Lifelong Health by Dr. David Lipschitz

Take a walk through the nearest grocery and you likely will see an unfamiliar label amid the low-fat, low-carbohydrate and high-fiber promotions: "gluten-free." Gluten is a protein found in many grass-related grains — most notably, wheat, barley and rye. For adults afflicted with celiac disease, gluten-free products are the key to lifelong health.

Occurring in about 1 percent of the population, celiac disease is an autoimmune disorder in which the body is intolerant of gluten. The presence of gluten in the diet leads to an immune response in which antibodies and immune cells damage the linings of the small and large intestines.

Gluten consumption causes major disruption in the body, from bloating and stomach pain to depression, anemia and lymphoma. In its severest form, celiac disease is seen in children who are unable to absorb fat and many other nutrients from the food they eat. That results in stunted growth and malnutrition.

More commonly, however, the disease is less severe and occurs in adulthood. In these patients, the symptoms are highly variable and are caused either by the patients' problems with absorbing nutrients or as part of their abnormal immune responses to gluten.

The most common symptoms include abdominal pain, bloating and mild to severe diarrhea. Patients also may exhibit anemia, caused by iron, folic acid or vitamin B-12 deficiency; osteoporosis, caused by impaired calcium and vitamin D absorption; and, more rarely, isolated deficiencies of a wide array of vitamins and minerals.

The immune component of the illness also may cause mild to severe arthritis, muscle pain and weakness, alterations in neurological function, chronic fatigue and an increased risk of infections. Patients with celiac disease are more likely to complain of anxiety and depression. And more serious complications include an increased frequency of diabetes, hypothyroidism, adrenal failure (Addison's disease), a serious skin disease called dermatitis herpetiformis and a higher incidence of lymphoma.

There are many reasons there is such a range in severity of celiac disease. If a patient gets celiac disease but has eaten a diet low in gluten, began gluten consumption at a later age, and was breast-fed for six months or more, he tends to get a milder form of the disease.

Because symptoms are so variable and readily ascribed to other problems, it is not surprising that many patients never are diagnosed or that the disease only is detected after many years of symptoms.

However, the longer it takes to make the diagnosis the greater the risk of severe adverse effects.

Symptoms of celiac disease are very similar to those of irritable bowel syndrome, which is the most common gastrointestinal problem affecting Americans. Like celiac disease, irritable bowel syndrome can present with abdominal pain in the lower part of the abdomen, bloating, constipation and diarrhea. The ailment also is associated frequently with depression, insomnia and fatigue.

There is no accurate test to make a diagnosis of irritable bowel syndrome, although many patients have blood tests, colonoscopies or gastroscopies, which are invariably normal. Unfortunately, this routine work-up yields similar results for patients with celiac disease, and without further screening, physicians often assume patients have irritable bowel syndrome over the rarer autoimmune condition.

Today it is uncommon for doctors to screen for celiac disease in every patient who presents with symptoms suggesting irritable bowel syndrome. However, a study just published in the Archives of Internal Medicine may push physicians to rethink the value of routine screening in patients who have been diagnosed with irritable bowel syndrome. In this report, researchers found that the incidence of celiac disease was fourfold higher in patients carrying the irritable-bowel diagnosis. Clearly, it follows that our index of suspicion of this disease must be increased in patients who have been diagnosed with irritable bowel syndrome, particularly if symptoms include diarrhea or severe abdominal pain.

Doctors can diagnose celiac disease by measuring antibodies against gluten, which they can do by testing patients' blood. Or physicians can perform biopsies of the small intestines. Once diagnosed, celiac disease is readily treatable. By following a gluten-free diet, a patient can resolve his symptoms completely and avoid the serious side effects. Unfortunately, despite the recent rise in gluten-free products, it is a difficult diet to follow. But with a little vigilance and determination, you can eliminate gluten from your diet and reap incredible rewards.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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