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Celiac Disease and a Gluten-Free Diet

What is celiac disease?

Celiac disease is a digestive system problem. It affects the lining of the small intestine and makes it hard for your gut to absorb nutrients from food. If this disease is not diagnosed and treated, it can cause serious problems.

How does it occur?

Celiac disease is a genetic problem, which means it runs in families. When you have celiac disease, your body has an abnormal reaction to a protein called gluten. Gluten is in wheat, barley, and rye grains. If you have celiac disease and you eat gluten, your immune system attacks the part of your gut (the small intestine, or bowel) that absorbs nutrients.

You might also have a similar reaction to another type of protein found in oats.

Researchers are trying to learn why celiac disease can affect people very differently. Some develop symptoms as children, others later in life. How long you were breast-fed, your age when you started eating foods with gluten, and how much gluten you eat seem to be related to when and how celiac disease appears. Some studies have shown that the longer a child is breast-fed, the later and less severe the symptoms appear.

What are the symptoms?

The symptoms can vary a lot from one person to the next. The symptoms are often different for children and adults.

Babies and children are more likely to have digestive symptoms, such as:

  • diarrhea that does not go away
  • crampy stomach pain
  • bloating and gas
  • foul-smelling bowel movements.

Because the body is not getting the nutrients it needs, the following symptoms are also common in children:

  • weight loss
  • poor growth
  • tiredness
  • behavior changes and irritability
  • tooth discoloration and loss of enamel from the teeth.

Adults are less likely to have digestive symptoms. More often they have 1 or more of the following symptoms:

  • bone and joint pain
  • tiredness
  • missed menstrual periods and trouble getting pregnant
  • seizures
  • itchy rash
  • sores inside the mouth
  • numbness or tingling in the hands and feet

Blood tests may show that they don't have enough iron (anemia).

Some people have celiac disease but do not have any symptoms. They are still at risk for the serious long-term complications of celiac disease, such as:

  • not getting the nutrients they need from food
  • anemia
  • liver disease
  • osteoporosis (bone loss)
  • cancer.

How is it diagnosed?

Celiac disease is diagnosed much more often now than it used to be. It is now estimated to happen in 1 of 133 Americans. It used to be hard to diagnose because many of the symptoms are like the symptoms of other problems, such as irritable bowel syndrome, chronic fatigue, or intestinal infection. Recently it was found that people with celiac disease have a higher level of certain antibodies in their blood. This means a simple blood test for these antibodies can now help with the diagnosis. Before having this test, you will be asked to eat your usual diet and to eat foods that contain gluten, such as bread. If you avoid foods containing gluten before the test, the test may be negative even if you have the disease.

If your blood test is positive for the antibodies and you have symptoms, you may need a biopsy of your small intestine. A biopsy is the removal of a tiny piece of the intestine. The sample of intestine is examined for signs of celiac disease.

How is it treated?

The only treatment for celiac disease is a gluten-free diet. For most people, this diet relieves symptoms in a few weeks. The gluten-free diet allows the intestine to heal and prevents more damage. Typically, in children and young adults, the bowel may be completely healed 3 to 6 months after you start the diet. In older adults, the healing may take up to a few years.

In some cases you may keep having symptoms even though you are eating a gluten-free diet. This may be caused by having a small amount of gluten still in your diet, or the intestine may have been too damaged before you started the diet. This is called unresponsive celiac disease.

What is a gluten-free diet?

A gluten-free diet is one that contains no wheat (including spelt, triticale, and Kamut), barley, or rye. It also avoids products that use additives containing gluten, such as some vitamins, medicines, and stamp or envelope adhesives. Because the American diet is based on grains and many processed foods contain grain-based additives, this diet can be hard to follow. You may need to talk to a dietitian who knows about gluten-free diets and celiac disease. You will need to have follow-up visits with the dietitian to check your diet and get help in staying up to date on gluten-free food products.

At first, gluten-free diet recommendations can be overwhelming. Keep it simple until you have had a chance to meet with your dietitian. Fresh fruits, vegetables, beans, milk, and unprocessed protein foods such as fresh beef, pork, poultry, fish, and eggs do not contain gluten. Natural nuts, seeds, and vegetable oils without additives are also safe. Add in foods from the allowed starches and grains listed below for a balanced diet.

What foods are included in a gluten-free diet?

Listed below are some foods it is OK to eat. The lists are not complete. Consult your dietitian and recommended Web sites for more details.

Allowed starches and grains:

  • breads and other baked goods made with potato, rice, bean, buckwheat, soy, tapioca, arrowroot, quinoa, millet, and flax flours
  • rice
  • wild rice
  • amaranth
  • rice noodles and pasta made with allowed ingredients
  • dried beans
  • quinoa
  • cornmeal
  • potatoes, sweet potatoes, and yams
  • corn and peas (avoid creamed varieties unless they are made with allowed ingredients)
  • gluten-free bread and pasta products
  • hot cereals made from white or brown rice, hominy, hominy grits, groats, soy, or millet
  • cold cereals such as puffed rice and corn.

Some people with celiac disease enjoy and can tolerate gluten-free oats. Including oats in your diet can make it easier for you to stick to a gluten-free diet. You can slowly include oats in your diet, making sure that package labels show that the oats are gluten free. Research shows that about 50 grams dry oats a day is generally safe. This means adults should have no more than 1/2 cup and children no more than 1/4 cup gluten-free dry oats a day.

For best results, gluten-free baked goods are made with a combination of flours from the starches and grains listed above.

Allowed fruits and vegetables:

  • all fresh, canned, and frozen fruit or fruit juices
  • fresh vegetables
  • canned and frozen vegetables made with allowed ingredients.

Allowed milk products:

  • milk
  • aged cheese
  • all other milk products made without gluten additives.

Allowed meats, poultry, fish, eggs, dried beans, nuts and seeds:

  • all unprocessed foods in this category
  • peanut butter.

Allowed fats, sweets, and drinks:

  • butter and vegetable oils
  • salad dressings and sauces made with allowed ingredients
  • sugar
  • honey
  • marshmallows
  • plain chocolate
  • coconut
  • jelly or jam
  • pure instant or ground coffee
  • carbonated sodas
  • some brands of soy and almond milk (check labels)

What foods do I need to avoid in a gluten-free diet?

Listed below are some foods you need to avoid. The lists are not complete. Consult your dietitian and recommended Web sites for more details.

Starches and grains to avoid:

  • wheat
  • rye
  • barley
  • bulgur
  • spelt
  • triticale
  • Kamut
  • semolina
  • couscous
  • all breads, baked goods, crackers, noodles, pastas, and cereals made with the above grains
  • cereals containing malt extract or malt flavoring
  • canned baked beans.

Fruits and vegetables to avoid:

  • some pie fillings and dried fruits
  • creamed vegetables
  • breaded vegetables.

Milk products to avoid:

  • some flavored milks and yogurts (including frozen yogurt)
  • malted milk.

Meats, poultry, fish, and eggs to avoid:

  • some egg substitutes
  • some marinated meats, poultry, and fish
  • cold cuts made with gluten stabilizers, wheat, barley, rye, oat fillers, and self basting turkey.

Fats, sweets, and drinks to avoid:

  • commercially prepared condiments, soups, salad dressings, and sauces
  • flavored instant coffees, herbal teas, and hot cocoa mixes
  • nondairy creamers
  • beer and malted beverages
  • sauces, gravies, and products made with hydrolyzed vegetable or plant protein (HVP or HPP) made from wheat.

What should I look for on food labels?

There are many hidden sources of gluten, so learning to read labels is a must. Ingredients that carry possible risk include:

  • unidentified starch
  • modified food starch
  • hydrolyzed vegetable or plant proteins ("HVP" or "HPP")
  • texturized vegetable protein ("TVP")
  • binders, fillers, and extenders.

The US Food and Drug Administration (FDA) has proposed a voluntary labeling for gluten-free products and has established rules for the use of the term "gluten free" on product labels. Any product with the gluten-free label has less than 20 parts per million (ppm) gluten per serving. Visit for updates regarding this ruling.

Some food companies are getting their products certified by the GFCO (Gluten Free Certification Organization). The GFCO is an independent organization that tests for gluten and has strict gluten free standards. These products will hold the GFCO stamp (logo) on their label. Many companies will send you a list of their gluten-free products.

If you have any question about the ingredients of a food, avoid the product until you have contacted the food manufacturer for more information.

What about medicines and supplements?

Some medicines and supplements contain gluten additives. It is important to ask your pharmacist or call the manufacturer to find out about the ingredients in your medicine.

If you have celiac disease, you have a higher risk for vitamin deficiency, especially for B vitamins. Also, having a gluten-free diet may mean that you don't get enough iron, folate, B vitamins, calcium, and zinc from the foods you eat. For these reasons, your healthcare provider may prescribe a daily gluten-free multivitamin and mineral supplement.

Can I still eat at restaurants?

You need to be very careful when you eat at a restaurant or deli.

  • Order simple dishes without sauces.
  • Ask your restaurant server about the ingredients.
  • Ask about the food preparation areas. Are grain products prepared with the same equipment or utensils used to prepare other foods?
  • Ask if the restaurant has a gluten-free menu.

How long will the effects last?

You must follow the gluten-free diet all your life. If you keep eating foods that contain gluten, the disease can become life threatening.

It's possible to have celiac disease for years before you are diagnosed. The longer you go without treatment, the more your intestine is damaged and the greater your risk for long-term problems. If you think you may have celiac disease, see your healthcare provider.

If you have been diagnosed with celiac disease, keep all of your checkup appointments. See your provider sooner than your next scheduled checkup if you are having symptoms again.

How can I get more information?

For more information about celiac disease, a gluten-free diet, and gluten-free products, see:

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File gase4734.htm Release 13/2010

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