Coeliac Awareness week runs from 12-18th May this year so I thought I would write a blog about this debilitating condition.
Coeliac disease is a digestive disorder. Sufferers have an abnormal immune response to the protein found in the grains wheat, barley, oats and rye, called gluten. As a result the villi, small protrusions in the small intestine that absorb food, become damaged and inflamed resulting in poor digestive function and malabsorption of nutrients.
Coeliac disease is diagnosed by a gut biopsy however, your GP may require a blood test where they will look for antibodies. It is very important that you do not remove gluten from your diet at this stage: the purpose of testing is to see how your body reacts to gluten so if you have eliminated if from your diet, it can result in a false reading. If you have cut out gluten you will be advised to reintroduce it usually once a day for a period of 6 weeks.
Unfortunately this can cause unpleasant symptoms to reappear but it is essential to get the right diagnosis.
Many people who eat gluten and think it disagrees with them may not be coeliac but have ‘non coeliac gluten sensitivity’ often known as ‘gluten intolerance’. You may suffer the same symptoms but the villi will not necessarily show as damaged under biopsy. However, eliminating gluten from your diet can make big improvements in your daiy well being.
Once coeliac disease has been diagnosed and a suitable diet adopted, the villi will repair and symptoms can be eliminated.
Symptoms are many and varied but often include the following:
- Abdominal pain, often accompanied by bloating, gas or indigestion
- Diarrhoea or constipation
- Nausea and poor appetite
- Low weight in spite of eating a normal diet
- Failure to thrive in children
- Dental enamel discolouration
- Micronutrient deficiencies
- skin rashes
Dos and Don’ts:
Grains that you CAN eat include:
- rice (white and brown) and wild rice
- buckwheat (despite it’s name this grain contains no gluten)
- Oats contain avenin which is similar to gluten but research suggests that eating moderate amounts of oats is not a problem for most people with coeliac disease: in one report approximately 95% of patients tolerated an intake of 50g daily over 12 months. However, for those who are particularly sensitive oats should be avoided. Gluten-free oats are available.
- Any of the gluten-free foods that are marked as such in the supermarket
Foods that you must AVOID:
The following foods must be eliminated, along with the many processed foods which contain them; labelling now makes this process easier but patients must look out for ingredients such as “modified starch” and “malodextrin”. Refer to the very comprehensive booklet produced by Coeliac UK. Beers and lagers must also be avoided.
- Wheat (including varieties like spelt and forms like durum and bulgur)
- Any foods that are made from the above including: cous cous, noodles, pastas
Vitamins and Minerals
- Vitamins A, D, K and E may become deficient because they are fat soluble and coeliacs often have impaired fat absorption.
- Increase Calcium, Magnesium and Zinc.
- It is a good idea to take a suitable multivitamin and mineral supplement to guard against any nutrient shortfalls in the diet. As malabsorption can be a problem, liquid supplements may be more suitable.
General Dietary advice
Refer to Coeliac UK who have an excellent website covering everything you need to know about coeliac disease. They produce an excellent directory that lists all the major supermarkets and manufacturers offering products suitable for those who are allergic to or cannot tolerate gluten. Click on this link:
My advice is to try to eat an anti-inflammatory diet:
- reduce dairy which can be difficult to digest – many people with coeliac disease also have lactose intolerance. Instead substitute with other milks including nut milks such as almond or coconut (but read the label for other ingredients)
- increase fresh fruit and vegetables
- use beans, lentils and legumes as staples in your diet
- include fish (oily fish contain omega 3 oils – both anti-inflammatory and a useful source of beneficial fat – salmon, sardines, trout, tuna, mackerel). White fish is a good source of digestible protein
- avocado (great source of Vitamin E)
- The enzymes papain (papaya) and bromelain (pineapple) reduce inflammation and support digestion
- Use seeds and nuts, either soaked overnight in water and dried in a paper towel, or crushed because whole seeds and nuts may irritate a sensitive gut.
- Cabbage soothes the digestive tract – use cabbage water to make gravies and soups. Pointed cabbage shredded thinly and steamed is naturally sweet and easy for children to eat.
There are numerous websites that offer gluten free foods and plenty of people blog about gluten free cooking. Nearly all supermarkets have ‘Free from’ sections although the choice can be limited.
Be aware that some of these packaged foods are not necessarily a healthy choice because they still contain large amounts of sugar, flavourings, additives and stabilisers – read the labels!
It would be sensible to invest in a good cook book to enable you to cook from scratch using appropriate ingredients – look online or in your local bookshop.