What is the treatment for 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.

A small percentage of people with celiac disease do not improve on the gluten-free diet. These people often have severely damaged intestines that cannot heal even after they eliminate gluten from their diet. Because their intestines are not absorbing enough nutrients, they may need to receive intravenous nutrition supplements. Drug treatments are being evaluated for unresponsive celiac disease. These patients may need to be evaluated for complications of the disease.

The Gluten-Free Diet

A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley--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. A dietitian is a health care professional who specializes in food and nutrition.

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. Hidden sources of gluten include additives, preservatives, and stabilizers found in processed food, medicines, and mouthwash. If ingredients are not itemized, you may want to check with the manufacturer of the product. With practice, screening for gluten becomes second nature.

A dietitian 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 the food does not contain gluten.

Food Categories	Foods Recommended	Foods To Omit	Tips
Breads, cereals, rice, and pasta: 6-11 servings each day
Serving size = 1 slice bread, 1 cup ready-to-eat cereal, 1/2 cup cooked cereal, rice, or pasta; 1/2 bun, bagel, or English muffin	• Breads or bread products made from corn, rice, soy, arrowroot corn or potato starch, pea, potato or whole-bean flour, tapioca, sago, rice bran, cornmeal, buckwheat, millet, flax, teff, sorghum, amaranth, and quinoa • Hot cereals made from soy, hominy, hominy grits, brown and white rice, buckwheat groats, millet, cornmeal, and quinoa flakes • Puffed corn, rice or millet, and other rice and corn made with allowed ingredients • Rice, rice noodles, and pastas made from allowed ingredients • Some rice crackers and cakes, popped corn cakes made from allowed ingredients	• Breads and baked products containing wheat, rye, triticale, barley, oats, wheat germ or bran, graham, gluten or durum flour, wheat starch, oat bran, bulgur, farina, wheat-based semolina, spelt, kamut • Cereals made from wheat, rye, triticale, barley, and oats; cereals with added malt extract and malt flavorings • Pastas made from ingredients above • Most crackers	Use corn, rice, soy, arrowroot, tapioca, and potato flours or a mixture instead of wheat flours in recipes. Experiment with gluten-free products. Some may be purchased from your supermarket, health food store, or direct from the manufacturer.
Food Categories	Foods Recommended	Foods To Omit	Tips
Vegetables: 3-5 servings each day
Serving size = 1 cup raw leafy, 1/2 cup cooked or chopped, 3/4 cup juice	• All plain, fresh, frozen, or canned vegetables made with allowed ingredients	• Any creamed or breaded vegetables (unless non-allowed ingredients are used), canned baked beans • Some french fries	Buy plain, frozen, or canned vegetables and season with herbs, spices, or sauces made with allowed ingredients.
Food Categories	Foods Recommended	Foods To Omit	Tips
Fruits: 2-4 servings each day
Serving size = 1 medium size, 1/2 cup canned, 3/4 cup juice, 1/4 cup dried	• All fruits and fruit juices	• Some commercial fruit pie fillings and dried fruit
Food Categories	Foods Recommended	Foods To Omit	Tips
Milk, yogurt, and cheese: 2-3 servings each day
Serving size = 1 cup milk or yogurt, 1 1/2 oz natural cheese, 2 oz processed cheese	• All milk and milk products except those made with gluten additives • Aged cheese	• Malted milk • Some milk drinks, flavored or frozen yogurt	Contact the food manufacturer for product information if the ingredients are not listed on the label.
Food Categories	Foods Recommended	Foods To Omit	Tips
Meats, poultry, fish, dry beans and peas, eggs, and nuts: 2-3 servings or total of 6 oz daily
Serving size = 2-3 oz cooked; count 1 egg, 1/2 cup cooked beans, 2 tbsp peanut butter, or 1/4 cup nuts as 1 oz of meat	• All meat, poultry, fish, and shellfish; eggs • Dry peas and beans, nuts, peanut butter, soybeans • Cold cuts, frankfurters, or sausage without fillers	• Any prepared with wheat, rye, oats, barley, gluten stabilizers, or fillers including some frankfurters, cold cuts, sandwich spreads, sausages, and canned meats • Self-basting turkey • Some egg substitutes	When dining out, select meat, poultry, or fish made without breading, gravies, or sauces.
Food Categories	Foods Recommended	Foods To Omit	Tips
Fats, snacks, sweets, condiments, and beverages
	• Butter, margarine, salad dressings, sauces, soups, and desserts made with allowed ingredients • Sugar, honey, jelly, jam, hard candy, plain chocolate, coconut, molasses, marshmallows, meringues • Pure instant or ground coffee, tea, carbonated drinks, wine (made in U.S.), rum, alcohol distilled from cereals such as gin, vodka, and whiskey • Most seasonings and flavorings	• Commercial salad dressings, prepared soups, condiments, sauces and seasonings prepared with ingredients listed above • Hot cocoa mixes, nondairy cream substitutes, flavored instant coffee, herbal tea, and beer • Beer, ale, cereal, and malted beverages • Licorice	Store all gluten-free products in your refrigerator or freezer because they do not contain preservatives. Remember to avoid sauces, gravies, canned fish, and other products with HVP/HPP made from wheat protein.

2001, the American Dietetic Association. "Patient Education Materials: Supplement to the Manual of Clinical Dietetics." 3rd ed. Used with permission.

source: http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/index.htm