Adherence to a strict gluten-free diet is currently the only treatment for Celiac. It is important to educate yourself on the diet immediately after diagnosis to learn which foods are allowed and which are not (see What Can I Eat, What Can’t I Eat) Knowing What to Eat section). Most people will feel better soon after starting the GF diet, however it can take anywhere from a few months to a few years for the intestines to heal, depending on the severity of the initial damage. If symptoms persist after being gluten-free (recommended 6 months), consult your health care provider. While the majority of people will respond well to the gluten-free diet, in some cases others will not. Some individuals with continuing symptoms may have sensitivities to other foods. Lactose intolerance often accompanies Celiac disease, so be sure to ask your doctor for a lactose test. Other foods which may cause sensitivities include: soy, fructose, corn, and carbohydrates, among others.
A very small percentage of people still experiencing symptoms may be diagnosed with Refractory Sprue or other medical conditions including bacterial overgrowth, pancreatic issues, or autoimmune enteropathy.
Most certainly if you are continuing to consume gluten, whether intentional or by cross contamination, you will continue to experience symptoms. The gluten-free diet must be adhered to 100% in order to eliminate symptoms and decrease the risk for other serious complications.
{Untreated Celiac puts people at an increased risk of cancer of the intestines or any surrounding organ, due to chronic inflammation which can lead to various abnormalities which then become precursors to malignancy. According to a Swedish study, a person has the same risk factor for developing gastrointestinal cancer as the “general” public after being 100% gluten free for one year. Developing cancer of other surrounding organs, such as the liver, requires further long-term studying, according to this AGA Journal article: http://agajournals.wordpress.com/2012/01/23/does-celiac-disease-increase-the-risk-of-gi-cancer/ }
Once a diagnosis of Celiac is confirmed, the following is recommended:
- Begin a gluten-free diet immediately
- Schedule an appointment with a registered dietitian, preferably one who is well versed in the gluten-free diet*
- Meet with Primary Care Physician to schedule blood work to check for nutritional deficiencies (Iron, Calcium, Folate, B-12, D, among others). You may need to take additional supplements & a daily multi-vitamin is recommended. Monitor until deficiencies are back to normal ranges
- Consider digestive enzymes or probiotic supplements
- Consider testing for other food sensitivities, especially lactose intolerance – as often times this accompanies Celiac
- Schedule a bone density exam to check for Osteopenia or Osteoporosis (at any age, not just if over 50!)
- Elderly may want to consider a vaccination for hyposplenism
- Join a local Support Group
- Educate yourself via books, internet, magazine subscriptions (see STORE)
Tip for the Newly Diagnosed (with a confirmed biopsy): The University of Chicago Celiac Disease Center offers a Gluten-Free Care Package – a basket filled with resources & food samples! Contact the center at 773.702.7593 or http://www.celiacdisease.net/care-package
Though there is no agreed upon guideline for management/follow-up among health care professionals, the majority suggest that an appointment be made with primary care physician twice in the first year of diagnosis. The first appointment should be scheduled three to six months after diagnosis for follow-up antibody levels testing, and the second should occur after one year on a gluten-free diet.*
- Meet with Primary Care Physician to schedule blood work to check for antibody levels and any nutritional deficiencies (3-6 months after diagnosis, and then again after 1 year on gluten-free diet)
- Schedule Bone Density exam (if not performed earlier on)
- Repeat endoscopy to check for healing of villi, if recommended by gastroenterologist
- Be sure Primary Care Physician is monitoring for any associated illnesses
- Continue strict adherence to gluten-free diet
Follow-up should then be repeated annually.
*Read The University of Chicago Celiac Disease Center’s article on Monitoring for Celiac Disease: http://www.cureceliacdisease.org/wp-content/uploads/2012/04/CdC_Newsletter_0412_v3.pdf