Celiac Disease: Treatment & Follow Up-new

How much gluten is
considered safe?
Answer: 20 PPM
(Parts Per Million)

TREATMENT

The only treatment for Celiac disease is to go on a lifelong gluten-free diet. This may sound like an easy solution first, but gluten unfortunately is hidden in food additives, flavorings, cosmetics, school supplies, and more. Therefore, it is more of adopting a gluten-free lifestyle.

Nutritional Concerns

At the time of diagnosis, parents and children should meet a registered dietitian who has sufficient knowledge about Celiac Disease and the gluten-free diet. The patient and the family members need to be educated regarding the consequences of untreated Celiac disease, including nutrition related complications such as iron deficiency, osteoporosis, and autoimmune disorders.

SAFE FOODS

Your gluten free diet should include any naturally gluten free foods, such as:

  • Meat
  • Fish
  • Fresh Fruits and Vegetables
  • Eggs
  • Plain milk and dahi (yoghurt)
  • Dals & Pulses
  • Plain nuts and seeds
  • Arrowroot, sabudana (sago), soya, singhara (water chestnut)
  • Spices in whole form (Sabut garam masala)
  • Sugar & Salt
  • Tea, coffee
  • Vegetable oils
  • Honey
  • Grains: All varieties and colors of plain rice, Bajra (Pearl Millet), Jowar (Sorghum), Ragi (finger millet), Kuttu (buckwheat), Makka (Corn), Ramdaana/Rajgira/Cholai (Amaranth), Quinoa, Wild Rice, Teff Look for products labeled gluten free to avoid cross contamination.
SAFE FOODS

These foods should be specifically avoided:

  • Wheat in all forms. Popular products made of wheat like bread, cakes, cereals, cookies, crackers, pretzels, pasta and pizza crusts. Read labels carefully.
  • Secondary meat products like kebabs that may have wheat flour listed in the ingredients.
  • Barley and malt – this includes malt syrup, malt extract, malt flavoring and malt vinegar.
  • Breaded products with breading made of wheat. Also sauces or marinades that contains gluten for e.g. soy and teriyaki sauces.
  • Foods that are fried in the same oil as breaded products.
  • Candies like licorice and desserts like ‘jalebis’ and ‘malpura’ that contain wheat or barley.
  • Avoid using ‘hing’, the powdered form uses wheat as an anti-caking agent.

BE VIGILANT!

  • Flours made of alternative grains may have been milled in plants where wheat is also ground so there might be a high chance of wheat contamination. Please grind these flours at home to be safe.
  • Grind your masalas at home for the same reasons as above.
  • Keep your grinder, cooking utensils, knives and chopping board separate and use exclusively for preparation of gluten-free food and masalas.

FOLLOW-UP CARE

Frequent follow up is important to ensure that the symptoms of Celiac disease have resolved. Families often encounter conflicting information, so the diet should also be reviewed to clear up any confusion and identify any potential sources of gluten. Periodic visits for assessment of symptoms, growth, physical examination, and adherence to the gluten free diet are necessary. Tissue Transglutam Mirase (TTG) should be measured after six months of starting a Gluten-free diet and then at one year intervals. A decrease in TTG indicates compliance with the diet and conversely a rise will indicate non-compliance.

Diagnosis of the disease is only the beginning, as the doctor will provide the education and support for life-long compliance to the gluten free diet. Support groups like Gluten-free Jio are important links, which allow participation of a person with Celiac and encourage adhering to a gluten-free diet, preventing further complications of untreated Celiac Disease and improving quality of life.

NON-CELIAC GLUTEN SENSITIVITY

People with non-celiac wheat sensitivity experience symptoms similar to those of Celiac Disease, which subsides when gluten is removed from the diet. However, they do not test positive for celiac disease. This is also known as Non-Celiac Gluten Sensitivity. Symptoms typically appear hours or days after gluten has been ingested. Clinically, it has been recognized as less severe than celiac disease.

Celiac Disease: Symptoms & Diagnosis