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  NutritionCeliac Sprue--What Is It? What Role Does Diet Have In Its Treatment?Table of Contents
What Role Does Diet Have In Its Treatment? Celiac disease (also known as celiac sprue or nontropical sprue or gluten enteropathy) is a chronic intestinal malabsorption disorder caused by gluten intolerance. The villi (fingerlike projections) on the jejunal mucosal cells in the small intestine become flattened and malabsorption of nutrients occurs; this can be improved by avoiding dietary gluten. This malabsorption affects the digestion of carbohydrates, proteins, fats, vitamins, and minerals. Celiac disease is different from tropical sprue that occurs in the Caribbean, India, and Asia, affecting the native populations and newcomers. Tropical sprue is caused by bacterial or viral infection, parasites, vitamin deficiencies or food toxins. Even though tropical sprue is a malabsorption disorder, the avoidance of gluten is not necessary. Cause and Prevalence Celiac disease is a hereditary congenital (inherited) disorder and is also an autoimmune (self fighting against self) disease. Autoimmune diseases (eg, type 1 diabetes, primary hypothyroidism, Lupus, Crohn's Disease, multiple sclerosis, and many others) are thought to occur after the body is exposed to a virus or antigen. The body produces antibodies to fight the virus or antigen but the virus/antigen/antibodies may become inactive; when they become activated later, the virus/antigen or antibodies may attack body tissues or organs causing one of the above diseases. It is thought that if a person has one autoimmune disease, he or she is more likely to develop another. Some studies have shown that persons newly diagnosed with type 1 diabetes may be more likely to develop celiac disease within 4 years; so children with type 1 diabetes may need annual screening for several years. Regular screening for celiac disease (every 3 years) may be recommended for other persons with type 1 diabetes. It is estimated that 1 in 10 to 1 in 20 persons with type 1 diabetes has celiac disease. Persons with type 2 diabetes have the same odds of developing celiac disease as the general public. Celiac disease is caused by a sensitivity to gliadin in gluten which is a cereal protein found in wheat, rye, barley, and oats (there is controversy as to whether the gluten in oats is harmful - some persons may be able tolerate it). It is the gliadin that acts as an antigen. The prevalence of celiac disease varies from 1:300 in Ireland to 1:5000 or more in North America (more recent estimates say 1:100 to 1:1000). Symptoms Persons with celiac disease may or may not have symptoms. It may occur in infancy, childhood or adulthood. Symptoms may include poor growth, mild bowing deformities of the long bones, osteoporosis, bone or joint pain, odorous bulky stools, painful abdominal bloating, diarrhea, lactose intolerance, poor appetite, weight loss, pale appearance, iron deficiency anemia, itchy blisters or a red bumpy rash, an enlarged belly, and edema (due to protein malabsorption and deficiency). In individuals with diabetes, malabsorption of carbohydrates could lead to poor blood glucose control - hyper- and hypoglycemia. A gluten-free diet can bring relief in a few days, and in months the intestinal villi heal. Diagnosis Symptoms, lab results, and x-rays may be utilized. An antibody test and a tissue sample from the intestine can identify and confirm celiac disease. An antibody test can indicate how compliant the person has been over time. Treatment Gluten in the diet must be avoided. Self-reports by affected persons indicate that even if one appears to be free of symptoms at the time of gluten ingestion, painful discomfort can still occur one to several days later. The individual must have good knowledge of the many foods containing gluten. Gluten is found in regular bread, pasta, and flour; beer; pancakes; breakfast cereals; ice cream; soups; sauces; and hot dogs. Supplemental vitamins (B vitamins) and minerals (iron, calcium) may be needed; consult with your physician since the degree of malabsorption can vary considerably from one person to another. It is important to understand food labels and to consume an adequate, varied diet including appropriate fiber; consult with your dietitian. It has been determined that prolamins, a type of alcohol-soluble protein, causes the intestinal villi damage; this includes wheat gliadin and other prolamins found in barley, rye, and oats. The term gluten-free may not be as accurate as prolamin-free. Carbohydrate content of these foods may differ from gluten/prolamin-containing foods. Foods with Gluten Wheat Triticale Barley Gluten flour Rye Durum flour Spelt Farina Kamut Wheat/Semolina Wheat bran Bulgur Graham flou Wheat germ Couscous Ein Korn Oats? (gluten may not be harmful) Read all labels carefully, especially boxed mixes and the following grain-based ingredients: Malt flavoring? Hydrolyzed vegetable protein? Textured vegetable protein? More foods with Gluten Soy sauces Chewing gum wrappers Glues on stamps, envelopes Starches/thickeners/emulsifiers in processed foods Lunch meats and sausages with fillers Salad dressings containing emulsifiers Soft cheeses and cheese spreads Flavored coffees Malted milk, instant cocoa mixes Cough drops, pills, other drugs (?) Beer, malted beverages/flavoring Licorice What Can I Eat? The following flours: Rice Buckwheat Corn/Grits Rice bran Soy Cornmeal Arrowroot Sago Potato Millet Oat Teff Tapioca Sorghum Chickpea Amaranth Nut flours Quinoa Flaxseed Hominy Gluten-free products can be found at some health- food stores and Asian markets Eat a Variety of Healthy Foods Milk, plain yogurt, cheese, cottage cheese, cream cheese Meat, fish, poultry, eggs Dried beans/peas, nuts, seeds, tofu Fruits/juices Vegetables Homemade soups/salad dressings made with allowed ingredients Fats, vegetable oil, margarine, butter, cream Any desserts made with allowed ingredients Tea, coffee, soft drinks, pure cocoa, cider Distilled alcohol (rum/gin/whisky/vodka), wines, pure liquor Honey, jam, jelly, marmalade, corn/maple syrup, molasses, sugar Plain popcorn Plain pickles, relish, olives, tomato paste, ketchup, mustard Pure herbs/spices/black pepper, MSG, gluten-free soy sauce Sauces/gravies made with allowed ingredients Pure baking chocolate/chocolate chips, carob chips/powder Cream of tartar, baking soda, yeast, aspartame, coconut Vinegar Gluten-Free Food Substitutions 1 T Wheat flour= 1/2 T cornstarch, 1/2 T potato flour, 1/2 T rice flour, 1/2 T arrowroot starch, 2 t quick-cooking tapioca/tapioca starch, or 2 T uncooked rice 1 c Wheat flour= Mix: 2 c brown rice flour+2 c sweet rice flour+2 c rice polish (use 7/8 c) 1 c Wheat flour= 5/8 c potato starch, 7/8 c white/brown rice flour, 1 c corn flour, 1 c fine cornmeal, 3/4 c coarse cornmeal, 5/8 c white/brown rice flour+1/3 c potato starch flour, 1 c soy flour+1/4 c potato starch flour, 3/4 c rice flour+1/4 c cornstarch, or 7/8 c whole-bean flour
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