A strict gluten-free diet is currently the only treatment for celiac disease.
The only treatment for celiac disease is lifelong avoidance of all foods containing gluten. Even trace amounts of gluten can cause damage to the mucosa of the small intestinal . Gluten is found in wheat, rye, barley and contaminated oats, and products that contain these ingredients. In addition to obvious sources of gluten, such as breads, pasta, cookies and baked goods, smaller quantities are also present in less obvious food products including processed meats, soups, sauces, candies and seasonings. Careful label reading is therefore recommended when shopping.
A large number of gluten free products are available in supermarkets, health food stores and online. Through the Evidence Analysis Library of the Academy of Nutrition and Dietetics dietary guidelines have been developed to provide a dietary pattern to meet the specific needs of the celiac patient . It is important to encourage your patients to select a wide variety of naturally gluten-free foods as well as those manufactured products that contain gluten-free whole or ancient grains to meet the nutritional needs of individuals with celiac disease .
Benefits of a gluten-free diet
Normalisation of antibody values
Regeneration of small intestinal mucosa
Reduced risk of medical complications/long term consequences
Improved nutrient absorption
Improvement in general health and wellbeing
Improvement in quality of life
Conditions associated with undiagnosed/untreated celiac disease
Failure to accurately diagnose celiac disease or to follow a strict gluten free dietary pattern following diagnosis may result in a number of serious long term health consequences:
Anemia and other micronutrient deficiencies are common in newly diagnosed celiac disease due to malabsorption caused by small bowel villous atrophy. Adherence to a strict gluten free diet will allow the small intestine to heal.
Undiagnosed/ untreated celiac disease is associatedwith low bone mineral density, osteoporosis and increased risk of fractures. Approximately 75% of adults with untreated celiac disease suffer from osteopenia or osteoporosis. A DEXA scan is recommended as part of the diagnostic process to assess bone health . A strict gluten free diet has been shown to improve bone mineral density .
Compared to the general population celiac disease is associated with a modestly increased risk of small bowel lymphoma, namely non-Hodgkin’s lymphoma . However, overall risk remains low and is likely to be reduced to the same level as the general population following 3-5 years on a gluten free diet [3,4].
- Fasano, A., Catassi, C. (2012). Clinical practice. Celiac disease. N Engl J Med.; 20; 367(25):2419-26. doi: 10.1056/NEJMcp1113994.
- Academy of Nutrition and Dietetics www.eatright.org
- Corazza GR, Di Stefano M, Maurino E. Bones in coeliac disease: diagnosis and treatment. Gastroenterology 2005 19(3): 453-465
- West J, Logan RFA, Smith CJ et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004 329:716-718
- Holmes GKT, Prior P, Lane MR et al. Malignancy in coeliac disease, effect of a gluten free diet. Gut 1989. 30: 333-338.
- Askling J, Linet M, Gridley G. Cancer incidence in a population-based cohort of individuals hospitalised with coeliac disease or dermatitis herpetiformis . Gastroenterology 2002. 123(5):142-135