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

Definition

Coeliac disease (also known as gluten-sensitive enteropathy) is an allergy to gluten, a protein found in wheat, barley and rye ¹. 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, most often the first symptom is diarrhoea. If gluten continues to be consumed, over time, these "villi" flatten in the intestine, resulting in the coeliac being unable to absorb food and consequently leading to malnutrition. Hence a person with coeliac disease can become malnourished even while eating a great deal. Severity of symptoms can vary from person to person, however the person is 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 insulin dependent diabetics have a higher tendency to develop coeliac disease, as do people with osteoporosis, thyroid disease and epilepsy. In children, it is currently understood that breastfeeding may prevent children from developing the disease. The condition is often diagnosed in childhood after weaning when cereals are introduced into the diet, omitting cereals from their diets 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 gluten³.

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 are produced by several manufacturers, such as Juvela, Orgran and Glutafin, but unless the coeliac receives free prescriptions⁴, can prove to be costly⁵. Even the simplest items such as brown sauce, soy sauce, stock cubes and crisps can contain gluten, so any items must be checked before consumption⁶. Most tinned goods contain gluten, such as wheat starch⁷, 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 usng the same knife to butter a gluten free slice of bread can be enough to affect sensitive coeliacs.

The easiest way for coeliacs is 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, however in smaller pubs food can often be pre-cooked outwith 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 accomodate this within their menus, however these restaurants are quite rare and tend only to 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 coeliacs can be daunting at first, but with helpful support, and occaisional check ups (to ensure side effects such as osteoporosis are not being developed), is manageable, and should not detract from a person's lifestyle overly much. A group exists to offer support, and can be invaluable to a person upon diagnosis, Coeliac UK.