—Sis living without wheat

Dear Sis living without wheat,

Food allergies and intolerances are becoming a hot topic, and as you may have experienced, some generally reliable information sources can present different information and even seem to contradict one another. The problem may lie partly in the varied language people commonly use to discuss problems with food (intolerance, allergy, sensitivity, autoimmune disorder — which is it?). It sounds like your sister has been diagnosed with celiac disease, an autoimmune disorder that causes an intolerance to gluten. Gluten is a protein found in wheat, barley, rye, and often oats — meaning that people with celiac disease must avoid these foods and any processed foods make from their byproducts (ranging from certain cereals to grain alcohol to soy sauce to MSG).

To confuse matters, some people have allergies or sensitivities to wheat (different from celiac disease) or other foods (the classic peanut allergy is an example). Symptoms of sensitivities and allergies can range in severity from a mildly itching or sore throat, to chronic congestion, to asthma, to anaphylactic shock. Testing is available from a health care provider to determine whether someone with these symptoms has food allergies, celiac disease, or another condition. Although conditions and symptoms may differ, people with food intolerances, allergies, and sensitivities often share the same treatment plan: to avoid the offending food(s).

For people with celiac disease, one of the damaging effects of eating gluten is that an autoimmune reaction can occur in the small intestine, damaging the lining and limiting the absorption of essential nutrients into the body. Without these nutrients, the body's systems and organs may be unable to function properly. In your sister's case, she may have been less able to absorb calcium into her bones because of the gluten in her system.

Symptoms of celiac disease can be similar to conditions like Crohn's disease, irritable bowel syndrome, ulcers, and anemia. In addition to low bone density, some indicators of celiac disease include:

• bloating, flatulence (gas), cramping, or generally upset stomach
• abnormal stools (appearance, odor, and quantity)
• depression
• joint pain or muscle cramps
• mouth sores or dental problems
• growth failure in children or weight loss in adults
• Dermatitis herpetiformis (an persistant, itchy skin rash, possibly with blisters)

Some people with celiac disease may take medications to manage some of the symptoms listed above; however the only treatment for the disease itself is to completely cut gluten out of the diet. This can seem like a challenging step for people accustomed to eating pizza, pasta, sandwiches, and drinking beer, however there are a number of gluten-free foods available to those avoiding wheat or gluten. It might be a good idea for your sister to visit a nutritionist to discuss her new diet and how to find gluten-free foods. If your sister is a student at Columbia, she can call x4-2284 or log on to Open Communicator to make an appointment with a nutritionist or her primary care provider.

In the mean time, there is an abundance of information available online; you can even order gluten-free food from online retailers! In addition, many grocery stores are beginning to understand the necissity of stocking and properly labeling gluten-free foods. Some resources to explore include:

• The Celiac Disease Center at Columbia University
• The Gluten-Free Restaurant Awareness Program
• CeliacChicks (a guide to "a hip and healthy celiac lifestyle")
• Gluten-Free Girl (a blog dedicated to wholesome gluten-free cooking)
• A guide to grocery stores across the country that list their gluten-free products

Your sister may have a lot on her plate right now, so to speak, because she is altering her diet to remove gluten. You can be supportive by learning about gluten-free eating and cooking, encouraging her to discuss questions with a health care provider and nutritionist, and helping family and friends understand her dietary needs. Many people who have gone "GF" find they enjoy cooking and eating more, knowing that the food they eat is not harming their bodies, and find that cutting out gluten can actually expand their cooking repertoire.

Best wishes to you and your sister for many happy meals,

Alice

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