Gluten-Free and Not Feeling Well?

The following articles can help you know what to expect during your recovery from CD, and
give you an idea of what might be wrong if you are not doing well.

Additional recommendations to help you
make a full recovery from Celiac Disease

"Why Symptoms Persist - I'm on the diet and not getting better"
Chapter 16 of "Celiac Disease: a hidden epidemic"

Effect of a Gluten-Free Diet on Gastrointestinal
Symptoms in Celiac Disease

Etiology of nonresponsive Celiac Disease:
results of a systematic approach

Histologic Follow-up of People with Celiac Disease
on the Gluten-Free Diet: slow and incomplete recovery

Vitamin D has been recently demonstrated to play an important role in
intestinal mucosal barrier maintenance (1, 2)

Effect of Elemental Diet on ... type 1 refractory Celiac Disease

Update on the Management of Refractory Coeliac Disease

Differential Diagnosis of Persisting Villous Atrophy

Protein Intolerance
From this article: dairy, soy and egg protein are the most common problems.
"The simplest type of elimination diet is elimination of suspected food antigens from the diet for 2-4 weeks or longer."

Mucosal Reactivity to Cow's Milk Protein in Coeliac Disease

AGA Technical Review on the Evaluation of Food Allergy in Gastrointestinal Disorders
See page 9 of the pdf for a discussion of elimination diets

A good description of elimination diets

AGA Medical Position Statement: Guidelines for the Evaluation of Food Allegies

Clinical Aspects of Gastrointestinal Food Allergy in Children

Effect of six-food elimination diet on clinical and histologica outcomes in eosinophilic esophagitis

Food Allergy Clinic at Cincinnati Children's Hospital

Quote from Textbook of Gastroenterology (2003, emphasis mine):
"Small amounts of antigenic macromolecules normally penetrate the gastrointestinal mucosal barrier and reach the systemic circulation, occurring more in early life and in conditions causing disruption of the mucosal defenses".

Note: Exposure to gluten increases intestinal permeability in everyone, although there tends to be a greater increase in people with CD (References 1 2). Increased intestinal permeabilitly may make people with CD more likely to have developed other food intolerances and allergies

Alterations in Intestinal Permeability

Small Intestinal Bacterial Overgrowth
from MedicineNet.com

Uninvited Guests: The Impact of Small Intestinal
Bacterial Overgrowth on Nutritional Status

Celiac Disease and Recurrent Pancreatitis
This article shows the connection between Celiac Disease,
Sphincter of Oddi Dysfunction (aka papillary stenosis) and pancreatitis

Risk of Pancreatitis in 14,000 Individuals with Celiac Disease

Sphincter of Oddi Dysfunction: diagnosis and treatment
Treatment of Sphincter of Oddi Dysfunction by ERCP with manometry/sphincterotomy
is best done at a specialist such as Stuart Sherman at Indiana University