Coeliac Disease : New Developments In Diagnosis & Current Dietary Recommendations

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It is thought that at least 125,000 people have been diagnosed with Coeliac disease in the UK, this is approx 1 in every 100 people. Furthermore, this only factors people who have actually been diagnosed with the disease, many more are thought to have it and are yet to be diagnosed! More and more people are diagnosed every year, and this isn’t because Coeliac disease is becoming more prevalent, but rather because the awareness and diagnostic procedures are improving. A good example of this are estimates from 2003 that saw only 1 in 250 people being diagnosed with the disease, meaning this figure has more than doubled!

What is Coeliac disease?

Coeliac disease is an autoimmune, genetic inflammatory disease that affects the inner walls of your small intestine. The autoimmune nature of the condition basically means the body attacks itself in order to reduce the possibility of the inflammatory alien substance infiltrating the rest of the body. The inflammation seen in Coeliac disease is always triggered by gluten, a protein present in wheat, barley, rye and foods/ drinks contaminated with gluten. When gluten is consumed (even in microscopic amounts) it causes a process known as villous atrophy whereby the absorptive hair like fingers (villi) found in the lining of the intestine in order to absorb nutrients into the body becomes flattened. The result of this flattening is discomfort, reduced surface area and therefore malabsorption! Coeliac disease can effect anybody at any age, but it is most common in children and young adults, and generally more prevalent in females at a ratio of approx. 1.5- 2 (CORE, 2012).

Diagnosis & Treatment

The diagnosis process of coeliac disease can be more complex than many people envision. The main symptoms of coeliac disease is mainly gastrointestinal distress (stomach pains) and malabsorption, so these can easily be attributed to other causes. There are several criteria that need to be met in order to isolate coeliac disease as the causative factor, and first on the list is villous atrophy. The flattening of the villi is one of the diagnostic factors because a gluten intolerance will always cause the villi to flatten. There are occasions when only partial villi flattening can be indicative of coeliac disease, however this then has to be alongside a positive serology. A positive serology refers to a blood test that has levels of IgA-EMA, tissue transglutaminase or IgC- DGP above the norm. So if the serology test is matched with some villi flattening then coeliac disease will be diagnosed. Should a Doctor and Dietitian wish to confirm this further then a gluten free diet that successfully clears the symptoms would be adequate.

New developments in coeliac diagnosis

One of the main concerns people have when facing a diagnosis of coeliac disease is the invasive nature of confirming a diagnosis. Coeloac disease may well be suspected in patients with stomach pains, diarrhoea, constipation, malabsorption and thus failure to thrive, but the conclusive test would require an upper endoscopy and duodenal biopsy, procedures which involve instruments being placed into the gut via the mouth. As nasty as this may sound, it is quite common and not as bad as people initially fear, however it is currently critical in the absolute diagnosis of coeliac disease. New research is now shedding light on less invasive ways for physicians to diagnose coeliac disease without the need to have an endoscopy or biopsy of any sort, however these methods are in their infancy and need more time. Coeliac disease may be able to be predicted if there is a strong family history and certain antibodies are found ‘close to one another’ in the intestinal lumen, but again, these are in the early stages.

Diet

A gluten free diet always has been, and probably always will be the main treatment of coeliac disease, this means that any food or drink containing the protein gluten should be avoided at all costs. Gluten can come from a variety of sources, but it will always stem from the proteins in wheat (gliadins), barley (hordeins), rye (secalins) and cereal hybrids such as triticale. Food and drinks containing gluten include bread, pastry, pasta, wheat based cereals and cakes. Less obvious sources include sauces, gravies, ready meals and beers. You may also find hidden sources of gluten under the disguise of modified wheat starch, wheat starch, gelatinised starch or pregelatinised starch, malt, malt extract, malt syrup and malt flour. Although gluten free foods can seem a bit of a mine field initially, resources such as Coeliac UK will support you with this along the way so DO NOT DESPAIR!

Gluten free Proteins

A lot of proteins on the market contain gluten in one form or another, but another issue many manufacturers have is that although the protein itself may not directly contain gluten, other products that were manufactured in the same warehouse may contain gluten. This increases the risk of contamination, and it only takes a miniscule amount of gluten to trigger a reaction, consequently manufacturers are unwilling to label a product as 100% gluten free if their factory uses gluten. So when considering a gluten free protein be sure to contact the manufacturer prior to consumption in order to confirm if the product is gluten free for sure. Some supplements are labelled as gluten free and/ or hypoallergenic meaning they are generally safe for consumption for people with allergies, but it is worth noting that the ingredients list on supplements changes from time to time, so a supplement that was gluten free a few months ago may not be now! Supplements that are gluten free at present include Pulsin Whey Protein, Pulsin Pea Protein Isolate, Pulsin Hemp Protein, and Pulsin Brown Rice Protein.

 

References
Coeliac UK, (2013). Coeliac disease. Retrieved 21st Feb, 2011, from http://www.coeliac.org.uk/coeliac-disease

Green & Jabri, (2003). Coeliac Disease. The Lancet. 9381(362): 383-391.

Ludvigsson, J, F., Bai, J, C., Biagi, F. (2014). Diagnosis and Management of Adult Coeliac Disease. Retrieved 20th August, 2014, from http://www.medscape.com/viewarticle/829007_9

 

Tapia & Murray, (2010). Celiac disease. Current Opinion in Gastroenterology. 26(2): 116-122.

About the Author

Job Role Qualified Dietitian and Sports Nutritionist Qualifications BSc (Hons) Sports Science | BSc (Hons) Dietetics Tom has always participated in sport both recreationally and competitively which led to an unquenchable thirst for information on anything health, nutrition and fitness. After leaving school Tom went on to play for a football academy during which time he studied Sport and Exercise Science. From here he went on to study a BSc (Hons) Sport Science at UEA followed by his second BSc (Hons) degree, this time at the University of Hertfordshire studying Dietetics. Tom has worked in the fitness, educational and clinical nutrition industry starting out at David Lloyd Health and Leisure Clubs. He then went on to work as a Dietitian (RD) in the NHS, during which time he conducted clinics for healthy eating, weight loss and weight gain, as well as specialised consultations on Diabetes, IBS and Coeliac disease to name a few. He has vast amounts of experience at devising diet plans and supplement regimens, as well as working in the community with schools and competitive athletes. As Head Nutritionist and Supplement expert at Discount Supplements Tom is here to provide current and evidence based health and nutrition information to help you reach your health and fitness goals!
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