Approximately 125,000 people have been diagnosed with Coeliac disease in the UK, which equates to approx 1 in every 100 people meaning it is by no means a common condition. This figure is growing gradually with more and more new diagnoses every year, estimates from 2003 saw only 1 in 250 people being diagnosed with the disease. So shouldn't we be concerned?
Well, yes and no… Coeliac disease is an autoimmune disease meaning the body’s immune system basically attacks itself, and yes it is becoming ever more prevalent with an estimated 7000 new diagnoses each year (based on data from Coeliac UK memberships). This figure does not take into account the many undiagnosed cases and those that are mistaken for irritable bowel syndrome, inflammatory bowel disorder, and lactose intolerance or other gastrointestinal conditions (Coeliac UK, 2013). The good news is this… until recently, the need for a Gluten free diet was largely unrecognised until better testing became available and public awareness increased. Numerous high profile sports stars and celebs have been diagnosed with Coeliac disease or choose to observe a gluten free diet through choice. This has resulted in greater awareness and less stigma being attached to Coeliac disease and Gluten free diets (Tapia and Murray, 2010).
What is Coeliac Disease?
Coeliac disease is a genetic inflammatory disease affecting the inner walls of your small intestine. The characteristic inflammation seen in Coeliac disease is always triggered by the protein Gluten which when consumed (even in miniscule amounts) causes a process known as villous atrophy. Villous atrophy is when the absorptive hair like fingers found in the lining of the intestine (needed to absorb nutrients into the body) becomes flattened; the result of this is discomfort, reduced surface area and therefore malabsorption! Coeliac disease can be diagnosed at any age including infancy and in old age, but is most common in children and young adults (CORE, 2012).
What Causes Coeliac Disease
This is not known for certain, but most researchers believe that it is a genetic factor with scientists gradually isolating the specific genes responsible. It is believed that stressful situations may act as a catalyst and worsen symptoms and hence it is quite often wrongly passed off as IBS or a similar gastrointestinal condition.
Symptoms can include one or all of the following…stomach pain, diarrhoea, nausea, headaches, unexplained weight loss or a failure to thrive (inability to gain weight or grow), and a visible paleness (related to anaemia), signs of bone disease, or a general lack of energy. In some instances, symptoms are not apparent (silent symptoms) meaning people can go years and sometimes a lifetime without actually knowing they had it! The problem with silent symptoms is that the person may be consuming gluten freely, causing damage to the intestine and persistently malabsorbing nutrients which can predispose them to several chronic conditions such as Osteoperosis and bowel cancer.
How is it diagnosed?
Diagnosis is not a quick process and there is not one single test involved. It begins with a full medical history review followed by a physical examination, and if at this point the doctor feels Coeliac disease is an option then you will be asked to provide a blood test. The doctors look for key Coeliac disease antibodies in the blood known as endomysial antibodies (EMA) and tissue transglutaminase antibodies (tTGA), which if present indicates Coeliac disease. The final step in diagnosis is biopsy and a categorical diagnosis should not be made without referral to a gastroenterologist who can perform such tests (Tapia and Murray, 2010).
As a Dietitian, I too was occasionally involved in the initial diagnosis of Coeliac disease when patients would come in complaining of the associated symptoms. If these symptoms were present and a diet history indicates that foods containing wheat, barley or rye were consumed at or around the time of discomfort, then I would refer the patient to a doctor for further testing.
Figure 1: Diagnosis of Coeliac disease
(Green and Jabri, 2003)
The principle is simple…avoid eating gluten, but unfortunately the application is not so easy and takes a bit of getting used to. Life can be made so much easier by signing up to Coeliac UK, a charity that provides health and nutritional information for existing or newly diagnosed Coeliac patients. Once a member you are sent a compendium (described as the bible of the Coeliac world) which has every gluten free food available for almost every single brand. You become part of a Coeliac community in which you can discuss everything that is Coeliac disease including gluten free living and information on how to avoid contaminating your food with gluten (Coeliac UK, 2013).
What is Gluten?
Gluten is the protein found in wheat, barley or rye and can be found in various foods and drinks, especially thickened beverages.
Food and drinks containing gluten
Bread, pastry, pasta, wheat based cereals and cakes are the main sources of gluten, with less obvious sources including sauces, gravies, ready meals and beers. Look out for hidden sources of gluten in the form of modified wheat starch, wheat starch, gelatinised starch or pregelatinised starch, malt, malt extract, malt syrup and malt flour. The variety of foods and ingredients containing gluten can be daunting, but don’t be disheartened as resources such as Coeliac UK will support you with this along the way.
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.
Tapia & Murray, (2010). Celiac disease. Current Opinion in Gastroenterology. 26(2): 116-122.