Who should be tested?
People with recurring, unexplained gastrointestinal
symptoms such as pain, bloating, or diarrhea should consider
testing for celiac disease. Iron-deficiency anemia or high
levels of certain liver enzymes (transaminases) should raise
a red flag, as should unexplained, recurrent miscarriages
Women who develop osteoporosis early (before menopause)
or whose osteoporosis suddenly worsens should also consider
the possibility of celiac disease. One small study reported
a 17-fold higher incidence of the disease among women with
osteoporosis compared to women in the general population.
Some doctors recommend that parents, siblings, and children
of people with celiac disease undergo testing because 5%–15%
of first-degree relatives of an affected person are likely
to have the disease, too.
Treatment: Avoid gluten
The good news is that the only treatment for celiac
disease — a gluten-free diet — starts to work within days,
and the small intestine usually heals completely within
three to six months. Although giving up favorite foods such
as wheat breads and pizza can be tough at first, many people
who have adapted to a gluten-free diet comment that while it
can be inconvenient, it does not prevent them from
socializing or traveling. Many gluten-free foods are
available by mail order and on the Internet, and gluten-free
items are becoming more common in supermarkets and
Recent developments are making shopping a bit easier,
too. As of January 2006, new FDA rules require that all
foods containing any of the eight major food allergens
(milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and
soybeans) must list that information on their labels. This
doesn’t mean that people with celiac disease are home free,
because even wheat-free products can still cause trouble.
For example, while oats don’t contain the gluten that harms
people with celiac disease, there is the possibility of
cross-contamination with wheat in the growing and milling
process. Also, some products labeled “wheat-free” contain
barley, usually in the form of malt or malt syrup. The FDA
is working on a rule for gluten-free labeling with action
expected sometime after 2007.
There are general guidelines you can follow (see table
below), but you’ll need to check labels carefully for hidden
gluten in commercially prepared foods, such as cured pork
products, self-basting turkeys, imitation meats and seafood,
and the thickeners found in gravy and some spaghetti sauces.
Another source of hidden gluten is dates and candies that
are dusted with flour to prevent sticking.
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