Coeliac Disease is a lifelong condition of the small intestine (bowel), where gluten causes the immune system to produce antibodies that attack the delicate lining of the bowel, which is responsible for absorbing nutrients and vitamins from food. It used to be thought that coeliac disease affected about 1 in 1500 people, however it is now known that the condition affects up to 1 in 300 people in the United Kingdom, Europe and the USA. It is more common in some areas of the world, particularly on the west coast of Ireland, where 1 in every 100 people are thought to have coeliac disease.
Gluten is a mixture of two proteins, gliadin and glutenin. It is found in wheat, barley, rye and to a lesser extent in oats. When combined with water gluten becomes sticky resembling the consistency of chewing gum. It is gluten that gives loaves that springy, airy texture so much in demand, and that is why hard wheat with its high gluten content is used for baking. The gluten content of refined flours is also higher, hence wholemeal loaves are more dense. Modern wheat grains tend to have a higher gluten content than traditional grains to make them suitable for factory baking processes.
Gluten features highly in allergic responses, where the protein is incompletely broken down. The body may, due to inherited tendencies or incorrect weaning, have a gluten intolerance causing malabsorption of any grain that contains this protein. The lining of the intestines contain villi, tiny finger-like projections that are only visible under a microscope. They provide a large surface area over which we absorb nutrients such as vitamins, folic acid, iron and calcium. If you have coeliac disease, a reaction occurs when gluten comes into contact with the lining of the intestines. The villi are attacked by the immune system and are eventually destroyed. This means that nutrients from food pass through the digestive tract without being absorbed, which can lead to diarrhoea, vitamin and mineral deficiencies, anaemia and thin bones (osteoporosis).
Coeliac disease can be diagnosed at any age, but it is often diagnosed in babies after weaning, when cereals are first introduced into the diet. The introduction of cereal grains before the body’s enzymes can digest them can only set the stage for gluten intolerance by causing gastric irritation, antibody reaction and intestinal thinning. Wheat is often added to the average infants diet much too early, digestive enzymes necessary for starch digestion are not even present until 6 – 8 months, let alone a complex substance like gluten.
Symptoms can be varied with a general feeling of unwellness. There may be weight loss with pale, offensive diarrhoea,
constipation, abdominal bloating with wind. Half of adults with coeliac disease do not have any of these bowel symptoms. They approach their doctor because of extreme tiredness, which is a sign of anaemia due to poor absorption of nutrients. Patients also report symptoms of anxiety, depression, infertility, bone pain, mouth ulcers and a blistering, itchy skin rash mostly on the elbows and knees, called dermatitis herpetiformis.
Coeliac disease is usually diagnosed by blood test and examination of the bowel by endoscopy.
Complications of Coeliac disease include osteoporosis due to poor absorption of calcium and vitamin D, deficiency of nutrients such as essential fatty acids, iron, vitamin D, vitamin K, calcium, magnesium, zinc and folic acid. Some people with coeliac disease may be intolerant to other foods, in addition to gluten. Foods that have been reported to trigger symptoms include cows milk and soya, therefore it may be helpful to have a food intolerance test which tests for IgG antibodies.
In addition to damaging the lining of the small intestine, coeliac disease can sometimes affect other parts of the body, such as the pancreas (increasing the risk of diabetes), the thyroid gland (increasing the risk of thyroid disease), and the nervous system (increasing the risk of peripheral neuropathies and other neurological disorders). Occasionally, such damage occurs only in one or more of these parts of the body in the absence of damage to the intestines.
Nutritional Supplements that could help. (Refer to the individual supplement for cautions in use.)
|Supplement/Herb||What it does||Dosage|
|Multivitamin and mineral complex||Because the Coeliac diet is restricted, it is wise to ensure that there are no nutritional deficiencies by taking a strong, high potency multivitamin and mineral supplement. For a coeliac this is very important as nutrients are not absorbed well to start with.||as directed|
|Fish oil or Borage oil||Fat absorption is impaired in people with coeliac disease, which can cause deficiencies in essential fatty acids and fat soluble vitamins.||as directed|
|Digestive Enzymes||People with coeliac disease often produce low levels of digestive juices, particularly from the pancreas. A digestive enzyme taken with meals can help to improve digestion and the absorption of nutrients.||as directed|
Diet and Lifestyle Factors
If you have been diagnosed with coeliac disease it is essential that you follow a gluten free diet. This should enable the lining of the bowel to return to normal, symptoms will return if you start eating gluten again. This condition is now so widespread that gluten free foods are commonly available in supermarkets and health stores. Look for makes such as Orgran and True Food which specialise in gluten free foods.
Look out for hidden gluten, if a product contains wheat, rye or barley then you need to avoid it, check the following products:
Tinned soups, sauces
Crisps and similar snacks, as well as chips in restaurants.
Cooking oil (mixed vegetable oil) can contain wheat-germ oil, so use sunflower or olive oil instead.
Some medicines contain gluten, so you must check with your doctor or pharmacist before taking them.
|Foods to avoid||Alternatives|
|All products made from wheat, rye, barley. Spelt.||Products made from rice, maize, chickpea, potato, millet, soya, nuts, buckwheat.|
|All bread and flours made from the above grains.||Gluten free breads and flour mixes.|
|Cous cous, bulgar wheat, semolina||Quinoa (rich in protein & calcium), rice or tapioca|
|Biscuits and cakes||Gluten free biscuits and cakes|
|Crackers or rye crispbreads||Rice cakes|
|Baking powder||Gluten free baking powder|
|Gravy mixes and stock cubes||Gluten free gravy mixes|
|Shoyu soya sauce||Tamari Soya sauce|
|Most breakfast cereals and muesli||Puffed rice, gluten free muesli|
|Wheat pasta||Gluten free corn, rice or buckwheat pasta|
|Hydrolysed vegetable protein||Textured vegetable or soya protein|
|Noodles||Gluten free noodle snacks|
|Starch and vegetable starch||Potato starch|
|Some instant coffees||Fresh ground coffee beans or a coffee alternative|
|Mayonnaise||Gluten free mayo|
|Beer, lager, stout, whisky||Wine, cider|
|Malt vinegar, mustard|
Ensure that your diet contains plenty of fruit, salads and vegetables. You can eat nuts, red meat, chicken, fish, eggs and dairy products.
Suggested further reading:
- Coeliac explained
- What to do about it