Celiac disease: while common, is complicated

As happens with other afflictions whose symptoms may be nonspecific but common (think Lyme disease), gluten sensitivity has emerged in the popular press, described in a supplement to USA Today as "the number one genetic condition in the United States" ( http://www.csaceliacs.org/news-press-release/USAToday.CD.May2010.pdf).

Search for celiac disease using Google, and more than 7.5 million Web sites are found. The sites range from scientific studies to foundations supporting celiac disease research to personal stories of changed lives through adherence to a gluten-free diet.

Improved understanding of the spectrum of gluten sensitivity and celiac disease has, however, brought new questions: Who should be screened for this relatively common condition? What is the most accurate screening test? What are the consequences for an asymptomatic person whose screening test is positive? What is the likelihood of associated conditions such as intestinal lymphoma?

Reports in the lay press describe athletes and celebrities whose lives have been changed by eliminating gluten from their diets. That kind of publicity leads some to hope that a dietary change could cure whatever ails them or their child, and that hope may lead them to your office door. Dr Hill's discussion makes it clear that we have underestimated both the frequency and the signs and symptoms of celiac disease. He cautions, however, that the diagnosis must be made carefully and definitively before restricting the diet of a child or an adult to one without gluten.

Supermarkets may be filled with gluten-free products, and it may be more convenient than in the past to eliminate wheat, barley, and rye from the diet, but it's difficult to imagine not being able to eat spaghetti, cereal, cupcakes, or gravy without specialized shopping and preparation. We may be making the diagnosis of celiac disease more frequently and more accurately than in the past, but there still is a great deal to learn about gluten sensitivity and its potential to affect health and lifestyle.

I've tasted a rice flour pizza crust, and you wouldn't want to be restricted to that unless it was really important.