From the Guidelines
The best way to manage celiac disease is to follow a strict, lifelong gluten-free diet, as recommended by the most recent study 1. This means completely avoiding foods containing wheat, barley, and rye, which are the primary sources of gluten. Patients should carefully read food labels, be aware of cross-contamination risks in food preparation, and look for certified gluten-free products. Common hidden sources of gluten include soy sauce, some medications, and processed foods. Nutritional counseling is recommended to ensure adequate intake of fiber, iron, calcium, and B vitamins that might be lacking in a gluten-free diet, as emphasized in 1. Regular follow-up with healthcare providers is important to monitor for complications and nutritional deficiencies, with a reasonable follow-up schedule being every 12 months, as suggested in 1. Blood tests to check antibody levels (tissue transglutaminase antibodies) may be performed to confirm dietary adherence. Unlike many conditions, celiac disease doesn't require medication for management unless there are specific complications or deficiencies, such as iron deficiency anemia, which may require oral or intravenous iron supplementation, as recommended in 1. The gluten-free diet works by eliminating the trigger (gluten) that causes the immune system to attack the small intestine, allowing the intestinal villi to heal and properly absorb nutrients again, as explained in 1. Most patients experience significant symptom improvement within weeks of eliminating gluten, though complete intestinal healing may take months to years. It is also important to note that a team-based approach, including a dietician, is preferentially used in the management and follow-up of patients with celiac disease, as stated in 1. Additionally, ensuring adherence to a gluten-free diet is crucial in improving iron absorption in patients with iron-deficiency anemia and celiac disease, as highlighted in 1.
Some key points to consider in the management of celiac disease include:
- The importance of a strict, lifelong gluten-free diet
- The need for nutritional counseling to ensure adequate intake of essential nutrients
- Regular follow-up with healthcare providers to monitor for complications and nutritional deficiencies
- The potential need for medication, such as iron supplementation, in specific cases
- The importance of a team-based approach, including a dietician, in the management and follow-up of patients with celiac disease.
Overall, the management of celiac disease requires a comprehensive approach that takes into account the patient's dietary needs, potential complications, and the importance of adherence to a gluten-free diet, as emphasized in the most recent study 1.
From the Research
Managing Celiac Disease
To manage celiac disease effectively, several key strategies must be employed:
- A strict gluten-free diet (GFD) for life is the only treatment for celiac disease (CD) 2, 3, 4, 5, 6
- Successful management of CD requires a team approach, including the person with CD, their family, physician, dietitian, and celiac support group 2
- The diet must be not only free of gluten but also healthy to avoid nutrient, vitamin, and mineral deficiencies or excess 3, 5, 6
- Nutritional education by a trained nutritionist is of great relevance to achieve long-term satisfactory health status and good compliance 3, 4, 5
Key Components of a Gluten-Free Diet
The following components are essential for a well-managed GFD:
- Eliminating gluten as an ingredient as well as hidden components and potential cross-contamination in foods 3
- Including a variety of naturally gluten-free foods and certified processed gluten-free products 3, 4
- Ensuring the diet is nutrient-dense, balanced with macro- and micronutrients, reasonably priced, and easily accessible 5
- Rotating pseudo-cereals to provide a good source of complex carbohydrates, protein, fiber, fatty acids, vitamins, and minerals 5
Monitoring and Follow-Up
Regular monitoring and follow-up are crucial for effective management of celiac disease: