What is Coeliac Disease?

Coeliac/Celiac Disease is considered to be a genetic autoimmune disease caused by a permanent intestinal intolerance (allergy) to dietary gluten, a protein found in wheat, and similar proteins in rye, barley and possibly oats.

Recent scientific studies indicates that oats may not be toxic to Coeliacs, however ongoing research is needed to confirm this(1).

What can Happen?

For Coeliacs, gluten causes damage to the small intestine lining. This greatly reduces the guts ability to absorb nutrients from food eaten, which leads to malnutrition and diseases associated with it.

When gluten is consumed the thousands of tiny, finger-like projections called villi that line the small intestine, become inflamed, shortened and flattened.

The villi cells function is to absorb nutrients from food eaten. In a healthy gut the finger-like protrusions dramatically increases the surface area of the small intestine allowing nutrients to be absorbed. In untreated Coeliac Disease this surface area is seriously reduced so minimal nutrients are absorbed leading to numerous deficiencies including vitamins, minerals, proteins, carbohydrates and fats. This lack of absorbed nutrients can lead to severe illness resembling malnutrition.

Who gets Coeliac Disease?

Coeliac Disease is considered a genetic condition, however more and more research is suggesting that the disease may be triggered by environmental and other factors, some as yet not identified. Finding a possible cause gives great hope to sufferers.
The disease affects mostly people of European decent but may also occur more rarely in Hispanic, Black and Asian populations. However knowledge of the disease and medical tests are more readily availalble in coutries with large populations of people of European decent so we may in future find that these figures change substantially as recognition of the disease grows and tests become more readily availalble.

Evidence shows that 4.5% (2) of first-degree relatives (brothers, sisters, parents, children) of people with Coeliac Disease will also have it.

Statistics

• North America: 1 in 133 or 2.18 million
• Canada : 0.23 million
• UK: 1 in 100, 1% of the population
• Worldwide: an estimated 24.3 million

Various country studies suggest that Celiac Disease is widely undiagnosed. Just suppose you add to this those who may benefit from a gluten-free diet such as people with Autism, ADD, the wheat intolerant, digestive disorders etc, the numbers would be significantly much higher.

When do Symptoms Appear?

The underlying genetic predisposition is present at birth. However symptoms can appear at any age - abruptly when gluten is introduced to a baby or gradually from infancy, childhood or adulthood.

In the UK most Coeliacs are now diagnosed between the ages of 30 and 45 years (3), maybe because there is now more information available for the public and doctors to be aware of the symptoms and recognize the disorder.

Studies have shown that many people with Coeliac Disease remain completely undetected.

What is the Diagnosis?

Currently people with CD are given the diagnosis that they will remain sensitive to gluten for the whole of their lives. A 100% gluten-free diet needs to be strictly adhered to daily. Removal of gluten from the diet gives the small intestines a chance to heal and can prevent most complications caused by the disease. Your general health and age will affect the speed of your recovery.

Even if symptoms disappear, damage to the small intestines can take place if gluten is reintroduced to the diet so you need to be ever vigilant with a life-long gluten-free diet. This means avoiding all products that contain wheat, rye, barley and oats and any of their derivatives. Often this can be a difficult job as gluten can be hidden in a lot of packaged and processed foods so you need to become an avid label reader.

What are the Symptoms?

Symptoms vary greatly from person to person, ranging from none to numerous, and can occur singularly or in combinations.

Symptoms

• Fatigue, weakness, lethargy, depression
• Intestinal upsets - pain, flatulence and abdominal distension
• Diarrhoea and/or Constipation
• Cramping and bloating
• Nausea and vomiting
• Weight loss – some may put weight on
• Anaemia
• Mouth ulcers
• Pale, bulky, foul smelling stools
• Delayed growth or delayed puberty in children
• Isolated or multiple nutrient deficiencies – especially Iron, Calcium, Magnesium, B12, A, D, E and K vitamin deficiency

Less common symptoms

• Easy bruising of the skin
• Miscarriages and infertility
• Muscle spasms
• Skin rashes such as Dermatitis Herpetiformis
• Dental defects
• Bone and joint pains

Most problems associated with Celiac Disease are related to the malabsorption of crucial nutrients caused by the inability of the gut to absorb nutrients. The longer the person goes undiagnosed, the higher the chance of developing related disorders and disease, or exacerbating current health problems.

Risks of Long Term Undiagnosis

Living undiagnosed with Coeliac Disease can lead to chronic ill health and increase the chance of many different ailments: Allergies & Asthma, Arthritis, Fibromyalgia, Diabetes (Type 1), Infertility, miscarriages, Mental illness, Osteoporosis, Nerve Disease, Cancer (Gastrointestinal carcinoma or Lymphoma), Epilepsy, Thyroid disorders, Kidney Disease, Dental defects.

In fact Coeliac Disease can affect any organ or system of the body.

In children, undiagnosed Coeliac Disease can cause lack of proper development, short stature and behavioural problems – Autism, Attention Deficit Disorder.

Diagnosis

Diagnosing Coeliac has been difficult in the past but newly developed screening methods (blood tests) provide a simple, easier and more rapid means for a doctor to decide if a biopsy is needed. This is leading to many more people being diagnosed.

A specific panel of blood tests that measures antibodies to gluten (Antigliadin AGA) and endomysium antibodies (EmA) are available as a screening aid. This may be followed by a biopsy test via endoscopy of the small intestine lining to prove the typical damage of villi associated with Coeliac Disease (villous atrophy). A gluten-free diet is started and adhered to with diagnosis being reconfirmed by repeating the biopsy 6 to 24 months later.

References
(1) New England Journal of Medicine, May 2, 1996. Vol 334, Number 18, “The Many Faces of Celiac Disease”, by Charles H. Halsted, M.D.
(2) Alessio Fasano MD, et al., Arch Intem Med. 2003; 163:286-292.
(3) Coeliac UK statistics