coeliac disease and the gut

Written by Annabel Sparrow

Unfortunately coeliac disease is more common than you may realise. In the UK is estimated approximately 1 in 100 people are affected by the disease (1). However, it is thought only 36% of people living with the condition receive a diagnosis (2). This means approximately half a million people don’t even know they have it!

so what is coeliac disease and how does it affect your gut?

It may surprise you to know that coeliac disease isn’t classed as a food allergy, or a food intolerance. Coeliac disease is an autoimmune disorder that inhibits the absorption of gluten found in wheat, rye and barley. So, what does this mean for you and your gut?

Short answer: this means when an individual with coeliac disease eats gluten, an immune response occurs in the body which leads to damage within the gut, preventing nutrition absorption.

The science: when an individual has an autoimmune condition their immune system mistakes healthy cells and substances for harmful ones, and to protect itself will produce antibodies to fight them off.

In the case of coeliac disease, the substance that makes up gluten (gliadin) is viewed by the immune system as the baddy, and the antibodies our bodies produce cause the surface of our intestine to become inflamed.

Our intestine is lined with lots of tiny finger-like structures called villi, which are pretty amazing and help to digest our food. However, for those with coeliac disease, the damage caused actually flattens the villi, which reduces their ability to help with digestion and therefore prevents the absorption of nutrients from our food. (3)

what might be some symptoms of coeliac disease?

What are the signs to look out for? Bear with us, as they’re pretty wide ranging:

gut related symptoms:

Diarrhoea – the most common symptom caused by the bodies inability to fully absorb nutrients
Malabsorption – leading to stools containing high levels of fat, which can lead to a foul smell, as well as a greasy texture which may make it difficult to flush
Abdominal pain
Bloating and flatulence
Indigestion
Constipation
Vomiting

general symptoms:

Extreme tiredness – which may be as a result of iron or vitamin B12 folate deficiency anaemia
Weight loss
Sensation of tingling and numbness in your hands and feet
Swelling of the hands, feet, arms and legs – as a result of built up fluid
An itchy rash (known as dermatitis herpetiformis) – this isn’t a symptom of coeliac disease, however it can occur as a result of an autoimmune response to gluten

(4)

We know this sounds like a lot, and could be a number of things, which does sometimes result in diagnosis of other disorders first such as IBS. (5,6,10) This is why it’s so important to visit your GP and get tested to ensure you receive the correct treatment.

but how do I know if I have coeliac disease?

Before rushing to any conclusions, and cutting out all gluten from your diet it’s important to be properly diagnosed. If you’re concerned book an appointment with your GP, who will look out for key symptoms, and run some tests, including:

A blood test – to check for antibodies, which help identify those who may have coeliac disease
A biopsy of the small intestine – this will help to confirm the diagnosis

It’s not known why people develop coeliac disease, however there are some known factors that can increase your risk of developing it. These include; a family history, environmental factors (such as digestive infections at a young age), and other health conditions (including type 1 diabetes, thyroid conditions, ulcerative colitis, epilepsy and down’s syndrome). (3

gluten isn’t bad for all of us!

Just a quick note before delving into the management of coeliac disease, as so far gluten has got a pretty bad rep. If you haven’t been diagnosed, for many of us without the disorder, we’re fine to keep including gluten in our diet, in fact research has shown cutting it out when we don’t need too could prevent health, not improve it.

One observational study in nearly 200,000 people, without coeliac disease, found those who consumed the most gluten (top 20%), were at a 20% lower risk of developing type 2 diabetes, compared to those with the lowest intake. Why? The researchers found those who cut out gluten also tended to eat less grain fibre – known to protect against type 2 diabetes.(7) It’s also not great for our gut microbiome – in fact a gluten free diet may decrease certain bacteria in our guts, and as we know variety is key. (8,9)

following diagnosis…

For those of you who have been diagnosed, don’t despair, it is not all gloom and doom we promise. To get you and your gut feeling better the best thing to do is cut all gluten out of your diet. Research has found by doing so, your gut architecture may be restored, as well as mucosal recovery occurring. Following this symptoms of malabsorption such as diarrhoea can also improve. (11)

To help with going gluten-free following diagnosis you’ll be referred to a dietitian, they’ll be there to support you and help you to adjust. Their role is super important as they’ll be able to help you ensure your diet is balanced and still containing all of the nutrients you need.

So, what are some common foods to avoid containing gluten? Gluten is found in foods such as bread, pasta, cereals, biscuits/crackers, cakes, pies, gravies and sauces.

As mentioned many foods do not naturally contain gluten, such as; fruits and vegetables, meat and fish (not including breaded etc.), potatoes, rice and rice noodles, most dairy products and gluten free flours and alternatives.

Importantly, never assume something is gluten-free and always check the labels, as well as making sure whoever is preparing your food is aware, to ensure cross-contamination does not occur. (12)

where to get support

The important thing is to know you’re not alone. There are lots of great sources and places to get further support. This includes the coeliacinsider.com (brought to you by Thermo Fisher Scientific) , an educational resource for anyone concerned that they or a loved one may have the disease.

A bit about the author

Annabel is a Registered Associate Nutritionist with a personal and professional interest in gut health. With a BSc degree in Psychology and MSc in Nutrition and Behaviour, she is passionate about building healthy relationships with food and understanding the connection between food, mood and health.
Annabel applies her psychological background in combination with her knowledge of nutrition to help people manage and improve their health without restriction.

This blog has been sponsored by Coeliac Insider brought to you by Thermo Fisher Scientific

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