Coeliac Disease - the fight with Gluten
What is Coeliac Disease?
Coeliac is an autoimmune disease:
Coeliac - also known as gluten-sensitive enteropathy - is an autoimmune disease. Meaning when the body comes into contact with gluten, it cannot recognise the typically harmless gluten molecule and overreacts causing inflammation, which over time leads repeated damage to the small intestine.
Coeliac is a genetic disease:
Coeliac disease is caused by a variance in your genes! Specifically a different allele of the Human Leukocyte Antigen (HLA) gene.
The HLA protein - encoded by the HLA gene - functions to differentiate the body's own proteins from foreign pathogens. Typically it recognises gluten and gliaden as harmless, however in Coeliac individuals, gliaden is marked as a pathogen, therefore inciting an immune response thus damaging the small intestine.
Classic vs Non-Classic:
Due to the damage of the intestinal lining, Coeliac individuals often have difficulty with nutrient absorption. This is the defining factor between Classic Coeliac and Non-classic Coeliac
Non-classic Coeliac disease is defined as an individual who does not suffer from nutrient malabsorption, however still exhibits the typical symptoms of Classic Coeliac disease.
What’s actually happening in the body when a Coeliac consumes gluten?
On a molecular level, a protein within gluten called gliadin damages the small intestine. The local inflammation process leads to the destruction of the small intestine villi, which is the small finger-like projections that line our small intestines.
The villi function to allow for better nutritional absorption. However, once these are damaged, nutritional absorption is limited. This lack of nutrient absorption not only directly impacts the intestines, but can also be indirectly detrimental to all other body systems, therefore resulting in generally poor health and explains why Coeliac individuals can have symptoms arise from various body systems.
Exclusion of dietary gluten actually allows healing of the intestinal lining which then resolves the malabsorption of nutrients, which is why a strict gluten free diet is compulsory for all coeliacs.
Prevalence:
Within the overall global population, the prevalence of Coeliac is 0.5% to 1%, however it has been slowly increasing over the last 10 to 20 years. The risk of having Coeliac is 1 in 10 for first-degree relatives to Coeliac individuals and the incidence rate increases in individuals with other autoimmune disorders.
What are some symptoms for Coeliac Disease?
You should look at getting screened for Coeliac if you have:
I was just diagnosed with Coeliac, what do I do???
Following a strict Gluten Free diet is the only form of treatment for people with Coeliac.
But don’t panic!! In this day and age, a gluten free diet has become more and more common - cafes and restaurants are now providing more options, and it is now much easier to for newly diagnosed individuals to become educated on the matter. Coeliac Australia provides extensive information for all individuals, whether you have Coeliac or not. You are not alone!
Gluten, the villain.
Individuals with Coeliac disease unfortunately have to battle this all their life. We normally come in contact with gluten through food, meaning the biggest impact on individuals with Coeliac is their dietary intake. This means despite being a lifelong disease, if the right actions are taken Coeliac individuals can actually live a medically symptom free life.
There are several culprits when it comes to gluten intake:
The ‘Big Three’:
Other grains:
Introducing: The Gluten free diet.
Before getting into grains (which may seem like the scary part of planning a meal and shopping) remember the food groups that are naturally gluten free:
When it comes to the grains, this is where a lot of people might freak out due to the common misconception that all grains have gluten. However there are actually many gluten-free grains to choose from to substitute:
But what about Oats?
Oats is a somewhat controversial grain for people with coeliac disease. Oats have a similar protein (avenin) to other gluten-containing grains, due to this, oats were opted out of a gluten free diet. However, there have been studies that suggest ‘pure oats’, uncontaminated with Wheat, Rye or Barley, are actually safe for most people with coeliac. It is quite difficult to identify which oats may be safe to try here in Australia, as producers cannot legally label oats gluten free. It is important that you seek advice from your medical specialist or dietitian before trialing oats to ensure that it is safe for you to do so.
Label reading - it’s not as scary as you think! (Prevention)
It is important to be aware of ingredients and (eventually) be an expert in reading labels. This may seem a bit daunting at first - having to think about all the foods that are ‘safe’ to consume, but with exposure, you will master label reading in no time!
Coeliac Australia has made it straightforward through their detailed website with information, endorsement program and app for when you’re out grocery shopping.
领英推荐
This logo is (or will become) your best friend.
You can confidently pick up foods with this on the packaging as it has the tick of approval from Coeliac Australia as a part of their endorsement program. I.e. Coeliac Australia has ensured that this is 100% gluten free.
If in doubt, look out for this label!
To make our lives easier, Coeliac Australia also has an app that lists ingredients and additives used in Australia and New Zealand indicating what is safe for your gluten free diet.
What can you do to be more aware if you are living with someone who has coeliac?
Comorbidities:
Coeliac Disease is further complicated by also predisposing individuals to numerous other illnesses if gluten is continuously consumed. These illnesses greatly impact the quality of life and in some cases even the life expectancies of Coeliac patients.
Increased risk of osteoporosis:
Increased risk of certain cancers:
Select cancers have been linked with ongoing untreated Coeliac disease.
Despite a gluten free diet being the gold-standard for treatment and mitigation of symptoms, in some cases, it is not enough to resolve the alternative complications associated with Coeliac. Most commonly this can manifest as neurological illnesses or Refractory Coeliac Disease. However, it is important to note, the most common reason for persisting symptoms after commencing a gluten-free diet is accidental ingestion, likely through cross-contamination, or intentional ingestion in as the gluten-free diet can be challenging.
Unfortunately, small amounts of gluten can still cause ongoing symptoms and increase risk of comorbidities and complications, hence why a strict gluten free diet is recommended for individuals diagnosed with coeliac.
So… I have coeliac disease, are my intestines and I done for??
Not at all! Although getting diagnosed with coeliac may seem scary at first, many individuals live a normal life without gluten. Being diagnosed with coeliac disease just means you (and those around you) will have to be more aware of having gluten and sharing certain things like utensils, just like other allergies! With the ever-growing awareness, there are now gluten free options everywhere, you definitely aren’t alone in all of this.
If you have any concerns, lease visit your GP for further information or see a dietitian for dietary advice.
Written by: Angelina Immary - Registered Dietician (BNutDietet, MDiet), Damien He (BBiomedSc, BH-BMED)
References:
1.??? Beyond Celiac. n.d. What is Celiac Disease.
2.???? Caio, G., Volta, U., Sapone, A., Leffler, D. A., De Giorgio, R., Catassi, C., & Fasano, A. ???????? (2019). Celiac disease: a comprehensive current review.?BMC medicine,?17(1), 142. ????? https://doi.org/10.1186/s12916-019-1380-z
3.???? Celiac Disease Foundation. n.d. Autoimmune Disorders.
4.??? Coeliac Australia. n.d. Coeliac Australia Endorsed Product List. ???? https://coeliac.org.au/live/endorsed-products/
5.???? Kreutz, J. M., Adriaanse, M. P. M., van der Ploeg, E. M. C., & Vreugdenhil, A. C. E. (2020). ???????? Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease.?Nutrients,?12(2), 500. https://doi.org/10.3390/nu12020500
6.???? Nelsen D. A., Jr (2002). Gluten-sensitive enteropathy (celiac disease): more common ?????????? than you think.?American family physician,?66(12), 2259–2266.
7.???? Posner, E. B., & Haseeb, M. (2023). Celiac Disease. In?StatPearls. StatPearls ?????????? Publishing.
8.???? Taylor, A. K., Lebwohl, B., Snyder, C. L., & Green, P. H. R. (2008). Celiac Disease. In ?????????? M.P. Adam (Eds.) et. al.,?GeneReviews?. University of Washington, Seattle.