Many people are unaware of the condition known as Coeliac Disease so this entry is intended to educate people about what it is and how it can be managed. As long as it is managed properly it is not life-threatening or contagious.

Definition

Coeliac disease (also known as gluten-sensitive enteropathy) is an allergy to gluten - a protein found in wheat, barley and rye¹. If eaten, this gluten affects small finger-like strands in the person's small intestine called villi. These villi are used in the absorption of food through the digestion process.

Symptoms

If gluten is eaten by a coeliac² the first symptom, most often, is diarrhoea. If gluten continues to be consumed, over time, the villi flatten in the intestine, resulting in the coeliac being unable to absorb food and consequently leading to malnutrition. As a result, a person with coeliac disease can become malnourished even while eating a great deal. Severity of symptoms can vary from person to person but they are more inclined to develop anaemia due to deficiencies of iron in the blood. Hence a coeliac is prone to fatigue and weakness. Dermatitis herpetiformis, a skin complaint, is also more prone to develop.

If children develop coeliac disease, their growth can be hampered, muscle wastage can occur and their general development can be adversely affected. Thus, it is especially vital in children that early detection is made.

Over time, if untreated, the risk of bowel cancer, infertility and osteoporosis is greatly increased.

Diagnosis

A simple blood test is available whereby suspected coeliac disease can be identified by analysis of a small sample of blood. For confirmation a biopsy must be performed, by endoscopy, whereby a tube is passed down the patient's throat and a small intestinal sample taken for analysis.

Who Is At Risk?

Although anyone can contract coeliac disease, it is believed that insulin-dependent diabetics have a higher tendency to develop coeliac disease as do people with osteoporosis, thyroid disease and epilepsy. It is currently understood that breastfed children have less chance of developing the disease. The condition is often diagnosed in childhood, after weaning, when cereals are introduced into the diet. Omitting cereals from the diet for at least the first four months may reduce the risk of coeliac disease developing. It can be passed down through families and it is believed about one in a hundred people within the United Kingdom are affected. The actual causes of the disease are not known.

Treatment

At present, there is no known cure for coeliac disease. Scientific research is ongoing to try and block the damaging effects of gluten on the intestine so that people are able to eat foods with gluten in them with no adverse reaction. However, at the current time, the only treatment is for coeliacs to avoid foods containing gluten, which is no mean feat.

Obviously, any foods containing bread are to be avoided, as are pizzas, pasta dishes, cakes, biscuits and pastries. An extensive gluten-free range of goods is produced by several manufacturers such as Juvela, Orgran and Glutafin but, unless the coeliac receives free prescriptions³, this can prove to be costly, as well as not being very nice. Even the simplest items such as brown sauce, soy sauce, stock cubes and crisps can contain gluten, so any items must be checked before consumption⁴. Most tinned goods contain gluten, such as wheat starch⁵, and so tend to be avoided by coeliacs. However, with better labelling most foods now tend to state if the item is gluten-free by an obvious badge.

Cross-contamination from other foods is also an issue. For example, chips from a chip shop are gluten-free but if the oil they are fried in has been used to fry battered foods, this can affect any chips subsequently cooked in the oil. Even spreading butter onto a normal slice of bread before using the same knife to butter a gluten-free slice of bread can be enough to affect sensitive coeliacs.

The easiest way is for coeliacs to cook everything from scratch, whereby all the ingredients are known and the meal can be guaranteed to be gluten-free. Substitute flours such as potato, rice or corn flours can be used.

Eating Out

Eating out in restaurants or from fast food shops can be difficult for a person with coeliac disease. In good quality restaurants the maitre'd will be able to ascertain whether a particular dish contains gluten or not. In smaller pubs, however, food can often be pre-cooked off the premises and merely heated on site. Very often staff are unaware of what ingredients are in these dishes.

As mentioned above, chip shops can be unsuitable for coeliacs, as are most types of fast food places where items containing gluten are prepared.

A few restaurants have identified a need for gluten-free cooking and try to accommodate this within their menus. These restaurants are quite rare and tend to only advertise locally. Most quality establishments should be able to cook gluten-free products upon request (if the food is provided to them) although, obviously, this should be checked in advance.

Summary

Being diagnosed with coeliac disease can be daunting at first, but with helpful support and occasional check-ups (to ensure side effects such as osteoporosis are not developing), it is manageable and should not detract from a person's lifestyle too much. A group exists to offer support and can be invaluable to a person upon diagnosis: Coeliac UK.