Coeliac disease - more common than you think

Coeliac Disease - more common than people think

By Deborah Condon

Coeliac disease is more common than most people realise. In fact, there is a major lack of awareness of the condition in this country, with the result that many people with it have not and may never be diagnosed, according to the Coeliac Society of Ireland.

Coeliac disease is a condition in which there is an abnormal reaction by certain cells in the immune system to gluten. This can result in symptoms, such as diarrhoea, chronic fatigue, anaemia, weight loss and recurrent mouth ulcers.

Gluten is a general term used for a type of protein that is found in wheat and related grains, such as barley, rye and oats. When it is consumed, the lining of the small intestine becomes damaged, reducing the person's ability to absorb certain nutrients, such as iron and calcium - these are essential to the body.

Gluten is a type of protein found in wheat

Ongoing damage to the lining of the intestine also increases the need for continuing tissue repair. This in turn can increase the risk of cancer of the intestine. Gluten sensitivity may also manifest in other ways, for example a person may develop a skin condition called dermatitis herpetiformis.

Speaking to irishhealth.com, Emma Clarke Conway of the society explained that because there are no official records about the disease in Ireland, the exact number of people affected is unknown. Estimates indicate that between seven and nine people per 1,000 are affected, or almost 1% of the population.

However many people remain undiagnosed because the condition may not be obvious.

"For example, people may not be tested for coeliac disease but they may be advised to stop eating wheat. This may improve their symptoms, but as a result they may never be diagnosed with the condition", she said.

While the exact cause is unknown, there is clear evidence of a genetic factor. In other words, some people will be born with a predisposition to developing the condition. The actual onset is then triggered in susceptible people by what the society refers to as 'an environmental event'.

"This can refer to a range of things, from stress on the body to becoming pregnant", Ms Clarke Conway said.

It has also been suggested that the introduction of gluten to the diet during weaning - either too much or too early - may contribute to the onset, as may a variety of viral infections.

The diagnosis of coeliac disease may involve blood tests, however these are insufficient to make a definite diagnosis. The only definitive way to diagnose the condition is to have a biopsy. A sample of tissue from the lining of the small intestine is taken. The procedure takes just 10 to 15 minutes.

The condition does not appear to be gender-specific. However according to Ms Clarke Conway, as women are more inclined than men to visit their GP if they are experiencing health problems, there are probably more women who have been diagnosed with the disease. The condition can also affect people of any age.

There is no cure for coeliac disease, however it can be effectively controlled by diet alone, therefore it is essential that those affected know what they can and cannot eat. So if a person is diagnosed, what exactly can they include in their diet?

Many foods are naturally gluten-free, such as unprocessed fruit, vegetables, milk, eggs, rice, fish and meat (except sausage meat). The main foods to be avoided include bread, cakes, biscuits, pizza, pasta, spaghetti, as well as certain soups, sauces, gravies and breakfast cereals.

Unprocessed vegetables are naturally gluten-free

When cooking, breadcrumbs should not be used and do not dust meat, fish or poultry with flour. Sauces and gravies that are thickened with flour or starch containing gluten, should be avoided. Wheat products such as wheat flour, wheat bran, noodles, spaghetti, macaroni and ravioli, should also be avoided.

The following are gluten-free products that can be used as substitutes for some of the foods above:

-Ground rice.

-Rice flour.

-Cornflour.

-Maize flour.

-Potato flour.

-Soya flour.

-Arrowroot.

-Rice.

-Sago.

-Tapioca.

-Maize.

-Buckwheat.

-Millet.

-Commercial gluten-free flours and breads. (These must comply with the international standard for gluten-free food.)

The availability of gluten-free products is not a major problem here, with most major supermarkets, including Superquinn, Tesco and Dunnes Stores, stocking such products.

According to Ms Clarke Conway, one of the biggest problems with the diet, apart from getting used to it perhaps, is cost. Gluten-free products are relatively expensive.

"If, for example, you are used to eating a sandwich for your lunch every day and you are diagnosed with coeliac disease, you will have to spend a couple of euro on one loaf of (gluten-free) bread and the slices are smaller than your average loaf. Every day items like these can prove expensive, especially for older people", she explained.

Unless gluten-free, bread must be avoided

The Coeliac Society would like to see more financial support offered to people with the disease.

People with a medical card can however avail of gluten-free products for free because essentially these foods are their medicine. However some of these products contain trace amounts of wheat and if a person is extremely sensitive, they may react to these trace amounts. As a result there have been calls for wheat-free products to be made available to medical-card holders as well.

With over 3,700 members and growing, the society holds regular meetings around the country. It also publishes an annual food list booklet, which provides updated details of what foods can be eaten.

For more information on coeliac disease or to obtain a copy of the food list booklet, contact the Coeliac Society at (01) 872 1471 or email coeliac@iol.ie


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