Gluten is everywhere
A gluten-free diet is complicated because it means avoiding all foods that contain wheat, rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. It requires a completely new approach to eating that affects a person's entire life. Hidden sources of gluten include additives, preservatives, and stabilizers found in processed food, medicines, and mouthwash. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. 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.

Ann Weber would love to go out and eat pizza with her friends.

A simple cold cut sandwich sounds great, but is out of the question.

Same for a bowl of cereal, a hot dog, or cup of hot cocoa.

Most of these and other commercially available food products contain gluten, a protein found in wheat, rye, and barley. While most people can eat whatever grains they want, gluten acts like poison ivy to people like Weber, who has celiac disease.

Also known as gluten intolerance, celiac disease is an immunologic disorder in people allergic to gluten.

"It's pretty hard to deal with because you have to go on a very restrictive diet," said Weber, a 27-year-old mother of three. "Even touching a commercially baked bread is a contaminating contact and should be avoided. We've had to buy a new toaster."

Breakfast, lunch, and dinner have new meaning for Weber and her family. Trips to the supermarket take much longer, and are more expensive, as she carefully reads labels in search of food products that are gluten-free.

"Eating is such a social occasion, and not being able to share the same foods as those around you, at home or at a restaurant, is pretty challenging," she said.

In Weber's case, the symptoms started with a simple but annoying rash that gradually worsened and became intensely itchy.

A skin biopsy showed that she had some of the features of dermatitis herpetiformis, the skin presentation of celiac disease. The diagnosis occurred after her younger brother tested positive for gluten allergy. Since then, so have her mother and sister.

David Elliott, M.D., director of the Celiac Clinic at the James A. Clifton Center for Digestive Diseases at University of Iowa Hospitals and Clinics, said nearly one in every 200 to 250 people experiences celiac disease.

"The disease is typically diagnosed in children or adolescents," Elliott said. "However, the disease can occur in adults and the elderly."

Symptoms can range from classic features--diarrhea, weight loss, and malnutrition--to latent symptoms such as isolated nutrient deficiencies but no gastrointestinal symptoms. In addition to damaging the linings of the small intestine, the disease may affect other organs and systems in the body, such as the bones, blood, the reproductive system, and the nervous system.

The disease can be detected through a simple blood test or biopsy.

"The real trick to treating celiac disease is a good dietitian because, if patients have bad teaching, they will be unsuccessful in their treatment," Elliott said.

Beverlee Clearman, a dietitian at UI Hospitals and Clinics, said her job is providing primary diet instruction to patients with celiac disease.

"Really, I'm the initial educator about their diets," Clearman said. "I point out products that may contain gluten, show patients how to read food labels, explain how to order when dining out, suggest gluten-free recipes, and provide information for contacting food manufacturers about a certain ingredient."

Currently, there are no drugs to treat celiac disease and there is no cure. By following a gluten-free diet, however, people with celiac disease can live long, normal lives.

For more information about celiac disease or support groups in your area, call UI Health Access and ask for the Celiac Clinic, or call the Clinic directly at 319-356-4060. Physicians wishing consultation or referral should call UI Consult.