“Gluten-free” foods are available in supermarkets more than ever before, thanks to increasing awareness of celiac disease.

In the United States, about one out of every 130 people has celiac disease – an autoimmune disorder triggered by the consumption of gluten.

Gluten is the protein part of wheat, rye, barley and triticale. When someone with celiac disease eats anything containing gluten, the immune system reacts abnormally because it identifies gluten as a foreign substance. This reaction causes inflammation and damage to the small intestine, and interferes with the absorption of nutrients.

Celiac disease is not an allergy to gluten – people can grow out of allergies. Rather, it’s an autoimmune disease that you can’t grow out of. It can appear at any time in a person’s life, and may be triggered by surgery, a viral infection, severe emotional stress, pregnancy or childbirth.

For many people with celiac disease, the time between the onset of the symptoms and diagnosis may be long. Celiac disease is commonly misdiagnosed as irritable bowel syndrome, gastric ulcer, Crohn’s disease or a parasite infection.

Typical symptoms of celiac disease include ongoing diarrhea or constipation or both, bloating and abdominal discomfort. Celiac disease should be suspected in children with stunted growth, pale appearance, irritability, potbelly, flat buttocks and/or foul-smelling stools.

Other symptoms of celiac disease include iron deficiency anemia, irritability, depression, fatigue, weight loss, canker sores in the mouth, joint pain, muscle cramps, and tingling in the hands and feet. Many of these problems result from vitamin and mineral deficiencies, because nutrients are not well-absorbed in the small intestine.

Some people with celiac disease have a blistering, intensely itchy skin rash – most often seen on the elbows, knees and buttocks – called dermatitis herpetiformis. This rash, with small clusters of red bumps, may or may not be associated with intestinal symptoms, but the treatment is the same.

The risk factors for celiac disease include a family history of celiac disease, autoimmune diseases such as diabetes and thyroiditis, and some genetic problems such as Downs syndrome and Turner syndrome.

To diagnose celiac disease, the first step is a blood test, looking for specific antibodies. If the antibody tests are positive, the next step is an endoscopic small bowel biopsy to confirm the diagnosis and assess the damage in the lining of the small intestine.

Once the diagnosis of celiac disease is made, the treatment is straightforward: complete exclusion of gluten from the diet. People living with celiac disease must completely avoid wheat – including farina, graham flour, durum, semolina, einkorn, Kamut, spelt, matzo meal and farro – rye and barley. There are no medications for celiac disease.

Once people with newly-diagnosed celiac disease start a gluten-free diet, they start feeling better within days.

Although the treatment is straightforward, it is not easy to stick to a gluten-free diet. Gluten is used as a protein filler in products such as sausage, soup, gravy, soy sauce and ice cream. Pizza, croutons, crackers, pasta, bread, most cereal, cookies, cakes and pies are all off-limits. Gluten is also used as a binder in some pharmaceutical products.

It’s not a matter of just decreasing the amount of gluten in the diet – it must be completely eliminated. Even trace amounts of gluten can cause intestinal damage in people with celiac disease.

Possible long-term complications of celiac disease include infertility, increased risk of miscarriage, osteoporosis, intestinal lymphoma and bowel cancer.

Some with celiac disease also become lactose intolerant, meaning they can’t digest the milk sugar found in dairy products.

Amaranth, buckwheat and quinoa are gluten-free grains, but they can be contaminated with gluten-containing grains during harvesting and processing. Flours made from rice, soy, potato and corn are gluten-free. Oats are gluten-free, but there is some controversy about whether or not they are safe. Oats are likely to be contaminated with wheat, and some people with celiac disease and dermatitis herpetiformis also react to a substance in oats. Be sure to look for “gluten free” labels.

People living with celiac disease must learn to read food labels to look for gluten-containing ingredients.

It’s a challenge to stick to a gluten-free diet when eating out. Try to find restaurants that understand your need to avoid gluten, get to know the staff and patronize them often.

If you have celiac disease, reach out and connect with others in your area and talk to grocery stores and restaurant owners about the importance of having gluten-free options available.

Kathryn B. Brown worked as a registered nurse and a nurse practitioner before going to work for the East Oregonian. She can be reached at kbbrown@eastoregonian.com.