The Truth About Coeliacs

This gluten-allergic disease affects many more people that conventional medical thinking previously believed. Full recovery is possible with the right diet and nutrients.

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:

  • Chronic psychological depression
  • Overweight or obesity
  • Abnormal elevation of liver enzymes of unknown cause
  • Permanent teeth with distinctive horizontal grooves and chalky whiteness
  • Chronic nerve disease of unknown cause (eg ataxia or peripheral neuropathy)
  • Osteoporosis in women not responding to conventional therapies
  • Intestinal cancers
  • Insulin-dependent diabetes
  • Thyroid disease (both overactive and underactive)
  • Increased risk of dementia

The osteoporosis connection

Undetected gluten sensitivity, whether or not it has led to coeliac disease, is commonly found among pre- and post-menopausal women and even children who suffer from osteoporosis. The same nutrient deficiencies found in osteoporosis – magnesium, vitamin D and vitamin K – are also seen in people suffering from coeliac disease. In fact, one recent study showed that a gluten-free diet actually reversed osteoporosis in people with coeliacs disease. The researchers took 44 coeliacs patients, who were aged from two to 20 years old at the time of the diagnosis, and compared them to 177 healthy, coeliacs-free people.

The lumbar spine and whole-body bone mineral density values of people with coeliacs were significantly lower than those without coeliacs. After one and a half years on a gluten-free diet, they retested the coeliac group and found that their bone density had improved such that is was almost indistinguishable from those of the non-coeliacs.

Increasing risk of cancer

Undetected coeliacs is associated with a 40 to 100 fold increased risk of intestinal lymphomas. This is because the immune system of a person with coeliacs doesn’t fight against cancer cells as well as it should.

More than 80 international studies have been published on the increased incidence of cancer in coeliacs. In the case of intestinal lymphomas – which are the most common kind of cancer associated with coeliacs – once these are diagnosed, the prognosis is generally very poor. On the other hand, if coeliacs is diagnosed before the cancer becomes clinically evident and a gluten-free diet is strictly followed, the risk of intestinal lymphoma decreases to near normal in five years. The prevention of cancer is the single most compelling argument for routine and repeated screening or monitoring for coeliacs disease in people with any of the above conditions, symptoms or who have a close relative with coeliacs.

Can coeliac sufferers eat oats?

There is growing evidence that most coeliac sufferers do not react to all gluten containing grains, but may be specifically reacting to gliadin, which is not found in oats. Oats originate from a different sub-tribe of grain to that of wheat, rye and barley and don’t contain the same proteins. The trouble is that many oat products are contaminated with wheat, rye or barley during processing (such as milling), making them unsuitable for a gluten or gliadin-free diet.

One study found that 79% of 108 oat foods analysed were severely contaminated with wheat, rye and barley, or mixtures of these three cereals. Nairns provides a number of guaranteed uncontaminated oat products. As to their safety for coeliacs, this is what Coeliac UK says: “Several studies have reported the safety of consuming large amounts of pure oats in people with newly diagnosed coeliac disease using clinical, serological and histlogical parameters. Research suggests that pure, uncontaminated oats and oat products are not toxic to the majority of adults and children with coeliac disease.

Although it is possible that a very small number of people with coeliac disease may still be sensitive to pure, uncontaminated oat products the weight of evidence supports the safety of oats obtained from gluten-free manufacturers.”

The only known cure

The only known effective therapy for coeliacs calls for the complete, life-long elimination of gluten/gliadin from the diet. No wheat, rye or barley, in any form, are allowed in the diet for the rest of one’s life. Initially, I also recommend the avoidance of oats. However, if an IgG food allergy test does not show the presence of oat antibodies, then try reintroducing oats and monitor symptoms. About 80% of coeliacs sufferers can tolerate oats. If strictly followed, a dramatic resurgence of health should occur.

Diseased intestines heal; deficient nutrients are again absorbed; bones get stronger; the high risk of intestinal cancer returns back to a normal risk within five years on a gluten-free diet. But obviously, you have to suspect and diagnose coeliac disease first.

Healing the digestive tract

Regardless of whether or not you have coeliacs, your ‘inner skin’ works hard to digest and deal with the mountains of food you eat and, as a consequence, can easily become damaged. Alcohol, antibiotics, caffeinated drinks, fried foods and painkillers, as well as food allergens, are the most common culprits. Painkillers can literally cause ulceration of the gut.

Over 2,000 people die annually as a consequence of gut damage caused by painkillers, and the average person in Britain takes over 300 a year! The result is that the digestive tract becomes more permeable and undigested food proteins which aren’t on the guest list so to speak, rather than amino acids, which are what protein should be broken down into, get through into the bloodstream. Then your immune system attacks the gate crasher. That’s the basis of most food allergies.

Glutamine – your gut’s best friend

There are eight ‘essential’ amino acids that your body uses to make the protein that makes you. Glutamine is not one of them. Yet, despite this, it is literally the most abundant amino acid in the human body. There’s lots of it in breast milk – five times more than any other amino acid – and hefty amounts can be found in food. For example, there’s about 175mg of glutamine in a large tomato, compared to less than 10mg of most other amino acids.

So, why does your body need all this glutamine and what does it do with it? It’s essential for your digestive tract, but it’s also highly beneficial for your immune system and brain. Although most of your body’s organs are fuelled by glucose, your digestive tract is a different story. The size of a small football pitch when stretched out flat, it’s a vast and highly active interface between your body and the outside world. It needs a lot of fuel to work properly day in and day out, and it runs on glutamine – thus sparing vital energy-giving glucose for your brain, heart, and the rest of your body. Not only does glutamine power your gut, it heals it as well. The endothelial cells that make up the inner lining of your digestive tract replace themselves every four days and are your most critical line of defence against developing food allergies or getting infections. As your ‘inner skin,’ your gut takes lots of hits.

In Japan, it’s a common practice to give patients taking non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 2,000 mg of glutamine 30 minutes beforehand to prevent stomach bleeding and ulceration. Many surgeons now give patients glutamine after operations. The main reason is because it heals the gut and your immune system thrives off it – including vital immune cells such as lymphocytes and macrophages. They just function better when they get an optimal intake of glutamine.

If you have been diagnosed with coeliacs you need to take glutamine for at least a month, ideally together with digestive enzymes and a probiotic supplement. Some supplements provide all three in one (visit Totally Nourish for details). However these don’t provide enough glutamine for rapid healing. For concentrated repair during the first month, take 4,000 to 8,000mg of glutamine a day, the equivalent of one to two heaped teaspoons of glutamine powder. (Capsules usually contain 500 mg, so you’d have to take 8 to 16!) This will provide your gut with all the glutamine it needs to heal and rejuvenate. It’s best taken last thing at night or first thing in the morning, when your stomach is empty, in a glass of water. Heat destroys glutamine so don’t have it in a hot drink. Do this every day for a month.

Beneficial bacteria – getting the balance right

Inside your body are more bacteria than living cells. Healthy bacteria flourish in a healthy digestive tract and die off in an unhealthy one. So, once you’ve improved your digestion, ‘reinoculating’ your digestive tract with probiotics (the name for these beneficial strains of bacteria) makes a big difference. These are called ‘human strain’ Acidophilus and Bifidus bacteria and work much better than dairy derived strains found in normal yoghurt. If you do eat yoghurt, it’s best to choose those that culture their yoghurt with the Acidophilus and Bifidus strains of bacteria. These friendly bacteria are not only good for your digestive tract but also for your immune system and overall health. Once you’ve got the right bacterial balance in your gut, feeding them the right food helps to maintain the gut’s perfect bacterial balance.

What our two main beneficial bacterial species – Lactobacillus Acidophilus and Bifidobacteria – need us to eat is a diet rich in the fibre found only in fresh, unprocessed fruit, vegetables and grains. These contain a type of fibre known as prebiotics, the best known and most widely tested of which are called ‘oligosaccharides’. They also come in a supplement form often shortened to FOS – fructo-oligosaccharides. Foods rich in prebiotics include chicory, Jerusalem artichokes and soybeans. Another desirable fibre is called ‘resistant starch’, which unlike normal starch, passes through the stomach and can only be broken down in the gut. Other favourite bacterial foods include flavonoids and lignans, found in vegetables, pulses and seeds. If you want to give your beneficial bacteria a boost, you may like to take a probiotic that also contains some FOS. That way you are giving the population a boost along with an added food supply.

Some probiotics also contain digestive enzymes and glutamine covering three bases in one. Having a capsule or powder for up to 30 days is all you need to get your inner flora flourishing.

30 day action plan for coeliac recovery

• Strictly avoid all wheat, rye, barley and gluten/gliadin containing foods. Eat only uncontaminated oats.
• Take a heaped teaspoon of glutamine powder last thing at night to improve the integrity of your digestive tract.
• Take digestive enzymes with each main meal.
• Reinoculate your gut with beneficial bacteria by taking a capsule or powder of human strain acidophilus and bifido bacteria. You can get combined digestive enzymes and probiotics (visit Totally Nourish).
• Eats lots of vegetables, fruit and fish, and less deep-fried food, alcohol, coffee and sugar. Start each main meal with some salad or something raw.
• Chew your food well and don’t eat when you’re stressed.