Dietary management 

Coeliac disease is unique among autoimmune conditions as removal of the extrinsic factor ('gluten') typically results in clinical improvement.  Hence, the complete treatment for coeliac disease is a gluten-free diet (GFD).

The pathological changes observed in coeliac disease result from the interaction between 'gluten' and immune, genetic and environmental factors (1).

What is gluten?

A number of toxic fractions have been identified in CD. 'Gluten' is a generic term used to cover the alcohol-soluble proteins:  

• gliadins in wheat
• secalins in rye 
• horedins in barley 

Oats contain similar proteins called avenins, which are now accepted as being safe for most people with coeliac disease. Click here to read more about this.   

Treatment of coeliac disease requires complete exclusion of gluten from the diet.

The dietary objectives are to ensure that people with coeliac disease:

• exclude all dietary sources of gluten
• know which foods and ingredients are naturally free from gluten
• substitute gluten-containing foods and ingredients with gluten-free alternatives to improve dietary acceptability, nutritional adequacy and compliance
• consume a balanced diet which helps maintain health and prevent or manage associated diseases, particularly osteoporosis.

Following a gluten-free diet may sound very straight forward, but is not as easy as it first seems! There are many factors that are important to take into consideration when managing patients with coeliac disease.

Use the left hand menu to learn more about

• contamination with gluten and how to prevent it
• barley malt extract and codex wheat starch
• Codex standard for gluten
• oats and the gluten-free diet

Reference:

1. Green P & Cellier C. Celiac Disease NEJM 2007; 357: 1731-43