Stomach Pain in a Slice of Bread: Gluten Is a Quiet Culprit

Since high school, 38-year-old Oakland resident Laura Linden experienced chronic, mysterious stomach pain. It became gradually worse over the years. A couple of times, while the doe-eyed blond was an undergrad at UC Davis, the pain got so bad that she took herself to the emergency room. Once, she overheard a health worker remark that she probably had an eating disorder.

Nothing was further from the truth. Although Linden ate a lot, she could never accumulate much more than 110 pounds on her five-foot-four-inch frame. She figured the cause of her malaise was in her blood. As a kid, she'd watched her mom pop Rolaids like candy. "I used to think to myself, 'Yeah, if you cut up my mom's veins there's probably chalk inside," she joked recently over a bowl of taco salad at a Berkeley raw foods restaurant.

Things got worse for the former journalist about ten years ago. She was exhausted all the time, and had frequent allergy attacks, colds, and sinus infections. Doctors viewed her symptoms in isolation. Sour stomach? Cut out orange juice and coffee. Sinus infection? Here are more antibiotics. But her constant sickness took its toll.

"I kind of knew something was wrong with me," Linden recalled thinking. "But at the same time, I also kind of bought this idea that maybe it was just me, maybe this was how it was supposed to be, or maybe I'm a stress case or something like that."

Her health deteriorated further a few years ago, as she attended grad school at the University of Arizona. Finally, Linden went to a campus doctor complaining of fatigue and a bad cold. After a series of tests, the results were clear: Linden had celiac disease, an autoimmune disorder that prevents the body from processing gluten, a protein found in wheat, barley, and rye. She had never heard of it before.

The doctor's prescription: a gluten-free diet for life.

That might have seemed daunting, but Linden was overjoyed. "I just cried!" she said. "I couldn't believe it 'cause I didn't really think that there was a thing that I was going to stumble across that was going to make me better."

As her gastroenterologist probed into her past, he found more than a few indications of the disease, such as the wart-like growths she would get in the corners of her mouth in junior high -- a sign of malnutrition. But up until that point, doctors never thought to screen her for celiac. "It's not like I had cancer or I was bleeding to death, so there's nothing very obvious," Linden rationalized.

These days, she hardly resembles the sickly girl she describes. She still has some digestive problems, but her weight is back up -- "probably more than I want it to be," she said -- along with her energy. She even works out at the gym these days.

Linden never suspected something as seemingly innocuous as bread could make her sick. Yet foods containing wheat, rye, or barley prompted her body to attack itself. Her own antibodies would inflame and damage the tiny, finger-like villi in her small intestine. The absence of these nutrient-absorbing structures explained why Linden was malnourished and often doubled over in pain.

She was one of the lucky few to be diagnosed. Researchers believe millions like her still suffer needlessly.

Chances are you know someone who has celiac, but even better that they don't know it. Although the numbers vary, researchers estimate that celiac affects about 1 in 133 Americans, and that a staggering 97 percent are undiagnosed. A large-scale study in 2003 estimated there were about fifteen thousand diagnosed celiac patients. This year, that number is expected to exceed one hundred thousand, said Michelle Pietzak, a pediatric gastroenterologist, assistant professor of clinical pediatrics at USC's Keck School of Medicine, and one of the authors of the 2003 study.