“Coeliac disease? Doesn’t that mean you’re allergic to gluten or something?” ” Coeliac disease? I’m sure a little cake won’t hurt” “Why won’t you eat my homemade pie? I made it with gluten free flour!!”
Anyone with coeliac disease will be all too familiar with conversations like the above. But the reality is, coeliac disease is a lifelong autoimmune condition which can have devastating results on your health if not managed properly. Let’s talk about it.
What Even is Coeliac Disease?
Coeliac disease is an autoimmune condition where the body’s immune system reacts abnormally to gluten, a protein found in wheat, barley, and rye. When someone with coeliac disease eats gluten, their immune system mistakenly attacks the lining of the small intestine, causing the flattening of the villi and microvilli. These are finger-like projections in the intestines which increase the absorptive capacity of the intestines- villi increase it by 40x, and microvilli, which are on the villi, increase it by 600x. Essentially, almost all of the absorptive surface area is from these projections.
When they are flattened, you can’t absorb nearly as much from your food as you used to be able to. This causes weight loss and nutrient deficiencies, alongside many other debilitating conditions.
How Does It Happen?
Coeliac disease is thought to be caused by a combination of genetic and environmental factors. If you have certain genes (HLA-DQ2 and HLA-DQ8), you’re more likely to develop the condition. However, not everyone with these genes will get coeliac disease, suggesting that other triggers, such as infections or stress, may also play a role. In fact, many with coeliac disease describe their symptoms starting following a period of illness; it may be that genetics load the gun, and an illness or time of stress pulls the trigger.
People with other autoimmune conditions are more likely to get coeliac disease; for example, those with Type 1 diabetes or Rheumatoid Arthritis. Equally, those with a close family member are also more likely to develop the condition.
What Happens If Left Untreated?
If coeliac disease is left untreated, it can lead to a host of health problems. Short-term effects include digestive issues like diarrhoea, bloating, and abdominal pain. However, the long-term consequences can be more severe.
Chronic inflammation and damage to the small intestine can result in malnutrition, anaemia, and osteoporosis, due to a lack of ability to absorb nutrients.
In rare cases, untreated coeliac disease can lead to certain types of cancer, such as intestinal lymphoma.
Coeliac Disease vs. Non-Coeliac Gluten Sensitivity vs. Wheat Allergy
Now, let’s clear up some confusion. Coeliac disease, non-coeliac gluten sensitivity (NCGS), and wheat allergy are often lumped together, but they’re quite different.
Coeliac Disease
As we’ve discussed, coeliac disease is an autoimmune condition where gluten triggers an immune response that damages the small intestine. It’s diagnosed through blood tests and a biopsy of the small intestine. The only treatment is a strict, lifelong gluten-free diet.
Non-Coeliac Gluten Sensitivity
NCGS is a bit of a mystery. People with NCGS experience symptoms similar to coeliac disease, such as bloating, diarrhoea, and fatigue, but they don’t have the same immune response or intestinal damage. The diagnosis is usually made by excluding coeliac disease and wheat allergy. While a gluten-free diet can help manage symptoms, it’s not as strictly necessary as it is for coeliac disease, as it has no long term, permanent consequences.
Wheat Allergy
A wheat allergy is an allergic reaction to proteins found in wheat. It’s different from coeliac disease and NCGS because it involves the immune system producing IgE antibodies in response to wheat proteins. Symptoms can range from mild (such as hives or itching) to severe (such as anaphylaxis). Unlike coeliac disease, a wheat allergy can sometimes be outgrown, especially in children.
Whilst people with coeliac disease can consume products derived from wheat if they are less than 20ppm gluten containing, people with a wheat allergy absolutely have to avoid these foods.
Living with Coeliac Disease
Living with coeliac disease can be challenging, but it’s entirely manageable with the right approach. The key is to maintain a strict gluten-free diet, which means avoiding all foods containing wheat, barley, and rye. Fortunately, there are plenty of delicious gluten-free alternatives available these days, from pasta and bread to cakes and biscuits.
It’s also important to be vigilant about cross-contamination. Even tiny amounts of gluten can cause a reaction, so it’s crucial to use separate utensils, cutting boards, and toasters if you share a kitchen with gluten-eaters.
The Gluten-Free Lifestyle
Adopting a gluten-free lifestyle can seem daunting at first, but it’s a great opportunity to explore new foods and recipes. Many naturally gluten-free foods are incredibly nutritious, such as fruits, vegetables, lean proteins, and whole grains like quinoa and brown rice.
There are also plenty of resources and support groups available for people with coeliac disease. Connecting with others who understand what you’re going through can be incredibly helpful and reassuring.
Coeliac disease is a serious condition that requires careful management, but with the right knowledge and support, it’s entirely possible to live a happy, healthy, gluten-free life. Whether you’re newly diagnosed or just curious about the condition, understanding the differences between coeliac disease, gluten sensitivity, and wheat allergy is crucial.
Got any more questions about coeliac disease? Leave them below!
Photo credit: UnSplash with thanks
Diets Debunked 