As a Nutritional Therapist, I help clients with a wide range of health problems. Some might be obviously associated with the food that people eat, like digestive disorders, in other cases, the links are not so clear. Nutritional therapy aims to help people feel better – have more energy, lose some weight, improve skin conditions, get rid of bloating. It was because I frequently see ‘unexplained’ digestive issues that I began to investigate further the role of gluten in our diets and coeliac disease in particular. I discovered the work of one American scientist, Dr Tom O’Bryan which helped me enormously in my research. I now work frequently with people with coeliac disease and with non-coeliac gluten sensitivity.
Coeliac disease is not an allergy to gluten; it is an auto-immune condition. That means that the body attacks itself, destroying the gut lining and other tissues within the body. It has a wide range of symptoms, which include stomach pain, cramps and bloating, but not everybody gets these digestive symptoms. Other symptoms include tiredness, anaemia, dermatitis ,infertility, joint and bone pain, depression, osteoporosis, weight loss and many, many others. The list is endless, and probably because of this, it can be difficult to diagnose. For example, if you go to the doctor saying you feel tired, headachy and depressed, why would you be referred to a gastroenterologist?
Coeliac disease can occur from early childhood, right through to old age. However, I think that many who are diagnosed with it later in life have probably had it for a long time. It runs in families – at least 97% of it is genetic. You can have the marker genes though, and never develop full blown coeliac. The genes have to ‘switch on’. You may be lucky and they never will. But if you have a relative with coeliac and you start to develop say, bloating, skin problems and mouth ulcers, you should definitely be checked for coeliac.
People with coeliac disease mustn’t eat gluten at all – that means no wheat, barley, rye and even oats for some people. Ever. Not the tiniest little bit. I think the most radical thing that I have had to learn is how dangerous cross contamination is. You can’t use the same toaster or pot of jam, you can’t go to a restaurant and take the bread off your plate and then eat the rest. Any gluten at all can provoke a severe relapse.
You receive a diagnosis of coeliac based on a test for gluten antibodies (tTG) in the blood followed by an endoscopy where biopsies are taken. What they are looking for is total (or partial) villous atrophy. Your intestinal wall is covered with small finger-like projections, called villi. They are covered in mucous and beneficial bacteria and contain more than half of your immune system. Nutrients from your food are digested through the villi.
In coeliac disease, these villi become eroded, so that instead of nice, fluffy shag pile carpet, you have a bare wasteland, hence total villous atrophy. Clearly, the ability to digest food is severely affected. It is possible to have a negative blood test, and still get a diagnosis of coeliac, particularly if you aren’t eating that much gluten. But it often takes many visits to the doctor before that happens.