Saturday 23 March 2019

Dear Dr Nina: 'I am hesitant to do the test for coeliac disease because we'd have to start eating gluten again. What do you think?

Coeliac disease requires a life-time diet adjustment
Coeliac disease requires a life-time diet adjustment

Nina Byrnes

Q I have a suspicion that one of my children has coeliac disease, and that possibly I may also be a sufferer. I have cut gluten out of our diets entirely and I was wondering if there were any need to be tested if this is the case? I believe we would have to start eating gluten again to be tested and I am hesitant to do that when we are all currently so well. What do you think?

Dr Nina replies:  Coeliac disease is an autoimmune disease where the body cannot tolerate gluten. Eating gluten-containing foods leads to damage to the gut and malabsorption of essential nutrients. This damage to the gut can be long-standing. The exact cause of coeliac disease is unknown. There is a strong genetic component with up to 50pc of those affected having a family member who also has the disease. Approximately one in 100 people in Ireland and the UK are affected. It is more common in women.

It is important not to self diagnose these kinds of conditions and if you genuinely feel that coeliac disease is a probability I think it is important that the correct diagnosis is made. True coeliac disease requires a lifetime diet adjustment. Abdominal pain and bloating can be symptoms of many conditions. Coeliac disease and gluten intolerance are possible culprits. Other often more common causes include, irritable bowels syndrome, lactose intolerance, diverticular disease and bacterial intestinal overgrowth.

Symptoms of coeliac disease include, abdominal pain, bloating and wind, diarrhoea, weight loss, feeling tired all the time, recurrent mouth ulcers and failure to grow properly in children. Coeliac disease can be diagnosed via a blood test and confirmed through a biopsy of the small gut, however it is important that you have been eating normal amounts of gluten containing food for several weeks prior to the test as avoiding gluten may render the tests normal. You will need to eat gluten again for eight weeks prior to testing

There is no cure for coeliac disease. The treatment is avoiding gluten. Nutritional supplements may also be required including B vitamins, iron, calcium and vitamin D.

Gluten intolerance can occur. This is not coeliac disease. In those affected eating gluten containing foods may cause abdominal bloating and cramping but there is no underlying damage to the gut. The TTG blood test and bowel biopsy will be normal in those with gluten intolerance. Food intolerance is common and the symptoms associated are similar to those of irritable bowel syndrome. Many foods can ferment in the gut leading to bloating, wind and abdominal pain. A low FODMAP diet can help if the diagnosis is irritable bowel.

Bloating and abdominal pain can occur in many conditions. Self-diagnosis isn't a great idea. Start with a visit to your GP who can examine you and arrange tests to help point you to a proper diagnosis.

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