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March 20, 2012 > A Gluten-Free Diet is Sole Treatment for Celiac Disease

A Gluten-Free Diet is Sole Treatment for Celiac Disease

Avoiding Gluten Can be Tricky

A decade ago there were very few gluten-free food products on the market. Today there are entire grocery store sections devoted to gluten-free foods, making life a little easier for people with celiac disease. But even with the increase in options, avoiding gluten can be difficult because it is in so many packaged and processed foods.

Celiac disease is a digestive disorder that damages the intestine and interferes with the absorption of nutrients in food. People with the disease can't tolerate gluten, found in a long list of grains, including wheat, barley, rye, couscous, matzo, orzo, and semolina.

"It wasn't that long ago that food manufacturers became aware that celiac disease is prevalent, affecting one in 133 people in this country," said Kim Alvari, a registered dietitian and director of Food and Nutrition Services at Washington Hospital. "It is even more prevalent in people with type 1 diabetes, affecting one in 23. The only treatment for celiac disease is a gluten-free diet."

For some reason, gluten triggers the immune response in people with celiac disease, according to Dr. Arun Srivatsa, a gastroenterologist and member of the medical staff at Washington Hospital. "It's an allergic phenomena," he added.

Common symptoms of celiac disease include bloating, chronic diarrhea, gas, constipation, abdominal pain, vomiting, and fatigue. But in about 40 percent of newly diagnosed cases among adults and 60 percent of newly diagnosed pediatric cases, there are no symptoms, according to Alvari.

Difficult to Diagnose

Unfortunately, celiac disease can be very difficult to diagnose, Srivatsa said. When you do have symptoms, they can look like irritable bowel disease or a number of other ailments.

"Even if there are no symptoms, the disease is still damaging the lining of the intestine," he explained. "This inhibits the intestine's ability to absorb the nutrients from food, which can lead to other conditions like anemia, osteoporosis, and malnutrition. It can also cause damage to your teeth. The scary part is you can have one of these conditions and nobody knows that celiac disease is causing it."

Srivatsa said patients and primary care doctors need to be aware that celiac disease can be an underlying cause of these health problems. Celiac disease is easy to diagnose once you consider it as a possibility, he explained. A simple blood test can determine whether the antibodies are present.

There are also genetic markers in the blood that can indicate whether celiac disease is present, Srivatsa added. Celiac disease is thought to be genetic, running in families.

"If still in doubt, a biopsy is the gold standard test that can determine for sure if you have celiac disease," he said. "A microscopic piece of the intestine is removed and examined under a microscope."

Life Without Wheat

Even just consuming the amount of gluten in a crumb is too much if you have celiac disease, according to Alvari. So people with the disease must completely cut gluten out of their diets.

"It's so much easier to find gluten-free foods these days," she said. "They are everywhere now. But gluten is used as a stabilizer and thickener, so you find it in a lot of things you wouldn't necessarily think contain any wheat or grain products. Avoiding gluten can be a little tricky."

Alvari recommends that people with celiac disease consult with a dietitian, at least when they are first diagnosed, to learn how to eat a gluten-free diet because it can be so complicated. For example, common ingredients like malt flavoring contain glucose.

"So you may think a rice-based cereal is safe because rice does not contain gluten," she explained. "But some rice cereals contain malt flavoring, so that would be off limits on a gluten-free diet. Gluten can be found in some yogurts and marinades. Even some lunch meats contain gluten."

Alvari said people with celiac disease need to avoid processed foods and stick to a simple diet filled with fruits and vegetables, low-fat dairy products, lean meats, nuts, and grains that don't contain gluten such as rice, corn, and buckwheat.

Cross contamination of food products is also an issue. For example, a toaster used for wheat bread shouldn't be used to toast gluten-free bread.

"You really need to be careful in the kitchen," Alvari said. "For example, flour can float in the air and land on surfaces and other food products, contaminating them with gluten."

For information about nutrition counseling services available at Washington Hospital, visit or call (510) 745-6542.

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