The next time a waiter puts a basket of fresh bread on your restaurant table, think twice before you eat it. Experts believe that at least one out of every 100 American adults has celiac disease, a condition that can make sufferers ill after eating even a single slice of bread. The culprit is gluten-a type of protein found in wheat, barley, rye and, in some cases, oats that creates an autoimmune, inflammatory reaction in the small intestine. The usual symptoms are bloating and diarrhea, but some people also experience abdominal pain and/ or constipation. In some cases, celiac disease causes only a blistery, itchy skin condition (dermatitis herpetiformis) or fatigue.

If you think you might have celiac disease, discuss it with your doctor. A diagnosis requires specific blood tests and, in some cases, an intestinal biopsy. If you do have celiac disease, your medical doctor will tell you to completely avoid gluten. This may sound like hard work, since gluten is in all sorts of things you might not suspect, such as many kinds of soy sauce, creamed soups and salad dressings. But it is definitely doable and gets easier as you learn where gluten-free products (even bread and pasta) are available--for example, in many health food stores and a growing number of restaurants.

Payoff: Once you start avoiding gluten, your celiac symptoms will disappear over a period of weeks and months. Other steps to consider....

  • Take supplements. Inflammation in the small intestine interferes with the absorption of key nutrients. I advise my celiac patients to take a daily regimen that includes 5 mg of folic acid...800 international units (IU) each of vitamins E and D...25,000 IU of vitamin A ...and 2 mg of vitamin K.

*To minimize inflammation, follow the dietary advice indefinitely and also continue to take the vitamin supplements to guard against a nutritional deficiency.

Note: Vitamin K supplements should be avoided by patients taking warfarin (Coumadin) or another blood thinner. I also recommend taking a botanical formula that contains one or more of these herbs in powdered form)-deglycyrrhizinated licorice root, slippery elm and marshmallow root. Follow label instructions and take until inflammatory bowel symptoms abate.

  • Eat healthful fats daily and fish twice a week. Olive oil, avocado, soy milk and small portions of unsalted nuts (eight to 12) are good sources of healthful fat. (However, celiac patients should avoid peanuts, which can be hard for them to digest.) Fatty fish, such as salmon or halibut, is an easily digested protein source.

Warning: In people with celiac disease, high-fat dairy products, as well as fried foods, tend to worsen diarrhea.

  • Use plant-based enzymes. Enzyme supplementation helps break down food and reduces post-meal bloating. Plant-based enzymes (available at natural food stores) are usually derived from pineapple or papaya, and they are safe for just about everyone unless you have ulcers or you are allergic to pineapple or papaya.

Typical dose: Take one or two capsules per meal.

  • Get support. Avoiding gluten isn't easy, but you'll feel much better if you do. For more advice, consult the Celiac Sprue Association/ USA, 877-272-4272,

Biofeedback May Relieve Constipation

Biofeedback—which helps the mind to control involuntary body processes, such as blood pressure can help with constipation if it is caused by rectal spasm or spasm of the pelvic muscles. In these cases of dyssynergic defecation—when muscles responsible for bowel movements don't work well due to a failure to relax pelvic floor muscles—biofeedback can retrain muscles to push more effectively. There is as yet no home-based biofeedback programone is under development.

To find a doctor who works with biofeedback: Contact the Biofeedback Certification Institute of America (303-420-2902, www

Other treatments include increasing consumption of dietary fiber...use of beneficial bacteria called probiotics and consuming supplements called prebiotics, which help good bacteria grow to aid digestion. Probiotics and prebiotics are available in health food stores.

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