Coeliac Disease
Defintion
Also called celiac sprue, non tropical sprue, coeliac disease, gluten enteropathy, gluten intolerance, gluten intolerant enteropathy, gluten sensitive enteropathy, celiac is a chronic disease and the result of a severe allergy to gliadin, the protein found in gluten. The reaction to gluten may be immediate or delayed.
The immune system recognises the gliadins as foreign agents and mobilises its defences every time gluten enters the digestive tract thereby causing swelling and lesions of the gut walls and eventually the flattening of the villi (the folded surface of the small intestine sometimes described as a carpet that has been piled). The damage caused to the villi will affect the absorption of nutrients since the role of the villi is to metabolise food by projecting digestive enzymes.
Who is likely to suffer from celiac? Caucasians are usually more affected especially those who live in Northern Europe although it is difficult to obtain precise data on who and how many individuals suffer from this condition since many people remain undiagnosed. A few decades ago scientists believed that celiac was a children's disease, however nowadays it is commonly accepted that many adults also suffer from celiac and according to the Celiac Society, most Celiacs are diagnosed when aged between 30 and 45 years.
The onset of the disease appears at all ages and is influenced by certain factors:
- Doctors believe that giving biscuits to babies in a family with a tendency to celiac increases the risk of developing the condition later in their life.
- Celiac is a genetic disorder and children in families with a history of dermatitis herpetiformis, diabetes mellitus or Sjogren's syndrome have a higher chance of having this condition
- Severe stress, a viral infection, pregnancy or an operation may trigger the condition.
Symptoms
Celiacs do not display the same symptoms and in some cases they may be asymptomatic for years which makes the diagnosis more difficult to establish. Babies who suffer from celiac usually have pale stools and fail to grow.
List of common symptoms:
- Abdominal distension
- Abdominal pain
- Diarrhoea or constipation flatulence
- Blood loss and anemia
- Bone fractures
- Bone pain
- Burning sensations in arms and legs weight loss
- Vomiting
- Tiredness
- Lethargy
- Growth retardation
- Hypocalcaemia
- Irritability
- Memory impairment
- Micro-nutrient deficiencies
- Mouth ulcers Related disorders
As the gut is not able to absorb nutrients from food properly, other conditions may also be associated with celiac:
| - Asperger's syndrome |
- Infertility |
| - Anorexia |
- Kidney disease |
| - Arthritis |
- Lung disease |
| - Addison disease |
- Learning difficulties |
| - ADD |
- ME |
| - ADHD |
- Multiple sclerosis |
| - Autism |
- Myalgic encephalomyelitis |
| - Cerebellar atrophy |
- Myasthenia gravis |
| - Collagenius sprue diabetes |
- Nerve disease |
| - Collagenous colitis |
- Osteoporosis |
| - Cancer |
- Pancreatic insufficiency |
| - Chronic active hepatitis |
- Pernicious Anemia |
| - Depression |
- Rheumatoid Arthritis |
| - Dermatitis Herpetiformis |
- Scleroderma |
| - Diabetes |
- Sjogren's syndrome |
| - Down syndrome |
- Systemic lupus erythematosus |
| - Encephalopathy |
- Schizophrenia |
| - Epilepsy |
- Thrombocytopenic Purpura |
| - Fibromyalgia |
- Thyroid Disorders |
| - Gall Bladder Disease |
- Thyrotoxicosis myositis |
| - Grave's disease |
|
It is believed that celiac disease will eventually deplete the immune system. Since the villi are damaged they cannot produce enough lactase, the enzyme used to break down the milk protein, and celiacs may also suffer from lactose intolerance.
Diagnosis
It is estimated that many Celiacs remain undiagnosed. The clinically latent lesions may only be discovered secondary to the presence of other conditions.
There are two ways of diagnosing celiac:
Serological screening:
This consists of a blood test which is a non-invasive way to detect high levels of IgA, IgG anti gliadin, anti reticulin and IgA anti endomysial (the covering of the muscle) antibodies. Serological tests are now widely available (see list of laboratories). The drawback is that these tests will not prove useful if done during a gluten or casein free diet since traces of gluten remain in the body for at least eight months after stopping taking gluten.
Biopsy:
When blood tests reveal the presence of antibodies, a biopsy of the small intestine is usually carried out by a gastroenterologist. It consists of the removal of a small piece of lining which allows doctors to microscopically examine the surface of the intestine. This type of diagnosis involves an operation under anaesthesia or conscious sedation. During this biopsy Celiacs may not be detected and a second one is often recommended after several months on a gluten free diet; in some cases doctors insist that a third one should take place.
Treatment
There is no cure for this condition but a change of lifestyle can make it manageable. The villi can be repaired with a strict diet which implies the complete removal of gluten products. It is thought that once gluten has been removed from the diet the intestine will heal within the following weeks. The list of foods absorbed must be carefully checked since even a minute amount of gluten may be enough to counteract any progress. Celiacs will have to remain on this special diet all their life.
Other food sensitivities should also be looked at, especially when the condition has not improved after several months of strict diet. If there is lactose intolerance it is also advised to stop taking dairy products.
There are no drugs that can repair the villi, although steroids are sometimes prescribed. Aloe vera is also said to help heal the villi, as well as some supplements and enzymes which are lacking in the body due to the malabsorption of food. Nutritionists often recommend supplementation of folic acid, vitamin A, B6, B12, D, E, K, copper, iron, selenium and zinc.
Please note we do not advocate self-medication. This condition should be diagnosed by a medical practitioner who will then advise you on the right diet to follow.
Gluten free food and substances
Gluten is the protein in wheat, barley, rye, oats and their derivatives: malt, grain starches, hydrolysed vegetable/plant proteins, textured vegetable proteins, grain vinegar, grain alcohol, malt, modified food starch, caramel, maltodextrin, soy sauce, flavourings and the binders found in medication. Since the texture of gluten is elastic it also appears in many processed foods as well as in the gum substance on envelopes.
The gluten free list below may vary according to celiac organisations:
| - Red and white meat (not bacon) |
- Lentils |
| - Fish |
- Sago |
| - Shellfish |
- Yam |
| - Vegetables |
- Corn |
| - Dried, canned or fresh fruits |
- Potatoes |
| - Juices (with no other ingredients) |
- Rice |
| - Fresh coffee |
- Flour (made from the above) |
| - Tea |
- Rice krispies |
| - Eggs |
- Plain crisps |
| - Soya |
- Nuts |
| - Rice |
- Oil (olive, walnut, sesame, soya, |
| - Potato |
sunflower, peanut, rapeseed, maize, cornflower) |
| - Corn |
- Pure spices |
| - Buckwheat |
- Herbs |
| - Chickpeas |
- Maize |
| - Lentils |
- Sugar |
| - Millet |
- Honey |
| - Peas |
- Jams or marmalade |
| - Beans |
- Yeast |
| - Quinoa |
- Almond |
| - Tapioca |
|
A comprehensive list of foods to avoid may be viewed on the internet at: http://www.fastlane.net/homepages/thodge/GFDIET.txt
Looking for gluten free products may not prove an easy task, it is recommended to read labels carefully. It is also advised to contact the manufacturers as gluten may represent such a tiny percentage that it may not appear on their ingredient list. Manufacturers also change the ingredients in their products from time to time.
When starting a gluten free diet the first step is to eliminate any processed food and cook only fresh food, after a while gluten substitutes can be added. Nowadays it is easy to find these substitutes, there is a large variety of products and it is even possible to find substances such as xanthan gum or guar which can be used to bind food to make dishes similar to processed food. Gluten substitutes are widely available from health stores, supermarkets, chemists or mail order companies. For those diagnosed with celiac disease a list of products is available on prescription.
Resources
Organisations
Companies that produce gluten and casein free products:
Trufree Foods
PO Box 99
Trowbridge
Wiltshire
BA14 0YN
Tel: 01225 711 801
http://www.trufree.co.uk
Nutricia Dietary Care
Newmarket Avenue
White Horse Business Park
Trowbridge
Wiltshire
BA14 0XQ
Tel: 01225 711801
http://www.glutafin.co.uk/
SHS International
100 Wavertree Boulevard
Liverpool
L7 9PT
Tel: 0151 228 1992
http://www.shsweb.co.uk
Distributed in Ireland by Nutricia Ireland.
Doves Farm Foods Ltd
Salisbury Road
Hungerford
Berkshire
RG17 0RF
Tel: 01488 684880
Lifestyle Healthcare Ltd.
Centenary Business Park
Henley on Thames
Oxfordshire.
RG9 1DS
Tel 01491 570000
Celiac Organisations
Coeliac Society
PO Box
220 High Wycombe
Buckinghamshire
HP11 2HY
Tel: 01494 437278
http://www.coeliac.co.uk
Coeliac Society of Ireland
Carmichael House
4 North Brunswick Street
Dublin 7
Tel: 00 3 531 872 1471
American Coeliac Society
58 Musano Court
West Orange, NJ
07052
Tel: (001) 973 325 8837
Coeliac Disease Foundation
13251 Ventura Boulevard,
Ste. 3
Studio City, CA
91604-1838
Tel: (001) 818 990 2354
Coeliac Sprue Association/USA
P.O. Box 31700
Omaha, NE
68131-0700
Tel: (001) 402 558 0600
Laboratories (mail order service available)
Biolab
The Stonehouse
9 Weymouth Street
London
W1W
Tel: 020 7636 5959
http://www.biolab.co.uk
Allergy Diagnostic Centre
Grays Farm production Village
Grays Farm Road
Orpington
Kent
BR5 3BD
Tel: 020 8308 1363
Allergy Diagnostic Laboratory
68 Milton Park Estate
Abingdon
Oxfordshire
OX14 4RX
Tel: 01235 862757
Genesis Diagnostics Ltd
Eden Research Park
Henry Crabb Road
Littleport
Cambridgeshire
CB6 1SE
Tel: 01353 862220
Health Interlink Ltd.
Interlink House
Unit B,
Asfordby Business Park
Welby
Melton Mowbray
Leicestershire
LE14 3JL
Tel: 01664 810 011
Books
These are some of the references that have been passed to us; the list is not exhaustive. We have not necessarily read the books, and cannot say how easy it will be to get them.
- The Celiac Cookbook from the Celiac Society - Greer R. Diets to help gluten and wheat allergy. Thornsons
- Greer R. Gluten free cooking ISBN 0-7225-0831
- Hagman, B. (1993) More From the Gluten-Free Gourmet. Henry Holt & Co. ISBN 0-8050-2324-0
- Kisslinger, J. (1987) The Joy of Gluten-Free Cooking, Kisslinger Publications ISBN 0-921019-03-3
- Lowell, J. P.(1995) Against the Grain, Henry Holt & Co. ISBN 0-8050-3624-5
- Rawcliffe, P.and Ruth R. (1985) The Gluten-Free Diet Book, Arco Publishing, ISBN 0-668-05973-7
- Redjou, P. (1990) The "No-Gluten" Solution, ISBN 0-9626052-0-4
- Thompson P. (1995) The Gluten-free Cookery, The Complete Guide for Gluten-free or Wheat-free Diets, Headway Hodder Headline, Oxon, UK, ISBN 0-340-62098-6
- Wood, M. N. (1982) Coping With the Gluten-Free Diet, Charles C. Thomas ISBN 0-398-04718-9
Websites
- http://www.celiac.com/
- The American Dietetic Association
- Celiac discussion list archives
- Fact sheet on Celiac
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