Coeliac disease is an autoimmune disease that targets the intestinal villi. It is estimated that only 1% of the UK population suffer from this disease. Diagnosis is affected by the knowledge of the medical profession. It is thought that MANY people are coeliac but haven`t been recognised as suffering from it. Many people will present with symptoms for 10 years or more before a diagnosis can be made. As the symptoms are very similar to other gastrointestinal problems, it is common for a sufferer to be labelled as having IBS.
The gluten protein triggers an immune reaction where antibodies are released. These antibodies mistakenly attach the intestinal villi, causing huge damage to their function. Most of our nutrient absorption is made through the intestinal villi. If these villi are damaged, our absorption of essential nutrients is severely impaired, leading to malnutrition and a whole host of other related problems.
In the picture below, you can see healthy villi on the left and those of a person with coeliac disease. In coeliac disease, the immune system is hyper-vigilant and sends out antibodies that attack the villi, causing atrophy. A healthy intestine, like the one on the left has the surface area of a tennis court. A damaged intestine has a vastly reduced surface area.
These are the common symptoms of coeliac disease, however, some people suffer from silent coeliac disease where they are unaware of a problem.
If your GP suspects that you may have coeliac disease then they will use the following route of diagnoses:
The good news is that whilst coeliac disease can not be cured, it can be put into remission. By following a strict gluten free diet, the villi can regrow. For this reason, it is very important to continue eating gluten before your endoscopy, or the damage will not show and you may get a negative diagnosis.
It is advisable to have yearly blood tests to monitor your coelic disease. Blood tests measure the antibodies responsible for the damage to the villi. Serum tissue transglutaminase and serum endonysium antibody results should be checked.
It may look like your coeliac disease has gone away if you are supporting your diet appropriately. Unfortunately, this isn`t the case. It is a disease that cannot be cured. It means that what you are doing is effective and you should keep doing it. Don`t be mislead into thinking you can start eating gluten again if your antibodies show as normal.
Whilst gluten free oats can be tolerated by some, they are NOT a good idea to eat in the early stages of your recovery, whilst your villi are still damaged. Gluten free oats can cause reactions whilst still in the healing phase.
How can a nutritional therapist help you?
Living gluten free
Gluten is hidden away in so many unexpected foods. It is so important to check food labels. Foods that are prepared in factories that prepare other gluten items should also be avoided as they can trigger an attack by way of cross contamination. Just one crumb of gluten can cause a reaction. Shopping can be difficult for a new coeliac. The Coeliac UK website produces an app to show you which foods are ok to eat. It also tells you how to be label aware.
Most foods have a symbol of a crossed grain. You should always look for this symbol, even if you think that the food is free from gluten. It may have been prepared in a cross contamination factory otherwise.
If you can, try to avoid gluten free foods. These foods are highly processed and contain so many unwanted chemical ingredients. a coeliac needs to heal their gut, these ingredients can cause inflammation.
If you wish to eat gluten free bread as toast, you should not share a toaster with the rest of your house. You should either get a separate toaster or purchase some special toaster bags to put your bread in to avoid cross contamination.
You should never use the same oil that has cooked something containing gluten in. Be mindful of this if going to a fish and chip shop. The oil that the chips are cooked in, will have been used for the fish batter, making the chips contaminated
It is common as a coeliac to react to other triggers, especially dairy. It is important to remove cow dairy if you are still experiencing symptoms after removing gluten. Sometimes, sheep or goat dairy is tolerated much better.
Coeliac sufferers should follow a strict anti-inflammatory diet during their healing phase. This should last for at least six months and focuses mainly on vegetables and fish. You can read more about the anti-inflammatory diet here.
Sometimes, being gluten free can make you feel like the "odd one out", especially at a party or gathering. Try to research the restaurants that you are going to with friends. If the menu doesn`t accommodate gluten free diners, suggest an alternative venue so that you don`t feel excluded. Some restaurants are great if you ring ahead and ask them if they can prepare something for you. The more time you give the restaurant, the better.
Holidays and travel can be a minefield for coeliacs. Plan ahead and look for accommodation that caters for coeliacs. Italy is a good place for coeliacs to go because Italy has a high incidence of coeliac disease. The restaurants and supermarkets are well stocked with gluten free foods. Spain is also great for accommodating coeliac sufferers. Remember, it is important to let your hotel or restaurant know that you can not have any cross-contamination.
Sometimes a GP will write a letter to your holiday company saying that you should be allowed an extra baggage allowance to take gluten free foods with you.
Staying and socialising with family and friends can be difficult. The kitchen will have gluten cross contaminated everywhere. It is important to educate your family and friends and emphasise the fact that just one crumb can cause a problem. Sometimes it is easier to take a meal with you to someone`s house.