This morning NPR had a feature on Celiac Disease. For those of you who may not be aware, Celiac involves severe gluten intolerance (gluten is the main protein in wheat, oats, rye and barley), and affects nearly 3 million Americans. But for every person who actually has Celiac, there are ten people who are merely sensitive to gluten without having the disease. This is missed a lot in standard medical practice, where a mention of gluten intolerance often leads to a biopsy of the intestines to look for Celiac.

Non-Celiac gluten sensitivity can be the result of several factors: poor digestion of the gluten protein; a minor hereditary gluten intolerance; an immune system gone awry; or a diet that relies heavily on bagels, pizza, bread, pasta, cookies, breaded foods and pastries. The symptoms include intestinal discomfort (bloating, pain, constipation, diarreah), fatigue, headaches, and irritability/behavioral changes. While Celiac itself can only be diagnosed through a biopsy, gluten sensitivity can often be detected through a simple blood test. Or, I will often give symptomatic patients the “withdrawal and challenge” test: basically, you eliminate all gluten from the diet for 2-3 weeks (that means all wheat, oats, rye and barley), then re-introduce it and see what happens. If your symptoms return, you can be reasonably sure that you have a sensitivity.

The only definitive treatment for gluten sensitivity is, sad to say, avoiding it all together. The good news is that there are many more satisfying food options for gluten-sensitive people than there were even a few years ago. Check out http://glutenfreegirl.blogspot.com/ for great recipes, food shopping ideas, and advice. And here’s another suggestion for those times when you either want to indulge, or have no choice (true confession – I’m normally gluten-free, and I ordered broiled fish in a restaurant a few nights ago that turned out to be breaded. It looked so good that I ate it anyway). There’s a supplement you can take called Similase GFCF that contains a digestive enzyme to help break down gluten. It’s not going to help someone with true Celiac Disease, but it might help those of us that have minor sensitivities.

Sometimes you just gotta have that breaded fish.