The treatment for celiac disease is a gluten-free diet. Celiac disease patients vary in their tolerance of gluten; some patients can ingest small amounts of gluten without developing symptoms while others experience massive diarrhea with only minute amounts of gluten. The standard treatment calls for complete avoidance of gluten for life. The principles of a gluten-free diet include:
- Avoid all foods made from wheat, rye, and barley. Examples are breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies.
- Avoid oats. Some patients with celiac disease can tolerate oats in the diet. But the long-term safety of oats in celiac disease patients is unknown. Also some oat preparations can be contaminated with wheat. Thus, it is probably best to avoid oats, at least during the initial treatment with a gluten-free diet. Once disease remission is achieved with a strict gluten-free diet, small quantities of oats can be reintroduced into the diet under medical supervision.
- Pay attention to processed foods that may contain gluten. Wheat flour is a common ingredient in many processed foods. Examples of foods that may contain gluten, to name only a few, include:
- Canned soups.
- Salad dressings.
- Ice cream.
- Candy bars.
- Instant coffee.
- Luncheon meats.
- Processed and canned meats.
- Beware of tablets, capsules, and vitamin preparations that contain gluten. Wheat starch is commonly employed as a binding agent in tablets and capsules. Gluten also can be found in many vitamin products, and cosmetic products such as lipstick.
- Avoid beer.
- It is alright to drink wine, brandy, whiskey and other non-wheat or barley alcohol (in moderation).
- Avoid milk and other dairy products that contain lactose. Untreated patients with celiac disease often are lactose intolerant. With successful treatment, dairy products can be reintroduced slowly into the diet later.
- It is okay to consume fish, fresh meats, rice, corn, soybeans, potatoes, poultry, fruits, vegetables, and dairy products (for patients who are not lactose intolerant).
- Consult dietitians and national celiac disease societies for lists of gluten-free foods. Read the food and product labels before buying or consuming any product. This is necessary because a manufacturer may change a product's ingredients at any time. A product that was gluten-free in the past may now contain gluten. Even branded products may be gluten-free in one country but contain gluten in another country. If one is not certain after reading the labels, call the manufacturer.
- Because patients with severe malabsorption can develop vitamin and mineral deficiencies, vitamin and mineral supplements are important. All patients should take a multivitamin daily. Patients with iron deficiency anemia should be treated with iron. Patients with anemia due to folate or vitamin B12 deficiency should be treated with folic acid and B12. Patients with an abnormal ProTime should be treated with vitamin K. Patients with low blood calcium levels or with osteoporosis should be treated with calcium and vitamin D supplements.
In most patients, a gluten-free diet will result in improvements in symptoms within weeks. Many patients report symptom improvements within 48 hours. In children with celiac disease, the response to a gluten-free diet can be dramatic. Not only will diarrhea and abdominal discomfort subside, but behavior also improves, and growth resumes (with rapid catch-up in height). These improvements in symptoms are followed by reappearance of intestinal villi. Complete normalization of the intestinal villi may take months. In many adult patients, the improvement in symptoms is followed by only partial regeneration of intestinal villi. In patients with dermatitis herpetiformis, the skin lesions also improve with a gluten-free diet.
Many individuals with celiac disease may not understand the importance of life-long adherence to a gluten free diet. A recent study found that among patients diagnosed at least 20 years earlier with celiac disease, only half of the patients were following a strict gluten-free diet. The primary reason that patients followed the diet was to prevent symptoms-not to prevent complications. There was evidence of mild iron deficiency and abnormal bone density in one-third of the patients, suggesting that the lack of adherence to the diet was having health consequences.
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