DEAR DR. DONOHUE: Will you write an article on celiac disease? What causes it? Is there a special diet for it? – A.C.

ANSWER: In the near past, celiac disease was considered a rare bird. It no longer is. More than 3 million Americans have it. And as the illness gains more recognition, more people are diagnosed with it.

It’s not unusual for someone to be tagged with having irritable bowel syndrome and find out, years later, that the illness really is celiac disease.

The troublemaker is a protein found in wheat, barley and rye – gluten. Gluten gives celiac disease one of its other names, gluten enteropathy (enteropathy is an illness of the intestines). In people with a sensitivity to gluten, the protein activates cells of the immune system that attack the digestive lining and interfere with food absorption.

Celiac disease can cause mild symptoms with unexplained weight loss. It leads to early osteoporosis because it prevents calcium absorption. Or it can cause more florid symptoms – bloating, diarrhea, stomach cramps and fatigue.

When symptoms are obvious, the diagnosis isn’t hard to make. When they are less obvious, the diagnosis is often missed. Suspicions about it can be resolved by taking a biopsy of the small intestine and by finding antibodies in the blood that are indicative of the illness.

Diet is the treatment. Elimination of wheat, barley, rye and sometimes oats relieves symptoms and restores health to the digestive tract.

Such a diet isn’t easy. Gluten is found in many foods that people would never suspect have it.

A dietitian should guide celiac patients in learning which foods are acceptable.

The Celiac Disease Foundation provides people with timely information on all aspects of this illness, including diet and new treatment breakthroughs. People can contact the foundation at 818-990-2354 or on the Web at www.celiac.org.

DEAR DR. DONOHUE: My 21-year-old grandson has weighed 130 pounds for the past six years in spite of drinking protein shakes, taking weight-gain pills and eating rich, calorie-laden foods. He is 6 feet 1 inch tall.

Why can’t he gain weight? His self-esteem is zero because of his appearance. He loves to swim but is ashamed to appear in bathing trunks.

A doctor told him to live with it. Is that the answer? Any help you can give will be appreciated. – D.T.

ANSWER: Your grandson isn’t on the lean side. He is truly skinny. If this isn’t a family trait, it needs to be looked into more seriously.

Malabsorption syndromes should be considered. These are illnesses where nutrients cannot pass through the intestinal wall into the body.

Celiac disease is an example. There are many more. Granted, most of these illnesses have other symptoms but, at times, those other symptoms can be so mild that they’re ignored.

Trouble with endocrine glands is another possibility. The thyroid gland, the adrenal glands, the testes and the ovaries have important roles in growth and development.

Genetic illnesses constitute a group of disorders that can manifest with nutritional signs.

I have many pat answers on how to gain weight. Your grandson needs more than pat answers.

DEAR DR. DONOHUE: We have a very sad situation in our family. My 22-year-old grandson has schizophrenia.

There seems to be little hope of improvement for him. He was hospitalized for six months, and he stayed one year at home, taking medicine off and on.

Then he stopped taking it. He left home, saying he is never coming back.

Is there any treatment or a new medicine for this illness? – M.A.

ANSWER: Schizophrenia is a sad illness both for the patient and for the patient’s family. While it is a lifelong illness, it can often be controlled. It affects about 1.5 percent of the United States’ population.

In a country of more than 300 million people, that’s 4.5 million patients, a sizable number.

The disordered thinking of schizophrenia makes it difficult for patients to fend for themselves.

They become isolated, often expressing little emotion and exhibiting limited interest in people or any of life’s activities.

Hallucinations (seeing things that are not there or hearing voices audible only to the patient) and delusions (mistaken beliefs, often of a persecutory nature) disrupt their lives.

Before 1953, when there were no dependable medicines for this condition, most schizophrenia patients spent their entire lives hospitalized. Now few do.

Some experts state that 20 percent to 30 percent can lead relatively normal lives, 20 percent to 40 percent have moderate symptoms and 40 percent to 60 percent have to deal with periods of severe symptoms interspersed with periods of relatively normal function.

New medicines are constantly being developed. Your grandson, more likely than not, doesn’t need a new medicine. He needs to stay on the medicine already prescribed for him. Lack of compliance in taking medicine is a frequent issue with this disease.

Has your family contacted your state’s or province’s Department of Health? The department can put them in touch with the mental-health section, which can furnish information for services available to people with this illness.

With a little help, your grandson might be persuaded to restart therapy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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