Winsberg, a psychiatrist in San Francisco, said she and a string of physicians had attributed her slower times and overwhelming fatigue to aging, new motherhood and chronic anemia. She began to follow an iron-rich diet, took iron supplements and received iron intravenously. Still, her health continued to deteriorate.

When a physician friend convinced Winsberg that her body was not absorbing the iron, she researched the problem online. She read about the symptoms of celiac disease, a genetic auto-immune disorder caused by eating the gluten protein in wheat and other grains like barley, rye and oats.

Winsberg said her first thought was, “This is what has been happening to me my whole life, and I just never put it all together before.”

Ingesting even small quantities of gluten causes the immune system to attack the lining of the small intestine in celiacs, hampering the absorption of vital nutrients like iron, calcium and fat. Untreated, it can lead to a wide range of problems including anemia, infertility, osteoporosis and cancer.

“Celiac is grossly underdiagnosed in this country,” said Dr. Peter H. R. Green, a professor at the College of Physicians and Surgeons at Columbia and director of the university’s Celiac Disease Center. He said that at least 1 percent of the population had the disease but that only a fraction of the cases were diagnosed.

The only known treatment is a gluten-free diet. Winsberg began reading labels vigilantly and avoiding everything containing gluten, including cereal, bread and beer as well as many seasonings, food additives and nonfood items like some vitamins and toothpastes.

“You can’t even take a sip from someone else’s water bottle, because they might have been eating a Powerbar and left a trace of it on the spout,” she said.

Within days, Winsberg’s chronic gastrointestinal problems abated. Gradually her energy, weight, iron stores and oxygen-carrying hemoglobin levels rebounded.

“It was like doping,” Winsberg, 42, said. “Suddenly I was running six-minute miles instead of nine-minute miles. Before I had placed in the bottom third in triathlons. Four weeks gluten free, and I placed second in a triathlon. It was like reverse aging. I went from feeling 38 to 28 to 18.”

Winsberg’s transformation did not surprise Dr. John Reasoner, a medical director with the United States Olympic Committee.

“In six to eight weeks, if they’ve followed the diet, it’s night and day,” he said.

Reasoner said that symptoms of celiac disease were often subtle but came at a high cost for athletes who expected maximum performance. Dave Hahn, who has reached the Mount Everest summit 10 times, said he found he had the disease after he became “inexplicably weak” on his second trip to the peak in 1999.

Hahn was the climbing leader on a search expedition for the remains of the Everest pioneer George Mallory, who had disappeared on the mountain in 1924. The search was successful, but Hahn struggled. Then 37, he had become anemic. Perilously weak and short of breath on summit day, he had to depend on his climbing partner to make it off the summit alive.

“It was a huge source of shame which made me feel like I had to get to the bottom of the health problems that I’d been ignoring for so long,” Hahn said.

He returned to the doctor he had seen eight years before for chronic gastrointestinal problems, common in celiacs, and this time she diagnosed the disease.

Hahn said he had difficulty adjusting to the gluten-free diet.

“I got stronger again without question, and you don’t really expect that in your late 30s,” he said. “I had gotten to the point up high and in the cold where I completely ran out of gas.”

Hahn, now 46, continues to guide high-altitude expeditions all over the world.

“I could have lived out my life without knowing I have celiac,” Hahn said. “But I wouldn’t have lived the best part of my life.”

Green said that most doctors had a limited understanding of celiac and often believed it was a childhood disease that people outgrew.

“I get calls from gastroenterologists, specialists in the field, and they don’t even know how to diagnose the disease,” he said.

Celiac disease is diagnosed through an inexpensive panel of blood tests.

Green said the current “lack of pharmaceutical backing for the disease” — the fact that it is controlled by diet, not drugs — was behind the scant research, medical education and public awareness. Doctors frequently miss the pattern within telltale symptoms of celiac, as happened to Winsberg and Hahn, Green said.

Winsberg reached a peak in her athletic career this summer. She qualified for the Ironman World Championship Triathlon to be contested on Saturday in Hawaii. She will compete in the 2.4-mile ocean swim, the 112-mile bike ride across volcanic desert and the 26.2-mile coastal run — a prestigious event she could not have dreamed of racing before her self-diagnosis.

Caffeine may make it tougher for people with diabetes to control their blood sugar, a new study shows. The finding, published in February’s Diabetes Care, adds to the confusion about the role coffee plays in diabetes risk. Although caffeine has consistently been shown to affect blood sugar levels, several studies have shown that coffee drinkers are at lower risk for diabetes.

The latest findings about caffeine come from a small study by Duke University researchers who set out to determine if caffeine consumption can undermine a patient’s effort to manage diabetes. The researchers studied the effects of caffeine in 10 patients with Type 2 diabetes. The patients were already regular coffee drinkers and were trying to manage their diabetes without using insulin.

Small glucose detection devices implanted under the abdominal skin tracked the rise and fall of patients’ blood sugar levels. On various days, study participants took either caffeine pills containing the equivalent of about four cups of coffee or identical placebo pills. Neither the patients nor the person giving them the pills knew which capsules contained the caffeine and which contained the placebo.

When the patients ingested caffeine, their average daily blood sugar levels went up by 8 percent. After meals, their blood sugar levels rose even higher, shooting up as much as 26 percent after dinner.

The researchers don’t know exactly why caffeine appears to drive up blood sugar. Caffeine may interfere with the movement of glucose through the body, or it could stimulate the release of hormones known to boost blood sugar levels.

However, the data don’t necessarily mean that people with diabetes or at risk for it should stop drinking coffee. Several large observational studies have shown that coffee drinkers have a lower risk for diabetes. Researchers speculate that other compounds in the coffee have a beneficial effect and may blunt some of the negatives of caffeine.

The data suggest that people with diabetes probably shouldn’t drink caffeinated soft drinks or other caffeine-containing beverages. Coffee drinkers who are having trouble managing their diabetes should consider quitting or switching to decaf to see if it helps, study author James Lane, a professor of medical psychology at Duke University, told HealthDay news. “It’s a simple thing that might make their diabetes better,” said Dr. Lane.

Earlier this month, another study showed that too much caffeine during pregnancy raises the risk for miscarriage.

“We offer what you’re supposed to eat — proper portions, great flavor-and we use fresh, local ingredients as much as possible,” says co-owner Tom Williams, who, with partner Judith Hammerschmidt, opened Rock Creek two years ago. The pair worked with Cynthia Payne Moore, R.D., a Baltimore, Maryland-based dietitian, to obtain nutritional analyses for every item on the menu, and they adjust recipes to avoid unnecessary fat and determine portion sizes.

“We put the nutritional information in the back of the menu-people who want to look at it do, and those who don’t, don’t,” Hammerschmidt says.

The concept and execution have proved so successful that earlier this year, the pair opened another Rock Creek in Washington, D.C.

Enjoying restaurant food like Rock Creek’s — tasty, good for you, and with a reasonable amount of calories — was once a difficult order to fill. No longer.

“The idea that eating healthy doesn’t mean feeling deprived is something restaurants see as a vehicle for change, as a way to differentiate their offerings from their competitors,” says Master Chef Mark Erickson, vice president for continuing education at the Culinary Institute of America.

While some restaurants make it clear they offer more healthful fare — by using symbols, calorie counts, and the like — others practice what Erickson calls “stealth health,” making some healthful changes on the menu without fanfare. “When restaurants make their menus more healthful, consumers benefit,” Erickson says. And, in fact, eating well when dining out is a growing trend.

Healthfulness on the menu

Part of what’s driving these positive changes is consumer demand. Nearly three out of four adults say they are trying to make healthier choices when eating out than they did just two years ago, according to the National Restaurant Association.

“It’s hard to refute that health is related to diet,” Erickson says. “And restaurants are making up more and more of the daily diet — the average American eats one out of three meals away from home.” Increasingly, savvy consumers expect restaurants to have a conscious approach to food preparation similar to the one they use in their own kitchens — using fruits and vegetables creatively or cooking with less saturated fat or salt.

Legislative changes are also having an effect. The New York City-initiated ban on trans fats has become far-reaching; at least eight other major metropolitan areas have legislated similar bans, as have restaurants, hotels, theme parks, cruise lines, and many other businesses.

Meanwhile, New York City recently took another stand on upgrading restaurant menus. In a move affecting mostly fast-food restaurants, the city’s board of health recently asked food service establishments with standardized preparation methods that already have nutrition analyses to post calorie information on menus so customers can see it when deciding what to order.

Many restaurants purposefully take their offerings to a more healthful level. Since he took over the kitchen at the highly regarded Gramercy Tavern in New York City last October, Executive Chef Michael Anthony has created lighter dishes, many of which feature vegetables rather than meat as the plate’s centerpiece. “The goal is to leave consumers feeling invigorated, not lethargic because they’ve overindulged,” Anthony says.

Like Rock Creek, some restaurants are building their business around a more healthful model. Seasons 52, which has five locations in Florida and two in Atlanta, Georgia, takes a lighter approach to dining by featuring fresh foods that rotate with the seasons and dishes that contain a maximum of 475 calories.

The chefs do this by taking out fat, lowering sugar and salt when possible, and relying instead on flavorful accents such as balsamic vinegar, lemon juice, garlic, and fruits. “We call it ‘palate distraction,’” explains Clifford Pleau, director of culinary development. “If you can give the mouth something else to focus on, it says, ‘Wow! I haven’t tasted something that interesting before,’ instead of ‘Wow! Something’s missing.’”

Tap into the trend
“While restaurants are becoming more health-conscious, it’s only going to keep happening if people ask for it,” says Katherine Tallmadge, R.D., a Washington, D.C.-based spokesperson for the American Dietetic Association. Here’s how to support the trend while ordering sensibly:

Do a little homework. “If you decide ahead of time what you want to order, it will eliminate temptation while you are at the restaurant,” Tallmadge says. Many national chains post nutrition analyses on their Web sites, so you can find out how much fat, cholesterol, sodium, protein, carbohydrates, fiber, and calories a potential meal contains.

Watch portion size. Prodigious entrees remain common in many restaurants, despite other changes for the better. Because patrons tend to place a premium on value — they want to feel as if they’re getting their money’s worth — piled-high plates aren’t likely to become a relic of the past anytime soon.

Sample small plates. Tapas-sized servings — i.e. small plates — will continue to be in fashion in coming years, according to Restaurant Startup Consultants, Inc., which counsels new food service businesses. Small plates allow you to sample a variety of dishes without consuming too many calories. In addition to high-end restaurants, the trend is also appearing in some national chains. In March, TGI Friday’s unveiled a new Right Portion, Right Price menu, offering smaller portions of certain entrees that contain 500 calories or less and 10 grams of fat or less per serving.

Choose seasonal ingredients. A less-is-more approach governs the preparation of fresh, seasonal ingredients: They’re often minimally dressed or sauced, allowing fresh flavors to play the starring role. Look for items like spinach and roasted beet salad or roasted butternut squash on fall menus.

Select healthful sides. These days, healthful sides, ranging from steamed broccoli to grilled asparagus to sautéed spinach with garlic, have more space on restaurant menus. “The idea that you can have an indulgent entree but improve your sides is something I enjoy because it’s a small change,” Blatner says. “If you make small steps to improve what you eat, you’ll be healthier for it.”

Look for balance. Chefs and restaurateurs are reexamining the fundamentals of their offerings. At Seasons 52, for example, each entree plate is made up of one-third protein and two-thirds fruits, vegetables, and starches. Others are practicing what the Culinary Institute refers to as “the protein flip.”

“Finer dining establishments are flipping the traditional plating concept. Vegetables and carbohydrates are the main component, and protein is secondary,” Erickson says.

Ask questions. When ordering, inquire about the meal’s composition or preparation. “Go to restaurants where the people serving the food know what the ingredients are,” Pleau says. For example, Rock Creek uses phyllo instead of traditional lard-laced dough in its piecrusts; but unless you ask them, you won’t know that you can enjoy a slice of their pie and avoid unnecessary saturated fat and calories.

Enjoy yourself. While we’re all eating out more often these days, consider a restaurant meal to be a treat. Savor the flavors, and select dishes you can’t or wouldn’t make in your own kitchen. “Look at the meal as a source of pleasure,” Anthony says. “The key is to relish the experience — within moderation.”