What is celiac disease?
Celiac disease is a chronic digestive problem that affects the
lining of the small intestine and blocks absorption of nutrients
from food. If this disease is not diagnosed and treated, it can
lead to malnutrition and other serious problems.
How does it occur?
Celiac disease is a genetic condition, which means it runs in
families. When you have celiac disease, your body has an
abnormal reaction to a protein called gluten, which is found in
wheat, barley, and rye grains: When you eat gluten, celiac disease
causes your immune system to respond by attacking the part of the
small intestine that absorbs nutrients.
You might also have a similar reaction to another type of protein
found in oats.
Researchers are studying why celiac disease affects people so
differently. Some develop symptoms as children, others later in
life. How long you were breast-fed, your age when you started
eating foods containing gluten, and the amount of gluten you eat
seem to be related to when and how celiac disease appears. Some
studies have shown that the longer a child is breastfed, the later
and less severe the symptoms appear.
What are the symptoms?
The symptoms can vary greatly from one person to the next, and the
symptoms are often different for children than they are for
adults.
Babies and children are more likely to have digestive symptoms,
such as:
- diarrhea that does not go away
- crampy abdominal pain
- bloating
- gas
- foul-smelling bowel movements.
Because celiac disease leads to poor nutrition, the following
symptoms are also common in children:
- weight loss
- poor growth
- tiredness
- behavior changes and irritability
- tooth discoloration and loss of enamel from the teeth.
Adults are less likely to have digestive symptoms. More often
they have 1 or more of the following symptoms:
- bone and joint pain
- tiredness
- missed menstrual periods and trouble getting pregnant
- seizures
- an itchy skin rash
- sores inside the mouth
- numbness or tingling in the hands and feet
Also, blood tests may show an unexplained iron deficiency.
Some people have no symptoms but are still at risk for developing
serious long-term complications such as not getting the nutrients
they need from food, anemia, liver disease, osteoporosis (bone
loss), and some cancers.
How is it diagnosed?
Once considered rare, celiac disease is now being diagnosed much
more often. It is now estimated to occur in 1 of 133 Americans. It
used to be hard to diagnose because many of the symptoms are like
the symptoms of other conditions such as irritable bowel syndrome,
chronic fatigue, or intestinal infections. Recently it was found
that people with celiac disease have a higher level of certain
antibodies in their blood. This means a simple blood test for
these antibodies can now help with the diagnosis. Before having
this test, you will be asked to eat your usual diet and continue
to eat foods that contain gluten, such as bread. If you avoid
foods containing gluten before the test, it may come up negative
even if you have the disease.
If your blood test is positive for the antibodies and you have
symptoms, you may need a biopsy of your small intestine. A biopsy
is the removal of a tiny piece of the intestine. The sample of
intestine is examined for signs of celiac disease.
How is it treated?
The only treatment for celiac disease is a gluten-free diet. For
most people, following the diet relieves the symptoms in a few
weeks. The gluten-free diet allows the intestine to heal and
prevents any further damage. Typically, in children and young
adults, the bowel may be completely healed 3 to 6 months after you
start the diet. In older adults, the healing may take up to a few
years.
In some cases you may keep having symptoms even though you are
eating a gluten-free diet. This may be caused by having a small
amount of gluten still in your diet, or the intestine may have
been too damaged before you started the diet. This is called
unresponsive celiac disease.
What is a gluten-free diet?
A gluten-free diet is one that contains no wheat (including spelt,
triticale, and Kamut), barley, or rye. It also does not include
products that use additives containing gluten, such as some
vitamins, medicines, and stamp or envelope adhesives. Because the
American diet is based on grains and many processed foods contain
grain-based additives, this diet can be hard to follow. You may
need to talk to a dietitian who knows about gluten-free diets and
treating celiac disease. You will need to have follow-up visits
with the dietitian to check your diet and get help in staying
up-to-date on gluten-free food products.
At first, gluten-free diet recommendations can be overwhelming.
Keep it simple until you have had a chance to meet with your
dietitian. Fresh fruits, vegetables, beans, milk, and unprocessed
protein foods such as fresh beef, pork, poultry, fish, and eggs do
not contain gluten. Natural nuts, seeds, and vegetable oils
(without additives) can also be included safely. Add in foods from
the allowed starches and grains listed below for a balanced diet.
What foods are included in a gluten-free diet?
The list of choices for gluten-free foods is growing. Below are
some acceptable foods as well as foods you need to avoid. The
lists are not complete. Consult your dietitian and recommended Web
sites for more detailed information.
Allowed starches and grains:
- breads and other baked goods made with potato, rice, bean,
buckwheat, soy, tapioca, arrowroot, quinoa, millet, and flax
flours
- rice
- rice noodles and pasta made with allowed ingredients
- beans
- cornmeal
- potatoes, sweet potatoes, and yams
- corn and peas (avoid creamed varieties unless made with
acceptable ingredients)
- gluten-free bread and pasta products
- hot cereals made from white or brown rice, hominy, hominy
grits, groats, soy, or millet
- cold cereals such as puffed rice and corn.
Allowed fruits and vegetables:
- all fresh, canned, and frozen fruit or fruit juices
- fresh vegetables
- canned and frozen vegetables made with allowed ingredients.
Allowed milk products:
- milk
- aged cheese
- all other milk products produced without gluten additives.
Allowed meats, poultry, fish, eggs, dried beans, nuts and seeds:
- all unprocessed foods in this category
- peanut butter.
Allowed fats, sweets, and drinks:
- butter and vegetable oils
- salad dressings and sauces made with allowed ingredients
- sugar
- honey
- marshmallows
- plain chocolate
- coconut
- jelly or jam
- pure instant or ground coffee
- carbonated sodas.
What foods need to be avoided in a gluten-free diet?
Listed below are some foods you need to avoid. The lists are not
complete. Consult your dietitian and recommended Web sites for
more detailed information.
Starches and grains to avoid:
- wheat
- rye
- barley
- bulgur
- spelt
- triticale
- Kamut
- semolina
- all breads, baked goods, crackers, noodles, pastas, and
cereals made with the above grains
- cereals containing malt extract or malt flavoring
- canned baked beans.
Your healthcare provider may also advise avoiding oats. Commercial
oats are often harvested and processed with wheat or barley,
making it likely that bits of wheat or barley will be in the oats.
Also, small studies have shown that some people with celiac
disease react to the protein in oats. Some national celiac
agencies approve of the addition of pure oats to the gluten-free
diet, while others advise adding oats only for healthy adults with
no sign of bowel inflammation. Other experts still recommend that
until more research is done, the only safe amount of oats is no
oats at all. Some healthcare providers allow the addition of oats
to the diet with careful follow-up tests. Follow-up tests may
include evaluation of your symptoms, blood tests, or a biopsy to
check your response to the addition of oats.
Fruits and vegetables to avoid:
- some pie fillings and dried fruits
- creamed vegetables
- breaded vegetables.
Milk products to avoid:
- some flavored milks and yogurts (including frozen)
- malted milk.
Meats, poultry, fish, eggs, dried beans, nuts and seeds to avoid:
- some egg substitutes
- some marinated meats, poultry, and fish
- cold cuts made with gluten stabilizers, wheat, barley, rye,
oat fillers, and self basting turkey.
Fats, sweets and drinks to avoid:
- commercially prepared condiments, soups, salad dressings, and
sauces
- flavored instant coffees, herbal teas, and hot cocoa mixes
- nondairy creamers
- beer and malted beverages
- sauces, gravies, and products made with hydrolyzed vegetable
or plant protein (HVP or HPP) made from wheat protein.
What should I look for on food labels?
There are many hidden sources of gluten, so learning to read
labels is a must. Ingredients that carry possible risk include:
- unidentified starch
- modified food starch
- hydrolyzed vegetable or plant proteins ("HVP" or "HPP")
- texturized vegetable protein ("TVP")
- binders, fillers, and extenders.
If you have any question about the ingredients of a food, you
should avoid the product or contact the food manufacturer for more
information. The US Food and Drug Administration (FDA) has
proposed a voluntary labeling for gluten-free products and has
been required to develop and finalize rules for the use of the
term "gluten free" on product labels. Visit
http://www.cfsan.fda.gov/~dms/wh-alrgy.html#consumer for updates
regarding this ruling. Any product carrying this label would
contain less than 20 parts per million (ppm) gluten per serving.
Many companies will send you a list of their gluten-free products.
What about medicines and supplements?
Some medicines and supplements contain gluten additives. It is
important to ask your pharmacist or call the manufacturer to find
out about the specific ingredients in your medicine. The risk for
vitamin deficiency, especially B vitamins, is greater in people
with active celiac disease, so you may need vitamin supplements
while you are having symptoms. In this case a prescription for a
gluten-free vitamin and mineral supplement is important. Usually
you are able to stop the vitamins when your symptoms go away on
the gluten-free diet.
Can I still eat at restaurants?
People following a gluten-free diet must be very careful when
eating at a restaurant or deli.
- Order simple dishes without sauces.
- When in doubt, ask your restaurant server about the
ingredients.
- Have the server inquire about food preparation areas (Are
grain products prepared with the same equipment or utensils
that are used to prepare other foods?)
- Ask if the restaurant has a gluten-free menu.
How long will the effects last?
You must follow the gluten-free diet all your life. If you keep
eating foods that contain gluten, the condition can become life
threatening.
It's possible to have celiac disease for years before you are
diagnosed. The longer you go without treatment, the greater the
damage to the intestine and the risk for long-term problems. If
you think you may have celiac disease, see your healthcare
provider. If you have been diagnosed, keep your checkup
appointments on the schedule recommended by your provider. See
your provider sooner if you are having symptoms again.
How can I get more information?
For more information about celiac disease, a gluten-free diet, and
available gluten-free products, see:
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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