Coeliac disease

Coeliac disease (CD) is a sensitivity to gluten, a protein found in wheat, barley and rye (some people also react to gluten in oats). In people with CD, gluten triggers an autoimmune response that leads to inflammation of the small intestine. Eventually the inflammation damages the lining of the intestine, making it less able to absorb nutrients.

Who's affected?

Traditionally it was usually thought of as a childhood disorder, but CD can develop at any age. It's most likely to be diagnosed between the ages of 30 to 50, and older people are also being diagnosed. This is probably because more people are aware of the condition and GPs now realise there are many different symptoms that may indicate CD.

It was previously thought that one in 1,000 people had CD, but this may now be as high as one in 100. The risk of developing CD increases if there's a family history of the disease.

What are the symptoms?

The symptoms of CD depend on age. Infants may develop them when first introduced to foods containing gluten during weaning. These symptoms include:

• Upset stomach, with pale and very bad smelling stools
• Feeling lethargic and miserable
• Failure to grow

Older children with CD may show poor growth or sometimes weight loss. They may also exhibit signs of poor absorption such as anaemia or other vitamin deficiencies.

In adults the symptoms can be less striking, which is why it's often not recognised as CD. These symptoms can include:

• Tiredness
• Irritability
• Depression
• Anaemia
• Stomach upsets and pain
• Weight loss
• Mouth ulcers
• Bone or joint disorders

CD is usually diagnosed initially by a blood test followed by a biopsy of the small intestine. A small tube is passed down into the digestive system and a tiny bit of the lining is cut out and examined under a microscope.

The treatment of CD involves the removal of all dietary sources of gluten from the diet. Once this happens symptoms can improve very quickly, and most people feel much better in just a few weeks. But it can take the gut wall up to a year to fully recover, and maintaining a gluten-free diet is important to aid this recovery.

What's the recommended diet for CD?

Gluten intolerance is permanent and requires a lifelong change to a gluten-free diet. It's vital this diet is undertaken only on advice from a GP and with support from a registered dietitian, who will be able to advise and guide you through the challenging dietary changes.

Foods that contain gluten such as bread, cakes, pasta and pastry need to be excluded from the diet. The use of special foods such as gluten-free bread, biscuits and pasta can help to make the diet seem less restrictive, and also ensure that intake of fibre and other nutrients doesn’t fall as a result of avoiding foods containing gluten. Some people with CD can include oats in their diet while others can't, so this decision should be taken in consultation with your GP or dietitian.

When it comes to manufactured foods, avoiding gluten can be tricky. It can pop up in all sorts of strange places, such as soy sauce, yoghurts, beefburgers and crisps. Cereals containing gluten must be stated on the label, so this means a lot of label reading. Organisations such as Coeliac UK also provide a wealth of information on which foods are gluten-free. Retailers have made it easier for people with CD, and gluten-free products often have dedicated shelf space in their stores.

A gluten-free diet requires planning and preparation, especially when it comes to eating out at restaurants, at friends' houses or when going away on holiday.

The good news is that there are many foods such as meat, fish, eggs, fruit, vegetables and milk that can be consumed freely as they don’t contain any gluten. But if you are craving baked goods, try these gluten-free baking recipes from the BBC Food website:

• Chickpea flour pancakes
• Amaretti biscuits
• Gluten-free blueberry muffins
• Chocolate Cherry Gateau

Are there any health complications with CD?

CD is a risk factor for osteoporosis. Even after diagnosis and the introduction of a gluten-free diet, individuals with CD still have an increased risk. This is possibly because of the poor absorption of calcium before diagnosis or a reduced intake of calcium after diagnosis. Bread and cereal products provide around 30 per cent of calcium intake, so avoiding these foods can reduce intake considerably.

In addition, the risk of type 1 diabetes , small intestinal cancer and lymphoma is increased in people with CD. Undiagnosed CD has also been associated with infertility.

The MRC Human Nutrition Research wrote this article in August 2008.