Coeliac disease is an increasingly more common autoimmune condition. It results from abnormal T-cell response to gluten when the exposure of gluten (found in wheat) triggers the immune system and an inflammatory response within the lining of the digestive tract (3). This leads to increasing damage and irritation/inflammation of the cells with more exposure with consequential effects on nutritional stores.
What are the Symptoms?
With digestive tract specific symptoms being the centre of where coeliac disease manifests, initial warning signs and symptoms that can prompt investigation can include:
Extreme bloating and abdominal pain
Chronic diarrhoea
Loose, greasy stools
Nausea and vomiting
These particular signs are non-specific to coeliac disease and can account for a multitude of conditions such as IBS, Chron’s disease, lactose intolerance and SIBO, however investigation into underlying causes is what is essential. In particular ruling out of Coeliac disease when there is a strong family history of autoimmune disease or coeliac genes present genetically.
Some may be asymptomatic and not experiencing obvious symptoms, with alternate symptoms that can warrant investigation into the condition such as: fatigue, unexplained weight loss, mouth sores, iron stores that won’t rise, and extreme nutritional deficiencies in nutrients such as B12, D and K.
How do I find out if I have Coeliac Disease?
In Australia approximately 1.9% of women and 1.2% of men are officially diagnosed with Coeliac Disease, but alternate statistics suggest 4 out of 5 go undiagnosed (1). Diagnosis is done through the medical system with a few tests being available.
Gluten antibodies such as antigliadin and endomysial antibodies can be tested via a blood test, this test determines if your immune system is mounting a response to gluten based proteins and indicates a high likelihood of Coeliac disease. With a downfall of this testing type being if gluten has not been consumed prior to testing a false negative can occur. (2)
Coeliac disease has particular genes that confirm a predisposition to the condition, this is not a form of diagnosis but can indicate a potential for the disease to be active at time of testing or that it may occur later in life.
An endoscopy is the surgical assessment and a biopsy of the small intestine and is essential for the diagnosis of adult Coeliac disease. If the tissue sampled shows damage to the cells it can confirm the diagnosis(4).
Notably the condition can be triggered at any stage of life, with large health events such as surgery, infections, chronic stress and pregnancy being known triggers.
Strict Avoidance of Gluten
The management of Coeliac disease is the strict adherence to gluten-free diet results in resolution of symptoms for some within days and can lead to negative serology, and normalisation of cell damage (3). Marked symptom improvements on the gluten-free diet are the biggest control for the disease, with noticeable flares of symptoms when gluten contamination has occurred happening. Gluten-free is markedly easier with Coeliac disease being commonly known and options provided for in restaurants and supermarkets in Australia.
So, what contains gluten? Gluten occurs naturally in wheat, rye, and barley. Cereals, grains, pasta, and processed foods commonly contain gluten. Drinks such as beer and other grain-based alcoholic drinks. Other foods to take note of that are less obvious include: soy sauce, chips, sauces and lollies.
The strict avoidance of gluten is crucial, minor exposure such as crumbs from a toaster shared with gluten-containing toast can trigger an inflammatory reaction in those with Coeliac disease and continuously trigger the immune response and therefore worsening the damage caused and the symptoms experienced.
Management Options
When diagnosed later in life the damage that occurs from the immune response and inflammation can take several years to heal completely, with a smaller time frame in children being observed.
Nutritional Deficiencies: A first point of call will be ascertaining any nutritional deficiencies that have occurred due to the condition being unmanaged, testing and supplementation to rectify deficiency states of nutrients like iron and B12 dramatically improves overall quality of life and bodily function.
Supporting Gut health: healing post-diagnosis and utilising gut-healing supplements to support mucosal lining and gastrointestinal health improve symptom management and can aid in lessening reactivity and symptoms experienced when accidental gluten exposure occurs.
Nutrition Planning: The shift into a strict gluten-free diet can be difficult if you have been raised eating a gluten based diet. Dietary management and figuring out what you can or can’t eat post-diagnosis and how to optimise nutritional stores to support healing is the most powerful tool to have in your toolbox due to the lifelong nature of the condition.
Wether you are experiencing gut symptoms, looking into being diagnosed with coeliac disease or have recently been diagnosed working closely with a naturopath or nutritionist can support you on your gut health journey.
References:
Marjorie M Walker, Jonas F Ludvigsson and David S Sanders. Med J Aust 2017; 207 (4): doi: 10.5694/mja16.00788 https://www.mja.com.au/journal/2017/207/4/coeliac-disease-review-diagnosis-and-management
Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, Elli L, Grizzi F. Celiac disease: From pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017 May 15;8(2):27-38. doi: 10.4291/wjgp.v8.i2.27. PMID: 28573065; PMCID: PMC5437500. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437500/
Tarar ZI, Zafar MU, Farooq U, Basar O, Tahan V, Daglilar E. The Progression of Celiac Disease, Diagnostic Modalities, and Treatment Options. Journal of Investigative Medicine High Impact Case Reports. 2021;9. doi:10.1177/23247096211053702 https://journals.sagepub.com/doi/full/10.1177/23247096211053702
Ludvigsson JF, Bai JC, Biagi F, et al Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology Gut 2014;63:1210-1228. https://gut.bmj.com/content/63/8/1210
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