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Commonly Asked Questions: Celiac Disease And Gluten Free Diets

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I became interested in celiac disease during medical school, and decided to become a pediatric gastroenterologist by my third year. During my pediatric residency at St. Louis Children’s (Washington University) I saw many patients with celiac disease. Ironically, six months after accepting a fellowship at Boston Children’s, I had symptoms concerning for celiac disease. I had the necessary blood tests and a confirmatory endoscopy.  Since that time, I am now a pediatric gastroenterologist at Texas Children's Hospital and “celiac” on a gluten-free diet.

With gluten free diets becoming increasingly more popular, I wanted to answer some of the most asked questions surrounding gluten and celiac disease:

What is this new gluten craze?

There has been a huge increase in people trying a gluten-free diet (GFD). Those with gluten sensitivity and others may try the GFD as a “fad” diet for an added health benefit.   Several movie stars and athletes, including tennis player Novak Djokovic have sworn by the GFD. However, the gluten-free diet has only been shown to be effective for celiac disease.

What is gluten?

Gluten is a protein, found in wheat, rye and barley.  It is what gives a lot of products their “stickiness”.  Other proteins like oats do not contain gluten, but are sometimes milled together so there can be cross-contamination.  Sometimes rice is “glutinous” because it is a little stickier, but does not necessarily containing gluten.

What is celiac disease?

Celiac disease is an autoimmune condition, in which the small intestine becomes inflamed when exposed to gluten in the diet.  In children and adolescents, it is common to have abdominal pain, diarrhea, and weight loss or growth failure. However, some patients have no symptoms even though they have damage to their intestine.

How do we diagnose celiac disease?

The current standard is that blood tests help identify patients at risk for celiac disease. These tests are very good, but an endoscopy (flexible camera) performed by a pediatric gastroenterologist is necessary to confirm the diagnosis. This is an outpatient procedure that usually takes less than 15 minutes.

What is the treatment of celiac disease?

A strict gluten-free diet, eliminating wheat, rye, and barley.  A gluten-free diet (GFD) can completely reverse the effects of celiac disease, but the GFD is needed lifelong.  No other medications or remedies have been shown to be effective.

What types of foods are gluten-free? 

Fruits and vegetables, and fresh meats and fish are naturally gluten-free.   Other grains like rice, quinoa, and buckwheat are gluten-free.

Where do you get gluten-free foods?

Most grocery stores and specialty stores carry gluten-free products. Many restaurants have gluten-free menus, but few are strictly gluten-free so patients need to be cautious. Also, abcsmartcookies.com recently teamed up with the Girl Scouts to create the first gluten-free Girl Scout cookies!

What I’ve come to realize is that everyone is different and needs different things. Because of my work with the Houston Celiac Support Group, many patients know that I have a special interest in helping and learning from people with celiac disease.  And I really believe that everyone becomes an expert for themselves, as they don’t eat the same breakfast, lunch or dinner that I might.  I sometimes rely on my patients to tell me about new products and places to eat.

For more information about Texas Children’s Gastroenterology Department, visit here.

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Dr. Douglas Fishman, Pediatric Gastroenterologist