What is coeliac disease?
Coeliac disease is an autoimmune condition in which consumption of gluten – a protein found in wheat, barley and rye – triggers an immune response. The immune system mistakes the gluten for a hostile organism and causes an inflammatory reaction, damaging the lining of the small intestine and interfering with the absorption of nutrients.
What are the symptoms?
The symptoms of coeliac disease vary from person to person and can range from very mild to severe. Potential symptoms include any of the following:
- Diarrhoea (more than three loose stools per day)
- Excessive wind
- Persistent, unexplained nausea
- Recurrent stomach pain, cramping or bloating
- Vitamin deficiencies
- Tiredness and/or headaches
- Mouth ulcers
- Weight loss
The affected area of the intestine may be patchy, leading to only very mild symptoms or even no symptoms at all . Many adults with subtle disease experience only mild fatigue or anaemia. Due to the wide range of potential symptoms and overlaps with other common digestive complaints (such as irritable bowel syndrome and wheat intolerance), large numbers of coeliac cases remain undiagnosed or misdiagnosed.
In babies, symptoms may appear shortly after they have been weaned onto solid foods, including cereals which contain gluten. The baby may fail to gain weight after previously growing well and start show signs of muscle wasting in the arms and legs. As their food is not being absorbed properly, their stools may become pale and bulky and diarrhoea might occur. The abdomen may become bloated and swollen and the baby may experience repeated vomiting.
The cause of coeliac disease is unknown, although it is thought to be associated with a mix of genetic and environmental factors. It is most common in individuals who have a close family member with the disease and those who suffer from other autoimmune diseases – such as hypothyroidism, type-1 diabetes and rheumatoid arthritis. It is more prevalent in women than in men. It is not currently known whether intolerance to gluten is present at birth or develops later on in life.
In cases where coeliac disease is suspected, a blood test to detect a specific antibody may be suggested in order to confirm a preliminary diagnosis. It is important that a diet including gluten is followed for at least six weeks before this blood test is performed in order for the antibodies to be detected. Professional guidelines recommend that a positive blood test is followed by an endoscopy (visual examination using a long tube) and tissue biopsy. Further investigations may also be performed to identify related complications such as anaemia, calcium deficiency and hypothyroidism.
A small proportion of patients with symptoms of IBS have underlying coeliac disease, and screening for coeliac disease is therefore recommended by NICE for those with IBS symptoms.
The only known effective treatment for coeliac disease is a lifelong gluten-free diet, which prevents the damage to the lining of the intestines and reduces associated gastrointestinal symptoms. Symptoms should improve considerably within weeks of starting a gluten-free diet, although it can take up to two years for the digestive system to completely heal. It is important to comply to the diet strictly, as even consuming small amounts of gluten can sensitise the gut and cause symptoms to return.
In addition to avoiding gluten you may be advised to take vitamin supplements such as iron, calcium and vitamin D following diagnosis (depending on the level of deficiency and grade of the diagnosis) in order to address any deficiencies and ensure that you obtain sufficient nutrients whilst the gut lining heals. Testing may be repeated several times in the first year following diagnosis, along with bone scans and biopsies to track progress and monitor risk of complications.
Foods to avoid
If you have been diagnosed with coeliac disease, you should always check the ingredients on any pre-prepared foods that you buy. Many processed foods contain gluten in additives, such as malt flavouring and modified food starch.
You must not eat any of the following unless they are labelled as gluten-free:
- Biscuits or crackers
- Cakes, pastries and pies
- Foods in batter or breadcrumbs
- Alcoholic drinks containing barley (such as beer and lager)
Wheat must be avoided, as well as wheat sub-species (such as spelt, semolina and durum) and related species such as barley and rye which will also induce symptoms. Some coeliac patients also react to oats as they are often contaminated with wheat during processing. Maize (corn), millet, amaranth, rice, and wild rice are safe for patients to consume, as well as quinoa and buckwheat.
You can buy special gluten-free flour, pasta, bread and other snack foods to eat as alternatives; look for the ‘Free-From’ ranges in your local supermarkets. You may also be able to obtain the basics on prescription following a confirmed coeliac diagnosis. However, it is important to be aware that these pre-prepared ‘convenience’ products can be expensive and highly processed, meaning they are often low in nutritional value. Health food shops and specialist online companies may be able to offer more reasonably priced, wholesome alternatives.
If successfully diagnosed, the outlook for coeliac disease is generally good. However, the prognosis for untreated coeliac disease can range from moderate to poor. Without treatment, coeliac disease can cause a wide range of potential long-term complications such as malnutrition, osteoporosis, infertility and growth defects. Some research has also suggested that having coeliac disease can increase your risk of developing certain types of cancer, including cancer, intestinal lymphoma and cancer of the oesophagus.
It is important to seek advice from your GP if you suspect you are suffering from coeliac disease. Do not simply attempt to treat yourself with a gluten-free diet unless you have received a confirmed diagnosis; is important to ensure you receive the appropriate medical follow-up and support in order to make a full recovery.
© Sarah West Nutrition