Treatment

You can effectively manage celiac disease through changing your diet. Once gluten is removed from the diet, inflammation in your small intestine will begin to subside, usually within several weeks. 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 2 to 3 years in older people.

Improvements after starting a gluten-free diet may be especially dramatic in children. Not only do their physical symptoms improve, but also their behavior. In addition, their growth starts to pick up.

To manage the disease and prevent complications, it's crucial that you avoid all foods that contain gluten. 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. 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 on a gluten-free diet can eat 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.

Still, many basic foods are allowed in a gluten-free diet. These include:

• Fresh meats, fish and poultry (not breaded or marinated)

• Most dairy products
• Fruits
• Vegetables
• 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 are often 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 those containing gluten. Cross-contamination may occur anywhere ingredients come together, such as 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.

Fortunately for bread and pasta lovers with celiac disease, an increasing number of gluten-free products are available 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, from brownies to beer.

Identifying gluten-free foods can be difficult. 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.

If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no 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. Going on and off a gluten-free diet can lead to serious complications.

Most people with celiac disease who follow a gluten-free diet have a complete recovery. Only a small percentage of people who have 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 by their doctors for other health conditions.