This diet eliminates all foods containing wheat, rye, barley, and oats. The specific names of the cereal prolamins that are toxic in Celiac Disease (CD) are gliadin in wheat, secalin in rye, hordein in barley, and avenin in oats. The storage proteins of corn and rice do not contain the toxic cereal prolamins and are not harmful to individuals with CD. Research is presently underway to determine the safety of oats for celiac patients, but the results are not yet conclusive.
Any product entering the digestive system must be gluten free. Careful review of ingredient lists on food and drug labels to determine if gluten-containing ingredients are present is important. The food manufacturer can be contacted for product information if an ingredient list is not available. Because many additives, stabilizers, and preservatives may contain gluten, it is best to check with each manufacturer for clarification. In addition, some medications, toothpastes, and mouthwashes may contain gluten. Individuals should be advised to check with their physician or pharmacist before taking any prescribed or over-the-counter medications. The Compendium of Pharmaceuticals and Specialties (CPS) contains a list of pharmaceutical manufacturers that do no use gluten as an excipient.
In severe, untreated cases of CD, malabsorption of fat, calcium, magnesium, fat-soluble vitamins A, D, E, and K, folate, iron, and vitamin B12 can occur. If the initial symptoms are severe, such as nausea, bloating, and diarrhea, avoidance of lactose-containing foods in addition to a gluten-free diet may be beneficial until the intestinal mucosa has recovered. Lactose intolerance often normalizes within months after starting a gluten-free diet. When severe malabsorption is present, supplemental vitamins and minerals may be required for several months as intestinal villi regenerate. Depending on individual food choices and adherence to a gluten-free diet, once the intestinal villi have regenerated, adequate amounts of most nutrients can usually be obtained from a well-balanced diet. Gluten-free cereals tend to be lower in B vitamins and fiber. Care must be taken to ensure adequate intakes of these nutrients. Villi recovery can take several months to years in an adult with celiac disease. If the patient does not appear to be responding to the gluten-free diet, a doctor should be consulted about the possible need for steroid therapy, vitamin and mineral supplementation, or further testing.
