Editing Coeliac disease (section)

===Diet===
{{Main|Gluten-free diet}}
At present, the only effective treatment is a lifelong [[gluten-free diet]].<ref name=Kupper/> No medication exists that prevents damage or prevents the body from attacking the gut when gluten is present. Strict adherence to the diet helps the intestines heal, leading to resolution of all symptoms in most cases and, depending on how soon the diet is begun, can also eliminate the heightened risk of osteoporosis and intestinal cancer and in some cases sterility.<ref>{{cite journal |vauthors=Treem WR |title=Emerging concepts in celiac disease |journal=Curr Opin Pediatr |volume=16 |issue=5 |pages=552–9 |year=2004 |pmid=15367850 |doi=10.1097/01.mop.0000142347.74135.73}}</ref> Compliance to a strict gluten-free diet is difficult for the patient, but evidence has accumulated that a strict gluten-free diet can result in resolution of diarrhea, weight gain and normalization of nutrient malabsorption, with normalization of biopsies in 6 months to 2 years on a gluten-free diet.<ref>{{cite journal |vauthors=Freeman HJ |title=Dietary compliance in celiac disease |journal=World J Gastroenterol |volume=23 |issue=15 |pages=2635–2639 |year=2017 |pmid=15367850 |doi=10.3748/wjg.v23.i15.2635|doi-access= free}}</ref>

[[Dietitian]] input is generally requested to ensure the person is aware which foods contain gluten, which foods are safe, and how to have a balanced diet despite the limitations. In many countries, gluten-free products are available on [[Medical prescription|prescription]] and may be reimbursed by [[health insurance]] plans. Gluten-free products are usually more expensive and harder to find than common gluten-containing foods.<ref name="economicburden">{{cite journal |year=2007 |title=Economic burden of a gluten-free diet |url=https://celiacdiseasecenter.columbia.edu/sites/default/files/2007-Economic-Burden-of-a-Gluten-Free-Diet.pdf |journal=J Hum Nutr Diet |volume=20 |issue=5 |pages=423–30 |doi=10.1111/j.1365-277X.2007.00763.x |pmid=17845376 |vauthors=Lee AR, Ng DL, Zivin J, Green PH |citeseerx=10.1.1.662.8399 |access-date=9 February 2018 |archive-url=https://web.archive.org/web/20150624043919/http://www.celiacdiseasecenter.columbia.edu/sites/default/files/2007-Economic-Burden-of-a-Gluten-Free-Diet.pdf |archive-date=24 June 2015 |url-status=dead }}</ref> Since ready-made products often contain traces of gluten, some coeliacs may find it necessary to cook from scratch.<ref name=Troncone2008>{{cite journal |vauthors=Troncone R, Ivarsson A, Szajewska H, Mearin ML |title=Review article: future research on coeliac disease – a position report from the European multistakeholder platform on coeliac disease (CDEUSSA) |journal=Aliment. Pharmacol. Ther. |volume=27 |issue=11 |pages=1030–43 |year=2008 |pmid=18315588 |doi=10.1111/j.1365-2036.2008.03668.x }}</ref>

The term "gluten-free" is generally used to indicate a supposed harmless level of gluten rather than a complete absence.<ref name=Akobeng2008>{{cite journal |vauthors=Akobeng AK, Thomas AG |title=Systematic review: tolerable amount of gluten for people with coeliac disease |journal=Aliment. Pharmacol. Ther. |volume=27 |issue=11 |pages=1044–52 |date=June 2008 |pmid=18315587 |doi=10.1111/j.1365-2036.2008.03669.x |doi-access=free}}</ref> The exact level at which gluten is harmless is uncertain and controversial. A recent [[systematic review]] tentatively concluded that consumption of less than 10&nbsp;mg of gluten per day is unlikely to cause histological abnormalities, although it noted that few reliable studies had been done.<ref name=Akobeng2008/> Regulation of the label "gluten-free" varies. In the European Union, the [[European Commission]] issued regulations in 2009 limiting the use of "gluten-free" labels for food products to those with less than 20&nbsp;mg/kg of gluten, and "very low gluten" labels for those with less than 100&nbsp;mg/kg.<ref>{{cite web |title=Gluten-free food |publisher=[[Directorate-General for Health and Consumers]] |access-date=25 July 2015 |url=http://ec.europa.eu/food/safety/labelling_nutrition/special_groups_food/gluten/index_en.htm |url-status=live |archive-url=https://web.archive.org/web/20150723135842/http://ec.europa.eu/food/safety/labelling_nutrition/special_groups_food/gluten/index_en.htm |archive-date=23 July 2015}}</ref> In the United States, the [[Food and Drug Administration|FDA]] issued regulations in 2013 limiting the use of "gluten-free" labels for food products to those with less than 20&nbsp;[[parts per million|ppm]] of gluten.<ref name="fda2013-08">{{cite web |url=https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363069.htm |title=What is Gluten-Free? FDA Has an Answer |date=2 August 2013 |publisher=[[Food and Drug Administration]] |access-date=2 August 2013 |quote=As one of the criteria for using the claim 'gluten-free,' FDA is setting a gluten limit of less than 20 ppm (parts per million) in foods that carry this label. This is the lowest level that can be consistently detected in foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods with very small amounts of gluten. This level is consistent with those set by other countries and international bodies that set food safety standards. |url-status=live |archive-url=https://web.archive.org/web/20130804202647/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363069.htm |archive-date=4 August 2013 }}</ref><ref>Section 206 of the Food Allergen Labeling and Consumer Protection Act of 2004, Title II of {{USStatute |108|282|118|891 |2004|08|02}}</ref><ref>{{USFR|78|47154}} (5 August 2013). Codified at {{USCFR|21|101|91}}.</ref> The current international [[Codex Alimentarius]] standard allows for 20&nbsp;ppm of gluten in so-called "gluten-free" foods.<ref name=CodexOfficial>{{cite web |publisher=FAO/WHO |title=Current Official Standards |url=http://www.codexalimentarius.net/web/standard_list.jsp |archive-url=https://web.archive.org/web/20110604194807/http://www.codexalimentarius.net/web/standard_list.jsp |archive-date=4 June 2011}}</ref>

Gluten-free diet improves [[Quality of life (healthcare)|healthcare-related quality of life]], and strict adherence to the diet gives more benefit than incomplete adherence. Nevertheless, gluten-free diet does not completely normalise the quality of life.<ref>{{cite journal |vauthors=Burger JP, de Brouwer B, IntHout J, Wahab PJ, Tummers M, Drenth JP |title=Systematic review with meta-analysis: Dietary adherence influences normalization of health-related quality of life in coeliac disease |journal=Clinical Nutrition |volume=36 |issue=2 |pages=399–406 |date=April 2017 |pmid=27179800 |doi=10.1016/j.clnu.2016.04.021}}</ref>