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To the Editor.—
Recently I delivered a healthy infant to an intelligent young mother who suffers from nontopical sprue or gluten-sensitive enteropathy. In reviewing her case, I found that she had received appropriate evaluation and treatment, with the diagnosis established by the finding of almost complete flattening of the villi on a small-bowel biopsy specimen. Treatment with a gluten-free diet (no wheat, oats, rye, or barley) resolved her symptoms.Managing her dietary restriction was still a major problem; she was unable to distinguish gluten-free products by reading labels when confronted with such terms as modified food starch or tapioca flour. Her main carbohydrate source was rice cakes, 4-in disks of pressed, puffed rice, used as a bread substitute. However, they are a poor replacement for the wide variety of bread products consumed by the rest of the American population, ie, cakes, cookies, pies, pasta, and pizza.My experience indicates that
Turner RB. Help for Those Intolerant of Gluten. JAMA. 1985;254(2):231. doi:10.1001/jama.1985.03360020061011