Welcome to Part 2. In Part 1 we briefly noted that celiac disease (CD) is an autoimmune condition. The immune system in a person with active CD will damage  the lining of their small bowel in such a way that they have markedly reduced capacity to absorb nutrients. This unfortunate response is triggered by the presence of gluten in their diet.

Actually many celiacs report that any other form of contamination causes problems, even from sources not considered 'dietary'. For example, using gluten containing lipstick is well known to be a problem, as minute amounts do find their way into the mouth and are swallowed. The strictest vigilence is required to avoid gluten and it is quite amazing to discover just how many products contain traces of gluten.

One thing that must be mentioned relates to rice. Rice contains a form of gluten that is quite different from the dangerous type for celiacs. If you see rice labelled as 'glutenous' just remember that it is not a problem. Other products labelled as containing gluten however, must be avoided by people with CD.

I was prompted to write this two part article, as the title suggests, because of concern at the quality of advice being given to celiacs from some health professionals. As a celiac myself, with a celiac daughter, and with many years experience helping other celiacs, I am quite certain about which foods contain dangerous gluten. To suggest that I am disappointed when other health professionals give poor advice, whether Harvard professors qualified in gastroenterology or well profiled naturopathic physicians as mentioned in Part 1, would be to put it far too mildly. Perhaps if they had more intimate experience with the condition they would demonstrate wiser counsel and greater empathy.

So, what is this dangerous gluten? Gluten is a form of protein found in wheat, rye, oats, barley, and triticale (which I classify as wheat). The component of gluten that causes problems for people with CD is the prolamine fraction. The prolamine fraction in:

• wheat is called gliadin
• rye is called secalin
• oats is called avenin
• barley is called hordein

A person with CD should avoid any foods that contain gluten. It is important to read the labels of all packaged or prepared foods. Some foods that commonly contain gluten include:

• Meat products - any products prepared with breadcrumbs or batter, most sausages and other processed meats (including smallgoods), thickened soups, meat pies and frozen meals.
• Dairy products - malted milk, some flavoured milks, soft cheeses, cheese spreads, icecream in a cone, many custards.
• Fruits and vegetables - canned and sauced vegetables, textured vegetable protein (found in some vegetarian products) and fruit-pie filling.
• Cereal and baking products - wheat, wheaten or unspecified corn flour, semolina, couscous, wheat bran, barley, oats, porridge, breakfast cereals containing wheat, rye, oats or barley, corn or rice cereals containing malt extract, icing sugar mixtures and baking powder.
• Pasta and noodles - spaghetti, pasta, lasagne, gnocchi, hokkein noodles, soba noodles and two-minute noodles.
• Bread, cakes and biscuits - all bread, cakes and biscuits prepared with flours that contain gluten, including communion hosts.
• Condiments - malt vinegar, many mustards, relishes, pickles, salad dressings, sauces, gravy and yeast extracts.
• Snacks - liquorice, some lollies and chocolates, packet savoury snacks, and some flavoured potato and corn chips.
• Drinks - cereal coffee substitutes, milk drink powders, beer, stout, ale, guinness, lager many soymilks.

The above is obviously by no means a comprehensive list. I recommend you do a Google search for "celiac support groups" and explore a few until you are satisfied that you know where to obtain the information you need. Joining one is a good idea because CD can present challenges at times and such groups can be very helpful indeed.

Remember, even tiny amounts of gluten can cause harm. When the lining of the small intestine is damaged, nutrients are poorly absorbed. Untreated, this can result in a range of disorders such as those mentioned in Part 1. Many people who know they are celiacs ignore their diets and choose to tolerate the symptoms or mask them with various drugs. This is quite dangerous. The symptoms of celiac disease are similar to those of other disorders, but may include:

• Anaemia
• Digestive upsets, such as flatulence and bloating
• Diarrhoea or constipation
• Nausea
• Vomiting
• Abdominal pains and cramps
• Weight loss
• Fatigue and generalised malaise.

Many people who treat themselves with over-the-counter products or who have been mis-diagnosed by their doctors, spend a large amount of money in attempts to overcome one or more of the symptoms listed above. If CD is the real problem then full and lasting relief will only be obtained by complete avoidance of gluten.

It is important to read the labels of all packaged or prepared foods. Increasingly around the world packaged foods have ingredient labels that indicate when products contain gluten. The gluten may be in the product as part of an intended ingredient or it may be there due to contamination from the processing method. Be wary of ingredients such as starches, thickeners and maltodextrin, which could be wheat based.

Naturally gluten free foods include corn (maize), rice, soy, potato, buckwheat, millet, quinoa, lentils and amaranth. Foods labelled 'gluten free' generally have to meet a standard that applies in the particular area in which they are sold. Become aware of the standard in your area if you have CD because it may not be entirely safe (fortunately this problem is quickly improving). Despite the restrictions, a person with CD can still enjoy a varied and healthy diet.

The cause of CD is unknown, but there appear to be both genetic and environmental factors involved. There is no cure, but the disease can be managed by lifelong adherence to a strict gluten free diet. A strict gluten free diet allows the microscopic, finger-like projections of the small intestine (villi) to recover and return to normal absorption of nutrients. The wellbeing and effectiveness of your bowel is possibly the single most significant contributor to your state of health, whether you have celiac disease or not. Learn to take care of your bowel and you will enjoy immense benefits: ignore it at your peril.