For More Information
American Celiac Disease Alliance
2504 Duxbury Place
Alexandria, VA 22308
American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606–6995
Celiac Disease Foundation
13251 Ventura Boulevard, #1
Studio City, CA 91604
Celiac Sprue Association/USA Inc.
P.O. Box 31700
Omaha, NE 68131–0700
Phone: 1–877–CSA–4CSA (272–4272)
Children’s Digestive Health and Nutrition Foundation
P.O. Box 6
Flourtown, PA 19031
Gluten Intolerance Group of North America
31214 124th Avenue SE
Auburn, WA 98092–3667
National Foundation for Celiac Awareness
224 South Maple Street
Ambler, PA 19002–0544
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
P.O. Box 6
Flourtown, PA 19031
The Celiac Disease Awareness Campaign
To meet the need for comprehensive and current information about celiac disease, the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), launched the Celiac Disease Awareness Campaign. The Awareness Campaign is the result of the combined ideas and efforts of the professional and voluntary organizations that focus on celiac disease, along with the NIDDK, the National Institutes of Health, and the Centers for Disease Control and Prevention.
You may also find additional information about this topic by visiting MedlinePlus at medlineplus.gov.
This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit fda.gov. Consult your doctor for more information.
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Ciaran Kelly, M.D., Beth Israel Deaconess Medical Center; Mitchell Cohen, M.D., Cincinnati, Children’s Hospital Medical Center; Walter Reed Army Medical Center; National Foundation for Celiac Awareness; Celiac Disease Foundation; Celiac Sprue Association/USA, Inc.; and Centers for Disease Control and Prevention staff. The gluten-free diet chart was reviewed by Alice Bast and Nancy Dickens, National Foundation for Celiac Awareness; Cynthia Kupper, R.D., C.D., Gluten Intolerance Group; and Elaine Monarch, Celiac Disease Foundation.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
Also called: Celiac sprue, Gluten-sensitive enteropathy, Nontropical sprue
If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine. Gluten is a protein in wheat, rye and barley. It is found mainly in foods but may also be in other products like medicines, vitamins and even the glue on stamps and envelopes.
Celiac disease affects each person differently. Symptoms may occur in the digestive system, or in other parts of the body. One person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Irritability is one of the most common symptoms in children. Some people have no symptoms.
Celiac disease is genetic. Blood tests can help your doctor diagnose the disease. Your doctor may also need to examine a small piece of tissue from your small intestine. Treatment is a diet free of gluten.
Celiac Disease - Nutritional Information
Celiac disease is an autoimmune disorder passed down through families.
Gluten is a protein found in wheat, barley, rye, or sometimes oats (including medications). When a person with celiac disease eats or drinks anything containing gluten, the immune system responds by damaging the lining of the intestinal tract. This damage affects the body's ability to absorb nutrients.
For specific information about the disease (including symptoms and treatment), see: Celiac disease.
Carefully following a gluten-free diet helps prevent symptoms of the disease.
Staples of the gluten-free diet include:
- Cereals made without wheat or barley malt
- Fruits and vegetables
- Meat, poultry, and fish (not breaded or made with regular gravies)
- Milk-based items
- Oats (may be okay for some people with celiac disease, but work closely with your doctor or nutritionist)
- Potatoes, rice, corn, beans
You can eat foods such as pasta, bread, pancakes, and pastries made with alternative grains (rice, buckwheat, tapioca, potato, or corn flours and starches).
You can buy these products through local and national food companies, or you can make them from scratch using alternative flours and grains.
Other food items you may use for cooking include:
- Potatoes, rice flax, millet
- Legumes, nuts, seeds, cassava
- Tapioca sorghum
The gluten-free diet involves removing all foods, drinks, and medications made from gluten. This means not eating anything made with barley, rye, and wheat. All items made with all-purpose, white, or wheat flour are prohibited.
Obvious sources of gluten include:
- Breaded foods
- Breads, bagels, croissants, buns
- Cakes, donuts, and pies
- Cereals (most)
- Cold cuts, hot dogs, salami, or sausage
- Crackers and many snacks bought at the store, such as potato chips and tortilla chips
- Pancakes and waffles
- Pasta and pizza
- Soups (most)
Less obvious foods that must be eliminated include:
- Candies (some)
- Communion breads
- Marinades, sauces, soy and teriyaki sauces
- Salad dressings (some)
- Self-basting turkey
There is a risk of cross-contamination. Items that are naturally gluten-free may become contaminated if they are made on the same production line as, or moved together in the same place as foods containing gluten.
Eating at restaurants, work, school, and social gatherings can be challenging. Call ahead and plan. It is important to read labels before buying or eating, due to the widespread use of wheat and barley in foods.
Despite its challenges, maintaining a healthy, balanced diet is possible with education and planning.
Once you have been diagnosed with celiac disease, it is very important that you talk to a registered dietitian who specializes in celiac disease and the gluten-free diet.
Joining a local support group is also recommended. Support groups can help people with celiac disease share practical advice on ingredients, baking, and ways to cope with this life-altering, lifelong disease.
Your doctor might prescribe a multivitamin and mineral or individual nutrient supplement to correct or prevent a deficiency.
Celiac Disease - Sprue
Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.
Causes of Celiac Disease
The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi.
This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.
The disease can develop at any point in life, from infancy to late adulthood.
People who have a family member with celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men.
People with celiac disease are more likely to have:
- Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome
- Addison's disease
- Down syndrome
- Intestinal cancer
- Intestinal lymphoma
- Lactose intolerance
- Thyroid disease
- Type 1 diabetes
Symptoms of Celiac Disease
The symptoms of celiac disease can be different from person to person. This is part of the reason why the diagnosis is not always made right away. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools.
Gastrointestinal symptoms include:
- Abdominal pain, bloating, gas, or indigestion
- Decreased appetite (may also be increased or unchanged)
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Because the intestines do not absorb many important vitamins, minerals, and other parts of food, the following symptoms may start over time:
- Bruising easily
- Depression or anxiety
- Growth delay in children
- Hair loss
- Itchy skin (dermatitis herpetiformis)
- Missed menstrual periods
- Mouth ulcers
- Muscle cramps and joint pain
- Tingling or numbness in the hands or feet
- Unexplained short height
Children with celiac disease may have:
- Defects in the tooth enamel and changes in tooth color
- Delayed puberty
- Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting
- Irritable and fussy behavior
- Poor weight gain
- Slowed growth and shorter-than-normal height for their age
Exams and Tests for Celiac Disease
- Albumin (may be low)
- Alkaline phosphatase (high level may be a sign of bone loss)
- Clotting factor abnormalities
- Cholesterol (may be low)
- Complete blood count ( CBC - test for anemia)
- Liver enzymes (transaminases)
- Prothrombin time
Blood tests can detect several special antibodies, called anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider will order these antibody tests if celiac disease is suspected.
If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.
Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.
A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment, which confirms the diagnosis. However, this does not mean that the disease has been cured.
Treatment for Celiac Disease
Celiac disease cannot be cured. However, your symptoms will go away and the villi in the lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat foods, beverages, and medications that contain wheat, barley, rye, and possibly oats.
You must read food and medication labels carefully to look for hidden sources of these grains and ingredients related to them. Because wheat and barley grains are common in the American diet, sticking with this diet is challenging. With education and planning, you will heal.
You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease.
The health care provider may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be prescribed for short-term use or if you have sprue that does not respond to treatment. Following a well-balanced, gluten-free diet is generally the only treatment you need to stay well.
When you are diagnosed, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet.