There is much talk these days about gluten free food and gluten free diets. I’d like to explain what this is all about.

Gluten is a protein found in foods containing wheat, barley or rye. The consumption of gluten by susceptible individuals causes celiac disease which affects the digestive system. People with celiac disease who eat gluten containing food experience an immune reaction which damages the lining of their small intestines. This damage interferes with the intestines ability to absorb certain nutrients which over time can deprive many of our vital organs of proper nourishment.

The most common symptoms of celiac disease are abdominal pain, vomiting, bloating and diarrhea. Less common symptoms are depression, irritability, joint pains, upset stomach, cramps, rashes and weight loss. Infants and young children seem to have more of the digestive symptoms than do adults.

About 3 million people in the U.S. have celiac disease. Having a family member with celiac disease does raise one’s risk of the disease.

Diagnosing celiac disease can be difficult because some of its symptoms are similar to other illnesses such as irritable bowel syndrome, diverticulitis, intestinal infections, and chronic fatigue syndrome. Diagnosis rates are increasing as doctors become more aware of the variety of symptoms of this disease and as reliable blood tests become more available. A biopsy of the small intestine can be done to confirm the diagnosis.

At this time there is no cure for celiac disease but it can be managed by a proper diet. For most people following a gluten free diet will alleviate the symptoms, heal the damaged intestinal lining and prevent further damage. Once beginning the diet, symptomatic improvement can occur within days but it may take many months for the small intestine to heal itself. To stay well, one needs to be on a gluten free diet for the remainder of their lives.

In spite of having celiac disease, one can still eat a well-balanced, healthy and tasteful diet. Wheat flour can be substituted by using rice, soy, potato, quinoa, buckwheat or bean flour. There are now a wide variety of gluten free pastas, breads, snacks and other foods.

People with celiac disease must be careful about food they buy at school, work, or restaurants, as well as food purchased at grocery stores. Eating out can be a challenge to avoid gluten containing foods.

Here are some examples of common foods and beverages to avoid unless they are labeled gluten free:

• Bread

• Cakes, pies, cookies, crackers and croutons

• Processed luncheon meats and gravies

• Salad dressings and sauces (including soy sauce)

• Soups

• Beer

Oats are technically free of gluten but are frequently contaminated with it. Be sure the oats label states that it is free of gluten.

See your doctor if you think you are having any symptoms of celiac disease to confirm the diagnosis and work on a treatment plan.

Terry Hollenbeck, M.D., is a retired urgent care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. He can be reached at

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