Who are Coeliacs?
Coeliac disease is a medically diagnosed condition of an intolerance to gluten in the diet. Gluten is the protein component of wheat, rye, barley and oats. In people with coeliac disease, after consuming gluten, the small intestinal lining (villi) becomes inflamed and the normal appearance changes so that it has a flattened appearance. A strict gluten-free diet can reverse these abnormalities, and is the only recognised treatment for coeliac disease.
Prevalence of coeliac disease is likely to be underestimated, and is probably in the region of 1 in 100, with diagnosis rates increasing. Coeliac disease also occurs in 10% of first-degree relatives.
It is becoming increasingly evident that there are a broad range of symptoms of coeliac disease. Increasing numbers of adults are being diagnosed, whereas years ago it was considered a disease that was only diagnosed in children. Coeliac disease can present at any age and the variability and often vagueness of symptoms can present a diagnostic challenge to many medical practitioners. Presentation can include:
Gastrointestinal symptoms such as:
- Loose stools/diarrhoea, or constipation (or a combination of both)
- Abdominal pain
These can often be labelled as irritable bowel syndrome. It is strongly recommended all people experiencing symptoms of irritable bowel syndrome be investigated for coeliac disease.
Alternatively, it may present with no gastrointestinal symptoms at all.
Other symptoms can include:
- Lethargy and fatigue
- Poor weight and growth gain in children
- Iron, folate, zinc, Vitamin D deficiency.
- Osteopaenia and osteoporosis. Approximately 5% of patients being investigated for reduced bone mineral density have undiagnosed coeliac disease as a cause.
- Delayed puberty
- Recurrent miscarriages in women
- Infertility (in males and females)
- Recurrent mouth ulceration
- Dental enamel defects
The gold standard for diagnosis is a small bowel biopsy (the doctors will look for histological evidence of villous atrophy +/- infiltration of lymphocytes). This involves a special camera being passed down the oesophagus, past the stomach, and into the first part of the small bowel. There, small samples of the lining of the small bowel are taken and investigated under the microscope. If the biopsy samples show flattening of the lining, then it confirms coeliac disease.
Is there a cure for Coeliac?
People with coeliac disease remain sensitive to gluten throughout their life, so in this sense they are never cured. However a gluten free diet does allow the condition to be managed effectively. A lifelong gluten free diet is the only recognised treatment for coeliac disease. By removing the cause of the disease, a gluten free diet allows the small bowel lining to heal and symptoms to resolve. As long as the gluten free diet is strictly adhered to, problems arising from coeliac disease should not return.
There is no correlation between symptoms and bowel damage, so even if asymptomatic (you have no symptoms), damage to the small bowel can still occur if gluten is ingested.
People with coeliac disease should remain otherwise healthy as long as they adhere to a diet free of gluten. Relapse occurs if gluten is reintroduced.
The gluten-free diet is a life-long diet, and strict dietary compliance is essential, even in the absence of symptoms. A gluten free diet involves a lot more than just avoiding regular bread and wheat-based pasta. It is very involved. Despite this, there are plenty of foods you can enjoy! As the diet must be strict and life-long, but to also to help ensure you are enjoying your diet safely
The Gluten Free Diet
A gluten-free diet is the only treatment for coeliac disease. It is therefore important to have a full understanding of what gluten is a which foods to avoid.
Gluten is a protein found in:
- Wheat (including spelt)
The most obvious sources of Gluten include normal bread, biscuits, cakes, pastry, pizza, pasta, batter and breadcrumbs. Beer also contains gluten (although gluten free beers are now available). Ingredients within packaged foods can also come from a gluten source. To become ingredient aware is essential.
Gluten may also be present in other foods such as confectionery, sausages and smallgoods, sauces, dressings and other condiments, canned soups, stock cubes, malted and cereal drinks, yeast extract spreads, soy milk, custard powder, icing sugar mixture, baking powder, beer, medications, etc
Now the good news….Naturally Gluten Free Food
Fortunately there are a great range of alternative gluten free products now available. This will enable you to make the transition from a wheat-based diet to gluten free easily without sacrificing good nutrition or enjoyment of food. Specialty gluten free products include gluten free pasta, breakfast cereals, breads, crispbreads, sweet biscuits and many others. The health food section of the supermarket, health food stores and other specialty outlets will stock a variable range of gluten free foods.
Gluten-free grains and starches:
(besan, urid, gram flour)
A gluten free diet involves a lot more than just avoiding regular bread and wheat based pasta. It is very involved. Despite this, there are plenty of foods you can still enjoy! For example, many food groups are gluten free already. The gluten free diet permits fruits, vegetables, plain meat, fish and chicken, legumes and lentils, most dairy foods, oils and margarines.
Gluten may also be present in other foods such as confectionery, sausages, sauces, dressings and other condiments, tinned soups, stock cubes, malted and cereal drinks, yeast extract spreads, soy milk, custard powder, icing sugar mixture, baking powder, beer, medications, etc.
People with coeliac disease can buy two types of gluten free foods;
- Those that are clearly labelled on the packet as being gluten free. These foods would normally be included in the Coeliac Society Approved Food List.
- Those that are determined to be gluten free by reading the ingredients of a packaged food, and confirming that each individual ingredient is gluten free, to then know that the whole product is safe.
Identifying the second category of foods mentioned above can be an overwhelming task! Understanding ingredients is a necessary skill and must be taught properly. To help ensure you are enjoying your diet safely and you are educated about making the correct choices and enjoying a good variety of foods, it is recommended you see a dietitian with experience in coeliac disease. Also, it is important to have access to ongoing information and support.
Publications through organizations such as the Coeliac Society of Ireland allow you to keep up to date. Make sure that you get in touch with them to keep your food list up to date.