Coeliac disease

Coeliac (celiac) disease (also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy) is a life-long inflammatory condition affecting about 0.5% of the population. The condition runs in families and onset typically occurs between the ages of 30 and 45. Coeliac disease is more common among those with type 1 (insulin-dependent) diabetes, autoimmune thyroid disease, osteoporosis, ulcerative colitis and epilepsy.

It is caused by an abnormal reaction to gluten, a protein found in wheat, and other similar proteins found in rye, barley and oats. These proteins trigger an auto-immune condition in some people, which damages the microscopic finger-like projections (villi) that line the small intestine. When damaged and inflamed, the villi are unable to absorb food properly, which may result in malnutrition. Symptoms include bloating, diarrhoea, nausea, wind, tiredness, constipation, anaemia, mouth ulcers, headaches, weight loss, hair loss, skin problems, short stature, depression, infertility, recurrent miscarriages and joint/bone pain. Possible long-term problems include infertility, osteoporosis and bowel cancer.

Diagnosis

Some symptoms may be confused with irritable bowel syndrome (IBS), or wheat intolerance, while others may be put down to stress, or getting older. As a consequence, it can take some time before an accurate diagnosis is sought, or made. It's important to consult your GP if you suspect coeliac disease. A specialised blood test has been developed to help in diagnosis. If positive, this may be followed by a biopsy taken from the intestine by a hospital specialist.

Some new evidence indicates that gluten intolerance may be around 30 times more prevalent than celiac disease. About 1 in 7 people are gluten-sensitive or gluten-intolerant but test negative or inconclusive for coeliac disease. However they suffer most of the same symptoms and long-term problems that are associated with coeliac disease when they ingest wheat. This group of people are sometimes referred to as "non-coeliac gluten sensitive."

Treatment

There's no cure for coeliac disease, but it can be controlled by following a gluten-free diet for life. This allows the damaged villi to recover and nutrients can then be absorbed normally again and symptoms disappear. However, it is not easy to avoid gluten. Gluten is present in wheat, barley and rye and a similar protein can be found in oats. Most processed foods including breads, cereals, pasta, biscuits, cakes, pastries, snack items, crackers, and most other commercial baked goods contain gluten. In addition, ice cream, puddings, desserts made from commercial mixes, cheese spreads, commercial salad dressings, meat, chicken, and fish products prepared with bread or breadcrumbs, soups, gravies, sauces and custards thickened with flour all can contain gluten as thickening agents, emulsifiers, stabilizers, and as hydrolysed vegetable protein. Malt, which is primarily used as a flavouring and colouring agent, can be a hidden source of gluten. Check all labels for wheat products in particular.

Gluten may also be hidden in some foods such as crisps and similar snacks, as well as in the reconstituted chips often served in restaurants.

Cooking oil (mixed vegetable oil) can contain traces of gluten but in practice is only likely to affect hypersensitive coeliacs. Traces of gluten may remain in malt vinegar, beer and lager, but again will only affect a very few coeliacs, except in the case of some cloudy beers. Other alcoholic drinks such as wine and cider are gluten-free.

Oat-based products should be avoided only if they cause a problem. Most coeliacs can tolerate a couple of ounces (50g) of oats per day, and because the fibre in oats is nutritionally valuable, oats should not be eliminated from the diet unless this is essential.

Safe foods:

All fruit, salads, vegetables, potatoes, rice and maize, nuts, red meat, chicken, fish, eggs and dairy products. Gluten-free substitutes are available from most supermarkets and pharmacies. You can also get staples such as gluten-free flour, breads, biscuits and pasta on prescription from your doctor.

Scientists in the UK are studying the effects of gluten on the intestine. In future, it may be possible to block the damaging effects of gluten on the gut, so people with coeliac disease are able to eat any food they wish.

Supplements

The poor absorption of nutrients that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron, vitamin D, vitamin K, calcium, magnesium, zinc and folic acid.

People with newly diagnosed celiac disease should get their doctor to carry out an assessment for nutritional deficiencies. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient. Prior to recovery following adoption of a gluten-free diet, it is a wise precaution to supplement with a high-potency multivitamin-mineral. Deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten, and periodic check-ups should be sought from your doctor.

Echinacea and goldenseal may help to speed the recovery process. These two immune system boosters are often packaged together in capsule form. They are also the principal ingredients in ‘Robert’s Formula’, which also contains slippery elm, marshmallow, geranium, and other herbs. This herbal product is made by a number of manufacturers and is intended to treat the digestive tract by creating a temporary protective layer in the intestine to aid regeneration of the villi. Do not take echinacea and goldenseal long term. Generally you should not exceed two weeks on and two weeks off for a period of up to two months.

New developments

Researchers in the Netherlands are investigating an enzyme originally developed for commercial food processing, as an aid for coeliacs. AN-PEP, an enzyme derived from the common black mould Aspergillus niger, may be able to break down gluten in the stomach before it reaches the small intestine. The researchers have demonstrated that the auto-immune response to gluten no longer occurs when food is pre-treated with AN-PEP. This means that there is a realistic prospect of the development of an enzyme capsule that when eaten with gluten-containing food will prevent problems in coeliac sufferers. This would at least allow the option to occasionally follow a normal diet -- for example, when dining out or with friends, when the need for a gluten-free diet can be extremely inconvenient.