Gluten intolerance, gluten sensitivity, coeliac disease, confused? You are not alone! Once, the term coeliac disease was rarely talked about but recent statistics from the United States suggest that coeliac disease has increased four-fold over the past 50 years; this also appears to be the case across many developed countries. But, can you be gluten intolerant and not have coeliac disease? What if you or a family member does have coeliac disease? Is it more than just a case of having to avoid bread? Huggies Nutritionist, Leanne Cooper unravels this perplexing area.
Gluten sensitivity tends to relate to a group of gluten reactions, many are part of a picture of an illness for example autoimmune diseases; but in addition coeliac disease (CD) falls within this group. You will tend to find that gluten intolerance and CD are terms used interchangeably in the literature, which is probably why there has been some confusion. In addition, some people who are sensitive to gluten don’t return positive tests to gluten, but we will see why shortly.
CD is a condition that can have a huge impact on a person’s nutrition, health and lifestyle. It particularly affects the small intestine (SI), which just happens to be one of the most important organs in our body relating to nutritional status. The SI is the part of our intestinal canal, which food “spills” into from the stomach. While digestion largely takes place in the stomach, it continues in the SI. However, the SI is the major site of nutrient absorption; and therein lies the root of many of the health issues related to CD.
People with CD react to the gluten contained in wheat, barely, rye and oats (and products containing these as ingredients). In fact gluten (or more specifically gliadin) reacts unusually with the enzymes in the SI causing an inflammatory response; it is this process that causes damage to the lining of the SI.
Let’s just review the SI so we can really understand how CD affects health. The SI has a greatly increased surface area because the lining undulates; some describe a healthy SI as looking like a shag-pile carpet. The “outcroppings” are called villi and these greatly increase the length and surface area of the SI. The function of these is to allow for increased contact of the food with the absorptive cells of the SI. The end result is that we can absorb as much nutrition as possible from the food we eat.
In those who have CD, the damage that gluten causes leaves the SI “blunted”. Using the carpet analogy, the shag-pile carpet is reduced to a threadbare carpet. This leaves us with two main issues:
1. Reduced ability to absorb precious nutrients and;
2. An ongoing inflammatory process that our body must cope with.
It’s not hard now to see why CD can cause nutrient deficiencies and failure to thrive (grow) in children; if the organ that is responsible for the majority of nutrient absorption is severely damaged, the amount and quality of nutrients that the body can obtain is significantly impaired. Any compromise of nutrition in life can have short and even long-term effects; this is even more pronounced in those who are still growing, recovering from illness, pregnant or elderly.
CD is more common among Caucasians and West Asians and rare in those of Oriental Asian or Aboriginal Australian background. Statistics on inflammatory bowel conditions in New Zealand suggest that it is less common in Maori and Pacific Island peoples, and in children is more common among boys than girls (5). If you have CD then your children have about a 10 per cent chance of also having CD.
In some cases there is a genetic cause for CD, specifically some people inherit genes referred to as the “coeliac genes”. While you can have a test that excludes CD, it isn’t necessarily useful as a marker of being positive for CD because not everyone who has CD has it as a consequence of their genetic makeup. About every one person in 30 with CD has the genes for CD. Positive screening tests are often then followed up by a medical procedure to make a diagnosis via sampling of tissue from the SI.
Some GPs will opt for a more common blood test for immune compounds that signal a potential reaction to gluten. Regardless, prior to any diagnostic test, it is recommended the person NOT be on a gluten-free diet.
Any dietary amendment must be undertaken with careful consideration, in particular changes that involve a reduction in variety and food groups. Anytime something healthy comes out of the diet it should be balanced with something added in. The potential outcome of restricted diets may include reduced nutrient intake, insufficient kJ/energy intake and the development of other food sensitivities from overexposure to a limited range of foods. All of these are even more important in childhood, given their rate of growth and limited tummy space. Removing wheat from the diet may well limit thiamin, B2, B3, folate and iron as well as other nutritive compounds.
It can be a tricky issue to detect, with the signs and symptoms range from severe and very obvious to more subtle and insidious. Also, irritable bowel syndrome can present in a similar way, likewise so too can other food reactions.
CD is not something you can cure, but you can certainly reverse the impact of gluten. Avoiding gluten, or adopting a gluten-free diet not only allows the SI time to heal, but improves the variety and quality of nutrients the body is able to take up and utilise. In the long term, this improved nutritional status can have a positive impact on health and vitality.
Now you can probably figure out that standard bread, cakes and pasta contain gluten. People on a gluten-free diet also need to avoid couscous as it is a wheat product, crumpets, muffins and many forms of noodles; however, gluten is one of those little devils that turns up as an unexpected ingredient in all sorts of food, such as foods containing thickeners, stabilisers and flavours.
Gluten-containing foods also include:
The message is be a good label reader!
Foods such as fresh fruit and vegetables, legumes, dairy products and unprocessed oils are great nutritious food options along with fish, chicken and meat all being gluten-free. Rice, wild rice, millet and corn are common gluten-free options.
Don’t confuse starchy foods with glutagenous foods, for example rice, corn (maize), soya, potato, buckwheat, millet, quinoa, sorghum, amaranth, sago and tapioca are all starchy foods but gluten-free.
1. Rubio-Tapia et al, Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology. 2009 July ; 137(1): 88-93.
2. Catassi et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr 2007;85:160 – 6.
3. Pogson, J. Coeliac disease on the rise, Gastroenterology, 2009; 137. 88-93.
4. AFGC; Coeliac disease
http://www.ausfoodnews.com.au/2010/10/12/rising-celiac-disease-prompts-new-gf-products.html. Accessed 11/2/11
5. Gearry and Day, Inflammatory bowel disease in New Zealand children – a growing problem. J of NZ Med Ass, 2008, 121; 1283.
This article was written by Leanne Cooper, nutritionist and director of Cadence Health and Nutrition Courses and Sneakys Baby and Child Nutrition