Understanding Coeliac Disease

Confusing symptoms

Doctors are told that the signs and symptoms of coeliac disease, mostly emanating from the abdomen, are unmistakable: 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. However today we know that most people with coeliac disease no longer go to the doctor with abdominal symptoms. Instead, we are seeing patients first presenting with:
• 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, peripheral neuropathy)
• Osteoporosis in women not responding to conventional therapies
• Intestinal cancers
• Insulin-dependent diabetes
• Thyroid disease (both overactive and underactive)
• Short stature in children

Undetected gluten sensitivity

Whether or not it has led to coeliac disease – glutenGluten is a protein found in the cereals wheat, rye and barley. Obvious sources of gluten in the diet are bread, pasta, breakfast cereals and… sensitivity is commonly found among pre- and post-menopausal women and even children who suffer from osteoporosis. The same nutrient deficiencies found in osteoporosis – calciumWhat it does: Promotes a healthy heart, clots blood, promotes healthy nerves, contracts muscles, improves skin, bone and dental health, relieves aching muscles and bones,…, magnesiumWhat it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous…, vitamin DWhat it does: Helps maintain strong and healthy bones by retaining calcium. Deficiency Signs: Joint pain or stiffness, backache, tooth decay, muscle cramps, hair loss…. and vitamin KWhat it does: Blood clotting. Deficiency Signs: Symptoms include those of a purpuric syndrome, i.e., ecchymosis, petechiae, bruising, abdominal pain, risk of massive bleeding, cartilage… – 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 coeliac disease. Researchers took 44 coeliac patients, who were aged from two years to 20 years old at the time of their diagnosis, and compared them to 177 healthy, coeliac-free people.

The lumbar spine and whole-body bone mineral density values of people with coeliac were significantly lower than those without the disease. But after one and a half years on a gluten-free diet, the coeliacs were retested and found to have bone density that had improved so much it was almost indistinguishable from those of the non-coeliacs. [1]

Diabetics at greater risk

Almost half of all people with type-1 diabetes have ATG antibodies, which are a diagnostic marker of coeliac disease, and the majority have deposits of these antibodies in their intestines. [2] A survey in Denmark found that one in eight children with type-1 diabetes also had coeliac disease. [3] This suggests that the early introduction of wheat products might increase risk.

Cancer and coeliac disease

Undetected coeliac disease is associated with a 40 to 100 fold increased risk of intestinal lymphomas. [4]

This is because the immune system of a person with this condition 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 coeliac disease. In the case of intestinal lymphomas – the most common kind of cancer associated with coeliac – by the time they have been identified, the prognosis is generally very poor. On the other hand, if coeliac disease is diagnosed before cancer becomes clinically evident and a gluten-free diet is strictly followed, the risk of intestinal lymphoma decreases from 100-fold back to near normal in five years.

The prevention of cancer is the single most compelling argument for routine and repeated screening or monitoring for coeliac disease in people with any of the above conditions or symptoms, or with a close relative with the disease. The only cure is gluten avoidance The only known effective therapy for this condition calls for the complete, life-long elimination of gluten 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 allergyA food allergy occurs when the body’s immune system reacts abnormally to a specific food as it is perceived as a threat. In the most… test does not show the presence of oat antibodies, then try reintroducing oats again once you become symptom free and monitor for any reaction. About 80% of coeliac sufferers can tolerate oats.

If the diet is strictly followed, a dramatic resurgence of health occurs. Diseased intestines heal, deficient nutrients are again absorbed, bones get stronger, and the high risk of intestinal cancer returns back to a normal risk within five years on a gluten-free diet. But you have to suspect and diagnose coeliac disease first. The very good news is that there has been a revolution happening in laboratory testing and screening for coeliac disease, with the development of a finger-prick test measuring IgATT (Anti-Tissue Transgltaminase antibodies). This test is considered to be very accurate [5] and can be done from a home-test kit called the Bio-Card Celiac Test, giving immediate results (available from Totally Nourish). Hopefully, if this style of test is utilised intelligently, often – and soon – by health professionals, better health for the tens of millions of gluten-sensitive people worldwide will be quickly realised.

REFERENCES

1. S Mora et al, Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease, American Journal of Clinical Nutrition (1998), vol 67, pp 477-481.

2. M Maglio et al, The great majority of children with type-1 diabetes produce and deposit anti-tissue transglutaminase antibodies in the small intestine, Diabetes (2009), vol 58(7), pp 1578–1584.

3. D Hansen, Clinical benefit of a gluten-free diet in type-1 diabetic children with screening-detected celiac disease: A population-based screening study with 2 years’ follow-up, Diabetes Care (2006), vol 29(11), pp 2452–6.

4. R Hoggan, Considering wheat, rye, and barley proteins as aids to carcinogens, Medical Hypotheses (1997), vol 49, pp 285-288.

5. K Giersiepen et al, Accuracy of diagnostic antibodyAn antibody is a protein produced by the body’s immune system when it detects a harmful substance known as an antigen. Examples of antigens include… tests for coeliac disease in children: summary of an evidence report, Journal of Pediatric Gastroenterology and Nutrition (2012), vol 54(2), pp 229-41.