Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an inflammatory condition of the small intestine caused by sensitivity to gluten (a protein found in wheat) and similar proteins found in barley and rye.

The word ‘coeliac’ is derived from Greek word ‘koiliakos’ meaning ‘suffering in the bowel’.  It was first described around 1800 years ago in the writings of Roman physicians however there was no real progress in understanding until after World War 2. 

Doctors noted that during the war, Dutch coeliac children’s symptoms improved dramatically when maize and rice consumption increased compared to wheat, rye and oat flours, which were unavailable at the time due to the war. However the children’s conditions relapsed at the end of the war once wheat began to be airlifted back into Holland. Since then it was discovered that it was specifically the gluten protein in the wheat that exacerbated the condition.

What causes coeliac disease?

In a healthy small intestine, the surface of the gut lining is covered with millions of tiny finger like growths called villi.  The villi increase the surface area of the gut and allow the body to absorb nutrients from food across to the blood more effectively.

However, in coeliac disease, the damage and inflammation to the lining of the gut over time flattens the villi, reducing their ability to help with digestion.  As a result, your gut is no longer able to absorb all the available nutrients.

Villi

Healthy villi vs villi damaged by Coeliac Disease

 What are the symptoms?

Symptoms vary from person to person, they can include:
– severe or occasional diarrhoea, excessive wind and/or constipation
– persistent unexplained gastrointestinal symptoms such as nausea and vomiting
– stomach pain, cramping or bloating
– mouth ulcers
– tiredness
– sudden or unexpected weight loss (not in all cases)
– anaemia
– deficiency in iron, calcium, vitamin D and folate

The way the body’s immune system reacts to gluten can affect other parts of the body as well. For example, the skin rash called dermatitis herpetiformis may develop.  Dermatitis herpetiformis is the skin manifestation of coeliac disease, this rash commonly occurs on the elbows, knees, shoulders, buttocks, and face, with red, raised patches often with blisters. It affects around one in 3,300 people.

How common is the condition?

It is estimated that 1 in 100 people have the condition in Ireland and the UK.  There is a genetic link to the disease, therefore having a first-degree relative with the condition increases a child’s risk of developing the disease to 1 in 10. 

Research has shown that introducing gluten during the first 3 months of life in groups of at risk children increased the risk by 5 times compared to when gluten was introduced at 4-6 months.  There was no benefit found in delaying introduction until after 6 months.  Therefore it’s generally recommended that gluten should not be introduced before 6 months, regardless of whether the child has a relative with the condition or not.

What are the long-term consequences?

Osteoporosis

Coeliac disease is a strong risk factor for osteoporosis with many studies reporting decreased levels of bone mineral density in newly diagnosed patients by up to ¼ when compared to healthy counterparts.  This reduction in density is thought to be due to the chronic malabsorption of calcium prior to diagnosis.

This malabsorption causes calcium to be drawn from the bones to meet the body’s requirements.   There is also reduced calcium intake following diagnosis as the gluten free diet will involve avoidance of bread and cereals which normally contribute around 30% of daily calcium intake in the Irish & UK diet.

Therefore it is recommended that the target calcium intake for prevention and treatment of osteoporosis in adult coeliac patients is 1500mg per day.

Malabsorption

As the body does not fully absorb nutrients from the food you eat due to the inflammation, over time this can lead to a deficiency of certain vitamins and minerals and in turn, other complications can develop such as osteoporosis (see above), or anaemia, caused by either lack of iron, B12 or folate in the body.

Cancer

There is research to suggest that coeliac disease is related to an increased risk of developing certain cancers including bowel cancer and lymphoma.  It’s estimated that coeliac patients are twice as likely to develop bowel cancer than the general population. However this is still a very small increase in risk with only 1 in every 200 people with coeliac disease developing bowel cancer in the first 10 years after diagnosis.  The risk drops as the gluten free diet takes effect.

Coeliac patient or not, if you have symptoms such as blood in stools, unexplained weight loss and changes to normal bowel habit that last over 4 weeks, you should see your GP.

What is the treatment for coeliac disease?

Once diagnosed, the only treatment for coeliac disease is a gluten-free diet.   Therefore complete avoidance of foods containing wheat, rye and barley .  Some people with the condition may also be sensitive to oats.   Including oats in the diet is a valuable source of soluble fibre however this should be considered on an individual basis depending on sensitivity.

Some gastrointestinal symptoms such as diarrhoea will improve within a few weeks of commencing a gluten free diet but it can often take over 12 months for the mucosal damage to the small bowel to repair and the villi return to normal.  So some other symptoms related to nutrient absorption may take longer to improve.

Practical advice to avoid contamination at home:

Use a separate toaster for gluten free breads or a toaster bag

Ensure chopping boards & utensils are thoroughly cleaned or use a separate set

Wipe down surfaces after preparing food

Separate containers for butter, jams etc.

Ensure gluten free food not prepared in a floury atmosphere.

More information

Book an appointment

Or contact the clinic for details

 

Associate Nutritionist

Liam Leech, Associate Nutritionist

Liam Leech, MSc. ANutr.

 

 

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

  • Our Newsletter

    Sign up for our newsletter and get the latest news.

    Thank you for submitting. Your first newsletter will follow shortly.
    there is an error in your submission. Please review your details and resend