DEAR DOCTOR K:

I suffered through years of unexplained gastrointestinal discomfort. My doctor finally diagnosed me with celiac disease. What do I need to know?

DEAR READER:

Celiac disease is an autoimmune disorder that we're just beginning to understand. We've known for a long time that the trigger that sets off symptoms in celiac disease is gluten. Gluten is an umbrella term for the proteins found in wheat, barley and rye.

In people with celiac disease, gluten triggers an immune reaction that causes inflammation of the lining of the small intestine. Left untreated, celiac disease can lead to severe malnutrition. It can put you at risk of serious consequences, including osteoporosis, anemia, infertility, neuropathy (damaged nerves) and seizures. It can produce such profound diarrhea that if celiac sufferers don't get massive amounts of new fluids into their bodies quickly, they can become severely dehydrated, their blood pressure can collapse and they can die.

Some of the symptoms and signs of celiac disease include:

-- gas

-- bloating

-- abdominal cramps

-- diarrhea

-- foul-smelling stools

-- fatigue

-- weight loss

-- canker sores

-- balance and gait problems

-- osteoporosis

-- iron deficiency with anemia

Celiac disease will cause symptoms as long as you continue to eat gluten. Treatment means following a strict gluten-free diet. This will allow your intestines to heal and your disease to be controlled. Any exposure to gluten can trigger a recurrence of symptoms.

Fortunately, food labels increasingly indicate the presence of gluten, which makes it easier to avoid gluten-containing foods. (I've put a detailed list of do's and don'ts for gluten-free eating on my website, AskDoctorK.com.)

A gluten-restricted diet can be challenging, so consider consulting a registered dietitian. Choose one who is knowledgeable about celiac disease. He or she can ensure that your diet contains adequate nutrients, calories, fiber and variety.

You also need to avoid cross-contamination, which happens when a gluten-free product comes into contact with something that is not gluten-free.

Foods and beverages aren't the whole story, either. Medications (both prescription and over-the-counter) as well as vitamins, minerals and other supplements often contain gluten. A pharmacist can tell you which medications contain gluten and advise you on gluten-free alternatives. Gluten is also found in some personal-care products, including lipstick, toothpaste and mouthwash -- even the glue on envelopes.

This may all sound a little overwhelming, but take heart. As long as you follow a gluten-free diet, you will be able to lead a normal life with no further symptoms.

There also is increasing evidence that some people have "gluten insensitivity" but don't have full celiac disease. They, too, feel much better on gluten-free diets. We'll talk more about this in future columns.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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