Celiac disease - nutritional considerations

Gluten sensitive enteropathy - diet; Celiac sprue - diet

Definition

Celiac disease is an immune disorder passed down through families.

Gluten is a protein found in wheat, barley, or rye. It may also be found in some medicines. When a person with celiac disease eats or drinks anything containing gluten, the immune system responds by damaging the lining of the small intestine. This affects the body's ability to absorb nutrients.

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

Food Sources

To follow a gluten-free diet means, you need to avoid all foods, drinks, and medicines made with gluten. This means not eating anything made with barley, rye, and wheat. All items made with all-purpose, white, or wheat flour should be eliminated from the diet.

FOODS YOU CAN EAT

  • 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
  • Gluten-free oats
  • Potatoes
  • Rice
  • Gluten-free products such as crackers, pasta, and breads

Common sources of gluten include:

  • Breaded foods
  • Breads, bagels, croissants, and buns
  • Cakes, donuts, and pies
  • Cereals (most)
  • Crackers and many snacks bought at the store, such as potato chips and tortilla chips
  • Gravy
  • Pancakes and waffles
  • Pasta and pizza (other than gluten-free pasta and pizza crust)
  • Soups (most)
  • Stuffing

Less obvious foods that must be eliminated if they contain gluten include:

  • Beer
  • Candies (some)
  • Cold cuts, hot dogs, salami or sausage
  • Communion breads
  • Croutons
  • Some marinades, sauces, soy, and teriyaki sauces
  • Salad dressings (some)
  • Self-basting turkey

There is a risk for cross-contamination of foods. 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. Due to the widespread use of wheat and barley in foods, it is important to read labels before buying food or eating.

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

Recommendations

Talk to a registered dietitian who specializes in celiac disease and the gluten-free diet to help you plan your diet. This is especially helpful because gluten contamination can happen even if a restaurant or label assures you a product is gluten-free. A dietician can help recommend products that will be safe.

You may also want to join a local support group. These groups can help people with celiac disease share practical advice on ingredients, baking, and ways to cope with this life-altering, lifelong disease.

Your health care provider might suggest you take a multivitamin and mineral or an individual nutrient supplement to correct or prevent a deficiency.

References

Lebwohi B, Green PHR. Celiac disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 107.

Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology guidelines update: diagnosis and management of celiac disease. Am J Gastroenterol. 2023;118(1):59-76. PMID: 36602836 pubmed.ncbi.nlm.nih.gov/36602836/.

Shand AG, Lean MEJ. Nutritional factors in disease. In: Penman ID, Ralston SH, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 24th ed. Philadelphia, PA: Elsevier; 2023:chap 22.

Troncone R, Auricchio R. Celiac disease. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 34.

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Review Date: 12/31/2023

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


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