Coeliac Disease

The word coeliac originates from the old Greek word koilia (stomach). Already in the second century before Christ there is mention of the disease. This suggests that gluten related problems have existed for as long as people have succeeded in crossing grasses and started growing crops. Children in particular suffered a lot and often died through celiac disease. Grains have only really been connected with the chronic disease of the small intestine due to the drop in mortality during the bread shortages of the Second World War and the increase in both availability and mortality at the end of the war.

However, it was only in the last 20-30 years that research has found the reason why grains make many people ill and can even kill children. The culprit is called "gluten", a protein in most grains. Coeliac disease is not an allergy, but an autoimmune disease that does not necessarily exist from birth, but can develop over the course of time during regular contamination with gluten. Around 25% where the "basic pre-conditions" are fulfilled do not get ill. This proves, that several factors need to accumulate for coeliac disease to "break out" – namely environmental impacts, genetics and a too penetrable small intestine.

It is the job of the small intestine to break the ingestate into molecules and hence prepare it for the absorption of the nutrients. It also plays an important role in defending the body against viruses and bacteria. The mucous in the small intestine of a healthy patient recognizes which substances are good and which ones are bad for the body. If somebody suffers from intolerance to gluten, the immune police in the mucous of the intestine do not recognize that gluten is food. Instead of breaking it down into amino acids they start a defence reaction and create antibodies. As gluten contains relatively high amounts of glutamine and polin, the immune system believes that they are germs. Because of this “blindness” of the immune defence the body literally tries to use a sledgehammer to crack a nut. The walls of the intestines are attacked and get inflamed. Research has found that the villi die faster under stress and that an intestine of a person with an autoimmune diseases like coeliac disease or Morbus Chron releases too much stress protein under this constant attack and hence too few anti-inflammatory messengers. The intestine loses control and the inflammation becomes chronic. Luckily the intestine nearly always recovers again if the disease is recognized early.

Some people are genetically pre-programmed and hence susceptible to the classical symptoms like indigestion, bloatedness, diarrhoea (possibly alternating with constipation), loss of appetite or weight loss. The symptoms can also include joint pains, restricted growth, lack of iron anaemia (through reduced iron absorption), depression, chronic fatigue, osteoporosis (through reduced calcium absorption), rickets (through reduced absorption of vitamin D), skin problems etc. Affected women possibly suffer from infertility or repeated miscarriages.

Coeliac disease is worldwide one of the most common diseases of the intestines not caused by an infection. Around one in a hundred people are affected, whereas studies show that around twice as many women suffer from the effects of this protein than men. Many affected people do not find out the real cause of their symptoms for a long time.

If there is a reasonable suspicion, it is recommended to run further tests in order to avoid long term consequences such as lack or nutrients, osteoporosis or intestinal cancer. Children in particular should be tested by a doctor if there are signs of coeliac disease in order to be able to react quickly and avoid developmental delays. If you have the slightest suspicion that you suffer from coeliac disease or any other auto-immune condition triggered by food, it is recommended to keep a detailed diary of food consumption and any symptoms. The next step is to cut out products containing gluten for a little while (and check carefully the ingredients list in all foods as many products contain gluten as a flavour enhancer or for binding). If the symptoms disappear, re-introduce food containing gluten and continue to monitor and document your symptoms. Consult your GP if this process confirms your suspicions. They will run further tests if necessary (e.g. a blood test).

As coeliac disease can be inherited, the first symptoms often show already during infancy. The gluten allergy can show for example through lack of growth, weak muscles, lack of appetite, stomach ache, bloatedness, frequent vomitting etc. There can also be behavioural problems such as hyperactivity, extremely bad mood, increased tantrums in autistic children.

There is currently no vaccination or medicine that would allow a correct digestion of gluten. Therefore the only therapy is a lifelong diet cutting out grains like wheat, barley, rye etc with a relatively high gluten content. As the composition of gluten is slightly different in oats, current advice in some countries such as Finland or England says that they may be included in small quantities in a coeliac diet. Buckwheat, Quinoa or wild rice however can be consumed even by coeliacs.

As a too penetrable intestine can also cause other autoimmune diseases (such as Morbus Chron etc.), there is hope that in the near future there will be a medicine that blocks off this autoimmune reaction. Thanks to modern research there are already several approaches to develop enzymes that completely break down gluten or suppress the immune reaction. It will take a while though until these are fully tested and allowed for sale. Until then only a strict diet can prevent the intestine system from attacking itself.

It is widely recognised that the digestive system still needs some time to develop after birth. There are currently hot debates though as to at what time gluten should be introduced into a baby’s diet. Some believe it is best to wait at least 12 months until the digestive system is fully developed. Swedish research found that early coeliac disease was less frequent when gluten was introduced from four months rather than delaying the introduction until after 6 months as per current advice. In my personal opinion every child is different and parents should trust their intuition as to when and how quickly to start introducing solids and particularly gluten.