If you're planning a diner party for family or friends, I wouldn't be surprised if some of your guests have reported they can't eat anything with gluten in it.
And I wouldn't be surprised if you wondered whether these guests are hypochondriacs latching onto the latest dieting fad.
Let me assure skeptics out there that gluten intolerance is indeed real. I know because I'm a gastroenterologist who treats digestive disorders and because I personally suffer from a serious form of gluten intolerance known as celiac disease.
Celiac is an autoimmune disorder triggered by the consumption of gluten -- a protein contained in wheat, rye and barley -- that damages the small intestine and prevents the body from properly absorbing nutrients.
People with celiac are genetically predisposed to their condition and often suffer from gas, bloating and diarrhea, as well as fatigue and weight loss. If untreated, celiac can lead to anemia, osteoporosis and diabetes.
Celiac can lay dormant for many years, without symptoms until later in life. Doctors can determine if someone has celiac with a simple blood test, known as a transglutaminase antibody test, followed by a small intestine biopsy.
The only treatment for celiac is simple: stop eating gluten. That's easier said than done. It's in everything from beer to bread to pasta. It's even added to soup, ice cream and chewing gum as a filler without being labeled.
An estimated 1.8 million Americans suffer from celiac, and 80 percent of those people are unaware they have it. Since celiac symptoms overlap with those of irritable bowel syndrome, some doctors are no doubt treating patients for that when a few of those patients may in fact have celiac disease.
Meanwhile, about 1.4 million Americans are on a gluten-free diet without a celiac diagnosis. In many cases, these people likely fall under the category of non-celiac gluten sensitivity. They find relief when they either go on a gluten-free diet or limit their gluten intake.
The tricky thing about gluten sensitivity is that unlike with celiac, there is no laboratory test to confirm a diagnosis. That's not to say gluten sensitivity isn't real.
Gluten is a complex protein that's not easy to digest and some sensitive people develop bloating and gas from undigested residues that remain in the gut.
But we live in an age where the Internet encourages people to self-diagnose and, in many instances, self-misdiagnose. This is especially the case with gluten intolerance since the cure -- not eating gluten -- doesn't require a prescription from a doctor.
I recommend if you think you are gluten intolerant get tested for celiac and make sure that you really need to go on a restricted diet. At the same time, if you find that you feel better after going gluten-free without a celiac diagnosis, well, it won't hurt to keep doing what you're doing. After all, a gluten-free diet is perfectly healthy even if it's not necessarily the cure to what really ails you.
To view a list of foods that are naturally free of gluten, see: www.fda.gov. Dr. Paul Reif is a gastroenterologist at Contra Costa Regional Medical Center. Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at firstname.lastname@example.org. For more information, go to www.cchealth.org.