At least one in 250 persons in the United States suffers from an inherited gluten sensitivity known as Celiac Sprue Disease or Gluten-Sensitive Enteropathy. Gluten is a type of protein mostly found in grains like wheat, barley, rye, and oats. Gluten sensitivity is not the same thing as food allergy, even though wheat is a common food allergen. Celiac disease most typically affects genetically susceptible Caucasians as opposed to those of Asian or Black African heritage. The only treatment is strict and life long adherence to a gluten -free diet.

Celiac disease causes severe inflammation of the small intestine when foods containing gluten are eaten. The small intestine controls digestion and the absorption of basic nutrients (proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts).

The most common clinical symptoms in adults and children are abdominal cramping, intestinal gas, distention and bloating, chronic diarrhea or constipation or both, infertility, fatigue, weakness and lack of energy, bone or joint pain, depression, and dental enamel defects.

If left untreated, celiac disease can lead to severe diarrhea, weight loss, and in children, multiple deficiencies, and failure to thrive. It is also linked to skin blisters known as dermatitis herpetiformis. Long-term disorders resulting from untreated celiac disease include:

• Iron deficiency anemia
• Osteoporosis
• Vitamin K deficiency associated with risk for hemorrhaging
• Intestinal lymphomas and other gastro-intestinal malignancies
• Liver Disease
• Other food sensitivities/lactose intolerance.
• Insulin-dependent diabetes mellitus
• Thyroid disease

Your healthcare provider may order specific antibody blood tests used to identify the possibility of celiac disease. This is important in screening individuals who are at risk of having celiac disease but have no symptoms, but who ho have family members who have been diagnosed with it. A person going for preliminary diagnosis must be consuming gluten. If a diagnosis of celiac disease is confirmed, you will need to plan active participation in the treatment plan.

Because gluten is present in just about every processed food product and in numerous medications, adapting to a gluten-free diet requires a considerable lifestyle change. It is crucial to learn to read labels, and identify ingredients that may contain hidden gluten. Examples of possible hidden gluten are some soups salad dressings, processed foods, soy sauce, even licorice. Even medications can contain gluten. I it is important to talk to both your physician and your pharmacist about any side effects or unusual health problems which may have occurred in the past when you were taking a medication. Many drug companies are now excluding wheat starch and other gluten-containing materials from their products—however, gluten may still find its way into vitamin products, which may contain wheat germ oil, wheat bran, or other forms of wheat extract.

A dietician can help you learn more about celiac disease, plan and prepare gluten-free meals, and give advice on how to eat out in restaurants safely. To locate a registered dietitian, go to the American Dietetic Association's website at www.eatright.org .

For more information on how to manage celiac disease, contact The American Celiac Society Dietary Support Coalition in West Orange, NJ 973/325-8837

Other useful websites:

• Celiac Disease Foundation, www.celiac.org 
• Celiac Sprue Association, www.csaceliacs.org
• Gluten Intolerance Group of North America, http://www.gluten.net/   

DeBusk R. Clinician Q&A. The Integrative Medicine Consult. July, 2000.