Celiac Disease Treatment - Get Your Life Back On Track

The chief celiac disease treatment is the exclusion of any foods containing a protein called gluten. (Or coeliac disease treatment as us Brits with our unreformed spelling would say.)

This is because the sufferer's immune system has wrongly identified gluten as a threat.

In response it attacks the nutrient absorbing villi (little projections) in the small intestine, damaging them, leading to very poor nourishment and a higher risk of other health problems. These attacks also cause widespread inflammation.

In order for the treatment to be successful this elimination has to be very strict.

This all sounds very difficult if not impossible. I hear you thinking Nooo...... No more favorite cookies when you have that mid afternoon dip in blood sugar. No more cheeky muffins when you are having a bad day.

Although nobody would pretend that going gluten free is easy in fact living a gluten free life is actually becoming easier than it used to be as more and more gluten free products and foodstuffs are now available to buy.

This article will explore how you can get back to good health and stay that way if you have been given a diagnosis of celiac disease.

Which Foods Must I Avoid?

Effective celiac disease treatment hinges on avoiding all foods containing gluten, a protein which is found in wheat, barley and rye. Here is a list of gluten containing products but it is not exhaustive.

• Bread made from wheat or rye including bagels, flatbread, naan, pita and potato bread
  
• Cakes, muffins, gateaux and doughnuts
  
• Biscuits and cookies
• Breakfast cereals (except uncontaminated oats see below)
  
• Crackers and pretzels
  
• Many sauces and gravies which contain flour or starch as thickeners
• Salad dressings which often contain thickeners or malt
• Farina
• Couscous
• Spelt
• Soy sauce
• Fish and oyster sauce (it depends on the brand)
  
• Malt such as in vinegar and malted drinks
• Pastry
• Semolina
• Pancakes
• Waffles
• Breadcrumb coatings like panko
• Beer made from barley or wheat
  
• Pasta and noodles
• Pizza
• Seitan
• Bulgur
• Dextrin
• Starch or modified starch
• Regular flour
  
• Brewer's yeast
• Processed meats (which often contain bread as fillers or starch as binders)
  
• Some ketchups and mustards although many brands are now going gluten free
• Many chocolate and candy bars (pure chocolate is gluten free)
  

Be wary of any food which is processed and read the ingredients in detail.

Which Foods Can I Eat?

There is a good list of naturally gluten free foods which you can eat freely such as:

• Fresh meat
• Fish
• Shellfish
• Vegetables
• Potatoes
  
• Salad leaves
  
• Herbs
  
• Lentils, beans and other legumes (uncontaminated)
  
• Fruits and berries
• Nuts and seeds
• Rice
• Corn/maize (sweetcorn)
  
• Polenta/cornmeal;(uncontaminated) this can be used in savory dishes and to make cakes
• Amaranth (a pseudo grain from Mexico and Peru)
• Buckwheat (a pseudo grain related to rhubarb)
  
• Millet (a grass traditionally grown in India, China and Africa and eaten as a porridge in Russia and Germany)
• Pea flour
  
• Sorghum (a cereal traditionally eaten in Africa and parts of Asia)
• Teff (a domesticated lovegrass traditionally used as a flour or made into a porridge in East Africa but now being introduced into Australia and America)
  
• Milk (except if you are lactose intolerant)
• Cheese (with the exception of some blue cheeses like Roquefort for example which are made with molds grown on rye).
• Natural yogurt and yogurt with fruit (check the ingredients as some yogurt recipes have added thickeners)
  
• Cream
• Ice cream: but verify the ingredients because a few recipes use thickeners made from flour and of course you cannot have Oreo Cookie Ice Cream!
  
• Eggs
• Butter, oils and fats (do not share with housemates who have been eating toast or crumpets!)
• Uncontaminated oats
• Wine, cider and balsamic vinegar
• Worcestershire sauce
• Most wines
  
• Hard liquor and spirits
  

With these foods it is important to note that in some cases they can become contaminated with gluten. Some nuts are shelled and processed in factories that also make products containing wheat for example.

In addition to foods which are naturally gluten free manufacturers now make many products which are specifically for people following a gluten free diet.

This range is expanding all the time and it is now possible to buy a wide variety of gluten free breads, pasta and cookies to name a few.

In the past it was only possible to buy these products in specialist shops but now even your local store will usually stock these types of foods.

Many manufacturers publish lists of their foods which are gluten free. For example see the list from Hienz.

Sometimes we do not want factory made foods but long for the comfort of home baking. It is possible to buy gluten free flours but baking with them needs a little bit of adjustment. The Gluten-Free Girl has published an excellent guide to gluten free baking.

As you can see there are many delicious recipes which can be made using foods which are naturally gluten free. I can think of some of my favorite dishes which would fit right in like lentil curry and rice or barbecue ribs with homemade sauce, coleslaw and baked potatoes.

When starting their celiac disease treatment many people start by concentrating on these and then add in foods which are specially made to be gluten free.

What About Oats?

We have already mentioned that uncontaminated oats are ok to eat but what does this mean?

Most people who have celiac disease can eat oats as they do not contain gluten but the problem is that many oats are processed in places and using the same equipment as wheat products.

Even a tiny amount of cross contamination caused in this way can be a real problem and cause a flare up of symptoms and a set back for affected people.

You should therefore look for 'gluten free oats' which sounds ridiculous as oats do not contain gluten but it really means oats uncontaminated with gluten.

Oats can even become contaminated if they are growing in a field next to wheat!

A very small percentage of celiac disease sufferers genuinely cannot tolerate oats because they contain a protein called avenin which is similar to gluten.

Although this protein only affects a very tiny number of people with celiac disease it is usually recommended that oats are initially excluded completely at the beginning of celiac disease treatment and only re-introduced once symptoms have subsided with monitoring for any adverse reactions.

Similar care should be taken with other foods that may become contaminated like cornmeal and lentils.

What About Quinoa?

Doctors often recommend that quinoa forms part of a celiac disease treatment diet as a good alternative to other grains however there is some hesitation as although quinoa does not contain gluten it does contain proteins which are very similar to gluten and could provoke a reaction in some people.

Laboratory tests have showed that quinoa could stimulate an immune response in people with celiac disease but a further study in real people was reassuring.

Nineteen people with confirmed celiac disease who were following a strict gluten free diet were given 50g of quinoa every day for six weeks and no adverse reactions were found after taking blood tests and tissue samples.

This was a small study however and research into the long term effects needs to be done.

Is it Only Foods That I Must Be Careful About?

No there are other sources of gluten which have to be avoided such as:

• Some medications (check at glutenfreedrugs.com)
  
• Some cosmetics especially lipsticks and lip balm (check with the manufacturer)
• Play doh or homemade playdough
• Communion wafers
  

Adhesives Contain Gluten Myth or Fact?

There has long been a story passed around that the adhesive used on stamps and envelopes contains gluten. This makes people afraid to lick.

Nearly all of these adhesives are in fact made from potato starch or cornstarch/cornflour which is safe and not wheat but if you are worried then use a damp sponge to 'lick' your envelopes.

How Often Should I Read Labels?

It is important to read labels of all processed foods and medications every time you use them because sometimes recipes are changed and even if you have eaten a product many times before you do not want to risk becoming ill because the manufacturer has suddenly changed the recipe.

It is also worth noting that recipes can vary from country to country even when the product and brand seem exactly the same.

How Long Do I Have to Stick to the Diet?

Unfortunately excluding gluten containing foods and products is a life long commitment. Celiac disease treatment with a gluten free diet is not something which can be dipped in and out of.

In order to avoid the serious health consequences of celiac disease like a damaged gut, malnourishment, anemia, osteoporosis, and damage to other parts of the body all sources of gluten must be excluded permanently.

Should I Take Extra Vitamins and Minerals?

In most cases yes, treatment for celiac disease should include vitamin and mineral supplements especially if you are newly diagnosed.

As the damage caused by celiac disease causes malabsorpbtion leading to malnourishment taking extra vitamins and minerals is an important part of celiac disease treatment. In addition excluding gluten from your diet can cause some deficiencies if you are not extremely careful so supplements can keep you safe.

The most often needed vitamin and mineral supplements are iron, vitamin B12 and folic acid, calcium, vitamin K and vitamin D3. However, it is best to check with your doctor or dietitian exactly which supplements are best for your individual case. 

After Celiac Disease Treatment Will My Intestinal Villi Regenerate?

This depends how long you have been suffering with celiac disease without knowing it and so have not had the celiac disease treatment you need.

The longer you have been left untreated the more extensive the damage will be so the likelihood that your villi will regrow is reduced.

There have been cases in children where after starting the strict celiac disease diet they have seen a complete recovery with re-growth of their small intestinal villi.

In adults that have been ill for a long time it is more likely that the villi will only partially regrow.

How Long Will It Take After Celiac Disease Treatment to Feel Better?

This is really a very similar answer to the one above. There have been cases of children showing miraculous signs of improvement after 48 hours but it is more likely that you will have to have to stick to a strict regime of no gluten for several weeks before you see improvements. 

A full recovery can take up to two years but this varies from person to person.

If you are suffering from skin rash symptoms then you may need to have treatment for this (usually a drug called dapsone) as the healing can take a long time without medication.

Will Celiac Disease Treatment Lessen My Risk of Other Health Problems?

If you are given a diagnosis of celiac disease it means that you also have a higher risk of other conditions. For some illnesses the risk is reduced back to normal if you have proper celiac disease treatment but not all.

Other Autoimmune Disorders

People with celiac disease are more likely to suffer from other auto-immune disorders like lupus, type 1 diabetes and autoimmune thyroid disease for example. Implementing a celiac disease treatment regime with a gluten free diet can allow better control of these illnesses and can slow down their evolution.

Chronic Inflammation

Celiac disease causes inflammation in many parts of the body. The main area of inflammation is in the small intestine but many other parts of the body like the skin, joints and organs like the liver, thyroid and pancreas can be affected.

A gluten free diet will allow this inflammation to subside.

Cancer

You are more at risk of developing cancer, particularly blood cancer and bowel cancer, if you are not treated. Your risk returns to normal after about 5 years of being gluten free.

Lactose Intolerance

A damaged intestine can interfere with the production of lactase which is needed to digest the lactose found in milk. This means that many people with celiac disease are also lactose intolerant.

Going gluten free can eventually allow the re-introduction of milk in some people.

Osteoporosis

Osteoporosis often develops because of the poor absorption of calcium. This can be helped by taking supplements. Sometimes stronger medication is needed.

Infertility Problems

Women who have a celiac disease treatment regime in place will not have infertility problems caused by their illness but unexplained infertility is often discovered to be caused by untreated celiac disease.

Anemia

Once the intestinal wall starts to heal and more nutrients are being absorbed across into the bloodstream anemia is normally reversed. Often iron is given as a supplement to help this process happen more quickly.

What is Refractory Celiac Disease and How Is It Treated?

The word refractory means stubborn or obstinate and in the medical world it means resistant to treatment.

In an extremely small percentage of cases the normal celiac disease treatment of excluding gluten does not work.

The exact reason is unclear but in these cases steroid treatment is normally recommended and sometimes due to very poor nourishment artificial feeding regimes are needed.

Celiac Disease Treatment and the Law

Of course legislation does vary from country to country but many places require restaurants and food manufacturers to include gluten on their labels and menus and define what is meant by gluten free. 

For example under US law food manufacturers have to include wheat on labels as an allergen but not barley or rye and not specifically gluten. They can label something gluten free if it contains less than 20 parts per million.

If something is labeled free from wheat this does not mean that it is gluten free!

In Europe labels have to include information about any cereals in the ingredients which have gluten in them.

It is worth checking which laws apply where you live and perhaps if there is no such requirements find out if anybody is agitating for change and join the campaign.

Laws such as these make everyday living much easier and safer for everyone living with celiac disease.

Celiac Disease Treatment and Eating Out

Eating out when you have celiac disease can be difficult and in some cases a bit of a nightmare because the risk of cross contamination and hidden ingredients is always there.

Some Tips for Maintaining Your Celiac Disease Treatment in the Restaurant

• Avoid buffets and salad bars as you don't know who has used those tongs or different foods may be sharing a plate
• Speak to the staff and if possible the chef before making your choice
• Pick off the à la carte menu as your dish is more likely to be cooked freshly just for you
• Avoid sauces and dressings unless you know exactly what is in them
• Ask about any rubs or marinades which have been used to flavor the food as they can contain starch or flour
• Fast food can become contaminated in the deep fat fryer so those fries may not be safe
  

In Europe staff in establishments that provide unpackaged food away from home such as restaurants, canteens and pubs have to provide information about 14 common allergens, including cereals containing gluten that are included in their dishes.

Find out what the legislation is in your area but even if food outlets are not required to provide this useful information then get to know the chefs in restaurants that you like.

Get them on side and make them aware of the danger of cross contamination and educate them about ingredients that they may not realize contain gluten.

As more and more people decide to cut gluten from their diets unfortunately some restaurants are becoming a little casual about its removal from their dishes thinking of it as just a lifestyle choice. They do not always realize that even a tiny trace of gluten can be harmful to a person with celiac disease. 

Celiac Disease Treatment - Closing Up

Living with celiac disease or celiac sprue (an alternative name) is not easy but the effort you have to put in to keep yourself healthy is worth it.

Being given this diagnosis can seem devastating to begin with but it is an opportunity to take back control of your body and your health.

Of course most people mean to stick to the diet but then think to themselves that "just one crouton will not hurt, surely".

This is more likely to happen with teenagers who want to break free from the constraints they have been living with since they were children.

Unfortunately those tiny amounts of gluten can all add up to a damaged gut.

Planning is not everybody's strength but it can really help when you are battling this condition to plan your celiac disease treatment ahead and have gluten free foods and recipes to hand.

It is a good idea to talk to doctors and dietitians but they do not usually have time to keep up with the latest information and advances. With this lifelong condition it is a good idea to become your own expert.

DiarrheaNurse appreciates that living with celiac disease and following a celiac disease treatment regime is not easy but hopes that this information has been useful and answered some of your questions.

For more information about gluten intolerance and celiac symptoms and tests please see the links below.

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Picture attributions:

Fruit and veg by Michael Stern https://www.flickr.com/photos/68711844@N07/15637894679

Cheese and corn by Michael Stern https://www.flickr.com/photos/68711844@N07/15825287272

Steak by Michael Stern https://www.flickr.com/photos/68711844@N07/15204314443

Salad bar by Natalie Maynor https://www.flickr.com/photos/nataliemaynor/5437033809