Coeliac disease is a permanent disease of the small intestines, caused by an allergic toxicity to the gliadin protein found in gluten cereals. Where the condition is present, the lining of the small intestines is unmercifully attacked by gliadin (it doesn't take much gliadin – less than half a gram a day can cause this reaction). The lining becomes damaged and loses its ability to absorb nutrients from food. Malabsorption and malnutrition therefore follow, inducing deficiencies in iron, zinc, calcium, magnesium, potassium and vitamins B6, B12, folic acid A, D, E and K.
There is a strong genetic aspect to coeliac disease. In identical twins, for example, of those who suffer, in 70% of cases both twins have it, making it 175 times more prevalent among twins than the general population. If you have a mother, father, brother or sister with coeliacs, you have a one in ten chance of having it too, which means you have a 30 times higher risk than the average person.
Medical textbooks still say, wrongly, that it occurs in only one in five thousand or so people. Due to remarkable advancements in laboratory screening for coeliacs, we have learnt that it occurs more frequently than ever imagined. According to a random sampling by the Red Cross, 1 in 250 Americans suffer from coeliac disease (19 out of every 20 of whom go undetected and untreated). More recent studies appearing in the Lancet medical journal have reported a prevalence of 1 in 122 in the Irish, 1 in 85 in the Finnish, 1 in 70 of the Italians in Northern Sardinia, and 1 in 18 in Algerian Saharawi refugee children. Coeliac disease is thought to be such a health threat in Italy that the government has considered mandating that all children, regardless if they are sick or not, must be tested for gliadin sensitivity and coeliac disease by age six.
In Britain, we are still in the Dark Ages in terms of recognising the widespread prevalence of coeliacs.
Screening and diagnosing coeliac disease
Coeliacs used to be diagnosed only by means of a gut biopsy showing atrophy (ie damage) of intestinal villi (the cells which line the intestine). Many doctors regard this biopsy as the ‘gold standard’ for the diagnosis of coeliac disease. It is commonly an outpatient procedure performed by a specialist, where a long tube is inserted through the mouth, oesophagus, stomach and finally into the small intestine, where several samples of mucosal lining are taken. A pathologist, looking for the characteristic mucosal lesions of coeliac disease, then studies these small pieces of tissue under a microscope.
While a gut biopsy is certainly thorough, it is also expensive and inconvenient. Many doctors and their patients are understandably reluctant to have it performed unless there is very good reason for doing so. So this is where modern laboratory science comes into play. Several antibody blood tests are currently being used with great success to help distinguish people who are likely candidates for coeliac disease from those who aren't. People with a positive screening now have a greater incentive to have a biopsy performed, with a much higher percentage of biopsies then coming back positive for coeliac disease. At the same time, fewer unnecessary and costly biopsies are performed. Since gliadin appears to be the key offending protein to which coeliacs are reacting, testing whether you are producing antibodies to gliadin is a useful place to start. Often, people with coeliacs produce anti-gliadin IgA antibodies, along with anti-gliadin IgG antibodies.
When you have an IgG food allergy test, one of the hundred or so foods you’ll be tested for will be gliadin, so you’ll get this information with your results. However, there is a problem with relying on just an IgG gliadin test. If you don't have coeliac disease, you can still test positive. You may be gliadin sensitive, but not have coeliacs. Also, if you’ve strictly avoided all sources of gluten/gliadin for several months, you may not test positive The answer to the dilemma is a test called IgA Anti-Transglutaminase (IgA-TGA). This is the newest lab test for coeliac disease. It measures anti-transglutaminase, which is a key enzyme that is targeted when you have coeliacs.
In a recent study, all coeliac sufferers (100%) were found to react positively to this test, and also the greater the level of reactivity, the greater was the level of damage to gut mucosa. So, it not only tested whether or not the person was sensitive, but also the degree of sensitivity. If positive, it is almost certain that you have coeliac disease. And if negative, it is almost certain that you don’t. Some doctors think that a positive result warrants further gut biopsy confirmation, but others consider this test to be just as good as a gut biopsy, and maybe better, hence avoiding further intervention. This test is also available as an inexpensive home-test kit giving immediate results.
The symptoms of coeliacs
The other medical myth about coeliacs is that a doctor should be able to diagnose this rarely seen coeliac patient easily from symptoms. The signs, mostly emanating from the abdomen, are unmistakable, doctors are told. Chronic diarrhoea/episodic diarrhoea with malnutrition, abdominal cramping, abdominal distention or bloating, foul smelling, bulky stools (steatorrhoea), weight loss or poor weight gain, and short stature. Expect to also hear complaints of weakness, fatigue, and loss of appetite.
Today, we know that most people with coeliac disease no longer go to the doctor with abdominal symptoms. Instead, patients are presenting with seemingly unrelated symptoms such as:
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