Celiac disease is a chronic disorder that affects the small intestine and can interfere with the absorption of nutrients. It can begin at any stage of life, from infancy through adulthood.
Gluten is found in wheat (including spelt, semolina, durum), rye, and barley, as well as "hybrids" of these grains—kamut and triticale.. Gliadin, the offending substance, is not present in corn or rice but is found in the other grains.
Since gluten/gliadin are the problem, patients with celiac disease have to stop eating foods that contain them. People with the disease cannot eat wheat, rye, barley, or any products made with these grains. They can have corn and rice even though they contain gluten, because they don't contain gliadin.
Oats have traditionally been avoided, but recent studies have challenged this restriction, and experts may allow ceratin types of oats for a celiac diet on a case-by-case basis.
In people with celiac disease, gliadin damages the tiny projections, called villi, that cover the lining of the small intestine. Villi help absorb and carry fluids and nutrients. When they are damaged, the body is unable to absorb the nutrients that it needs.
This causes problems that may include: diarrhea from malabsorption of nutrients, especially fats.weight lossfatigueirritabilitya distended bellyA neuropathy (nerve problem) or brain diseaseAnemia or low blood count, especially iron deficiencyA malignancy of the lymphoid system later
Celiac disease can cause vitamin and mineral deficiencies, lactose intolerance, and a foul smell to feces from the undigested fats. .
Celiac disease may be completely silent or asymptomatic.
Diet is the most important part of treatment. A person with celiac disease is put on a gluten-restricted, gliadin-free diet.
It is best to obtain initial dietary consultation with a registered dietician and maintain followup for ongoing professional advice about diet.
Foods to avoid are any products made with wheat, rye, barley, and, sometimes oats.
In addition, starches are found in many flours and thickening agents. Starch may contain wheat unless it is made from corn, rice tapioca, or potato. Couscous is to be avoided.
Similar problems may exist with certain dextrimaltoses, malts and malt syrups, dextrins, dextrates, cyclodextrins, maltodextrins, starch glycolate, and caramel coloring. As a result, many processed foods may have hidden sources of either gluten or gliadin.
People with celiac disease should carefully read food labels to find hidden gliadin-containing ingredients. Commonly overlooked items that are bad include: baked beans, chocolate bars, croutons, dry roasted nuts, icings and frostings on cakes, licorice, pastas, salad dressing, self-basting poultry, soy sauce, thickeners.
Foods such as corn, rice, soybeans, chickpeas, tapioca, arrowroot, and potatoes can be eaten.
It also can be helpful to avoid lactose, a milk sugar found in most dairy products.
A person with celiac disease should supplement his or her diet with fiber, iron, vitamins and minerals, including calcium and vitamin D, magnesium, zinc, and electrolyte and fluid replacements.
The cause of celiac disease is not completely understood, but is a combination environmental (proteins in dietary cereal grains), genetic (specific genes and an enzyme in the bowel called tissue transglutaminase (TTG), and immune (lymphocytes that fight invasion of the body that respond to the gluten) factors.
Complete recovery from this disease may take as long as 6 months, but most people get better within weeks on a gluten free diet.
The good news is that people with celiac disease may access multiple support services.. There are many groups that provide resources for these people and their families including: the Celiac Disease Foundation (www.celiac.org), Celiac Sprue association (www. Csaceliacs.org), Gluten intolerance Group of North America (www.gluten.net), and the Canadian Celiac Association (www.celiac.ca).
There are also more choices today than ever before for gluten-free foods. At one time, people with celiac disease had to prepare their own foods. Bread was prepared from potato flour and cereals from non-gluten grains.
Now there are food companies that produce pasta, breads, and cereals specially made from gluten-free grains. In many cases, these foods are available through mail order.
Mahan, K, MS, RD, CDE&Escott-Stump, S., MA, RD, LDN. (2000). Krause's Food, Nutrition,&Diet Therapy (10th ed.). Pennsylvania: W.B. Saunders Company.
American Dietetic Association. (1996). Manual of Clinical Dietetics (5th ed.). The American Dietetic Association.