Coeliac disease is caused by an intolerance to gluten, a protein found in wheat and rye (and something similar in barley and possibly oats). This immune reaction to antigenic factors damages the mucosal lining of the small intestine, flattening the villi and reducing its ability to absorb nutrients.
The resulting symptoms of malabsorption which occur in varying degrees, may be acute
– steathorrhea, diarrhoea and abdominal discomfort, or more chronic
– tiredness, irritability and unexplained weight loss or failure to thrive in children.
The intolerance requires complete, life-long exclusion of gluten from the diet.
The peak age of onset of coeliac disease is now between 40 and 50 years, with increasing numbers of people being diagnosed in later life. The disease is more common in women than men by almost 3:1 in middle aged adults
Much remains to be learnt about how or why gluten harms the intestine. Gluten intolerance can also result in a skin disorder, dermatitis herpetiformis, which may or may not be associated with intestinal damage but is less likely to result in gastrointestinal symptoms.
A gluten-free diet is a major undertaking and always requires expert dietetic advice
It can take several months of gluten avoidance before the gut mucosa and villi return to normal and a year before previously impaired blood biochemistry improves
Complete and permanent avoidance of gluten is essential to reduce the risk of bowel malignancy and other long terms consequences of the disease.
Not to be confused with coeliac disease, wheat may provoke allergic reactions (delayed type IV) or chronic gastrointestinal symptoms of intolerance with no obvious immunological basis. Wheat allergy or intolerance will require total wheat exclusion though partial exclusion may suffice for those with a non-immunologically mediated form of intolerance for whom there seems to be a threshold of sensitivity. Commercially wheat free (and gluten-free) products are not prescribable for wheat allergy/intolerance per se.
1 in 100 people in the UK has coeliac disease. However, research has showed that only 12.5% of
those have been diagnosed equating to over half a million people currently undiagnosed in the
UK.
For people with coeliac disease, eating gluten damages the lining of the gut, which prevents
normal digestion and absorption of food. If a gluten-free diet is not followed, the disease can
ultimately lead to malnutrition, osteoporosis, bowel cancer and also cause infertility problems.
Gluten is a protein found in wheat, rye and barley; beer; obvious sources of
gluten include breads, pastas, flours, cereals, cakes and biscuits. It is also often used as an
ingredient in many favourite foods such as fish fingers, sausages, gravies, sauces and soy sauce.
People with coeliac disease can also be sensitive to oats.
The symptoms of coeliac disease range from mild to severe and can vary between individuals. Not
everyone with coeliac disease experiences gut-related symptoms; any area of the body can be
affected.
Symptoms of coeliac disease can include diarrhea, but occasionally constipation, tiredness,
anemia, mouth ulcers, recurrent miscarriages, weight loss (but not in all cases), skin problems,
depression, joint or bone pain, and nerve problems. Sometimes the symptoms can mimic irritable
bowel syndrome that is bloating, abdominal pain and constipation. The only treatment is the life-
long avoidance of ingestion of gluten.
Due to the wide variety of the symptoms of the disease, not only do patients suffer from a
reduced quality of life during the years prior to diagnosis, but also they can be unnecessarily
hospitalised and quite often completely misdiagnosed, and treated with costly drugs.
We have often stated that Coeliac disease is a life-long autoimmune disease, which is triggered
by eating gluten, a type of protein found in wheat, rye and barley.
Untreated it can lead to serious ill health and be life-threatening.
There is currently no cure for the condition; the only treatment is
life-long adherence to a strict gluten-free diet.
Coeliac UK, the national charity for people with coeliac disease, is being proactive and hosting a conference on Wednesday 3rd Decemberin central London announcing the latest findings in coeliac disease research including progress on the development of a possible vaccine for the condition.
Research at The Walter and Eliza Hall Institute in Australia has identified the toxic elements of gluten creating the potential for a vaccine therapy to suppress or prevent gluten toxicity. The research indicates that there are only a few dominant peptides in the gluten protein that trigger the autoimmune response in people with coeliac disease which makes the creation of a vaccine easier.
The lead researcher stated “We have developed a peptide-based therapeutic vaccine based on the dominant problem T-cell epitopes of gluten. The “vaccine” has the potential to treat about 80% of people with the disease. In common with traditional desensitization therapy for allergy, peptide-based therapeutic vaccines administered in many small doses over a course of injections could induce immune tolerance not only to the selected gluten fragments but also suppress the toxicity of other toxic gluten components,”.
Further research findings will be provided at the conference identifying a new genetic risk factor for coeliac disease and, following continued research, discovered an additional seven gene regions implicated in causing the condition. Of the nine coeliac gene regions now known, four of these are also predisposing factors for type 1 diabetes. Their research sheds light not only on the nature of coeliac disease, but on the common origins of both diseases.
Other speakers at the conference will be highlighting advancements in testing of gluten in food, the nutritional content of a gluten-free diet and the need for point of care testing in order to help increase the number of people diagnosed.
Long, long ago, man was a simple hunter/gatherer and he enjoyed this. His diet consisted of fruits, nuts, perhaps tubers and the occasional feast of meat. But eventually, he learned to cultivate plants, and the agricultural revolution began. Soon, the hunter/gatherer way of life was replaced by domestication of crops and animals which had implications for our diet.
As habits changed, some unanticipated problems arose. The human gut had developed, over more than 2 million years, into a sophisticated organ that could tolerate food antigens that were staples of the human diet over hundreds of thousands of years. But how would it react to new antigens, suddenly appearing in the diet? He may like the food but would it like him? The agricultural revolution of the Neolithic period generated a whole battery of food antigens previously unknown to man, including protein from cow, goat, and donkey milk, as well as birds’ eggs and cereals. Most individuals were able to adapt. Among those who could not, food intolerances appeared and celiac disease was born.
Some 8,000 years after its onset, celiac disease was identifed and named. This was the begining of better understanding. A clever Greek physician named Aretaeus of Cappadocia, living in the frst century AD, wrote about The Coeliac Affection.” In fact, he named it “koiliakos” after the Greek word “koelia” (abdomen). His description: “If the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs.
During the 1980’s it became increasingly clear that Celiac Disease could be associated with other conditions, mostly autoimmune disorders such as type 1 diabetes, but also some syndromes such as Down. It was also apparent that Celiac Disease was changing patterns of presentation, becoming less an intestinal disorder, and more a variety of extra-intestinal symptoms and signs.
In the late 80’s, a large multicenter Italian study that I conducted demonstrated that by relying on strict clinical and laboratoristic criteria, a correct diagnosis of Celiac Disease could be reached in 95% of cases by limiting to the one initial biopsy, and new diagnostic guidelines were published in 1990 by ESPGHAN, guidelines that stand to this day. After 1990,Celiac Disease was increasingly accepted as an example of an autoimmune disease, associated with a specifc gene (either DQ2 or DQ8) and the missing autoantigen was fnally identifed in the enzyme tissue transglutaminase. At long last, there was universal acceptance that celiac disease is an autoimmune condition whose trigger (gluten) and autoantigen (tissue transglutaminase) are known.
Scoop – an internal memo from a chef to the kitchen staff about the gluten content of their meals.
Fried foods: i have been informed that some celiacs may be sensitive to foods that have been fried in the same deep fat that floured and breaded foods have been fried in. Many of our items are breaded using flour. For example, if french fries are cooked in the same shortening as breaded chicken, it is possible that minute particles of wheat flour may still be suspended in the oil and be deposited on the french fries. Unfortunately, this restaurant does not have a separate fryer for french fries. We use the same fryer for breaded foods. Therefore, we do not recommend eating fried items at this café.
Griddled foods food that is sauteed on the griddle (like breakfast potatoes) may pick up tiny grains of flour from pancakes that have been cooked on the same griddle. Please check with your doctor on this, as sensitivity varies from person to person. We can have griddled foods prepared singularly in a saute pan and get the same relative cooking effect. Please ask if concerned about crossover contamination.
Appetizers:
Fresh vegetable quesadillas – order them made with corn tortillas, without chipotle sauce. The fresh salsa is ok.
Salads:
A note on dressings: our mayonnaise contains “vinegar” as an ingredient but does not specify what type of vinegar it’s distilled from. Also, we use ketchup in some salad dressings (heinz and hunt’s) and mustard (french’s and grey poupon) which both contain “vinegar” on their labels, without further Specifying.
Lemon wedges and bottles of oil & vinegar are available, or you may bring your own dressing. This restaurant nonfat sweet & sour french dressing will be ok, as long as you can eat ketchup. Our other dressings may contain grain vinegar, soy sauce, worcestershire sauce and/or caramel coloring. Ranch dressing is very bad, it has hvp and yeast extract, so avoid this.
Cobb salad – ok (see note on bacon, in breakfast section) order without dressing
Zesty tostada chicken salad – ok, order without ranch dressing and without chipoltle sauce.
Chicken and fruit – ok, request broiled chicken
Salads are accompanied by a muffin or bread. You can order corn tortillas instead.
Read this internal memo recently from a restaurant and their recommendations for visiting Celiacs.
This list shows specifically what can be ordered from each menu category. If it’s not on this list, you may assume that it is made with wheat flour, caramel color, grain vinegar, or with a flavoring base that includes hvp or msg or both, and it is produced in a facility that manufactures items using wheat gluten.
Avoid all muffins, quick breads, dessert items, soups, sauces, salad dressings and marinades from mimi’s restaurants, as they are made in a facility that utilizes flour and wheat by-products. Food service manufacturers change their formulas quite frequently, so what has no hvp today might have it tomorrow.
Occasionally you’ll come across a new server who will be unfamiliar with our liberal substitution policy. Our managers are always present and always happy to help just ask for a manager if you don’t see one. We are always happy to make substitutions for anything. Most of our guests get “creative” and we’re very good at fulfilling special requests in the kitchen. Please direct your allergen requirements directly to a unit manager. Due to the large quantity of menu items at mimi’s, we want to ensure your saftey, while providing you with mimi’s own great tasting food and service.
You can order just a side order of anything we have in the restaurant. If you want just a piece of chicken or meat, or just a cup of yogurt and a wedge of fruit, or a little plain green salad please ask. It is something we do quite frequently.
It would also be a good idea to take a good look at your plate when it’s delivered to your table. Occasionally, during the hustle and bustle, it’s quite possible for a server to pick up the wrong plate by mistake; or for a chef to mis-read a hastily entered check.
Bon appetit! Please don’t hesitate to let us know how we can better serve you.
Please note that the companies we buy food products from do change formulas from time to time. If in doubt, please don’t eat it. If you’ve ordered the wrong thing by mistake, please don’t be embarrassed to send it back. We will never charge our guests for something they didn’t eat.
At least it shows they are aware and are trying to help.