Change my eating habits? Substituting foods or food agents is now a frequent course of action against some allergies. It sounds like a hassle, truly. At least there is course of treatment for some disorders, so we begin by realizing how fortunate we are to live at a time when there are options to what ails us. With that outlook, previously fatal disorders or allergies we are able to live with instead of being debilitating or fatal.

Celiac Sprue is one of those disorders that involves a lot of dietary substitutions and I've witnessed my friends doing this dance when we dine together. These disorders are becoming increasingly more common. They simply require testing and proper diagnosis for accurate dietary plans of action.

Celiac disease itself is an immune reaction to an environmental agent (the gliadin component or gluten [a protein found in many cereals]) causing gastrointestinal symptoms including chronic diarrhea, malabsorption, weight loss and abdominal distension. This problem had been known since at least the 2nd century, but first described by Samuel Gee in 1888. The association between eating breads and cereals and diarrhea was noted by the Dutch pediatrician Willem K. Dicke and was corroborated during WWII when children with chronic diarrhea improved when other foods were substituted for bread.

Interestingly, celiac disease is seen mostly in people of northern European descent with a prevalence of 1:300 to 1:500 people. Some are symptomatic, but many are not. Certain genes are found among families with celiac disease and antibodies to gliadin ( a component of gluten a protein found in wheat). This leads to the concept of an immune disorder triggered by an environmental agent. In children, a broad array of gluten peptides may trigger a clinical response which fortunately may narrow as they grow older. One concept is that the body's immune system is primed for gluten based on exposure to a similar viral amino acid sequence. In other words, the immune system "remembers" this amino acid sequence and triggers a defensive immune response when exposed to gluten.

Celiac disease may be a possibility in people with chronic diarrhea, malabsorption weight loss, and abdominal distension. Other people to consider are people with elevated liver function tests, short stature, delayed puberty, anemia, and infertility. Don't forget the genetic basis of this disease, which means that first and second-degree relatives of people with celiac disease are at risk of celiac disease.

No test, however, is perfect to make this diagnosis. If the probability is high for celiac disease, the best test is a small bowel biopsy which is done by a pediatric gastroenterologist. If there is a small chance of disease (which would be done for screening a population), blood tests are an appropriate test. Obviously all testing should be done on a regular diet, not on a gluten-free diet.

Management of the disorder revolves around a gluten-free diet. This means no wheat, rye and barley. Oats contain gluten but some consider it non-toxic. Foods containing soybean or tapioca flours, rice, corn, buckwheat and potatoes are safe. A gluten-free diet requires a major lifestyle change since Western diets are based around wheat flour (hamburger buns, pizza dough, Pop Tart crust and Krispy Kremes!). Luckily cookbooks, websites, and ingredient labels on foods provide useful information. Eating out may provide unwanted adventure, but it is very possible. Now many restaurants are recognizing this large population with unfulfilled requirements and are supplying a gluten-free menu (i.e., Outback, Bonefish Grill.)

Realize that avoiding gluten is not the only medical issues needed to be addressed in celiac disease. Many people are also lactose intolerant and milk products should be carefully evaluated for gastrointestinal side effects. Micronutrient deficiencies are common due to malabsorption from the intestines and vitamin D, iron, folic acid, calcium and sometimes vitamin B12. As a result, many patients with celiac disease should be monitored for osteoporosis. Constipation may also be a problem due to lack of roughage in the diet. Other recommendations include follow up appointments with a pediatric gastroenterologist and finding a support group.

Diagnosis results in relief. Keep a positive outlook. Get cooking and "Bon appetit!"