Coeliac disease, Celiac disease, Non tropical sprue, Gluten enteropathy.
Description: This is a quite common usually inherited disease affecting almost 1 in 130 people. Some people believe we all have partial gluten intolerance, some are affected more than others. It is caused by an allergic reaction to Gliadin (which is part of the Gluten protein) found in wheat, barley and rye. The immune system creates antibodies against the gliadin but also attacks the lining of the small intestine. The fine villi (tiny finger like projections into the small bowel) are damaged by this process and this hugely reduces food and nutrient absorption. This causes diarrhoea, bloating,abdominal pain, often an intolerance to milk (lactose), and greatly reduces the nutrients absorbed from the food leading to nutritional deficiency (anaemia, osteoporosis, selenium, copper and zinc deficiency and can also affect bleeding (vitamin K). It also may allow larger molecules to enter the blood stream (leaky gut); this is believed to be the cause of many immune diseases or symptoms. The disease is inherited, and there is a blood test for the gene HLA-DQ2 or HLA-DQ8 alleles – but not everyone with these genes develops Coeliac and some people without them can also have the disease. There is also a very wide spread from very mild and asymptomatic disease right through to severe symptoms.
What doctors can do
Previously the diagnosis has been difficult, but there are now blood tests, immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA), and IgA anti-endomysium antibodies (AEA). Note that these tests must be done while eating a diet that contains gluten. The levels will fall when the patient is eating a gluten free diet. Genetic screening (for the Alleles) is probably unnecessary.
The doctor will usually recommend a gluten-free diet – avoid foods containing wheat, barley and rye. Surprisingly although it is known Celiac disease causes poor absorption, few doctors recommend nutritional supplements!
What you can do
- Even a tiny amount of gluten can cause the reaction, so it is best to be meticulous in taking no gluten – this means a person with coeliac disease should not eat most grain, pasta, cereal, and many processed foods. Check the label for gluten because many additives and fillers contain gluten. It is exciting to see the gluten free foods now becoming available making the diet of celiac patients much less boring.
- It is helpful to note foods that are safe – soybean, tapioca flour, rice, corn, buckwheat and potatoes.
- Dairy foods may cause problem – not because of the gluten, but patients can often be lactose intolerant as well.
- There is some debate about oats. It is best to eliminate those initially and then when stable, try and see if oats also cause the problem.
- A gluten-free diet is not easy to adhere to, but the benefits for people with this disease are huge, because untreated, the condition can lead to some very serious illnesses, including cancer. Fortunately, more and more gluten-free foods are becoming available. It is important to check the labels on food, as many fillers and additives can contain gluten.
- Remember, this is an inherited disease, so check other family members.
- A new approach to the disease is appearing – the use of enzymes which dismantle the gluten before it reaches the small bowel. It is still safer to eat gluten free is possible, but when one is uncertain about a meal in a restaurant, this product may be very useful.
- In coeliac disease, where poor absorption of food is the major pathology and causes symptoms and complications, the value of taking supplements seems so obvious that it is hard to understand why the medical profession ignores it.
- A good multivitamin/multimineral makes sure that the body has a surfeit of all the nutrients and minerals required to function, grow and develop perfectly.
- Omega 3 fish oils, 1–2 grams daily. These are very important for tissue, joint and brain health.
- Calcium and magnesium, 800-1,000mg/day. Magnesium has a very calming effect, helps with sleep, and relieves the cramps which many coeliac patients suffer.
- Vitamin D affects many allergic and inflammatory illnesses, it would be worthwhile taking this, 5,000iu at least daily. (Vitamin D seems to have many beneficial actions, including turning the genes on and off when required. Low D levels are present in many diseases and it does seem important to have adequate levels all year round)
- Probiotics – because of poor absorption higher in the bowel, many sugars and undigested foods reach the colon and cause much of the bloating and diarrhoea. It can also change the bacteria colonising the gut. Regular use of a probiotic containing the good bacteria seems a wise option.
- Selenium. In countries where there are low levels of selenium in the soil, selenium supplements are very important in reducing the risk of developing a number of diseases.
The Nutritional supplements I use and recommend to my patients
For Coeliac patients – USANA – Cellsentials * , Biomega, Active Calcium plus, , Proflavanol C, probiotics and vitamin D –