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Celiac disease: When the body goes against the grain -Diagnosis

Not always obvious

Diagnosis: Blood tests and biopsies

In a person with celiac disease, gluten produces higher-than-normal levels of two antibodies: anti-tissue transglutaminase (tTG-IgA) and antiendomysium (EmA-IgA). The tTG-IgA screening test is the most sensitive; it identifies people who are at risk for celiac disease even if they have no symptoms.  The treatment — following a gluten-free diet for a lifetime — can be challenging and costly.

 Trying a gluten-free diet on their own before receiving a firm diagnosis can be done. However the antibody tests are accurate only if you are eating gluten-containing foods.

Who should be tested?

People with recurring, unexplained gastrointestinal symptoms such as pain, bloating, or diarrhea should consider testing for celiac disease. Iron-deficiency anemia or high levels of certain liver enzymes (transaminases) should raise a red flag, as should unexplained, recurrent miscarriages and infertility.

Women who develop osteoporosis early (before menopause) or whose osteoporosis suddenly worsens should also consider the possibility of celiac disease. One small study reported a 17-fold higher incidence of the disease among women with osteoporosis compared to women in the general population.

Treatment: Avoid gluten

The good news is that the only treatment for celiac disease — a gluten-free diet — starts to work within days, and the small intestine usually heals completely within three to six months. Although giving up favorite foods such as wheat breads and pizza can be tough at first, many people who have adapted to a gluten-free diet comment that while it can be inconvenient, it does not prevent them from socializing or traveling. Many gluten-free foods are available by mail order and on the Internet, and gluten-free items are becoming more common in supermarkets and restaurants.

Recent developments are making shopping a bit easier, too. Why, For example, while oats don’t contain the gluten that harms people with celiac disease, there is the possibility of cross-contamination with wheat in the growing and milling process. Also, some products labeled “wheat-free” contain barley, usually in the form of malt or malt syrup. The FDA is working on a rule for gluten-free labeling with action expected sometime after 2007..

General guidelines for gluten-free eating*
Food typeDo not eatOkay to eat
Grains, potatoes, flours, and cereals
  • wheat, rye, or barley (breads, bread crumbs, pasta, noodles)
  • spelt, semolina, kamut, triticale, couscous, bulgur, farina
  • rice mixes, some converted rice
  • unidentified starches or fillers
  • most commercial cereals
  • gluten-free pastas and breads (made from soy, rice, corn, potato, and bean flours)
  • plain rice, corn, popcorn, potatoes, sweet potatoes, soybeans, other beans, nuts, millet, amaranth, quinoa
  • oats (consult doctor first), buckwheat
  • cornstarch, tapioca, and arrowroot starch
  • gluten-free cereals (e.g., corn and rice)
Fruits and vegetables
  • canned soups, soup mixes, bouillon cubes
  • creamed vegetables
  • most salad dressings
  • fresh, frozen, or canned fruits or vegetables, unprocessed and without sauces
  • homemade soups with allowed ingredients
Meat, fish, poultry, main dishes
  • commercially prepared fresh or frozen meat and main dishes, lunch meats, and sausages
  • fresh meat, fish, poultry
Dairy products
  • processed cheese, cheese mixes, blue (veined) cheese
  • yogurt or ice cream that’s unlabeled or that contains fillers or additives
  • low-fat or fat-free cottage cheese, sour cream, or cheese spreads
  • plain natural cheese
  • gluten-free plain yogurt and ice cream
  • whole, low-fat, and fat-free milk
  • full-fat cottage cheese and sour cream
  • beer, whiskey, bourbon, grain alcohol
  • wine, light rum, potato vodka
  • distilled alcohol
  • grain vinegar
  • malt vinegar
  • beer
  • commercial pudding mixes
  • malt from barley
  • soy sauce made from wheat
  • distilled rice, wine, or apple cider vinegar
  • homemade puddings from tapioca, cornstarch, rice
  • sugar, honey, jam, jelly, plain syrup, plain hard candy, marshmallows
  • gluten-free soy sauce

 vitamins, minerals, and other supplements are often packed in a starch base that may contain gluten. Make sure yours is derived from corn or tapioca. Gluten is also found in some personal care products, such as lipstick, toothpaste