Coeliac disease is triggered by an autoimmune reaction which occurs in the small intestine in response to eating gluten, a protein which is typically found in wheat, barley and rye products. By time, this repeated reaction may cause damage to the linings of the small intestine, which could also lead to the malabsorption of micronutrients.
Genetic contribution, along with certain infant-feeding practices, gastrointestinal infections and gut bacteria, are thought to contribute to the formation of this disease. Moreover, such condition may also flare following surgery, pregnancy and childbirth, viral infections, or periods of intense, emotional stress.
Coeliac disease is likely to be more common in persons with a concurrent family history of coeliac disease or dermatitis herpetiformis, type 1 diabetes, Down syndrome, Turner syndrome, autoimmune thyroid disease, microscopic colitis as well as Addison’s disease.
Signs and symptoms
Digestive signs relating to coeliac disease may include chronic diarrhoea lasting for more than two weeks, fatigue, weight loss, bloating, abdominal pain, nausea, vomiting, or constipation. Other signs may include anaemia which is usually from iron deficiency; loss of bone density; an itchy, blistery skin rash that typically occurs on the elbows, knees, chest, scalp or buttocks; mouth ulcers; headaches; as well as numbness or a tingling sensation in the feet and hands; along with balance and cognitive impairment; joint pains; or reduced spleen functioning.
In children, coeliac disease may also present with failure to thrive, delayed growth, pale, foul-smelling stools, damage to the tooth enamel, short stature, attention-deficit hyperactivity disorder, learning disabilities or a lack of muscle coordination and seizures.
Left untreated, coeliac disease could lead to malnutrition, osteoporosis, infertility and miscarriage, lactose intolerance, lymphoma or small bowel cancer, as well as other nervous system conditions.
Two blood tests can help diagnose coeliac disease, mainly serology testing, which looks for the elevated levels of certain antibody proteins in the blood, which may indicate an autoimmune reaction to gluten, as well as genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8), which may be used to exclude the presence of coeliac disease.
If gluten is consumed regularly by someone who suffers from coeliac disease, they will be at a greater risk of developing complications like osteoporosis and cancer
If coeliac disease is likely, usually an endoscopy with a small tissue biopsy to analyse for damage to the small intestine villi, as well as a skin biopsy in the presence of dermatitis herpetiformis, are also organised. It is important to be tested for coeliac disease before trying a gluten-free diet, as eliminating gluten from one’s diet might make the aforementioned tests results appear falsely normal.
Is there a cure?
There is, as yet, no cure for coeliac disease but, for most people, following a strict, life-long, gluten-free diet can help in managing symptoms and promoting intestinal healing. Moreover, other treatment options include the use of steroid medication which helps reduce inflammation in the small intestine caused by the immune system.
Foods that contain wheat, barley or rye – the major sources of gluten – must be avoided. Gluten-containing products include bread, pasta, cereals, biscuits, crackers, cakes, pastries, pies, gravies, and sauces. Even if one only consumes a small amount of gluten, such as a spoonful of pasta, or there is cross-contamination from foods that contain gluten, one might experience unpleasant intestinal symptoms and damage to the small intestine, even in the absence of symptoms. If gluten is consumed regularly by someone who suffers from coeliac disease, they will be at a greater risk of developing complications like osteoporosis and cancer.
It is important to always check food labels and know what to look out for. Many foods, especially processed or ready-made foods, contain gluten in additives, such as malt flavouring and modified food starch.
Gluten may also be found in some non-food products like cosmetics, postage stamps and some medications. Many natural foods, like meat products, vegetables, eggs, dairy, potatoes and rice, are naturally gluten-free so one can still include them in the diet.
As regards other foods, one should make sure that the product is certified gluten-free on its label or avoid products where it is uncertain that a product includes gluten or not.
In order to avoid cross-contamination, gluten-free foods must be prepared using different utensils, like wooden spoons, griddles, chopping boards, toasters and cleaning cloths, ideally using a separate section of the kitchen that is dedicated to gluten-free food preparation.
For some items, like stainless steel cutlery and pans, ceramic plates and glasses, cleaning well with soapy water will be enough to remove any gluten traces. It may be practical for the whole household to go gluten-free in order to minimise the risk of cross-contamination and accidental ingestion of gluten, especially when there are children who suffer from coeliac disease.
Sometimes, coeliac disease can make the person more vulnerable to infection, therefore, one needs to take extra vaccinations or boosters to prevent such diseases. In addition, especially during the first months after diagnosis, one may be recommended vitamin and mineral supplementation to make up for any malabsorption that may have occurred before the diagnosis was made. These may include iron, calcium, vitamin B12, and folate. Once the intestinal damage has been reverted, deficiencies have been corrected and the diet is appropriate, there may no longer be a need for regular supplementation.
One in every 140 people with coeliac disease will develop refractory coeliac disease, where symptoms persist despite being on a strict gluten-free diet. The exact cause is as yet unknown.
Georgiana Mifsud Bonnici is a medical doctor and Antonella Grima is a medical doctor and registered nutritionist. For updates on nutrition, lifestyle modifications and holistic health, follow the following blogs www.facebook.com/be.heart.healthy and www.facebook.com/antonella.grima.nutritionist/.