Coeliac disease is a chronic disease of the small intestine (also called the small bowel) caused by intolerance to gluten. Gluten is a protein found in wheat, oats, rye, barley, spelt and kamut.
Cause of coeliac disease
As we mentioned above, coeliac disease is caused by an abnormal immune reaction to the protein gluten. In people with coeliac disease, gluten causes inflammation and flattening of the villi of the small intestine. Villi are small finger-like projections that line the wall of the small intestine. The role of villi is to absorb nutrients from your food. In coeliac disease, the villi are so inflamed and flattened that they are unable to fulfill their role. The surface area of the bowel that absorbs food is greatly reduced, leading to malabsorption of nutrients, and nutrient deficiencies.
Symptoms of coeliac disease
The most common symptoms of coeliac disease include diarrhoea, abdominal pain, bloating, flatulence, nausea and vomiting, weight loss, anaemia, and fatigue. Untreated coeliac disease can lead to infertility, loss of bone mineral density (osteoporosis), neurological disorders, and dental problems. Some of the symptoms of coeliac disease are related to the gluten-induced damage to the wall of the small intestine, while other symptoms, such as anaemia, are related to nutritional deficiencies caused by poor absorption of nutrients from food. In children, untreated coeliac disease can affect growth and normal development, leading to short stature, weight loss or poor weight gain, and behavioural problems.
How is coeliac disease diagnosed?
Two blood tests are used to screen for coeliac disease. These are tissue transglutaminase antibodies (TTG), and deamidated gliadin peptide antibodies (DGP). Other tests that may be used are anti-endomysial antibodies and anti-gliadin antibody, but these tests are less commonly used these days.
If you suspect you may have coeliac disease, do not commence a gluten free diet before you have these tests. Cutting out gluten can make the tests unreliable, and you can get a false negative result. If you have already cut gluten out of your diet, but wish to have the tests done, you will have to re-introduce gluten into the diet for at least six weeks prior to getting the tests to make sure your results are reliable.
The most reliable diagnostic test for coeliac disease is a biopsy of the small intestine. In coeliac disease, the biopsy will find inflammation and flattening of the villi. If your blood tests come back positive for coeliac disease, your GP may recommend that you see a gastroenterologist and have a biopsy.
Treatment options for coeliac disease
The only recognised treatment for coeliac disease is to remove all gluten from the diet. This means cutting out all wheat, oats, rye, and barley, and all food products that contain them, such as bread, pasta, pizza, biscuits, cakes, and pastries. Ingredients within packaged foods can also come from a gluten source. Reading labels and becoming ingredient aware is essential to following a gluten free diet. At The Health Lodge, we work closely with your chef and dietitian or nutritionist to provide you with a gluten-free diet that is tailored to your individual needs.
At The Health Lodge, we recommend a multidisciplinary program that integrates the best of medical and complementary therapies in managing all aspects of coeliac disease, including gastrointestinal health, psychological wellbeing, and potential nutrient deficiencies. There is a range of therapies available to you, including:
- Medical care: People with coeliac disease are at a higher risk of nutrient deficiencies, especially iron, folate, calcium, and B12. Your GP may order blood tests to screen for nutrient deficiencies.
- Nutrition: A dietician or nutritionist can offer nutritional advice and counseling to ensure you enjoy a healthy, nutritious diet that is sustainable in the long run.
- Psychological support: Research has shown that psychological factors such as anxiety, depression and fatigue contribute to poor compliance to a gluten-free diet. A psychologist can support you in your mental wellbeing, and help you develop strong beliefs in personal control and self-management. These factors, along with a greater understanding of coeliac disease, have been shown to contribute to improved quality of life and improved dietary self-management in people with coeliac disease.
- Naturopathy: Many of the symptoms and nutrient deficiencies seen in coeliac disease are due to chronic inflammation of the gut wall. Your naturopath may suggest the use of herbs with anti-inflammatory properties to help decrease inflammation and aid in repairing the gut wall.
Helpful tips for a gluten free diet
- Read labels: Gluten can be found in many packages foods. Always read the label and check if any ingredients are made from gluten sources.
- Look for gluten free products: The public is becoming increasingly aware of gluten-intolerance. You can find gluten free flour, bread and pasta and other products in supermarkets and many food stores.
- Focus on what you can eat: For many at first, following a gluten-free diet can feel very restricted. Try to focus on the huge amount of food that is available to you, including fresh fruits and vegetables, fish, meats, eggs, legumes, nuts, seeds, and dairy. Many grains are also gluten free, including buckwheat, rice, corn, and quinoa.
- Plan ahead when eating out: Many cafes and restaurants now offer gluten-free options. Find out which cafes and restaurants cater to your needs, or phone ahead to check menu options when going somewhere new.
- Build a gluten free recipe repertoire: A simple internet search will find many sites that offer gluten free recipes. Get cooking, get creative!
In the long run
The gluten-sensitivity seen in coeliac disease is a life-long sensitivity. Symptoms will flare-up if gluten is reintroduced to the diet. A gluten free diet allows the wall of the small intestine to heal and resume normal function. If a life-long gluten free diet is strictly followed, the condition can be managed effectively, and symptoms and nutritional deficiencies can be prevented. At Byron integrated Medicine, we suggest that you seek out ongoing support and education, and see that any changes in nutritional needs are addressed, to ensure a high level of general wellbeing and quality of life.
Coeliac Australia www.coeliac.org.au
For enquiries call The Health Lodge on 02 6685 6445