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Coeliac Disease

People with coeliac disease (pronounced see-liac) have an immune reaction when they eat any food containing gluten. Gluten is found in wheat, barley and rye and any products using these ingredients such as bread, pasta, cakes, biscuits, sauces.

Coeliac disease is an autoimmune disease. This means that in those with the condition the immune system is mistakenly triggered by a substance to produce antibodies and to attack parts of their own body. In the case of coeliac disease, this substance is gluten and the antibodies produced attack the micro villi that line the small intestine. As food passes through the small intestine the function of the micro villi is to absorb the nutrients necessary to sustain the body and its functions. Eventually, if coeliac disease remains undiagnosed and the afflicted person continues to consume gluten, the micro villi die off and can no longer absorb any nutrients, see below diagramme. This in turn leads to a multitude of symptoms ranging from minor discomfort to life-threatening conditions, such as severe anaemia. 

(Courtesy of Family Health magazine, Canada)

Images of real tissue samples

      

healthy villi                      damaged villi

(Courtesy of Österreichische Arbeitsgemeinschaft Zöliakie, Austria)

What are the symptoms?

The symptoms of coeliac disease can vary significantly from person to person with in some cases only one symptom and in others multiple symptoms being experienced. 

Symptoms include:

  • diarrhoea, excessive wind, and/or constipation
  • persistent or unexplained gastrointestinal symptoms, such as nausea and vomiting
  • recurrent stomach pain, cramping or bloating
  • any combination of iron, vitamin B12 or folic acid deficiency
  • tiredness and/or headaches
  • weight loss (but not in all cases)
  • mouth ulcers
  • hair loss (alopecia)
  • skin rash (dermatitis herpetiformis (DH))
  • tooth enamel problems
  • osteoporosis
  • depression
  • infertility
  • repeated miscarriages
  • joint and/or bone pain
  • neurological (nerve) problems such as ataxia (poor muscle co-ordination) and neuropathy (numbness and tingling in the hands and feet).

What about children?

In babies, symptoms may develop after weaning onto cereals which contain gluten.

Other symptoms in young children include:

  • muscle wasting in the arms and legs
  • bloated tummy
  • irritability
  • failure to gain weight or lose weight after previously growing well

Symptoms in older children may vary as they do in adults.

Common confusion

Contrary to popular belief, you do not need to be underweight or have lost weight to have coeliac disease. Most people are of normal weight or even overweight at diagnosis.

Some symptoms may be mistaken as Irritable Bowel Syndrome (IBS) or wheat intolerance. 

What should I do if I think if have Coeliac Disease?

If you think you may have coeliac disease, it’s essential to continue eating gluten until your doctor makes a diagnosis.

The diagnostic tests for coeliac disease look at how the body responds to gluten. Some people may start to reduce or eliminate gluten from their diet because they feel ill. Unfortunately this is very likely to cause an inaccurate result for both the blood test and the gut biopsy. Therefore, it’s very important to keep eating gluten throughout the diagnosis process.

As a general guideline, the recommendation is to eat some gluten in more than one meal every day for at least six weeks before testing.

If you've already reduced or eliminated gluten from your diet, you will need to reintroduce it to make sure you get the most accurate test results. While it may be difficult and uncomfortable, it’s essential for your long term health.

If you are reintroducing gluten into your diet, you should discuss how best to manage your symptoms with your doctor.

To get advice on first steps to take and how to maintain a gluten-free diet you can also approach the coeliac society in your country that may be able to provide relevant information. See our list of member societies.

Managing a gluten-free diet

Maintaining a gluten free diet can be easier than you think. Grains and their flours that do not contain gluten can be used to make a range of gluten free foods. Many staple foods are naturally gluten free such as meat, fish, eggs, vegetables, fruits and milk. See our page on the Gluten Free Diet for more information.

Due to the increased risk of osteoporosis it is important to regularly consume calcium-containing food, such as milk and cheese. A daily intake of 1500mg of calcium is recommended for adults suffering from coeliac disease.