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Once a diagnosis has been confirmed through a biopsy to be celiac disease, the patient is instructed to begin following the gluten-free diet. This can often be difficult at first because so many foods contain gluten. However, through support and guidance from experienced celiac patients and a skilled dietitian, many newly diagnosed patients learn that the gluten-free diet requires some creativity and planning, but that great-tasting food isn’t out of reach. The only treatment for celiac disease is to follow a gluten-free diet—that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within weeks of starting the diet. Although the vast majority of children undergo full healing of their intestinal lining, research has shown that the healing may remain incomplete in many adults, even though symptoms may regress. The gluten-free diet is a lifetime requirement. Eating any gluten, no matter how small an amount, can damage the small intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. Antibody levels take a long time (sometimes more than a year) to normalize after a person has stopped eating gluten. The doctor will assess if your intestinal damage is improving satisfactorily or not, based on the, based on the pace of the decline of antibody levels. Depending on a person’s age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including gluten-free bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. The gluten-free diet requires a completely new approach to eating that affects a person’s entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, identifying potential sources of gluten becomes second nature and people learn to recognize which foods are safe and which are off limits. A dietitian, who is a healthcare professional specializing in food and nutrition, can help people learn about their new diet. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life. Over time, the diet becomes easier—even second nature. If you fi nd that the diet is still diffi cult after several months, or you are still sick, talk to your doctor, your dietitian, and your support organizations. You may be eating gluten accidentally and need an outside perspective to identify foods that are keeping you from regaining your health. These are exciting times for the development of treatment options that go beyond the diet. Research is very active on several fronts. Among the most promising: A gluten-free diet is currently the only way to effectively treat celiac disease. Fortunately, maintaining a gluten-free diet isn’t as hard as it may seem as long as you are educated about some basic rules about the food and beverages you can and cannot consume. At The University of Chicago Celiac Disease Center, we strongly recommend that you first seek a professional opinion before removing gluten from your diet because following a gluten-free diet can make it difficult to diagnose celiac disease. While medical advice should be obtained directly from your doctor, the information in this section can help you make lifestyle decisions to get on the right track for a healthier and happier life. Once patients have been diagnosed as having celiac disease they are instructed to begin following the gluten-free diet. This can often be difficult, at first, because so many foods contain gluten. However, through support and guidance from other people with celiac disease and a skilled dietitian, many newly diagnosed patients learn that the gluten-free diet requires some creativity and planning, but that great-tasting food isn’t out of reach. The only treatment for celiac disease is to follow a gluten-free diet—that is, to avoid all foods that contain gluten. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within weeks of starting the diet and the small intestine is usually completely healed—meaning the villi are intact and working—in 6 to 18 months. (It may take up to 2 years for older adults.) Left untreated, celiac disease may result in: The gluten-free diet is a lifetime requirement. Eating any gluten-containing food, no matter how small an amount, can damage the intestine. This is true for anyone with the disease, including people who do not have noticeable symptoms. It can take weeks for antibody levels (indicating intestinal damage) to normalize after a person with celiac disease has consumed gluten. Depending on a person’s age at diagnosis, some problems, such as delayed growth and tooth discoloration, may not improve. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods, including gluten-free bread and pasta. For example, instead of wheat flour, people can use potato, rice, soy, or bean flour. Unprocessed meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat these foods. The gluten-free diet requires a completely new approach to eating that affects a person’s entire life. People with celiac disease have to be extremely careful about what they buy for lunch at school or work, eat at cocktail parties, or grab from the refrigerator for a midnight snack. Eating out can be a challenge as the person with celiac disease learns to scrutinize the menu for foods with gluten and question the waiter or chef about possible hidden sources of gluten. However, with practice, identifying potential sources of gluten becomes second nature and people learn to recognize which foods are safe and which are off limits. A dietitian, a health care professional who specializes in food and nutrition, can help people learn about their new diet. It is important to find a dietitian who specializes in celiac disease. You can find one at www.EatRight.org. Also, support groups are particularly helpful for newly diagnosed people and their families as they learn to adjust to a new way of life. If you find that the diet is still difficult after several months, or you are still sick, talk to your doctor, your dietitian, and your support organizations. You may be eating gluten accidentally and need an outside perspective to identify foods that are keeping you from regaining your health. A gluten-free diet is currently the only way to effectively treat celiac disease. Fortunately, maintaining a gluten-free diet isn’t as hard as it may seem as long as you are educated about some basic rules about the food and beverages you can and cannot consume. At The University of Chicago Celiac Disease Center, we strongly recommend that you first seek a professional opinion before removing gluten from your diet because following a gluten-free diet can make it difficult to diagnose celiac disease. While medical advice should be obtained directly from your doctor, the information in this section can help you make lifestyle decisions to get on the right track for a healthier and happier life. Caramel color is manufactured by heating carbohydrates and is produced from sweeteners. Although gluten-containing ingredients can be used, they are not used in North America; corn is most often used, however it is important to check with food manufacturers. Maltodextrin is made from cornstarch, potato starch, or rice starch. Distilled white vinegar is safe to consume on the gluten-free diet. Vinegar is a solution made of acetic acid and flavoring materials such as apples, grapes, grain and molasses. For example, cider vinegar is made from apple juice; malt vinegar is made from barley malt, balsamic vinegar is made from grapes. Distilled vinegars are gluten-free because the distillation process filters out the large gluten proteins so that they do not pass through to the end product. Therefore, the finished liquid is gluten-free. Patients with celiac disease should not be concerned about distilled white vinegar or foods such as pickles, which may contain it. The exception to this rule is MALT VINEGAR, which is not distilled and therefore is not safe to consume. Check out our free resource for more helpful tips on diet: Jump Start Your Gluten-Free Diet eBook *Historically, oats were not recommended because it was thought that avenin was toxic to gluten-intolerant individuals. However, research in Europe and the U.S. has found that oats are well tolerated by most people when consumed in moderation and do not contribute to abdominal symptoms, nor prevent intestinal healing. PLEASE NOTE: Regular, commercially available oats are frequently contaminated with wheat or barley. However, “pure, uncontaminated” oats have become available from several companies in the U.S. and Canada. These companies process oats in dedicated facilities and are tested for purity. Pure, uncontaminated oats can be consumed safely in quantities of less than 1 cup per day. It is important that you talk to your physician and your registered dietitian prior to starting oats. ** May be made with wheat—call company to verify. *** Types of wheat
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Autorica članka: dr.sc. Lea Pollak, dipl.ing. Jedini lijek za celijakiju je bezglutenska dijeta, koje se oboljeli moraju strogo pridržavati. Novim smjernicama EU zakonodavstva konačno se rješava problem dopuštenih količina glutena u bezglutenskim proizvodima. Celijakija je bolest probavnog sustava. Uzrok oboljenja je trajna nepodnošljivost na protein glutena koji se nalazi u pšenici (pšenični prolamin i glutenin), ječmu (hordein), raži (sekalin) i eventualno zobi (avenin). Istraživanja su pokazala da oboljeli nisu osjetljivi na ostale žitarice, rižu i kukuruz, budući da one ne sadrže toksične prolaminske frakcije. Kada je tolerancija na gluten ograničena, tijelo stvara antitijela – znači stvara svoje molekule, anti-gliadin antitijela, koja napadaju molekule glutena. Na taj način dolazi do oštećenja sluznice tankog crijeva i uništenja crijevnih resica, zvanih villi. Posljedica je malapsorpcija, odnosno otežana i smanjena apsorpcija hranjivih tvari. Simptomi celijakije Kliničke manifestacije celijakije vrlo su različite. Razlozi toj raznolikosti su nepoznati, ali mogu ovisiti o dobi i imunološkom statusu pojedinca, količini i vremenskoj izloženosti organizma glutenu, te stanju gastrointestinalnog trakta. Same kliničke manifestacije bolesti mogu se podijeliti u gastrointestinalne (tzv. klasične) i negastrointestinalne. Gastrointestinalne kliničke manifestacije se obično javljaju kod djece od 4 do 24 mjeseca starosti, a negastrointestinalne se javljaju u vidu simptoma kod starije djece i odraslih osoba. Osobe s kliničkim manifestacijama, odnosno sa simptomatskom celijakijom su u manjini u odnosu na ukupni broj oboljelih. Nažalost, većinu čine osobe s „tihom“ celijakijom, koje imaju pozitivne serološke testove i oštećenu sluznicu tankog crijeva, a sve bez nutritivne deficijencije. Pojava prvih simptoma bolesti je različita, i ovisi da li se javlja kod djece ili kod odraslih osoba. Simptomi celijakije kod djece Prvi simptomi javljaju se kod djece nekoliko mjeseci nakon uvođenja žitarica u prehranu dojenčadi. Stanje oboljele djece od celijakije u odnosu na zdravu djecu je u svijetu prosječno 1:100, a kreće se u rasponu od 1:80 do 1:300. Neki od uobičajenih simptoma bolesti su: - kronični proljev, odnosno kašaste, ali ne vodenaste, obilne i svijetle stolice, čiji je rezultat pothranjeno dijete u dobi od 1-2 godine; - bolovi i nadutost u trbuhu; - gubitak apetita; - nerazjašnjena slabokrvnost – zbog nedostatka željeza (tzv. sideropenijska anemija) ili sam nedostatak željeza koji još nije doveo do slabokrvnosti (tzv. sideropenija) koja traje bez obzira na liječenje kapima ili tabletama željeza. Uslijed kontinuiranog gubitka mikroskopskih količina krvi stolicom iz oštećenog crijeva smanjuje se apsorpcija željeza. Anemija se javlja kod 20-40% bolesnika s celijakijom kao posljedica poremećaja apsorpcije željeza i folne kiseline, a ukoliko bolest zahvaća ileum i vitamina B12; - učestalo povraćanje; - slabiji rast – uslijed značajno smanjenog lučenja hormona rasta. Kod djece progresivna, ubrzana malapsorpcija nutrijenata može dovesti do zastoja u rastu, razvitku i do znakova neurološke usporenosti. Simptomi celijakije kod odraslih Međutim, godinama je već poznato da klinička slika celijakije može kod starije djece i odraslih biti potpuno drugačija. Bolest se općenito češće manifestira monosimptomatski ili u blažem obliku. Negastrointestinalne kliničke manifestacije su raznolike i češće su rezultat dugotrajne malapsorpcije koja dovodi do rekurentnih abdominalnih bolova, dispepsije, recidivirajućeg povraćanja, nedostatka željeza (anemije), anoreksije, opstipacije, neplodnosti i osteoporoze ili osteopenije. Svaka od navedenih manifestacija može biti sama za sebe jedini gastrointestinalni simptom celijakije. Većina autora smatra da kod nejasnog povišenja aminotransferaza (kod 10-20% bolesnika) i recidivirajućih pankreatitisa, također treba posumnjati u celijakiju. Tihi oblik celijakije obilježen je nedostatkom ili blagim simptomima i nalazom parcijalne ili subtotalne atrofije sluznice tankog crijeva; otkriva se obično probirom populacije ili aktivnim traženjem bolesti u skupinama pod većim rizikom za razvoj bolesti, npr. kod dijabetičara ili članova obitelji bolesnika. Manjina takvih bolesnika ima gastrointestinalne simptome, a većinom se radi o bolesti manjeg intenziteta, često povezanoj sa smanjenim osjećajem psihofizičkog zdravlja. Dakle, kod odraslih pacijenata, prvi simptomi mogu biti prikriveni s drugim bolestima, odnosno njihovim simptomima, kao na primjer: - bolovi u kostima, krhkost kostiju – čak 40% bolesnika pati od osteopenije (blaži poremećaj gustoće kostiju), a kod 20% javlja se osteoporoza (teži poremećaj); - neurološki oblici bolesti – dolazi do epilepsije, cerebralne ataksije, polineuropatije i teške miastenije; - smetnje reprodukcije – neplodnost ili učestali spontani pobačaji; - kožna celijakija (herpetiformni dermatitis) – javljaju se sitni mjehurići na koži laktova, koljena i bedara; - oštećenje zubne cakline; - zadnjih 20 godina poznato je da bolesnici sa celijakijom češće oboljevaju od nekih malignih bolesti. Tako je npr. maligni limfom crijeva 40 puta učestaliji, a karcinom ždrijela i jednjaka 10-12 puta češći kod neliječenih osoba sa celijakijom. Bezglutenska dijeta Jedini lijek za oboljele od celijakije je bezglutenska dijeta koje se moraju pridržavati cijeli život. Celijakija je neizlječiva bolest, čiji se simptomi mogu povući samo uz dosljedno provođenje bezglutenske dijete. Oboljeli mogu konzumirati dozvoljene namirnice u koje ulaze prirodno bezglutenske namirnice i specijalne bezglutenske dijetetske namirnice namijenjene upravo ovoj populaciji. Uvjetno prikladne namirnice su jednostavne industrijske prerađevine bez dodataka, namirnice za široku potrošnju s oznakom „ne sadrži gluten“, te analizirane namirnice. Budući da deklariranje glutena na proizvodima nije zakonom propisano, konkretna pomoć oboljelim od celijakije je analiziranje količine glutena u namirnicama ili grupama namirnica. Prvi i najveći problem predstavljaju sami bezglutenski proizvodi. Zahvaljujući zdravoj konkurenciji, na tržištu je sve više notificiranih (odobrenih od Ministarstva zdravstva) bezglutenskih proizvoda čija se količina glutena periodički provjerava, a i sve je više domaćih proizvođača. Samom pojavom veće količine proizvoda i njihovom raznovrsnošću, cijene se uravnotežuju i proizvodi postaju dostupniji oboljelima. Čak i kod bezglutenskih proizvoda može doći do kontaminacije glutenom, a neki oboljeli pogrešno smatraju kako bezglutenski proizvodi uopće ne sadrže gluten. Time se dolazi do problema legislative, edukacije i krajnje informiranosti pacijenta. Prema istraživanjima Zakardasa i suradnika, prehrambeni status oboljelih od celijakije ovisi o više čimbenika kao što su: utjecaj bezglutenske dijete na svakog oboljelog pojedinačno, kvaliteta informiranja o bezglutenskoj dijeti, kvaliteta življenja, osjetljivost na gluten. Zakonodavstvo Hrana bez glutena namijenjena je prehrani osoba s intolerancijom na gluten, odnosno celijakijom. Definirano je da se radi o vrsti hrane proizvedenoj od žitarica i njihovih mješavina koje prirodno ne sadrže gluten ili od žitarica kao što su pšenica, raž, ječam i zob, iz kojih je gluten odstranjen tehnološkim postupkom. Dugi niz godina trajala su usuglašavanja oko pojma glutena, usavršavanja analitičkih metoda određivanja te pokušaji rješavanja problema oko deklariranja. Brojne radne skupine pri Codex Alimenariusu radile su još od 1981. godine i konačno 2008. godine usuglasile svoja stajališta. Zahvaljujući tome, Europska Komisija je izglasala Uredbu broj 41/2009 o sastavu i označavanju namirnica namijenjenih oboljelima od celijakije. No, dok Uredba konačno nije izglasana, industrija je koristila vrijeme za proizvodnju „bezglutenskih“ i njima sličnih proizvoda, a svaka je zemlja članica imala svoj sistem notifikacije i provjere količina glutena. Potrošač je bio sve zbunjeniji, jer se čak i na proizvodima koji po svom sastavu ne mogu sadržavati gluten nalazio navod „bez glutena“. Time se trebalo vjerovati proizvođačkoj specifikaciji, jedinom dokumentu koji ima navedenu količinu glutena, a u koju potrošač, odnosno oboljeli od celijakije nije imao uvida. Novom Uredbom 41/2009 regulirane su količine glutena ovisno o porijeklu i vrsti pojedinih bezglutenskih namirnica, te deklariranje glutena. Konačno su se navodi o količini glutena promijenili i sada glase: Gluten free (bez glutena) - količina glutena ne smije biti veća od 20 mg u kilogramu originalnog pakiranja proizvoda koji se prodaje. Very low gluten (s niskom količinom glutena) - količina glutena ne smije biti veća od 100 mg u kilogramu originalnog pakiranja proizvoda koji se prodaje. To su jedini navodi koji se smiju navoditi. Nažalost, smatra se da će nova terminologija označavanja hrane namijenjene oboljelima od celijakije dovesti do nerazumijevanja i nepovjerenja kod te specifične skupine. Ostaje nam vidjeti i nadati se da će navođenje podataka o količini glutena u bezglutenskim proizvodima biti odgovarajuće, a ne neki marketinški trik, jer je i sama Europa uvidjela da kontrola količina glutena u hrani treba biti češća i ozbiljnija, budući da je hrana doista jedini lijek oboljelima od celijakije. Literatura: COMMISSION REGULATION (EC) No 41/2009 of 20 January 2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten FARRELL RJ. KELLY CP. Celiac sprue. CATASSI C i sur. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. American Journal of Clinical Nutrition 2007;85 (1): 160-6. ZARKADAS M i sur. The impact of a gluten-free diet on adults with Coeliac disease: results of a national survey, J Hum Nutr Dietet 2006; 19: 41–9. Izvor: Stručni časopis "inPharma", BR.3, GOD. Copyright 2011Lucas Intertrade d.o.o.Site mapIzrada web stranica Virtus Dizajn