Key Points on Coeliac Disease

Following on from my interview with PJ Coogan this morning on the Opinion Line on Cork's 96FM, here is a link to the podcast if you wish to listen back http://utv.vo.llnwd.net/o16/96FM/2015/03/24/2303OPINIONLINE2.mp3 ... and here are some key summary points on Coeliac Disease: Definition Coeliac Disease isn’t a wheat intolerance or Gluten allergy. It’s an Autoimmune Disease where the immune system mistakenly attacks and destroys healthy body tissue.  Coeliac disease causes sufferers to react to gluten, the protein found in wheat, barley, rye and malt. Some Coeliacs are also sensitive to the protein found in oats. If a Coeliac eats gluten, the lining of the small intestine becomes damaged and reduces the ability to absorb nutrients from food. If undiagnosed, it can potentially lead to many complications such as osteoporosis, cancer, infertility, nutritional deficiencies & malnutrition.   Signs & symptoms vary in type and severity from one person to the next. The classical symptoms are diarrhoea, constipation, abdominal pain, bloating, pale stools, Dermatitis Herpetiformis, fatigue, vomiting, weight loss, unexplained anaemia (iron, vitamin B12, folate deficiency), recurrent mouth ulcers and alopecia (hair loss). It is a common condition in Ireland, affecting 1 in 100 people. However, it is a significantly under-diagnosed disease; for each person diagnosed there are likely to be 5-10 people who remain un-diagnosed. It is also possible to have Coeliac disease without any symptoms! It is damaging to your health if it goes undiagnosed and untreated.   Special cases Coeliac Disease should be ruled out in women with fertility issues. It should also be considered and investigated in people with premature unexplained Osteopenia, Osteoporosis, Type 1 Diabetes, and abnormal thyroid function. People with Down Syndrome have a 40 times higher incidence of Coeliac Disease and so should always be screened. Investigations & diagnosis Prior to being tested for Coeliac Disease, a high-gluten diet should be consumed for at least 6 weeks prior to any blood tests or biopsies. Because the symptoms of Coeliac disease can mimic other serious conditions such as Cancer or Crohn’s disease, thorough investigation by a qualified medical doctor is essential. Your GP can take a blood test for antibodies - Immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (IgA tTG) and anti-endomysial antibodies (IgA EMA). If antibody results are positive then you should be referred to a consultant gastroenterologist for a biopsy.   Dangers of Self diagnosis People often self diagnose their gut symptoms as irritable bowel syndrome (IBS), a very dangerous practice indeed! Self-diagnosis kits sold in many pharmacies are also strongly discouraged; they can be difficult to use, and they can give false results. In the event that the kit yields a positive diagnosis of Coeliac Disease, patients typically proceed without nutrition and dietetic treatment, and without medical follow-up regarding long term complications.   A word of caution Unreliable tests offered by alternative practitioners and many health food shops include Vega testing, Pulse testing, Kinesiology, saliva testing & so-called “Food Intolerance tests” costing up to €250! This is all pseudoscience! There is no scientific evidence to support such claims, diagnostic methods or diagnoses. The most common diagnosis resulting from such quackery is wheat and dairy intolerance which leads the unsuspecting person to embark on a DIY wheat-free diet! Residual gluten will still be present in the diet of an undiagnosed Coeliac on a DIY wheat-free diet, and there would a high risk of long term medical complications.   Treatment Once a positive diagnosis has been made by a medical doctor, the only treatment is a 100% gluten-free diet for life. All Coeliacs, particularly at initial diagnosis, should have a lengthy one-to-one consultation with a qualified state-registered dietitian (RD or clinical Nutritionist www.indi.ie). Whilst nutrition information from other sources such as social media platforms, family members, friends, work colleagues, other Coeliacs and even other health professionals may be very welcome, it is frequently incorrect! Coeliacs should also join the Coeliac Society of Ireland for ongoing support.