Gluten-Free Diet for Nontropical Sprue

DURING WORLD WAR II Dicke in Holland observed that when bread was scarce or unobtainable, children having celiac disease improved clinically—their diarrhea ceased and they began to gain weight. After the war, when bread became available these same children relapsed.¹Following this clinical observation, Weijers and van de Kamer, utilizing carefully conducted fat balance studies in patients having celiac disease, showed conclusively that by withdrawing flour from the diet the fat content of the stool returned to normal coincident with clinical remission. The addition of flour made from wheat and rye to the diet of these patients resulted in steatorrhea in every case.²It was shown later that oats had a similar effect and finally that the material responsible was the gliadin fraction of gluten.³In 1952 McIver in England reported a patient having nontropical sprue who recovered following the administration of the gluten-free diet.⁴This