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People with coeliac disease react to gluten - a nutritious protein in wheat and other grains - as if it were poison. Gluten damages their intestines so badly that they cannot absorb food, vitamins or minerals. They suffer abdominal cramps, gas, diarrhoea, malnutrition and weight loss. The disease is so debilitating that children with it grow slowly - if at all.
Coeliac disease isn't an allergy. But it's related to allergy in that many cases are provoked early in infancy by an allergic reaction to cow's milk. The damaged intestines then reject not only wheat and milk, but sometimes other foods as well. And coeliac disease is treated much like an allergy - by careful avoidance of gluten-containing grains.
The four offenders in coeliac disease are wheat, rye, barley and oats (although some coeliacs can eat oats safely). Their close botanical relative, rice, and distant cousins, corn and millet, have such low levels of gluten that most coeliacs can tolerate them, especially after several months of totally avoiding all sources of gluten.
But even when eating high-gluten grains, some coeliacs do not get as severely ill as others. A study in Britain tested the effects of barley, rye, rice and corn in a group of coeliacs. As expected, rice and corn did no harm. With barley and rye, the damage varied from one person to another, even though everyone ate the same amounts. Evidently, coeliacs vary in how much damage their intestines suffer when they eat gluten (Quarterly Journal of Medicine).
Standard treatment for coeliac disease begins with a high-protein, gluten-free diet of skimmed milk, egg whites, lean meat, fish, liver and protein-rich vegetables such as peas and beans. Starchier foods such as fruit, vegetables and low-gluten grains come later, after the digestive system has healed enough to be able to handle them.
But because gluten can show up where you least expect it, you need to stop and think before you put anything in your mouth. For example, a woman in Toronto was doing very poorly despite a strict gluten-free diet. Doctors finally discovered that the woman, a Catholic, was receiving daily Communion -and that the wafers were made of wheat flour. Within two days of taking Communion without wafers, she no longer had abdominal cramps, bloating or diarrhoea (Lancet).
'It's not unusual for a person to adhere strictly to the diet but to be unaware that the Communion wafer or stick of gum may be an unsuspected source of gluten,' says Joyce Gryboski, a pediatrician at Yale University School of Medicine (American Journal of Diseases of Children).
Until you heal, you will probably need to take a B-complex vitamin and other nutritional supplements to replace nutrients lost either through poor absorption or from avoiding grain and other B-vitamin-rich foods.
After you've done well on the high-protein, low-gluten diet for six months, you can work towards a regular diet by adding one food at a time. It may take a year or two for the intestinal damage to heal completely. Some coeliacs can eventually eat wheat and other sources of gluten, especially if they begin with rice or corn. A few lucky ones - mostly children - are able to eat gluten indefinitely without symptoms. But the basic tendency for gluten intolerance will remain, so it's best to eat only small amounts of gluten-containing foods occasionally rather than making them a major part of your daily diet.
Some people, however, may not improve until milk or egg has also been removed from the diet. One doctor noticed that out of 120 people with coeliac disease, ten did not improve on a gluten-free diet until milk protein was avoided. Two other coeliacs failed to get better until egg was avoided (Progress in Gastroenterology).
Other doctors report the case of a woman who was careful to follow a strict gluten-free diet, yet failed to improve. They noticed that her symptoms were the worst when she ate egg, chicken or tuna. But when those foods - along with gluten -were removed from her diet, she made a full recovery, say Drs Alfred L. Baker and Irwin H. Rosenberg, of Chicago, Illinois. The doctors emphasize that while coeliac disease due to foods other than gluten is unusual, it does occur {Annals of Internal Medicine).
Coeliac disease seems to be somewhat preventable. The first step is for women to breastfeed their babies, especially if coeliac disease or allergies run in their family - or if they're Irish. (Irish people or their descendents are genetically more susceptible to the problem.) A study done a few years ago shows that coeliacs are more likely to have asthma, hay fever and eczema than non-coeliacs. While no one understands the full significance of the coeliac-allergy connection, it could indicate that since breastfeeding protects against allergies, it may guard against coeliac disease, too. Also, by delaying exposure to cow's milk until the baby has developed the proper enzymes to handle it, breastfeeding also prevents the intestinal damage that sets the stage for coeliac disease.
And don't be too hasty to add cereal and other solid foods to the baby's diet. Wait until the infant is at least four to six months old, and then add each grain, one at a time, in small amounts. Begin with rice, millet and other low-gluten grains.
'Delayed introduction of gluten to the diet in infancy may prevent. . . gluten intolerance and lead to a drop in the number of people who get coeliac disease,' say doctors in Britain.
Other doctors report that as more mothers breastfeed - and breastfeed longer - the incidence of coeliac disease seems to be dropping. 'We believe that the incidence of coeliac disease in childhood is falling and that this is directly related to changes in infant feeding practices occurring in the mid-1970s,' they conclude {Lancet).
It's nice to hear that even some of the most mysterious health problems are within our control - if we know what to do about them.


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