What role does nutrition play in celiac disease?
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 days of starting the diet, and the small intestine is usually completely healed--meaning the villi are intact and working--in 3 to 6 months. (It may take up to 2 years for older adults.)
The gluten-free diet is a lifetime requirement. Eating any gluten, 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. Depending on a person's age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve.
The Gluten-Free Diet
A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats--in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Or, they can buy gluten-free bread, pasta, and other products from special food companies.
Whether people with celiac disease should avoid oats is controversial because some people have been able to eat oats without having a reaction. Scientists are doing studies to find out whether people with celiac disease can tolerate oats. Until the studies are complete, people with celiac disease should follow their physician or dietitian's advice about eating oats.
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. Examples of foods that are safe to eat and those that are not are provided below.
The gluten-free diet is complicated. It 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, screening for 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. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life.
The Gluten Free Diet: Some Examples
Following are examples of foods that are allowed and those that should be avoided when eating gluten-free. Please note that this is not a complete list. People are encouraged to discuss gluten-free food choices with a physician or dietitian who specializes in celiac disease. Also, it is important to read all food ingredient lists carefully to make sure that th food does not contain gluten.
| FOOD GROUP | ALLOWED | NOT ALLOWED |
| Beverages | Coffee, tea, carbonated drinks, wine made in U.S., rum, some root beer. | Ovaltine, malted milk, ale, beer, gin, whiskey, flavored coffee, herbal tea with malted barley |
| Milk | Fresh, dry, evaporated, or condensed, milk, cream, sour cream, whipping cream, yogurt | Malted milk, some commercial, chocolate milk, some nondairy creamers |
| Meat, Fish, Poultry | Fresh meats, fish, other seafood, and poultry, fish in canned oil, brine, or water; some hot dogs and | Prepared meat containing wheat, rye, oats, or barley, tuna canned in vegetable broth lunch meats |
| Cheese | All aged cheese, such as cheddar, Swiss, edam, parmesan; cottage cheese; cream cheese; pasteurized processed cheese; |
Any cheese products containing oat gum, some veined cheeses (bleu, stilton, roquefort, cheese gorgonzola) |
| Starches | White and sweet potatoes, yams, hominy, rice, wild rice, gluten-free noodles, some oriental rice and bean thread noodles | Regular noodes, spaghetti, macaroni, most packaged rice mixes, seminola, spinach noodles, frozen potato products with wheat flour added |
| Cereals | Hot cereals made from cornmeal, Cream of Rice, hominy, rice; Puffed Rice, Kellogg's Corn Pops, cereals made without malt | All cereals containing wheat, rye, oats or barley; bran, graham, wheat germ, durum, kaska, bulgar, buckwheat, millet, triticale amaranth, spelt, teff, quinoa, kamut |
| Breads | Specially prepared breads using only allowed flours | All breads containing wheat, rye, oat or barley flours and grains listed above. |
| Flours | Arrowroot starch, corn bran, corn flour, corn germ, cornmeal, corn starch, potato flour, potato starch flour, rice bran, rice flour, rice polish, rice starch, soy flour, tapioca starch, bean and lentil flours, nut flours | Amaranth, wheat germ, bran,
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