Celiac disease
Celiac disease is an autoimmune reaction to gluten that flattens the villi of the small intestine. The only treatment is a strict, lifelong gluten-free diet.
At a glance
Dietary principles
| Point | Recommendation | Why |
|---|---|---|
| Gluten | Remove wheat, barley and rye completely, for life; oats only if certified uncontaminated and tolerated | Even small amounts keep the villi damaged |
| Energy and protein | High at first to regain lost weight and growth | Malabsorption causes weight loss and wasting |
| Fat | Low at first if stools are fatty; normal once the gut heals | Fat is poorly absorbed while villi are flat |
| Lactose | Limit milk for the first weeks; use curd | Damaged villi make less lactase; this usually recovers |
| Vitamins and minerals | Iron, folate, B12, calcium, vitamin D, zinc, fat-soluble vitamins | These are poorly absorbed and often deficient |
| Fibre | Use millets, pulses, vegetables and fruits | Gluten-free diets made only of rice and potato can be low in fibre |
Foods allowed, hidden gluten and foods to avoid
| Group | Allowed (gluten-free) | Avoid (contain gluten) |
|---|---|---|
| Cereals and millets | Rice, ragi, jowar, bajra, maize, foxtail and other millets, rajgira (amaranth), kuttu (buckwheat), quinoa, sabudana, arrowroot | Wheat atta, maida, suji or rava, dalia, seviyan, barley, rye |
| Pulses and flours | All dals, besan, urad and moong flours | Mixed flours with wheat |
| Bakery and snacks | Snacks made at home from rice, besan or millets | Bread, biscuits, cakes, rusk, pizza, noodles, pasta, samosa, batter-fried snacks |
| Hidden gluten | Read every label | Malted health drinks (barley malt), some hing (mixed with wheat flour), soy sauce, packet soups, sauces thickened with flour, beer |
| Others | Milk, curd, paneer, egg, meat, fish, vegetables, fruits, nuts, oils | Cross-contamination: shared flour mill (chakki), toaster, frying oil |
Sample one-day gluten-free menu
| Meal | Menu |
|---|---|
| Early morning | Milk (or curd in the first weeks) with a few almonds |
| Breakfast | Ragi dosa or rice idli (3) with sambar and coconut chutney |
| Mid-morning | Guava or banana |
| Lunch | Rice, rajma or dal, palak poriyal, cucumber raita |
| Evening | Besan chilla or roasted makhana; buttermilk |
| Dinner | Jowar or bajra roti (2), chicken or paneer curry (no flour thickening), mixed vegetables |
| Bedtime | Rice kheer or milk |
In a hospital kitchen, a celiac patient's food needs a separate tawa, ladle and flour; one roti dusted with atta can undo the diet. Teach the family to read labels for wheat, barley, malt and hing.
2 marks: “What is gluten? Name two cereals that contain it.” Gluten is the protein complex (gliadin and glutenin) of wheat that triggers celiac disease; also present in barley and rye.
5 marks: “List gluten-free foods and sources of hidden gluten.” Rice, millets, maize, sabudana, pulses, milk, eggs, meat, vegetables; hidden in malted drinks, hing, soy sauce, packet soups, bakery items.
10 marks: “Discuss the causes, symptoms and dietary management of celiac disease. Plan a gluten-free menu.” Define, causes, villous atrophy, symptoms, diagnosis, principles table, allowed and avoided foods with hidden gluten, a one-day menu.
Avoid BROW: Barley, Rye, Oats (unless certified pure), Wheat.