The only treatment is a gluten-free diet. Celiac disease patients vary in their tolerance of gluten — some patients can ingest small amounts of gluten without developing symptoms, while others experience massive diarrhea with only minute amounts of gluten. The standard treatment calls for complete avoidance of gluten for life. The principles of a gluten-free diet include:
- Avoid all foods made from wheat, rye, and barley. Examples are breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies.
- Avoid oats. Some patients with celiac disease can tolerate oats in the diet. But long-term safety of oats in celiac disease patients is unknown, and some oat preparations can be contaminated with wheat. Thus, it is probably best to avoid oats at least during the initial treatment with a gluten-free diet. Once the disease is in remission with a strict gluten-free diet, it may be possible to reintroduce small quantities of oats into the diet under medical supervision.
- Pay attention to processed foods that may contain gluten. Wheat flour is a common ingredient in many processed foods. Examples of foods that may contain gluten include:
- Canned soups
- Salad dressings
- Ice cream
- Candy bars
- Instant coffee
- Luncheon meats and processed or canned meats
- Ketchup and mustard
- Beware of tablets, capsules, and vitamin preparations that contain gluten. Wheat starch is commonly employed as a binding agent in tablets and capsules. Gluten also can be found in many vitamin products, and cosmetic products such as lipstick.
- Avoid beer, but wine, brandy, whiskey, and other alcohols without barley are fine in moderation
- Avoid milk and other dairy products that contain lactose. Untreated patients with celiac disease often are lactose intolerant. With successful treatment, dairy products can often be reintroduced slowly into the diet later.
- Consult dietitians and national celiac disease societies for lists of gluten-free foods. Read the food and product labels before buying or consuming any product. This is necessary, because a manufacturer may change a product’s ingredients at any time. A product that was gluten-free in the past may now contain gluten. Even branded products may be gluten-free in one country but contain gluten in another country. If one is not certain after reading the labels, call the manufacturer.
- Because people with celiac disease who have severe malabsorption can develop vitamin and mineral deficiencies, vitamin and mineralsupplements are important. Ask your doctor if a multivitamin is right for you. Patients with iron deficiency anemia should be treated with iron. Patients with anemia due to folate or B12 deficiency should be treated with folic acid and B12. Patients with an abnormal ProTime should be treated with vitamin K. Patients with low blood calciumlevels or with osteoporosis should be treated with calcium andvitamin D supplements.
Following a gluten-free diet should result in improvements in symptoms within weeks. Many patients report symptom improvements within 48 hours. In children with celiac disease, the response to a gluten-free diet can be dramatic. Not only will diarrheaand abdominal discomfort subside, but behavior also improves, and growth resumes (with rapid catch up in height). These improvements in symptoms are followed by reappearance of intestinal villi, finger-like surface projections in the small intestine that are damaged by gluten.
Complete normalization of the intestinal villi may take months. In many adult patients, the improvement in symptoms is followed by only partial regeneration of intestinal villi. In patients with dermatitis herpetiformis, the skin lesions also will gradually improve with a gluten-free diet. Often a medication called dapsone may be used for a short time to speed up healing.
Many patients with celiac disease may not understand the importance of life-long adherence to a gluten-free diet. Many of those affected do not follow the diet closely. People who are poor and undereducated are most likely to have trouble following the diet, as are people who were diagnosed when they were children.