Some of my favorite people have gluten allergies. TV and radio talk show hosts Keith Olbermann and Thom Hartmann, along with my community activist friend Ross, have at least two things in common: they are politically progressive, and they can’t go to restaurants and eat pizza or pasta, or indulge in cereal or pancakes for breakfast. Gluten allergy is an inconvenient autoimmune disease also known as celiac disease, gluten enteropathy, and celiac sprue that adversely affects the small intestine.
What is gluten? It’s a blend of two proteins, gliadin and glutenin, that is found in wheat, rye, and barley. Normally gluten consumption is not a problem, but for those who have an allergy to it, gluten leads the immune system to produce antibodies that attack the bowel lining. This is dangerous because the lining, through tiny projections called villi, absorbs nutrients and vitamins from the food we eat.
Gluten allergy is a lifelong condition that is often first noticed after a baby is weaned but can appear at any age, and it affects men and women equally. Although the symptoms of gluten allergy are not dramatic, prolonged consumption of gluten can eventually result in diarrhea, vitamin and mineral deficiency, anemia and osteoporosis (thin bones), and, occasionally, cancer. What’s the cure? There is only one: staying away from gluten-containing foods for life. Currently there is no medication that will treat gluten allergy.
In children, the introduction of foods containing gluten, such as bread and cereal, can cause loss of appetite, irritability, malnutrition, and an inability to gain weight. As the disease progresses, other symptoms appear: pale, foul-smelling stools, vomiting, diarrhea, a swollen abdomen, and wasted arm and leg muscles. In adults, there may be weight loss, pale, smelly diarrhea alternating with constipation, and stomach bloating with flatulence. However, up to 50 percent of adults do not suffer from these symptoms. Instead, they may feel very tired (a sign of anemia), depressed, have bone pain and fractures, experience difficulty walking and coordinating movements, and develop mouth ulcers and a skin rash on the elbows and knees called dermatitis herpetiformis.
Blood tests that measure adequate levels of iron, folic acid, calcium and certain antibodies can indicate the probability of celiac disease, but an endoscopy test with biopsy that involves a thin tube with a camera inserted through the mouth will confirm it.
Be aware that some of the symptoms of gluten allergy can mimic those of other disorders. For example, diarrhea and weight loss could be caused by tropical parasites picked up on vacation, too much bacteria in the small intestine, lactose intolerance, or intestinal lymphoma.
Celiac disease affects as many as 1 in 300 people in Europe and the United States and often runs in families. Serious complications of celiac disease can include female infertility, anemia in pregnancy, growth retardation of the fetus due to a mother with celiac disease, and the development of other autoimmune diseases (type 1 diabetes, thyroid disease, ulcerative colitis, primary biliary cirrhosis, osteoporosis, and increased risk of bowel cancer, intestinal lymphoma and esophageal cancer).
A gluten-free diet will reverse intestinal damage and other symptoms. The help of a dietitian may be needed because so many foods contain gluten (bread, pasta, cereals, cakes, pastries, biscuits, soy sauce, mustard, mayonnaise, malt vinegar, some soups and sauces, crackers, chips, cooking oil, beer, whiskey, even some medications). If it sounds like there’s nothing left to eat, there is actually quite a lot to choose from: fruits, vegetables, rice, corn, nuts, meat, fish, eggs and dairy products. So whether you’re a vegetarian or a meat eater, you can conquer celiac disease. Gluten-free products can be found in supermarkets, health food stores and pharmacies. Make sure that you replace any lost vitamins and minerals with nutritional supplements that are gluten-free. A gluten-free diet can be expensive, but the silver lining in the black cloud of celiac disease is that it’s tax deductible.
I think it’s encouraging to know that with a carefully planned diet, all the Keiths, Thoms and Rosses of the world who have gluten allergies can keep fighting the good fight, stay healthy, and live just as long as anyone else.