The management of confirmed celiac disease is a life-long diet that is devoid of gluten. While this seems like a simple treatment it is often difficult for patients to comply with this dietary restriction. Factors that contribute to non-compliance include the lack of readily available gluten-free foods, particularly when eating out of the home, the less acceptable taste of gluten-free products and the difficulties associated with preparing dishes with gluten-free ingredients .
Inadvertent ingestion of gluten may occur as a result of trace amounts of gluten in a wide variety of food stuffs and medications, contamination of gluten-free products with gluten during processing and misinformation about food contents on the part of manufacturers, restaurant staff and even well-meaning friends and relatives. The diet poses particular difficulties for children, teenagers and their parents. Newly diagnosed celiacs should be encouraged to join local chapters of the various national celiac organizations. Information supplied by certain of these organizations can be superior to that provided by physicians or even dieticians since these health care workers may not have sufficient opportunity to become familiar with the dietary care of celiac patients.
There is some controversy as to what constitutes a gluten-free diet. One standard defines a product as gluten-free when the total nitrogen content of the gluten containing cereal grains used in the product does not exceed 0.05 g per 100 g of these grains on a dry matter basis. Recent studies suggest that 10 mg of gluten or less per day can be considered safe, and the new FDA labeling will take this into account. Oats have been an area of controversy since in older studies avenin (oat prolamine) was shown to activate an immune response in intestinal biopsy specimens, yet a significant number of recent studies showed that oats were well tolerated in adult and pediatric celiac patients and that avenin does not induce Th1 responses in celiac tissues [35, 73-75]. There are reports, as noted above, that challenge whether this is always the case . These suggest that a very small subset of celiacs may react to oat peptides. It is generally recommended that oats be omitted from the diet of newly diagnosed celiacs largely since there are issues of cross-contamination with most commercially available sources of oats, but oats are generally well tolerated in celiac patients in remission, and there is no strong evidence that oats should be excluded from the diet of those who tolerate them .
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