Education

Treatment of Celiac Disease

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Once a diagnosis has been confirmed through a biopsy to be celiac disease, the patient is instructed to begin following the gluten-free diet. This can often be difficult at first because so many foods contain gluten. However, through support and guidance from experienced celiac patients and a skilled dietitian, many newly diagnosed patients learn that the gluten-free diet requires some creativity and planning, but that great-tasting food isn’t out of reach.

The only treatment for celiac disease is to follow a gluten-free diet—that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within weeks of starting the diet. Although the vast majority of children undergo full healing of their intestinal lining, research has shown that the healing may remain incomplete in many adults, even though symptoms may regress.

The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the small intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Antibody levels take a long time (sometimes more than a year) to normalize after a person has stopped eating gluten. The doctor will assess if your intestinal damage is improving satisfactorily or not, based on the, based on the pace of the decline of antibody levels. Depending on a person’s age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.

A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including gluten-free bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour.

Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. The gluten-free diet requires a completely new approach to eating that affects a person’s entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, identifying potential sources of gluten becomes second nature and people learn to recognize which foods are safe and which are off limits.

A dietitian, who is a healthcare professional specializing in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life. Over time, the diet becomes easier—even second nature. If you fi nd that the diet is still diffi cult after several months, or you are still sick, talk to your doctor, your dietitian, and your support organizations. You may be eating gluten accidentally and need an outside perspective to identify foods that are keeping you from regaining your health.

The future

These are exciting times for the development of treatment options that go beyond the diet. Research is very active on several fronts. Among the most promising:

  • Pills that, when ingested immediately before a meal that may contain small amounts of gluten, would make the small intestine less permeable to gluten, thus preventing its toxicity
  • Pills that, when ingested along with meals containing some gluten, would break it down (thus, making gluten nontoxic) before it reaches the small intestine
  • Drugs that will quench the inflammatory response of the intestine to gluten
  • Therapeutic vaccines that would be able to restore the tolerance to gluten that was lost before celiac disease struck

Living Gluten-Free

A gluten-free diet is currently the only way to effectively treat celiac disease. Fortunately, maintaining a gluten-free diet isn’t as hard as it may seem as long as you are educated about some basic rules about the food and beverages you can and cannot consume.

At The University of Chicago Celiac Disease Center, we strongly recommend that you first seek a professional opinion before removing gluten from your diet because following a gluten-free diet can make it difficult to diagnose celiac disease.

While medical advice should be obtained directly from your doctor, the information in this section can help you make lifestyle decisions to get on the right track for a healthier and happier life.

Gluten-free diet

Once patients have been diagnosed as having celiac disease they are instructed to begin following the gluten-free diet. This can often be difficult, at first, because so many foods contain gluten. However, through support and guidance from other people with celiac disease and a skilled dietitian, many newly diagnosed patients learn that the gluten-free diet requires some creativity and planning, but that great-tasting food isn’t out of reach.

The only treatment for celiac disease is to follow a gluten-free diet—that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within weeks of starting the diet and the small intestine is usually completely healed—meaning the villi are intact and working—in 6 to 18 months. (It may take up to 2 years for older adults.) Left untreated, celiac disease may result in:

  • Vitamin and mineral deficiencies
  • Osteoporosis
  • Anemia
  • Increased risk of infertility or miscarriage
  • Lymphoma
  • Adenocarcinomas of the intestinal tract
  • Depression

The gluten-free diet is a lifetime requirement. Eating any gluten-containing food, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. It can take weeks for antibody levels (indicating intestinal damage) to normalize after a person with celiac disease has consumed gluten. Depending on a person’s age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.

A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including gluten-free bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour.

Unprocessed meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat these foods. The gluten-free diet requires a completely new approach to eating that affects a person’s entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, identifying potential sources of gluten becomes second nature and people learn to recognize which foods are safe and which are off limits.

A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. It is important to find a dietitian who specializes in celiac disease. You can find one at www.EatRight.org. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life. If you find that the diet is still difficult after several months, or you are still sick, talk to your doctor, your dietitian, and your support organizations. You may be eating gluten accidentally and need an outside perspective to identify foods that are keeping you from regaining your health.

What Can I Eat?

A gluten-free diet is currently the only way to effectively treat celiac disease. Fortunately, maintaining a gluten-free diet isn’t as hard as it may seem as long as you are educated about some basic rules about the food and beverages you can and cannot consume.

At The University of Chicago Celiac Disease Center, we strongly recommend that you first seek a professional opinion before removing gluten from your diet because following a gluten-free diet can make it difficult to diagnose celiac disease.

While medical advice should be obtained directly from your doctor, the information in this section can help you make lifestyle decisions to get on the right track for a healthier and happier life.

Gluten-free ingredients

  • Acorn
  • Almond
  • Amaranth
  • Arborio rice
  • Aromatic rice
  • Arrowroot
  • Basmati rice
  • Brown rice, brown rice flour
  • Buckwheat
  • Calrose
  • Canola
  • Cassava
  • Channa
  • Chestnut
  • Chickpea
  • Corn, corn flour, corn gluten, corn malt, cornmeal, cornstarch
  • Cottonseed
  • Dal
  • Dasheen flour
  • Enriched rice
  • Fava bean
  • Flax, flax seeds
  • Garbanzo
  • Glutinous rice
  • Hominy
  • Instant rice
  • Job’s tears
  • Millet
  • Modified corn starch
  • Modified tapioca starch
  • Montina™
  • Peanut flour
  • Potato flour, potato starch
  • Quinoa
  • Red rice
  • Rice, rice bran, rice flour
  • Risotto
  • Sago
  • Sesame
  • Sorghum
  • Soy, soybean, tofu (soya)
  • Starch (made from safe grains)
  • Sunflower seed
  • Sweet rice flour
  • Tapioca
  • Taro flour
  • Teff
  • Wild rice

Gluten-free additives

  • Acacia gum (gum arabic)
  • Acetic acid
  • Adipic acid
  • Algin
  • Annatto
  • Aspartame
  • Baking yeast
  • Benzoic acid
  • Beta Carotene
  • BHA
  • BHT
  • Brown sugar
  • Calcium Disodium EDTA
  • Carrageenan
  • Caramel color1
  • Carboxymethyl cellulose
  • Carob bean gum
  • Cellulose
  • Corn syrup
  • Corn syrup solids
  • Cream of tartar
  • Dextrose
  • Ethyl maltol
  • Fructose
  • Fumaric acid
  • Gelatin
  • Glucose
  • Guar gum
  • Invert sugar
  • Karaya gum
  • Lactic acid
  • Lactose
  • Lecithin
  • Malic acid
  • Maltodextrin 2
  • Maltol
  • Mannitol
  • Methylcellulose
  • MSG – monosodium glutamate
  • Papain
  • Pectin
  • Polysorbate 60; 80
  • Propylene glycol
  • Psyllium
  • Sodium benzoate
  • Sodium metabisulphite
  • Sodium nitrate; nitrite
  • Sodium sulphite
  • Sorbitol
  • Stearic acid
  • Sucralose
  • Sucrose
  • Sugar
  • Tartaric acid
  • Tartrazine
  • Titanium dioxide
  • Tragacanth
  • Vanilla extract
  • Vanillan
  • White vinegar3
  • Xanthan gum
  • Xylitol
  • Yam
  • Yeast

1. Caramel color is manufactured by heating carbohydrates and is produced from sweeteners. Although gluten-containing ingredients can be used, they are not used in North America; corn is most often used, however it is important to check with food manufacturers.

2. Maltodextrin is made from cornstarch, potato starch, or rice starch.

3. Distilled white vinegar is safe to consume on the gluten-free diet. Vinegar is a solution made of acetic acid and flavoring materials such as apples, grapes, grain and molasses. For example, cider vinegar is made from apple juice; malt vinegar is made from barley malt, balsamic vinegar is made from grapes. Distilled vinegars are gluten-free because the distillation process filters out the large gluten proteins so that they do not pass through to the end product. Therefore, the finished liquid is gluten-free. Patients with celiac disease should not be concerned about distilled white vinegar or foods such as pickles, which may contain it. The exception to this rule is MALT VINEGAR, which is not distilled and therefore is not safe to consume.

Check out our free resource for more helpful tips on diet: Jump Start Your Gluten-Free Diet eBook

What Contains Gluten?

Ingredients to avoid (contain gluten)

  • Abyssinian hard wheat (Triticum duran)
  • Avena (wild oat)
  • Barley (Hordeum vulgare)
  • Barley malt, barley extract
  • Beer, ale, porter, stout, other fermented beverages
  • Blue cheese**
  • Bran
  • Bread flour
  • Broth**
  • Bulgur (bulgur wheat and nuts)
  • Bouillon
  • Cereal (cereal extract, cereal binding)
  • Cracker meal
  • Croutons
  • Couscous
  • Dinkle***
  • Durum***
  • Einkorn, wild einkorn***
  • Emmer, wild emmer***
  • Edible starch
  • Farina
  • Farro***
  • Filler
  • Flour (Including but not limited to: all-purpose, barley, bleached, bread, brown, durum, enriched, gluten, graham, granary, high protein, oat, wheat, white)
  • Fu
  • Germ
  • Gluten, Glutenin
  • Graham flour
  • Hordeum (Horderum vulgare)
  • Hydrolyzed oat starch, hydrolyzed wheat gluten, hydrolyzed wheat protein
  • Kamut***
  • Malt, malt beverages, malt extract, malted milk, malt flavoring, malt syrup, malt vinegar, maltose
  • Matzo (matzah)
  • Mir (wheat, rye)
  • Miso (may contain barley)
  • Mustard powder**
  • Oats, oat bran, oat fiber, oat gum, oat syrup*
  • Oriental wheat
  • Rice malt, rice syrup, brown rice syrup**
  • Rye
  • Soy sauce**
  • Seitan
  • Semolina
  • Spelt***
  • Sprouted wheat
  • Tabbuleh
  • Triticale
  • Udon
  • Vital gluten
  • Wheat, wheat berry, wheat bran, wheat germ, wheat germ oil, wheat grass, wheat gluten, wheatstarch, whole wheat berries

*Historically, oats were not recommended because it was thought that avenin was toxic to gluten-intolerant individuals. However, research in Europe and the U.S. has found that oats are well tolerated by most people when consumed in moderation and do not contribute to abdominal symptoms, nor prevent intestinal healing. PLEASE NOTE: Regular, commercially available oats are frequently contaminated with wheat or barley. However, “pure, uncontaminated” oats have become available from several companies in the U.S. and Canada. These companies process oats in dedicated facilities and are tested for purity. Pure, uncontaminated oats can be consumed safely in quantities of less than 1 cup per day. It is important that you talk to your physician and your registered dietitian prior to starting oats.

** May be made with wheat—call company to verify.

*** Types of wheat