Celiac Disease (Gluten-Induced Enteropathy): Therapy

General measures

  • The only and most effective therapy is a lifelong gluten-free diet (see nutritional medicine below). Even the smallest amounts or only occasional intake of gluten-containing cereals should be avoided.Within 3 years, regeneration of the small intestinal mucosa and normalization of zoeliac disease-specific serologic laboratory parameters (transglutaminase antibody (tTG) or endomysium antibody (EMA)) occur on a gluten-free diet.
  • Strive to maintain normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised program for the underweight.
    • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.

Regular checkups

  • Regular medical check-ups (follow-up): monitoring with regard to clinical symptoms; furthermore, determination of zoeliacspecific antibody (TG2-IgA). The first serological control is recommended after 6 months, then at six-monthly intervals, until seronegativity is achieved (= individuals in whom no antibodies to specific antigens are detectable by serological examination methods).

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific nutritional recommendations:
    • Therapy for gluten intolerance consists of lifelong, consistent adherence to a gluten-free diet. Even asymptomatic celiac patients benefit from a gluten-free diet. In one gluten-free group, histologically positive changes were seen. The ratio of villi height to crypt depth was significantly increased in the mucosa of the small intestine. Furthermore, the titer of celiac disease-specific antibodies (endomysium IgA antibodies) had fallen and gastrointestinal symptoms had improved significantly. Note: Gluten does not have to be labeled as a food ingredient and for this reason can also be present in many industrially produced, non-cereal foods. Foods with a gluten content < 20 ppm (mg/kg) are considered “gluten-free” and “low gluten” if the gluten content is between 20 and 100 ppm.
    • Avoid foods containing gluten
      • Cereals containing gluten – wheat, rye, barley, spelt, einkorn, emmer, kamut, green spelt (unripe spelt, einkorn or emmer), triticale (wheat-rye cross), wild rice and products made from them, such as flour, pearl barley, semolina, flakes, groats, germ, bran, meal, breadcrumbs, bread and bakery products, rusks and pastaNote: Allowed cereals are amaranth, buckwheat, oats, millet, corn, quinoa and rice.
      • Grützwurst, breaded meat, fish sticks, nuggets, canned fish in spicy sauce.
      • Croquettes, potato products, ready meals including soups, sauces, flour sauces.
      • Yogurt with cereal content, fruit yogurts, cottage cheese, ice cream.
    • Prefer gluten-free foods
      • Gluten-free grains and their flours – buckwheat, millet, potatoes, potato flour, corn, cassava, rice (not wild rice), (pure wheat starch and other pure starch products), sorghum, soy, sweet chestnuts, and specialty products made from them.
      • South American grains – quinoa, amaranth.
      • Staple foods of animal origin (without additives), such as meat, offal, fish, eggs, milk and dairy products, such as butter and cheese.
      • Fresh vegetables and fruits, legumes, nuts.
      • Oils and fats
      • Syrup, jam, marmalade, sugar, sweetener
      • Food with the indication “gluten-free” respectively specially for the gluten-free diet manufactured products, such as gluten-free bread, pastries, pasta.
    • Caution with
      • Pure wheat starch – may contain traces of gluten.
      • Finished products and canned goods – gluten is often used as an emulsifier, stabilizer or binder.
      • Cured meats, fish products and canned goods.
      • Dairy products and other industrially manufactured products.
      • Sauces, spice mixtures
      • Desserts, sweets
    • In rare cases, celiac disease patients respond to a gluten-free diet with symptom improvement only if other protein (protein)-rich foods, such as egg, poultry or milk, are avoided.
    • Until the intestinal villi are largely regenerated, foods and beverages rich in oxalic acid should be avoided. Avoid:
    • For fatty stools, reduce fat intake until the intestinal villi are largely regenerated. In addition, dietary fats (LCT fats) should be partially replaced by the very well tolerated MCT fats.
    • Avoid lactose-containing foods; often celiac patients suffer from a secondary lactase deficiency, ie the organism can not lactose (milk sugar) verwerten; due todietary recommendations see under lactose intolerance.
  • Selection of suitable food based on the nutritional analysis.
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.