To monitor dietary adherence to the gluten-free
diet, the dietitian will examine the person’s dietary
history and habits. Blood tests will be conducted to
see is gluten antibody levels have returned to normal
levels. If there is clinical concern that a person is not
adhering to the gluten-free diet or that the diet is not
effective, a biopsy of the small intestine may be
conducted.
The gluten-free diet is complex and it cannot be
assumed that chefs in restaurants or others who pre-
pare food (including friends and family) are aware of
potential sources of gluten contamination. Education
of family and friends is important in accomplishing a
life-style change. In restaurants simple dishes without
sauces should be ordered, and the person should
inquire whether grain products are prepared with the
same equipment or utensils used to prepare other
foods. Although a food may be considered to be gluten-
free by the ingredients it contains, it may be gluten-
contaminated by the way in which it is prepared or
stored. Other difficulties associated with following a
gluten-free diet include lifestyle changes such as avoid-
ing travel, finding gluten-free foods, especially those of
good quality, determining whether foods are gluten-
free, not being invited out because of the diet, with
resulting social isolation, and maintaining a gluten-
free diet when in the hospital.
As with any restrictive diet, the gluten-free diet
has potential for nutritional inadequacy. Persons who
are sensitive to gluten are at increased risk forosteo-
porosisand osteomalacia, due to malabsorption of
calciumandvitamin D. Most persons with celiac dis-
ease have some degree of osteopenia or osteoporosis.
Calcium and vitamin D supplementation along with
strict adherence to a gluten-free diet usually results in
remineralization of the skeleton.Ironor other vitamin
deficiencies may also be present and must be treated
appropriately. The consumption of gluten-free fiber-
rich foods (for example, brown rice, fruits, and vege-
tables) and adequate fluid intake is recommended to
assist in the prevention of constipation.
Women with untreated celiac disease often exhibit a
history of miscarriages, anaemia, low birth weight
babies, and unfavorable outcome of pregnancy. It is
suggested that testing for celiac disease be included in
the battery of tests prescribed for pregnant women. Cel-
iac disease is considerably more common than most of
the diseases for which pregnant women are routinely
screened. Unfavorable events associated with celiac dis-
ease may be prevented by a gluten-free diet.Research and general acceptanceThe gluten-free diet is recognized as the required
treatment for persons exhibiting gluten-sensitivity.
The National Institutes of Health noted in 2004
that the strict definition of a gluten-free diet remains
controversial due to the lack of an accurate method to
detect gluten in food products and the lack of scientific
evidence for what constitutes a safe amount of gluten
ingestion. No international agreement has yet been
developed on how much gluten a person with gluten-
sensitivity can tolerate. Research is on-going to better
identify levels that are acceptable, and health profes-
sionals involved in the therapy of celiac disease should
keep up-to-date on the latest research. As of February,
2007, the United States Food and Drug Administra-
tion is proposing to set a standard of 20 part per
million as the maximum acceptable level of gluten
allowed for a product to be labeled as gluten-free.
Research continues on the benefits of a gluten-free
diet for persons with multiple sclerosis and other auto-
immune disorders, as well as for persons with autism
spectrum disorders, ADHD, and some behavioral
problems.
In addition, a new enzyme that was being devel-
oped for commercial food processing has been found to
break down gluten molecules quickly and almost com-
pletely. The enzyme is made from Aspergillis niger, a
common fungus that is the source of other food gradeQUESTIONS TO ASK YOUR
DOCTOR Can oats be added to my gluten-free diet? What
medical tests are necessary to monitor possible
adverse effects due to oat consumption?
What foods can I eat?
What foods must I eliminate or reduce?
How do I prepare gluten-free foods?
What types of on-going monitoring should I
undergo?
How do I ensure that I am getting the nutrients
and vitamins that I need?
Where can I go to join a support group to help
me to adhere to the gluten-free diet?
Should I take a nutritional supplement?
Will I have to avoid gluten for the rest of my life?
How often should I follow up with the doctor?
With the dietitican?Gluten-free diet