Irish dietitian Orla Walsh: What exactly is coeliac disease?
It is estimated that 1pc of the Irish population has coeliac disease - but what exactly is it?
* Coeliac Disease - When an individual with coeliac disease consumes gluten, an autoimmune process is triggered and the body attacks the small intestine, often leading to malnutrition. It's thought to affect approximately 1pc of the Irish population.
Despite common belief, not everyone who has undiagnosed coeliac disease will have gut issues like diarrhoea, bloating and discomfort. Some people may be checked for coeliac disease by their GP in reaction to a diagnosis of anaemia, osteoporosis or fertility issues.
Unfortunately, it appears that anyone with an autoimmune condition is predisposed to developing other autoimmune conditions.
* Coeliac disease and thyroid disease - For instance there appears to be a strong connection between coeliac disease and autoimmune thyroid disease. A similar autoimmune process occurs with autoimmune thyroid disease except this time the immune system targets the thyroid gland. This leads to a deficiency (hypothyroidism) or excess (hyperthyroidism) of thyroid hormones which plays havoc on the body's metabolism.
A large longitudinal study showed that adults with coeliac disease were 4.4 times more likely to develop hypothyroidism and 2.9 times more likely to develop hyperthyroidism than the general public. In children, the rates were slightly higher.
The problem with diagnosing any medical condition is that symptoms can overlap. For instance weight changes and fatigue can occur with both coeliac and thyroid disease.
To be tested for coeliac disease, your GP will take bloods to measure levels of antibodies. Interestingly there is growing amount of research suggesting that when people who are diagnosed with coeliac disease follow a gluten free diet, not only do their coeliac-related antibody levels improve, but also their thyroid antibody levels. It's too early to say with total certainty that following a gluten-free diet will improve thyroid function, but the potential is there and scientific studies are ongoing.
* Coeliac disease and Type 1 diabetes - Another autoimmune disease associated with coeliac disease is Type 1 diabetes. Type 1 diabetes is an autoimmune disease resulting in a lifelong condition where the body doesn't produce insulin.
Insulin is a hormone that an organ called the pancreas produces to help sugar get into our body's cells where it is used to produce energy. Without adequate insulin, the sugar can't get into the cells and builds up in the blood. Due to this, blood sugar levels rise to unhealthy levels. The short-term symptoms include fatigue, weight loss, extreme thirst and frequent urination. Uncontrolled blood sugar levels can damage the eyes, kidneys, nerves and heart. Type 1 diabetics control their blood sugar levels manually by injecting insulin into their body. It is different to Type 2 diabetes which is often a result of being overweight or obese.
A study investigated 383 patients with Type I diabetes for coeliac disease. Out of 383 Type I diabetic patients, 32 (8.3pc) were coeliac, of which more were female. For a lot of people, Type 1 diabetes is diagnosed before coeliac disease. When coeliac disease is diagnosed before diabetes, the symptoms of Type 1 diabetes tend to be more severe.
A sign of undiagnosed coeliac disease in Type 1 diabetics is recurrent episodes of low blood sugar levels. In kids, it can interfere with growth. For this reason National Institute for Health and Care Excellence (NICE) guidelines recommend that people with Type 1 diabetes should be tested for coeliac disease at diagnosis and retested if any symptoms of coeliac disease develop.
* Complications of undiagnosed Coeliac Disease
Undiagnosed coeliac disease, or non-compliance with a gluten free diet, causes damage to the small intestine. This reduces the absorption of many nutrients into the body causing harm to the body.
For example, this may affect fertility. The reason that undiagnosed coeliac disease, or non-compliance with a gluten free diet results in fertility issues is being investigated. However it's likely that deficiencies in nutrients known to be important for fertility, such as folic acid, zinc and selenium may be part of the problem. Couples with fertility issues or suffering complications in their pregnancies should be tested for coeliac disease at their local GP. When undiagnosed, there is an increased risk of fertility issues. However, if diagnosed with coeliac disease, following a gluten- free diet rigidly has been shown to remove this risk and lead to healthy pregnancy.
Another complication of undiagnosed coeliac disease is osteoporosis. Bones are a live tissue. They are constantly breaking down and rebuilding. Deficiencies in vitamin D and calcium due to the damage caused to the small intestine can result in the thinning of bones. Studies show that low bone mineral density occurs in up to 75pc of people upon diagnosis with coeliac disease. It's important that when diagnosed, the individual reaches their daily target of 1000mg of calcium through food sources like milk, yogurt, tofu and oily fish. For those over the age of 50-55 years, 1500mg of calcium each day may be required. It's advisable to take a supplement of vitamin D each day due to limited food sources.
Due to the damage to the small intestine, lactose intolerance can become a temporary issue in those with coeliac disease. Lactose is the naturally occurring sugar in dairy foods. Symptoms include diarrhoea, bloating and cramping. There is more lactose in a glass of milk compared to a pot of yogurt, while soft cheese contains less again. Hard cheese is naturally lactose-free. This issue with lactose intolerance usually resolves once the small intestine heals upon commencing a gluten-free diet. Until this happens, it may be best to choose lactofree milk and yogurt as well as fortified dairy alternative like soy milk and yogurt.
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