbed. In addition to vitamin deficiencies and their associated maladies, left untreated, villi damage can result in full-blown mal-absorption, accompanied by nerve damage, wasting and even organ distress and failure.

If a person with celiac disease continues to eat gluten, studies have shown that he or she will increase chances of gastrointestinal cancer by a factor of up to 100 times that of the normal population. It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.

Who Should Screen?

An unusual number of celiac disease patients suffer from other, related conditions, and therefore people with certain conditions are urged to also test for celiac disease as a possible underlying cause. Examples include: thyroid disease, anemia of unknown cause, type I diabetes, and immune disorders. (For more on anemia in this issue, see Root Causes of Anemia [LINK].) In addition, a family history of celiac disease or any of the above conditions warrants a routine screening. Otherwise, patients are generally screened on a case-by-case basis according to individual symptoms.

Testing is fairly simple and involves screening the patient's blood for gluten antibodies, the positive results of which will likely require an intestinal biopsy to confirm the diagnosis.

Treatment

The only acceptable treatment for celiac disease is strict adherence to a 100-percent gluten-free diet for life. An adherence to a gluten-free diet can prevent almost all complications caused by the disease. A gluten-free diet means avoiding all products that contain wheat, rye and barley, as well as their derivatives. The list includes types of wheat like durum, farina, graham flour, and semolina. Also prohibited are bulgur, kamut, kasha, matzo meal, spelt and triticale. A further challenge comes from the fact that there are many hidden sources of gluten in the ingredients of processed foods. Examples of products that commonly contain some form of gluten include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies. Wheat flour is commonly used in many processed foods as a thickener or binder.

It is also important to avoid oats, at least during the initial treatment stages of a gluten-free diet, as the effects of oats on celiac patients are not fully understood, and wheat contamination in processing is common. Eliminate oats at least until symptoms subside and their reintroduction into the diet can be fairly monitored and evaluated.

The good news is that by avoiding gluten the small intestine can, and usually does, heal. The majority of celiac disease and gluten-intolerant patients who go on a gluten-free diet experience a significant reversal of symptoms and intestinal damage within a year, and most begin to feel better within a few days. It's not uncommon for the healing process to take several years in patients with severe intestinal damage, however.

Hope

The pleasures of dining out are often denied people with celiac disease. Besides obvious culprits like bread, sauce thickeners, pasta and desserts, gluten also lurks in soy sauce, brewer's yeast, bourbon, vegetable starch, vinegars, salad dressings, processed cheeses and some spices. As Columbia Celiac Disease Center nutritionist Anne Roland Lee explains, "I've had patients go to some of the city's most famous restaurants only to leave after being told they could only safely have a Coke."

So what about all those delicious gluten-based foods celiac sufferers have had to give up? Restaurants like Joseph Pace's Risotteria in New York City have developed a special gluten-free menu. Gluten gives baked goods elasticity; without it, cakes, breads and pastries can be leaden, dry and crumbly. By their count Risotteria tried about 40 dozen batches of cookies before offering gluten-free Sicilian pizza, brownies and beer made from sorghum (instead of malted barley).

A growing number of restaurants have decided it's worth catering to the gluten-free crowd, including chains like Outback and P. F. Chang's, which now offer gluten-free menu items. Consult www.glutenfreerestaurants.org and http://glutenguide.blogspot.com for info on where to find gluten-free dining.

(Celiac Disease Gluten-free Diet Support Center, "Celiac Disease From Medical Authorities " and "Celiac Disease Statistics, " by Jefferson Adams, with additional material by Scott Adams, www.celiac.com/index.html; The New York Times, Wednesday, July 25, 2007, "For the Gluten-Averse, a Menu That Works, " by Jennifer Romolini; Arch. Intern. Med., 2003, Vol. 163, No. 3, pp. 286-292)