This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc. Subscribe to FREE Celiac.com email alerts What are the major symptoms of celiac disease? Celiac Disease SymptomsWhat testing is available for celiac disease? - list blood tests, endo with biopsy, genetic test and enterolab (not diagnostic) Celiac Disease ScreeningInterpretation of Celiac Disease Blood Test ResultsCan I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful?The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-FreeIs celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic TestingIs there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and DisordersIs there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients)Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients)Gluten-Free Alcoholic BeveragesDistilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free?Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free DietFree recipes: Gluten-Free RecipesWhere can I buy gluten-free stuff? Support this site by shopping at The Celiac.com Store.For Additional Information: Subscribe to: Journal of Gluten Sensitivity
InterestsAppreciation of classical music, and traditional/folk music of cultures throughout the world. Enjoyment of most "world music." Appreciation of canvas art and sculpture, both modern and classical. Exploration of legal, technical, and creative writing styles; development and practice of legal research and analysis skills. Occasional dabbling in poetry composition.
The Sensitive Baker (SB) in Culver City has a dedicated gluten-free, casein-free, peanut-free, and kosher facility.
SB is now open Monday-Saturday, 10 a.m. - 6 p.m.; and Sunday, 10 a.m. - 2 p.m.
SB makes beautifully decorated Gluten-free Casein-free cakes for all occasions, including weddings. Please call SB at (310) 815-1800 for a price quote on a wedding or any other cake you may wish to order.
If you're ordering any baked good other than cake, SB will ship it ivia UPS, ground only, arriving the next day at most any location in California. Or if you are ordering cake from SB, whether for a wedding or other occasion, you'll have to come pick it up in Culver City, California. 'Sounds to me like an errand for the best man. You should place a cake order at least 5 days in advance.
Dr. Erika Schwartz, M.D., holds herself out as an "nternationally recognized physician, expert in conventional and integrative medicine, Dr. Erika is also a well known author, television and radio personality, speaker, and medical advice columnist helping more than ten million weekly readers find their way to wellness and life in balance . . . .
"As a 'Patients Advocate' her guiding principle has been to help protect the public by providing them with sound and unbiased information that makes it easy for people to take responsibility for creating a positive outcome in their health and life.
"Dr. Erika's warm, encouraging, honest and common-sense approach is enhanced by a courageous ability to stimulate discussion and debate with the goal of improving a health system that has failed the individual and is in desperate need of fixing."
This post focuses on one piece of advice proferred by Dr. Schwartz, i.e., "How to Eliminate Wheat?" Like it or not, this is the name she chose to give as the topic of her advice concerning celiac disease and how a person (whom she somehow presumes doesn't have it) can eliminate wheat. To approach to this area of medicine knowledge, she might have named it instead as "What Are the Risk Factors of C.D. or Gluten Intolerance, and How Do I Adopt a Gluten-free Diet Once I've Been Rx'd?"
But Dr. Schwartz uses no such name for her piece of advice on this topic, simply because it appears she doesn't take a knowledgeable approach. Indeed, she only spends 88 seconds in giving this piece of advice (
"The beauty of being young is that our bodies can process and tolerate practically anything. Wheat is among those foods that is all pervasive during our youth, and that we can digest and actually use as nourishment. As we get older, our bodies stop being able to process the wheat. There's a thing called celiac disease, where people cannot tolerate wheat and gluten. But most people don't need to be diagnosed with anything.
"As you get older, your inability to eat and digest and process wheat causes you bloating, discomforting. The waist gets thicker. And you get a lot of bloating and a lot of gas. So the first thing to do is not to run to the gastroenterologist to get a test, but rather eliminate the wheat from your diet. That means: eliminate bread, eliminate pasta, and anything else that has wheat like cereal.
"It's not that dramatic. You can actually eliminate wheat and eat rice bread. Rice bread is really delicious. It's found at the health food stores in the frozen food section, and it doesn't contain wheat or the gluten that makes it so difficult for us to absorb. And you'll feel good and it tastes delicious. Try it."
Perhaps the brevity of the piece of advice would lead one to disregard. "Brevity is the soul of wit," wrote Shakespeare. The point is that in the fast-paced, soundbite media-driven culture in the United States today, an 88-second video can have a lasting impact on the thinking of millions of people, undiagnosed celiacs and gluten intolerants among them. And the impact is especially great, coming from an M.D. who is right in the public spotlight, giving members of the public what I regard as shabby advice:
If anyone among Dr. Schwartz's 10 million weekly readers experiences bloating, gas, or discomfort, or gets a thicker waist, she need not entertain the possibility that she has celiac disease (although it happens to be the most-underdiagnosed disease in the country). Vigilance for this disease is not warranted, simply because it doesn't concern "most people."
Rather, Dr. Schwartz says that if her 10 million weekly readers experience these symptoms, what they need to do is head straight for the health food store, bypassing the gastroenterologist's office, where they might get a test and discover the hard facts about their own health. Just whistle past the graveyard, says this "Patient Advocate" and medical doctor who openly discourages people from seeking medical care.
May I please ask if you perform a biopsy on yourself after every meal with McDonald's French fries? Regardless of the existence or nonexistence of other symptoms, there is no "individual physiology" that allows the body of anyone with celiac disease to tolerate gluten, such as that contain in McDonald's French fries:
"Potatoes, vegetable oil (canola oil, hydrogenated soybean oil, natural beef flavor [wheat and milk derivatives]*), citric acid (preservative), dextrose, sodium acid pyrophosphate (maintain color), salt. Prepared in vegetable oil ((may contain one of the following: Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness), dimethylpolysiloxane added as an antifoaming agent). *
"CONTAINS: WHEAT AND MILK (Natural beef flavor contains hydrolyzed wheat and hydrolyzed milk as starting ingredients)."
I would like to invite you to join Gluten Free Fresno, a Yahoo! group at http://health.groups.yahoo.com/group/glutenfreefresno/ . If for some reason you choose not to join, please feel free to visit any time.
But my point is that since 1950, long before today's gluten-free fad, it's been known that the gluten contained in wheat, barley, rye, and sometimes oats is what triggers celiac, which is not a rare disease.
You're most welcome! I'd like to clarify my comment about the list of celiac symptoms in today's N. Y. Times article. Of course, if there's any chance a person has celiac, the person should be screened for the disease, defined as the gluten-induced destruction of the upper gut's villi--regardless of the presence or absence of any other symptoms.
As I reflect on the N. Y. Times's task to educate the public with this article, some words of John Dewey came to mind, and I'd like to share them: "Education is a social process. Education is growth. Education is, not a preparation for life; education is life itself."
On one hand, the obvious reason we like a list of celiac symptoms being at least as long as in today's article, is, hopefully, to lead the reader to stop and think if s/he or a friend should be screened for it. On the other hand, a list so long gives the reader the impression that the disease does not (usually) have a silent presentation. It's fairly typical, however, that it only presents with iron-deficiency anemia and possibly an intolerance to dairy products. Thus, the complexity of this disease may stir a conflict in people's minds.
"Conflict is the gadfly of thought. It stirs us to observation and memory. It instigates to invention. It shocks us out of sheep-like passivity, and sets us at noting and contriving. Not that it always effects this result; but that conflict is a 'sine qua non' of reflection and ingenuity." (Dewey)
Well, stepping back for a moment, why would someone care to learn the material in an article like that in today's New York Times? Because doing so is "a social process . . . growth . . . life itself." It's also a concrete act in pursuit of our aspirations as human beings. Turning to Dewey again, "We cannot seek or attain health, wealth, learning, justice or kindness in general. Action is always specific, concrete, individualized, unique."
So, the individual reader may wonder how celiac can present with so many unpleasant symptoms in one patient and so few in another. "The symptoms of celiac disease can vary significantly from person to person" (N. Y. Times). People are by nature social, and will express concern for one another, comparing notes about health. But without a firm understanding of this disease, such sociability can interfere with making the determination that someone is a candidate for screening. "We can have facts without thinking but we cannot have thinking without facts." (Dewey)
Indeed, "[t]his is part of the reason the diagnosis is frequently delayed. For example, one person may have constipation, a second may have diarrhea, and a third may have no irregularity in stools" (N. Y. Times). This is an example of variability in GI symptoms. I'd hasten to add that it may or may not present with variable symptoms in the nervous, reproductive, and cardiovascular systems.
Though the list of symptoms is daunting, I certainly hope New York Times readers are taking this article seriously, and do not dismiss it as some sort of scare tactic. I've noticed that people who are newly informed about celiac will at first feel puzzled over its multifarious symptoms, which can cause real alarm in some people. To respond to such alarm, they then look for a simple way to understand the disease. "Arriving at one goal is the starting point to another." (Dewey)
Unless falling prey to the mistaken notion that the disease is rare, they'll quickly come to an understanding of its trigger, gluten. At this juncture, they are puzzled again because no other disease has diet as its treatment per se. And, no other autoimmune disease has a known trigger. I think it's worthwhile to counsel people when they've been introduced to these facts, which give a simple way to understand celiac that their minds may be naturally be longing. And I'd like to point out that even though these are well-established scientific facts, it's perfectly okay to be skeptical at first. "Skepticism: the mark and even the pose of the educated mind." (Dewey)
But, whether they've heard of the Atkin's diet, Oprah's cleansing diet, or the recent gluten-free fad, people new to celiac may then be prone to repeat whatever stuff they've heard about gluten. "Genuine ignorance is profitable because it is likely to be accompanied by humility, curiosity, and open mindedness; whereas ability to repeat catch-phrases, cant terms, familiar propositions, gives the conceit of learning and coats the mind with varnish waterproof to new ideas." (Dewey)
In our media-saturated culture, I don't think we should be surprised if someone new to celiac spouts references to low-carb diets or Oprah's diet. Perhaps one way to counteract this saturation is to warmly acknowledge some good exists in these fads. Then, someone who still wants to learn about celiac but is repeating catch-phrases, cant terms, or familiar propositions may be politely confronted with the question: Is Oprah, the late Dr. Atkins, or low carb mentioned anywhere in this New York Times article? If s/he seriously wants "health, wealth, learning, justice . . . kindness," the answer must be no. You may want to give a further response as follows, or in abbreviated form:
Thank you for answering no. That's an honest answer. Celiac has been carefully studied by scientists for 17 centuries--long before Atkins and Oprah, though I'd like to say she's also done some good work in publicizing the facts about this disease, which I'm afraid to say are massively misunderstood or unknown.
In the late second century, A.D., Galen, the Roman physician Galen, named the disease celiac, a word that originally meant
Unfortunately, the awkward-sounding name of the article is not its only problem: Well, it may be true that celiac is "most common in Caucasians and those of European ancestry" ; but it's important (for journalists and publicists) to drive home the point that this disease affects people of all wheat-eating countries:
"[T]oday it is well known that celiac disease is a common disorder not only in Europe but also in populations of European ancestry (North and South Americas, Australia), in North Africa, in the Middle East and in South Asia, where until a few years ago it was historically considered extremely rare."
(S. Accomando and F. Cataldo, Dept of Pediatrics, Univ. of Palermo, Palermo, Italy. "The global village of celiac disease" in Digestive and Liver Disease, vol., issue 7, July 2004, pp. 492-498.)
In my opinion, however, an outstanding part of this article comes under the heading, Symptoms. It may not actually be a complete list of symptoms; for I recall that over 300 have now been found. But the list is long enough to give the reader the impression that this disease truly is a chameleon, and deserves serious attention!
I think that Josh simply likes to drink barley-based "light" beer and doesn't really believe what he's saying. He points out that the fact of distilled vinegar being harmless to celiacs was at one time unknown; but we know it's since been studied by GIG and others and found to be safe for us, so we know we may consume it. But we can't say the same about barley malt in the "light" beer which Josh drinks, hoping it will also be found safe, though he says he doesn't mean to encourage any of us to follow suit. Former USDA research scientist Donald Kasarda made these remarks, to which a resourceful Forum member gave me the hyperlink:
"We know from work described in the scientific literature that relatively small polypeptide chains can still retain activity in celiac disease and we know something about a few sequences that seem to be harmful. But we probably dont [sic] know all the sequences that are harmful and we havent [sic] put our fingers on the common theme that gives rise to the activity in celiac disease. So the question arises as to whether or not the remaining sequences in malted barley are harmful."
( http://www.celiac.com/articles/187/1/Celia...ture/Page1.html )
Kasarda then offers three possible scenarios wherein barley malt, under varying conditions, may or may not be harmful to the celiac. He doesn't rule out the possibility that it could.
Well, I don't think there's truly a lack of civility on the part of those who've questioned Josh's judgment on this particular matter, or any need to apologize to him for doing so.
Now, what kind of responses to this did you really expect to those of us in this Gluten Free Forum, Josh? Condonement of your penchant for drinking "light" barley beer? I don't think so, dude. For the sake of your good health, man, check out New Grist or Red Bridge. These beer brands do cost a lot more than Bud Light; but you may recoup this investment in your good health with the cost in future medical bills you might incur, not to mention the pain and agony of complications--which I, confidently speaking for everyone else, sincerely wish on no one!
Mountaineer Josh writes: "You do realize there are varying degrees of the disease right? Look at the literature."
As another person wrote, "just because you don't notice a symptom doesn't mean there isn't one present." Antibodies come, and antibodies go. They're like a snapshot of what's going on with the autoimmune system. So, the IgA tTGA test is a quick, affordable means of determining compliance with the gluten-free diet; but its results are not an absolute certainty. The more expensive upper GI biopsy is the real way to know the effects of celiac disease because it actually examines the destructive effect of the disease where it begins occurring.
As far as the "degree" of a disease goes, I suppose a cancer patient could deliberately expose his body to carcinogens because his disease appears to be in remission and has not (yet) metastasized. Perish the thought!Why, the very notion that it's okay for a celiac to deliberately consume some gluten, especially when gluten-free options are available!