What is coeliac disease?

Coeliac disease is an increasingly diagnosed disease which affects approximately 1% of Western, Middle-eastern, and Indian communities (ref. 12, 13). It is often under recognised and under researched.

Coeliac disease is caused by an inappropriate immune response to gluten proteins present in wheat, rye and barley, toxicity can also extend to oats in some cases (ref. 14).

Coeliac disease is not an allergy and should not be confused with forms of irritable bowel syndrome which improve with gluten-free diet (“wheat intolerance” or “gluten sensitivity”) (ref. 15). And although coeliac disease is associated with antibodies targeted to “self” proteins and autoimmune diseases such as type-1 diabetes are increased, coeliac disease is not strictly an autoimmune condition itself because it is caused by proteins foreign to the body (in food) (ref. 14).

Effects
The small intestine is the organ most affected in coeliac disease (ref. 15, 16). Inflammatory and immune cells crowd into the lining of the small intestine where they release damaging enzymes, cause premature death of the lining epithelial cells and increase leakiness of the gut (ref. 14). In more severely affected patients, the ability to absorb nutrients can be greatly compromised. In many patients, increased food intake can compensate for poor absorption of nutrients. In such cases, it is only when food intake is limited or another intestinal illness occurs that malabsorption has obvious clinical effects such as weight loss or diarrhoea (ref. 15, 16).

Other symptoms
Fatigue (“tired all the time”) is a common feature of chronic immune diseases, and in coeliac disease it may be the only obvious symptom (ref. 15, 16). Fatigue may be further aggravated by iron deficiency and anaemia. Within a few weeks of gluten exclusion, energy levels often dramatically improve. Unrecognised and untreated coeliac disease is associated with an increased risk of cancer, infertility, osteoporosis, nutritional deficiencies, educational under-performance, and an overall three-times increased risk of death (ref. 3).

Diagnosis
It may be diagnosed at any age but almost always coeliac disease is present from early childhood. Various precipitants may “unmask” symptomatic coeliac disease; these can include trauma, stress, infections, food poisoning, traveler’s diarrhoea, and medications that stimulate the immune system such as interferon therapy for viral hepatitis.