It’s called celiac disease, or celiac sprue, an immune disorder in which the body adversely reacts to foods containing grains such as wheat, barley, rye and oats. More specifically, the body is reacting to a protein called gluten found in these grains.
Although the disease is common in Europe, the perception long has been that celiac disease is a rare disorder in the United States. But a new study reported in the Archives of Internal Medicine suggests it may be much more common in the U.S. than previously thought. In this large multi-centered study, researchers looked at more than 13,000 adults and children. They found the disease to be present in one out of every 22 people having a close relative with celiac disease and in one of every 133 people without a family history. This means that more than 1.5 million Americans may be affected by the disorder, many of whom have not been diagnosed. In another study, the average time between onset of symptoms and diagnosis of the disorder was 11 years.
Symptoms of gluten sensitivity include diarrhea, bloating, gas, abdominal pain, fatigue and sometimes vomiting. In children there may be failure to grow, failure to gain weight or weight loss. Of interest is the growing recognition of its prevalence among people affected with other disorders, including Type 1 diabetes, anemia, arthritis, osteoporosis, infertility and Down syndrome, even in the absence of gastrointestinal symptoms. A blood test is used to screen for the antibodies typical among people with the disorder. If positive, a biopsy of the intestine is used to confirm the diagnosis. Unfortunately, there is no cure.
Gluten-restricted diets are the treatment of choice for people with various forms of celiac disease. This requires avoidance of any foods containing gliadin, the protein fraction of gluten that seems to be the culprit. This protein is found in wheat, barley and rye. Oats are also considered a problem due to widespread cross-contamination between oats and wheat in U.S. fields.
Adherence to a gluten-free diet is easier to describe than to follow since gluten is the primary component responsible for the structure and elasticity in breads and other baked products. Even foods not thought of as baked products, like ice cream and catsup, often contain small amounts of gluten or wheat flour added as thickeners or stabilizers. Therefore, it’s essential to carefully read all food labels.
Rice, corn and potatoes are tolerated well by people on a gluten-restricted diet. Allowable flours and cereals include those made from corn, rice, soybeans, garbanzo beans, potatoes and arrowroot. In theory, flours made from buckwheat and millet also should be acceptable since these cereal grains are botanically different from other gliadin-contain grains. In reality, buckwheat and millet flour often cause problems due to cross-contamination with wheat, barley or rye in the field, mill or bulk-food bin.
Rice cereal frequently is the first food introduced to infants because it contains no gluten and causes few allergic reactions. Asian food stores and the Asian section of your supermarket are good places to find a variety of rice-based foods, including rice noodles, that when cooked closely resemble and can be served like spaghetti. Rice crackers are available and plain potato chips, and corn chips are permitted.
Low-gluten wheat starch flours that have been washed free of their gliadin content also may be used. Recipes that call for cake flour or no more than two cups of wheat flour can be adapted more easily for use with low-gluten flours than those having larger amounts. Using a well-mixed combination of low-gluten flours, such as half cornstarch and half potato or rice flour, often will improve product results.
The structure of low-gluten bread also can be improved by following specially developed recipes that use vegetable gums such as xanthan gum or methylcellulose. These gums generally are available through mail-order companies that specialize in products for people with allergies and sensitivities.
A good resource for recipes using gluten-free flours is the booklet, "Wheat, Gluten, Egg and Milk Free Recipes for Use at High Altitudes and at Sea Level." Copies are available from the Colorado State University Cooperative Extension Resource Center Bookstore. For more information, call 970-491-6198 or 877-692-9358 toll-free, or visit their Web site at www.ext.colostate.edu.