Celiac disease Treatment – What are the guidelines and What needs to be avoided?

What is the treatment of Celiac Disease?

The only celiac disease treatment is to remove gluten from the diet (known and unknown sources) and from other non-dietary sources that can go into the mouth and reach the intestine.

Typically, there is no medicine required for celiac disease, and consuming a gluten-free diet stops further damage to the small intestine and initiates healing and recovery.

After stopping the consumption of gluten many people show improvement in symptoms of celiac disease with several days to weeks. In children, the small intestine may take about 3-6 months to heal whereas in adults this may take several months to years.

During the recovery period in celiac disease treatment, many patients are given supplements for several months to manage nutritional deficiencies and to avoid complications.

If the celiac disease is left untreated or undiagnosed it may result into a number of conditions and complications as detailed above. This makes following a strict gluten-free diet essentially important for celiac disease treatment.

Dermatitis herpetiformis and gluten-free diet

If you develop dermatitis herpetiformis in celiac disease, then consuming a gluten-free diet is generally enough to treat the condition. Although medicine such as Dapsone can be taken to manage the skin symptoms, the ongoing intestinal damage can’t be controlled. Moreover, the medicine causes certain side effects which needs to monitored by means of blood tests.

Refractory celiac disease

Rarely a person may have refractory celiac disease, where his or her small intestine doesn’t heal. Currently, no specific celiac disease treatment is effective and the condition may lead to serious damage to the small intestine.

What are the guidelines or standards for a gluten-free diet in Celiac Disease Treatment?

Gluten-free diet:

Gluten-free diet has been defined by the FDA as any food that fulfills the below criteria:

1) Food item not containing wheat, barely, rye or their crossbreeds as the main or even a smaller component. If there’s is gluten preset in the food it should be less than 20 parts per million, that is less than 20 milli-gram in 1 kilo-gram of food.

2) Food items derived from these grains but processed to remove gluten to below the threshold level of 20 parts per million, less than 20 milli-gram in 1 kilo-gram of food.

Understand how even a tiniest piece of bread or gluten source can’t fulfill gluten-free criteria.

Understand how even a minimal consumption of gluten can cause harm in people with celiac disease

What are the items that are unsafe or need to be avoided in celiac disease?

If a person wants to follow a gluten free diet, he or she should completely avoid gluten from the following possible sources, this comprises of “what not to eat” or “unsafe items” celiac disease treatment:

1. Obvious sources of gluten (wheat, barley or rye):

Some common food items containing an obvious source of gluten in celiac disease treatment, are given below:

Wheat: predominant gluten-containing food item consumed in India. Wheat in any form such as whole wheat flour (aatta), white flour (maida), semolina (sooji or rawa), or broken wheat (Dalia).

They can be used to make a variety of food items which needs to be avoided:

Indian breads: rotis, parathas, pooris, kulchas, naans, and others.

Bakery items: biscuits, cookies, cake, pastries, breads, buns, rusk, and others.

Fast-food: patties, burger, pav, samosa, kachori, golgappa, papdi, sevpuri ,  namkeen, and others.

South-Indian dishes: upma, rawa dosa and others.

Chinese and Italian food items: noodles, chow mein, macaroni, momo, dumpling, pasta, pizza, and others.

Barley: is used in food items like multigrain bread, biscuits. It is more commonly used to make malt (fermented grain) which is used to make drinks like beer, whiskey, malted milk, malted vinegar, and popular health drinks available in the market. It is also used in some of the breakfast cereals like cornflakes, rice krispies, and others.

Rye: rarely eaten in India. It is found in rye bread and rye whiskey. It can be found in some multigrain bread or biscuits. This is completely different from “rai”  seeds (mustard seeds or sarson) which are used very commonly in various forms in Indian food.

2. Hidden sources of gluten (wheat, barley, or rye):

In many products available in the market for treatment of celiac disease, a small amount of gluten is added during the process of production. These products are primarily made of other items but may contain enough gluten to be dangerous for health. Some of the products are non-food items and are not eaten, but a small amount of gluten may reach the intestine by contact from hands or mouth.

Some of the commonly used products available in the market for celiac disease treatment are:

• Preservatives and food stabilizers

• Food colors

• Sauces, marinades and soups available in market

• Indian sweets (mithai) available in the market

• Ice-creams

• Packaged Idli and dosa batter available in the market

• Spices available in the market especially ‘heeng’

• Breakfast cereals such as rice krispies, cornflakes, and others

• Some medicines may contain gluten but less likely causes any symptoms.

• Nutritional supplements such as vitamin, mineral and herbal supplements

• Lipstick, lip gloss, lip balm, and some other cosmetic products

• Some hair and skin products

• Toothpaste and mouth wash

• Playdough

3. Transfer of small amount of gluten during storage, cooking/production or serving (cross-contamination)

There are chances that a gluten-free item may get contaminated by gluten from a gluten-containing item during the process of production, cooking, storage or even serving in celiac disease treatment.

Know how to avoid contamination of gluten-free items

What a person can eat in celiac disease treatment or “safe food items” or “gluten-free” items?

As discussed above all the items that are not an obvious or hidden source of gluten from wheat, barley or rye are safe to eat and are considered as gluten-free.

Items available in the market which are declared as gluten-free according to international standards are also safe to be used in celiac disease treatment.

These naturally available gluten-free food items that can be eaten are as follows:

1. Food grains: all grains except wheat, barley, or rye can be used. These food items when used without gluten-containing additives can provide a healthy and safe source of nutrition:

• Rice, all types including brown rice and rice noodles

• Millets like bajra (pearl millet), ragi (finger millet), jowar (sorghum) and others

• Kuttu (buckwheat) commonly used during fasts in the northern part of India

• Makka (corn)

• Ramdaana or rajgira (Amaranth)

• Quinoa

2. Soya, sabudana (sago)

4. Vegetables

5. Fruits

6. Pulses/daal and legumes (rajma, chola, chana and others)

7. Plain milk

8. Coffee or tea- unflavored-check for the ingredients

9. Eggs

10. Fish

11. Meat- plain/ unprocessed

12. Honey

13. Sugar, salt or whole spices (sabut masala)

Oats have been considered as unsafe during celiac disease treatment but the study suggests the most people can eat moderate amount of oats that have not come in contact with wheat gluten during processing.

What to keep in mind while shopping or eating outside during treatment of Celiac Disease?

When shopping and eating out, remember to

• Read food labels especially on canned, frozen, and processed foods—for ingredients that contain gluten. Reading the product labels can sometimes help you avoid gluten. Some product makers label their products as being gluten-free for celiac disease treatment. If a product label doesn’t list the product’s ingredients, ask the maker of the product for an ingredients list.

• Identify foods labeled “gluten-free;” by law, these foods must contain less than 20 parts per million, well below the threshold to cause problems in the great majority of patients with celiac disease.

• Ask restaurant servers and chefs about how they prepare the food and what is in it.

• Find out whether a gluten-free menu is available.

What you should do if you think gluten is causing your symptoms?

Consult a doctor before stop eating gluten during celiac disease treatment. You must visit a doctor who may ask to get some standard blood tests done to screen you for celiac disease. These tests may show false results if you have been avoiding consuming gluten for some time. Moreover, your doctor would also like to evaluate you for other conditions that may cause similar symptoms.

Know the 4-week gluten-free diet plan

Starter guide for a gluten-free diet

Quick reference for gluten-free diet by gluten intolerance group

What does gluten free tag on food means/ know the FDA guidelines for gluten free food

Know about wheat sensitivity/non-celiac gluten sensitivity

Guide to food and products containing gluten/ guide to know what to avoid to be celiac free

Meal plans

Gluten-Free Recipes

Know more about gluten-containing food items