What is Coeliac Disease?
Coeliac Disease is an autoimmune disorder of the small intestine caused by a reaction to a dietary protein known as gluten in genetically predisposed people. Gluten is found in wheat, rye, triticale, barley, kamut, oats and wheat subspecies such as spelt, semolina and durum. Coeliac disease can occur in people of all ages from infancy to adulthood.
Ingestion of gluten causes an immune response, resulting in inflammation of the small intestine. This inflammation damages the lining of the small intestine, known as the intestinal villi. Villi are tiny finger-like projections (similar to a shag-pile rug) that are responsible for the absorption of nutrients from our food. Damage to the lining of the small intestine causes the villi to flatten out (known as villous atrophy) which significantly decreases our ability to absorb nutrients, ultimately leading to malabsorption. Currently the treatment of coeliac disease is a 100% gluten free diet.
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What are the symptoms of Coeliac Disease?
- Diarrhoea &/or constipation
- Fatigue and weakness
- Bloating/fluid retention
- Foul stools (steatorrhoea)
- Anaemia (low Iron)
- Abdominal cramping and discomfort
- Increased flatulence
- Lowered immune resistance
- Weight loss (in some cases weight gain)
- Failure to thrive (in children) including poor weight gain or delayed growth/puberty
- Mental “fogginess”
- Lowered mood/depression
- Nausea and vomiting
- Vitamin and mineral
deficiencies, especially Vitamin D, K, B12, folate, zinc and calcium
Less common symptoms
- Recurrent mouth ulcers
- Recurrent miscarriage and infertility
- Skin conditions such as dermatitis herpetiformis
- Bone, muscle and joint pains
- Hyposplenism (a small and underactive spleen)
- Osteopenia or osteoarthritis (as a result of intestinal malabsorption of Vitamin D and calcium)
Coeliac disease may be asymptomatic in many people, meaning they experience no gastrointestinal symptoms at all.
Other medical conditions associated with Coeliac Disease
- Autoimmune thyroiditis
- Microscopic colitis
- Diabetes Mellitus Type 1
- Primary Biliary Cirrhosis
How is Coeliac Disease Diagnosed?
There are several tests used to screen for coeliac disease. Generally the initial test performed is a coeliac serology, which is a blood test. This includes:
- Anti-tissue transglutaminase antibodies (tTG)
- Deamidated gliadin peptide (DGP) IgA and IgG tests. The DGP IgG test can detect individuals with coeliac disease who may be deficient in IgA antibody, rendering the tTG IgA test unreliable in those cases.
- Anti- endomysial antibodies (EMA).
If a coeliac serology shows a positive a gastroscopy is then requested to confirm the diagnosis. This is where approximately 5 biopsies are taken of the duodenum at varying locations.
*It is important to note that if a gluten free diet has been implemented prior to testing, a coeliac serology and duodenal biopsies may show a false negative. It is recommended to include gluten in the diet on a regular bases for at least 6 weeks prior to the above testing.
Genetically Coeliac Disease is characterised by a strong human leucocyte antigen (HLA) component. More than 90% of people affected by coeliac disease carry at least one of the genes that encode HLA DQ2 or HLA DQ8. The risk for coeliac disease is greater in those with the HLA DQ2 genes compared with the HLA DQ8 genes. The genetic test can be done as a blood test or a buccal (cheek) swab. Not all people that carry the gene will develop coeliac disease; therefore the genetic test alone cannot specifically diagnosed coeliac disease. However, the genetic test is not dependent on gluten intake so can be used when people have already implemented a gluten free diet.
How can a Naturopath help support people diagnosed with Coeliac Disease?
- Dietary advice and education on which foods and beverages that do & do not contain gluten
- Help to establish a balanced diet rich in B12, folic acid, iron, A, E, K, calcium, zinc and other phytonutrients
- Help to replenish nutritional deficiencies
- Support the repair of the intestinal lining
- Rebalance and replenish the good bacteria in the bowel
- Support digestive enzyme levels to ensure food is digested efficiently and completely, which may help prevent the development of other food sensitivities.
- Address any digestive symptoms such as diarrhoea, constipation, bloating or generalised discomfort that may still be present after implementing a gluten free diet.
- Address any other symptoms that may still be present after implementing a gluten free diet such as lowered immunity, mental “fogginess”, fatigue, weight gain/loss.
Here’s what you can expect:
1. Your Naturopath will take a thorough case history, reviewing your diet, general health and in particular, digestive function.
2. Functional and blood testing and other medical investigations may be recommend to check nutritional status, other potential food allergens, digestive enzyme status and bacteria balance of the bowel.
3. Based on the above information your naturopath will advise particular dietary and lifestyle adjustments and provide information on gluten free dietary alternatives. Specific nutritional and herbal medicines may also be prescribed.