Coeliac disease – Treatment – NHS

Coeliac disease is treated by excluding foods that contain gluten from your diet.

This prevents damage to the lining of your intestines and the associated symptoms, such as diarrhoea and stomach pain.

If you have coeliac disease, you must stop eating all sources of gluten for life. Your symptoms will return if you eat foods containing gluten, and it will cause long-term damage to your health.

This may sound difficult to do, but a GP can give you help and advice about ways to manage your diet. Your symptoms should improve considerably within weeks of starting a gluten-free diet. However, it may take up to a few years for your digestive system to heal completely.

A GP will offer you an annual review during which your height and weight will be measured and your symptoms reviewed. They’ll also ask you about your diet and assess whether you need any further help or specialist nutritional advice.

A gluten-free diet

When you’re first diagnosed with coeliac disease, you’ll be referred to a dietitian to help you adjust to your new diet without gluten. They can also ensure your diet is balanced and contains all the nutrients you need.

If you have coeliac disease, you’ll no longer be able to eat foods that contain any barley, rye or wheat, including farina, semolina, durum, bulgar, cous cous and spelt.

Even if you only eat a small amount of gluten, such as a spoonful of pasta, you may have very unpleasant intestinal symptoms. If you keep eating gluten regularly, you’ll also be at greater risk of developing complications, such as osteoporosis and some types of cancer in later life.

Find out more about the complications of coeliac disease.

Gluten is not essential in your diet and it can be replaced by other foods. There are many gluten-free versions of common foods such as pasta, pizza bases and bread available in supermarkets and health food shops. Some GPs may provide bread and flour mixes on prescription.

Many foods, such as meat, vegetables, cheese, potatoes and rice, are naturally free from gluten so you can still include them in your diet. A dietitian can help you identify which foods are safe to eat and which are not. If you’re unsure, you can use the following lists as a general guide.

Foods containing gluten (not safe to eat)

If you have coeliac disease, do not eat the following foods, unless they’re labelled as gluten-free versions:

• bread
• pasta
• cereals
• biscuits or crackers
• cakes and pastries
• pies
• gravies and sauces

It’s important to always check the labels on the foods you buy. Many foods (particularly processed foods) include additives which contain gluten, such as malt flavouring and modified food starch.

Gluten may also be found in some non-food products, including some medicines.

Cross-contamination can happen if gluten-free foods and foods that contain gluten are prepared together or served with the same utensils.

Gluten-free foods (safe to eat)

If you have coeliac disease, you can eat the following foods, which naturally do not contain gluten:

• most dairy products, such as cheese, butter and milk
• fruits and vegetables
• meat and fish (although not breaded or battered)
• potatoes
• rice and rice noodles
• gluten-free flours, including rice, corn, soy and potato flour

By law, food labelled as gluten-free can contain no more than 20 parts per million (ppm) of gluten.

For most people with coeliac disease, these trace amounts of gluten will not cause a problem.

The Coeliac UK website has more information about living gluten-free.

Oats

Oats do not contain gluten, but many people with coeliac disease avoid eating them because they can become contaminated with other cereals that contain gluten.

There’s also some evidence to suggest that a very small number of people may still be sensitive to products that are gluten-free and do not contain contaminated oats. This is because oats contain a protein called avenin, which is suitable for most people with coeliac disease but may trigger symptoms in a few people.

If, after discussing this with your healthcare professional, you want to include oats in your diet, check the oats are pure and that there’s no possibility of contamination with gluten.

You should avoid eating oats until your gluten-free diet has taken full effect and your symptoms have been resolved. Once you’re free of symptoms, gradually reintroduce oats into your diet. If you develop symptoms again, stop eating oats.

Advice on feeding your baby

Do not introduce gluten into your baby’s diet before they’re 6 months old. Breast milk is naturally gluten-free as are all infant milk formulas.

The Coeliac UK website provides more information about feeding your baby.

Other treatments

As well as eliminating foods that contain gluten from your diet, there are other treatments available for coeliac disease.

Vaccinations

In some people, coeliac disease can cause the spleen to work less effectively, making you more vulnerable to infection.

You may therefore need to have extra vaccinations, including:

• flu vaccine
• Hib/MenC vaccine, which protects against sepsis (blood poisoning), pneumonia and meningitis (an infection of the lining of the brain)
• pneumococcal vaccine, which protects against infections caused by the Streptococcus pneumoniae bacterium

However, if your spleen is unaffected by coeliac disease, these vaccinations are not usually necessary.

Supplements

As well as cutting gluten out of your diet, a GP or dietitian may also recommend taking vitamin and mineral supplements if you need them, for example for iron deficiency anaemia.

This will ensure you get all the nutrients you need while your digestive system repairs itself.

Dermatitis herpetiformis

If you have dermatitis herpetiformis (an itchy rash that can be caused by gluten intolerance), cutting gluten out of your diet should help.

However, it can sometimes take longer for a gluten-free diet to clear the rash than it does to control your other symptoms, such as diarrhoea and stomach pain.

If this is the case, you may be prescribed medicine to speed up the healing of the rash. It’s likely that this will be a medicine called dapsone, which usually comes as a tablet you swallow twice a day.

Dapsone can cause side effects, such as anaemia, headaches and depression, so you’ll always be prescribed the lowest effective dose. You may have regular blood tests to check for anaemia.

You may need to take medicine for up to 2 years to control dermatitis herpetiformis. After this time, you should have been following a gluten-free diet long enough for the rash to be controlled without the need for medicine.

Refractory coeliac disease

Refractory coeliac disease is a rarer type of coeliac disease where the symptoms continue, even after switching to a gluten-free diet. The reasons for this are unclear.

If refractory coeliac disease is suspected, it’s likely you’ll be referred for a series of tests to make sure your symptoms are not being caused by another condition.

If no other cause can be found and the diagnosis is confirmed, you’ll be referred to a specialist. Treatment options include steroid medicine, such as prednisolone, or immunosuppressant medicine, which help block the harmful effects of the immune system.

Page last reviewed: 31 March 2023
Next review due: 31 March 2026

Dietary Changes for Celiac Disease

Celiac disease is a disorder that damages your small intestine and keeps it from absorbing the nutrients in food. The damage to your intestinal tract is caused by your immune system’s reaction to gluten. Gluten is a protein found in wheat, barley, and rye. Some oats contain gluten. 

When you have celiac disease, gluten causes your immune system to damage or destroy villi. Villi are the tiny, fingerlike tubules that line your small intestine. The villi’s job is to get food nutrients to the blood through the walls of your small intestine. If villi are destroyed, you may become malnourished, no matter how much you eat. This is because you aren’t able to absorb nutrients. Complications of the disorder include anemia, seizures, joint pain, thinning bones, and cancer.

Lifestyle changes to cope with celiac disease

A gluten-free diet is the only treatment if you’ve been diagnosed with celiac disease. You’ll have to avoid gluten for the rest of your life. Even the slightest amount will trigger an immune system reaction that can damage your small intestine. Eating a gluten-free diet requires a new approach to food. A gluten-free diet generally means not eating most grains, pasta, cereals, and processed foods. The reason is that they usually contain wheat, rye, and barley. You’ll need to become an expert at reading ingredient lists on packages. Choose foods that don’t contain gluten. You can still eat a well-balanced diet with many different foods, including meat, fish, rice, fruits, and vegetables, along with prepared foods that are marked gluten-free. 

Gluten-free bread, pasta, and other products have long been available at organic food stores and other specialty food shops. Today, you can find gluten-free products in just about every grocery store. Gluten-free dishes are on menus at all kinds of restaurants.

Tips for following a gluten-free diet

Here are steps to take when getting gluten out of your diet.

Rethink your grains:

• Avoid all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour, including self-rising and durum, not labeled gluten-free.

• Be careful of corn and rice products. These don’t contain gluten, but they can sometimes be contaminated with wheat gluten if they’re produced in factories that also manufacture wheat products. Look for such a warning on the package label.

• Go with oats. Recent studies suggest you can eat oats as long as they are not contaminated with wheat gluten during processing. You should check with your healthcare provider first.

• Substitute potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour for wheat flour. You can also use sorghum, chickpea or Bengal gram, arrowroot, and corn flour, as well as tapioca starch extract. These act as thickeners and leavening agents.

 Become a label expert:

• Know terms for hidden gluten. Avoid einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, and hydrolyzed wheat protein. Stay away from emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors because they can contain gluten.

• Check the labels of all foods. Gluten can be found in food items you’d never suspect. Here are some likely to contain gluten:

  • Beer, ale, and lagers

  • Bouillon cubes

  • Brown rice syrup

  • Candy

  • Chips, potato chips

  • Cold cuts, hot dogs, salami, and sausage

  • Communion wafers

  • French fries

  • Gravy

  • Imitation fish

  • Matzo

  • Rice mixes

  • Sauces

  • Seasoned tortilla chips

  • Self-basting turkey

  • Soups

  • Soy sauce

  • Vegetables in sauce

More strategies for a gluten-free lifestyle

Here are ideas to better make the transition to a gluten-free diet:

• Separate all kitchen items used for preparing gluten and gluten-free foods. These include cooking utensils, cutting boards, forks, knives, and spoons.

• When eating out, if you’re not sure about the ingredients in a particular dish, ask the chef how the food was prepared. You can also ask whether a gluten-free menu is available. Most restau­rants have a website where you can review the menu in advance. 

• Ask your pharmacist if any of your medicines contain wheat or a wheat byproduct. Gluten is used as an additive in many products from medicines to lipstick. Manufacturers can provide a list of ingredients on request if they are not named on the product. Many herbals, vitamins, supplements, and probiotics contain gluten. 

• Watch your portion sizes. Gluten-free foods may be safe and good for you, but they’re not calorie-free.

If you still feel symptoms on your gluten-free diet, double check that you’re not still consuming small amounts of gluten hidden in sauces, salad dressings, and canned soups or through additives, such as modified food starch, preservatives, and stabilizers made with wheat. Even some medicines can contain gluten. Tablets and capsules can be sources of gluten contamination. The risk of your medicines containing gluten is very small but, if you are concerned, you should discuss this with your healthcare provider. 

As you and your family become experts in reading food and product labels, you’ll be able to find hidden sources of gluten before they can cause a problem. You might also get more ideas from joining a support group, in person or online, that can help you adjust to your new way of life. These are great forums for learning a wealth of delicious recipes for everything from gluten-free cookies and banana bread to biscuits, trail mix, and grits.

Nutritional advice for people with celiac disease

Celiac disease is a common disease with a hereditary predisposition, which consists in damage to the small intestine when eating food containing gluten.

Gluten (gluten) is a special type of water-insoluble proteins contained in cereal grains and intended for germination and nutrition of plant embryos. In cooking, gluten gives elasticity to dough and splendor to baked goods. Most of all gluten is in modern wheat and its older types (spelled, spelled and kamut), as well as in barley and rye. Oats are gluten-free, but oats often contain wheat, so for celiac disease, oat products can only be used with a gluten-free label.

Learn more about celiac disease :

• What is celiac disease and how is it treated?
• Why is celiac disease dangerous in adults?

Not only children, but also adults suffer from celiac disease, the disease can manifest itself, it can manifest itself with a variety of symptoms and proceed in a latent atypical form.

The main signs of celiac disease

1. Abdominal pain, flatulence, bloating, nausea.
2. Loose, loose stools, diarrhea or constipation.
3. Weight loss, excessive thinness, difficulty gaining weight and muscle mass.
4. May also be overweight.
5. Muscle weakness, loss of strength, headaches, joint pain, osteoporosis.
6. Rash, dermatitis, psoriasis, dry skin, brittle nails, hair loss.
7. Menstrual disorders, miscarriage, male and female infertility, decreased potency and libido, hormonal disorders.
8. Anemia, beriberi.

Due to the variety of symptoms, the diagnosis of celiac disease and gluten intolerance in adults is a complex multi-stage process, the diagnosis is made by the doctor on the basis of the results of all examinations.

The primary treatment for celiac disease is the continued strict adherence to a gluten-free diet. In addition to diet, especially at the initial stage of treatment, patients with celiac disease need additional drug therapy. It is important that the therapeutic effect of dieting occurs within 3-6 months, but noticeable improvements may already begin in the first weeks.

Diagnosis of celiac disease in more detail:

• Blood tests for celiac disease
• FGDS (videogastroscopy) for the diagnosis of celiac disease

Attention!!! Do not eliminate foods with gluten before consulting a doctor, as eliminating gluten, despite temporary improvement, may subsequently cause an exacerbation and distort the results of the examination for diagnosis.

Diet and lifestyle for people with celiac disease

If you have passed all the necessary examinations and have been diagnosed with celiac disease, I suggest you use the following tips.

The transition to a gluten-free diet is an important stage in a person’s life with the formation of a new lifestyle and eating habits. This is a complex process, however, all the difficulties are compensated by an improvement in well-being and getting rid of problems that have been bothering you for years, as well as a decrease in the risk of oncological diseases of the gastrointestinal tract (especially if relatives had a similar problem). For support of adaptation to a new way of life and diet, you can contact the GC “Expert”.

Difficulties in following a gluten-free diet are associated with:

• accidental ingestion of gluten;
• the presence of hidden gluten in products due to violations of their labeling rules;
• contamination of cereals, flour and other products with traces of gluten;
• difficulties in finding gluten-free products;
• lack of support and understanding from other people.

EU gluten free are products whose gluten content does not exceed 20 ppm (20 mg of gluten per kg of finished product).

A gluten-free diet should not be broken, as scientific studies have shown that eating more than 50 mg of gluten per day (500 g of food with a gluten content of more than 20 ppm) for three months or a single intake of a large amount of gluten leads to intestinal damage and return of disturbing symptoms.

How to create a gluten-free menu

According to the content of gluten, we can divide all foods and drinks into 4 categories :

1. Products that are definitely free of gluten

Products from this category can be safely consumed without restriction.

Fresh Meat and Poultry

All meals prepared with beef, lean pork, lamb, chicken, turkey without additives or sauces containing gluten.

Fresh fish and seafood, eggs

All dishes prepared without additives and sauces containing gluten.

Mushrooms

All dishes prepared without additives and sauces containing gluten.

Vegetables and fruits

Fresh and prepared without additives or sauces containing gluten.

Vegetable and animal oils

Butter, sunflower, olive, corn, etc.

Flour, starch, pasta, dumplings, pastries, desserts and sweets

From rice, corn, quinoa, amaranth, labeled gluten-free (crossed ear and number) from Russian and foreign manufacturers specializing in the production of such products. The range of gluten-free products can be found on the websites of specialty stores. Pay attention to the packaging of the goods, the product you need must be marked with a crossed-out ear symbol with a number under it!

2. Foods and drinks that definitely contain gluten

For the treatment of celiac disease, these foods and drinks must be excluded !!!

Flour, starch, bread, pastries, pasta, muesli, dumplings, sweets, croutons from wheat, rye, barley, oats, spelt, kamut spelled, triticale, durum.

Cereals, baby cereals: pearl barley, barley, wheat, semolina, wheat, couscous, bulgur, freekeh, oatmeal.

Chocolates with wafer crumbs.

Sauces soy sauce and others.

Drinks kvass , kissel , alcoholic beverages (beer, vodka, whiskey).

Food additives : caramel colors E-150a – E-150d (confectionery, coca-cola, bread, pastries, dairy products), maltol E-636 (chocolate, essences, soft drinks, canned fruits and vegetables, bakery products, tea, coffee, cocoa), isomaltol E-953 – sweetener (milk, fruit, egg-fat and grain desserts, fruit ice, ice cream, jelly sweets, marmalade, jam, glazed fruits), maltitol and maltitol syrup E- 965 (sweets without sugar, drugs), mono- and diglycerides of fatty acids E471 (confectionery and dairy products, margarine)

Products that may contain gluten and products with hidden gluten (gluten content not indicated on the label)

Dairy products without sugar and fillers : kefir, fermented baked milk, cottage cheese, sour cream, natural yogurt without additives, soft and hard cheese.

Recommendations: these dairy products can be tested with an iodine test (if you drop iodine on a sample of the product and the iodine changes color, it means that the product contains flour or starch and should not be eaten). Also read the ingredients carefully.

Sweet dairy products : curd mass, filled yoghurts, ice cream, curd snacks.

Recommendations: exclude or follow the algorithm below.

Chips, flakes, croutons Corn, rice flakes and croutons, chips, French fries.

Recommendations: exclude or follow the algorithm below.

Prepared meat and fish semi-finished products in any form : semi-finished products from minced meat and fish, breaded semi-finished products, sauces.

Recommendations: To be excluded, except for self-prepared.

Sausages : ham, boiled sausages, sausages, pates.

Recommendations: exclude or follow the algorithm below.

Canned food : canned meat, fish, canned vegetables and legumes, industrial jam.

Recommendation: delete.

Imitation seafood : crab sticks, crabmeat

Recommendation: Delete.

Sauces : tomato paste, ketchup, mustard, salad dressing, vinegar, mayonnaise. Recommendations: exclude or act according to the algorithm given under the table

Seasonings: ground one-component and multi-component dry seasonings and spices.

Recommendation: delete.

Sweets : chocolate bars, caramel, filled chocolates and soy candies, oriental sweets, marshmallows, marshmallows.

Recommendations: exclude or follow the algorithm below the table

Drinks : juices with pulp, instant coffee, cocoa, tea, hot chocolate.

Recommendation: delete.

Algorithm for using products of the third category:

1. Find a substitute product labeled gluten-free.
2. If you could not find a gluten-free analogue, check the composition on the package, check the composition of the product and the presence of gluten with the manufacturer. If there is no certainty, then it is better to exclude the product.
3. Search gluten-free stores for products in this section that are more likely to be gluten-free. Store employees conduct periodic random checks of products without labeling and check the composition with the manufacturer.
4. You can check the composition of the product in celiac communities, where you can find information on manufacturers and products from this category that do not contain gluten. Be sure to read the composition on the packaging of products from the found list before each use, sometimes the manufacturer changes the composition or manufacturing conditions and traces of gluten appear in previously allowed products.

Products made in the EU are subject to stricter control, so the composition indicated on the packaging of such products can be trusted more. In Russia, the situation has improved recently, but there are still many products with unspecified content of wheat flour and starch and their derivatives.

Care should be taken when choosing medicines , carefully read the composition of medicines before buying. Coated and uncoated tablets, dragees, powders, granules may contain wheat flour and starch as a forming component, which, with prolonged use or persistent inflammation in the intestines in the early stages of therapy, can cause undesirable consequences. Tell doctors before writing a prescription that you have celiac disease .

In addition, toothpaste and lipstick may contain gluten.

Attention!!! Anytime you use the products in this section, other than those labeled gluten-free or iodine-tested, you are at risk of a dietary disorder.

4. Products with traces of gluten

These products did not contain raw materials containing gluten, but may have been produced on the same production line as products with gluten. Usually manufacturers indicate such information on the label, but they may not indicate it, in addition, not all factories for the manufacture and packaging of products have a high degree of purification of raw materials from impurities.

Permitted cereals : rice, millet, quinoa, buckwheat.

Recommendations: Rinse all cereals several times in running water before cooking, and pre-sort buckwheat and rice, as they may contain single grains of wheat. Buckwheat should contain a minimum of broken grains and dust. Also, to improve the quality, cereals can be poured with cold water, brought to a boil and drained, and then add a new one and cook.

Legumes : peas, beans and other legumes.

Recommendations: rinse several times before cooking in running water, carefully read the instructions on the packaging, recently manufacturers have been required to indicate whether legumes contain traces of gluten.

Cereal flakes : rice, millet, buckwheat

Recommendation: delete.

Flour : from corn, rice, legumes, nuts, flax not specifically labeled

Recommendation: delete.

Seeds and nuts, dried fruits : peeled seeds, any nuts and dried fruits

Recommendations: exclude seeds and dried fruits, wash nuts several times before eating vegetables

Recommendation: delete.

Sweets : chocolate, sweets.

Recommendation: delete.

Over time, it is worth looking for a manufacturer of legal cereals whose raw materials, in your experience, have fewer impurities.

All products with traces of gluten, except for permitted cereals, legumes and nuts, are not recommended. Flour can only be used with a special gluten-free label or one sold in specialized gluten-free shops.

Manufacturers of gluten-free products

Recently, the range of gluten-free products in Russia has expanded significantly, but not all Russian manufacturers have passed the certification for compliance with gluten content standards, which is being introduced by the Emilia Celiac Society.

Russian manufacturers:

• Garnets
• Diet
• Diet product
• McMaster
• First Baby Food Plant
• Di & Di
• Korner and others.

Foreign manufacturers:

• Almondy (frozen cakes)
• Balviten
• Bezgluten
• Ball
• G-FREE. CLUB
• Gullon
• Le Veneziane
• Mevalia
• NUTRI FREE
• Provena
• Sotelli and others.

How to prepare and store food

If you are preparing gluten and gluten-free meals at home, we recommend that you follow these safety guidelines:

• Store all gluten-free foods separately.
• Wash dishes thoroughly after cooking with gluten.
• Do not cut gluten-free and gluten-free products with the same knife, the same applies to using other kitchen utensils. It is better to have separate cutting boards for gluten-free products.
• If you have handled regular bread or other pastries with gluten, wash your hands before eating.
• To prevent wheat dust from getting into gluten-free pastries, it is best to cook them separately or before baking with wheat flour.
• Do not use the same butter for spreading gluten and gluten-free bread as crumbs can get into it.

Special gluten-free recipes can be used to prepare meals, or conventional recipes can be adapted. Semolina and crackers can be replaced with rice flour or rice grits, rice flour is best suited for rolling. More delicious pastries are obtained from special b / g mixtures, you can buy ready-made or make them yourself.

Products can be found in specialty stores and large chain stores have small sections of gluten-free products.

Diet disruption. What to do?

Everyone can fall off a gluten-free diet, so don’t panic and get back on a strict diet (gluten-free products from the first category) as soon as possible!

As a rule, relapse can occur for a variety of reasons, which include:

• eating habits that have been formed over the years and the difficulties associated with them in the transition to a new diet;
• psychological difficulties in the initial stages after diagnosis;
• misunderstanding and provocations from others;
• unscrupulous labeling of products by the manufacturer.

Adherence to a gluten-free diet can be especially affected by visiting, going on a picnic or on vacation (provoking smells of forbidden foods and feast situations).

With an abrupt transition from a gluten-free diet to a normal diet, celiac patients also abruptly resume and even intensify the complaints that preceded a gluten-free diet. If the patient continues to consume foods with gluten, progressive damage to the small intestinal mucosa and subsequent intestinal malabsorption develops, leading to the development of anemia, osteoporosis, hypo-avitaminosis, and hormonal disorders. In addition, the risk of oncological diseases of the gastrointestinal tract increases.

If you find yourself in such circumstances and are faced with a deterioration in health, a gastroenterologist-nutritionist of the HC “Expert” will provide you with all the necessary support and will help you cope with the renewed symptoms of the disease .

How to eat out?

Nowadays, the emergence of gluten-free cafes and restaurants has made it easier to have lunch or dinner out. If you can’t find gluten-free food nearby when ordering, check with the waiter or chef if the dish you have chosen contains wheat flour or starch. What is better to choose: vegetable salads without sauce, vinaigrette, vegetable soup, broth, natural meat or fish without additives and sauces, rice, natural potatoes. The simpler the dish you choose, the less likely it is to contain gluten.

At a party, use the same principles, do not hesitate to ask the hosts for menus and ingredients in advance, bring homemade bread or other pastries with you.

Gluten-free cafes and restaurants (includes those with n/g labeled dishes) .

Gluten-Free Kitchen Territory, production and delivery of gluten-free dishes to order.

Please note that you need to check with the waiter and chef the composition of the dishes and the method of their preparation in any case , even if the dishes are labeled gluten-free. Sometimes restaurateurs put this badge only because the prepared dish does not explicitly contain products from wheat, rye, barley or other cereals, but the products have not been tested for gluten content.

Be careful !!! By eating out, you are always at risk of breaking a gluten-free diet.

If symptoms persist or do not completely disappear

Carefully check the ingredients of the products you use, some of them may contain latent gluten, and try to diet more strictly.

If you follow a strict diet for six months, and there is no improvement, you should contact a gastroenterologist-nutritionist at the HC “Expert” to clarify the diagnosis and decide on the appointment of additional treatment. At the appointment, the doctor will evaluate the dynamics of disturbing symptoms and their change before and after the introduction of a gluten-free diet together with you.

Personal histories of patients of GC “Expert”

Patient, 52 years old, complaints of weakness, abdominal pain, bloating, frequent stool disorders, low levels of magnesium and calcium in the blood, difficulty gaining weight with proper nutrition, pain in the legs, son previously diagnosed with celiac disease.

I’ve been on a gluten-free diet for 9 years, at first it was very difficult to get used to, but during the first year I managed to adapt to cooking delicious gluten-free familiar dishes. To make it easier to follow the diet, my husband and I stopped using wheat flour at home. From gluten-free flour, delicious cakes and pizza are obtained, all guests eat them with pleasure. Natural foods predominate in my diet, semi-finished products, sausages, ice cream and other foods that may contain gluten are excluded.

Improvements did not start immediately, especially at the beginning of the diet there were mistakes related to eating out. The support and advice of a gastroenterologist-nutritionist at the GC “Expert” helped me learn how to avoid mistakes and follow a diet correctly. On the diet, pain in the abdomen, bloating and weakness disappeared, my health and mood improved, the pain in my legs stopped bothering me, I began to look better, gaining the missing kilograms.

I buy gluten-free products in specialized stores, mainly flour, bread, sweets, pasta. Sometimes we buy ready-made gluten-free bread in the shop of the Benois Farm restaurant. Now in St. Petersburg there is a fairly wide range of gluten-free products, so the most difficult thing is eating out, if I need to eat in the city, I prefer Na Pair and Pound Raisins cafes.

Recommendations for the dynamic monitoring of patients in the HC “Expert”

1. After the diagnosis is made, a follow-up visit with a consultation of a gastroenterologist-nutritionist 1 time per year or in case of deterioration of health. Scientific studies have shown that patients who are under the supervision of a doctor follow a gluten-free diet more successfully.
2. FGDS with biopsy 1 time per year for the first 3 years, then 1 time in 2-3 years.
3. Ultrasound of the abdominal organs 1 time per year.
4. Blood and stool tests once a year.
5. Feedback with a doctor: the opportunity to ask questions to a specialist by e-mail or by phone during the year.

Sex in patients with celiac disease or association with infertility, erectile dysfunction in men and menstrual disorders in women

We understand that the quality of sexual life in patients with celiac disease may be affected by:

This is due to malabsorption and digestion of a number of nutrients in the intestines, including fats. This leads to a decrease in the level of cholesterol – the precursor of male and female sex hormones, which leads to a violation of the ratio of hormones in the body.

Moreover, in men, the exchange of male sex hormones, including testosterone, is disturbed. Hormone deficiency can be manifested by impotence, premature ejaculation, increased urge to urinate, decreased muscle mass and male strength. The process of formation and quality of sperm is also disrupted, which can be manifested by a decrease in the number or absence of spermatozoa, low mobility or an abnormal structure of spermatozoa. In some cases, this can lead to male infertility.

In women, in turn, the exchange of female sex hormones is disturbed, which causes menstrual irregularities, dysmenorrhea, amenorrhea and can cause infertility, miscarriage, miscarriages.

With the early debut of the disease, there is a slowdown in sexual development.

Please note that in the atypical form and in the early stages of the disease, the above symptoms may be the only manifestation of celiac disease. Therefore, HC “Expert” recommends to exclude celiac disease when examining the above conditions.

With a timely visit to a doctor and a correct diagnosis, as well as a constant adherence to a gluten-free diet, most functions are restored by 80-90%.

Best Foods and Supplements for a Gluten-Free Diet｜ iHerb Blog

The information in this blog has not been verified by your country’s public health authority and is not intended as a diagnosis, treatment, or medical advice.
Read more

Published May 2018 / Updated March 2023

Why do people follow a gluten-free diet?

Reducing or avoiding gluten consumption is becoming more and more common.

People go on a gluten-free diet primarily to avoid immune-mediated inflammation and gluten-induced disease reactions or digestive upsets such as gas and bloating that occur after eating gluten-containing grains.

What should I avoid on a gluten-free diet?

Gluten and related compounds are a specific plant protein found in wheat and other cereals (barley, spelled and rye).

Oats contain another type of protein that can also be a problem for people who are sensitive to gluten.

Rice, quinoa, amaranth, millet, corn and sorghum are gluten-free and can be used on a gluten-free diet.

Major problems with gluten

Below are some of the disorders that are important in understanding the spectrum of problems associated with gluten products.

Celiac disease

Celiac disease is an autoimmune disease caused by gluten sensitivity that damages the digitiform villi in the small intestine. Celiac disease is characterized by 200 possible symptoms, but is usually gastrointestinal (GI) problems ranging from very mild discomfort to severe malabsorption (eg, diarrhea, flatulence, bloating, increased fat and undigested food particles in stool). Symptoms of celiac disease and structural damage to the small intestine usually improve with a strict gluten-free diet. To make an accurate diagnosis of celiac disease, a biopsy of the small intestine is performed. Screening tests currently measure IgA antibodies to proteins (transglutaminase and/or endomysium) from blood samples. In people with celiac disease, these IgA antibodies indicate an immune response and sensitivity to gluten.

Non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) is an immune-mediated sensitivity to gluten. However, it does not cause the typical gut damage of celiac disease and does not have the same markers of autoimmune disease in the blood. People with NCGS develop a variety of intestinal and/or other symptoms that subside when gluten is eliminated from the diet.

Gluten intolerance is a term used to describe gastrointestinal symptoms, such as intermittent gas and bloating, that are not mediated by the immune system but occur after eating gluten.

Wheat allergy

Wheat allergy may resemble NCCG but is associated with a positive test for non-gluten wheat proteins in a classic allergic reaction.

Non-gluten disorder

Non-gluten disorder is an intolerance to other components of wheat and other grains that is not mediated by the immune system but may cause minor gastrointestinal symptoms such as occasional gas, bloating and indigestion . Most often, these are fiber components, especially oligosaccharides and fructans.

Gluten and non-GI problems

One of the hallmarks of celiac disease and non-celiac gluten sensitivity (NCGS) is the presence of symptoms such as confusion, inflammation, headache, joint pain, fatigue and autoimmune disorders.

All of these symptoms are caused by an increased permeability or “leakage” of the intestine.

In celiac disease, this is due to two factors: (1) the inability to completely break down gliadin, which is part of the gluten complex, and, as a result, the immune system is triggered, which leads to the destruction of the intestinal mucosa; and (2) undigested gliadin triggers the release of zonulin, a compound produced by cells that line the small intestine. Zonulin helps form tight adhesions that connect the cells that line the small intestine. In celiac disease and NCCG, gliadin increases the release of zonulin, resulting in loss of tight junctions between cells and increased intestinal permeability. Ultimately, this causes larger molecules that are not normally allowed into the body to enter the bloodstream. This can lead to a number of problems, including activation of the immune system and overburdening the detoxification mechanisms.

Why is it important to rule out celiac disease or NCCG?

If gluten caused only minor gastrointestinal symptoms, it wouldn’t matter much, but there is a long list of diseases associated with celiac disease and NCCG. The most serious consequence is premature death. One important study, conducted from 1969 to 2008, looked at almost 30,000 people with celiac disease and analyzed deaths in four groups: those with complete celiac disease; with intestinal inflammation, but not complete celiac disease; with latent celiac disease or NCCG (high gluten antibodies but negative bowel biopsy) and a control group without evidence of celiac disease or gluten sensitivity. The results were impressive: compared with the control group, the risk of death in patients with celiac disease was increased by 39%, in patients with intestinal inflammation caused by gluten – by 72%, and in patients with gluten sensitivity, but without celiac disease – by 35%.

Another review article lists 55 diseases associated with celiac disease and gluten sensitivity, including: irritable bowel syndrome, inflammatory bowel disease, anemia, migraine, epilepsy, fatigue, cancerous ulcers, osteoporosis, rheumatoid arthritis, lupus, multiple sclerosis and almost all known autoimmune diseases. Additional research has linked celiac disease and gluten sensitivity to fatigue, thyroid problems, type 1 diabetes, psychiatric disorders (including schizophrenia), mood depression, impaired mental function, and autism. Celiac disease carries an increased risk of developing malignancies, especially non-Hodgkin’s lymphoma.

If you think you have celiac disease or gluten sensitivity, you should see your doctor, as these diseases carry an increased risk of premature death.

How quickly does a gluten-free diet work?

With all forms of gluten sensitivity/intolerance, gluten withdrawal usually results in clinical improvement within days or weeks. In celiac disease, 30% of patients get rid of symptoms within 3 days, another 50% within 1 month, and 10% within 2 months. However, about 10% of patients recover only after 24-36 months of gluten-free. Looking at this data from a different perspective, 8 out of 10 cases of celiac disease resolve within a month of starting a gluten-free diet.

Recommended iHerb Gluten Free Specialty Store for gluten free supplements, food, skincare and more.

Benefits of Digestive Enzyme Supplements

Digestive enzyme supplements that break down gluten, such as dipeptidyl peptidase IV (DPP-IV), may be helpful in neutralizing low levels of inadvertent gluten ingestion, but they are not a replacement for a gluten-free diet.

Research shows that even when following a gluten-free diet, many people with celiac disease or gluten sensitivity are unintentionally exposed to enough gluten to cause symptoms. Supplements with gluten-breaking enzymes can help neutralize small amounts of ingested gluten.

Gluten-breaking enzymes are not a treatment for celiac disease or NCCG, but they can be used as digestive aids to reduce exposure to gluten if small amounts are inadvertently ingested for both conditions.

The US Food and Drug Administration (FDA) sets strict criteria and labeling requirements for food manufacturers for gluten-free products. However, even with these guarantees, it appears that people on a gluten-free diet consume enough gluten to cause problems. Consuming as little as 10mg of gluten can cause problems for some sensitive people, although most celiacs can tolerate up to 100mg of gluten per day. However, according to one recent study, the average unintentional exposure to gluten in people with celiac disease on a gluten-free diet is 150–400 mg per day, as measured by levels of gluten metabolites in urine and feces.

In other words, avoiding gluten with a gluten-free diet alone is not possible. Digestive gluten enzyme supplements can help break down small amounts of inadvertently ingested gluten.

However, it should be emphasized again that gluten-breaking enzymes are not a substitute for a gluten-free diet, especially for people with celiac disease or gluten sensitivity.

Sources:

1. Leonard MM, Sapone A, Catassi C, Fasano A. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA. 2017 Aug 15;318(7):647-656.
2. Roszkowska A, Pawlicka M, Mroczek A, Bałabuszek K, Nieradko-Iwanicka B. Non-Celiac Gluten Sensitivity: A Review. Medicine (Kaunas). 2019 May 28;55(6).
3. Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. 2018 Apr 14;24(14):1521-1530.
4. Fasano A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000 Res. 2020 Jan 31;9.
5. Cardoso-Silva D, Delbue D, Itzlinger A, et al. Intestinal Barrier Function in Gluten-Related Disorders. Nutrients. 2019 Oct 1;11(10).
6. Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009 Sep 16;302(11):1171-8.
7. Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, Zinsmeister AR, Melton LJ 3rd, Murray JA. Increased prevalence and mortality in undiagnosed celiac disease. gastroenterology. 2009Jul;137(1):88-93
8. Syage JA, Kelly CP, Dickason MA, et al. Determination of gluten consumption in celiac disease patients on a gluten-free diet. Am J Clinic Nutr. 2018 Feb 1;107(2):201-207.
9. Konig J, Brummer RJ. Is an enzyme supplement for celiac disease finally on the cards? Expert Rev Gastroenterol Hepatol. 2018 Jun;12(6):531-533.
10. Salden BN, Monserrat V, Troost FJ, et al. Randomised clinical study: aspergillus niger-derived enzyme digests gluten in the stomach of healthy volunteers. Aliment Pharmacol Ther. 2015 Aug;42(3):273–285.