Living without gluten

At the grocery store you can now buy beer, cookies, pasta, and even dog food that claim to contain no gluten, a protein found in wheat and some other grains. But is it really necessary to avoid the stuff?

Yes, if you have celiac disease, as an estimated 1 in 130 people do. That inherited condition causes the body to react to gluten as if it were a toxin, triggering an immune-system reaction that attacks several parts of the body, primarily the small intestine.

But knowing whether you have celiac disease isn't easy because the symptoms can be vague or varied. As a result, many people who have the condition go undiagnosed, and many of those who avoid gluten don't need to.

About half of the people with celiac disease experience stomach complaints, such as cramping and diarrhea. But patients and doctors often dismiss those complaints or attribute them to other causes. Other people don't have any obvious symptoms at all. Instead, they experience nutrient deficiencies and various systemic effects, such as anemia and weight loss. By the time the condition is diagnosed it often has led to complications, including osteoporosis, seizures, and cancer of the small intestine.

To diagnose celiac disease, doctors use blood tests to detect elevated levels of two antibodies produced in response to gluten. They should generally confirm positive tests with a biopsy of the small intestine and in some cases a DNA blood test.

Our consultants say you should consider getting tested if you have:

• Digestive or nutritional problems that don't respond to treatment or are not explained by another condition.
• Any condition that is more prevalent in celiac patients, notably autoimmune disorders, cancer of the small intestine, osteoporosis, and seizures.
• A family history of the disease.

If it turns out you do have celiac disease, you should take the following steps:

• Consult a dietitian for tips on consuming a gluten-free diet.
• Read labels carefully. Avoid foods that contain any form of wheat, including bulgur, farina, kamut, spelt, and triticale; barley and rye; and possibly oats, which are often contaminated by gluten during harvesting and processing. Also avoid ingredients that can contain gluten, including brown-rice syrup, caramel coloring, dextrin, malt extract, modified food starch, and soy sauce.
• Eat out in peace. Ask your waiter or the chef about ingredients and preparation methods, or if a gluten-free menu is available. To find a gluten-free restaurant, go to a Web site sponsored by the Gluten Intolerance Group of North America.
• Check your meds. Some pills include inactive ingredients that contain gluten, so read the labels of over-the-counter drugs and let your pharmacist know that you have celiac disease, or go to Glutenfreedrugs.com.

This article first appeared in the November 2009 issue of Consumer Reports on Health.