Coeliac Disease

What is Coeliac Disease?

Coeliac disease (CD) is an autoimmune condition where the body starts to attack and damage tissue in the small intestine, resulting in inflammation and poor absorption of nutrients. CD is triggered by gluten, a protein found in wheat and close relatives of wheat, including spelt, faro, kamut, bulgur wheat, einkorn and durum, rye and barley. CD is an autoimmune condition that increases the likelihood of developing other autoimmune conditions. It is a serious, debilitating condition when left undiagnosed, but has a very positive response following diagnosis and commencement of gluten avoidance.

What causes Coeliac Disease?

CD is caused by exposure to proteins found in wheat called gluten and proteins very similar to gluten found in other grains. In CD, these proteins trigger a specific immune reaction that damages and flattens the gut surface. Other factors that may increase the likelihood of developing CD include:

  • Viral illness
  • Other infectious illness
  • Genetic predisposition
  • Early weaning on gluten foods

How common is Coeliac Disease?

CD is estimated to affect 1% of the UK population, however around 75% of those who have the condition remain undiagnosed.

What are the symptoms of Coeliac Disease?

Some people have no obvious CD symptoms, yet have damage to their gut lining. Symptoms of CD include:
  • Severe diarrhoea
  • Pale, oily and foul smelling stools
  • Weight loss
  • Anaemia
  • Skin condition known as dermatitis herpetiformis
  • Tiredness and fatigue
  • Stomach pain
  • Failure to thrive (adolescents)

What is the treatment for Coeliac Disease?

Treatment involves strict lifetime adherence to a gluten free diet. For this reason it is important to get a clear diagnosis before commencing a gluten free diet, as not knowing with certainty could considerably affect dietary compliance.

What diet and lifestyle strategies can support Coeliac Disease?

Dietary strategies to support CD should focus on providing good education about how to effectively avoid all dietary exposure to gluten and provide alternative meal ideas to ensure a nutritious balanced diet. General dietary and lifestyle strategies include:

Eliminate all gluten foods: strictly avoid all wheat, rye, barley and other grains within the wheat family (e.g. bulgur wheat, spelt, einkorn, triticale and kamut). This means avoiding the obvious bread, cakes, pastries, cereals, biscuit and pasta. The tricky part is to avoid absolutely any food that may contain them in small or trace amounts, such as sauces, beer, spices, processed meat, dips etc. Any deviation from a gluten free diet or accidental ingestion has the potential to cause long lasting symptoms and damage to the gut lining.

Replace with gluten free alternatives: staple gluten foods can be replaced with gluten free alternatives, including buckwheat, millet, maize, quinoa, tapioca, teff and sorghum. There is some concern about contamination of any of the grain-like products, so to reduce exposure, rinse ‘seeds’ thoroughly in a very fine sieve before cooking. Other useful gluten free carbohydrates include rice, potato, cassava, sweet potato and root vegetables.

Eat a calcium rich diet: untreated CD can affect bone health. In combination with a gluten free diet, a diet rich in calcium and low in salt is important to support future bone health. Include sources of calcium-rich food, e.g. fish, eggs, dairy, pulses, nuts, seeds and plenty of green leafy vegetables such as kale and spring greens.

Oats: gluten free oats appear to be well tolerated in small daily portions for most people with CD. Using a brand of oats that has taken extra steps to reduce factory contamination of their oats with gluten can help to reduce exposure to gluten. The protein in oats is, however, similar enough to gluten to provoke an immune reaction in a small number of sensitive individuals with CD.

Avoid sugary and processed ready-made foods: straight forward swaps of wheat biscuits for gluten free biscuits and gluten free versions of similar high fat and high sugar food can be initially tempting to help people feel less restricted. However the gluten free versions are nevertheless high in calories, sugar, and unhealthy fats, with an overall poor nutritional value too. Aim to keep the gluten free treats as occasional additions to the diet.

Avoid all packaged food if highly sensitive: coeliacs who are extra sensitive to minute traces of gluten may need to avoid packaged food altogether, despite the apparent absence of gluten in the ingredients listed. This is because contamination and exposure to trace amounts of gluten can occur where grains are milled and transported. An alternative diet can be based around meat, potatoes, rice and large amounts of vegetables cooked from scratch.

A Nutritional Therapist can help you identify diet and lifestyle factors, which may be contributing to your symptoms.