The treatment of celiac disease is a gluten-free diet. This involves avoidance of foods that contain wheat, rye or barley or their derivatives. A gluten-free diet will result in reversal of the inflammatory villous atrophy in the small intestine causing resolution of symptoms. The second role of the diet is to prevent the development of complications. There is overwhelming evidence that a strict gluten-free diet reduces the risk of the development of malignancy in adults.
The gluten-free diet has two major components. The first is avoidance of the toxic grains/ ingredients and the second is including a variety of nutritious gluten-free foods (some of these will be labeled gluten-free and others will be naturally gluten-free).
Consultation with an experienced dietitian is very important because some of the older materials that are given by physicians and dietitians/nutritionists are out of date. We see many patients who are avoiding foods unnecessarily. There are surprising sources of gluten that an expert nutritonist can advise you of.
On a gluten-free diet gastrointestinal symptoms may respond rapidly–sometimes within days or weeks. Normalization of serum antibody levels to tissue transglutaminase and gliadin takes much longer. Usually six to twelve months. The pathological changes in the intestine assessed by a duodenal biopsy can take even longer and in adults may not totally normalize. It is unclear whether that is due to persistent gluten ingestion or an ongoing autoimmune process. There is evidence that children will usually normalize the intestinal biopsy though it is not always necessary to repeat the biopsy if the clinical course is good.
The gluten-free diet includes a plethora of options. You may be surprised at the number of naturally gluten-free foods you already eat on a regular basis. Meats, poultry, fish, fruits, vegetables, legumes, and dairy products that are in their natural or unprocessed state are all safe. In terms of starch: rice, corn, potato, oats, yucca, buckwheat, quinoa, millet, and teff are all safe. They do not contain the same protein sequence that wheat, rye, and barley have. Oats may be contaminated by gluten and if eaten should be labeled gluten-free. Similarly quinoa, buckwheat, millet and teff should be labeled gluten-free. Rice does not need to be labeled gluten-free.
Here is a basic list of safe and toxic starches.
Gluten-Free Replacement Choices
Available as flours, grains as well as in pastas, baked goods, crackers and snack choices
The items in bold are healthier choices
(they contain more fiber and nutrients)
- Buckwheat (purchase only buckwheat labeled gluten-free)
- Corn grits
- Cornmeal (preferably whole grain, enriched cornmeal)
- Montina (Indian rice grass)
- Oats (purchase only oats labeled gluten-free; see section on oats)
- Potato (preferably sweet potato)
- Rice (preferably enriched white rice, whole grain brown rice or wild rice)
- Wheat (all forms including kamut, semolina, spelt, triticale)
- Contaminated Oats
- Barley (including malt)