Against the Grain

Longtime readers of this column know that I'm a big fan of eating whole grains as part of a healthful, balanced diet. But that's not always so easy. There are some people--most of them of European ancestry--for whom many grains are dangerous. Their body can't tolerate a protein called gluten that's found in wheat, rye and barley. For reasons that aren't clear, their immune system responds to the presence of gluten in the diet by attacking the small intestine. Gluten sensitivity can lead to severe malnutrition, and appears to increase the risk of certain cancers.

Now comes word that this condition, known as celiac disease, may affect the brain as well. In a study published in the journal Neurology, Dr. Marios Hadjivassiliou and his colleagues at the Royal Hallamshire Hospital in Sheffield, England, found that a wheat-free diet dramatically reduced the number of debilitating headaches suffered by some of their gluten-sensitive patients. MRI brain scans suggest that gluten somehow triggered an inflammatory response in the white matter of the cerebrum.

It was a small study, and it has yet to be reproduced. But the Neurology report underscores an important point about celiac disease: its symptoms can be unpredictable and may mimic those of other disorders.

Fortunately, doctors have developed reliable tests to diagnose the illness. The presence of several key antibodies in the blood provides one important clue. The clincher is an endoscopic examination of the small intestine that reveals damage wrecked by a runaway immune system.

Although celiac disease is a hereditary disorder, it can strike at any time, starting in childhood. "The first peak occurs at one to three years of age," says Dr. Marvin Ament, a pediatric gastroenterologist at UCLA. "Typically, within six months after the introduction of cereals [to an infant's diet], you'll see a change in the stools. There's progressively more diarrhea, and you'll notice that the growth rate starts to slow." Other peaks occur just before puberty and in the 40s.

Adults often exhibit a much wider range of symptoms. They may or may not have diarrhea. Frequently they become anemic, because their intestine can't absorb much iron. Complicating the diagnosis is the fact that many symptoms of celiac disease are seen in other illnesses, such as Crohn's disease, ulcerative colitis, diverticulosis or intestinal infections.

If you are found to suffer from gluten sensitivity, you'll soon discover that it's difficult to adopt a gluten-free diet. The protein is widely used as a thickener in soups, canned vegetables and other processed foods and often contaminates products made with oats. It also takes a while to get used to bread baked with flour made from rice, soy or potatoes (none of which contain gluten).

Whatever you do, don't assume that you can reliably diagnose the condition yourself. "We get calls all the time from people who have been gluten-free for six months or a year and now wonder if they have celiac disease," says Sue Goldstein, founder of the Westchester Celiac Support Group in New York. By then, diagnosis is very difficult; the telltale antibodies will have disappeared, and the intestinal biopsy may not show anything wrong. You may even have to re-expose yourself to wheat--and get sick again--to prove that your gut instinct was right.

For more info, search for "celiac" at www.niddk.nih.gov . E-mail Christine at gorman@time.com