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Celiac disease - nutritional considerations

Definition

Celiac disease is an autoimmune disorder passed down through families.

Gluten is a protein found in wheat, barley, rye, or sometimes oats (including medications). When a person with celiac disease eats or drinks anything containing gluten, the immune system responds by damaging the lining of the intestinal tract. This damage affects the body's ability to absorb nutrients.

For specific information about the disease (including symptoms and treatment), see: Celiac disease.

Carefully following a gluten-free diet helps prevent symptoms of the disease.

Alternative Names

Gluten-free diet; Gluten sensitive enteropathy - diet; Celiac sprue - diet

Function

Food Sources

Staples of the gluten-free diet include:

• Cereals made without wheat or barley malt
• Fruits and vegetables
• Meat, poultry, and fish (not breaded or made with regular gravies)
• Milk-based items
• Oats (may be okay for some people with celiac disease, but work closely with your doctor or nutritionist)
• Potatoes, rice, corn, beans

You can eat foods such as pasta, bread, pancakes, and pastries made with alternative grains (rice, buckwheat, tapioca, potato, or corn flours and starches).

You can buy these products through local and national food companies, or you can make them from scratch using alternative flours and grains.

Other food items you may use for cooking include:

• Potatoes, rice flax, millet
• Legumes, nuts, seeds, cassava
• Tapioca sorghum

The gluten-free diet involves removing all foods, drinks, and medications made from gluten. This means not eating anything made with barley, rye, and wheat. All items made with all-purpose, white, or wheat flour are prohibited.

Obvious sources of gluten include:

• Breaded foods
• Breads, bagels, croissants, buns
• Cakes, donuts, and pies
• Cereals (most)
• Cold cuts, hot dogs, salami, or sausage
• Crackers and many snacks bought at the store, such as potato chips and tortilla chips
• Gravy
• Pancakes and waffles
• Pasta and pizza
• Soups (most)
• Stuffing

Less obvious foods that must be eliminated include:

• Beer
• Candies (some)
• Communion breads
• Croutons
• Marinades, sauces, soy and teriyaki sauces
• Salad dressings (some)
• Self-basting turkey

There is a risk of cross-contamination. Items that are naturally gluten-free may become contaminated if they are made on the same production line as, or moved together in the same place as foods containing gluten.

Eating at restaurants, work, school, and social gatherings can be challenging. Call ahead and plan. It is important to read labels before buying or eating, due to the widespread use of wheat and barley in foods.

Despite its challenges, maintaining a healthy, balanced diet is possible with education and planning.

Side Effects

Recommendations

Once you have been diagnosed with celiac disease, it is very important that you talk to a registered dietitian who specializes in celiac disease and the gluten-free diet.

Joining a local support group is also recommended. Support groups can help people with celiac disease share practical advice on ingredients, baking, and ways to cope with this life-altering, lifelong disease.

See also: Celiac disease support group

Your doctor might prescribe a multivitamin and mineral or individual nutrient supplement to correct or prevent a deficiency.

References

Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731-1743.

Gemrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. Philadelphia, Pa: Saunders Elsevier;2007:chap 143.