What is coeliac disease?
Coeliac disease is an autoimmune condition where the body produces antibodies in response to the presence of gluten in the body. These antibodies mistakenly perceive the gluten as a threat and attack the body’s own healthy intestinal tissue, preventing you from absorbing nutrients properly. This case of mistaken identity leads to symptoms like abdominal pains, nausea, bloating, wind, tiredness, diarrhoea, constipation, skin problems, weight loss and feeling tired all the time, although sometimes people with coeliac disease don’t display any symptoms at all.
Coeliac disease is not the same as an allergy or intolerance. The best way to control the condition is through diet. Otherwise, it can lead to malnutrition, anaemia, bone disease and, on rare occasions, certain forms of cancer (such as bowel cancer). It can also cause problems related to pregnancy, like low birth weight, as well as growth problems in children.
Coeliac disease affects approximately 1 in every 100 people in the UK. There are two to three times more reported cases in women than men. Symptoms can develop at any age but are most likely to appear during early childhood – between 8-12 months old (though it may take several years before a correct diagnosis is made) and in later adulthood – between the ages of 40 and 60 years.
What foods should I enjoy as part of my coeliac (gluten-free) diet?
The gluten-free diet mainly consists of fresh, naturally gluten-free foods like meat and poultry, fish, fruit and vegetables, most dairy products, fresh eggs, unprocessed beans, lentils, seeds and nuts, as well as rice and potatoes. There are also plenty of grains and starches that can still be included such as buckwheat, cornmeal, millet and quinoa. Corn and rice also contain gluten, but are considered gluten-free for the purposes of this diet, as the gluten in these species doesn’t damage the small intestines of coeliac sufferers. There are also plenty of gluten-free substitute foods like specially made gluten-free bread, flour, pasta, crackers and biscuits that are available in the shops if you really miss them. So there’s plenty of choice, you just need to get creative and arrange your shopping list a little differently!
What foods should I avoid as part of my coeliac (gluten-free) diet?
Steer clear of the three gluten containing cereals wheat, barley and rye, as well as triticale (a cross between barley and wheat). This can be especially tricky with wheat as it goes by so many different names. A few to remember are: bulgur, durum flour, farina, graham flour, kanut, semolina and spelt. The best way to avoid gluten is simply to think about what foods are made up of. For example, we all know that most bread and pasta, pastries and breakfast cereals contain wheat. Thinking like this helps us easily cross other obvious foods off the list, like cakes, cookies, biscuits, crackers, pizza, battered and breaded food. Be careful with snack foods like crisps or tortilla chips too… even though tortillas are made from potato and corn respectively, the seasoning will most likely have gluten in. It’s best to avoid additives and flavouring agents generally. Processed foods often contain gluten as a stabilising agent and imitation meats and most ready meals also normally contain gluten. Lots of store-bought sauces like ketchup, soy sauce and salad dressings also use gluten as a stabilising agent, and you need to be aware of it being used as a thickening agent in soups and sauces like gravy and cheese sauce. Beers are made from barley (or sometimes wheat) so avoid that too, unless it’s gluten-free beer.
There have also been cases of coeliac sufferers having an adverse reaction to oats, even though the protein they contain is different to the gluten in wheat. The problem with oats is probably somewhere in the processing, manufacturing and transportation processes, as cross-contamination with other grains isn’t uncommon. Therefore it is best to avoid them (unless specifically labelled gluten-free of course).
It is also important to be aware of cross-contamination when preparing food at home. For example, if you are the only one in your household on a gluten-free diet it is obviously not a good idea to share a common toaster! Remember, consuming even a very small amount of gluten can cause damage to your small intestines, even if you are not showing any side-effects… so stick with the mantra: “better safe than sorry” when it comes to your gluten-free diet.
A note on labelling and eating out.
As ever, the most important thing to remember when shopping gluten-free is to always check the label. International food labelling standards enforce the labelling of products as "gluten-free", but this standard doesn’t apply to foods that don’t contain gluten in their “normal form”. This means that in the UK, only cereals must be labelled; labelling of other products is voluntary. For example, most British sausages contain a food additive made from grain. It is also important to remember that ‘wheat-free’ labelling doesn’t necessarily mean ‘gluten-free’, as these products may still contain rye or barley.
Cafes, restaurants and pubs are provided guidance by the Food Standards Agency, but they aren’t required to meet any labelling requirements, so it’s always a good idea to have a word with your waiter or chef before ordering if you are unsure of your menu choice (don’t worry, they won’t spit in your food for being awkward if you are nice about it!).
What are the benefits of a gluten-free diet?
A strictly gluten-free diet is the only way to alleviate your symptoms and avoid the complications related to coeliac disease – there is no other treatment available. And you really need to stick to it! A small amount of gluten in your diet can still be damaging to your small intestines even if you are not getting any symptoms.
Thankfully, most people who go gluten-free start to feel better within a few days. The common symptoms of gluten-sensitivity like nausea, diarrhoea and bloating will normally clear up completely within a few weeks of going on a gluten-free diet (some symptoms will clear up faster than others; it depends on your body).
However, the time it takes for gut damage to heal completely varies and can take between six months and two years. In some severe cases, a gluten-free diet alone can't stop the symptoms and complications of coeliac disease. In these cases, doctors might prescribe medications to suppress the immune system, if your gluten-free diet isn’t working for you it is imperative to go and see your doctor.
Gluten-free/casein-free diets are often recommended as an alternative therapy for the treatment of Autism. However, although studies have shown the benefits in these exclusion diets in treating symptoms, the studies themselves were not conclusive.
What are the risks of a gluten-free diet?
The grains that are excluded from the gluten-free diet are nutrient-rich so you do need to make sure that you are consuming enough of these nutrients elsewhere. The ones to be aware of are: iron, calcium, foliate, thiamine, riboflavin, niacin and fibre. Of course, you can always take supplements, but it’s relatively easy to balance your nutritional regime to ensure that you are injecting these into your diet from other sources.