FrankenWheat

There are parts of this article that are over the top. Among other things, there isn’t generally gluten in vodka (distillation removes the heavy proteins) nor is there gluten in envelope adhesive. However much of it is quite true. The wheat we eat now bears little resemblance to the wheat we have eaten for most of our history — and even that wheat is a relatively recent introduction to the human diet.

I do want to note the distinction he makes in the article about modern wheat being more likely to trigger celiac disease. That does not mean older wheat is somehow safe for celiacs to eat. The autoimmune disease doesn’t work that way. Once triggered, any gliadin based gluten will trigger an autoimmune response. But we have so many more with celiac disease today because the disease is now triggered much more often than it was even as recently as the 1950s.

I also like the way he stresses the fact that gluten-free processed food is still bad for you. Do I indulge at times? Sure. And it shows in my weight gain over the past three years as I’ve come to terms with this disease and struggled to adapt to an entirely different way of eating. Too many people today seem to assume that simply removing gluten by replacing foods with gluten-free junk food is all you need to do. It isn’t.

My wife actually forwarded me the above article and even though she doesn’t have active celiac disease, she’s now considering going gluten-free herself. She already has auto-immune issues and, since her husband and two younger children do have active celiac disease, it’s not really a stretch for her. She would just have to stop eating gluten when she goes out to eat. Pretty much everything in our house and every meal is already gluten free.

Thoughts from anyone? Should those without a diagnosed problem with gluten but with other potentially related health issues consider going gluten free? Heck, should everyone start avoiding FrankenWheat?

Mama Fu’s

Mama Fu’s is a restaurant I had seen on a number of local gluten free restaurant lists for years, but had never visited. We recently watched the release of Titanic in 3D (which was fun) and happened to be near one of the local restaurants and decided to give it a try.

Chinese and Asian restaurants where we can safely eat are few and far between. Most soy sauce is fermented with wheat and soy sauce tends to be everywhere in an Asian restaurant. There’s Pei Wei and PF Chang’s, of course. And there are higher end local restaurants like Uchi’s (which is really more Japanese). But the options are pretty limited.

Their gluten free guide contains a note that not all locations outside Texas have the gluten free sauce, so check first if you live in another state with a Mama Fu’s.

The food was decent. I wouldn’t call it great, but it was pretty good and as far as my daughter and I could tell it was safe. Neither of us got noticeably sick, anyway. And it was reasonably quick, convenient, and not too expensive. I got what was listed on the menu as one of the spiciest dishes and found it somewhat bland personally. But then, I tend to like spicy things.

So if we’re out doing something and need to go grab a bite to eat somewhere, Mama Fu’s definitely makes the list of options.

King Arthur Gluten Free Bread Mix

I never thought a great deal about bread before I was diagnosed with celiac disease. We would sometimes make homemade bread. I would buy different sorts of bread, especially freshly baked bread. I loved bread, but I didn’t realize how pervasive it actually is. We use it to make lunches. We have it on the side. We use it as the foundation to some dishes on our plates. Bread is everywhere. And bread is one of the main things that simply doesn’t normally work the same without wheat flour.

We like Rudi’s and Udi’s, especially for ease and convenience when making lunches for work or school. But sometimes we want a little more. My wife has always been a better baker than me (and used to make killer sourdough), but while she has learned to bake almost everything gluten free from scratch, she hasn’t yet tackled bread from scratch.

We have, however, tried a number of different bread mixes. Most of the ones we’ve tried have been decent. Some have had a complex flavor I enjoyed, but none of them produced a good, all-purpose loaf with that freshly baked flavor and which also holds together when making and eating a sandwich. None of them, that is, until we tried King Arthur’s Gluten Free Bread Mix.

We had always like King Arthur’s flours in the past and so we were happy to hear the news when they began to move into the gluten free area. (As far as all-purpose flour goes, though, we still think Jules is the superior gluten free flour.) So we tried their bread mix. It’s fairly straightforward to prepare, rises well, and produces a delicious loaf which is good for many purposes, but definitely makes great sandwiches. And it produces the same results consistently every time. (We’ve noticed that’s not always the case with gluten free mixes.)

I definitely recommend this product. You won’t be disappointed.

Prayer, Evil, and the Nature of Things

A post about prayer on the blog, Permission to Live, kicked the wheels of my mind into gear and started it whirling. As my mind peeled back layer upon layer, I quickly realized I couldn’t really say anything meaningful in a comment. But in this case I also realized I did want to write something on the topic. The post in question actually touched on a number of areas, but I’ll primarily focus my thoughts on the purpose of prayer and the deeper question of why God does not prevent evil things from happening to people who do not deserve it and allows good things to happen to the wicked. Obviously, those are topics that can’t possibly be addressed in a blog post. The Library of Congress would not suffice.

When I try to express thoughts in areas like these I particularly feel the need to state up front that the things I say will of necessity be incomplete. I have to discuss God, but God is greater than me in such a way that no analogy, no description, no words could ever truly describe him. My mind and imagination are insufficient to the task, but they are the tools I have. So the reality is always far greater than anything I can understand or say. Please keep that in mind and try to work with my imagery rather than against it — at least for the short time that you are reading this post.

Before we can move to a discussion of prayer on a topic this deep, we have to begin with the nature of things from a Christian perspective. The fundamental division of reality lies between the uncreated and the created. Only the Father, the Son, and the Spirit can be placed in the category of uncreated. Everything else that exists is a creation of God. Moreover, God created all things good. Nothing was created evil. (Elizabeth Esther actually just posted on the innate goodness of human beings.) It’s important to grasp this fundamental Christian tenet since it runs directly counter to the narrative of some religions — both ancient religions and present day ones.

When we acknowledge that truth, something should immediately stand out. There is no place in those divisions for evil. This is one of the thoughts behind my recent post on evil as mystery. Evil is not uncreated; the only uncreated is God. Moreover, all created things are created by God and are created good. Part of the mystery of evil is that it cannot be said to have the same sort of existence as created things. In fact, it almost has to said to have no existence in the sense that creation exists. Yet evil is palpably real. So what then is evil? That’s the question to which we have to turn.

One of the aspects of creation is its freedom. There is a randomness woven into the fabric of created things that seems to provide the framework within which, for example, human freedom can exist. While that provides the basis from which we can exercise our free will and creative abilities and thus have the potential of truly being in the likeness of God, it’s not limited to humanity. That element of freedom is woven into the fabric of created things by a God of overflowing love. And that freedom is, as part of creation, also an innately good thing.

Such freedom does introduce a certain wildness into creation — even absent the influence of man. I think people often particularly misread the second creation narrative in Genesis. The garden cannot represent some idyllic, perfect unfallen reality. There was already a wilderness outside the garden into which the man and the woman could be banished. I tend to think of the image of the garden in terms of a nursery. It was a place of few challenges in which the man and the woman could learn to fulfill their created function.

And what was that function? At least part of it was to order the wildness and randomness of creation. Some of that can be seen in the act of naming (though that bit also has other meanings) since names are powerful. It’s also seen in God’s command to them. A part of our natural function is also to act as priests in creation, offering it back to God in Thanksgiving. In this sense, Jesus commanding the storm, healing the sick, and feeding the many displays his true humanity at least as much as his divinity. Yet, the story of the garden illustrates that even in the safest possible nursery environment with only a single ascetic challenge, we still do nothing but turn away and hide from God. Read the story. Man accomplishes nothing in the garden but sin. From the time we were able to lift our heads above the animals, we have turned away from God.

And that provides our first clue into the nature of evil. Evil is an aberration, a distortion, of that which was created good. It flows from the freedom instilled in creation when that freedom is turned against God. (It wouldn’t be freedom if that capacity did not exist. And if it exists, it happens.) We could ask why God then created such freedom, but that strikes me as a futile question. Any such reality we could imagine would be incredibly diminished. Beauty flows from that freedom. Love flows from it. I don’t see how a God of overflowing love could have created anything less.

Yes, I’m sure God knew from the beginning that evil would flow from the fabric of such a creation. That’s why we have the apocalyptic image of the Lamb slain before the foundation of the world. God knew and was planning to rescue and complete his creation from the start. In that respect, creation is not simply something that happened in the past. Creation continues to happen every time the darkness is pushed back even a little, every time evil is transformed into good, every time love conquers. Creation is the ongoing process of renewing all things.

So what then is prayer? It seems to me that many Christians today reduce prayer to little more than intercessions. While that’s an aspect, I don’t believe it’s the central purpose of prayer at all. What is our truly human created role and responsibility in creation? Humanity was created to be the ruling, royal priesthood of our world. We were to order creation and offer it back in thanksgiving to God. (There is much that could be pursued from the Eucharist beginning as bread and wine rather than wheat and grapes, but I’ll set that aside for now.) First and foremost, prayer is our direct connection to God. And it’s in and through our communion with God that we order time and the rest of creation.We are created for communion with God and prayer is an expression of that communion.

Of course, even most of us who are Christian do not live in constant, unceasing prayer. I don’t think most of us regularly or ever recognize the extent of our culpability in the evil of the world. We are not isolated individuals. We were created not only for communion with God, but for communion with each other. As such, we share a common nature and bond with each other and with the created world we are intended to rule. It’s through that shared nature that the work of Jesus is efficacious. He became one of us in every way, sharing the fullness of our common nature, and by doing so he redeemed us and defeated death on our behalf. And by healing the human nature Jesus also completed all that was necessary to heal and redeem the whole created order.

But therein lies the rub. The evil we do spreads to others and to the world in ways we do not always directly perceive. As we particularly see in Romans 8, creation itself groans beneath that weight. When we turn away from God, we turn energies shared in the human nature to evil. By our own acts, we have contributed to the evil others experience and to the evil others do. I rarely hear of a crime or evil act and think to pray for the way my sin contributed to it. We deny our interconnectedness or we embrace only the positive and personally beneficial aspects of it. But to the extent we have each done evil, we have contributed to the evil of humanity and the world.

Finally, we are also instructed to pray for intercession, especially for others. And God sometimes intercedes. God miraculously heals a person. God protects an innocent in desperate need in a manner that offers no easy explanation. And yet many other people die despite many intercessions. Children suffer. Not everyone is healed. Not everyone is protected. All of this is true. And sometimes Christian attempts to explain this truth away do more harm than good, I think, especially when they try to call evil something sent by God or something that was really somehow “good.” Evil is evil and it is not of God. Our hearts look on evil and cry out, “Why?”

This is where I try to remember that God is not willing that any perish, that God is actively working for the salvation of all. I remember that God is constantly turning evil into good. I think of Joseph, who is certainly a type of Christ. Great evil was done to him again and again and God did not stop it. But Joseph did not despair. Joseph did not curse God.  And ultimately he could tell his brothers that God had taken their unquestionably evil act and turned it into a tremendous good. That’s the gospel of Christ prefigured. Jesus suffered in every way we suffer. He endured torture and execution under supremely unjust and evil conditions. Jesus absorbed the worst that evil could do and defeated evil and death on behalf of us all.

I believe God perceives all possible outcomes of every decision and every interaction. Reality is not static, so there is no single path. I tend to think of a bubbling stew, though that’s a weak analogy. It has states of being that are fluid and change. And the freedom of creation, especially our freedom, has immense value. Even in those times when God has blocked a human action, he has not blocked the intent or the effort to perform the act. God does not make human beings less than they were created to be. (Though it must be said we tend to do that ourselves.) And from all the stories I’ve read throughout Christian history, it’s rare even for God to so physically restrain someone from acting.

God is always working for our salvation — the salvation of every human being. And God is always working to transform evil into good. But he does not reach into our being and restrain our hearts from working evil. I believe God intercedes or doesn’t according to those goals and more. Other influences are the prayers of the communion of the saints. As the evil we do works its tendrils into the fabric of reality in ways we can’t perceive, so our prayers permeate creation. Either the things we do accomplish something or there is no point doing them.

It’s not an answer that explains. As one who has suffered evil and seen those I love suffer evil, I don’t think it’s something that can be explained. But I trust reality is at least somewhat like what I’ve described. We can’t avoid choosing a narrative framework and a perspective on reality. Of all the ones I’ve explored or held over my life, the Christian narrative offers the best lens through which to understand the nature of things. I’ve encountered this strange God, but even if I hadn’t I would want to believe this framework over the alternatives.

We cry, “Lord have mercy!” And he does.

One Year Gluten Free

It’s been roughly a year now since I was diagnosed with celiac disease and began a gluten free diet. It was quite a shift at first, but it’s almost become second nature now. I read the ingredients on everything I pick up and am still sometimes surprised. Just the other day my wife was making a Thai sauce when she noticed that the container of peanuts said it could contain wheat. (She noticed before she added them.) Who expects to find wheat in peanuts? Such is life these days.

We don’t go out to eat that often anymore, and when friends or family want to meet at a restaurant, I tend to skip the food and stick to coffee if it’s not a place I already know. It’s surprising how often food is involved when people gather for any reason, business or social. Whole foods are the safest at such gatherings. I always look for the raw vegetables, though I skip the dipping sauces that typically come with them.

It’s not been as difficult for me in many ways because I’ve always liked vegetables of different sorts, even as a kid. And many of my favorite dishes were already rice, bean, or lentil based and required little, if any, adjustment. The transition has also been easier since both my wife and I can really cook. I’ve always been grateful to my Dad for teaching me how to cook, but never more so than this past year. And my wife has been amazing. She was a little overwhelmed at first, but adapted quickly and has since become quite an accomplished gluten free chef. I know that a lot of people in our modern world never truly learn how to cook for a wide variety of reasons. But if your lifestyle and eating habits revolve around dining out and eating packaged, processed food, I’m not sure how you could make this particular transition. At the very least, it would have to be a lot more challenging than it has been for us.

Business travel remains a challenge. Fortunately, I don’t have to travel very often and I typically have plenty of advance warning when I do, so I can do research and plan how I am going to eat. It’s almost like putting together a battle supply plan in unfriendly territory. I know the stores, restaurants, and other resources in the Austin area pretty well. It’s much more of a challenge in an unfamiliar place. Moreover, the worst time to make yourself sick would be when you are traveling, so I tend to be especially conservative about what I eat when I’m on the road.

My family has also pretty thoroughly adjusted. Even though I’m the only one who has to eat gluten free, we don’t make separate meals for me. So much of what we eat at meals does not contain gluten. On my last business trip, my wife asked the kids if there was anything they had missed and would like for meals while I was gone. They couldn’t think of anything.

I feel better than I’ve felt in years, even if I’m still a long way from healed and healthy at this point. I’m not thrilled at all the doctors I’ve acquired over the past few years. I was used to having only one whom I saw infrequently. That’s not only no longer the case, it’s unlikely to ever be the case again. I’ve landed in a new phase of life.

Now that I’ve made the transition to life as a celiac and am feeling better, it’s time to start trying to get back into some kind of shape. I’ll make that my goal for this next year.

Baptists, Eucharist, and History 15 – Irenaeus on Christ’s True Flesh

We’re going to examine most of Chapter II, Book V, Against Heresies in today’s post. Before we start, I will note that Irenaeus is refuting a specific group of those who held that our corruptible flesh is incapable of incorruption and resurrection. This was likely one of the gnostic groups, but I’m struck by the similarity of this issue to the one Paul faced in the Church of Corinth and which built up to the magnificent 1 Corinthian 15. The group Paul was addressing had no problem believing in the specific resurrection and glorification of Jesus. Rather, they did not believe our corruptible bodies would be resurrected. Irenaeus seems to be refuting a similar line of thought.

But vain in every respect are they who despise the entire dispensation of God, and disallow the salvation of the flesh, and treat with contempt its regeneration, maintaining that it is not capable of incorruption. But if this indeed do not attain salvation, then neither did the Lord redeem us with His blood, nor is the cup of the Eucharist the communion of His blood, nor the bread which we break the communion of His body. For blood can only come from veins and flesh, and whatsoever else makes up the substance of man, such as the Word of God was actually made. By His own blood he redeemed us, as also His apostle declares, “In whom we have redemption through His blood, even the remission of sins.” And as we are His members, we are also nourished by means of the creation (and He Himself grants the creation to us, for He causes His sun to rise, and sends rain when He wills). He has acknowledged the cup (which is a part of the creation) as His own blood, from which He bedews our blood; and the bread (also a part of the creation) He has established as His own body, from which He gives increase to our bodies.

Basically, if our bodies cannot attain salvation, if they are not capable of incorruption, if they will not thus be resurrected, then the Lord did not redeem us with his blood, the cup is not the communion of his blod, and the bread is not the communion of his body. All of that comes only from a body like ours. Jesus, the Word of God, acknowledges the cup as his blood and establishes the bread as his body. And through both, he nourishes our body and our blood.

The interesting thing again here is that as Irenaeus makes his argument he simply assumes that everyone knows the Christian confession is that the wine and bread of the Eucharist are the body and blood of Jesus. I’m not sure, in our modern era, that the import is immediately obvious. St. Irenaeus, Bishop of the Church in Lyons, one-time student of St. Polycarp, who in turn learned from St. John and who was martyred, writing specifically against a raft of heresies the Church faced, apparently does not imagine and has not encountered any group that does not know that the Christian confession is that they consume life in the form of the body and blood of Jesus in the Eucharist. He assumes everyone knows that point.

When, therefore, the mingled cup and the manufactured bread receives the Word of God, and the Eucharist of the blood and the body of Christ is made, from which things the substance of our flesh is increased and supported, how can they affirm that the flesh is incapable of receiving the gift of God, which is life eternal, which [flesh] is nourished from the body and blood of the Lord, and is a member of Him?—even as the blessed Paul declares in his Epistle to the Ephesians, that “we are members of His body, of His flesh, and of His bones.” He does not speak these words of some spiritual and invisible man, for a spirit has not bones nor flesh; but [he refers to] that dispensation [by which the Lord became] an actual man, consisting of flesh, and nerves, and bones,—that [flesh] which is nourished by the cup which is His blood, and receives increase from the bread which is His body. And just as a cutting from the vine planted in the ground fructifies in its season, or as a corn of wheat falling into the earth and becoming decomposed, rises with manifold increase by the Spirit of God, who contains all things, and then, through the wisdom of God, serves for the use of men, and having received the Word of God, becomes the Eucharist, which is the body and blood of Christ; so also our bodies, being nourished by it, and deposited in the earth, and suffering decomposition there, shall rise at their appointed time, the Word of God granting them resurrection to the glory of God, even the Father, who freely gives to this mortal immortality, and to this corruptible incorruption, because the strength of God is made perfect in weakness, in order that we may never become puffed up, as if we had life from ourselves, and exalted against God, our minds becoming ungrateful; but learning by experience that we possess eternal duration from the excelling power of this Being, not from our own nature, we may neither undervalue that glory which surrounds God as He is, nor be ignorant of our own nature, but that we may know what God can effect, and what benefits man receives, and thus never wander from the true comprehension of things as they are, that is, both with regard to God and with regard to man. And might it not be the case, perhaps, as I have already observed, that for this purpose God permitted our resolution into the common dust of mortality, that we, being instructed by every mode, may be accurate in all things for the future, being ignorant neither of God nor of ourselves?

So we’ve not found any historical evidence to date for the modern Baptist view, the 1689 London Confession, and Zwingli’s view. In fact, the ‘mere symbol’ (or even not-so-mere) approach seems flatly contradicted. The above also seems to specifically negate Calvin’s idea of a purely “spiritual meal”. Irenaeus rejects the idea that when Paul speaks of us as members of Christ’s body he is speaking in a purely spiritual sense. And he grounds that rejection in part in the Eucharist.

Outback

Tonight after watching Harry Potter 6, my family and I decided to try the Outback Steakhouse for dinner. They are one of the chains that have a gluten free menu. Still, I wasn’t sure what to expect. But I needn’t have worried. The words, “I can’t eat wheat. I have celiac” were barely out of my mouth when the waiter interrupted, “You need the gluten free menu.” I said yes. Exactly. It’s always a relief when I get better than a blank stare. When I ordered, our waiter made a point of telling me he would double-check with the manager to make certain that what I had ordered was safe for me to eat and that he would make sure to let the kitchen know so nothing got accidentally contaminated.

Wow!

That’s the level of service, knowledge, and concern I had previously only associated with premium restaurants like Flemings and locally owned non-chain restaurants. I liked Outback somewhat before my diagnosis with celiac. My opinion of them just went up several notches. Needless to say, we will be going back. Definitely impressed.

Taste of Ethiopia

My wife, our law school son, and I headed to Taste of Ethiopia for lunch. None of us had had any prior experience with Ethiopian food, but the reviews were enticing. This restaurant is truly a dining jewel hidden away in a corner of a strip mall here in our own town of Pflugerville. If you live here and have not yet eaten here, you need to correct that omission as soon as possible.

We were met by the owner, Woinee Mariam, as we entered. My wife and I got the coffee while our son got the spiced iced tea. Since this was lunch, Woinee explained, it was not the full coffee service, but the coffee was still amazing. As a big poster declares, coffee truly is Ethiopia’s gift to the world. Apparently, in the full evening coffee service, Woinee will roast, grind, and brew the coffee in the traditional way. (Actually, I’m not sure if she does that at the restaurant or not, since it would certainly take time. But I’m anxious to find out!)

I then explained to Woinee that I had celiac and couldn’t eat wheat, barley, or rye. While not exactly an allergy, for practical purposes it can be treated that way. She said that her daughter can’t eat gluten or dairy, so she understands the diet. And she makes everything herself, so she knows exactly what is in it. Unfortunately, the injera (ethiopian flat bread) they typically make does contain wheat, so I couldn’t have any. However, Woinee said that if I call three days in advance, she can ferment the teff and make traditional gluten free injera for me! Wow! Obviously, that’s now high on my list of dining plans. I can’t wait!

I had the Doro Wat with rice (since I couldn’t have the injera). The chicken fell off the bone. The hardboiled egg was delicious. And the sauce was absolutely wonderful. I thought I would start with what is considered the national dish of Ethiopia for my first visit and it lived up to the reviews in every way.

My wife and son got the vegetarian lunch buffet. Woinee wouldn’t let them get forks! She came over and walked them through how to unroll and tear of pieces of injera and pick up and eat the food using the injera as their only utensil in the traditional Ethiopian manner. They tried some of everything and cleaned their plates – picking up all the food with their fingers.

At one point an older gentleman who was eating when we arrived left and Woinee ran out the door to ask him if he wanted some water to go. She came back in to get it for him and told us he was working outside and it was too hot not to have water. That sort of individual care and attention characterizes her approach to everyone. It’s as though we were guests in her home. When Woinee found out that our son was in law school, she gave him a big hug and told him that he must be very smart and a hard worker to be doing that.

If you live here and you’ve never eaten at Taste of Ethiopia, 1466 Grand Avenue Parkway, Pflugerville, TX, then go. You won’t regret it.

What Is Celiac Disease?

Update 10/12/2009: The Gluten-Free Doctor has posted just about as comprehensive a list as I can imagine of the possible symptoms of celiac disease.

Given that I often have and will refer to celiac disease on this blog, I realized I should write a post that explains the disease. I know that prior to my diagnosis I had a number of misconceptions and it’s likely, if you’ve heard of the disease at all, that you do as well. Everything I write here is based on my best current understanding, but that certainly doesn’t mean there won’t be some errors in what I write. As I discover any potential errors, I will update this post so it remains as accurate as I can make it. There are actually a variety of terms used to refer to celiac and “celiac” is not actually the most medically accurate. However, it is the common term and the one I will use on this blog, so I won’t bother going through all the possibilities.

First, I think I need to clarify what celiac is not, since this is the area where I was most confused prior to my own diagnosis with the disease. Celiac is not an allergy nor is it an intolerance. An allergic reaction, for instance to wheat, is your body’s mistaken immune system response to a substance that is actually harmless. Your body creates antibodies that attach themselves to the molecules of the substance and then floods your system with histamines to cause other cells to attack the substance. An allergic reaction can create a wide array of symptoms, but subsides when the allergen is removed or antihistamines take effect. As long as you stay away from the allergen there is no further long term effect. The amount of allergen that triggers an allergic reaction will also vary from individual to individual and may change over time. It is even possible for people, especially children, to grow out of an allergy.

A food intolerance (gluten intolerance, lactose intolerance, etc.) occurs when your body is unable to metabolize a particular food. Typically a food intolerance will produce a lot of gastrointestinal symptoms, but as long as you don’t eat the food in question you’re fine. Even if you do eat the food in question, you only have to deal with the immediate short-term result of your decision or mistake.

Celiac disease, on the other hand, is an autoimmune disease.  If you aren’t familiar with that category of disease, that means that your body’s immune system inappropriately attacks itself. With celiac, we know that the inappropriate immune system response is a response to gliadan, a protein in the gluten molecule which is found in wheat, barley, and rye (and cross-breeds and other related grains). We do not know what activates the disease in those with the appropriate genetic makeup. From what I have read, it appears that the disease will never activate in about one-third of those with the genetic markers. And there is apparently no way to predict the age at which it will activate in those who have it. This is actually something of a blessing, though. As far as I can tell, this is the only autoimmune disease with which we actually know the trigger for the inappropriate immune system response. With celiac, if you remove gluten, you send the disease into full remission.

The direct effect of celiac is that your immune system attacks and damages the villi in the small intestine that have absorbed the gluten you’ve ingested. The villi are tiny hair-like tissues (described as something like a shag carpet in the intestine) that absorb the nutrients from the food we ingest. As they are blunted and flattened, your small intestine loses its ability to absorb nutrients. Over time, that will lead to the malabsorption of food and nutritional deficiencies. I know I have struggled with calcium deficiencies in the past, in retrospect probably as a result of celiac disease. Despite both medication and altering my diet, I’ve also remained severely deficient in the “good” cholesterol, again likely as a result of celiac. It was when I became anemic, though, something which is highly unusual in an otherwise fairly healthy middle-aged male, that the warning flags went off for my physician and the sequence of events that led to my diagnosis (fortunately only one month later) began. In my case, when the EGD and endoscopy were done, the first part of my small intestine looked completely pink and smooth like tiles, not like a shag carpet at all. Clearly, I had been suffering from celiac for a long time, probably a decade or more.

However, that is not the end of it. Since celiac is an autoimmune disease, it also does not respond immediately to the removal of gluten from your diet. Most people begin to feel better in days or weeks, and I have begun to feel better in areas unrelated to digestion. However, it usually takes about six months for your immune system to return to normal as determined by blood tests. And it takes from six months to two years for the damage to the small intestine to heal. Basically you stop eating all gluten and in a few weeks you’ll begin to feel better. Maybe in a year you’ll be well. That aspect of the disease is a little frustrating to someone like me who, at the time of this writing, is still in the early stages of recovery.

Also since it is an autoimmune disease, if someone with celiac does not stop eating all gluten they have an increased likelihood that their malfunctioning immune system will trigger another autoimmune disease such lupus, thyroid disease, type 1 diabetes, liver diseases, or rheumatoid arthritis. Celiacs also have an elevated risk of developing gastrointestinal cancers. Celiac may also cause neurological damage and is hereditary. It’s a nasty disease and the consumption of as little as an eighth of a teaspoon of gluten (1/1000 of a slice of bread) is sufficient to keep it active if you continue to ingest that small amount each day or even several days a week. The occasional accidental ingestion of a small dose, which will happen despite your best efforts, won’t significantly affect the health of most people. It’s not like a severe allergy where even a tiny exposure can cause shock and death. But it is imperative that any ongoing exposure to gluten be eliminated.

Recent rigorous clinical studies have demonstrated that 1 out of every 133 Americans suffer from celiac disease. It is hereditary, so first degree relatives of a celiac are much more likely, about 1 in 22, to have the disease. That makes it comparable to type 1 diabetes in prevalence. However, the vast majority of those with celiac, perhaps as many as 90% are currently undiagnosed. Why? Because until things get really bad, for a lot of people celiac doesn’t have a lot of clear and overt symptoms. (And there is still a fair level of ignorance or misinformation in the medical community as well.) That was certainly true for me. Looking back, my digestion has probably been a little off for a long time, but no serious pain or anything that pushed me to think something was wrong. I  have had a lot of symptoms that are not digestive tract issues but which are directly related to celiac. I just didn’t know the various disparate symptoms were even related to each other.

This is a list of some of the symptoms that could indicate celiac disease:

• anemia
• autoimmune disorders
• behavioral changes (think depression, mental fogginess, irritability, inability to concentrate, etc.)
• bloating and gas or abdominal distention
• bone or joint pain
• changes in appetite
• chronic diarrhea
• colitis
• collagen vascular disease
• constipation
• dermatitis herpetiformis (skin rash)
• delayed growth in children and delayed onset of puberty
• dizziness
• easy bruising
• failure to thrive in infancy
• fatigue and lethargy
• fibromyalgia
• hair loss
• headaches
• hypoglycemia
• hyposplenism
• increased risk of infections
• infertility and miscarriage
• iron deficiency
• irregular or speedy heartbeat
• lactose intolerance
• liver disease
• lupus
• lymphoma
• malnutrition
• missed menstrual periods
• mental fogginess
• muscle cramps
• nausea
• vomiting
• neurological problems (schizophrenia, ataxia, epilepsy, etc.)
• nosebleeds
• osteoporosis or esoteopenia
• pale, foul-smelling, bulky, and/or fatty stools that float
• pale skin
• seizures
• short stature
• shortness of breath
• Sjogren’s syndrome
• some intestinal cancers
• thyroid disease
• tingling or numbness in the hands and feet.
• tooth discoloration or dental enamel defects/loss.
• type 1 diabetes
• ulcers inside the mouth
• vitamin or mineral deficiency
• weight loss or weight gain

There are now blood tests that will detect the antibodies (and probably other markers – I haven’t studied the details of the three blood tests in the panel) associated with celiac disease that can be used to screen for the disease and to monitor progress on a gluten free diet post-diagnosis. An endoscopy of the upper portion of the small intestine remains the certain form of diagnosis. The damage to the villi is not always visually evident like the damage to mine was, particularly if the person has not had the disease for very long. But it will show up in the biopsy.

That’s a quick intro to celiac disease based on what I currently understand about the disease. For a more detailed look into the history of celiac disease, recent studies and developments, and future research directions, watch the following presentation by Alessio Fasano, MD, the founder of the Center for Celiac Research at the University of Maryland.