Coeliac Disease – Should You Stop Eating Gluten?

It may be a staple in the Western diet but gluten can cause serious health complications for many people. The most serious immune reaction to gluten, coeliac disease, affects one in 100 people, most of who don’t know they have it.

As a coeliac myself and a specialist in digestive health and autoimmune conditions, I see the damaging effects of gluten in the diet daily in my clinic. In this post I give you an overview of coeliac disease and its signs and symptoms. If you suspect gluten is a problem for you then do seek professional support and get tested.

What is Coeliac Disease (CD)?

Coeliac disease is an autoimmune disease triggered by the ingestion of gluten (found in wheat, barley and rye) in genetically susceptible individuals. It is one of the most chronic digestive disorders worldwide and can affect children and adults alike. For those with CD, gluten sets off an autoimmune reaction that can eventually lead to complete destruction of the villi, the tiny finger like projections lining the small intestine. For those diagnosed with coeliac disease it is essential to follow a gluten free diet for life.

What Causes Coeliac Disease?

Healthy villi are vital to the proper digestion and absorption of food. People with coeliac disease produce antibodies that, in combination with hormone-like substances called cytokines and the direct effect of immune cells, attack the intestine and flatten the villi, leading to malabsorption and illness. Because villi allow the small intestine to absorb nutrients from food, people with coeliac disease may easily become malnourished and low in certain vitamins and minerals. This autoimmune response is the main difference between gluten sensitivity and coeliac disease.

In coeliac disease there is normally a genetic component involved. We know that the genetic predisposition markers, HLA- DQ2 or -DQ8, must almost always be present in people with coeliac disease. This is not the case with wheat allergy and gluten sensitivity. However having the genes does not mean you will develop coeliac disease – normally other environmental factors are involved in addition to consuming gluten that results in increased intestinal permeability (sometimes known as ‘leaky gut’) and the development of the disease.

Environmental factors may include

  • Stress (lowers SigA and affect microbiota)
  • Medications (including antibiotics), NSAIDs etc
  • Environmental toxins and insufficient levels of key nutrients for gut health / immune health
  • Viruses, bacteria and other infections.

In order to develop coeliac disease you must first have a genetic predisposition to it, you must be exposed to a trigger (which will include eating gluten) and have developed intestinal permeability (Fasano 2012).

This can happen at any time during your life and can develop after many years of seemingly ‘coping’ with gluten. In coeliac disease it is important to address all these factors, remove gluten, nourish the body and heal the gut. This is what I talk about in the The Gut Health Diet

How Common is Coeliac Disease?

Coeliac disease is twice as common as crohn’s disease, ulcerative colitis, and cystic fibrosis combined. It has an overall prevalence worldwide of 1 % with large variations between countries.

If you have a family member with coeliac disease your risk of developing the disease is greater (8–15 %). Other at risk groups are people with other autoimmune or genetic diseases like type 1 diabetes mellitus, Addison’s disease, psoriasis , Hashimoto’s thyroiditis, Down syndrome, IgA deficiency  and a skin rash known as dermatitis herpetiformis.

If you have an autoimmune condition you may wish to consider whether gluten is playing a role.

CD appears to be increasing, particularly over the last 2-3 decades. One study comparing the blood of 10,000 people from 50 years ago to 10,000 people today found that the incidences of full-blown coeliac disease increased by 400 percent during that time period.

However many people still remain undiagnosed. A recent study in the UK demonstrated the diagnosis of those with CD has increased fourfold over the past two decades yet three quarters of sufferers remain undiagnosed.  So if you think gluten may be affecting your health seek professional advice and testing.

if you think you have a problem with gluten – get yourself tested before taking gluten out of your diet. The Cyrex test is available through our clinic.

 

What are the Signs and Symptoms of Coeliac Disease?

Firstly the effects of coeliac disease are NOT just limited to the digestive tract. In fact gluten can affect any body system.

The classic digestive symptoms of coeliac disease include abdominal pain or discomfort, constipation, diarrhoea and bloating, which is one of the reasons it is often misdiagnosed for conditions such as Irritable Bowel Syndrome (IBS). However many people with coeliac disease will not show any gut symptoms at all.

A review paper in The New England Journal of Medicine listed 55 “conditions” that can be caused by eating gluten. These include osteoporosis, irritable bowel disease, inflammatory bowel disease, anaemia, cancer, fatigue, canker sores, and rheumatoid arthritis, lupus, multiple sclerosis, and many other autoimmune diseases. Gluten is also linked to many psychiatric and neurological diseases, including anxiety, depression, schizophrenia, dementia,  migraines, epilepsy, and neuropathy (nerve damage).

In some patients liver blood test abnormalities may be the sole presentation of atypical CD and the adoption of a gluten free diet has been shown to lead to normalization of serum transaminases in 75% to 95% of patients with CD, usually within a year of following a gluten free diet.

The role of gluten in other disease processes also appears to be more widespread than previously – this review lists a wide range of gluten-associated disorders.

The diverse range of symptoms makes it difficult to get a diagnosis. In one study the majority of coeliac patients had visited five or more doctors prior to diagnosis and it had taken an average of 5 to 10 years, after initial visit to their doctor, for Coeliac Disease to be diagnosed.

If you suspect gluten is a problem and you are experiencing a number of the following symptoms – GET TESTED

Common Symptoms associated with Coeliac Disease

Diarrhoea, abdominal dissention, failure to thrive, colic, vomiting, irritability, anorexia and constipation (Babies)

Short stature, behavioural problems, learning disabilities, autism, ADHD, skin problems, anaemia, tooth enamel defects, digestive symptoms, epilepsy, delayed puberty (Children)
Digestive symptoms – abdominal pain, constipation, diarrhoea, bloating, wind, nausea and vomitingWeight loss, Infertility, still birth, poor fetal growth, miscarriageAutoimmune conditions e.g thyroiditis, diabetes type 1, rheumatoid arthritis, autoimmune hepatitis, sarcoidosis, alopecia areata (hair loss)

Menstrual irregularities, delayed menarche, loss of periods, early menopause

Migraines, foggy head, poor concentration

Osteoporosis, osteopenia, bone and joint pain

Dermatitis hepitaformis

Chronic fatigue

Abnormal liver function

Depression and mental health issues

Neurological issues such as ataxia (poor muscle coordination), migraines and neuropathy (numbness and tingling in the hands and feet)

Vitamin and Mineral deficiencies and malabsorption

Iron deficiency anaemia

Mouth ulcers, glossitis

Dental enamel defects

Hypoglycaemia

 

REMEMBER If you suspect gluten is a problem for you it is essential to get tested before removing gluten from you diet. For further information contact our clinic 

 

Additional References

Bushara KO. Neurologic presentation of celiac disease. Gastroenterology. 2005 Apr;128(4 Suppl 1):S92-7. Review.

Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002 Jan 17;346(3):180-8. Review.

Green PH, Jabri B. Coeliac disease. Lancet. 2003 Aug 2;362(9381):383-91. Review.

Green PH, Neugut AI, Naiyer AJ, Edwards ZC, Gabinelle S, Chinburapa V. Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States. J Insur Med. 2008;40(3-4):218-28.

Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive impairment and celiac disease. Arch Neurol. 2006 Oct;63(10):1440-6.

Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009 Sep 16;302(11):1171-8.

Ludvigsson JF, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of schizophrenia and other psychosis: a general population cohort study. Scand J Gastroenterol. 2007 Feb;42(2):179-85.

Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders–a general population-based cohort study. J Affect Disord. 2007 Apr;99(1-3):117-26. Epub 2006 Oct 6.

Margutti P, Delunardo F, Ortona E. Autoantibodies associated with psychiatric disorders. Curr Neurovasc Res. 2006 May;3(2):149-57. Review.

Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004;(2):CD003498. Review.

Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, Zinsmeister AR, Melton LJ 3rd, Murray JA. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009 Jul;137(1):88-93