A gluten-free diet is difficult to follow, and continued
health problems are usually associated with
problems with adhering to the gluten-free diet. A person
can exhibit celiac-related symptoms for months
after a single gluten intake. Persons with gluten-sensitivity
who do not treat their disease are at a higher risk
for enteropathy-associated T-cell lymphoma and
other gastrointestinal cancers.
However, the maintenance
of a long-term gluten-free state reduces the risk
of lymphoma to the level seen in the general population.
Other complications of gluten-sensitivity include
decreased mineral bone density and iron-deficiency.
Persons with celiac disease and dermatitis herpetiformis
must maintain a gluten-free diet for the rest of
their lives, for these diseases cannot be cured.
Persons are more likely to adhere to the diet if a
dietitian and support group are involved. If a person is
not responding well to a gluten-free diet, the doctor
should:
-Investigate whether the initial diagnosis of celiac disease
was correct
-Check for other conditions that can be causing symptoms,
such as pancreatic insufficiency, irritable bowel
syndrome, bacterial overgrowth, lymphocytic colitis, Tcell
lymphoma, fructose intolerance, or tropical sprue
-Refer the person to a dietician to check for errors in
the diet or for compliance with the diet
To monitor dietary adherence to the gluten-free
diet, the dietitian will examine the person’s dietary
history and habits. Blood tests will be conducted to
see is gluten antibody levels have returned to normal
levels. If there is clinical concern that a person is not
adhering to the gluten-free diet or that the diet is not
effective, a biopsy of the small intestine may be
conducted.
The gluten-free diet is complex and it cannot be
assumed that chefs in restaurants or others who prepare
food (including friends and family) are aware of
potential sources of gluten contamination. Education
of family and friends is important in accomplishing a
life-style change. In restaurants simple dishes without
sauces should be ordered, and the person should
inquire whether grain products are prepared with the
same equipment or utensils used to prepare other
foods.
Although a food may be considered to be glutenfree
by the ingredients it contains, it may be glutencontaminated
by the way in which it is prepared or
stored. Other difficulties associated with following a
gluten-free diet include lifestyle changes such as avoiding
travel, finding gluten-free foods, especially those of
good quality, determining whether foods are glutenfree,
not being invited out because of the diet, with
resulting social isolation, and maintaining a glutenfree
diet when in the hospital.
As with any restrictive diet, the gluten-free diet
has potential for nutritional inadequacy. Persons who
are sensitive to gluten are at increased risk for osteoporosis
and osteomalacia, due to malabsorption of
calcium and vitamin D. Most persons with celiac disease
have some degree of osteopenia or osteoporosis.
Calcium and vitamin D supplementation along with
strict adherence to a gluten-free diet usually results in
remineralization of the skeleton. Iron or other vitamin
deficiencies may also be present and must be treated
appropriately. The consumption of gluten-free fiberrich
foods (for example, brown rice, fruits, and vegetables)
and adequate fluid intake is recommended to
assist in the prevention of constipation.
Women with untreated celiac disease often exhibit a
history of miscarriages, anaemia, low birth weight
babies, and unfavorable outcome of pregnancy. It is
suggested that testing for celiac disease be included in
the battery of tests prescribed for pregnant women. Celiac
disease is considerably more common than most of
the diseases for which pregnant women are routinely
screened. Unfavorable events associated with celiac disease
may be prevented by a gluten-free diet.
