Leslie Beck's Q and A on celiac disease

Question: What exactly is celiac disease?

Celiac disease is a lifelong genetically-based disorder that occurs when gluten - a protein found in wheat, rye and barley - triggers an abnormal immune response that damages the lining of the small intestine interfering with the absorption of nutrients. Because the disease is inherited, people with a first degree relative (parent or sibling) with celiac disease are at greater risk for the condition.

Classic symptoms include diarrhea, abdominal pain, weight loss and, in children, delayed growth. But most people with the disease have symptoms that are subtle, like bloating or gas. In many cases, people don't complain about digestive problems. Symptoms such as iron deficiency anemia, weakness, joint pain, and migraine - ones typically not recognized as gut-related - are commonly reported in celiac disease.

That's why many people with celiac disease are delayed in getting diagnosed. According to a recent survey of members of the Canadian Celiac Association, the average time it took to get diagnosed was 12 years. Their symptoms were often diagnosed as anemia, stress, irritable bowel syndrome, or chronic fatigue syndrome.

Question: Isn't celiac disease something that mainly children get?

Contrary to popular belief, celiac disease is not limited to children. It can occur at any age in people who are genetically predisposed. In fact, two-thirds of individuals diagnosed with celiac disease are adults. In adults, the disease can be triggered by pregnancy, surgery, gastrointestinal infection, or severe emotional stress.

Question: How does someone go about getting diagnosed?

Screening tests are available that measure the level of antibodies to gluten in the blood. (Antibodies are immune cells that work to eliminate foreign substances in the body. People with celiac disease have higher than normal levels of antibodies to gluten.) A blood test, however, is only the first step in diagnosing celiac disease; it is used to detect people who are likely to have the condition. Confirming a diagnosis requires a small bowel biopsy in which an endoscope is passed through the mouth into the stomach and upper intestine so that the lining of the gut can be examined and a biopsy taken.

Question: What is the treatment for celiac disease? What foods do you need to avoid?

The only treatment for celiac disease is a lifelong gluten-free diet. That means eliminating all foods and food ingredients made from wheat, rye, and barley. And that includes any type of wheat, even those that don't sound like wheat - spelt, kamut, and semolina. The main sources of gluten are breads, cereals, crackers, and pastas but it's also found in luncheon meats, yogurt, seasonings, salad dressings, sauces, marinades, soy sauce, soups and beer.

Oats, previously on the list of gluten-containing foods to avoid, have now been given the green light for people with celiac disease. The Canadian Celiac Association maintains that eating pure, uncontaminated oats - up to � cup dry oat per day for adults and � cup for children - is safe.

The problem is that oats may become contaminated with other gluten-containing grains during processing. Pure, uncontaminated oats will be trademarked "Pavena" to ensure accurate identification. A small number of people may not be able to tolerate oats and should follow up with their doctor when adding them to a gluten-free diet.

Gluten-free grains that are safe to eat include amaranth, buckwheat, cornmeal, flaxseed, millet, pure oats, quinoa, popcorn and rice as well as flours made from these grains.

Question: What are some gluten-free alternatives?

Today, it's getting easier to follow a gluten-free diet with the influx of gluten free products in supermarkets and natural food stores. Manufacturers of gluten-free products include El Peto, Glutino, Kinnikinnick, Enjoy Life, Kaybe, Rizopia, and Tinkyada.

Even if you are following a gluten-free diet you may be unknowingly consuming gluten as a hidden ingredient in food products, medications and vitamin supplements. That's why careful label reading is essential to adhering to a gluten-free diet. Ingredients to avoid or question include graham flour, malt, dextrin, modified food starch, hydrolyzed vegetable protein, MSG, emulsifiers, stabilizers, caramel colour and natural flavour.

If you suspect you have celiac disease, resist putting yourself on a gluten-free diet until you are properly diagnosed. If you do have celiac disease, going off gluten will cause your gut to heal and gluten antibodies in your blood to decline which can result in a false negative diagnosis.