Which nutritional recommendation usually accompanies a diagnosis of celiac disease?

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Abstract

Celiac disease is a genetically-determined chronic inflammatory intestinal disease induced by gluten in wheat, barley, rye etc. Celiac disease affects approximately one percent of people in the world and strict gluten-free diet (GFD) for a lifetime is the only available treatment. As gluten-free products available in the market are known to have low nutritional quality as well as are more expensive than gluten-containing food products, there is a strong need to develop gluten-free products that are nutritionally complete as well as economical. This review focuses on the special considerations during developing gluten-free products viz., finding an alternate non-gluten source, ensuring nutrition and sensory quality characteristics, compliance with the regulatory guidelines, economics and product.

Keywords

Celiac disease

Gluten

Gluten-free diet

Functional foods

Sensory properties

© 2016 Beijing Academy of Food Sciences. Production and hosting by Elsevier B.V.

What is celiac disease?

Celiac disease is a digestive disorder caused by an abnormal immune reaction to gluten. Celiac disease is also known as:

• sprue
• nontropical sprue
• gluten-sensitive enteropathy

Gluten is a protein found in foods made with wheat, barley, rye, and triticale. It is also found in oats that have been made in processing plants that handle other grains. Gluten can even be found in some medicines, vitamins, and lipsticks. Gluten intolerance, also known as gluten-related disorders, is characterized by symptoms after eating gluten containing foods. People with non-celiac gluten sensitivity may have a mild sensitivity to gluten, while others have celiac disease which is an autoimmune disorder.

In celiac disease, the immune response to gluten creates toxins that destroy the villi. Villi are tiny finger-like protrusions inside the small intestines. When the villi become damaged, the body is unable to absorb nutrients from food. This can lead to malnutrition and other serious health complications, including permanent intestinal damage.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 1 in 141 Americans has celiac disease. People with celiac disease need to eliminate all forms of gluten from their diet. This includes most bread products, baked goods, beer, and foods where gluten may be used as a stabilizing ingredient.

Celiac disease symptoms usually involve the intestines and digestive system, but they can also affect other parts of the body. Children and adults tend to have a different set of symptoms.

Celiac disease symptoms in children

Children with celiac disease can feel tired and irritable. They may also be smaller than normal and have delayed puberty. Other common symptoms include:

• weight loss
• vomiting
• abdominal bloating
• abdominal pain
• persistent diarrhea or constipation
• pale, fatty, foul-smelling stools

Celiac disease symptoms in adults

Adults with celiac disease may experience digestive symptoms. In most cases, however, symptoms also affect other areas of the body. These symptoms may include:

• iron-deficiency anemia
• joint pain and stiffness
• weak, brittle bones
• fatigue
• seizures
• skin disorders
• numbness and tingling in the hands and feet
• tooth discoloration or loss of enamel
• pale sores inside the mouth
• irregular menstrual periods
• infertility and miscarriage

Dermatitis herpetiformis (DH) is another common symptom of celiac disease. DH is an intensely itchy skin rash made up of bumps and blisters. It may develop on the elbows, buttocks, and knees. DH affects approximately 15 to 25 percent of people with celiac disease. Those who do experience DH usually don’t have digestive symptoms.

It’s important to note that symptoms can vary from person to person depending on various factors, including:

• the length of time someone was breast-fed as an infant
• the age someone started eating gluten
• the amount of gluten someone eats
• the severity of intestinal damage

Some people with celiac disease have no symptoms. However, they may still develop long-term complications as a result of their disease.

Schedule an appointment with your doctor right away if you suspect that you or your child has celiac disease. When diagnosis and treatment are delayed, complications are more likely to occur.

Diagnosis begins with a physical examination and a medical history.

Doctors will also perform various tests to help confirm a diagnosis. People with celiac disease often have high levels of antiendomysium (EMA) and anti-tissue transglutaminase (tTGA) antibodies. These can be detected with blood tests. Tests are most reliable when they’re performed while gluten is still in the diet.

Common blood tests include:

• complete blood count (CBC)
• liver function tests
• cholesterol test
• alkaline phosphatase level test
• serum albumin test

In people with DH, a skin biopsy can also help doctors diagnose celiac disease. During a skin biopsy, the doctor will remove tiny pieces of skin tissue for examination with a microscope. If the skin biopsy and blood test results indicate celiac disease, an internal biopsy may not be necessary.

In cases where blood test or skin biopsy results are inconclusive, an upper endoscopy can be used to test for celiac disease. During an upper endoscopy, a thin tube called an endoscope is threaded through the mouth and down into the small intestines. A small camera attached to the endoscope allows the doctor to examine the intestines and to check for damage to the villi. The doctor can also perform an intestinal biopsy, which involves the removal of a tissue sample from the intestines for analysis.

The only way to treat celiac disease is to permanently remove gluten from your diet. This allows the intestinal villi to heal and to begin absorbing nutrients properly. Your doctor will teach you how to avoid gluten while following a nutritious and healthy diet. They will also give you instructions on how to read food and product labels so you can identify any ingredients that contain gluten.

Symptoms can improve within days of removing gluten from the diet. However, you shouldn’t stop eating gluten until a diagnosis is made. Removing gluten prematurely may interfere with test results and lead to an inaccurate diagnosis.

Maintaining a gluten-free diet isn’t easy. Fortunately, many companies are now making gluten-free products, which can be found at various grocery stores and specialty food stores. The labels on these products will say “gluten-free.”

If you have celiac disease, it is important to know which foods are safe. Here is a series of food guidelines that can help you determine what to eat and what to avoid.

Avoid the following ingredients:

• wheat
• spelt
• rye
• barley
• triticale
• bulgur
• durum
• farina
• graham flour
• semolina

Avoid unless the label says gluten-free:

• beer
• bread
• cakes and pies
• candy
• cereals
• cookies
• crackers
• croutons
• gravies
• imitation meats or seafood
• oats
• pasta
• processed lunch meats, sausages, and hot dogs
• salad dressings
• sauces (includes soy sauce)
• self-basting poultry
• soups

You can eat these gluten-free grains and starches:

• buckwheat
• corn
• amaranth
• arrowroot
• cornmeal
• flour made from rice, soy, corn, potatoes, or beans
• pure corn tortillas
• quinoa
• rice
• tapioca

Healthy, gluten-free foods include:

• fresh meats, fish, and poultry that haven’t been breaded, coated, or marinated
• fruit
• most dairy products
• starchy vegetables like peas, potatoes, including sweet potatoes, and corn
• rice, beans, and lentils
• vegetables
• wine, distilled liquors, ciders, and spirits

Your symptoms should improve within days to weeks of making these dietary adjustments. In children, the intestine usually heals in three to six months. Intestinal healing may take several years in adults. Once the intestine completely heals, the body will be able to absorb nutrients properly.