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Glenn D. Braunstein, M.D. Headshot

Living a Gluten-Free Life

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Strolling through the aisles at Whole Foods or one of the other fancy specialty grocery stores that dot Los Angeles, a label you will start seeing more and more is "gluten-free."

It's not part of a new fad diet craze - though, more and more people are adopting a gluten-free lifestyle because they find it has a number of health benefits. These products are intended to help those who have celiac disease, a lifelong digestive disorder that is affecting a growing number of people. It's estimated to affect about 1 percent of the world's population, and about 1 in 133 Americans have been diagnosed with it. However, the actual numbers may be far greater. Many medical experts suspect this is only the tip of the celiac iceberg.

When people with celiac disease, or CD, eat foods that contain gluten, it triggers their immune system to set off a toxic reaction that can damage the villi - tiny hair-like projections in the small intestine - and prevent basic nutrients from food such as protein, carbohydrates, fats, vitamins and minerals from being properly absorbed.

Gluten refers to proteins in specific grains, including all forms of wheat (durum, semolina, spelt and others) and grains such as rye, barley and triticale. Avoiding these proteins is a necessity for those with CD, and it's no easy task. Check the labels the next time you're buying groceries to see just how prevalent gluten is. Breads, crackers and pasta are all off the menu for CD sufferers.

The disease largely goes undiagnosed, in part because many physicians don't recognize its symptoms or its symptoms can be so vague that they're not recognizable. For instance, occasional bouts of diarrhea, abdominal cramping, intestinal gas, distention, occasional constipation and occasional bloating are all symptoms of celiac disease. And who hasn't experienced a few of those from time to time?

Sometimes it's discovered when a patient is anemic, and yet no cause can be found for the blood to be lacking iron, or when weight loss occurs despite a voracious appetite.

CD has been mistaken as a gastrointestinal disorder or a food allergy. It's neither. It's an autoimmune disease that affects multiple systems in the body. The disease is more than a matter of discomfort for those who have it. If undiagnosed, it can lead to a number of serious conditions including iron deficiency anemia and osteoporosis, as well as an increased risk of certain cancers including lymphoma.

The treatment for CD is strict adherence to a gluten-free diet. The upside to the diet is that it's extremely effective. Eliminating the pesky protein often makes patients feel significantly better within two weeks.

Peter Green, M.D., director of the Celiac Disease Center at Columbia University, recently shared an anecdote when he spoke to medical faculty at Cedars-Sinai Medical Center to illustrate just how sensitive patients with CD are to wheat. One patient was extremely faithful to her gluten-free diet, making only a single exception: the communion wafer she took during mass at her Catholic church. That tiny morsel was enough to keep her symptoms going despite all of her other efforts.

Don't even think about disturbing a gluten-free gourmet's culinary efforts. Just dipping a cracker into a sauce to steal a taste will be cause to have to start over from scratch.

You'd be amazed how many unexpected places gluten crops up. Starchy products like breads, pastas, crackers and cereals are obviously suspect. But labels that don't mention wheat or gluten, but contain malt (which is made from barley) or hydrolyzed vegetable protein (often containing wheat) are also suspect.

Fortunately, more products are becoming more widely available for those dodging gluten. For example, there are breads made with rice or potato flour instead of wheat. While some classic cereals, like cream of wheat, are out of the question, rice and corn cereals are good alternatives.

A nice grilled steak with vegetables, and rice or a baked potato would be a perfectly acceptable menu for your average gluten-free dinner guest. For the pre-meal dips, just swap out crackers with rice cakes. While a toast with a couple of frosty beers isn't feasible, wines are generally gluten-free.

If you think you have celiac disease, check with your doctor. The condition can be diagnosed through specific antibody tests in the blood, and confirmed with a small bowel biopsy. Blood tests can only screen for the risk of the disease or rule it out - but cannot confirm it. The cause is unknown, but genetics seem to play a large role.

For the newly-diagnosed, there are many resources available from your doctor, as well as many online communities devoted to creative celiac-friendly cuisine. A good place to start is the Celiac Disease Foundation (http://www.celiac.org), a national organization that has been raising awareness of celiac disease since 1990. Its website has lots of great information, including a diet guide on good and bad food categories for those with CD, as well as links to other online resources.