COELIAC DISEASE

How can a specialist dietitian help optimise people diagnosed with coeliac disease?

This is a great question and one that is asked every day by enquiring patients. Here at 121 Dietitian we have helped thousands of people, many diagnosed with coeliac disease. It can be overwhelming to learn of such a diagnosis and it can be difficult to know who to turn to. Thankfully we are the experts in optimizing health for all conditions and we have a dedicated programme that takes all the worry and stress away!

WHAT IS COELIAC DISEASE?

Coeliac disease is an autoimmune disease triggered in those people who are genetically at risk. This trigger causes your immune system to attack your own tissues when you eat gluten. The gastrointestinal tract is the targeted organ for this attack and the consequences are many.

Interestingly 35-40% of the general population have the genes that predispose a person to celiac disease, but only around 1% of the general population develop the autoimmune disorder.

SYMPTOMS

There are several classical symptoms and a few more not so common, so if you feel you have an issue with Gluten you may find this helpful in getting a diagnosis.

The most well-known symptoms of coeliac disease include

• diarrhoea (pale foul smelling fatty stools)
• fatigue
• bloating
• weight loss
• stomach ache

Other not so well know coeliac disease symptoms include:

• indigestion
• constipation
• itchy rash
• nerve damage (B vitamin deficiencies)
• malnutrition – not getting enough nutrients from food,
• infertility problems –  women with coeliac disease can have difficulty becoming pregnant
• disorders that affect coordination, speech, and balance (B vitamin deficiencies)

Children with coeliac disease:

have all the above symptoms along with

• • nausea and vomiting
  • may not grow at the expected rate and
  • may have delayed puberty.

And some people do not have any notable symptoms and this diagnosis comes as a complete surprise.

IMPORTANT COELIAC STATISTICS

• 1 in 100 -people worldwide are affected by coeliac disease
• In Europe: Germany, The Scandinavian countries, Ireland, and the United Kingdom population have a higher prevalence of coeliac disease ~ 1000 to 1500 per 100,000 individuals
• Women to men ratio 3:1
• Of patients diagnosed with Coeliac disease 50% still report symptoms while following a gluten-free diet (this is where 121 Dietitian can help)
• Family members 1 in 10 also have coeliac disease
• If you are diagnosed with coeliac disease you have a x 2 increased risk of coronary artery disease
• You have an increased risk of small bowel cancers x 4.

COELIAC DISEASE TESTING

Coeliac disease diagnosis can be made by your GP. They will take a history of your symptoms and arrange a blood test to check for antibodies that are present in the blood of people with coeliac disease.

You need to keep eating gluten foods otherwise you may have an inaccurate blood test result. If this is +ve you will then be referred to a gastroenterologist to confirm this with an endoscopy and a biopsy. They will also be looking for blunt villi. Villi are finger-like projections in the gastrointestinal tract required for nutrient absorption, and when flattened do not have enough surface area to absorb sufficient nutrients.

COELIAC DISEASE TREATMENT

As this is an autoimmune disease – Gluten a protein found in grains is the trigger, coeliac disease is treated with a gluten-free diet. If you have been experiencing symptoms for a while with malabsorption you may need vitamins and minerals to be replaced. A specialist Dietitian who is trained in gastrointestinal diseases is the best person to assist you with optimising your diet and health for the long term.

COELIAC MEDICAL TREATMENTS

Coeliac disease unfortunately does not have a cure.  So a strict gluten-free diet will help control symptoms and prevent long-term complications.

What can often be a problem is when people have none to mild symptoms, or their symptoms go away within a few weeks of the diet, they can continue to eat or sneak some gluten and over time if not addressed serious complications can occur.

Many years ago my patients often presented as very underweight, anaemic, exhausted, and having multiple nutrient deficiencies. Today this is not always the case. Many people are now being diagnosed who come to see me eating an unhealthy poor quality diet. Some carry excess weight and are nutrient deficient from this and less so from malabsorption. The worst for these people is that, if not educated in the right choices, they replace their poor gluten diet with gluten-free processed unhealthy choices.  Unhealthy choices lead to the consumption of insufficient nutrients causing the patient to feel poorly and gain further weight.

It is really important to therefore ensure that your gluten-free diet is designed to suit you and is wide in variety, healthy and balanced.

Overall it has been fantastic that there has been an increase in the range of available gluten-free foods in the past 10 years. But the negative to this is that it is now possible to eat a diet full of unhealthy choices instead of focusing on a healthy and varied gluten-free diet.

WHAT FOODS TRIGGER COELIAC DISEASE?

Foods and fluids that contain Gluten include:

Wheat and derivatives of wheat such as:

• Durum
• Emmer
• Couscous
• Semolina
• Spelt
• Farina
• Farro
• Kamut
• Einkorn wheat
• Rye
• Barley
• Triticale
• Malt including, malted milk, milkshakes, malt extract, malt syrup, malt flavouring, malted barley flour, malt vinegar
  Brewer’s Yeast
• Wheat Starch that has not been processed to remove gluten to below 20ppm
• Oats are contaminated in processing and packaging so are not allowed even though they do not naturally contain gluten.

GLUTEN FOOD EXAMPLES 

The following are examples of popular foods containing gluten  -so these are no longer suitable to eat – lifelong.

• bread
• pasta
• cereals
• cakes and pastries
• biscuits or crackers
• pies
• gravies, stocks and sauces
• beer

WHAT HAPPENS IF SOMEONE WITH COELIAC DISEASE EATS GLUTEN?

I advise and treat hundreds of newly diagnosed and refractory Coeliac patients. It is a common fear that when not in control of the cooking they are going to be “glutaminated”. When gluten is eaten intentionally or unintentionally symptoms can vary from mild to very unpleasant. Symptoms can be immediate or can take a few hours to develop. It can be a real setback and can take a few days to several weeks to regain full energy and trust in eating again. If this is a repeated occurrence disordered eating can be a side effect.

WHAT HAPPENS IF COELIAC DISEASE GOES UNTREATED?

People who are autoimmune can be at increased risk of developing other autoimmune disorders like type 1 diabetes and multiple sclerosis (MS). Patients with coeliac disease can have dermatitis herpetiformis (an itchy skin rash), osteoporosis, anaemia, infertility and miscarriage, and neurological conditions like peripheral nerve damage and migraines.

WHAT ORGAN IS MOST AFFECTED BY COELIAC DISEASE? 

Your small intestine is the main organ affected by gluten in Coeliac disease. This stops your body from taking in nutrients from food with your villi being flattened.

WHAT CANCERS ARE ASSOCIATED WITH COELIAC DISEASE? 

There are 3 types of cancer associated with celiac disease: enteropathy-associated T-cell lymphoma (EATL), non-Hodgkin’s lymphoma, and adenocarcinoma of the small intestine.

DOES RICE HAVE GLUTEN? 

All rice (in its natural form) is gluten-free. This includes brown rice, white rice, wild rice and rice flour. Even Asian or sticky rice, also called “glutinous rice,” is gluten-free, despite its name.

HOW LONG AFTER NOT EATING GLUTEN CAN YOU SEE A DIFFERENCE? 

1 month on average, people report feeling better after eating a gluten-free diet. This can vary from person to person. Some people feel better sooner than this, and others can take more than 1 month to get symptom relief. But if you are deficient in other nutrients and vitamins you would need to see a dietitian.

WHICH PASTAS ARE GLUTEN-FREE? 

Though traditional pasta is typically made using wheat flour, there are plenty of gluten-free alternatives available.

• Gluten-Free Pasta and Noodles
• Brown Rice Pasta
• Soba buckwheat noodles
• Shirataki Noodles
• Chickpea Pasta
• Quinoa Pasta
• Lentil Pasta

WHAT VITAMINS AND MINERALS DO PEOPLE WITH COELIAC DISEASE LACK? 

Micronutrient deficiencies most common in coeliac people are iron, folic acid, vitamins B1, B6 and B12, vitamin D, zinc and copper. If untreated, these micronutrient deficiencies can cause neurological complications, psychiatric symptoms, and bone deterioration. We would recommend taking tailored individual advice from our dietitians.

WHAT CAN YOU EAT IF YOU HAVE COELIAC DISEASE: 

• Dairy products, such as cheese, butter and milk.
• Fruits and vegetables.
• Meat and fish – no batter, dusted in flour or breadcrumbs
• Potatoes – red/sweet
• Rice and rice noodles
• Nuts and seeds
• Quinoa, buckwheat, amaranth
• beans and pulses
• suitable gluten-free herbs and spices
• Gluten-free flours, including rice, corn, potato flour, coconut, buckwheat and almond…

Clever use of the above foods and ingredients and you can make anything and everything again. If you are a patient of 121 Dietitian you will receive plenty of recipes to get you started.

Gluten Free Chocolate cake 

One of my favourites and handy for birthdays and celebrations is my gluten-free chocolate cake recipe. Let me know if you like it too!

GLUTEN INTOLERANCE

How do I know if I’m gluten intolerant or coeliac?

If you are gluten intolerant, the consumption of gluten can cause bloating and belly pain that may last several hours and as much as it is painful worrying and uncomfortable it doesn’t usually cause harm to the body.

We at 121 Dietitian provide the gold standard in treating gluten sensitivity or intolerance. So if you are unsure as to what your symptoms are from do get in touch and we can assess and assist you further.

COELIAC RELATED RESEARCH – Future ideas…

Gluten-Sensing Tech May Change Fight Against Celiac Disease

Elizabeth Millard May 31, 2022  -https://www.medscape.com/viewarticle/974842

“Tortajada-Genaro and his team have come up with a system that detects gluten simply and quickly in food. The test, described in a new paper in the journal Food Control, reveals not just the presence of gluten but also its concentration – and it involves snapping a picture with your smartphone.

As a bonus, this system may also help in food fraud prevention by exposing meat products tainted with grains, which some manufacturers add to improve texture and reduce costs, he says.

“The protection of the consumer against foodborne illnesses and fraudulent practices requires cheaper, simpler, and faster methods,” Tortajada-Genaro says. This new system aims to check all three boxes.

The system works by detecting gluten DNA in food, Tortajada-Genaro says. Typically, a sample must be analyzed in a lab by a specialist, which can take several hours to generate results, he says. But this system, which is similar to an antigen test, can do it in less than 2 hours.

Simply take a food sample, grind it up, and mix it with “gold nanoparticles,” tiny gold bits that can trigger chemical reactions. Wait 10 minutes for that gold to pull out the gluten’s DNA. Then place 3 drops on a plastic slide and snap a picture with your phone”

Fascinating stuff but as it is only in the research stage it may be a long time till we see this in action!

Useful Coeliac Disease websites

UK – https://www.coeliac.org.uk/home/

USA –  https://celiac.org/

Need help optimising the foods you eat or are unsure of how to change your eating habits? please do contact us.

We would love to help you or your family and friends with any nutrition-related queries big or small.

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