Celiac disease occurs in 5-15 percent of offspring and siblings of a person with the disease. In 70 percent of identical twin pairs, both twins have the disease. Family members should be tested, even if asymptomatic. Family members who have an autoimmune disease are at a 25 percent increased risk of having celiac disease.
Gluten is a protein that celiac patients cannot tolerate and which causes intestinal damage if ingested. Main sources of gluten are wheat, barley and rye, grains included in many foods, making a gluten-free diet an everyday challenge.
The cause of celiac disease, also known as celiac sprue or gluten sensitive enteropathy, is still a mystery. It is not a food allergy, but an autoimmune disease, meaning the body attacks itself. While people with food allergies can sometimes grow out of them, those with celiac disease have it for life.
When individuals with celiac disease eat gluten, the tiny hair-like projections in the small intestine that absorb nutrients from food known as villi are damaged. Damaged villi do not effectively absorb basic nutrients and, in some cases, water and bile salts. Left untreated, damage to the small bowel can be chronic and life threatening.
Celiac disease can appear at any time in a person's life. In adults, the disease can be triggered after surgery, viral infection, severe emotional stress, pregnancy or childbirth. Symptoms vary and are not always gastrointestinal. Symptoms can mimic other bowel disorders.
Infants, toddlers and young children with celiac disease may exhibit growth failure, vomiting, bloated abdomen, behavioral changes and a failure to thrive. Some long-term conditions from untreated celiac disease are iron deficiency anemia, early onset osteoporosis or osteopenia, Vitamin K deficiency associated with risk for hemorrhaging, vitamin and mineral deficiencies, central and peripheral nervous system disorders, pancreatic insufficiency, intestinal lymphomas and other gastrointestinal cancers and gall bladder malfunction.
The only treatment of celiac disease is a lifelong gluten-free diet. When gluten is removed, the small intestine will heal and overall health improves. Adapting to a gluten-free diet requires lifestyle changes. It is essential to read labels and to learn how to identify ingredients that may contain hidden gluten. Even small amounts of ingested gluten can cause health problems.
Fresh fruits, vegetables, beef, chicken, fish, lamb, pork and dairy products are naturally gluten-free. But, Lavoie said even products labeled wheat-free might not be gluten-free. She said there are terms such as kamut, wheat flour, malt extracts, starch and uncertified oats that are red flags.
"Unless it is certified gluten-free, it can be cross contaminated," Lavoie said. "There are recognized companies, Bob's Red Mill, Udi's and Bisquick, to name a few that sell gluten-free products.
Allowed grains and flours are rice, corn, soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, flax, and nut flours. A physician or dietician should be consulted before including oats in the diet.
Wines and distilled alcoholic beverages and vinegars are gluten-free. Beers and malt vinegars made from gluten-containing grains are not distilled and thus not gluten-free, though gluten-free beers are available in the United States.
Eileen Behan, a registered dietician at Exeter Hospital, through the Core Physician Group, has written several books on family nutrition. She said following a gluten-free diet has gotten easier.
"In the early 2000s, the Centers for Disease Control took a look at the prevalence of celiac disease," Behan said. "They found it was much higher than previously believed. As a result, in 2004, labeling laws were passed that require gluten to be listed if it's not obvious."
Most retailers now offer clearly marked gluten-free products, including granola bars, cereals and breads.
"They are more expensive," Behan said. "And eating out can still pose problems. There are some restaurants now, like the Common Man and Flatbread in Portsmouth that offer gluten-free choices. Mexican restaurants can be a good choice as they are more often corn-based."
Breads are the hardest products to find, Behan said, adding Philbrick's Fresh Market in Portsmouth offers a variety of gluten-free breads and other foods.
"Celiac patients must also be aware that gluten can be used as filler in some prescription and over the counter drugs," she said. "Ask your pharmacist. Also, for Catholics, the host bread is an issue. Some churches are offering a gluten-free version, but you need to ask for it."
Even restaurants with gluten-free menu items raise concerns due to the risk of cross-contamination, said Lee Appel of Rye. Food must be stored separately and prepared away from other meals. Appel is a member of the Seacoast Celiac Sprue Disease Support Group. She became involved when her son, Mark Stanchfield, was diagnosed. He was born with Down syndrome and celiac disease is a fairly common ailment associated with Downs.
"Mark passed away four years ago but I stay involved as a legacy to him," she said. "I act as an advocate for people who have questions or are newly diagnosed. It is a great place to make friends with people who have something in common."
The Seacoast Celiac Sprue Support Group meets bi-monthly, on the third Thursday. It also holds periodic Celiac Awareness Day at Philbrick's Fresh Market.ates are affected. Recognizing this, the food industry is stepping up to the plate. 
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