Celiac Disease (cont.)
What is the treatment of celiac disease?There is no cure for celiac disease. The treatment of 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 of disease patients 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 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,
- ketchup,
- mustard,
- processed and canned meats,
- yogurt,
- sausages and,
- pasta.
- 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 all right 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 alright to consume fish, fresh meats, rice,
corn, soybean, potato, 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 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 patients 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 each in one-third of the patients, suggesting that the lack of adherence to the diet was having health consequences.
Next: What if patients fail to respond to gluten free diet? »
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