Celiac Disease: Pining for Pizza?

I have recently been diagnosed with celiac disease. Is there any course of treatment that will allow me to keep eating some of my favorite foods such as pizza and sourdough bread?

– October 10, 2002

Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is an inherited, autoimmune disorder that damages the small intestine when the diet contains gluten. Gluten is the protein in wheat that makes dough elastic. It also is found in rye, barley and, possibly, oats. The autoimmune damage causes the loss of the tiny protrusions in the small intestines called villi, which are essential to the proper absorption of nutrients from food. This can lead to malnutrition, no matter how well you’re eating. Celiac disease tends to run in families and, like other autoimmune conditions, is often triggered by physical stress such as surgery, pregnancy, childbirth and viral infection. Sometimes, severe emotional stress can also set it off.

Celiac disease manifests differently from person to person. It can cause a long list of symptoms both in and out of the gastrointestinal system. These include recurring abdominal bloating and pain, chronic diarrhea, weight loss, anemia, bone pain, fatigue, and in children and infants, delayed growth and failure to thrive.

The only treatment is a gluten-free diet – for life. Eating even a small amount of this protein can result in damage to the intestine. I’m sorry to say that you can’t eat regular pizza, or sourdough bread, on a gluten-free diet. You must try to avoid all foods containing wheat, oats, barley and rye. Read labels carefully because gluten can turn up where you don’t expect it: in cold cuts, soups, candies, and even soy sauce. Look for ingredients such as starch, modified food starch, hydrolyzed vegetable protein (HVP), hydrolyzed plant protein (HPP), texturized vegetable protein (TVP), binders, fillers, excipients, extenders, malt, and natural flavorings, all of which may indicate the presence of gluten.

But these days a gluten-free diet isn’t the hardship it once was. My colleague, Kathleen Johnson, a dietician here at the Arizona Center for Integrative Medicine, tells me that you have lots of options. You can find gluten-free mixes for muffins, pizza dough and even bread. Check with the Celiac Disease Foundation (www.celiac.org) or the Celiac Sprue Association (www.csaceliacs.org) for information.

Andrew Weil, M.D.

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