Gluten-free diet poses challenge

Imagine that for the rest of your life, you couldn't eat anything that contained wheat, rye, oats or barley.

You couldn't eat pizza crust, cookies, cake, pie or a dinner roll. No toast, no raisin bran, no biscuits. Even the glue on the backs of postage stamps and envelopes might contain tiny amounts of these forbidden grains.

About one out of every 100 people in this country -- including a few readers who have contacted me -- have celiac disease, an autoimmune disorder caused when the body reacts to gluten, a protein found in several common grains. A wide range of symptoms may include gas, chronic diarrhea, fatigue, abdominal pain and bloating, anemia, smelly stools, weight loss or gain, joint pain or muscle cramps and many others. There may also be no symptoms at all. The disease can show up in children or adults.

Celiac disease is also called gluten-induced enteropathy or nontropical sprue.

According to the National Institutes of Health, the prevalence of celiac disease is 10 times higher than estimates from as recently as a few years ago. It's likely that many cases go undiagnosed or misdiagnosed because testing isn't done and because symptoms may be attributed to other conditions.

Complications include damage to the intestines and malnutrition that can lead to other diseases and conditions. There's no cure, and the only treatment available is diet.

The good news is that a gluten-free diet usually halts symptoms and allows the intestines to heal over a period of months or a couple of years. Painstaking care has to be taken at all times, though, to keep any amount of wheat, rye, barley -- and usually oats -- out of the diet. For example:

* Types of wheat, including spelt, triticale and kamut, ancient grains used more often these days in breakfast cereals and natural foods products, must be avoided.

* Residual bits of off-limits grains can hitchhike onto corn or rice products made in factories that also process other grains. Common ingredients such as modified food starch and other additives used in processed foods may also contain tiny amounts of gluten. Looking for foods labeled "gluten-free" is one way to avoid hidden sources of gluten.

* Gluten is used in some medications and supplements. A pharmacist can guide you to gluten-free products.

* Special care is needed when eating out, since foods in cafeterias, restaurants and at other peoples' homes usually don't come with ingredient labels.

It's a challenge to eat a gluten-free diet, no doubt about it. But it's not impossible. In fact, you can get all the nutrients you need on a diet that excludes all sources of gluten.

What's left if you don't eat wheat, rye, oats and barley?

For starters, people with celiac disease can eat rice, buckwheat, amaranth (another ancient grain) and quinoa. Potatoes, soybeans and other dried beans can also be used to make flours that can be substituted for wheat in recipes. Health food stores and other specialty food stores carry these products, and some are even sold in conventional supermarkets now.

Fruits, vegetables and meat or fish with no added sauces or breading are also gluten-free.

If you are diagnosed with celiac disease, you'll need a referral to a registered dietitian for individual counseling. You'll also need reliable sources of information about common and hidden sources of wheat, rye, oats and barley, tips for recipe substitutions, and advice on eating out. Two good online resources: www.nlm.nih.gov/medlineplus/celiacdisease.html and http://digestive.niddk.nih.gov/ddiseases/pubs/celiac.

And take heart in knowing that if you do have celiac disease -- or any other food intolerance -- you have more resources and options today than ever before.