Food allergies force some to give up the bread of life

By Amy Olson

Wednesday, August 13, 2003 8:58 AM CDT

For years, Carol Fenster suffered from chronic sinus problems and never knew the cause.

"I always felt like I was coming down with a cold" that never really developed, she said.

Finally, a co-worker who experienced similar symptoms urged her to visit an ears, nose and throat doctor. After a thorough check up, Fenster said the physician told her her sinuses were functioning normally and sent her to an allergist, thinking she might have a food allergy.

"I was very resistant," she said. "I ate everything."

So in 1988, when she was diagnosed with being intolerant to gluten a protein found in wheat, she said she was elated to finally learn what was causing her problem. As long as she avoided wheat-based products, she would not suffer sinus headaches or laryngitis or have to take doses of antibiotics.

The Nebraska-born woman who'd married into a wheat-farming family said her euphoria lasted until she went into kitchen to make the next meal.

"We're in an environment saturated with wheat," she said.

That's when she realized she'd have to revise her entire cooking repertoir.

Realizing there were few resources available to people like her, Fenster decided to put her home economics background to use, experimenting with recipes and "unlearning everything" she had learned about cooking from the time she was a small girl. From those experiences were born Savory Palate Inc., her publishing and consulting business based in Centennial, Colo. Her fourth book, "Gluten Free 101: Easy Basic Dishes Without Wheat," was published earlier this year.

Fenster is not alone. An estimated 10 percent to 15 percent of the U.S. population has problems digesting gluten, which is found in wheat and related grains such as barley, rye, spelt, kamut and triticale.

Allergies, gluten intolerance and celiac disease

There are three major types of conditions associated with wheat: wheat allergies, gluten intolerance and celiac disease.

Dr. Giana Nicoara, an allergist at All Saints Health Care in Racine, said only 1 percent to 2 percent of the population has a true food allergy.

"They're not as common as people think," Nicoara said.

Allergies to foods like milk, eggs and wheat are most common in infants and toddlers and tend to develop when adult foods are introduced too early. Introducing solid foods before a child is 6 months old � especially when there is a family history of food allergies � increases the chances of having eczema, Nicoara said.

In adults, the most common allergenic foods are tree nuts like walnuts, peanuts, fish and shellfish.

Those who are allergic know almost instantaneously because they will have a systemic reaction, break out in hives and experience difficulties in breathing, among other symptoms. Intervention with medication from an EpiPen (a syringe containing epinepherine) can give people enough time to get to a hospital for treatment.

While most children will outgrow their allergies by the time they enter school, adults with food allergies typically have them for life.

Though only a small percentage of the population has true food allergies, millions more have food intolerances, where symptoms reduce one's quality of life with annoying � but rarely life-threatening � symptoms like headaches, nasal congestion, rashes and stomach aches, Fenster said. Those symptoms can make life miserable, but for the most part they can be avoided by not eating products that contain the offending protein.

Somewhere between allergies and intolerances is celiac disease, or sprue, which afflicts more than 2 million Americans and is considered the nation's most commonly inherited autoimmune disorder. Fenster said celiac disease affects more people than Parkinson's and multiple sclerosis, which have gained more recognition with the general public.

"It's the common disease no one knows about," Fenster said.

Once believed to be rare, one out of every 133 Americans is believed to have celiac sprue. Just one in 4,700 people have been diagnosed, however. It tends to affect people of European descent more than other races.

According to the National Institutes of Health, it takes an average of 10 years for someone to get diagnosed as having celiac sprue.

Part of the reason is that doctors don't look for the disease unless a patient complains of chronic diarrhea and extreme weight loss. Most celiac sufferers experience a broader category of symptoms.

Some never have gastrointestinal problems like stomach pain, diarrhea or bloating, but they experience problems with anemia, muscle cramps, fatigue, bone or joint pain, seizures, tingling in the legs from nerve damage, painful rashes called dermatitis herpetiformis or missed menstrual periods.

In infants, delayed growth and development, failure to thrive and irritability can be signs of celiac sprue.

The damage to intestines isn't caused by gluten itself, but rather the body's reaction to the protein.

Celiac sprue is an autoimmune disease in which the body's own immune system attacks the small, finger-like protrusions in the small intestine called villi. Those villi absorb nutrients from food and channel them into the bloodstream.

Getting a diagnosis of celiac sprue early is critical to avoiding other serious health complications. Nicoara said continuing to eat gluten can increase the risk of gastrointestinal cancers 40 percent more than the average population; it can also increase risk for cancers such as lymphoma.

Relearning how to cook

Ironically, people often crave the very foods that make them sick or feel bad.

"It gives us a momentary high," Fenster said, even though those with gluten intolerances or celiac disease pay the price afterward.

She recalled how she once ate a bagel, loaded with cream cheese.

She picked the biggest one she could find, knowing if she was going to cheat, she might as well do it right.

"I was euphoric," Fenster said. Not long afterward, however, she began to feel terrible.

Carlyne Klein, a dietitian who runs Echo Services in Burlington, said a diagnosis of gluten intolerance or celiac disease means a patient has to eliminate all wheat-based products from the diet.

"It's probably one of the most difficult diets around," Klein said. "That pretty much takes out all the complex carbohydrates."

Avoiding gluten can be tough. Products like hot dogs, medications and even soup can contain wheat. When eating out, items not containing gluten like steak can inadvertently be contaminated if they are grilled in the same place where garlic bread is toasted.

Klein said even products like Ovaltine and instant coffee can contain wheat.

Alcoholic beverages such as beer, malt liquor, whiskey and gin are also on the list of drinks to avoid; other alternatives like fruit drinks, teas, regular coffee, soda, saki, cognac, tequila or anything made from grapes or potatoes are OK.

With products like wheat and oat cereals containing gluten, breakfast can be an especially tough meal for those with gluten intolerance. Klein said rice or corn cereals are OK.

Other foods can contain hidden flour or wheat-based products as well. Sausages and luncheon meats spreads can contain gluten; Klein said any product with a label that indicates a product contains hydrolyzed protein should be avoided.

Even commercially prepared soups, salad dressings, ketchup, soy sauce and packaged potato products like scalloped potatoes can contain wheat, which is used as a thickener.

"You have to read labels," Klein said.

Eating out or having a meal at the home of a relative or friend can be challenging too.

Fenster said she's turned more and more to cooking at home to avoid encountering hidden sources of gluten.

Klein said the best thing a cook can do for a gluten-intolerant guest is to call ahead and ask what the guest is able to eat.

"It's better than presenting something in front of them that they can't eat," she said.

The Associated Press contributed to this report.

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