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Treatments and drugs
By Mayo Clinic staffCeliac disease has no cure, but you can effectively manage the disease through changing your diet.
Once gluten is removed from your diet, inflammation in your small intestine will begin to subside, usually within several weeks, though you may start to feel better in just a few days. If your nutritional deficiencies are severe, you may need to take vitamin and mineral supplements recommended by your doctor or dietitian to help correct these deficiencies. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people.
Avoiding gluten is essential
To manage the disease and prevent complications, it's crucial that you avoid all foods that contain gluten. Even a small amount of gluten is enough to cause symptoms and complications — that means all foods or food ingredients made from many grains, including wheat, barley and rye. This includes any type of wheat (including farina, graham flour, semolina and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt and triticale.
Amaranth, buckwheat and quinoa are gluten-free as grown, but may be contaminated by other grains during harvesting and processing, so be sure the label says gluten-free or manufactured in a gluten-free facility. Cross-contamination may also occur if gluten-free products are prepared in unwashed bowls previously containing gluten products. Oats may not be harmful for most people with celiac disease, but oat products are frequently contaminated with wheat, so it's best to avoid oats as well.
The question of whether people eating a gluten-free diet can consume pure oat products remains a subject of scientific debate. Difficulties in identifying the precise components responsible for the immune response and the chemical differences between wheat and oats have contributed to the controversy.
Your doctor may recommend that you meet with a dietitian who can instruct you on a gluten-free diet. There are still many basic foods allowed in a gluten-free diet. These include:
- Fresh meats, fish and poultry (not breaded or marinated)
- Most dairy products
- Fruits
- Vegetables
- Rice
- Potatoes
- Gluten-free flours (rice, soy, corn, potato)
Most foods made from grains contain gluten. Avoid these foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:
- Breads
- Cereals
- Crackers
- Pasta
- Cookies
- Cakes and pies
- Gravies
- Sauces
Many other foods have ingredients that contain gluten. Grains containing gluten may be used in food additives, such as malt flavoring, modified food starch and others. Other sources of gluten that might come as a surprise include medications and vitamins that use gluten as a binding agent, lipstick, postage stamps and contamination of gluten-free foods with foods containing gluten. Cross-contamination may occur anywhere ingredients come together, such as on a cutting board. You may also be exposed to gluten by using the same utensils as others, such as a bread knife, or by sharing the same condiment containers.
Gluten-free products abound
Fortunately for bread and pasta lovers with celiac disease, there are an increasing number of gluten-free products on the market. If you can't find any at your local bakery or grocery store, check with a celiac support group or the Internet for availability. In fact, there are gluten-free substitutes for many gluten-containing foods.
Identifying gluten-free foods can be difficult. Because a gluten-free diet needs to be strictly followed, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet. A dietitian can advise you on how to best maintain the nutritional quality of your diet and help you come up with gluten-free alternatives. She or he will also help you identify your need for vitamin, calcium and mineral supplements. Revisiting the dietitian over the years will help keep you up to date on newer food products as well as answer your questions.
What if you eat gluten?
If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn't mean it's not hurting them. Even trace amounts of gluten in your diet can be damaging, whether or not they cause signs or symptoms.
Most people with celiac disease who follow a gluten-free diet have a complete recovery. Rarely, people with severely damaged small intestines don't improve with a gluten-free diet. When diet isn't effective, treatment often includes medications to help control intestinal inflammation and other conditions resulting from malabsorption.
Because celiac disease can lead to many complications, people who don't respond to dietary changes need frequent monitoring for other health conditions.
- Kelly CP. Patient information: Celiac disease. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/. Accessed Sept. 25, 2008.
- Schupann D, et al. Pathogenesis, epidemiology, and clinical manifestations of celiac disease in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Hill ID. Management of celiac disease in children. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Ciclitira PJ. Management of celiac disease in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 17, 2008.
- Nelson DA. Gluten-sensitive enteropathy (celiac disease): More common than you think. American Family Physician. 2002;66(12):2259-2266.
- Picco MF [expert opinion]. Mayo Clinic, Jacksonville, Fla. Oct. 9, 2008.
