Coeliac Disease

Digestion, Immune | September 17, 2017 | Author: Naturopath

autoimmune

Coeliac Disease

Coeliac disease is an autoimmune disease where the body has an abnormal reaction to the protein gluten which is found in wheat, rye and barley. It affects the small intestine, causing inflammation, damage and malabsorption. Coeliac disease is one of the most common chronic diseases that is often underdiagnosed—approximately 1 in 70 Australians are affected. If left untreated it can lead to malnutrition, bowel cancer, anaemia, depression and osteoporosis. Even small amounts of gluten can cause a lot of harm and therefore the treatment is to avoid all gluten-containing foods. This allows the inflammation to reduce and the bowel lining to repair.

The damaging effects of gluten

Our small intestines are part of our digestive system located between the stomach and large intestine. They are lined with finger-like projections called villi which break down and absorb nutrients in food. In a person with coeliac disease, gluten causes inflammation of the villa and mucosa of the small intestines. It is a process referred to as villous atrophy, which leads to a decreased, flattened surface area in which to absorb nutrients. This is why nutrient deficiencies are so common in those with coeliac disease.

What are the symptoms?

For some people symptoms of coeliac disease can be severe, while others have much milder reactions.

Here are some of the most common symptoms:

  • Abdominal pain and cramps
  • Bloating and flatulence
  • Diarrhoea or constipation
  • Fatigue and changes in mood
  • Nausea and vomiting
  • Weight loss
  • Anaemia

In children, there may also be delayed growth or puberty.

What increases your risk

Coeliac disease affects males and females of all ages. It can run in families, which means that people can have a genetic predisposition to develop the disease. If you have a first-degree relative with coeliac disease you have a 10 per cent chance of also having the condition. Over 99% of people who have coeliac disease possess at least one of the genes that encode HLA DQ2 or HLA DQ8. However, only 1 in 40 people with one or both of these genes will develop the disease. Other genes and environmental factors play a role too.

How coeliac disease is diagnosed

Doctors will often do special blood tests (coeliac serology) as an initial screening. It measures levels of antibodies in the blood which are usually elevated in individuals with coeliac disease. While blood tests can be helpful the only way to get a definitive diagnosis is to undergo an endoscopy that takes a small bowel biopsy. Under sedation a small slender instrument (an endoscope) is passed through your mouth into the small intestines where tiny samples are taken from the lining.

Prior to these tests it is important that normal gluten intake be followed. If you have put yourself on a gluten-free diet it may lead to inaccurate results.

Avoiding gluten

Avoiding glutenFor people with coeliac disease they should avoid all foods containing gluten. Any labels on packaged foods should be read closely—even unlikely sources such as garnishes and dressings can contain gluten. Education on what foods contain gluten is imperative. Obvious foods that contain gluten include:

  • Biscuits
  • Bread
  • Breakfast cereals
  • Cous cous
  • Crackers
  • Pastries
  • Pizza
  • Pasta
  • Cakes and muffins
  • Breadcrumbs

Finding alternatives

Initially can take a bit of work in finding out what foods are safe to buy and eat. On packaging look for ‘gluten free’ or the coeliac Australia endorsement logo. Unfortunately, some foods that may not contain gluten cannot verify with absolute certainty that they are gluten free due to possible cross contamination.
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Other grains that can be used include gluten-free oats, rice, amaranth, buckwheat, millet and quinoa. Gluten-free flours can be substituted in recipes where you would usually use wheat in baking and crumbing. Flaked quinoa can be used to make a porridge, while corn or rice cakes can be substituted for wheat or rye-based ones. Some processed meats like sausages or deli meats can contain gluten, but there are many gluten-free options now available in these ranges.
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Repairing the damage

After complete avoidance of gluten, it can take many months and in some cases years to repair the damage. Here are some things that can help promote faster healing.

Slippery elm powder

Rich in mucilage, slippery elm powder produces a slimy protective barrier on the mucus membranes of the small intestine. This has a cooling effect that reduces inflammation and promotes repair. For best results take as a powder. 1 teaspoon taken 2-3 times daily is advised for optimal results.
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Aloe veraAloe Vera juice

The inner gel from the aloe vera plant acts a soothing digestive tonic. It assists in the functioning of the digestive tract and as a prebiotic helps to maintain healthy intestinal bacteria. For optimal results take 40mls of the fresh juice twice daily. When purchasing a product look for one that is unsweetened and over 99% pure.
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Probiotics

Probiotics line the small intestine providing protection against the colonisation of pathogens. These important micro-organisms regulate the intestinal barrier function—preventing leaky gut and autoimmunity. Some have even been found to enzymatically degrade gluten. In people with coeliac disease dysbiosis and an altered gut microbiome has been identified. This results in an uneven balance between good and bad bacteria—leading to poor digestive and immune health. Lactobacillus and especially Bifidobacterium strains may be helpful in the treatment of celiac disease to restore healthy intestinal function.
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Nutrient deficiencies

Due to the damage to the villi in the small intestine, nutrient deficiencies commonly occur. Getting a blood test through your doctor will help determine what nutrients may be lacking. Common deficiencies include vitamin D, zinc, B6, B12, niacin, riboflavin, copper, magnesium, folate, calcium and iron. Supplementation may be required to fill in any gaps even though dietary intake may seem adequate. Just make sure any supplements taken are free from gluten.

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References

http://www.coeliac.org.au/coeliac-disease/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coeliac-disease-and-gluten-sensitivity

Kelly CP, et al. Advances in Diagnosis and Management of Celiac Disease. Gastroenterology. 2015 May; 148(6): 1175–1186

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409570/

Plugis NM, Khosla C. Therapeutic approaches for celiac disease. Best Pract Res Clin Gastroenterol. 2015 Jun; 29(3): 503–521

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465084/

http://www.cureceliacdisease.org/faq/what-common-nutrient-deficiencies-might-an-adult-experience-prior-to-diagnosis/

Wierdsma NJ, et al. Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients. Nutrients. 2013 Oct; 5(10): 3975–3992

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820055/

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