Celiac disease is an autoimmune response to gluten, the protein found in certain grains, that destroys the intestinal villi needed for absorbing food. To get rid of the symptoms, you have to get rid of the gluten. That means avoidance of all forms of wheat, barley and rye. Corn, millet, rice and buckwheat don’t cause the disease but may aggravate symptoms in sensitive people.
Many sources continue to ban oats. But recent, better designed studies show that most celiacs actually do tolerate moderate amounts of oats (BMJ
2004;53:649-54; Scand J Gastroenterol
2008;43:1094-101): 95% of celiacs have been shown to tolerate 50g of oats a day for up to a year (NEJM
Being able to eat oats is important, not only because it makes the diet easier, but because it improves your nutrition. Celiacs who eat moderate amounts of oats improve their intake of fiber, B1, magnesium, iron and zinc (Eur J Clin Nutr
2010;64(1):62-7). But be careful because it is common for oat products found in the mass market to be contaminated with gluten (NEJM
2004;351:2021-2). When people who thought they were on a gluten free diet were put on a truly gluten free diet, 77% of them improved (Scand J Gastroenterol
If you eliminate gluten from your diet, symptoms usually start going away fast. As many as 30% may start responding in as little as 3 days. Another 50% will respond within a month, and another 10% within one more month. 10% will, unfortunately, take much longer, and 2-5% will not improve even though they eliminate gluten (Nat Rev Gastroenterol Hepatol
2010;7(4):204-13). If you don’t get better, and you really do have celiac disease, and you really aren’t eating unknown gluten, then get tested for zinc deficiency. Zinc deficiencies are common among celiacs, and celiacs do not respond to a gluten free diet if there is a zinc deficiency.
Dairy should be eliminated until the intestines return to normal. Giving milk early in childhood is a major causative factor in celiac disease (Acta Paediatrica Scand
1965;54:101-15; J Ped Gastroenterol Nutr
1983;2:S304-9; Ann Rev Nutr
1985;5:241-66). Breast milk, on the other hand, protects against celiac disease (Pediatr Gastroenterol Nutr
1983;2:428-33; Am J Clin Nutr
2002;75:914-21; Croat Med J
2010 15;51(5):417-22; Evid Based Med
2013;18(3):98-103). Breast feeding and holding off on the introduction of milk and grains is a good strategy for reducing the risk of celiac.
Because celiac disease leads to malabsorption, celiacs often develop deficiencies. The most common ones are vitamins E, D, K, B12, folic acid, iron, selenium, zinc, calcium, magnesium, carnitine and essential fatty acids. So, a high potency multivitamin/mineral is a very good idea. Additional supplementation of particular deficiencies may also be necessary. Supplementing folic acid, B12 and B6 has been shown to benefit celiacs (Aliment Pharmacol Ther
Because women with celiac are at much higher risk of having babies with neural tube defects (Clin Genet
1996;49:107-8), the gluten free diet must be supplemented with folic acid during child bearing years.
Because of these deficiencies, celiacs are at increased risk of osteoporosis (Bone
2003;125:429-36; Arch Intern Med
2005;165:393-9). Amazingly, a gluten free diet can increase bone mineral density to about normal in only a year (Am J Clin Nutr
1998;67:477-81; J Pediatr Gastroenterol Nutr
2003;37:434-6; Gut 1996;39:180-4) and staying on the diet will keep it normal (Am J Gastroenterol
Glutamine and probiotics help rebuild the damaged intestines. By helping repair damaged intestines, probiotics improve the disease (Ann NY Acad Sci
Fatigue and low L-carnitine are common in celiacs. 2g a day of carnitine for 180 days significantly reduced fatigue in a placebo-controlled study (Dig Liver Dis
The protein digesting enzyme papain seems to be able to digest gluten and render it harmless to celiacs (Gut
1964;5:295-303). So, it may be a good insurance policy to take 500-1,000mg with meals in case of hidden gluten. That dose may allow some celiacs to tolerate gluten (Lancet
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