spaghetti, and many processed foods that use flour as a
thickening agent.
When individuals fail to improve on agluten-free
diet, it is sometimes because they are unintentionally
consuming sources of hidden gluten. A few people on
truly gluten-free diets do not improve. They can be
treated with corticosteroid drugs to reduce inflamma-
tion, but this does not heal the intestine. Clinical trials
concerning treatment of celiac disease are underway.
Patients interested in participating in a clinical trial at
no cost can find a list of trials currently enrolling
volunteers athttp://www.clinicaltrials.gov
Nutrition/Dietetic concerns
Individuals newly diagnosed with celiac disease
need counseling from a nutritionist and help in meal
planning from a dietitian. Two issues need to be
addressed. First, what is safe to eat, and second, how
to get the right balance of nutrients in a gluten-free diet.
Complicating matters, damage to the intestines may
make some people lactose intolerant, so that they either
cannot eat or must limit dairy products in their diet.
Many cookbooks are available to help people on a
gluten-free diet. Home cooks must learn to substitute
ingredients such as cornstarch and rice flour for wheat
flour in their foods. An increasing number of gluten-
free foods are available commercially. However, these
often cost more than their gluten-containing counter-
parts. Below are listed just a few foods people with
celiac disease can safely eat.
plain fruits and vegetables
plain meat that has not been breaded, coated, or
mixed with fillers
potatoes
rice (all types)
cornmeal, cornstarch, and products made of corn,
such as corn tortillas
tapioca
buckwheat
dried beans and peas
nuts
quinoa
amaranth
arrowroot
Other foods must be avoided. Individuals with
celiac disease must also avoid cross-contamination
with these foods. For example, they should not cut
gluten-free bread using a knife that has cut regular
wheat bread unless the knife has been thoroughly
washed. Even small amounts of gluten can cause dam-
age to the intestine. Some of the foods people with
celiac disease must avoid are listed below.
wheat flours including durum flour, enriched flour,
graham flour, semolina flour, and white flour
wheat germ, wheat starch, wheat bran, cracked
wheat
products made with the above mentioned wheat
products such as pasta, bread, cakes, cookies
barley, barley flour, and products made with barley
rye, rye flour, and products made with rye
triticale and other wheat hybrids
Learning how to read food labels is very impor-
tant to people who must avoid gluten. However, this
may become easier in the future. In January 2007, the
United States Food and Drug Administration (FDA)
published preliminary regulations s for foods that
could be labeled ‘‘gluten free.’’ Labeling will be volun-
tary. The FDA hopes to have these rules take effect by
August 2008. This will make it easier for shoppers who
must avoid gluten to find products they can safely eat.
Meanwhile, people with celiac disease must be alert to
‘‘hidden’’ sources of gluten that often serve as binders
or thickeners in commercially prepared foods. Some
of these non-obvious sources of gluten that may
appear on food labels are listed below.
starch (type unspecified)
modified food starch
hydrolyzed vegetable protein (HVP)
hydrolyzed plant protein (HPP)
texturized vegetable protein (TVP)
binders
fillers
extenders
excipients (ingredients used in medications that do
not have medicinal value, such as coatings of tablets.
Consult a pharmacist or physician about whether
before taking drugs, vitamins, etc.)
malt
Some brands of commercially prepared french
fries, potato chips, hot dogs, meatballs, gravy mixes,
soups,soysauce, and candy contain these hidden sour-
ces of gluten. Others are gluten-free. A nutritionist and
dietitian can help people with celiac disease learn to
read labels accurately to distinguish that foods are
safe for them.Therapy
Switching to a gluten-free diet requires major life-
style changes. It can be especially hard on children and
teens who want to be able to go out with their friendsCeliac disease