What is celiac disease?

Doctors once considered CD a childhood disease, but they now know it can develop at any age. These days, says Rashid, most people with the condition are diagnosed when they are adults, although many are likely to have had symptoms since childhood. A recent Canadian Celiac Health Survey showed that, on average, adults with CD aren't properly diagnosed for nearly 12 years, and it suggested three reasons: CD has wide-ranging symptoms; physicians often misunderstand it, which means many Canadians may go a lifetime without knowing they are affected; or people may be misdiagnosed as having stress, anemia, chronic fatigue or irritable bowel syndrome.

One of the difficulties with diagnosis is that not all adults with the disease have the common symptoms, such as bloating and diarrhea. Anemia sent Barbara Metler of Timmins, Ont.,* to her doctor in 1996, when she was 40. After testing negative for colon cancer and stomach ulcers, she was diagnosed with CD when a small bowel biopsy showed damage to her intestine. "It was unexpected," says Barbara, who was otherwise asymptomatic. A bone-density test later revealed she had the bones of an 80-year-old, the result of her not absorbing essential calcium earlier in life. Since her diagnosis, Barbara has built up her bones with strength-training exercises, and now takes calcium and vitamin-D supplements and lives a careful gluten-free lifestyle.

People with other autoimmune diseases, such as type 1 diabetes, are also at greater risk of developing CD, though researchers don't understand why. Dale says her son Wade already had type 1 diabetes when he was diagnosed with CD just before his sixth birthday. "I remember thinking, What's gluten? Are you telling me he can't eat more things?" she recalls.

How to keep the disease under control
The most effective way to treat CD is to remove gluten from your diet. For most people with the disease, the absence of gluten will improve all symptoms and heal intestinal inflammation. But, says Rashid, those with CD must adhere strictly to living gluten-free, and do it for life. Even a small amount of ingested gluten can re-inflame the small intestine, which may take a while to recover.

Living gluten-free can be difficult, since the staples of a typical North American diet are wheat-based, and not all sources of gluten are obvious. For instance, gluten may be hidden in food products such as soy sauce, tomato sauce and potato chips; and in ingredients listed as seasonings, dextrin, MSG and more (though more stringent labelling regulations are changing that). It can also be in medicines or supplements.

The good news is that many foods are naturally gluten-free: meats, fish, poultry, eggs, legumes, milk products, fruits, vegetables and rice. While wheat, rye, spelt and barley must be avoided in all forms, there are healthy, tasty substitutes for these grains, such as millet, amaranth, buckwheat and quinoa. As well, ground flaxseeds, almonds and legumes can be substituted for gluten flours.

*Name and city have been changed.

Page 3 of 5