Gastroenterologists worry about physicians who prescribe gluten-free diets without first testing their patients for coeliac disease.

Prof. Knut Lundin, president of the European Society for the Study of Coeliac Disease, insisted that the public should continuously be told they should take a serology test before going on a gluten-free diet.

This was pointed out by Knut Lundin, professor of medicine at Oslo University’s Faculty of Medicine and a leading consultant gastroenterologist at the Endo-scopy Unit of Rikshospitalet, the Oslo University hospital.

Speaking to the Times of Malta to mark International Coeliac Day and ahead of the Fourth National Coeliac Conference, Prof. Lundin, president of the European Society for the Study of Coeliac Disease, insisted the public should continuously be advised to take a serology test before going on a gluten free diet.

Referring to what is known as non-coeliac gluten sensitivity (NCGS), a condition where people are not coeliac but feel uncomfortable or unwell after consuming gluten, he admits that though he believes this is a real condition, a paper he published on the subject did not find much support.

There is no official method of diagnosing NCGS, but he estimates sufferers could number between zero and five per cent.

Should everyone be on a gluten-free diet?

“No. That is unreasonable. Humans have been consuming gluten for centuries and our quality of life and life expectancy has increased all the time. In fact, a strict gluten-free diet can be considered a nutritionally inferior diet. However, most coeliacs are concerned about their diet and compensate with a focus on re-placements,” Prof. Lundin said.

Most common food-related chronic disease in children but often undiagnosed

Research showed that people in the US who led a gluten-reduced (not gluten-free) life had an increased risk of ill health.

“This may not be related to the gluten amount as such, but rather with what they replace their bread with,” Prof. Lundin noted.

Coeliac disease is an auto-immune condition, that is, a sufferer’s immune system is mistakenly triggered by a substance to produce antibodies that attack parts of their own body. In the case of coeliac disease, this substance is gluten, and the antibodies produced attack the microvilli that line the small intestine.

As food passes through the small intestine, the role of the microvilli is to absorb the nutrients necessary for sustaining the body and its functions.

Eventually, if coeliac disease remains undiagnosed and the afflicted person continues to consume gluten, the microvilli die and can no longer absorb any nutrients. This, in turn, leads to a multitude of symptoms ranging from minor discomfort to life-threatening conditions.

The Association of European Coeliac Societies (AOECS) estimates that one in 100 people suffers from coeliac disease in Europe, and applying that ratio, it can be assumed that more than seven million people are affected by coeliac disease across Europe, with only about one-fourth actually being diagnosed.

This year, the AOECS and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition are collaborating in an appeal to the EU and its Member States to take action to ensure processes for earlier diagnosis of the disease in children.

“Coeliac disease is the most common food-related chronic disease among children in Europe, with the prevalence rising in recent decades. However, up to 80 per cent of coeliac disease cases remain undiagnosed among children, which can lead to many serious associated health complications,” they said.

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Coeliac awareness

PR consultancy firm Narrative Structures held its first National Coeliac Conference in 2015 to raise awareness of the disease.

The keynote speaker then was paediatric gastroenterologist Stefano Guandalini, a world expert and medical director of the University of Chicago’s Celiac Disease Centre. He was followed in 2016 by Chris Mulder, professor of gastroenterology at the UV University Medical Centre in Amsterdam and by Carolina Ciacci, professor of gastroenterology at the University of Salerno, Italy, last year.

This year the keynote speaker will be Knut Lundin.

In a bid to ensure a better quality of life for people on a gluten-free diet, Narrative Structures last year announced their partnership with Coeliac UK, the world’s largest coeliac NGO, as part of an ongoing coeliac awareness campaign and commitment to making education and training available in gluten-free catering to restaurants, schools and hospitals.

The courses so far have covered various angles in gluten-free preparation, including what is required by law to adhere to safe gluten-free cooking.