Also indexed as: Celiac Sprue, Non-Tropical Sprue
The gluten found in grain may trigger celiac disease in some
people. By keeping a close eye on your diet, you can remedy many of the symptoms. According to
research or other evidence, the following self-care steps may be helpful:
- Mix in a multi
- Take a daily high potency multivitamin that will supply your body
with all the essential micronutrients, especially iron, vitamin D, vitamin K, calcium,
magnesium, folic acid, and zinc
- Breast-feed your baby
- Reduce your newborn’s risk of developing celiac disease by
breast-feeding for more than a month
- Go gluten-free
- Work with a knowledgeable health professional to find out which
gluten-filled foods should be avoided
- Get routine checkups
- Have your healthcare provider monitor your bone health, check for
anemia, and make sure you are not developing nutritional deficiencies
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full celiac disease article for
more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About celiac disease
Celiac disease (also called gluten enteropathy) is an intestinal disorder that results from
an abnormal immunological reaction to gluten, a protein found in wheat,
barley, rye, and, to a lesser extent, oats.
In addition to damaging the lining of the small intestine, celiac disease can sometimes
affect other parts of the body, such as the pancreas (increasing the risk of diabetes), the
thyroid gland (increasing the risk of thyroid disease), and the nervous system (increasing the
risk of peripheral neuropathies and other neurological disorders). Occasionally, such damage
occurs only in one or more of these parts of the body in the absence of damage to the
Product ratings for celiac
What are the symptoms?
Celiac disease may not cause symptoms in some people. However, others may have a history of
frequent diarrhea; pale, foul-smelling, bulky
stools; abdominal pain, gas, and bloating; weight loss; fatigue; canker sores; muscle cramps; delayed growth or short
stature; bone and joint pain; seizures; painful skin rash; or infertility. Microscopic
examination of the small-intestinal lining reveals severe damage, especially in the jejunum
(the central portion of the small intestines). People with untreated celiac
disease may eventually experience malaise and weight loss and have an increased risk of
developing anemia, osteoporosis, osteomalacia, and certain types of cancer. In addition to physical symptoms, some people
may experience emotional disturbances, including feelings of anxiety and depression.
Over-the-counter antidiarrheals, such as
loperamide (Imodium AD®) and bulk-forming laxatives, such as methylcellulose (Citrucel®) or psyllium (Konsyl®, Metamucil®,
Perdiem®) might help stop diarrhea caused
by celiac disease. People with gas and bloating may respond to simethicone (Mylicon®, Gas-X®).
Prescription medications used to treat people who do not respond to dietary changes include
immunosuppressive and anti-inflammatory drugs. Agents prescribed include glucocorticoids, such
as prednisone (Deltasone®), prednisolone (Prelone®), azathioprine (Imuran®) and cyclophosphamide (Cytoxan®).
Strict adherence to a gluten-free diet is
essential, although doctors are questioning the need for all celiac patients to avoid oats.
People with severe damage to intestinal tissue may be prescribed intravenous nutritional
supplements in order to replace unabsorbed nutrients.
Dietary changes that may be helpful
All doctors agree that consumption of the gluten-containing grains wheat,
barley, and rye must be avoided in all
celiac patients. Less consensus exists regarding the advisability of eating or restricting oats and oat products. While oats contain a
substance similar to gluten, modern research suggests that eating moderate amounts of oats
does not cause problems for most people with celiac disease.1 In one of these
reports, approximately 95% of people with celiac disease tolerated 50 grams (almost two
ounces) of oats per day for up to 12 months.2
Strict avoidance of wheat, barley, and rye, and of foods containing ingredients derived
from these grains, usually results in an improvement in gastrointestinal symptoms within a few
weeks, although in some cases the improvement may take many months. Tests of absorptive
function usually improve after a few months on a
Many people with celiac disease become symptom-free when following gluten-free diets.
Others, however, continue to experience symptoms, often resulting from the presence of trace
amounts of gluten either permitted in some gluten-free diets or consumed by mistake. Such
mistakes are easy to make because many processed foods contain small amounts of gluten. For
people with residual symptoms, a diet that truly eliminates all gluten, followed by open and
double-blind challenges, resulted in symptomatic improvement in 77% of those
studied.4 A careful dietary analysis should ensure that all trace amounts of gluten
are removed from the diet. If this fails to relieve symptoms after three months, then other
food intolerances should be ruled out using an
Avoiding gluten may also reduce cancer
risk. In one trial, 210 people with celiac disease were observed for 11 years. Those who
followed a gluten-free diet had an incidence of cancer similar to that in the general
population. However, those eating only a gluten-reduced diet or consuming a normal diet had an
increased risk of developing cancer (mainly lymphomas and cancers of the mouth, pharynx, and
Children with untreated celiac disease have been reported to have abnormally low bone
mineral density. However, after approximately one year on a gluten-free diet, bone mineral
density increased rapidly and approximated the level seen in healthy children.6
Long-term adherence to a gluten-free diet ensures normal bone density and is an important
preventive measure in young people with celiac disease.7
Adults with celiac disease also have significantly lower bone mineral density than do
healthy adults. After consumption of a gluten-free diet for one year, bone mineral density of
the hip and lumbar spine has been reported to increase by an average of more than
Infertility, which is common among people with celiac disease, has been reportedly reversed
in both men and women after commencement of a gluten-free
Some people with celiac disease may be intolerant to other foods, in addition to gluten.
Foods that have been reported to trigger symptoms include cows’milk10 and soy.11 12 13
Lifestyle changes that may be helpful
In one study, children who were breast-fed for less than 30 days were four times more
likely to develop celiac disease, compared with children who were breast-fed for more than 30
days.14 Although this study does not prove that breast-feeding prevents the
development of celiac disease, it is consistent with other research showing that
breast-feeding promotes a healthier gastrointestinal tract than does
Vitamins that may be helpful
The malabsorption that occurs in celiac disease can lead to multiple nutritional
deficiencies. The most common nutritional problems in people with celiac disease include
deficiencies of essential fatty acids, iron,
vitamin D, vitamin K, calcium,
magnesium, and folic acid.16 Zinc malabsorption also occurs frequently in
celiac disease17 and may result in zinc deficiency, even in people who are
otherwise in remission.18 People with newly diagnosed celiac disease should be
assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely
recovered should supplement with a high-potency
multivitamin-mineral. Some patients may require even higher amounts of some of these
vitamins and minerals—an issue that should be discussed with their healthcare
practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for
supplementation with that nutrient.
After commencement of a gluten-free diet,
overall nutritional status gradually improves. However, deficiencies of some nutrients may
persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency
was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and
were symptom-free. When these adults were supplemented with magnesium for two years, their
bone mineral density increased significantly.19
In another study, six people with diet-treated celiac disease had abnormal dark-adaptation
tests (indicative of “night blindness”), even though some were taking a
multivitamin that contained vitamin A. Some of
these people showed an improvement in dark adaptation after receiving larger amounts of
vitamin A, either orally or by injection.20 People with celiac disease should
discuss the possibility of vitamin A deficiency with a healthcare practitioner before taking
vitamin A supplements.
Malabsorption-induced depletion of vitamin
D can lead to osteomalacia (defective bone
mineralization) in people with celiac disease.21 Although supplementation with
vitamin D appears to increase bone density, the excess risk of bone fracture may not be
It is possible that subtle deficiencies of other nutrients may exist in people with celiac
disease who are on a gluten-free diet and are in remission. People who are not strictly
avoiding gluten are likely to have more severe deficiencies. Because of the complexity of this
condition and the multiple nutritional factors involved, people with celiac disease should be
under the care of a doctor. Some doctors may recommend use of nutritional supplements,
including a high-potency multivitamin-mineral
supplement, to reduce the risk of future deficiencies. No controlled trials have investigated
the value of supplements in the minority of celiac disease patients who do not go into
remission in response to a gluten-free diet.22
In one trial, 11 people with celiac disease suffered from persistent depression despite being on a gluten-free diet for
more than two years. However, after supplementation with vitamin B6 (80 mg per day) for six months, the
People with celiac disease often do not produce adequate digestive secretions from the
pancreas, including lipase
enzymes24 In a double-blind trial, children with celiac disease who received a
pancreatic enzyme supplement along with a
gluten-free diet gained significantly more weight in the first month than those treated with
only a gluten-free diet.25 However, this benefit disappeared in the second month,
suggesting enzyme supplements may only be useful at the beginning of dietary treatment.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
1. Srinivassan U, Leonard N, Jones E, et al. Absence of oats toxicity in
adult coeliac disease. BMJ 1996;313:1300–1.
2. Jantauinen EK, Pikkarainen PH, Kemppainen TA, et al. A comparison of
diets with and without oats in adults with celiac disease. N Engl J Med
3. Greenberger JN, Isselbacher KJ. Disorders of absorption. In: Fauci AS,
Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal
Medicine, 14th ed. New York: McGraw-Hill, 1998, chapter 285.
4. Faulkner-Hogg KB, Selby WS, Loblay RH. Dietary analysis in symptomatic
patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and
non-gluten food intolerances. Scand J Gastroenterol 1999;34:784–9.
5. Holmes GKT, Prior P, Lane MR, et al. Malignancy in coeliac
disease—effect of a gluten free diet. Gut 1989;30:333–8.
6. Mora S, Barera G, Ricotti A, et al. Reversal of low bone density with
a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr
7. Mora S, Barera G, Beccio S, et al. Bone density and bone metabolism
are normal after long-term gluten-free diet in young celiac patients. Am J
8. McFarlane XA, Bhalla AK, Robertson DAF. Effect of a gluten free diet
on osteopenia in adults with newly diagnosed coeliac disease. Gut
9. Baker PG, Read AE. Reversible infertility in male coeliac patients.
10. Sewell P, Cooke WT, Cox EV, Meynell MJ. Milk intolerance in
gastrointestinal disorders. Lancet 1963;2:1132–5.
11. Haeney MR, Goodwin BJF, Barratt MEJ, et al. Soya protein antibodies
in man: their occurrence and possible relevance in coeliac disease. J Clin Pathol
12. Mike N, Haeney M, Asquith P. Soya protein hypersensitivity in coeliac
disease: evidence for cell mediated immunity. Gut 1983;24:A990.
13. Ament ME, Rubin CE. Soy protein—another cause of the flat
intestinal lesion. Gastroenterology 1972;62:227–34.
14. Auricchio S, Follo D, de Ritis G, et al. Does breast feeding protect
against the development of clinical symptoms of celiac disease in children? J Pediatr
Gastroenterol Nutr 1983;2:428–33.
15. Udall JN, Colony P, Fritze L, et al. Development of gastrointestinal
mucosal barrier. II. The effect of natural versus artificial feeding on intestinal
permeability to macromolecules. Pediatr Res 1981;15:245–9.
16. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds.
Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994,
17. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac
disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin
18. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac
sprue. Am J Clin Nutr 1976;29:371–5.
19. Rude RK, Olerich M. Magnesium deficiency: possible role in
osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int
20. Russell RM, Smith VC, Multak R, et al. Dark-adaptation testing for
diagnosis of subclinical vitamin-A deficiency and evaluation of therapy. Lancet
21. Basha B, Rao S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D
depletion: neglected consequence of intestinal malabsorption. Am J Med
22. O’Mahony S, Howdle PD, Losowsky MS. Review article: management
of patients with non-responsive coeliac disease. Aliment Pharmacol Ther
23. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult
celiac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol
24. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent
pancreatitis. Gastrointest Endosc 1999;50:823–7.
25. Carroccio A, Iacono G, Montalto G, et al. Pancreatic enzyme therapy
in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci