What is celiac disease?

Celiac disease – also known as celiac sprue, nontropical sprue, sprue or gluten sensitive enteropathy – is an autoimmune, inheritable disease of the small intestine. When persons with celiac disease eat the protein gluten, which is found in wheat, rye and barley, the lining of the small intestine becomes inflamed and unable to absorb nutrients from food. If untreated, vitamin and mineral deficiencies and malnutrition may result. The presence and intensity of symptoms is highly variable. Symptoms may appear at any age and include diarrhea or constipation, gas, bloating, abdominal cramping and pain, fatigue, weight loss, anemia, headaches, bone thinning (osteopenia/osteoporosis) and, in children, growth failure. Emotional and psychological symptoms, such as depression, anxiety and irritability, may also be present.

What is dermatitis herpetiformis?

A form of celiac disease that causes a skin reaction when gluten is eaten is called dermatitis herpetiformis (DH). Patches of itchy or burning hives or small blisters form. Although medicine is usually prescribed, following the gluten-free diet is essential to treatment. Avoiding skin applications of products containing gluten is also important.

How is celiac disease diagnosed?

The first step to diagnosis is a physical examination, including both a review of symptoms and a celiac antibodies (tTG and EMA) blood test. If indicated by the results of the blood test, biopsies of the small intestine may then be taken. If DH is present, skin biopsies may be taken. It is essential to stay on a gluten-containing diet during this testing to obtain accurate results. The diagnosis is finalized when one follows the gluten-free diet, and signs and symptoms of gluten sensitivity improve.

How is celiac disease treated?

Although there is no cure for celiac disease or DH, following the gluten-free diet is the key treatment. The diet requires the total avoidance of all foods made from or including ingredients made from wheat, rye, barley and related grains. (See foods/ ingredients and nonfoods lists.)

How long must I stay on this diet?

Lifelong avoidance of gluten is necessary to prevent symptoms, allow the intestine and skin to heal and remain healthy, and to lower the risk of other autoimmune diseases, such as diseases of the thyroid and the liver.

Is it necessary to see a dietitian?

Is it necessary to see a dietitian? According to recommendations by the National Institutes of Health (NIH) in 2004, consulting a skilled dietitian can help you achieve complete avoidance of gluten to include nonfoods, such as cosmetics, dental products, medications, postage stamps and envelopes. You will also receive guidance on meeting your personal nutrition needs tailored to your health history and food preferences, and an introduction to the array of tasty (!) gluten-free foods available.

Reading food labels

Beginning January 2006, all food packages with a Nutrition Facts label must state the presence of major food allergens, including wheat. Guidelines for identifying gluten are being written. As ingredients may change over time, read the ingredients and food allergy panels on food packages every time you shop, unless a package is clearly marked “gluten-free.”

Grains/Flours/Ingredients that are gluten-free

Amaranth, arrowroot, beans, buckwheat, corn, millet, poi, potato, quinoa, rice, sorghum, starch (in foods, check source in pharmaceuticals), soy, tapioca, teff, wild rice. Oats, if uncontaminated by gluten during harvesting and processing, may be tolerated. Follow your doctor’s or dietitian’s advice about including oats in your diet.

Foods/Ingredients that contain or may contain gluten

  • Forms of wheat: durum, semolina, farina, bulgur, couscous, orzo
  • Related grains: rye, barley, einkorn, emmer, farro, kamut, spelt, triticale
  • Broth/bouillon
  • Brown rice syrup Caramel coloring/flavoring
  • Communion wafers
  • Marinades
  • Malt/malt flavoring
  • Malt vinegar
  • Modified food starch (if source is wheat)
  • Panko
  • Salad dressings
  • Soy sauce

Nonfoods to check for gluten

  • Dental products
  • Lip balm/lipsticks
  • Any lotion/sunblock or other product that comes in contact with the mouth or may be swallowed
  • Prescription and over-the-counter medications
  • If you have DH, any topically applied product, including soaps, shampoos, lotions and deodorants

Sample gluten-free menu

Breakfast

  • Orange juice (1/2 cup)
  • Cream of Rice cereal (1 cup) topped with banana (1/2)
  • Chopped walnuts (2 tbsp)
  • Sugar or honey (1 tbsp)
  • 1% milk (1 cup)

Lunch

  • GF sliced turkey (2 oz)
  • Corn tortillas (2)
  • GF salsa
  • Sliced avocado, tomato and lettuce
  • Carrot sticks
  • Apple (1 whole)
  • 1% milk (1 cup)

Dinner

  • Mixed green salad (1 cup)
  • Oil and wine vinegar dressing (1 tbsp)
  • Broiled chicken or fish (4 oz) seasoned with lemon juice and herbs
  • Baked potato (1 medium)
  • Margarine (2 tsp)
  • GF sour cream (1 tbsp)
  • Steamed broccoli (1 cup)
  • GF frozen yogurt (1 cup)

Snack

  • GF rice cakes (2)
  • Peanut butter (1 tbsp)
  • Grapes (1/2 cup)

Support Groups

Celiac Disease Foundation

High Sierra Gluten-Free Support Group

Reno ROCK Group (Raising Our Celiac Kids)

Online Support Groups

E-mail: Celiac-Request@maelstrom.stjohns.edu

Listings of Gluten-Free Foods/ Products

The CSA Gluten-Free Products Listing

Celiac Sprue Association/USA, Inc. (CSA) (See contact information above.)

Wild Oats Natural Marketplace

  • 5695 S. Virginia St.
  • Reno, NV 89502
  • Phone: (775) 829-8666
  • Web: Wild Oats

Trader Joe’s Market

  • 5035 S. McCarran Blvd.
  • Reno, NV 89502
  • Phone: (775) 826-1621
  • Web: Trader Joe's

Books/Cookbooks/other resources

  • Living a Full Life with Celiac Disease (2005). CSA
  • Guidelines for a Gluten-Free Lifestyle (2006). Celiac Disease Foundation
  • Jax Lowell (2005). The Gluten-Free Bible, Henry Holt Publishers
  • Shelley Case (2006). Gluten-Free Diet: A Comprehensive Resource Guide, Centax Books
  • Danna Korn (2001). Kids with Celiac Disease, Woodbine House Publishers
  • Bette Hagman (2000). The Gluten-Free Gourmet Cooks Fast and Healthy and The Gluten-Free Gourmet Bakes Bread, Henry Holt Publishers
  • Connie Sarros (2003). Wheat-Free, Gluten- Free Dessert Cookbook
  • Kim Koeller and Robert LaFrance (2005). Let’s Eat Out! Your Passport to Living Gluten and Allergy Free. R & R Publishing.
  • Obtain The Gluten-Free Nutrition and Shopping Guide free from University of Nevada Cooperative Extension, (775) 784-4848.

References

  • “NIH Consensus Statement on Celiac Disease” NIH Consensus and State-of-the-Science Statements Vol. 21, No. 1, June 28- 30, 2004
  • Guidelines for a Gluten-Free Lifestyle 3rd ed., Celiac Disease Foundation, June 2004
Seymour, K. and Wilson, M. 2006, Living With Celiac Disease, Extension | University of Nevada, Reno, FS-06-15

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