Coeliac disease is an inflammatory condition of the gastrointestinal tract caused by intolerance of the protein gluten found in wheat, barley, rye and oats. The gluten damages the intestinal lining causing a reduction in the absorption of nutrients from the diet. Symptoms can present at any age, affecting 1 in 1,500 of the UK population, with an increased risk in those who suffer from autoimmune disease (insulin dependent diabetics). Symptoms can vary from individual to individual and can range from mild to severe.
Possible symptoms may include weight loss (not in all cases), gastrointestinal symptoms (diarrhoea, constipation, flatulence), anaemia (iron, B12, or folic acid deficiency), tiredness, lethargy and headaches, hair loss, infertility, joint pain and neurological symptoms (numbness in hands and feet), mouth ulcers, skin rash, teeth problems and osteoporosis.
If you suspect coeliac disease it is important to see your doctor to make arrangements for diagnosis. ONLY those with diagnosed Coeliac Disease, or a related medical condition should follow a gluten-free diet. Some symptoms may be mistaken as Irritable Bowel Syndrome (IBS) or Wheat Intolerance.
The clinical management of Coeliac Disease is to follow a gluten-free diet for life. An improvement of symptoms will be seen within a few weeks of following the diet. Strict adherence to a gluten-free diet is essential to control symptoms, improve the absorption of dietary nutrients and prevent further medical problems.
Once a diagnosis has been made management involves excluding all foods that contain gluten. The main gluten containing foods to exclude are breads, many breakfast cereals, pasta, pastries, cakes, custards, sauces, gravies, puddings and processed meats. The most popular alternative grains and starches are corn, potatoes, rice and tapioca (cassava). Other less common alternatives include amaranth, arrowroot, millet, montina, lupin, quinoa, sorghum, taro, teff, chia seed and yam. Bean, soybean and nut flours are sometimes used to add protein and dietary fibre into gluten-free products. Almond flour can be used as an alternative to flour in cakes, and buckwheat is considered acceptable, although check that it is not mixed with wheat flour. Gram flour made from chickpeas is also acceptable.
Gluten is used in food manufacturing as a stabilising agent, or thickener. Therefore it is essential to check the ingredients of food products. It is also used in medications and makeup products such as lipsticks and lip balm. Always check the ingredients of medications and cosmetics with your pharmacist.
A gluten-free diet allows fresh meats, fish, fruit, vegetables, beans and pulses. The diet allows rice, corn, soy, potatoes, tapioca, beans, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, montina and nut flours with strict avoidance of wheat, barley, rye and related components (triticale, durum, graham, kamut, semonlina, spelt, malt, malt flavouring or malt vinegar). Always check the ingredient list as gluten comes in many forms such as vegetable protein, or modified starch that can be derived from wheat (exclude maltodextrine, dextrin and malt flavouring, unless derived from corn). Many kosher foods manufactured for Passover are gluten free.
The suitability of oats in a gluten-free diet is still controversial. Research shows that pure oats are gluten free, but during milling they become contaminated by other grains. Specialist gluten-free products are available on prescription and your dietitian will be able to advice on suitable products. The main supermarkets also stock gluten-free breads, bread mixes, flour, cake and cake mixes, pancakes mix, pasta and biscuits.
Many gluten free products tend not to be fortified with nutrients and have a lower fibre, folate and iron content. Those on gluten free diets may not meet the recommended intake for fibre, thiamin, riboflavin, niacin, folate, iron and calcium. Therefore, a general multivitamin/mineral may be useful especially in the first few months after diagnosis. Speak with your physician or dietitian.