How Celiac Disease Is Treated

There is no cure for celiac disease. Following a gluten-free diet is the mainstay of treatment. Prescription treatments for celiac disease exist, but are typically reserved for when avoiding food triggers is not enough to ease symptoms.

With the right treatment plan, most people with celiac disease live a full, productive life. That said, if celiac disease is not treated, it can lead to life-threatening problems. You may need to see a gastroenterologist and your healthcare provider regularly to manage your symptoms. Some people choose to see a dietitian or counselor too.

This article covers treatment options for celiac disease. It includes foods to avoid, how to follow a gluten-free diet, prescriptions, specialist procedures, and more.

Home Remedies and Lifestyle

Gluten is a natural protein found in some grains like wheat, rye, and barley. In people with celiac disease, gluten triggers an immune response that attacks the small intestine. Following a gluten-free diet is the only known therapy to control celiac disease.

Foods to Avoid

Having celiac disease can make you feel limited with what and where you can eat. You may need to tweak your diet, even if it otherwise seems healthy and balanced. It can also take time to learn your body's triggers and the ingredients causing your flares.

To control celiac disease, you may need to avoid many, if not all, sources of gluten. This will depend on how sensitive you are to gluten and the stage of your disease.

Cereal grains are a central part of the Western diet and a major source of gluten. Types of cereal grains you may need to avoid include:

• Wheats, including durum wheat and wheat germ
• Rye
• Barley
• Bulgur
• Couscous
• Farina
• Graham flour
• Kamut matzo
• Semolina
• Spelt
• Triticale

Furthermore, you may need to avoid all ingredients or packaged foods that contain or are derived from cereal grains.

These may include:

• Bacon
• Baked goods
• Beer
• Bouillon cubes
• Bread
• Breakfast cereals
• Candies
• Canned baked beans
• Cold cuts
• Egg substitutes
• French fries (which are often dusted in flour)
• Gravy
• Hot dogs
• Ice cream
• Instant hot drinks
• Ketchup
• Malt flavoring
• Mayonnaise
• Meatballs
• Non-dairy creamer
• Oats or oat bran (if not certified gluten-free)
• Pasta
• Processed cheese
• Pudding and fruit filling
• Roasted nuts
• Salad dressings
• Sausage
• Seitan
• Soups
• Soy sauce
• Tabbouleh
• Veggie burgers
• Vodka
• Wheatgrass
• Wine coolers

In the United States, a product can be labeled "gluten-free" if it contains less than 20 parts per million (ppm) of gluten. While the threshold is usually low enough to avoid symptoms in most people living with the disease, there are some who will react to levels as low as five to 10 ppm.

People with extreme gluten sensitivity may also need to avoid certain non-food products that contain gluten, such as cosmetics, lip balms, shampoos, and non-adhesive stamps and envelopes.

Prescription and over-the-counter medications sometimes use wheat gluten as a binding agent. Talk to your gastroenterologist about the drugs you are taking so that substitutions can be made.

Work with a Dietitian

The best way to embark on a gluten-free diet is to work with a registered dietitian (RD) who is medically trained and certified in dietetics. The dietitian can work closely with your healthcare provider to build a dietary strategy based on your medical results and lifestyle.

This is especially important since many Americans get their nutrients and daily fiber from fortified, gluten-containing products like cereal and bread. Working with a dietitian can help identify and prevent nutritional deficiencies that can arise from the loss of dietary gluten.

Because a gluten-free diet can be so challenging, particularly at the start, the dietitian will offer food substitutions to help ease you into the changes. You will also be offered dietary counseling so that you will be better able to:

• Read and understand food labels
• Understand where gluten is "hidden" in foods
• Find the appropriate foods to eat in restaurants
• Avoid accidental gluten cross-contamination in your home
• Source gluten-free foods and non-food products online or at stores

Foods to Eat

As challenging as all of this may seem, a gluten-free diet is really not all that different from most healthy diets. In addition to avoiding packaged or processed foods, you would fill your plate with naturally wholesome gluten-free foods such as:

• Eggs
• Dairy including yogurt, butter, and non-processed cheeses (but check the label of flavored dairy products)
• Fruits and vegetables including canned or dried
• Grains including rice, quinoa, corn, millet, tapioca, buckwheat, amaranth, arrowroot, teff, and gluten-free oats
• Legumes like beans, lentils, peas, peanuts
• Meat, poultry, and fish (not breaded or battered)
• Non-gluten starches including potato flour, corn flour, chickpea flour, soy flour, almond meal/flour, coconut flour, and tapioca flour
• Nuts and seeds
• Soy foods like tofu, tempeh, and edamame
• Tamari (a good substitute for soy sauce)
• Vegetable oils (preferably monounsaturated or polyunsaturated)

Prepared foods that are certified gluten-free are increasingly available on grocery store shelves, including bread, baked goods, frozen meals, and gluten-free meal kits.

Avoiding Accidental Gluten Exposure

Managing celiac disease involves more than just a change in diet; it requires a change in lifestyle and the support of the people around you. This is not always easy.

Trying to maintain two separate diets in a family can be time-consuming and may also expose you to gluten cross-contamination. On the other hand, placing a child without celiac disease on a gluten-free diet can be unhealthy.

It is important, therefore, to gain the support of those around you. Even loved ones with the best of intentions may not understand celiac disease and turn off the second you mention the words "gluten-free."

There are other tips to help avoid gluten exposure at home or in restaurants:

• Keep gluten-free and gluten-containing foods separate in sealed containers and in separate drawers or cabinets.
• Clean cooking surfaces and food storage areas.
• Wash dishes, utensils, and food preparation equipment thoroughly.
• Avoid wood utensils or cutting boards that can absorb food and potentiate cross-contamination.
• Speak to your child's teachers and lunch staff so that accidents can be avoided and special accommodations can be made.
• Check restaurant menus online before eating out to be sure there are food items you can eat.
• Call the restaurant in advance to inform them about your health concerns and dietary needs.
• Book early or late when a restaurant is less busy and better able to accommodate your special requests.

Prescriptions

A gluten-free diet may be all that is needed to control celiac disease symptoms and prevent flares. But, for some people, this may not be enough.

In fact, according to a 2015 study in the journal Digestive Diseases, between 1% and 2% of people with celiac disease will not respond to a gluten-free diet.

The condition, referred to as refractory celiac disease, is rare but serious and can significantly increase the risk of T-cell lymphoma, a type of cancer. To avoid this cancer complication, your healthcare provider may prescribe medications that actively suppress the immune system and, with it, the autoimmune response.

The first-line drug of choice is a class of steroids known as glucocorticoids. Prednisolone and budesonide are the two oral glucocorticoids most commonly prescribed.

While effective at alleviating symptoms, glucocorticoids only appear to reverse intestinal damage in around 33% of patients, according to a 2014 review in Therapeutic Advances in Chronic Diseases. Glucocorticoids can also mask the signs of intestinal lymphoma.

Other pharmaceutical options include:

• Cyclosporine, an oral disease-modifying antirheumatic drug (DMARD) used to treat a variety of autoimmune disorders
• Imuran (azathioprine), an oral immunosuppressive drug traditionally used for organ transplant recipients
• Remicade (infliximab), an injectable biologic drug that blocks the chemical processes that lead to inflammation

In rare cases when T-cell lymphoma is diagnosed, combination chemotherapy would be used. The mainstay of treatment is CHOP therapy, which stands for the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone.

Other promising drugs in the developmental pipeline including larazotide acetate (a potent digestive enzyme that breaks down dietary gluten) and BL-7010 (a high-density polymer that binds to gluten so that it cannot be absorbed).

Surgeries and Specialist-Driven Procedures

In addition to steroids, people with refractory celiac disease may be placed on an elemental diet, a type of liquid diet that is more readily absorbed than solid foods.

Total parenteral nutrition (TPN), in which nutrients are delivered through a vein, may be recommended for those with extreme weight loss who are unable to eat.

Surgery

Surgery might be needed for the treatment of certain complications of the disease, such as bowel obstruction (bowel blockage), perforation (a hole in the bowel wall), hemorrhage (bleeding), and malignancy (cancer).

If you have T-cell lymphoma, surgery may be considered prior to chemotherapy to prevent the perforation of vulnerable tissues.

Autologous stem cell transplants—in which stem cells are harvested from your body prior to chemotherapy and returned to you afterward—have been used successfully to treat intestinal lymphoma in people with refractory celiac disease.

Complementary Alternative Medicine (CAM)

By most accounts, a gluten-free diet is considered the most "natural" approach to celiac disease possible. With that being said, complementary and alternative practitioners believe that there are other ways to control the symptoms of celiac disease and/or better tolerate a gluten-free diet.

Peppermint Oil

Peppermint oil has antispasmodic (anti-spasm) effects that may help ease intestinal cramping and spasms. Research from the University of South Alabama reported that a sustained-release peppermint oil capsule was twice as effective in alleviating irritable bowel syndrome (IBS) than a placebo. Whether the same would occur with celiac disease has yet to be confirmed.

Peppermint oil taken directly by mouth may cause heartburn and stomach upset. Enteric-coated peppermint capsules are less likely to cause harm. Excessive doses of peppermint oil can be toxic.

Slippery Elm Powder

Slippery elm powder is derived from the bark of the slippery elm. Some people believe that it can protect the intestines by creating a mucus-like coating as it is digested.

While slippery elm is used widely in traditional medicine to treat gastrointestinal conditions, there is no evidence thus far that it can treat symptoms of celiac disease itself.

Summary

Following a gluten-free diet is the only effective therapy known to relieve symptoms of celiac disease. When symptoms do not improve within one year of following a strict gluten-free diet, a diagnosis of refractory celiac disease can be made. At this point, prescription medications, such as glucocorticoids, may be required. Surgery does not cure celiac disease, but it may be needed to treat or prevent complications.

A Word From Verywell

An important but underestimated part of managing celiac disease is ensuring that family, friends, and others in your circle are aware of your needs. You may find it helpful to teach people a helpful acronym for foods to avoid, like BROWS (barley, rye, oats, wheat, spelt), or to make a list of things you wish others knew about celiac disease and sharing it to social media. While it shouldn't have to fall on you to educate others about celiac disease, doing so can make things easier both for you and those who wish to support you.