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Dealing with celiac disease

You can manage this digestive disorder with a gluten-free diet.

Recently, I wrote an article about irritable bowel syndrome, a common digestive disorder. Afterward, I received requests to write about celiac disease, another digestive disorder with symptoms similar to IBS. In fact, some folks diagnosed with irritable bowel syndrome actually may have celiac disease.

Celiac disease occurs when the body's immune system overresponds to foods containing gluten, a substance found in numerous items. People with celiac disease can have very mild to severe symptoms, including abdominal pain, gas, bloating, and stools that are loose, watery and bulky. Some also may vomit after eating. Over time, those with celiac disease may lose weight, in spite of having a good appetite. Children with the disorder may present what is called "failure to thrive," a condition in which they are not maturing and growing as expected. The disorder also can cause fatigue and weakness.

Unfortunately, because the symptoms of celiac disease vary so widely in intensity and quality, sufferers often go undiagnosed. The good news is that dietary changes alone are remarkably effective at improving the condition.

Gluten proteins are found in many foods, including some we recommend as part of a healthy diet. These proteins trigger the reaction that damages the lining of the intestinal tract. To give the intestines a break, patients with celiac disease need to go on a gluten-free diet. This means avoiding all foods that contain rye, barley and wheat. Beer (including non-alcoholic beer) also contains gluten, so it needs to be avoided, too.

When starting a gluten-free diet, remember that even tiny amounts of gluten can precipitate problems. We recommend that patients visit a registered dietitian, because many foods containing gluten are not easily recognized. If this isn't possible, another good resource is the Celiac Sprue Association's website (csaceliacs.org), which has a lot of great dietary information.

A gluten-free diet generally starts paying dividends within the first few weeks. According to a New England Journal of Medicine study published a few years ago, about 70% of people with celiac disease are doing better two weeks into the diet. Over time, the dietary changes that lead to improvement generally become second nature for them.

Because celiac disease is an immune system disorder, you never "cure" the problem, you manage it. Going off of the gluten-free diet will lead to a return of symptoms.

Tedd Mitchell, M.D., is president and medical director of Dallas' Cooper Clinic.