top of page
Search

Understanding Coeliac Disease

  • Writer: William Stivaletta
    William Stivaletta
  • Sep 7, 2023
  • 9 min read

Updated: Sep 8, 2023

Hello everyone!


Welcome back to my blog, where I explore a wide range of topics to keep you informed and engaged.


This week, I dive into - Coeliac Disease.


'Coeliac' comes from the Greek word koiliakos, which means suffering in the bowels.


Coeliac Disease isn't just a food allergy or intolerance; it's an autoimmune condition that deserves our attention and understanding.


In this blog post, I'll explore the key differences between coeliac disease, food allergies, and food intolerances, its symptoms, diagnosis, treatment, and more.


Photo by Karyna Panchenko: https://www.pexels.com/photo/brown-wooden-spoon-with-brown-wheat-grains-11034657/
Photo by Karyna Panchenko

Coeliac Disease vs. Food Allergies and Intolerances:


First and foremost, let's clarify the difference between coeliac disease, food allergies, and food intolerances.


Coeliac disease is an autoimmune condition.

When someone with coeliac disease consumes gluten, it triggers their immune system to attack and damage their own tissues, particularly the intestine lining. These attacks lead to damage to the villi, small fingerlike projections that line the small intestine, and promote nutrient absorption. This damage can lead to nutrient absorption issues.


In contrast, food allergies involve an immune system reaction, often causing immediate symptoms like itching, swelling, vomiting, or diarrhoea.


Food intolerances, on the other hand, do not involve the immune system and can manifest in various symptoms.


What is gluten?

<a href="https://www.freepik.com/free-photo/gluten-free-food-various-pasta-bread-snacks-wooden_9970874.htm#query=gluten&position=2&from_view=search&track=sph">Image by master1305</a> on Freepik

Gluten is a complex mixture of proteins found in specific grains, primarily wheat, but it's also present in barley and rye. It's important to note that "gluten" is used as a generic term to encompass all the proteins derived from the grains.


Gliadins: Gliadins are proteins found in wheat.


Secalins: Secalins are proteins found in rye.


Hordeins: Hordeins are proteins found in barley.


Avenins: Oats contain a protein known as avenins, which share similarities with gluten proteins. However, their place in the gluten-free diet is not uniform, and individual tolerance should be assessed.


These gluten proteins are the secret behind the success of wheat flour in baking. They give the dough its unique viscoelastic properties, making it suitable for various baked goods. Gluten is responsible for the chewy texture of bread and its ability to trap air, resulting in dough rising during fermentation.


While wheat, barley, and rye are the primary sources of gluten or gluten-like proteins, some other grains also contain similar components, often with different names:


Triticale is a hybrid grain created by crossbreeding wheat and rye. It does contain gluten and is not suitable for individuals with gluten-related disorders.


Spelt, an ancient wheat variety, contains gluten. It is not recommended for those with gluten intolerance or coeliac disease.


Kamut is another ancient wheat variety that contains gluten. People with gluten-related disorders should avoid it.

Photo by Anton Uniqueton: https://www.pexels.com/photo/person-making-dough-on-brown-wooden-table-6852939/
Photo by Anton Uniqueton

Symptoms and Risk of Coeliac Disease and Nutritional Implications


The symptoms of coeliac disease can vary widely.


In children, it may result in diarrhoea, vomiting, or difficulty gaining weight.


Adults with coeliac disease often experience abdominal discomfort, diarrhoea, or bloating.


However, some individuals may not exhibit gut-related symptoms at all.


Coeliac disease can also lead to other problems like anaemia, osteoporosis, or neurological issues.


You might wonder why certain symptoms seem to accompany coeliac disease.


It primarily affects the small intestine and can lead to a range of complications and associated health problems.


Here's why the coeliac disease can lead to other problems like anaemia, osteoporosis, and neurological issues:


Malabsorption of Nutrients: Coeliac disease damages the lining of the small intestine, specifically the tiny finger-like projections called villi, which are responsible for absorbing nutrients from food. When these villi are damaged, the intestine becomes less effective at absorbing essential nutrients, such as iron, calcium, and certain vitamins. This malabsorption can lead to various secondary health issues.


Anaemia: Iron deficiency anaemia is a common consequence of coeliac disease. The impaired absorption of iron in the small intestine can result in reduced red blood cell production, leading to anaemia. Anaemia can cause fatigue, weakness, and other symptoms.


Osteoporosis: Calcium is another nutrient that may not be properly absorbed in individuals with coeliac disease. Over time, this can result in decreased bone density and an increased risk of osteoporosis, a condition characterized by brittle and fragile bones.


Neurological Issues: While the primary site of damage in coeliac disease is the small intestine, it can also affect other systems in the body, including the nervous system. Some individuals with coeliac disease may experience neurological symptoms, such as headaches, peripheral neuropathy (nerve damage in the extremities), and even cognitive problems. The exact mechanisms behind these neurological issues are not fully understood but may involve immune-mediated reactions.


Inflammation and Autoimmunity: Coeliac disease is characterized by an immune response to gluten, which can lead to chronic inflammation in the intestine and other parts of the body. This inflammation and the autoimmune nature of the disease can contribute to a wide range of symptoms and complications beyond those directly related to nutrient malabsorption.


Hyposplenism Risk in Coeliac: Hyposplenism is a condition where the spleen, an organ in your abdomen that helps your immune system fight infections, doesn't function properly. This condition can be found in people with coeliac disease. When the spleen isn't working as it should, it can lead to various health issues.

These complications can be severe and include bacterial infections, especially those caused by encapsulated bacteria like Pneumococcus, Haemophilus influenzae, and meningococcus infections. In addition, there is an increased risk of sepsis, a severe infection that can be life-threatening.


Cancer Risk in Coeliac Disease: Coeliac disease itself is associated with an increased risk of certain cancers. People with coeliac disease have a higher chance of developing malignancies, including Hodgkin's and non-Hodgkin's lymphoma, small bowel adenocarcinoma, and pancreatic cancer.

  1. Non-Hodgkin's Lymphoma: The risk of non-Hodgkin's lymphoma is two to four times higher in individuals with coeliac disease compared to those without the condition.

  2. Small Bowel Adenocarcinoma: The risk of small bowel adenocarcinoma is significantly increased, with more than a 30-fold higher risk in people with coeliac disease.

  3. Pancreatic Cancer: There is also an increased risk of pancreatic cancer in individuals with coeliac disease.

Associated Conditions: Coeliac disease is also associated with other autoimmune conditions, such as type 1 diabetes, thyroid disorders, and certain skin conditions like dermatitis herpetiformis. These conditions can further complicate health outcomes.


It's important to note that the symptoms and complications of coeliac disease can vary widely among individuals.


The combination of all the risks, including hyposplenism and the increased risk of cancer makes it crucial for people with coeliac disease to be vigilant about their health. Regular check-ups and monitoring can help detect and manage potential complications and reduce the risk of severe infections and cancer.


Diagnosis:


If you or someone you know is experiencing unexplained health issues, it's important to consider the possibility of coeliac disease. This autoimmune condition can manifest in various ways, and early recognition and management are crucial.


Let's dive into the key recommendations from the NICE guideline CG20 for recognizing and managing coeliac disease.


Recognition of Coeliac Disease: Who Should Get Tested?


Coeliac disease should be on the radar if you have persistent unexplained abdominal or gastrointestinal symptoms. Don't ignore that discomfort; it could be your body's way of signalling an issue.


If your child is experiencing unexplained faltering growth, it's time to consider coeliac disease as a potential cause. Growth should progress steadily, so any deviations warrant attention.


We all get tired from time to time, but if you're dealing with prolonged fatigue that seems unconnected to your activities, it might be a sign of something more. Coeliac disease could be one factor contributing to your tiredness.


Weight fluctuations can occur for various reasons, but if you're experiencing unexpected and unexplained weight loss, it's worth investigating the possibility of coeliac disease.


Severe or persistent mouth ulcers might be related to coeliac disease. These oral sores can be painful and disruptive.


Coeliac disease can lead to deficiencies in essential nutrients like iron, vitamin B12, and folate. If you're dealing with unexplained deficiencies, it's time to consider the possibility of coeliac disease.


Certain medical conditions, such as type 1 diabetes and autoimmune thyroid disease, are associated with a higher risk of coeliac disease. It's advisable to screen for coeliac disease at the time of diagnosis for these conditions.


While irritable bowel syndrome (IBS) is common, it's essential to rule out coeliac disease, especially in adults who receive an IBS diagnosis.


If you have a first-degree relative (parent, child, sibling) with coeliac disease, you should consider getting tested. There's a higher likelihood of developing coeliac disease if it runs in the family.


Serological Testing for Coeliac Disease: Getting the Right Tests


When healthcare professionals suspect coeliac disease, they rely on serological tests to confirm it. The choice of tests depends on age and circumstances:


For Young People and Adults, laboratories typically start with total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the initial tests. If IgA tTG is weakly positive, IgA endomysial antibodies (EMA) may be used. In cases of IgA deficiency, alternative tests like IgG EMA, IgG deamidated gliadin peptide (DGP), or IgG tTG might be considered.


For Children, the primary tests are total IgA and IgA tTG. Similar to adults, if IgA is deficient, alternative tests like IgG EMA, IgG DGP, or IgG tTG may be used.


These tests should be done while you're still consuming gluten-containing foods. An endoscopy with biopsy may be necessary to confirm the diagnosis.


It's crucial to continue eating gluten during testing for accurate results.


Treatment:


The only treatment for coeliac disease is a strict, lifelong, gluten-free diet.


Maintaining a gluten-free diet is essential to prevent further damage to the intestine and alleviate symptoms.


Once gluten is removed from the diet, the small intestine has an opportunity to heal. Over time, the damaged villi can regenerate and return to a more normal, healthy state. This process can take several months to years, depending on the extent of the damage.


As the intestine heals, it becomes more efficient at absorbing nutrients from food. Nutrient deficiencies, such as those in iron, vitamin B12, and folate, can be corrected as absorption improves.


Coeliac disease requires ongoing monitoring to ensure overall health.


Regular check-ups, including blood tests and bone scans, may be recommended:

  • Weight and Height Measurement: Tracking your weight and height ensures that you're maintaining a healthy trajectory.

  • Symptom Review: Discuss any symptoms or concerns you may have. Open communication with your healthcare provider is key.

  • Diet Assessment: Your dietitian will assess your diet and adherence to the gluten-free diet, offering guidance as needed.

  • Nutritional Support: Depending on your individual needs, you might receive specialist dietetic and nutritional advice and supplementation when required.

Additionally, consider joining support groups or seeking advice from organizations like Coeliac UK and Guts UK, which offer valuable resources, recipes, and expert guidance.


Gluten-Free Diet:


Understanding which foods contain gluten is vital for managing coeliac disease. Standard bread, pasta, cereals, cakes, and biscuits are typically made from wheat flour and contain substantial amounts of gluten. Be vigilant when checking food labels, as gluten can also be present in unexpected places like sauces or processed foods. Gluten-free alternatives are widely available, and some countries offer prescription options.


In both the UK and the EU, specific rules and regulations are in place to ensure that allergen information, including the presence of gluten, is clearly provided on packaged foods. This helps individuals identify products that are safe for them to consume. Here are some key points about food labelling laws in the UK and the EU:


Food labels must clearly highlight the presence of common allergens, including cereals containing gluten. This information is typically provided in the ingredients list or as a separate allergen statement.


If a product contains wheat, barley, rye, or oats (unless they are gluten-free oats), it must be clearly stated in the ingredients list.


Labels should also indicate if there is a risk of cross-contamination with gluten during manufacturing or processing. Phrases like "may contain traces of gluten" or "produced in a facility that handles wheat" may be used to convey this information.


https://www.food.gov.uk/business-guidance/allergen-labelling-for-food-manufacturers
An example of how allergens are listed by the FSA

Products that are specifically formulated to be gluten-free should be labelled as such. In the UK and the EU, a "gluten-free" label indicates that the product contains less than 20 parts per million (ppm) of gluten, which is considered safe for most people with coeliac disease.

Crossed Grain Trademark

Navigating a gluten-free diet can be a daunting task, especially with the complex world of food labels and ever-changing legislation. In such an environment, the Crossed Grain Trademark has emerged as a vital resource, offering consumers a straightforward way to identify gluten-free products.


The Crossed Grain Trademark is a globally recognized symbol that acts as a reliable indicator for gluten-free products, simplifying choices for those with dietary restrictions. It's not just a marketing gimmick; it's a legally protected trademark with strict criteria for usage. Only products meeting these criteria for gluten content can display the trademark, assuring consumers that the item has undergone rigorous testing to ensure minimal or no gluten presence. This is especially important for individuals with gluten sensitivity or celiac disease, for whom even tiny traces of gluten can be harmful.


Eating out with coeliac disease may seem challenging, but many restaurants now provide gluten-free options. By law, caterers should be able to provide information on gluten in their dishes. Organizations like Coeliac UK offer accreditation to restaurants meeting gluten-free standards, making it easier to identify safe dining options.


Lots of foods are naturally GF and can still be enjoyed on a GF diet. See below:


Category

Naturally Gluten-Free Foods

Foods to Avoid

Gluten-Free Substitute

Grains and Cereals


Rice, corn, quinoa, millet, buckwheat

wheat, barley, rye, spelt, kamut

​Gluten free pasta, rice noodles, cornmeal, polenta quinoa pasta, pasta made with legume protein

Bread and Baked Goods

GF bread, rice cakes and cornbread

regular bread, muffins, bagels, croissants

​Gluten-free bread, crackers, made from gluten-free flours (rice, corn, almond, coconut, etc.)

Protein

Meat, Fish, Poultry, Legumes, Eggs, Tofu, nuts and seeds

Breaded or battered meats/fish, processed meats, meats with fillers and meat substitutes

fresh fish. and meat, eggs, plain tofu and natural seeds and nuts

Dairy

milk dairy

milk and cheese natural yogurt

flavoured yogurt with additives and malted milk drinks

Plain dairy product are naturally GF, Dairy free alternative in most case are GF but you might want. to double check the labels

Fruits and vegetable


All fruits and vegetables

all fruit and veggies are naturally GF

Frozen fruits and veggies are also GF but you might want to double check the labels

Condiments and sauces

Most herbs, spices oils and vinegars

Soy sauce unless GF

Any process food that you buy need to be double check, read the labels when you buy ketchup, mustard, balsamic vinegar, mayonnaise etc,

Beverage



​Water, 100% fruit/vegetable juices, tea, coffee (unflavoured)

Beer (unless gluten-free), malted

Wine, cider, gluten-free beer, distilled spirits e.g. gin and vodka


As we wrap up this article, I hope you've found the information here to be genuinely helpful. Living with coeliac disease can be quite intricate and demanding, but it's crucial to invest the energy needed to enhance your quality of life.


Remember, a gluten-free diet is not just a choice; it's the essential treatment for this condition. With the information provided, I trust that you now have the knowledge required to start to manage your condition effectively.


Your journey toward a healthier, gluten-free life begins with understanding, and I'm here to support you every step of the way.


I can't wait to share more insights with you in my next blog article! Stay tuned, and let's keep this journey going together! xxx


William Stivaletta, AfN RD2Be


References

Komentáre

Subscribe Form

Thanks for submitting!

©2019 by William Stivaletta. Proudly created with Wix.com

bottom of page