-IBIS-1.7.0-
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digestive system
celiac disease
Nutrition
dietary guidelines
eating principles:
AVOID FOODS CONTAINING GLUTEN! (Wheat, oats, rye, barley, triticale)
The first month of a gluten-free diet may also have to be dairy-free. Many times a dairy sensitivity or allergy accompanies Celiac Disease. After 1-2 months of a dairy-free and gluten-free diet, dairy may be introduced slowly as a challenge with close supervision and jejunum testing
elimination/rotation diet, rotation diet, rotation diet expanded
foods allowed:
rice, corn, buckwheat, millet (may or may not be tolerated), amaranth, quinoa, potatoes, gluten-free wheat starch, cornflakes, corn meal, hominy, puffed rice, rice cakes, cornstarch, cornstarch pudding, custard, rice pudding, fruits, vegetables, eggs, oils, legumes, nuts
avoid:
Avoid all gluten: wheat, barley, oats, rye, triticale, in all forms. Rice, corn, buckwheat, and sometimes millet are often tolerated. Initially, however, they should be avoided. Other grains that might be tolerated later are quinoa and amaranth. Read labels very carefully. It should be noted that 30% respond in 3 days, 80% in one month, and 90% in 2 months. 10% respond only after 2-3 years of gluten avoidance. Sometimes cortisone is useful in such cases to stabilize the condition. It seems likely that there are other food sensitivities that are exacerbating the condition, probably related to leaky gut syndrome, and lack of pancreatic and intestinal mucosal digestive enzymes.
Avoid all milk products: Since patients are often milk sensitive, it is a good idea to avoid milk products as well. Sometimes dairy products may be reintroduced at a later time.
Most breaded products, stuffing, gravies, cream sauces, flour, macaroni, spaghetti, noodles, biscuits, rolls, breads, crackers, beer, Postum, malted milk, Ovaltine, most commercial salad dressings, pies, cake, prepared meat patties, bread crumbs, canned meat dishes, canned soups, instant soups, cream soups, pretzels, wheat germ, bran, ice creams, puddings, candies
supplements
Digestive enzymes, especially bile salts, pancreatic enzymes, and HCl.
Carroccio A, et al. Pancreatic enzyme therapy in childhood celiac disease: A double-blind prospective randomized study. Dig. Dis. Sci. 40, 2555-60, 1995.
Megavitamin and mineral supplementation: Many nutrients, especially fat-soluble vitamins, can be deficient due to malabsorption. Important nutrients which may need supplementation are:
Folic acid: 15 mg per day, is especially effective because most is absorbed in the proximal small intestine, the area most affected by the disease.
Fat soluble vitamins:
Vitamin A: 75,000 IU per day (this is a TOXIC DOSE if liver disease co-exists, otherwise absorption is not great, can use this dose without problem)
Vitamin D: 3,000 IU per day
Vitamin E: 1000 IU per day
Vitamin K: 3 mg per day
Vitamin B12, 1000 mcg IM or 3 mg per day, best given IM
Calcium citrate: 3 g per day, is important in prevention of osteoporosis and muscle spasms (Marz, p. 365, 1997)
Quercetin: stabilizes mast cells and eosinophils to keep them from degranulating. Sodium cromolyn can also be used.
Clinical Note: Almost all patients with dermatitis herpatiformis (DH) have some mucosal lesions similar to that of celiac disease. DH is characterized by clusters of intensely itchy vesicles, papules and urticaria type lesions. They are sensitive to gluten 90% of the time, showing positive antibodies in almost all cases. However, people with celiac disease don't always have dermatitis herpatiformis. (Marz, p. 365, 1997)
footnotes
Carroccio A, et al. Pancreatic enzyme therapy in childhood celiac disease: A double-blind prospective randomized study. Dig. Dis. Sci. 40, 2555-60, 1995. Abstract: It was demonstrated that supplemental pancreatic enzymes improved the growth of children with controlled Celiac disease.