Receiving a disease diagnosis isn't usually a good thing. But for people who learn they have celiac disease, the news often comes as a relief.
Celiac disease is an autoimmune disorder in which the body overreacts to gluten, a protein found in wheat, rye and barley. When celiacs ingest gluten, their immune system attacks the hairlike villi lining their small intestines, hampering their ability to absorb nutrients to disperse to the bloodstream.
While diarrhea, bloating, constipation and vomiting are short-term hallmarks of celiac disease, the malabsorption of nutrients can lead to longer-term problems, including weakened bones, anemia and neurological problems. Celiacs are also at increased risk of gastrointestinal cancers, among other diseases.
Left unchecked, celiac disease can even lead to death. Recent research suggests that the disease is far more common than had been believed, affecting as many as one in 133 people.
But once you get that diagnosis, the remedy is obvious: Eliminate gluten from your diet, and watch your symptoms vanish. Better yet, strict avoidance of gluten over time can reverse damage. Not only does diarrhea cease, intestines heal.
Jan Terry of Modesto was diagnosed with celiac disease 23 years ago and says she's been gluten-free ever since.
"Going gluten-free is not as bad as it sounds," she wrote in an e-mail. "You just need to read labels, cook most foods from scratch and ask questions."
Avoiding gluten was far trickier then than it is today. "When I first learned (in 1988) I could no longer eat gluten, most people didn't know what I was talking about," said Cheryl Hagan Brown of Modesto in an e-mail. "Even friends and family thought it was something I would get over."
Since January 2006, food-item packaging has been required to note any of eight known foods or ingredients that can cause problems: wheat, eggs, milk, peanuts, tree nuts, fish, shellfish and soybeans.
That's made managing celiac easier.
"The nutrition labeling requirements from the FDA, most recently the listing of the presence of major recognized allergens in food products, is a huge help," said Roxanne Lemos of Modesto in an e-mail. "I often will e-mail various food product companies for further information before buying products that do not explicitly state that they are gluten-free on labeling."
Gluten-free has reached the mainstream. According to a survey from the National Restaurant Association, cooking that is gluten-free and food-allergy conscious ranked
No. 9 in a listing of 214 current food trends. So it's no wonder it's become big business, with major companies such as General Mills, Betty Crocker and Wal-Mart offering no-gluten foods.
That growth is fueled in part by consumers who, while not having received a diagnosis of celiac disease, find they don't tolerate gluten well and would just as soon avoid it. Gluten-free products are generally more expensive than their gluten-containing equivalents; some celiacs learn to rely heavily on meats, fruits, vegetables and other foods that naturally contain no gluten. Those who follow a strict diet have dedicated cookware to prepare gluten-free or allergen-free foods. Even a residual amount of an allergen can have dire medical consequences, depending on the severity of the allergy.
Dining out remains problematic. Celiac diners have to remain vigilant, as gluten lurks not just in the obvious beer, bread and other baked goods but also in sauces, marinades, salad dressings and other places you might not expect to find grains.
And one small mistake can lead to misery, as Jennifer Hobbs can attest.
"I consumed wheat two days in a row — at lunch one day and lunch and dinner the following day. By the time I was driving home from dinner that second day, I felt like I was getting the flu — my joints and muscles hurt so badly," the Modestan said in an e-mail.
Biopsy of the intestine's lining via endoscopy remains the most definitive way to diagnose the disease. Blood tests can reveal whether a person's body has developed antibodies to gluten proteins, a sign that celiac disease may be present. Genetic analyses, including a new saliva test developed by Prometheus Laboratories, can determine whether one has the genetic makeup associated with celiac; this at-home test has the advantage of being able to rule out celiac altogether.
As with all autoimmune diseases, it's believed that celiac occurs when a person who has a genetic predisposition encounters some environmental trigger that moves the faulty immune response into action. But celiac is the only autoimmune disease for which that environmental trigger — in this case, gluten — has been identified, according to Alessio Fasano, director of the University of Maryland Center for Celiac Research.
Fasano has discovered that people with autoimmune diseases tend to have abnormalities in their intestines that make them permeable — what he calls "leaky guts." That permeability may be the factor that gives environmental triggers access to the immune systems of genetically susceptible people. Fasano has launched research of a drug called larazotide, which inhibits the action of zonulin, a protein that increases intestinal permeability. Early results on people with celiac disease have been promising.
Here are places readers suggested for shopping and dining:
- O'Brien's Market carries pizza crust, frozen products and mixes; 4120 Dale Road, Suite H, Modesto, 545-8100; 839 W. Roseburg Ave., Modesto, 524-9234; and 6331 Oakdale Road, Riverbank, 869-9050.
- Raley's supermarket has an aisle dedicated to gluten-free foods; 3430 Tully Road, Modesto, 527-2201; 2401 E. Orangeburg Ave., Suite L, Modesto, 577-5656; 1611 E. Hatch Road, Modesto, 537-1770; 3020 Floyd Ave., Suite 189, Modesto, 551-2050; and 2900 Geer Road, Turlock, 667-5253.
- Trader Joe's has a few gluten-free mixes and great labeling of all products; 3250 Dale Road, Suite E, Modesto, 491-0445.
- Groceries 4 Less is a hit-and-miss source for damaged and surplus items; 1012 N. Carpenter Road, Modesto.
- Village Health Foods has ingredients and prepared foods that are gluten-free; 1700 McHenry Ave., Suite 15, Modesto, 523-3466.
- Blue Diamond Growers has gluten-free crackers in eight flavors; 4800 Sisk Road, Modesto, 545-3222.
- Cornucopia Natural Foods, 2625 Coffee Road, Suite V, Modesto, 575-1650.
- Sheri's Turlock Health Foods, 202 Lander Ave., Turlock, 634-7765.
- Safeway, 2001 McHenry Ave., Modesto, 571-6280; 3051 Countryside Drive, Turlock, 669-2725.
Many restaurants can accommodate gluten-free dining requests. Here are some eateries that readers suggested:
- Outback Steakhouse, 2045-D W. Briggsmore Ave., Modesto, 577-2410.
- Fresh Choice labels all of its foods for various types of dietary restrictions; 2225 Plaza Parkway, Modesto; 523-8875.
- UNO Chicago Grill has a separate gluten-free menu; 1533 Oakdale Road, Modesto, 521-8667.
- In-N-Out Burger has a protein burger wrapped in lettuce. 3900 Pelandale Ave., Modesto.
On the Web
- www.celiac.com: provides information on celiac disease and gluten-free diets.
- www.celiac.org: The online home of the Celiac Disease Foundation, with recipes, product guides, news and more.
- www.ener-g.com: A one-stop online shop that also includes articles and forums.
- www.giftsofnature.net: An online store with retail locations. Offers recipes, information.
- www.glutenfree.com: Sells products, offers newsletter and links to other sites.
- www.glutenfreemall.com: A one-stop online shop for gluten-free goods, including baking ingredients and personal care items.
- www.tasteofhome.com/Top-10-Recipes/Top-10-Gluten-Free-Recipes: Tips on how to cook gluten-free
- P.F. Chang's China Bistro, 1530 J St., Sacramento, 916-288-0970; and 1180 Galleria Blvd., Roseville, 916-788-2800: Gluten-free dishes include moo goo gai pan, chicken lettuce wraps and Chang's lemon scallops.
- Mariposa Baking Co., Oakland: www.mariposabaking.com
- Whole Foods: www.wholefoodsmarket.com
- Azna Gluten Free, 2647 Cameron Park Drive, Cameron Park; 530-677-5810: Gluten-free baked goods, including cinnamon rolls, brownies and waffles. Some items are also available at select Raley's Supermarkets.
- Gluten Free Specialty, 2612 J St., Sacramento; 916-442-5241: A wide range of food items, personal care items, books and other items are available.