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    Celiac disease - nutritional considerations

    Gluten-free diet; Gluten sensitive enteropathy - diet; Celiac sprue - diet

    Celiac disease is an immune disorder passed down through families.

    Gluten is a protein found in wheat, barley, rye, or sometimes oats (including medications). When a person with celiac disease eats or drinks anything containing gluten, the immune system responds by damaging the lining of the intestinal tract. This damage affects the body's ability to absorb nutrients.

    For specific information about the disease (including symptoms and treatment), see: Celiac disease.

    Carefully following a gluten-free diet helps prevent symptoms of the disease.

    Food Sources

    Staples of the gluten-free diet include:

    • Beans
    • Cereals made without wheat or barley malt
    • Corn
    • Fruits and vegetables
    • Meat, poultry, and fish (not breaded or made with regular gravies)
    • Milk-based items
    • Oats (may be okay for some people with celiac disease, but work closely with your doctor or dietitian)
    • Potatoes
    • Rice

    You can eat foods such as pasta, bread, pancakes, and pastries made with alternative grains (rice, buckwheat, tapioca, potato, or corn flours and starches).

    You can buy these products through local and national food companies, or you can make them from scratch using alternative flours and grains.

    Other food items you may use for cooking include:

    • Flax, millet
    • Legumes, nuts, seeds, cassava
    • Tapioca sorghum

    The gluten-free diet involves removing all foods, drinks, and medications made from gluten. This means not eating anything made with barley, rye, and wheat. All items made with all-purpose, white, or wheat flour are prohibited.

    Obvious sources of gluten include:

    • Breaded foods
    • Breads, bagels, croissants, buns
    • Cakes, donuts, and pies
    • Cereals (most)
    • Cold cuts, hot dogs, salami, or sausage
    • Crackers and many snacks bought at the store, such as potato chips and tortilla chips
    • Gravy
    • Pancakes and waffles
    • Pasta and pizza
    • Soups (most)
    • Stuffing

    Less obvious foods that must be eliminated include:

    • Beer
    • Candies (some)
    • Communion breads
    • Croutons
    • Marinades, sauces, soy and teriyaki sauces
    • Salad dressings (some)
    • Self-basting turkey

    There is a risk of cross-contamination. Items that are naturally gluten-free may become contaminated if they are made on the same production line, or moved together in the same place, as foods containing gluten.

    Eating at restaurants, work, school, and social gatherings can be challenging. Call ahead and plan. It is important to read labels before buying or eating, due to the widespread use of wheat and barley in foods.

    Despite its challenges, maintaining a healthy, balanced diet is possible with education and planning.

    Recommendations

    Once you have been diagnosed with celiac disease, it is very important that you talk to a registered dietitian who specializes in celiac disease and the gluten-free diet.

    Joining a local support group is also recommended. Support groups can help people with celiac disease share practical advice on ingredients, baking, and ways to cope with this life-altering, lifelong disease.

    See also: Celiac disease support group

    Your doctor might prescribe a multivitamin and mineral or individual nutrient supplement to correct or prevent a deficiency.

    References

    Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731-1743.

    Kagnoff MF. AGA Institute medical position statement on the diagnosis and management of celiac disease. Gastroenterology. 2006;131(6):1977-1980.

    Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 142.

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            Review Date: 2/19/2012

            Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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