Treatment
The dietary key to celiac disease was first described by Samuel Gee in 1888: "If the patient can be cured at all, it must be by means of diet."
The only treatment for celiac disease is a strict gluten-free diet for life. When gluten is removed, the flattened villi in the small intestine gradually return to normal. In most cases gluten can never be reintroduced — once the body is sensitive to gluten, it will always be affected by it.
People diagnosed with celiac disease and their families should consult a well-qualified nutritionist to learn how to manage the disease and follow a gluten-free diet. It's important to protect against the nutritional and vitamin deficiencies associated with a gluten-free diet; the value of a "coach" through this transition can't be overstated. Eating all the colours of the rainbow at every meal, with advice from a nutritionist, health coach or registered dietitian, helps restore gut health and rebalance the immune system. Download the Rainbow Diet (PDF).
What is a gluten-free diet?
A gluten-free diet excludes all foods containing any form of wheat, barley, rye and oats. Roti, bread, cakes, biscuits, rusks, pasta and pastries made with wheat flour are obvious sources of gluten. Including gluten-free grains adds variety and improves nutrition.
Life and food habits will need some changes. They can feel overwhelming at first, but as knowledge and experience grow, choosing the right foods becomes easier.
| Foods containing gluten | Foods that do not contain gluten |
|---|---|
| Wheat | Cereals: rice, buckwheat, maize, bajra |
| Barley | Vegetables |
| Rye | Pulses |
| Oats | Fruits |
| Spelt (a species of wheat) | Nuts |
| Kamut | Meat, fish, poultry, eggs |
| Triticale | Cheese and milk |
| Others: spirits, wines, liqueurs and ciders; whisky (except malt whisky) |
Take great care when buying flours and cereals. They may be gluten-free, but if they're milled in a factory that also handles gluten-containing flour there is always a risk of cross-contamination.
Cross-reactivity
Some people keep having symptoms even on a gluten-free diet. This can be due to cross-contamination — or to cross-reactivity, where proteins in one food are so similar to gluten that the immune system treats them the same way.
For example, about 50% of people who are gluten-intolerant are also sensitive to dairy. Foods that may cross-react include dairy, chocolate, corn, hemp, buckwheat, soy, sorghum, spelt, amaranth, yeast, sago, oats, instant coffee and whey. Whether to eliminate any of these depends on individual sensitivity — always with professional guidance.
Hidden gluten
Gluten may be hiding in many common foods and ingredients:
- Gulab jamun, jalebi, ghevar
- Heeng (asafoetida)
- Mustard (powder / paste)
- Ketchup, Worcestershire sauce, HP sauce
- Soy sauce and other Chinese sauces
- Some chocolates and ice creams
- Malt vinegar
- Haleem
- Some processed meats
- Bhel puri
- Rawa in South Indian food
- Coatings, binders and gravies
- Barfis
- Flours ground in contaminated flour mills
Can you cheat on a gluten-free diet?
No. When you have a gluten-related disorder, the treatment is a strict gluten-free diet without exception. In the words of Dr. Tom O'Bryan, "You can't be a little pregnant; you can't have a little gluten." Cheating once a month has been associated with a six-fold increase in the risk of early death (Lancet, 2001).
Whether you have celiac disease or gluten sensitivity, take your gluten-free diet seriously. People who are "just" sensitive to gluten can experience as much inflammation as someone with celiac disease.
Common cheat statements to watch out for:
- "I'm not celiac, so I can eat a little gluten here and there."
- "I'm just gluten-intolerant, so I'm not worried about cross-contamination."
- "I'm on a low-gluten diet because I have silent celiac."
- "Gluten doesn't bother me that much, so I avoid it — but I'm not strict about it."
- "I always eat gluten-free, but it's my birthday, so just this once."
- "I'm on holiday — I'll go back to gluten-free when I'm home."
- "It's fine, I'll eat your lasagna and just pick out the noodles."
Gluten red flags on labels
People on a gluten-free diet need a sharp eye for labels. Some red flags are obvious — wheat, wheat gluten, barley, rye. Others are "stealth" gluten. Watch for malt (made from barley) and hydrolysed vegetable protein (often contains wheat). Oats don't contain gluten themselves but may still increase symptoms such as abdominal pain, bloating and diarrhoea.
The dangers of an unplanned gluten-free diet
A healthy diet isn't just about avoiding harmful foods — it's about eating beneficial ones. A poorly planned gluten-free diet can cause problems of its own.
Nutritional deficiencies
An unbalanced food selection and poor choice of gluten-free replacement products can lead to deficiencies. Many gluten-free products are high in low-nutrient starches, are not enriched or fortified like their wheat-based equivalents, and are often higher in fat, sugar and carbohydrates. This can mean less iron, B vitamins, folic acid, zinc, calcium and phosphorus. Children in particular tend to over-eat gluten-free snacks and biscuits.
Pseudocereals and millets — quinoa, amaranth, buckwheat — are healthier alternatives with higher nutritional value.
Lower fibre
Wholegrain breads are a good source of fibre. Without them, it takes real effort to get enough fibre — which matters for gut health, and for its antioxidant and anti-inflammatory benefits that help reduce the risk of cancer and heart disease.
Type 2 diabetes risk
A well-planned gluten-free diet can help manage diabetes, but a poorly planned one can do the opposite. People who switch to a gluten-free diet by choice may give up foods that are important for a balanced diet.
Weight gain
Gluten-free does not automatically mean healthy. Many gluten-free baked goods like cookies and brownies are higher in calories and sugar than their gluten-containing versions — and a lot of junk food is already gluten-free. Check labels and nutrition facts.
Stress
Choosing a gluten-free diet without needing one makes balanced eating harder, and can add unnecessary stress.
The bottom line
- If you go gluten-free, focus on healthier gluten-free choices — for example, high-fibre bread rather than white bread.
- Seek professional help. A nutritionist, health coach or registered dietitian can help you avoid deficiencies and eat the rainbow at every meal.