When your gut Screams 'NO!'

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House Call

If you have a genetic inability to absorb gluten, a protein found in bread, your gut is probably making you miserable. This food allergy needs a quick diagnosis and treatment-or it can lead to more serious consequences.
Bread is often called the "staff of life." But for the more than one million people in North America who have a genetic inability to absorb gluten, a protein found in wheat, barley, rye, and some oat products, that staff may feel more like a big bully's stick-to the stomach.

If you have celiac disease (CD), also known as celiac sprue (celiac means "pertaining to the abdominal cavity"), this is what happens: When your body is exposed to gluten, the membrane that lines your small intestine gradually loses its usual texture, becoming inflamed, smoother, and less and less able to absorb nutrients. As a result, you can suffer increasingly acute abdominal pain and swelling, diarrhea, fatty yellow stools, weight loss, and lack of energy.

And that's just the beginning. Undiagnosed CD can lead to intestinal damage, gastrointestinal cancers, and serious autoimmune disorders such as insulin-dependent diabetes. In addition, the nutritional deficiencies that are a hallmark of the disease can precipitate a host of seemingly unrelated problems, including osteoporosis and even fetal distress. (Low folic acid stores in moms can predispose unborn babies to serious neurological problems such as spina bifida.)

Getting diagnosed isn't easy, but try to persevere: Once you know you have CD, dietary changes can soothe your stomach and reverse the damage that can lead to more serious illness.

The First Step Is the Toughest
It takes an average of 10 years-and as many different physicians-to be diagnosed with CD. The longer a celiac is exposed to gluten, the greater his risk of autoimmune disease or cancer, so it's imperative that a potential celiac seek out the right help.

The problem is that CD can be masked by-or mistaken for-a laundry list of similar or associated conditions. Diabetes, thyroid disease, and digestive cancers often take the rap, as do anemia, allergies, colitis, irritable bowel syndrome, chronic fatigue syndrome, and plain old, garden-variety stress. Throw in a CD-related food sensitivity such as lactose intolerance, and you have mass confusion-on the part of the doctor as well as the patient.

To get the right diagnosis-and get it promptly-you may have to see a specialist. If you suspect that you may have CD (either because you're experiencing symptoms or you have a family history of the illness), get a referral, if necessary, and schedule an appointment with a gastroenterologist, a physician who specializes in problems affecting the stomach, intestines, gallbladder, and bile duct.

Gastroenterologists are often more experienced at recognizing and treating people with CD and will know exactly what to do.

It's in Your Genes
CD is genetic. Unfortunately, the tests for genetic markers don't tell you if you have the disease; they're used to rule out CD. For a positive diagnosis, the gold standard remains a small-bowel biopsy, in which doctors remove a tiny piece of your intestinal wall to analyze its texture and note any CD-related changes.

Before you sign on for this outpatient procedure, however, you may want to ask your doctor about two relatively new blood tests: the antiendomysial antibody test and the tissue transglutaminase test. Both tests are designed to reveal the presence of CD-related antibodies in your blood-and to diagnose the bedeviling disease with a quick stick. If you test positive, your doctor will want to follow up with a small-bowel biopsy to make sure.

How to Get Better
The only way people with CD can remain disease-free is to swear off gluten forever, eating only gluten-free grains (such as rice, corn, sorghum, flax, amaranth, buckwheat, and quinoa) and nut-, bean-, or potato-based flours. In the total absence of gluten, most of the symptoms of CD disappear within 6 months, says Joseph Murray, MD, a gastroenterologist at the Mayo Clinic. And recent research indicates that within 5 years of starting treatment, a celiac's risk of malignancies diminishes to match that of the general population.

Trouble is, eliminating gluten from your diet doesn't just mean eliminating foods made from grains that contain gluten. Gluten itself is used as a food additive, so it might show up where you don't expect it. And finding it on a food label can be tricky. Gluten is contained in other food additives ("modified food starch," for instance), so it's often not mentioned by name. (See "Unusual Suspects: Foods with Hidden Gluten" on p. 116.)

Important: If you suspect that you have CD, talk to your doctor before eliminating gluten from your diet. In order to use one of the new diagnostic blood tests, you must be consuming gluten at the time of the test, or your results may not be accurate.

A registered dietitian can help and can even suggest ways to help you stick with your gluten-free diet. To find one near you, ask your physician for a referral or contact the American Dietetic Association at (800) 366-1655; you can visit them online at www.eatright.org. Another big help: gluten-free products, which are available in some health food stores, by catalog, or online. (See "Buyers' Guide: Gluten-Free Foods" at left.)

Quick Tip
If you can't tell what's in a food from the label, pass it up.

What Triggers CD?
Celiac disease is inherited. That is, your susceptibility is written in your chromosomes. But the actual disease isn't always passed down from parent to child. And if it is, it can be triggered at any stage of life-from infancy to adulthood-by severe emotional stress, physical trauma, viral infection, pregnancy, or even surgery.

Buyers' Guide
Gluten-Free Foods
Because gluten travels under several assumed names, it's often hard to spot on food labels. Thankfully, there is a wide selection of gluten-free foods available. Check your local health food store, or contact these companies that specialize in gluten-free products:

• Gluten Solutions
toll-free (888) 845-8836

www.glutensolutions.com

• Gluten Free Mall (online only)
www.glutenfreemall.com

Unusual Suspects
Foods with Hidden Gluten
Here are a few of the foods that may contain "undercover gluten":

Bouillon cubes
Cereal
Cottage cheese
Herbal teas (some)
Ice cream Instant coffee Licorice Malt Margarine Marshmallows Meat sauce Nondairy creamer Salad dressing Soup (mixes and cans) Sour cream Tomato sauce Yogurt with fruit

PHOTO (COLOR): Eliminate gluten, and you'll be back in the saddle in no time.

PHOTO (COLOR)

Alice H. Mangum writes about health from her home in Bethlehem, PA. Jaime Pumphrey is an assistant research editor at Prevention. Celiac Disease Foundation Director Elaine Monarch also contributed to this article.

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