Zeroing In On Gluten

An article in the Cleveland Plain Dealer, Zeroing in on Gluten, offers a good basic overview on the subject of celiac disease, the better and more modern name for gluten intolerance.

An estimated 3 million Americans have celiac disease. The medical community doesn't define celiac disease as an allergy but an autoimmune disorder in which nutrients aren't properly absorbed in the small intestine. The culprit is gluten, a variety of grain-based sticky protein found in a vast array of natural and manufactured ingredients and food products -- including wheat, barley and rye flours that provide the tender, elastic texture in that slice of bread.

It is estimated that the condition affects one in every 130 people worldwide, and it is undiagnosed in about 90 percent of Americans who have it.

Normally, nutrients are absorbed in the small intestine, which is lined with tiny fingerlike projections called villi. Villi add to the intestine's surface area, increasing its ability to absorb nutrients. But in celiac disease, gluten appears to flatten the villi and damage them, reducing the body's ability to take in nutrients properly. Inflammation of the intestine results.

Celiacs don't only suffer discomfort or serious pain when they consume gluten. The condition can lead to a wide range of symptoms and ailments, says Dr. Lori Mahajan, a pediatric gastroenterologist at Cleveland Clinic Children's Hospital.

"When infants and children develop celiac disease, it's typically when solid foods are introduced," she says. "They can exhibit abdominal pain, diarrhea, vomiting, bloating and gassiness. They can test positive for anemia. In older kids, there may be delayed puberty, or elevated liver enzymes, which can be misdiagnosed as hepatitis. Type 1 diabetes can occur."

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In adults, common symptoms can include abdominal distention -- a "bloated" feeling -- and intestinal discomfort ranging from bouts of flatulence to chronic severe pain. Weight loss can accompany the disease because of the body's inability to absorb nutrients, and fatigue and exhaustion often result.

"If the villi have fallen off the intestinal walls, you can't easily absorb carbohydrates," Mahajan says. Milk sugars become a problem for the patient who becomes lactose intolerant, which can be misdiagnosed as irritable bowel syndrome, she says.