At present, the only treatment for coeliac disease is to eliminate the foods that contain gluten, namely any food containing wheat, rye, barley or oats. Most sufferers have to avoid all traces of gluten, but some can get away with eating a small amount occasionally, and some do not have to avoid oats, which contain far less gluten than the others. However, it is very risky for coeliacs to experiment with eating gluten, even if they have avoided it for some years and are fully recovered. Some have an acute reaction to even the smallest amount, known as coeliac shock.
A few patients do not get better, even though they are very careful to avoid
gluten. This may be because their gut lining is badly damaged and needs time to repair itself. Zinc deficiency can contribute to this problem, and a zinc supplement may be useful. Continuing symptoms can also be due to lactase deficiency, a consequence of structural damage to the gut lining. Avoiding milk may help in such cases. Soya milk can be used instead, and yoghurt or cheese made from cow, sheep or goat milk can be eaten, but not cottage cheese.
Alternatively, persistent symptoms may be due to some other problem, such as a tumour, or a defective pancreas. More commonly, however, the patient turns out to have sensitivities to other foods, besides wheat. The damage done to the gut lining by coeliac disease makes it much more leaky, so other food molecules get through into the bloodstream, paving the way for food sensitivity. Soya is a common culprit, perhaps because it is so widely used in gluten-free products. Milk, fish, rice and chicken have also been known to cause this problem. They can perpetuate the damaging reactions in the gut lining long after gluten has been eliminated from the diet. In theory, any food might have this effect. An elimination diet should help to track down the offender, but this should only be tried under medical supervision.