Coeliac disease (pronounced see-liac) is a relatively common auto-immune disease in which an individual is intolerant to the protein gluten. This means that in the event a person with this intolerance consumes any foods containing the protein, the immune system will launch an attack on itself and will potentially cause some damage to the lining of the small intestine, preventing the body from effectively absorbing the necessary nutrients.
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The nature of coeliac disease
The severity of symptoms and side effects will vary from person to person but can include abdominal pain, bloating, malnutrition and diarrhoea.
Up until the 1980s it was believed that coeliac disease was quite rare, that was until significant developments were made in testing for the condition, which according to the charity Coeliac UK is thought to affect 1 in 100 people, though many of those individuals remain undiagnosed.
In some sufferers symptoms are very mild, meaning that their case either goes undiagnosed, or it is misdiagnosed as another digestive disorder or food intolerance.
The exact cause of this auto-immune disease remains unknown, though experts do believe it could be related to a variety of environmental and genetic factors in combination.
Gluten, meaning 'glue' in Latin, is a protein composite found in grass like grains such as barley, wheat and rye. It provides elasticity to dough which helps bread to rise and remain chewy, as well as acting as a binding agent which holds flour products together.
Gluten is most commonly found in products derived from grains such as bread, cereals, pasta, flour and biscuits, but is also present in a variety of other foods such as ready meals, sauces, soups and some processed meats.
In recent years the UK has come to rely heavily on gluten in order to obtain the desired texture of food, though studies are emerging which suggest that the human body may actually have more difficulty digesting the protein than was initially thought.
Though there is little scientific evidence to support this theory, some researchers believe that issues with digesting gluten are related to evolutionary development and are of the opinion that the reason coeliac disease is far less prevalent in countries that have been consuming grains for a longer period, is because they have fully developed the ability to digest gluten.
The National Institute for Health and Clinical Excellence (NICE) established a set of guidelines in 2009, intended to help medical professionals with the diagnosis of coeliac disease. Key recommendations featured in the guidelines suggest that adults and children displaying the following symptoms should be tested:
- abdominal pains
- bloating or cramping
- chronic/regular diarrhoea
- gastrointestinal symptoms such as nausea and vomiting
- unexplained weight loss.
The guidelines also advise that individuals suffering from under or overactive thyroid glands, irritable bowel syndrome, type 1 diabetes, or dermatitis herpetformis (an itchy rash sometimes caused by intolerance to gluten) undergo testing to determine whether or not they have coeliac disease.
Individuals who have experienced more than one incidence of miscarriage, infertility, sudden and unexplained weight loss, or those suffering from epilepsy, bone diseases, Turner syndrome, Sjogren’s syndrome, lymphoma, Downs syndrome or Addison’s disease may also require testing in certain circumstances:
The screening itself is a process which is made up of two parts, the former of which is a blood test which assists in the identification of people who may have coeliac disease, and the latter is a gut biopsy which confirms the diagnosis.
The blood test will typically be carried out by your GP and involves a small sample of your blood being extracted so that it can then be tested to see whether it contains some specific antibodies, which usually appear in the bloodstream of coeliac disease sufferers. Though it is rare, there are some cases in which these antibodies are not present in a person with coeliac disease.
Individuals who are to be tested for coeliac disease should make sure they are not avoiding the consumption of gluten, as removing it from your diet prior to testing could result in inaccurate test results and misdiagnosis.
If your GP does identify coeliac disease antibodies within your bloodstream the next step is referral for a biopsy of your gut.
Unlike the blood test which can be carried out at your local GP surgery, a gut biopsy will have to be performed in hospital, usually carried out by a stomach specialist known as a gastroenterologist.
The procedure is carried out using an endoscope, which allows the inside of the body to be examined internally. A long, thin, flexible tube will be inserted into the body via the mouth, after which it is threaded down into the small intestine. The process is usually carried out whilst the patient is awake so in order to promote relaxation and prevent discomfort, local anaesthetic will be given as a sedative to numb the throat.
Once the endoscope has reached the small intestine, the minute cutting tool positioned on the end will be used to extract a very small piece of tissue which can be examined back in the laboratory for any signs of coeliac disease.
In the event you are found to have coeliac disease your healthcare provider may recommend that you undergo additional tests in order to establish what effects the condition has already had on your body.
In some cases, coeliac disease can lead to the development of anaemia due to poor digestion, so it is not uncommon for additional blood tests to be carried out to check vitamin and mineral levels.
Other tests may include a skin biopsy to confirm cases of dermatitis herpetiformis and a DEXA scan to measure your bone density. In coeliac disease, nutrient deficiencies which are caused by poor digestion can result in osteoporosis (brittle and weak bones), and a DEXA scan may be required if your GP thinks your condition may have already caused damage to your bones.
Coeliac disease management
As it stands there is no known cure for coeliac disease and treatment is a case of excluding any foods which contain gluten from your diet, indefinitely. Sufferers who continue to eat gluten once they have been diagnosed are at risk of causing damage to the lining of their intestines and may be increasing their risk of developing a variety of long-term complications such as anaemia, infertility and osteoporosis.
Switching to a gluten free diet may sound like a daunting prospect but individuals could start to see an improvement in their symptoms within a matter of weeks. Taking gluten out of your diet will also mean the digestive system has a chance to start rectifying the damage caused, with the healing process thought to take an average of two years to complete.
Gluten is present in a variety of everyday foods that individuals who are new to the disease may have taken for granted previously. If you have recently been diagnosed with the condition and are concerned about the foods you will have to cut from your diet, what you should be substituting them with and what you should be eating from here forward, then a qualified nutritionist may be able to provide you with help and advice about ways to manage a gluten free diet.
Your GP may refer you to a nutritionist or you may decide to seek help independently. Either way, a nutritionist may be able to help you adjust to your new diet and will monitor your progress, the balance of your diet and your vitamin, mineral and nutrient intake.
Gluten is not actually an essential component of the human diet and this means it can be replaced with other foods. Basic foods such as meat, vegetables and rice are all free from gluten and can be included in your diet without causing gluten-related problems. It is foods containing or derived from wheat, barley and rye which will be off limits, although many supermarkets and health food stores now stock a gluten free foods range, offering other products that can be used as substitutes.
Your nutritionist will try to help you to identify which foods are safe to eat and which foods are not, and could also provide you with helpful information about gluten free recipes, eating out, snacking, planning meals, and making packed lunches for children with coeliac disease. If you do come across a food type and are unsure about whether or not it contains gluten then you may find the following guide to be of use.
Unless they are labelled as gluten-free, your GP or nutritionist may advise you to be wary of the following:
- beers, lagers, stouts and ales
- barley water drinks (e.g. fruit and barley squash)
- biscuits or crackers
- cakes and pastries
- packet and jar gravies and sauces
In addition to the food and drink listed you should also read the labels on the foods you buy. Many processed foods contain gluten in the form of additives such as modified food starch.
Eating gluten by mistake
Learning to follow a strict gluten-free diet is a learning curve, not only for you but also for the people around you such as your friends and family. It will take some time to get used to, and along the way you may make the odd mistake or two.
If you do eat gluten accidentally then you may experience immediate symptoms which last for a short period of time, or onset may be slightly delayed and symptoms may last a few days. It really depends what you have eaten, how much of it and how sensitive you are. However, if you make the occasional mistake and eat gluten by accident, it is unlikely to cause lasting damage to your gut.
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