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 children, 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. The earlier it is diagnosed, the less likely that your child will develop other problems. Having 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 eating gluten, your child’s 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 lipstick, lip balm, medicines, and supplements contain gluten. Ask your healthcare provider or pharmacist about gluten in your medicines and supplements.

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 breastfed
• How old your child was when your child 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, it is important that your child eats a 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.
• Your child also may be tested for deficiencies of iron, folate or vitamin B12.
• 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 throughout 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 (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 rice, quinoa, millet, corn, sorghum, teff, buckwheat, amaranth, 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 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.
• Check with your child’s school to see if they offer a gluten-free meal option.
• If your child attends birthday parties or sleepovers, make sure your child’s dietary needs are known.
• 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 child’s healthcare provider may prescribe a daily gluten-free multivitamin and mineral supplement for your child.

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
• Teach your child about how to make healthy food choices, so your child can feel comfortable eating away from home.

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

For more information, contact:

• National Institute of Diabetes and Digestive and Kidney Diseases
  https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease
• The Celiac Disease Foundation
  https://celiac.org/