Coeliac disease (gluten intolerance)
Coeliac disease, or gluten intolerance, is an autoimmune reaction to gluten, a constituent of various cereal grains.
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In Switzerland roughly one per cent of the population suffers from coeliac disease. In sufferers, gluten, the binder protein in different types of grains, causes damage to the mucosal lining of the small intestine. A symptom-free life is usually possible with a gluten-free diet.
Causes and triggers
Genetic predisposition is an important factor in the development of coeliac disease. In sufferers, the consumption of gluten results in damage to the mucosa of the small intestine and in the breakdwon of villi lining the small intestine, thereby reducing the surface area of the intestine. This means that nutrients (carbohydrates, fats, proteins, vitamins and minerals) may be absorbed less effectively and sufficient quantities of these nutrients are no longer available to the body. During the course of the disease, these nutrient deficits can cause deficiency symptoms (e.g. iron deficiency) and relevant consequences (e.g. anaemia).
Gluten is a collective term for binder proteins found in different types of grain (wheat, spelt, rye, barley, emmer, unripe spelt, kamut, einkorn and triticale).
The symptoms of coeliac disease are many and varied. There are also some forms of coeliac disease in which few, if any, noticeable symptoms occur.
Common symptoms in infants:
Weight loss, loss of appetite, diarrhoea, bloating, arrested growth, delayed development, being prone to irritability and whining.
Common symptoms in adolescents and adults:
Fatigue/exhaustion, anaemia, iron deficiency and other states of deficiency, diarrhoea or constipation, recurring abdominal pain, bone pain, loss of weight and strength, reduced physical capacity, concentration difficulties, depressive moods, infertility and premature births in women.
When a case of coeliac disease is suspected, it is important to measure the specific coeliac disease antibodies in the blood. These are transglutaminase IgA antibodies in serum and endomysial IgA antibodies as well as total IgA. IgG-based antibody tests may also be required as a second step, but only if the total IgA is low or undetectable. A further diagnostic test commonly used to confirm coeliac disease is gastroscopy with a tissue sample (biopsy).
Sufferers may develop lactose intolerance or osteoporosis if their coeliac disease has not been detected (over a prolonged period).
Symptoms can be reduced with a low-fructose diet. Following diagnosis, it may be helpful for a short period to eat foods low in fructose and avoid sugar alcohols. Then individual tolerance of fructose is determined in a test phase. This involves gradually increasing the amount of food containing fructose that is consumed. A dietitian can provide assistance in these matters.
Tips and tricks
The only known treatment for coeliac disease is a life-long, gluten-free diet. Sufferers can usually lead a symptom-free, healthy life if they avoid gluten.
They should strictly avoid:
wheat, rye, barley, spelt, kamut, unripe spelt, emmer, triticale, einkorn and any foods produced from them (e.g. bread, bakery products, pasta, sauces thickened with flour, etc.).
Gluten-free oats (uncontaminated with wheat, rye, barley or spelt) are permissible in small quantities for most sufferers. The attending GP or gastrointestinal specialist can provide information on this point.
The following are gluten-free:
potatoes, maize, rice, buckwheat, quinoa, amaranth, millet, teff flour and pulses.
Unprocessed foods such as meat, fish, eggs, milk and dairy products, vegetables, fruit, vegetable oils and sugar are also suitable.
In the case of ready foods it is important to read the declaration. If the food contains gluten, this must be clearly labelled.
A wide range of gluten-free specialist foods are available on the market. Sufferers can be guided by the Allergy Seal of Quality (recommended by aha!) and the gluten-free symbol (crossed-out wheat ear).