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by Mary Shomon

Gluten intolerance -- also known as celiac disease, celiac sprue, and sprue -- is a genetic autoimmune condition that makes it difficult for the body to properly absorb nutrients from foods. It affects an estimated 1.5 million Americans.
What happens in gluten intolerance is:

1. The body lacks a particular digestive enzyme, intestinal glutaminase, that can digest gluten products
2. Gliadin antibodies are produced as the body's reaction to the presence of the gluten
3. the villi in the bowels become flattened, making them less able to sweep along waste products and filter out toxins
4. The bowel, in a state of irritation, becomes more permeable, allowing larger proteins to pass through, which further aggravates the "allergic" response
5. The body responds by producing more histamine, seratonin, kinins, prostaglandins, and interleukins -- which can trigger or aggravate autoimmune and inflammatory conditions

• Recurring abdominal pain and bloating
• Gas, intestinal difficulties
• Aggravated allergies
• Difficulty losing weight
• Muscle aching
• Joint stiffness and pain, especially in hands, with swelling
• Fatigue
• Burning sensations in the arms and legs
• Numbness and tingling in hands, arms and legs
• Brain fog, memory problems, disorganized thinking
• Sores inside the mouth
• Painful skin rash on elbows, knees, and buttocks
• Hives

The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.

A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diets. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease.

If a person responds to the gluten-free diet, the physician will know for certain that the diagnosis of celiac disease is correct.

A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-free bread, pasta, and other products from special food companies.

Whether people with celiac disease should avoid oats is controversial because some people have been able to eat oats without having a reaction. Scientists are doing studies to find out whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician or dietitian's advice about eating oats.

Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Examples of foods that are safe to eat and those that are not are provided below.

The gluten-free diet is complicated. It requires a completely new approach to eating that affects a person's entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, screening for gluten becomes second nature and people learn to recognize which foods are safe and which are off limits.

A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life.

The Gluten Free Diet: Some Examples

Following are examples of foods that are allowed and those that should be avoided when eating gluten-free. Please note that this is not a complete list. People are encouraged to discuss gluten-free food choices with a physician or dietitian who specializes in celiac disease. Also, it is important to read all food ingredient lists carefully to make sure that the food does not contain gluten.

FOOD GROUP	ALLOWED	NOT ALLOWED
Beverages	Coffee, tea, carbonated drinks, wine made in U.S., rum, some root beer	Ovaltine, malted milk, ale, beer, gin, whiskey, flavored coffee, herbal tea with malted barley
Milk	Fresh, dry, evaporated, or condensed milk; cream; sour cream; whipping cream; yogurt	Malted milk, some commercial chocolate milk, some nondairy creamers
Meat, Fish, Poultry	Fresh meats, fish, other seafood, and poultry; fish in canned oil, brine, or water; some hot dogs and lunch meats	Prepared meat containing wheat, rye, oats, or barley; tuna canned in vegetable broth
Cheese	All aged cheese, such as cheddar, Swiss, edam, parmesan; cottage cheese; cream cheese; pasteurized processed cheese; cheese spreads	Any cheese product containing oat gum, some veined cheeses (bleu, stilton, roquefort, gorgonzola)
Potato or Other Starch	White and sweet potatoes, yams, hominy, rice, wild rice, gluten-free noodles, some oriental rice and bean thread noodles	Regular noodles, spaghetti, macaroni, most pachaged rice mixes, seminola, spinach noodles, frozen potato products with wheat flour added
Cereals	Hot cereals made from cornmeal, Cream of Rice, hominy, rice; Puffed Rice, Kellogg's Corn Pops, cereals made without malt	All cereals containing wheat, rye, oats, or barley; bran; graham; wheat germ; durum; kaska; bulgar; buckwheat; millet; triticale; amaranth; spelt; teff; quinoa; kamut
Breads	Specially prepared breads using only allowed flours	All breads containing wheat, rye, oat, or barley flours and grains listed above
Flours and Thickening Agents	Arrowroot starch, corn bran, corn flour, corn germ, cornmeal, corn starch, potato flour, potato starch flour, rice bran, rice flour, rice polish, rice starch, soy flour, tapioca starch, bean and lentil flours, nut flours	Amaranth, wheat germ, bran, wheat starch; all flours containing wheat, rye, oats, or barley; buckwheat; spelt; quinoa; teff; kamut; millet
Vegetables	All plain, fresh, frozen, or canned vegetables; dried peas and beans; lentils; some commercially prepared vegetables	Creamed vegetables, vegetables canned in sauce, some canned baked beans, commercially prepared vegetables and salads
Fruits	All fresh, frozen, canned, or dried fruits; all fruit juices; some canned pie fillings	Thickened or prepared fruits; some pie fillings; raisins and dried dates that have been dusted with flour
Fats	Butter, margarine, vegetable oil, nuts, peanut butter, hydrogenated vegetable oils, some salad dressings, mayonnaise, nonstick cooking sprays	Some commercial salad dressings, wheat germ oil, nondairy cream substitutes, most commercial gravies and sauces
Soups	Homemade broth and soups made with allowed ingredients, some commercially canned soups, specialty dry soup mixes	Most canned soups and soup mixes, bouillon and bouillon cubes with hydrolyzed vegetable protein
Desserts	Cakes, quick breads, pastries, and puddings made with allowed ingredients; cornstarch, tapioca, and rice puddings; some pudding mixes; custard; ice cream with few, simple ingredients; sorbet; meringues; mousse; sherbets; frozen yogurt	Commercial cakes, cookies; pies made with wheat, rye, oats, or barley; millet, amaranth, buckwheat, spelt, teff, quinoa, kamut; prepared mixes; puddings; ice cream cones; Jell-O instant pudding; cream fillings; products made with brown rice syrup
Sweets	Jelly, jam, honey, brown and white sugar, molasses, most syrups, some candy, chocolate, pure cocoa, coconut, marshmallows	Commercial candies dusted with wheat flour, butterscotch chips; flavored syrups; sweets containing malt/malt flavorings; some brown rice syrup; some corn syrup
Miscellaneous	Salt, pepper, herbs, herb extracts, food coloring, cloves, allspice, ginger, nutmeg, cinnamon, chili powder, tomato puree and paste, olives, active dry yeast, bicarbonate of soda, baking powder, cream of tartar, dry mustard, some condiments, apple cider, rice or wine vinegar	Curry powder, dry seasonings mixes, gravy extracts, meat sauces, catsup, mustard, horseradish, chip dips, most soy sauce, some distilled white vinegar, instant dry baking yeast, some cinnamon, condiments made with wheat-derived distilled vinegars, communion wafers/bread, some alcohol-based flavoring extracts