Diet & Nutrition

The good news is that you can control celiac disease very easily by avoiding foods that contain gluten. By following a gluten-free diet, you can help your body to repair the damage to your intestines and live a normal, healthy life.

Remember that you will have to follow the gluten-free diet every day for the rest of your life. Eating small amounts of gluten, even if you don’t have any symptoms, can do further damage to your body.

If you are having diarrhea and/or other stomach problems caused by celiac disease, the following tips might be helpful for you:

• Decrease your intake of high fat foods such as fried foods and snacks.
• Eat fewer dairy products, such as milk, yogurt, and cheese. Many people with celiac disease also have trouble digesting lactose, a sugar found in dairy products. These products can be added back into your diet slowly, as your stomach discomfort gets better.
• Discuss with your doctor the idea of taking a multivitamin to replace some nutrients that may have been lost through diarrhea.

The following table will help you to choose gluten-free foods:

Gluten-Free Diet Recommendations

Grains are used in processing many foods, so read labels carefully. The following tips will help you to find “hidden gluten” on food labels.

Avoiding “Hidden” Gluten

In certain medical conditions (Crohn’s disease, Ulcerative colitis, diverticulitis, hemorrhoids etc.) and/or before and after abdominal/intestinal surgeries or cancer treatments it is important to restrict fiber intake and avoid foods that increase bowel activity. This diet may also be used to treat diarrhea and to reduce the possibility of intestinal blockage when the intestines are narrowed for any reason. A low residue diet typically contains less than 10 grams of fiber per day. Extended use of this diet may not provide required amounts of vitamin C, calcium, and folic acid because of the lack of fruits and vegetables. Supplements may therefore be recommended. It is also important to stay well hydrated, especially during active disease. Many low fiber/low residue products are available in the health food or organic sections of most grocery stores.

Foods to avoid:

• Whole grain breads and pastas, corn bread or muffins, products made with whole grain products, bran, seeds, or nuts
• Strong cheeses, yogurt containing fruit skins or seeds
• Raw vegetables and pickles
• All beans, peas, and legumes
• Fruit peels and hard fruits
• Tough meat, meat with gristle
• Crunchy peanut butter
• Nuts, seeds and popcorn
• Millet, buckwheat, flax, oatmeal
• Dried fruits, berries, other fruits with pulp or seeds
• Food containing chocolate, coconut
• Juices with pulp
• Highly spiced food and dressings, pepper, hot sauces
• Caffeine

The following information should help guide you through the process of increasing the amount of fiber in your diet.

What is fiber?

Fiber is found in plants and is generally not digested or absorbed by the body. Many different types of fiber exist. They can be separated into two broad categories. Each has a role in promoting good health. The two types of fiber are water soluble and water insoluble.

Water soluble fibers can aid in the treatment of high cholesterol levels, diabetes and obesity. By forming a gel, water soluble fibers stay in your stomach longer and help slow food absorption. Water-soluble fibers are found in oats, bran, dried beans, potatoes, seeds, apples, oranges, and grapefruit.

Insoluble fibers hold water to produce softer, bulkier stools. These fibers are found in wheat and corn brans, nuts and many fruits and vegetables. By promoting better regularity, a diet high in insoluble fibers helps relieve constipation and control diverticular disease. People with diverticular disease are encouraged to eat a high fiber diet. The latest data show that one need not avoid pits, nuts, or seeds with diverticulosis. Actually, as reported in a study of men only, popcorn and nuts may be protective against both diverticulitis and diverticular bleeding.

Insoluble fibers may also help in preventing colon cancer.

Fiber and Weight Loss

High fiber foods offer a great plus for dieters! Many high fiber foods are naturally bulkier and more filling than refined foods; you tend to eat consume less calories on high fiber diets.

Avoiding Problems with Increasing Fiber

When increasing your dietary fiber, remember to include a variety of soluble and insoluble fiber food sources including whole grain breads and cereal, fruits and vegetables. While increasing your dietary fiber you should also drink at least 8 cups of fluid every day. Remember that water, milk, juice and decaffeinated sodas, teas and coffee are also sources of fluid.

People who typically eat low fiber diets may experience increased flatulence (gas from below), bloating and occasionally diarrhea when they begin to eat large amounts of fiber all at once. To prevent these discomforts, the amount of fiber in your diet should be gradually increased.

The amount of fiber in your present diet can be estimated with the charts below. Estimate your present fiber intake and increase your weekly fiber intake by 2-4 grams. Thus, if in Week 1, you have a base fiber content of 20 grams/day you would try to increase the amount of fiber to 22-24 grams/day for the first week. Then, in Week 2, the total fiber would be 24-28 grams/day. You can determine the amount of fiber added per day that works best for you. This should be based upon the amount of gas and bloating you experience with the dietary changes. If there is too much gas and bloating, then decrease the amount of fiber.

Remember, the overall goal is to increase the fiber in your diet gradually and maintain this over a lifetime.

Dietary Fiber Values

Breads and Pastas

Flours and Grains

Cereals

Cooked Vegetables

Raw Vegetables

Legumes

Snacks

Fruits

DESCRIPTION

The soft/ bland diet consists of foods that are easily digestible, mildly seasoned and tender. Fried foods, highly seasoned foods and most raw gas-forming fruits and vegetables are eliminated. Drinks containing Xanthine and alcohol should also be avoided.

What changes can I make?

If you are highly lactose intolerant and not able to digest any lactose, you’ll likely have to make some major changes in your eating habits, to remove all dairy and dairy-derivative ingredients from the foods you eat. Most people, however, are not completely lactose intolerant and can live quite comfortably by making a few modifications to the foods they choose.

• Lactase supplements. There are a variety of lactase supplements available over-the-counter today, made especially for those who have a hard time digesting lactose. They contain the enzyme lactase, which is either missing from your digestive tract, or isn’t there in sufficient quantities. By adding lactase, you are helping your body digest the lactose in foods. The most common brand name of lactase supplement is Lactaid, but similar products are made by a number of manufacturers, and many large chain stores also market this under their “house brand” names.
• Lactase caplets (or tablets): Take this supplement just before meals containing dairy ingredients and you will have a much easier time digesting your food. Available in caplets and chewable tablets.
• Lactase drops: Add these drops to a container of milk to begin breaking down the milk sugars before you drink it.
• Lactase-added milk: Lactaid sells pre-mixed milk in the dairy section of your grocery store that already contains the lactase enzyme. This may be more expensive than regular milk.

Other options:

• Yogurt: Yogurt contains a live bacteria culture, called acidophilus, which begins breaking down milk sugars. Many people who can’t drink milk find that they can tolerate yogurt well.
• Sweet Acidophilus Milk: Sold in cartons in the dairy section at your grocery store, this milk contains the same acidophilus bacteria found in yogurt, so it has milk sugars that have already begun breaking down into simpler sugars your system can digest. The cost is similar to regular milk, and it tastes like regular milk.
• Soy Milk/Cheese/Yogurt: In the past, these foods were only available at health-food stores, but today you can also find a small selection at your neighborhood grocer. Some are located on the shelf right next to their milk-based counterparts (like yogurt), while others are located in special sections of the store alongside foods for people with other special health concerns (like sugar-free foods, organic products, etc.). Soy milk may be refrigerated, or in cartons on a store shelf.
• Cheese: (especially aged cheese, like cheddar or parmesan) contains little lactose, and many people who can’t drink milk find they can digest small quantities of cheese, especially if eaten with other foods, rather than alone.
• Lactose-free or Reduced Lactose foods: Several manufacturers have begun selling lactose-free versions of dairy foods, such as cheeses, as well as lactose-free foods that typically contain dairy ingredients, such as cookies, puddings, and salad dressings. Look for these in the same places you might find soy-based products. (See above.)
• Eating or drinking dairy products in smaller quantities. Have fewer glasses of milk in a day, and/or smaller amounts in each glass, or maybe a glass in the morning and one with dinner, and have a yogurt (which is easier to digest) at lunch time.
• Eating or drinking dairy products along with other foods. Many people find they can tolerate dairy products if they consume them along with other non-dairy foods. For instance, someone who can’t drink a large glass of milk might be able to eat a bowl of cereal with milk poured on it, or eat cheese when it’s on a pizza, but not cheese alone.
• Look at recipes from other cultures for new ideas. A large percentage of people from Asia and Africa are lactose intolerant, so many of the recipes originating from these regions are high in protein and other necessary nutrients, but contain little or no dairy ingredients.

Good sources of calcium

When planning meals, make sure that each day’s menu includes enough calcium, even if you’re not eating any dairy products. Many nondairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are excellent sources of calcium. To help in planning a high-calcium and low-lactose diet, the table below lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

Recent research shows that yogurt with active cultures may be a good source of calcium for many people with lactose intolerance, even though it is fairly high in lactose. Evidence shows that the bacterial cultures used to make yogurt produce some of the lactase enzyme required for

Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives. Available at: www.soyfoods.org. Accessed March 5, 2002.

Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. However, factors other than calcium and lactose content should be kept in mind when planning a diet. Some vegetables that are high in calcium (Swiss chard, spinach, and rhubarb, for instance) are not listed in the chart because the body cannot use the calcium they contain. They contain substances called oxalates, which stop calcium absorption.

Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun, food sources may not be necessary.

Watch for Hidden Lactose

Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as:

• bread and other baked goods
• processed breakfast cereals
• instant potatoes, soups, and breakfast drinks
• margarine
• lunch meats (other than kosher)
• salad dressings
• candies and other snacks
• mixes for pancakes, biscuits, and cookies
• powdered meal-replacement supplements

Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose.

Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents, but also for such words as:

• butter
• cheese
• cream
• dried/powdered milk
• lactose
• whey
• curds
• milk by-product

If any of these are listed on a label, the product contains lactose.

In addition, lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.

The esophagus is a tube that connects the throat and the stomach. At the bottom of the esophagus, there is a valve that usually prevents acid from washing up from the stomach. A muscle usually keeps this valve tightly closed.

Some foods cause the muscle at the bottom of the esophagus to relax. Other foods cause the stomach to create more acid. This diet is designed to avoid these foods. Choose your foods according to the Food Guide Pyramid to meet your needs.

GERD-Friendly Diet Recommendations

* Fat can be skimmed from the top of soups and stews when they are hot or cold.