Welcome back fellow geeks. Today’s Health Bar is going to take a deep dive into the world of Coeliac disease.
We will look at the history, the treatments, the science and the pseudoscience surrounding this fascinating and misrepresented disease.
Coeliac Disease: What’s in a name?
Pretty straight forward this one, coeliac comes from the Greek Koiliakos, meaning abdominal.
Coeliac Disease: What is it?
First let me tell you what it’s not. It’s not an allergic reaction and it’s not intolerance either. It is an autoimmune disease – think along the lines of other autoimmune diseases such as Diabetes or Amyloidosis. It is when the body reacts to Gluten found in 3 different types of cereal (Barley, Rye and Wheat). The gluten causes the body’s immune response to produce a variety of antibodies that then causes an inflammatory reaction in the small intestines. This inflammation means that nutrients struggle to be absorbed and can lead to deficiencies. In the intestines are projections (like the bristles on a hairbrush) called intestinal villi that line the inside of the intestine and when the intestines become inflames it damages these villi. That aspect is the major difference between coeliac disease and non-coeliac gluten sensitivity. Whilst they share many symptoms, non-coeliac gluten sensitivity doesn’t damage the intestinal lining and doesn’t share any associated antibodies with coeliac disease. Simple right? Well no, hence why there is so much misinformation out there regarding coeliac disease.
Coeliac disease affects roughly 1 in every 140 people globally, though this is deceiving as it varies greatly between developed and undeveloped parts of the world, with Finland having the highest rate at 1 in every 60.
If coeliac disease is left untreated it can lead to even more horrible effects such as malnutrition, deficiencies and slightly increased chance of digestive organ cancers.
Coeliac Disease: History
So let’s go right back to 950 BCE and meet Aretaeus of Cappadocia (a part of modern day Turkey). He was a celebrated early physician who had attempted to describe many diseases way before we really knew what was happening. He was the first we know of, to describe a malabsorptive disease with chronic diarrhoea that was prone to repeating periodically, though he believed it was because there was not enough heat in the stomach to properly breakdown food.
Quite a while later, in 1887 English paediatrician Samuel Gee gave us the first modern day description and commented that it is best controlled via diet. Though his beliefs on what foods are best avoided was off.
Wheat was first identified as an important part of coeliac disease by Dutch paediatrician Wilem Dicke, during the Dutch famine in the mid 1940’s. He noted a drop off in infant deaths from coeliac disease during the period flour was scarce but then rose back up again once the flour shortage subsided. Then in 1952 Jean Smellie and her team were the ones to discover that it is the family of proteins called gluten in the wheat that is the root cause of coeliac disease. Slight side note, Gliadin and Glutenin are the 2 main proteins, though there are hundreds of types in the gluten family.
Coeliac Disease: Is it in your genes?
Yep. Coeliac disease is something passed down in generations. It is, however, multifactorial, meaning that it relies on more than one genetic factor to be present, then it can show. This equates as, if someone in your family has it then you have a 10% chance. Environmental factors also play a part as different regions globally have different access to foods which is why the rate varies as we saw earlier in the article.
Coeliac Disease: Diagnosis
This should be simple, but as with all things, there are complications with delivery of this. For a formal diagnosis to be made you have to have a blood test which looks for the antibodies found in coeliac disease, but importantly you should be having gluten in your diet when you have the tests or it can give an inaccurate result. This is obviously unpleasant for the patient as they could have very horrible symptoms from gluten. However, this is not definitive as the antibodies are not always present or picked up, which is why it should only be used as a clinical indication tool, not the final diagnosis. That’s when we call up the gastroenterologist! For the final diagnosis you need to go and have a biopsy done in hospital whereby a small camera is passed down through your mouth and into the small intestine where a biopsy is taken. Without the biopsy, you can only have suspected coeliac disease, but the rubber stamp is the biopsy.
This is important as there may still be a different underlying cause for your symptoms.
The complication here lies in GP’s not getting people into have a biopsy done before making coeliac disease the official diagnosis. Due to constraints on the health service, this is becoming more and more common sadly.
After diagnosis you should be having regular blood test to keep an eye out for nutritional deficiencies that may arise from the damaged villi we spoke about earlier, not absorbing things like iron. For people with a family history of osteoarthritic diseases they may offer DEXA (dual energy x-ray absorptiometry) scans to keep an eye on bone strength.
Coeliac Disease: Treatment
The only thing you can do is change your diet to a gluten free diet. This can be difficult, but thankfully most countries have good food labelling laws so it should be easy enough to check if something does contain gluten. Any food containing less than 20 parts per million is considered gluten free, but if the sensitivity is severe enough this can still affect them.
Regarding diet, it is very much what works best for you. A horrible game of trial and error. Your GP or a dietitian (not a nutritionist – this isn’t a protected term and any weirdo can call themselves this with zero training, and even with training it isn’t recognised so no way to check the validity of the statements) may recommend supplements depending on your blood tests to help cover the gap in nutritional uptake.
It shouldn’t take long to see an improvement is condition once gluten free (2 weeks roughly), but it can take up to 2 years for your organs to recover to the full extent they can. This is unless the patient has refractory coeliac disease, where symptoms persist even after stopping gluten. We are really unclear on why this happens.
Coeliac Disease: The future
As we grow our knowledge of coeliac disease we endeavour to find ways of treating it. There are lots of different trials going on with different enzymes being tested and we are also looking at ways to reprogram the body’s immune system to tolerate gluten. With the prevalence of coeliac disease, it is only a matter of time before we find a way to make it have less of an impact on people’s lives.
This disease is not fun, at all, but we do know how to manage it. The future looks bright and hopefully everyone has learned a little from this. Please bear in mind that, if anyone you know has coeliac disease then it’s probably a good idea to be careful if you are prepping food as they might be very sensitive.
As always, take care of yourselves and happy geeking!
Coach Rob House – he broke the bread, and didn’t give it to his friend
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