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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - Celiac Disease Disease State Management - March 21, 2018

Celiac Disease Disease State Management

The Role of a Gluten-free Diet for Celiac Disease and as a Personal Dietary Choice
by JoAnne Conrad, MS, Licensed Dietitian

The dietary practice of following a gluten-free diet has become popular in the last few years. Gluten refers to specific peptide fractions of proteins found in wheat, rye, and barley. A gluten-free diet might also exclude oats. Medical practitioners are divided as to whether oats are acceptable. Some research suggests that oats in themselves are gluten-free, but can be contaminated by other grains during distribution or processing.

Products made from corn, potatoes, rice, quinoa, millet, flax, nut flours, and buckwheat are allowed. Individuals can expect differences in textures and flavors of common foods using the substitute flours.

The major indication for a gluten-free diet is Celiac disease, an inflammatory small intestinal disorder that results from an inappropriate T cell-mediated autoimmune response to the ingestion of gluten by persons who are genetically predisposed. The autoimmune inflammatory response leads to malabsorption, malnutrition, and possibly malignancy. The prevalence of the disease has been underestimated in the past and now is considered to be about 1 in 133 persons in the US.

The onset and first occurrence of symptoms may appear any time from infancy to adulthood, but the peak in diagnosis occurs between the fourth and sixth decade. Approximately 20% of cases are diagnosed after age 60 years. Because the presentation and onset of symptoms vary greatly, celiac disease may be misdiagnosed as irritable bowel, lactase deficiency, or other disorders not necessarily involving the GI tract. Symptoms might include generalized fatigue, failure to gain or maintain weight, chronic diarrhea, or the consequences of nutrient malabsorption, including anemias, or bone loss.

A gluten-free diet is the keystone in the treatment for celiac disease. Celiac disease is considered chronic and requires lifelong omission of gluten from the diet.

Gluten-free diets have become popular among individuals who want to treat celiac disease-like symptoms in the absence of a positive test for celiac disease. In 2011 a panel of celiac experts concluded that there is a condition related to gluten other than celiac disease and named it "non-celiac gluten sensitivity". People with gluten sensitivity usually complain of gas, abdominal bloating, diarrhea or constipation. Many individuals report feeling better on a gluten-free diet.

Other individuals turn to the diet as a personal health choice. At this time, there are no documented studies demonstrating health benefits to a gluten-free diet for those who are not gluten sensitive. As the popularity of following a gluten-free diet has increased, more gluten-free products are available of which many can be unhealthy. Manufacturers often add extra sugar for flavor and fat to simulate the texture and satisfying fullness that gluten imparts. Gluten free does not mean calorie or fat free.

Reading labels is vital as many products, such as ice cream, processed luncheon meats, herbal supplements and some over-the counter and prescription medications, may have offending grains included. There are many restaurants that advertize gluten-free menu items, but it is important to be aware that the variety of cooking procedures and utensils used may lead to cross contamination.

Sales of gluten-free products increased 16 percent in 2012 according to the Nielson Company. Until recently, manufacturers have been able to use their own discretion as to how much gluten they include in a product because these products were not regulated. However, The FDA has now set a standard for labeling gluten-free foods. The amount of gluten allowed is low enough so that most people who have celiac disease will not experience an adverse effect if they eat the product.

Celiac disease patients will often be deficient in numerous vitamins and minerals due to malabsorption, diarrhea, and/or steatorrhea. Initially a multi-vitamin mineral supplement should be recommended to remedy deficiencies and replenish nutrient stores. Anemias should be treated with iron, folate or B12 supplementation depending on the nature of the anemia. Bone loss should be treated with calcium and vitamin D. Zinc, magnesium, and other mineral deficits may need to be corrected. Vitamins A and E may be necessary to replenish stores depleted by steatorrhea.

Adequate intake of the B vitamins is also important for any individual following a gluten-free diet. Whole grains containing gluten are typically rich in the B vitamins and most refined grain products are supplemented with B vitamins in addition to calcium, iron, and other minerals. That is not always the case for gluten-free foods as many gluten-free products are not fortified or enriched. A person following a gluten-free food plan should keep this in mind. It is important to read labels and consult with a health care provider if supplementation is necessary.

Care must be taken to assure proper intake of vitamins and minerals whether a gluten-free diet is followed for medical reasons or as a personal dietary choice.

  1. Beyer, Peter L MS,RD, "Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders"; Mahan, L Kathleen and Sylvia Escott-Stump, eds. 2008. Krause's Food and Nutrition Therapy 12th ed. St. Louis, Missouri. Saunders.
  2. Fuaci, Anthony S., Braunwald, Eugene, and Kasper Dennis L., eds. 2008. Harrison's Principles of internal Medicine, 17th Ed. New York, McGraw Hill.
  3. Natural Medicines Comprehensive Data Base (

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