Celiac Disease and Gluten-Free Diet

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KEY POINTS

• Celiac disease is a digestive system problem. It damages the lining of the small intestine and makes it hard for the intestines to absorb nutrients from food. If this disease is not diagnosed and treated, it can cause serious problems.
• The only treatment for celiac disease is a gluten-free diet. A gluten-free diet contains no wheat, barley, or rye. Fresh fruits, vegetables, beans, milk, fresh beef, pork, poultry, fish, and eggs do not contain gluten. Nuts, seeds, and vegetable oils without additives are also safe.
• For most people, this diet relieves symptoms in a few weeks.

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What is celiac disease?

Celiac disease is a digestive system problem. It damages the lining of the small intestine and makes it hard for your child’s intestines to absorb nutrients from food. If this disease is not diagnosed and treated, it can cause serious problems. Celiac disease increases your child’s risk of:

• Not getting enough nutrients from food
• Anemia (not enough iron in your blood)
• Liver disease
• Osteoporosis (bone loss)
• Cancer

What is the cause?

Celiac disease is an autoimmune disease, which means that it is a disease that causes the body to attack its own tissue. When your child has celiac disease, after she eats gluten her immune system attacks the part of the intestine that absorbs nutrients. Gluten is a protein in wheat, barley, and rye grains. Gluten can also be found in oats if they are processed or packaged in factories that process wheat, barley, or rye. Also, some medicines and supplements contain gluten.

Celiac disease is inherited, which means that it’s passed from parents to children through their genes. Genes are inside each cell of the body. They contain the information that tells the body how to develop and work.

What are the symptoms?

The symptoms vary a lot from one child to the next. When your child starts having symptoms, the kinds of symptoms your child has, and how severe the symptoms are, is affected by:

• How long your child was breast-fed
• How old your child was when she started eating foods with gluten
• How much gluten your child eats

Digestive symptoms may include:

• Diarrhea
• Stomach pain and bloating
• Foul-smelling bowel movements

Because the body is not getting the nutrients it needs, your child may also have:

• Weight loss
• Poor growth
• Unusual tiredness
• Behavior changes and irritability
• Tooth discoloration and loss of enamel from the teeth

Some children have celiac disease but do not have any symptoms. Or they may start having symptoms after surgery, a viral infection, or severe emotional stress.

How is it diagnosed?

Your healthcare provider will ask about your child's symptoms and medical history and examine your child. Tests may include:

• Blood tests, including a blood test for certain antibodies. Antibodies are the proteins your child’s immune system makes to fight infections, such as the flu and measles. Celiac disease has many of the same symptoms as irritable bowel syndrome or an intestinal infection. However, children with celiac disease have a higher level of certain antibodies in their blood. Before having this test, your child should eat her usual diet, including foods that contain gluten, such as bread. If your child avoids foods containing gluten before the test, the test may be negative even if your child has the disease.
• Biopsy. If your child's blood test is positive for the antibodies, your child may need a biopsy of the small intestine. A biopsy is the removal of a small sample of tissue for testing. It is done with a slim, flexible tube passed through the mouth and down into the small intestine.

How is it treated?

The only treatment for celiac disease is a gluten-free diet. For most children, this diet relieves symptoms in a few weeks. The gluten-free diet lets the intestine heal and prevents more damage. The longer your child keeps eating gluten, the more the intestine is damaged and the greater the risk for long-term problems. If your child keeps eating foods that have gluten, the disease can be life threatening. Your child must follow the gluten-free diet all his life.

In children and young adults, the bowel may be completely healed after 3 to 6 months on the gluten-free diet.

What is a gluten-free diet?

A gluten-free diet contains no wheat, barley, or rye. Because the American diet is based on grains, and many processed foods contain grain-based additives, this diet can be hard to follow. You may need to work with a dietitian to help your child eat a healthy, gluten-free diet. Here are some suggestions:

• Grains are high in carbohydrates, also called carbs, which are a source of energy and nutrients. It is important to replace carbs from wheat, rye, and barley with carbs from foods such as wild rice, quinoa, millet, corn, and potatoes.
• Fresh fruits, vegetables, beans, milk, fresh beef, pork, poultry, fish, and eggs do not contain gluten. Nuts, seeds, and vegetable oils without additives are also safe.
• Any product with a “gluten-free” label is usually OK to eat. Some food products are certified by the Gluten Free Certification Organization (GFCO) and have a GFCO stamp on them. The GFCO tests for the amount of gluten in products and has strict standards.
• Always read labels to check for gluten, but remember that "wheat free" doesn't always mean "gluten free." Wheat-free products may contain barley or rye.
• Many companies will send you a list of their gluten-free products. If you have any question about whether a food contains gluten, avoid the product until you check with the manufacturer.
• When you eat at a restaurant or deli, ask if they have a gluten-free menu. Order foods without sauces since wheat flour is used as a thickener in many sauces.

Your healthcare provider may prescribe a daily gluten-free multivitamin and mineral supplement for your child. Ask your pharmacist or call the manufacturer to find out about the ingredients in your child’s medicine.

How can I take care of my child?

Follow the full course of treatment prescribed by your child’s healthcare provider. Ask your provider:

• How and when you will get your child’s test results
• How long it will take your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup.

You can get more information from:

• National Institute of Diabetes and Digestive and Kidney Diseases
  https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/overview.aspx
• The Celiac Sprue Association/USA, Inc.
  https://www.nationalceliac.org/
• The Celiac Disease Foundation
  https://celiac.org/