How to diet for celiac patients + Important restrictions

Celiac disease: what causes this disease?

Celiac disease is a well-known and well-established term. However, you may also find this disease under other lesser-known names, such as Herter-Heubner disease, Herteri intestinalis infantilis, celiac sprue, non-tropical sprue, idiopathic sprue, gluten enteropathy or gluten-sensitive.

It occurs worldwide, affecting both men and women at a rate of 1:2. However, the prevalence of the disease varies worldwide (1:300 to 1:6000). Sometimes it is detected in young children, other times it is found incidentally in nutritional disorders, malabsorption, digestive or other difficulties in adults.

Celiac disease is an autoimmune disease directed against a protein called gluten. The term autoimmune implies the body's immune response is excessive, active and attacks its own structures. In the case of celiac disease, the target of attack is the small intestine.

Gluten, part of European cuisines

Gluten, also known as gluten, lectin or prolamin, belongs to the group of glycoproteins. Simply put, it is a protein of plant origin that is found in some commonly used foods. Despite the perfect preparation of foods, it remains difficult to digest in the small intestine. However, in a healthy individual, its consumption does not cause problems. This is not the case in patients with gluten intolerance.

Interesting fact: Gluten, or gluten, is a sticky substance in its material, physical form. It is even used to make some adhesives. It is difficult to digest. Its consistency causes it to accumulate and stick to the small intestine when gluten-containing foods are consumed in excess (even in a healthy individual).

Gluten is a traditional part of the European diet. You will come across it in every supermarket, every restaurant and every kitchen. Its use in the food industry is so ingrained that it is unavoidable.

Which foods contain gluten?

The highest amounts of gluten are found in plants of the grass family (lat. Poaceae). In general, gluten is known to be a component of most starchy foods.

Which foods should be avoided?

• Wheat products
• barley products
• rye products
• spelt products
• kamut products
• white flour / spelt
• oats
• rye
• cereals and oat flakes
• teff
• rice (white)
• groats
• protein bars
• pasta
• potatoes/chips
• modified kitchen starch - dextrin
• biscuits and sweets made from gluten flour
• soya and other sauces and flavourings
• some sachet soups
• some condiments
• imitation crab meat and sticks

It is important to keep in mind that gluten is used as an additive almost everywhere. It is an important ingredient in food production and is used as a thickener. Therefore, it is imperative that celiac patients visit stores that specialize in specialty foods and supplements or carefully study labels with every purchase.

What does gluten free mean?

Despite the fact that the food industry is full of gluten, gluten-free products are creeping into our stores more and more. On the packaging of these foods, you will find a label with the information gluten free.

Nowadays, there are even stores dedicated exclusively to food for patients with various diseases or dietary restrictions. Most often, these are organic stores where you can find food for diabetics and celiac patients.

Interesting fact: Despite the label saying that the product is gluten-free, you will find some trace amounts of gluten in this product as well. However, this amount should not exceed the recommended standards, i.e. 20 ppm.

What happens in the small intestine when it encounters gluten?

The small intestine forms part of the digestive system. It is directly responsible for the absorption of certain substances and nutrients into the body. Without the digestive system and its function, we would exist about as much as without the heart.

Anatomy and physiology of the small intestine

The small intestine (Lat. intestinum tenue) is a tubular organ, anatomically bent into villi and located in the abdominal cavity. It reaches an average length of 3 m to 5 m. It consists of three interconnecting parts (duodenum, jejunum, ileum).

The wall of the small intestine, in contrast to the other compartments of the digestive system, has certain differences. The inner part of the small intestine is physiologically adapted for the breakdown and absorption of almost all the substances of the stomach contents - the chyme. This means that there are many more mucous algae with villi than in the other compartments of the intestine.

It is in the first compartment of the small intestine that the main breakdown of all nutrients from food occurs via digestive enzymes. In the second and third compartments these nutrients are absorbed, as indicated by the shortening of the intestinal villi. Their movement is also an important factor.

What happens in the small intestine in patients with celiac disease?

In coeliac disease, a genetic predisposition is thought to result in a defect in the metabolism of intestinal peptidases, which are responsible for the breakdown and degradation of gluten. Coeliacs suffer from the development of toxicity, for which the gluten molecule is directly responsible, and its accumulation in the small intestine.

In the small intestine, gluten not only builds up and sticks, but also damages its mucosa (mainly enterocytes). It acts as an allergen (unwanted substance in the body) for the organism and the body puts up a fight. Autoimmune mechanisms are triggered, resulting in the activation of the body's immune response. Antibodies start to build up, similar to other allergies.

Interestingly, in patients with celiac disease, lactose intolerance is also detected. Alternatively, it is most likely to develop as a result of damage to the lining of the small intestine. Antibodies to the proteins contained in cow's milk start to form.

How does celiac disease manifest itself?

About 10% of patients with this disease are asymptomatic. The disruption and thinning of the villi in the small intestine does not cause them problems in everyday life or they are not aware of it due to lack of information.

Symptomatic manifestations of coeliac disease usually remain at the level of the digestive tract. However, some manifestations of the disease may not immediately give the impression that it is lactose intolerance.

Table with symptoms of celiac disease:

How do I know if my child has celiac disease?

Sometimes the disease is not detected until adulthood. However, observant mothers can figure out that something is wrong with their baby much earlier. In newborns and infants, detecting celiac disease based on symptoms is impossible. They are fed breast or artificial milk, which does not contain gluten.

Already in the infant period, when the baby's diet is changing, it is possible to observe problems. Gradually, flour and other products are added to the baby's diet. These contain gluten. This does not take long to manifest itself and shows itself externally in a similar way to an adult.

How is celiac disease diagnosed? Do we know the treatment?

Coeliac disease is suspected when the patient has otherwise unexplained intestinal problems. The most typical symptoms are abdominal pain, a distended abdomen, low overall weight even in relation to the patient's intake, and stools that are usually thin, diarrhoeic and yellow or foamy in colour. There is also vomiting and a lack of iron and folic acid in the blood.

Sometimes the disease is discovered accidentally if an abdominal X-ray has been taken for any reason. On the image, the intestinal villi are dilated and stasis (accumulation) of intestinal contents in the intestines is visible. The overall picture resembles "snowflakes".

The basic pillars of the final diagnosis

The xylose tolerance test is used for definitive diagnosis. It is done in patients with malabsorption syndrome by administering D-xylose and fasting at several hour intervals followed by laboratory testing of blood and urine. A positive test will show decreased excretion of xylose in the urine.

The most important diagnostic method is a biopsy of the small intestinal mucosa, which usually reveals a smoothed intestinal mucosa (atrophy of the intestinal villi) and a reduction in the epithelial layer of the intestine.

Is there a treatment for celiac disease?

Treatment of celiac disease is the future. Today, despite attempts, no cure or vaccination has been developed to suppress the autoimmune processes in a patient with celiac disease. Today's treatment consists only of diet and restriction of gluten-containing products.

By following these restrictions, all symptoms associated with the disease are suppressed and eliminated. Diet is therefore also the only available "treatment" for celiac disease.

Interesting: Before the era of gluten-free diets and gluten-free foods, the mortality rate for this disease was 10 to 30%. After the introduction of special diets on the market, it is less than 1%.

Celiac disease and pregnancy

Because of the reported spontaneous abortions in pregnant patients with celiac disease, it is advisable that pregnancy be planned. It should never be planned in the acute phase, but when the disease and symptoms are in remission (improving).

The patient should undergo regular gynaecological examinations aimed at the correct development of the foetus. There should be no problem with adherence to dietary restrictions. It is worse for mothers who do not know they have celiac disease. They experience delayed intrauterine development of the foetus.

Mothers with coeliac disease can be quite troubled by anaemia during pregnancy. Regular blood tests and blood draws when there is undue fatigue and drowsiness should be routine.

The good news is that the complications described above are rare. Pregnancies usually proceed without any problems. But that doesn't mean you can underestimate the condition.

What dietary restrictions apply to patients with celiac disease?

The basis of the disease is gluten intolerance and at the same time, in most cases, lactose intolerance. The diet of patients with celiac disease should therefore be aimed at avoiding foods containing these substances. Patients should be especially careful in the acute phase of the disease.

A gluten-free diet - the basis is the omission of flour

Cereals, which are used to make flour, contain the most gluten. Flour should be completely excluded from the patient's diet. All foods that contain even traces of cereals should also be excluded.

Most products state that they may contain traces of cereals. These also have a negative effect and cause problems, even if the amount is minimal.

Which foods are suitable?

Gluten-free flour, which can be bought in speciality shops, as well as rice, corn or soya flour, are good substitutes. Nowadays, ready-made products made from suitable flours are also available. These include gluten-free pasta, bread, cakes, biscuits and various sweets.

In addition to gluten-free foods, fruit, vegetables, potatoes, meat, fish, corn, rice (not white) are suitable. A sufficient supply of protein (cottage cheese, cheese, yoghurt, milk - lactose-free) is important.

How to proceed with the diet in the acute phase of the disease?

In the acute phase of celiac disease, a diet with a gradual loading of the digestive tract, especially the small intestine, is appropriate. Of course, complete avoidance of any trace amounts of gluten is necessary.

1. For the first 3 to 5 days (depending on the severity of the condition) a diet is recommended. Only fruit food (grated, mixed) should be eaten.
2. On the third or fifth day, a protein component (cottage cheese, lean meat) is gradually added.
3. If no difficulties occur on the fifth or sixth day, sugars and fats (of vegetable origin) are added.

A few tasty recipes without adding gluten

We've been writing about restrictions for celiac patients since the beginning, but even a gluten-free diet can be tasty. It just takes proper knowledge of what you can eat, caution when shopping for food, and a positive attitude toward cooking.

Breakfast - the right start to every day

1. Gluten-free pastries - Even celiacs can enjoy a completely classic breakfast, such as pastries with a variety of toppings (tuna, vegetables, ham, cheese, yoghurt, egg, brie spread, avocado spread).
2. Omelette - The omelette can be made with normal eggs, vegetables to taste and fried preferably in olive oil.
3. Zucchini pancake - Grate the zucchini, squeeze out the excess juice, add 2 tablespoons of olive oil, thicken with a little gluten-free flour, add salt and season with herbs of your choice.
4. Fruit, semolina porridge - Mix semolina with water at a steady boil (lactose-free milk), flavour it with various fruits (strawberries, raspberries, berries, nuts).
5. Apple-cinnamon fritters - Pour water over one cup of buckwheat and let stand in the refrigerator until morning. In the morning, strain the remaining water, add eggs, grated apples with cinnamon, a little lactose-free milk, sweeten with stevia and fry in a pan. Season with fruit of your choice.

Are you a soup lover?

1. Classic Chicken or Beef Broth - In a large pot, simmer chicken soup mix or beef ribs for about an hour and a half. Clean. Add diced or ringed carrots, parsley, kohlrabi, celery, onion, Brussels sprouts or cauliflower or broccoli (to taste). Add salt, pepper, veggies and finely chopped parsley. Cook until vegetables are tender. Finally, add diced potatoes or gluten-free noodles.)
2. Mushroom soup - Cook the mushrooms in boiling water according to your taste. Drain the water, add clean water and cook again. Add grated carrots, finely chopped parsley, salt and pepper to the mushrooms. Simmer again for a while and add the gluten-free flour roux. Add the grated garlic head and cook. You can also add a crumble prepared from gluten-free flour, salt and eggs to the soup.
3. domácí zelňačka v bezlepkovém bochníku – Nejprve si připravíme těsto na bochník. Do trochy vlažného mléka přidáme rozdrobený kvásek a necháme přikrytý vykynout na teplém místě asi 2 hodiny. Do misky dáme bezlepkovou mouku, špetku soli, cukru a kmín. Zamícháme a přidáváme směs s kváskem a vlažnou vodu, dokud nám nevznikne tužší těsto. To necháme ještě asi hodinku kynout. Vytvarujeme bochník a vložíme na 40 minut do rozehřáté trouby. Pečeme na 180°. Pro křupavější kůrku potíráme povrch chleba vodou během doby pečení. Nadrobno nakrájíme cibuli a smažíme dozlatova v hrnci. Přidáme kousky slaninky (kdo chce). Nakrájíme si na kostičky vepřové nebo hovězí maso a přidáme do hrnce, trochu osmahneme, zalijeme vodou a vaříme, dokud maso nezměkne. Pravidelně podléváme vodou, pokud se vypaří. Přidáme zelí a zalijeme vodou. Dochutíme bobkovým listem, solí a pepřem. Pro chuť a barvu je vhodná mletá červená paprika. Polévku vař
4. Cauliflower soup - Place a small cube of butter in a saucepan and add the finely chopped onion. Sauté. Pour in a little meat stock, which you have previously prepared in another saucepan, or water. Add thyme or herbs to taste and finely chopped cauliflower. Bring to the boil and then blend the vegetables. Add the cooking cream while simmering. Season with salt and a little pepper.
5. Tomato soup - Put a little oil in a pot and add finely chopped onion. Fry until glassy. Remove the skin from the fresh tomatoes and cut them into marigolds or small pieces. Add them to the pot together with the crushed garlic clove, pour a little water. Season with salt, pepper and oregano. Cook the mixture until the tomatoes are cooked. Finally, blend the soup and serve with grated cheese.

Interesting fact: According to the latest studies, sourdough does not cause problems for people with celiac disease. It even helps heal the intestinal lining at the beginning of the disease. However, it is not recommended if, despite the above, you have intestinal problems after eating sourdough.

The best lunch!

1. Grilled Salmon on Vegetables - Clean the salmon, remove the skin, salt, pepper (spices without added gluten), add herbs to taste, a pinch of butter and grill in a heated oven. As a side dish you can use grilled or steamed vegetables.
2. Natural chicken steak and roasted potatoes - Clean the chicken, tenderize, salt and pepper (seasoning without added gluten). Roast in a pan or on the grill. Clean the potatoes, cut into smaller pieces and roast in olive oil until golden brown. The potatoes can be seasoned with a pinch of salt.
3. Bryndza gnocchi - Clean the potatoes and grate finely. Add one egg and season with salt. Stir. Gradually add gluten-free flour to the mixture and keep stirring until you have a thicker batter. Boil water and salt on the stove, you can add a little oil. Push the previously prepared gnocchi mixture through a sieve into the boiling water. Cook until the gnocchi float to the surface (about 10 min). Strain, rinse with cold water so they don't stick. Serve with bryndza or sour cream. For a classic flavouring, use browned bacon.
4. Gluten-free pancakes - Add one egg, gluten-free flour, baking powder, a pinch of salt and one tablespoon of sugar to milk (preferably lactose-free). Mix the mixture thoroughly with a whisk or blender. Brush the pan lightly with olive oil and add the required amount of mixture. Spread it around the perimeter of the pan and fry on both sides. Spread the finished pancake with gluten-free jam. You can also add fruit.
5. Gluten-free fancies - Prepare a batter with gluten-free flour, eggs, hera, cottage cheese. Add two tablespoons of sour cream, baking soda. You can flavor with a tablespoon or two of rum. Mix the mixture well and let it rest for one hour. Roll out the dough on a board dusted with gluten-free flour to a thickness of 2 mm. Cut the dough into small diamonds with a knife, making two smaller cuts in the center of the diamond. Bake the fancies in oil or lard until they are brown. After baking, dust the surface with stevia.

Tasty dinner

1. babiččiny škubánky se strouhankou – Ve větším hrnci uvaříme brambory. Zbavíme je slupky a nastrouháme. Přidáme bezlepkovou krupici, jedno vajíčko, půlku másla a dochutíme špetkou soli. Směs smícháme a vypracujeme z ní těsto. Na prkénku pomoučeném bezlepkovou moukou vytvarujeme z těsta škubánky. Hotové škubánky hodíme do vroucí vody, dokud nevyplavou na povrch. Přecedíme přes sítko. Na drobenku použijeme bezlepkovou strouhanku, kterou osmahneme na pánvi. Přidáme moučkový cukr nebo stévii a zamícháme. Škubánky obalíme v drobence a můžeme je pokapat troškou rozpuštěného másla.
2. bezlepkové špagety s rajčatovou omáčkou (italský způsob) - Na pánvi s olivovým olejem si osmahneme tři až čtyři rozmačkané stroužky česneku. Přidáme nadrobno nakrájená rajčata bez slupky, chvilku osmahneme a podlijeme troškou vody. Vaříme doměkka, dokud nebudou rajčata poddajná. Můžeme je rozmixovat tyčovým mixérem. Do horkých rajčat přidáváme nastrouhaný sýr, který se musí úplně roztát. Směs osolíme, přidáme špetku pepře a vypeckované, na kroužky nakrájené olivy. Povaříme, přidáme oregano a bazalku. Ve vedlejším hrnci si připravíme bezlepkové špagety. Hotové špagety podáváme s omáčkou a nastrouhaným sýrem.
3. Duck liver stuffed lokše - Boil the potatoes, peel them and grate them. Add gluten-free flour to the potato mixture so that the dough does not stick and is not too full of flour. Divide the finished potato dough into small loaves. Roll out the individual loaves and fry them in a frying pan. In another pan, fry the onion in oil, add the cleaned duck liver and cook slowly until soft. At the end, pepper and salt. Spread the liver on one side of the lokše and roll up the lokše. Serve.
4. brynzové pirohy – Brambory uvaříme v hrnci, zbavíme je slupky a rozmixujeme. Přidáme špetku soli a bezlepkovou mouku, dokud nevytvoříme těsto. Hotové těsto rozválíme na prkénku pomoučeném bezlepkovou moukou. Z těsta vykrojíme sklenicí malé kroužky. Do středu kroužků dáme posolenou a dochucenou brynzu dle vlastního uvážení a překlopením půlky těsta na druhou stranu vytvoříme měsíčky. Konce popřitlačujeme vidličkou. Hotové pirohy hodíme do vroucí vody, dokud nevyplavou na povrch. Přecedíme. Podáváme se zakysanou smetanou a osmaženou slaninkou nebo osmaženými kroužky cibule.
5. Panini - Take two slices of gluten free bread and brush the inside of the bread with olive oil. Brush one inside of the bread with tomato pesto. Add ham, sandwich cheese, mozzarella cheese, vegetables (cucumber, olives, basil). You can add ingredients of your choice. Combine the sandwiches and bake in the oven or toaster oven.