Celiac Disease

Besides avoiding gluten, are there other diet changes I might need to make?

The ability to digest lactose, the sugar naturally found in milk and milk products, is often diminished in untreated CD. The enzyme lactase, which digests lactose, is produced on the tip of the villi. When gut damage occurs, lactase is the first enzyme to be affected and one of the last to recover when the gut heals. Without adequate lactase enzyme, lactose is not fully digested and may cause gas, cramping and diarrhea. Therefore, individuals newly diagnosed with CD may be placed on lactose-free or lactose reduced gluten-free diets. As the intestine heals, lactase enzyme levels increase, and the ability to digest lactose improves. If tolerated, milk products should be gradually reintroduced to the diet to obtain the calcium and other nutrients supplied by milk products. Some people may have persistent low lactase levels and lactose intolerance, but still be able to tolerate limited amounts of low lactose foods such as LactAid milk and hardened cheeses.

Allergies, sensitivities or intolerances to foods other than gluten may occur in people with CD as they do with anyone else in the general population. If you do not tolerate a food, it may not be because it contains gluten, but because of an allergy or some other reaction to it. The most common food reported by celiacs to be a problem seems to be soy, although the overall number of soy intolerant people is small. Avoid eliminating whole groups of foods from your already limited diet unless you are certain they cause you a problem.

The gluten-free diet can be very healthful and nutritious if a variety of foods are included. Ideally, ample amounts of fruits, vegetables and complex carbohydrates should be used, including such high fiber foods as brown rice, beans and legumes, nuts and seeds. Diets limited in variety and high in refined flours (white rice, potato starch, etc) may be lacking in certain nutrients. Once you have learned the basics of the gluten-free diet, make sure to pay attention to the overall quality of your diet. Consult a registered dietitian experienced in CD for guidance in your diet, if necessary.