The treatment of coeliac disease is exclusively dietary and requires the complete exclusion of gluten. This means avoidance of all sources of wheat, rye and barley. Oats are controversial and may be tolerated in moderate amounts.
The aim of medical advisors is to give first line dietary advice on a gluten-free diet for patients with confirmed coeliac disease or dermatitis herpetiformis. People who are allergic/intolerant to wheat will require different dietary advice.
Practical dietary advice is often given such as: -
The exclusion of gluten means avoiding a wide range of manufactured and processed foods, which imposes considerable constraints on food choice and variety. Food labeling is not always helpful because although ingredient lists on food products can confirm the presence of gluten, they cannot confirm that they are gluten-free.
Gluten may be present via constituents which do not have to be declared or through cross-contamination during processing. Any food in a can, packet or jar or food that has been coated or modified in any way has therefore to be suspected of containing gluten.
Many manufacturers and supermarkets are voluntarily identifying gluten-free products by providing information or a logo on the label. In the UK, the Coeliac Society maintains a continually up-dated database of manufactured foods free from gluten.
Proprietary gluten-free foods such as breads, crackers, biscuits, pasta, flour and flour mixes are prescribabled for people medically diagnosed with coeliac disease or dermatitis herpetiformis. Their use should be encouraged to reduce the risk of dietary imbalance or non-compliance. Luxury items such as gluten-free cakes, chocolate and fancy biscuits are also available but not prescribable to reduce the costs on the NHS.
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.
For some people, food allergies can be very serious. One bite of a cookie with ground peanuts can cause a life-threatening emergency in someone with a peanut allergy, while just the smell of fish can make a highly sensitive person feel ill.
Although these are extreme reactions, it’s no wonder many people worry about food allergies. Unfortunately, because of a lack of good information about severe food allergies, many people are restricting their diet unnecessarily. One allergist found that, out of 23 people who thought they had a food allergy, approximately 4 actually did. Some of those who didn’t have allergies were avoiding so many foods they had become sick and malnourished. Don’t guess. If you suspect you have a food allergy, have it properly diagnosed by a doctor, then obtain nutritional advice from a registered dietitian.
What is a Food Allergy?
People with food allergies have an unusually sensitive immune system. For some reason, swallowing a protein from a particular food causes the person’s own antibodies to rush into action to attack the foreign substance. This starts a chain reaction of chemical changes which cause swelling and irritation in certain parts of the body.
Food allergies are most common in young children. Many infants become sensitive to foods, such as cow’s milk, soy and eggs during their first year of life. Fortunately, most infants outgrow these sensitivities in a year or two.
However, a child with an allergy to peanut or shellfish will not outgrow it. In fact, the symptoms may become more severe each time the child is exposed.
What is a Food Intolerance?
Food can cause problems for people in ways that do not involve the immune system. For example, people with lactose intolerance don’t have enough of the enzyme lactase to digest the sugar or lactose in milk. People with celiac disease cannot digest wheat protein. Other people have trouble with caffeine, chili peppers, horseradish or hot sauce. These food- related problems are called “food intolerances” not food allergies.
It is important to know the difference between food intolerances and food allergies. A person with a milk allergy must avoid all milk protein, even the small amount found in a slice of bread, whereas a person with a lactose intolerance may be able to eat some cheese and drink certain modified milk.
Facts About Food Intolerances
· Milk, eggs, peanuts, nuts, soy, wheat, and fish are responsible for 95% of all actual food allergies. It is rare for people to have two or more food allergies.
· It is usually not necessary to avoid an entire food family. For example, people who are allergic to lobster can often tolerate shrimp and crab. Even children with a life-threatening peanut allergy are rarely sensitive to other legumes, such as soybeans and lentils.