Coeliac disease (also known as gluten-sensitive enteropathy or coeliac sprue or gluten intolerance) is a condition of the small intestine caused by a complex immunological response provoked by gluten. Gluten is a storage protein found in wheat and other cereals like rye, barley and oats. Coeliac disease manifests as an array of debilitating symptoms but by following an appropriate gluten-free diet, sufferers can make a full recovery.

Not an allergy

Coeliac disease is not an allergy. An allergic response occurs when the body’s immune system produces antibodies against a normally harmless substance from food or the environment as if it were a pathogen. With coeliac disease the gluten in foods leads to damage of the gut lining which in turn prevents food being digested and absorbed into the body properly. The result is essentially chronic malnutrition, where there is a deficiency of calories and essential nutrients like protein, vitamins and minerals.

Symptoms

The classic symptoms of untreated coeliac disease relate to malabsorption of food which leads to diarrhoea, bowel cramps and bloating, and malnutrition causing weight loss in adults, growth failure in children, anaemia and bone disease (among others). More recently it has been suggested that the effects of gluten intolerance extend far beyond the gut lining (1) and conditions as diverse as liver disease, dermatitis, type I diabetes and infertility are thought to be linked to the condition.

Prevalence and diagnosis

Because symptoms are diverse and can be mild, perhaps lethargy, irritability and bowel discomfort, many sufferers of gluten intolerance may be undiagnosed. Sometimes gluten intolerance is diagnosed quite late in life. It was previously thought that gluten intolerance affected about 1 in 1500 people but new studies have found that about 1 in a 100 people have blood tests suggesting the condition (2). Although endoscopy plus gut biopsies are needed to confirm diagnosis, it is likely that many Europeans have coeliac disease and don’t know it.

Gluten-free diet

When people with coeliac disease follow a gluten-free diet (3), the gut lining gradually repairs itself and normal function returns. For many people the results can be life changing as the body heals itself and symptoms disappear. Gluten is found in grains of wheat, rye, barley, and oats, which are used to make many everyday foods like bread, breakfast cereals, pasta, pizza, pastry, cakes and biscuits. But it is not as simple as that, as gluten containing grains are also used as ingredients in batters and sauces, and are found in some meat products like sausages and burgers. Rice, potatoes and corn do not contain gluten and there are many special gluten-free products which are now available for people with coeliac disease.

Help and advice

Following a gluten-free diet can be time-consuming and inconvenient but plenty of help is on hand for people once coeliac disease is diagnosed. A qualified dietitian will help identify suitable foods and how to go about constructing a palatable, balanced diet that suits the individual’s lifestyle. There are also lists available which contain up-to-date information on which manufactured products are gluten-free and can be safely included in the diet. Many countries have official coeliac societies (4) which are national support groups and a mine of information on all aspects of the disease.

Can it be prevented?

It is not yet known why some people develop coeliac disease but it does run in families. At present the only recommended preventative action is to avoid introducing foods containing wheat into a baby’s diet until at least six months of age (3).

Better detection

As there are probably many more people with coeliac disease than originally thought, how to improve diagnosis is under debate. Some suggest mass screening (5) others offering blood tests to those with symptoms such as anaemia, chronic tiredness, irritable bowel syndrome or a family history of the disease (1). At the same time self-diagnosis should be discouraged; the adoption of a gluten-free diet ‘just in case’, without professional help, can lead to an unbalanced and inadequate diet that could do more harm than good.

References

• Duggan JM (2004) Coeliac disease: the great imitator. Medical Journal of Australia 180:524-526
• Dube C Rostom A Sy R et al (2005) The prevalence of coeliac disease in average-risk and high-risk Western European populations: a systematic review. Gastroenterology 128(4 Suppl 1): S57-67
• http://www.eatwell.gov.uk
• Association of European Coeliac Societies provides website addresses for all its members see: http://www.aoecs.org
• Mearin ML Ivarsson A & Dickey W (2005) Coeliac disease: is it time for mass screening? Best Practice Research in Clinical Gastroenterology, 19 (3): 441-52

FOOD TODAY 06/2006