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Imagine not being able to eat pizza, paying $3 to $5 for a loaf of bread and having to think twice about licking a stamp.
For individuals with celiac disease, this is simply a normal day.
Celiac disease is an autoimmune disorder in which the lining of the intestine reacts to gluten, a protein found in wheat, rye, barley and possibly oats. With an autoimmune disease, the immune system mistakenly attacks itself, targeting the cells, tissues and organs of a person's own body.
Once considered a rare condition in the United States, celiac disease is now thought to occur in as many as one out of every 130 people.
Avoiding wheat is probably the biggest challenge. That's because wheat is the main ingredient in countless foods, including baked goods, bread, breakfast cereal, crackers, pretzels, pizza and pasta.
Buying bread at the supermarket is often not an option. Patients must either make their own bread using special flour or buy gluten-free bread, which can cost as much as $5 a loaf.
Symptoms of celiac disease include nausea, vomiting or diarrhea but this is not always the case. According to the Celiac Disease Foundation, patients can be asymptomatic for years, with the disease becoming active for the first time after surgery, viral infection, severe emotional stress, or pregnancy and childbirth.
Other symptoms can result from nutritional deficiencies caused by the poor absorption of food. For example, infants, toddlers and children may exhibit growth failure, vomiting, bloated abdomen and behavioral changes, while adults may experience fatigue, weakness, depression, bone or joint pain and dental enamel defects.
Celiac disease may appear at any time in the life of a person with a hereditary predisposition. The Celiac Disease Foundation recommends family members be tested because the condition occurs in 5 percent to 15 percent of the offspring and siblings of the celiac patient. In 70 percent of identical twin pairs, both will have the disease.
The gold standard for diagnosis comes from a biopsy of the small intestine, which is evaluated for damage. A blood test also can screen for antibodies to gluten.
If celiac disease is left undiagnosed or untreated, the intestine's reaction to gluten will destroy its absorptive capacity, robbing the body of the nourishment it needs to stay healthy.
"Untreated celiac disease can also increase the risk for a long list of medical conditions, including lymphoma, osteoporosis, fetal abnormalities, lactose intolerance and seizures," said registered dietitian Leslie Bonci, author of "The American Dietetic Association's Guide to Better Digestion" (ADA, $14.95). "That's why it is extremely important for people with celiac disease to follow a gluten-free diet lifelong. What one eats is critical."
But excluding gluten from the diet is no simple matter.
"Wheat, rye, barley and oats are the main offenders," said Bonci, adding that spelt (a nutty-flavored grain), semolina (coarsely ground Durham wheat) and kamut (a relative of Durham wheat) also contain gluten.
Then there are the less obvious sources. According to Bonci, gluten can be hidden in ingredients such as hydrolyzed plant or vegetable protein, starch, modified food starch, flavorings, seasonings, dextrin, barley malt and barley malt syrup.
And as if that isn't enough, gluten can also be found in many nonfood products, including the glue of some envelopes and postage stamps as well as certain medications and lipstick.
Bonci recommends finding good resources to develop a dietary strategy including cookbooks, support groups and on-line organizations.
(c) 2003, Duluth News Tribune (Duluth, Minn.). Distributed by Knight Ridder/Tribune News Service.