Gluten-free an­swer for those with celiac dis­ease

The Hazleton Standard-Speaker - - HEALTH & SCIENCE - ASK THE DOC­TORS

Q: My 40-year-old grand­son has just been di­ag­nosed with celiac dis­ease af­ter months of feel­ing poorly and be­ing un­der­weight. What’s next? Where can he go for guid­ance and what should he do?

A:

Let’s be­gin with the ba­sics: Celiac dis­ease is an in­flam­ma­tory re­ac­tion within the small in­tes­tine. The re­ac­tion is caused by gluten, a pro­tein found in wheat, rye, spelt and bar­ley, and oc­curs in peo­ple ge­net­i­cally prone to the dis­ease.

In years past, celiac dis­ease was di­ag­nosed only in peo­ple with the clas­sic, or se­vere, form of the dis­ease, which dam­ages the fin­ger­like pro­jec­tions of the small in­tes­tine that help ab­sorb nu­tri­ents. When those pro­jec­tions are dam­aged, the body is un­able to ab­sorb fats, lead­ing to in­creased ab­dom­i­nal gas; stools that are bulky, foulsmelling and float; and poor ab­sorp­tion of vi­ta­mins and nu­tri­ents.

Your grand­son prob­a­bly suf­fered for months prior to his di­ag­no­sis be­cause his symp­toms were mild. In less-de­bil­i­tat­ing forms of the ill­ness, symp­toms can be ei­ther mis­di­ag­nosed or not se­vere enough to push some­one to seek med­i­cal at­ten­tion.

Re­gard­less of sever­ity, how­ever, celiac dis­ease can be ad­dressed. The cor­ner­stone of treat­ment is re­mov­ing gluten from the diet. That means avoid­ing wheat, rye and bar­ley, which are in a sur­pris­ing num­ber of foods — not just breads, pas­tas, crack­ers and snacks, but also sauces, vine­gars, salad dress­ings, mari­nades, sea­son­ings, soup stocks, soy sauces, and even beers, ales and lagers. For that rea­son, any­one with celiac dis­ease should care­fully read the la­bels of all pre­pared foods and condi­ments that they con­sume.

On the plus side, many condi­ments and beers are in­creas­ingly avail­able with­out gluten, as are breads and pas­tas. The lat­ter foods are made with quinoa, tapi­oca, rice, soy­beans or buck­wheat, all of which are safe to eat.

In 70 per­cent of pa­tients with celiac dis­ease, fol­low­ing a gluten-free diet leads to a re­duc­tion in symp­toms within two weeks, and lev­els of in­flam­ma­tory an­ti­bod­ies de­cline sub­stan­tially af­ter six weeks.

Among peo­ple who con­tinue to have symp­toms, 90 per­cent ei­ther don’t ad­here prop­erly to a gluten-free diet, or they con­sume foods they mis­tak­enly be­lieve are gluten-free. For those who are strict about a gluten­free diet but still have se­vere symp­toms, oral steroids or other med­i­ca­tions to sup­press the im­mune sys­tem can re­lieve symp­toms.

Your grand­son is prob­a­bly al­ready see­ing a gas­troen­terol­o­gist who is mon­i­tor­ing his symp­toms and eval­u­at­ing him for nu­tri­tional de­fi­cien­cies, but he also should con­sult a nu­tri­tion­ist to re­view the types of foods and drinks he is con­sum­ing. With a gluten­free diet, he should be feel­ing bet­ter soon.

is writ­ten by Robert Ashley, M.D., Eve GlAzier, M.D., And El­iz­A­beth Ko, M.D. Send ques­tions to Ask­the­do­c­tors@ med­net.uclA.edu, or write: Ask the Doc­tors, c/o Me­diA Re­lA­tions, UCLA HeAlth, 924 West­wood Blvd., Suite 350, Los An­ge­les, CA, 90095.

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