Coeliac (Celiac) Disease

What is Coeliac Disease?

Coeliac disease, also spelled celiac disease, is a chronic autoimmune disorder that primarily affects the small intestine and is triggered by the consumption of gluten. Gluten is a protein found in wheat, barley, and rye, and it is commonly present in many staple foods such as bread, pasta, cereals, and baked goods. When individuals with coeliac disease consume gluten, their immune system responds abnormally by attacking the lining of the small intestine.

This immune response results in inflammation and damage to the small intestine's villi – small finger-like projections that play a crucial role in nutrient absorption. Over time, this damage can lead to various gastrointestinal and systemic symptoms, nutrient deficiencies, and potential complications.

What causes Coeliac Disease?

Coeliac disease is a complex autoimmune disorder that is believed to result from a combination of genetic, environmental, and immunological factors. The exact cause of coeliac disease is not fully understood, but researchers have identified several key factors that contribute to its development:

1. Genetics: Genetic predisposition plays a significant role in the development of coeliac disease. Certain genes, particularly human leukocyte antigen (HLA) genes, are strongly associated with an increased risk of the condition. The presence of specific HLA gene variants, such as HLA-DQ2 and HLA-DQ8, is found in the majority of individuals with coeliac disease. However, having these genetic markers does not guarantee that someone will develop the disease, as other factors are also involved.

2. Immune system response: Coeliac disease is fundamentally an autoimmune disorder. In genetically susceptible individuals, the immune system reacts abnormally to the presence of gluten. Normally, the immune system's role is to defend the body against harmful substances, such as bacteria and viruses. In coeliac disease, the immune response targets gluten and, in doing so, inadvertently attacks the lining of the small intestine, specifically the villi. This immune response triggers inflammation and damage to the intestine.

3. Environmental trigger: While genetic factors predispose individuals to coeliac disease, an environmental trigger – namely, the consumption of gluten – is necessary for the disease to become active. Gluten is a protein found in wheat, barley, and rye. When individuals with a genetic susceptibility to coeliac disease consume gluten-containing foods, their immune system launches an immune response that leads to the characteristic intestinal damage seen in coeliac disease.

4. Microbiome and early life factors: Emerging research suggests that the gut microbiome (the community of microorganisms in the digestive tract) and early life factors, such as early exposure to gluten and certain infections, may also influence the development of coeliac disease. Changes in the gut microbiome could potentially impact the immune response to gluten.

It's important to note that coeliac disease is not caused by lifestyle choices or emotional factors. It is a legitimate medical condition with a biological basis. While the precise interplay between genetics, the immune system, and environmental triggers remains an active area of research, understanding these factors is crucial for developing effective treatments and interventions for coeliac disease.

What are the symptoms of Coeliac Disease?

Coeliac disease can manifest with a wide range of symptoms, and these symptoms can vary greatly from person to person. Some individuals may experience severe symptoms, while others may have milder or even no noticeable symptoms at all. Additionally, the age at which symptoms appear can vary, with some people experiencing symptoms in childhood and others not showing signs until adulthood. Common symptoms of coeliac disease include:

1. Digestive symptoms:

   • Abdominal pain and discomfort

   • Bloating and flatulence

   • Diarrhea or frequent loose stools

   • Constipation

   • Nausea and vomiting

2. Fatigue and weakness:

   • Unexplained and persistent fatigue

   • Weakness and lack of energy

3. Nutritional deficiencies:

   • Iron-deficiency anemia (resulting from impaired iron absorption)

   • Osteoporosis or bone density loss (due to reduced calcium and vitamin D absorption)

   • Vitamin B12 deficiency

   • Folate deficiency

4. Skin problems:

   • Dermatitis herpetiformis: A blistering, itchy skin rash that is closely associated with coeliac disease. It often appears on the elbows, knees, buttocks, or scalp.

5. Weight loss:

   • Unintended weight loss despite adequate food intake

6. Joint pain and muscle cramps:

   • Joint pain, inflammation, and stiffness

   • Muscle cramps and weakness

7. Mood disorders:

   • Anxiety

   • Depression

   • Irritability

   • Mood swings

8. Delayed growth and development (in children):

   • Slowed growth

   • Delayed puberty

   • Failure to thrive

9. Neurological symptoms:

   • Peripheral neuropathy: Numbness, tingling, or pain in the extremities

   • Migraines or frequent headaches

10. Mouth ulcers:

    • Recurrent mouth ulcers

It's important to note that some individuals with coeliac disease may not exhibit any noticeable symptoms, or their symptoms may be subtle and difficult to attribute to the condition. In such cases, coeliac disease may be discovered during routine screenings or investigations for other health issues.

How is Celiac Disease diagnosed?

Diagnosing coeliac disease involves a combination of medical assessments, laboratory tests, and sometimes invasive procedures to confirm the presence of the condition. It's important to work with a healthcare professional for an accurate diagnosis. The diagnostic process typically includes the following steps:

It's important to note that if you suspect you have coeliac disease or are experiencing symptoms, you should not start a gluten-free diet before undergoing testing. Removing gluten from your diet can affect the accuracy of blood tests and biopsies.

What are the treatment options for Coeliac Disease?

The primary treatment for coeliac disease is a strict, lifelong adherence to a gluten-free diet. This means completely avoiding all sources of gluten, including wheat, barley, rye, and their derivatives. Removing gluten from your diet helps prevent the autoimmune response triggered by coeliac disease and allows the small intestine to heal over time. Here are key aspects of the treatment and management of coeliac disease:

1. Gluten-free diet: Following a gluten-free diet is the cornerstone of coeliac disease management. This involves avoiding all foods and products that contain wheat, barley, and rye. Common sources of gluten include bread, pasta, cereals, baked goods, and many processed foods. It's essential to carefully read food labels, as gluten can be present in unexpected places, such as sauces, soups, and even some medications.

2. Whole, natural foods: Emphasise whole, naturally gluten-free foods in your diet, such as:

   • Fruits and vegetables

   • Lean meats and fish

   • Legumes and beans

   • Nuts and seeds

   • Gluten-free grains like rice, quinoa, corn, and oats (make sure the oats are certified gluten-free due to potential cross-contamination)

3. Avoid cross-contamination: Preventing cross-contamination is crucial, as even small amounts of gluten can trigger symptoms. This involves:

   • Using separate utensils and cooking equipment

   • Cleaning surfaces thoroughly

   • Avoiding shared toasters and deep fryers

   • Being cautious when dining out, and informing restaurant staff about your dietary needs

4. Consult a dietitian: Working with a registered dietitian who specialises in coeliac disease can be immensely helpful. They can provide guidance on meal planning, label reading, and ensuring you get adequate nutrients while following a gluten-free diet.

5. Monitoring and follow-up: Regular follow-up appointments with your healthcare provider are important to monitor your progress, assess nutrient levels, and address any concerns or challenges you may be facing.

6. Medications and supplements (as needed): In some cases, your doctor may recommend supplements to address specific nutrient deficiencies. For example, iron, vitamin B12, and calcium supplements might be necessary to correct deficiencies caused by malabsorption. However, these supplements should not replace a gluten-free diet.

7. Support groups: Connecting with support groups, both online and in person, can provide valuable information, resources, and a sense of community for individuals living with coeliac disease.

It's important to note that there is currently no medication or cure that allows individuals with coeliac disease to consume gluten safely. The only effective treatment is a strict gluten-free diet. Additionally, individuals with coeliac disease should avoid self-diagnosis or self-treatment and should always work with qualified healthcare professionals to manage their condition.

If you have been diagnosed with coeliac disease or suspect you may have it, it's essential to follow your healthcare provider's recommendations and seek guidance from a healthcare team experienced in coeliac disease management.