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July 12, 1985

Help for Those Intolerant of Gluten

Author Affiliations

USA Reynolds Army Hospital Fort Sill, Okla

JAMA. 1985;254(2):231. doi:10.1001/jama.1985.03360020061011

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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