Celiac disease Treatment

The only treatment for celiac disease presently is a strict gluten free diet for life. There is no medication needed except for supplements for nutrition deficiencies, which need to be taken for 6-12 months after diagnosis.

The intestine starts healing almost immediately after gluten is removed from the diet though it may take up to two years for it to heal completely. As the intestines start to recover, there is visible improvement in symptoms within 2-4 weeks, especially gastrointestinal symptoms.

tTG value too starts to reduce, though it may take 2 years to normalize. One must remember however, that a normal tTG value does not mean that the individual has been cured but only that the disease is under control with gluten free diet. These patients, their family and friends do deserve a pat on their back but does not give them a green signal to restart gluten!

Compliance to a strict gluten free diet is thus critical. Accidental or frequent ingestion of even small amounts of gluten can cause short term symptoms and long term damage. Read some of our patients’ experiences with non-compliance to the diet. In rare instances, refractory celiac disease occurs where the intestine does not heal despite all precautions.

Follow-up visits are thus essential to evaluate the response to gluten free diet. Follow-ups are recommended after 2 weeks, 3 months, 6 months of diagnosis and thereafter annually. Refer to the gluten free health card for the tests which one must undergo at the time of follow-up and for keeping track of one’s health.

Biopsy need not be repeated if the individual is doing well on gluten free diet. Only in certain cases – where the diagnosis was not clear, response is not as expected or the diagnosis had taken place before the age of 2 years – the doctor may consider repeating the biopsy.

Gluten free diet

Gluten (meaning glue in Latin) is a storage protein found in several grains. Gluten found in the three grains – wheat, barley and rye is antigenic and responsible for the development of celiac disease. About 5-10% of the celiac disease population also reacts to the storage protein found in oats in the same way as they do to gluten of wheat, barley and rye.

20 parts per million, i.e. 20 mg of gluten per kg of food, is the generally accepted limit of gluten in ‘gluten free’ labelled food items in most parts of the world.

Safe and unsafe items

‘Which food items are safe and which are not?’ is the most critical question for individuals with celiac disease and for their families. The good news is that 3 out of 4 basic food groups are completely safe for a gluten free diet. The bad news – that wheat finds its way in many food items, especially packaged products.

Safe items

Except wheat, barley, rye, oats and their hybrid grains, all naturally occurring food items are inherently gluten free. This would make many food items which you are eating presently gluten free in their natural form. Some of these items are listed below.

• Grains *:  Most of these alternate grains are easily available in India and had been used traditionally for many years but fallen out of favour over the last few decades.
• Rice (all varieties and colours)
• Millets including pearl millet (bajra), sorghum (jowar), finger millet (ragi)
• Amaranth (ramdaana /cholai / rajgira)
• Buckwheat (kuttu)
• Corn (makka)
• Fresh vegetables
• Fresh fruits
• Plain meat and fish
• Plain milk
• Daals/ Pulses *
• Arrowroot, tapioca, sago(sabudana), soya, water chestnut (singhara) *
• Plain nuts and seeds *
• Egg
• Whole spices (sabut masala) *
• Salt, Sugar
• Tea, Coffee
• Vegetable oil
• Honey

*Flours and/or starches made out of these.

Note

• Heeng, though inherently gluten free, could have gluten in commercial packaging in the form of wheat flour as an anticaking agent. Till we have information from the manufacturers, it is advisable to avoid using heeng.
• Many of these flours are commercially available in India but care needs to be taken as most are usually milled in factories where wheat is also milled. Hence the chance of cross contamination with wheat is extremely high in them. It is recommended that one grinds these flours at home using an electric grinder.
• It is also recommended that you grind spice/masala powders in your own grinder or in a shop where wheat is not used. Do also remember NOT to use the grinder meant for gluten free flours and spices for grinding any gluten containing item.
• Packaged and processed products could be safe if declared gluten free as per laid down international standards.

Unsafe items

Gluten can be present in a food product in many ways:

• As an ingredient – If it has wheat (or any of its forms such as maida, daliya, sooji), barley, rye or oats as one of the ingredients
• As the source of one of the ingredients, additives or as a processing aid.
• Due to cross – contamination - It is important to keep in mind that gluten protein is very resistant to alteration and no amount of cooking or method of cooking alters its toxic potential for a celiac.

Source: Celiac India

Related resources

1. ICMR Guideline on Diagnosis and Management of Celiac Disease in India