Coeliac disease and a gluten free diet
In the final instalment of our autoimmune series learn more about coeliac disease and what a gluten-free diet is.
What is coeliac disease?
Coeliac disease is a very common autoimmune digestive condition that affects around 1 in 100 people in the UK, with many people being diagnosed in their adult life. However, it is thought the number of people with coeliac disease could be higher than this due to under-reporting and misdiagnoses [1, 2].
In those with coeliac disease, the immune system mistakes gliadin, one of the substances that make up gluten, as a threat to the body. The antibodies that the immune system produces cause the surface of the intestine to become inflamed. The intestine surface is usually covered with millions of tiny tube-shaped growths called villi, which help the intestines to digest food more effectively. In those with coeliac disease, the villi are damaged which reduces their ability to absorb key nutrients from food. Many people mistake coeliac disease as an allergy or food intolerance, however this is not the case, and the only treatment option for coelia disease is a gluten-free diet.
What are the symptoms and causes of coeliac disease?
It is not known for certain exactly why people develop coeliac disease but there are several factors thought to increase the risk. These include having a close relative with coeliac disease, environmental toxins and already having another autoimmune disease . Coeliac disease is considered to be more prevalent in people with autoimmune conditions such as Type 1 diabetes and autoimmune thyroid disease.
Aside from the unexpected weight loss caused by the malabsorption of nutrients, other general symptoms associated with coeliac disease include diarrhoea, abdominal pain, iron or vitamin deficiencies such as vitamin B12, constipation and fatigue. Although there is no cure for coeliac disease, switching to a gluten-free diet can help to control these symptoms and prevent the long-term consequences of the condition. Even if symptoms are non-existent to mild, eliminating gluten is still recommended as continuing to eat gluten can lead to future health complications .
Going gluten free
As the only treatment option for coeliac disease is a gluten-free diet, we asked nutritionist Effie Parnell-Hopkinson to explain more about what this is. “Gluten is found in foods that contain the cereals wheat, barley and rye including pasta, cakes, breakfast cereals, most bread, certain sauces including soy sauce, soba noodles, beer, couscous and can also show up as an ingredient in barley malt, chicken broth, malt vinegar, seasonings, spice mixes and condiments. Although following a gluten-free diet may seem extremely restrictive and daunting at first, it is possible and very important to have a healthy, varied and balanced diet. There is an increasing number of gluten-free products that are sold at most supermarkets and whilst this makes following a gluten-free diet a lot easier, it is also vital to still check the food labels, particularly of processed foods that may contain gluten in additives ( such as malt flavouring and modified food starch).
The good news is gluten isn’t essential in your diet and there plenty of foods available for someone following a gluten-free diet. The list of naturally gluten-free foods includes meat, fish, seafood, eggs, dairy products, fruits and vegetables, legumes, seeds, beans, nuts, potatoes, corn, rice, quinoa and oils. So, despite the long list of foods that contain gluten, the advantages of increasing naturally gluten-free foods in your diet far outweigh the inconvenience of cutting out gluten-containing foods. Swapping out all the gluten-containing foods in your kitchen with gluten-free alternatives is a quick way of reducing the chance of eating gluten and the risk of cross-contamination. Another great method is to shop at food stores that cater to your needs (there are even more options if you look online for gluten-free alternatives) and then cooking meals from scratch. This will not only ensure your meals are gluten-free but it will also help educate you on gluten-free ingredients and foods, which is really useful for when you go out to eat at restaurants. Again, a bit of research into which restaurants have gluten-free options will go a long way and make the whole experience a lot less stressful and restrictive for you, and with more and more restaurants now catering to people on gluten-free diets, the choices are more varied than ever! In summary, if you have coeliac disease, following a gluten-free diet is essential for symptom management, quality of life and long-term health . With time, effort and a bit of planning ahead, following a gluten-free diet will become second nature.”
 NICE (2008). Coeliac disease: recognition and assessment of coeliac disease. Vol 1, 1-74.  Gujral, N., Freeman, H. J., & Thomson, A. B. (2012). Coeliac disease: prevalence, diagnosis, pathogenesis and treatment. World journal of gastroenterology, 18(42), 6036-59.  NHS.uk. (2019). Causes. Available at: https://www.nhs.uk/conditions/coeliac-disease/causes/ [Accessed 27 Feb. 2019].  Zarkadas, M., et al. (2006). The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. Journal of Human Nutrition and Dietetics, 19, 41-49.