Twenty-five years ago the only gluten-free bread came in a can and was so hard it could have doubled as a weapon. Today even Betty Crocker has a line of gluten-free cakes and brownies, and there's a gluten-free superstore online (www.thegfreview.com; click store).

All the ``gluten-free'' labeling may leave you thinking you should avoid gluten, which is a type of protein found in wheat, rye and barley. In fact, for 99 percent of the U.S. population, it's a healthful, well-tolerated part of most whole grains.

It's a different story for the 1 percent who have celiac disease, an autoimmune intestinal disorder. When they consume gluten, the surface of the small intestine becomes inflamed and flattened. The most common symptoms are gastrointestinal -- diarrhea, flatulence, bloating -- but they can include chronic fatigue, joint pain, migraines and swelling of the hands and feet.

Besides the discomfort, celiac sufferers experience vitamin and minerals deficiencies that can lead to anemia, osteoporosis and neurological disorders.

The wide array of symptoms complicates diagnosis. A blood test for an antibody called Immunoglobulin A (IgA) is a first step, but only a biopsy of the small intestine is definitive.

Treatment is a gluten-free diet, and that means much more than eliminating bread. Gluten pops up in the most unexpected places, from beer to blue cheese, soy sauce and mustard powder. If you are newly diagnosed, studying ingredient labels should become second nature.

It's a good idea for most everyone with celiac disease to see a registered dietitian at least once for help choosing foods that won't make them sick and will provide adequate nutrition.

Registered dietitian Shelley Case has written a valuable reference, Gluten Free Diet (Centax, $26.95). For local support, contact GlutenFreeSouthFlorida@yahoogroups.com.

Sheah Rarback is a registered dietitian and on the faculty of the University of Miami Leonard M. Miller School of Medicine. Her column runs every other week.

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