Some people react with dramatic symptoms to a component in wheat and other grains. Others don't even realize their health is being compromised.

A few years ago, Mary, a 45-year-old researcher, developed abdominal bloating and itchy blisters on her legs. Danielle, the one-year-old daughter of pro football quarterback Rich Gannon, experienced such extreme diarrhea that she became dangerously ill. Yvonne, a 37-year-old website designer, had her long-unexplained iron deficiency anemia turn so severe that she became pale and short of breath, with curled-up fingernails.

Different people, different symptoms, but each had the same underlying condition behind their health problems: a sensitivity or intolerance to gluten.

Gluten is a gluey collection of proteins found in wheat, rye, barley, oats, spelt, kamut, triticale and an endless variety of processed foods. Eliminating gluten from the diet isn't easy, but it's the nutritional solution for anyone with gluten sensitivity. It makes the difference between good health and poor health and sometimes between life and death.

Gluten sensitivity includes a wide variety of immune system reactions to gluten. Unfortunately, the only type of gluten sensitivity recognized by conventionally trained physicians is the most severe type, celiac disease - a condition in which the body reacts so strongly to gluten that it begins to destroy the lining of the small intestine, thereby causing malabsorption of nutrients. To be diagnosed with celiac disease, a person has to have high levels of antibodies to gluten in his blood and damage to his intestine detectable on biopsy.

Gluten sensitivity more common than once thought
Until recently, celiac disease was believed to be very rare, occurring in only 1 in every 4,850 Americans. It was characterized by its "classic" symptoms-bloating, diarrhea, acute abdominal pain, fatty stools, and often weight loss.

Increased research in the area and newly developed blood screening tests have led to shocking revelations. First, celiac disease is very common: it's found in 1 in every 167 healthy children in the United States and 1 in every 111 healthy adults.¹

Second, many people who have the disease, especially most children, don't have classic celiac gastrointestinal symptoms and some don't have any symptoms at all. These people have "silent celiac disease"-a condition in which all of the damage to the small intestine normally found in classic celiac disease is present without any obvious symptoms. As a result, many people go for years (sometimes decades) not being diagnosed while health complications worsen, says Alessio Fasano, M.D., co-director of the Center for Celiac Research at the University of Maryland. The first indication of trouble may be finding out they have anemia, osteoporosis or some type of autoimmune disease.

But classic celiac disease and silent celiac disease form just the tip of an iceberg of illness provoked by gluten. Ten to 25 percent of Americans have gluten sensitivity detectable in their blood: they test positive for antibodies to gliadin, the key protein fragment celiacs don't tolerate,² but don't test positive to more definitive tests for celiac disease, such as the anti-tissue transglutaminase (anti-tTG) antibody blood screening test and an intestinal biopsy. Non-celiac gluten sensitivity can provoke ailments such as gastrointestinal complaints, malabsorption, chronic neurological disorders, frequent headaches of unexplained origin, psoriasis, and some cases of a gluten-dependent skin condition called dermatitis herpetiformis.³

Harder-to-detect gluten sensitivity may affect even more than 25 percent of the population. A few years ago, Kenneth Fine, M.D., a gluten sensitivity researcher and director of the Intestinal Health Institute in Dallas, Texas, saw that many people who seemed to be intolerant to gluten didn't always have high levels of antigliadin antibodies in their blood. Fine suspected that these antibodies should be detected more frequently in the stool than in the blood because the immune reaction to gluten begins in the intestinal tract. He followed up on this idea, developing a gluten sensitivity stool test and testing more than 500 people with it. Based on this test, 1 in 3 asymptomatic people, and 1 in 2 symptomatic people, have gluten sensitivity. Those that remove gluten from their diets experience improved health and psychological well-being.⁴

The picture that emerges is that people don't go from perfect health to end-stage celiac disease overnight. Gluten sensitivity is a disease process that can take decades to develop.

Most physicians don't recommend a gluten-free diet until a diagnosis of celiac disease is made. However, waiting until people have damage to their intestine is "ludicrous from a health perspective," says Fine. "That's like saying nothing should be done to protect against heart disease until people have a heart attack."

Determining gluten sensitivity as early as possible is the best policy to prevent serious disease. People who have gluten sensitivity can develop celiac disease in the future and an undiagnosed celiac who continues to eat gluten is at greatly increased risk for intestinal lymphoma⁵, autoimmune diseases⁶, and bone diseases such as osteoporosis.⁷

To help detect gluten sensitivity and celiac disease, most doctors perform anti-gliadin and anti-tTG antibody blood screens. Anti-gliadin antibody stool tests, though, appear to be more sensitive for picking up earlier, hidden stages of gluten sensitivity. If you have any type of unexplained illness that hasn't responded to many types of treatment, it's a good idea to have one of these tests.

You also can try a gluten-free diet for a week or two and see if you feel better. The big drawback to this approach is if you have silent celiac disease: you probably won't feel much of a difference on a short gluten-free diet and may continue eating gluten. Then you'll be at risk for serious health complications.

Eating gluten free
When a gluten-free diet is strictly followed, longstanding health problems clear up, intestinal lesions heal, and the risks for intestinal cancer, autoimmune diseases and osteoporosis in gluten-sensitive people normalize. If gluten is added back to the diet, health complications return. Avoiding gluten, therefore, is paramount for good health.

But many gluten-sensitive make the mistake of substituting too many non-gluten grains (rice, corn, millet, buckwheat, quinoa, amaranth and teff) and sugars in place of gluten grains. This can lead to carbohydrate sensitivity and conditions such as Syndrome X and type II diabetes. To prevent the development of a new health problem, emphasize vegetables, such as salad greens, broccoli, green beans and asparagus, in place of gluten grains.

It's a good idea to supplement with a multivitamin/mineral supplement, but be sure to get one that is specifically labeled gluten-free. If you have celiac disease, work with a nutritionally oriented health professional who can evaluate nutrient deficiencies and recommend the nutrient supplements and dosages you specifically need.

Supplements are helpful, but nothing can take the place of eating against the grain. Yvonne at one time took nine iron supplements a day and her blood iron levels barely registered! Within a year on a gluten-free diet, her anemia was reversed-proof positive that diet is the key.