Treatment: Gluten-free Diet
Regardless of the causative factor(s) for gluten sensitivity, the treatment remains the same: a 100% gluten-free diet. The duration of this diet for celiac disease patients is for life, while currently unknown for those with gluten sensitivity. Ultimately, the best diet for eliminating the largest number of dietary antigens would be the elimination diet. An authentic elimination diet removes ('eliminates') all possible food allergens, of which the eight most common are milk, eggs, peanuts, tree nuts, soy, wheat, fish and crustacean shellfish. The American Dietetic Association has proposed an elimination diet for people, usually children, with food allergies. This diet works by eliminating the major food allergens for a period of time (1–4 weeks), after which foods containing the allergens are added back into the diet (reintroduced or 'rotated') to determine whether or not the child is sensitive to this food. It may be the best 'default diet' for people with gastrointestinal symptoms of unknown origin as a means to eliminate diet as a contributing factor. Failing to incorporate this step means that other food sensitivities, medications and treatments may mask the problem, interfere with symptom alleviation and possibly lead to a series of invasive, expensive tests that do not solve the underlying problem.
The curious suggestion that such a diet is 'dangerous' is not justified considering the serious side effects associated with celiac disease. Any 'problems' are easily addressed by referring patients to a dietitian, who will customize the diet and possibly recommend specific dietary supplements such as fiber and calcium.
Benefits from an elimination diet may also be maximized by minimizing food allergens, utilizing digestive enzymes and providing omega-3 fatty acids or other dietary supplements. Additional dietary modifications may include foods that decrease inflammation, probiotics influencing gut microflora concentrations and limiting carbohydrates.
Expert Rev Gastroenterol Hepatol. 2012;6(1):43-55. © 2012 Expert Reviews Ltd.