Coeliac disease – May 2009

The Afternoon Show recently invited me to chat about coeliac disease; I’ve put down some of the areas we discussed below…

Coeliac disease results in abnormal immunological reaction to dietary gluten
causing tissue damage. Symptoms of Coeliac Disease can include;

• Weight loss
• Diarrhoea
• Bloating
• Abdominal cramps
• Anaemia
• Fatigue
• Failure to thrive in children
• & occasionally some individuals are asymptomatic

So what is gluten? Gluten is a protein found in wheat. It gives dough made from wheat flour its elasticity and therefore its good baking properties. Gluten is also used to describe similar proteins in rye, barley and oats. The prolamins in wheat (i.e. gliadin), rye (i.e. secalin), barley (i.e. hordein) and oats (i.e. avenin) are not identical, although they are closely related in structure. For this reason those with coeliac disease must avoid wheat, barley, rye and oats. There is controversy regarding the avoidance of oats but current recommendations in Ireland state that oats must be avoided unless they are specifically described as gluten free oats.

The only treatment for coeliac disease remains a strict lifelong gluten free diet. Once a strict gluten-free diet is commenced, the villi in the gut begin to re-grow and symptoms begin to improve.Assessment with a qualified dietitian is essential to ensure proper avoidance of gluten while maintaining nutritional adequacy in the diet.

Correct diagnose should only come from your doctor. Your doctor will look for symptoms of coeliac disease and take a blood test that can identify the presence of serum antibodies to gliadin, endomysium or transglutaminase. A small bowel biopsy remains essential and diagnosis should not be based on symptoms or serological tests alone.

The good news is that there are many foods which are naturally gluten free.

• Fresh and frozen fruit and vegetables
• Eggs
• All meat: lamb, pork, beef, venison. (except sausages).
• Poultry and fowl
• Shellfish/fish: (except those that have breadcrumbs or coatings)
• Dairy products: milk, plain cheese, some yogurts.
• Pulses, nuts and seeds
• Non-alcoholic drinks: fruit or vegetable juices, soft drinks.
• Alcoholic drinks: wine, sherry, brandy, rum, whiskey, vodka, cider.

There are also gluten free alternatives for breads, pastries, pastas and
cereals…so a gluten free diet can be a tasty healthy diet.

What foods should I avoid?

As well as obvious gluten sources (breads, pastas, noodles, cakes, pizza, sausage meats, some soups and gravies), there are a number of hidden sources. Look out for the following ingredients;

Wheat, Rye, Barley, Oats, Bulgar, Most soya sauces,
Spelt, Pearl Barley, Couscous, Rusk, Cereal Fillers, Durham wheat,
Most mincemeat, Wheat starch*, packet suet, Farina, semolina, baking powder
Hydrolysed vegetable protein, Starch and modified starch (unless Codex standard)*
Malt, malt extract and flavouring, wheat grass, wheat germ oil, wheat germ, wheat bran

*Where starch appears in an ingredient list on a label and the source of the starch is not declared, it is best to avoid eating that product just in case.

It is advisable for anyone who suffers with coeliac disease check labels carefully and to use a Gluten Free Food List from the Coeliac Society as a guide.

Following a strict gluten free diet is vital for those with coeliac disease. Dietary non compliance can lead to can lead to both minor and major long-term complications;

• Anaemia
• Osteoporosis/ Osteopaenia
• Poor nutritional status
• Impaired fertility
• Dental enamel defects of permanent teeth
• Arthritis or other joint symptoms
• Lactose intolerance
• & malignancy

Research has shown that a significant proportion of people on a gluten free diet are not getting enough calcium and iron.

Osteoporosis means thinning of the bones and can be a complication of coeliac disease due to reduced absorption of calcium in the gut when the gut is damaged. The best way to prevent osteoporosis is to stick to a strict gluten free diet, include weight bearing exercise daily and eat calcium rich foods.
It is recommended that all people with coeliac disease take 1500mg of calcium per day = 5 portions of calcium rich foods.

People with coeliac disease are also at a higher risk of iron deficiency anaemia secondary to malabsorption. The best way to prevent this is to stick to a strict gluten free diet and include iron rich foods in the diet regularly e.g. lean red meat, dark green vegetables, pulses, nuts, raisins & eggs.

Common Queries for those with celiac disease…
1. I’m feeling better so…can I relax my gluten free diet now? No, a lifelong gluten free diet is required in the
treatment of coeliac disease. Reintroduction of gluten will cause gut damage again and malabsorption.
2. I don’t seem to be able to take dairy…sometimes lactose intolerance can occur temporarily in coeliac disease when the gut has been damaged. Lactose is the sugar present in dairy and occasionally people can suffer problems digesting lactose when first diagnosed with coeliac disease as the gut has been damaged. Symptoms include diarrhoea, nausea, bloating and cramps after consuming dairy. If you are unable to tolerate dairy try calcium enriched soya products. You need to take extra care to meet your calcium requirements. You can discuss this with your dietitian when going through your gluten free diet.

Top tips
Join the coeliac society
Have a dietary assessment with a qualified dietitian
Avoid cross contamination; Storing food separately, Using a separate toaster, Use a separate chopping board, Use a separate butter container or jams, Always inform restaurants that you are suffer from coeliac disease.
Read food labels
Eat a healthy diet
Exercise regularly
Keep hydrated
And your main motto; If in doub
t…leave it out!