What is coeliac disease?

Coeliac disease (pronounced see-liac and spelled celiac in other countries) is an autoimmune disease, not an intolerance as is often assumed.

This means that the body’s immune system attacks its own tissues, through the production of antibodies. In the case of coeliac disease, this reaction is triggered by gluten.

Gluten is a protein composite found in wheat and related cereals, including barley and rye. If eaten by coeliacs, it inflames and damages the lining of the small intestine.

The primary functions of the small intestine are to breakdown and absorb the nutrients in food. In untreated coeliac disease, the cells lining the small intestine become flat and inflamed and their surface area significantly reduced. This results in a reduction in the absorption of nutrients from food and can lead to malnutrition and deficiencies in vitamins, iron, folic acid and calcium. Sugars, proteins and fats are often poorly absorbed as well.

Coeliac disease is closely related to dermatitis herpetiformis, which is an autoimmune blistering disorder associated with a gluten-sensitive enteropathy.

What causes coeliac disease?

The precise cause, or causes, of coeliac disease are not yet known. However, it is believed that there are three primary factors that underlie its development. These include:

  • an environmental trigger (in this case gluten)
  • a genetic susceptibility
  • an unusually permeable gut.

Occasionally, the stress of an operation, accident, intestinal infection or pregnancy can trigger the onset of the condition.

How is coeliac disease diagnosed?

Research shows that coeliac disease affects around 1 in 100 people in the UK, making it much more common than previously thought. Under-diagnosis is also significant problem, with it being estimated that around 500,000 people have not yet been diagnosed.

Coeliac disease can be diagnosed at any age. For example, even babies can be diagnosed – after weaning, when cereals containing gluten are first introduced into their diet. However, the most common age of diagnosis is currently between 40 and 60 years old.

What are the symptoms of coeliac disease?

The physical signs of coeliac disease vary from person to person and can range from mild to severe – it affects people differently.

Symptoms may present in the digestive tract, or in other parts of the body. For example, one person might have diarrhoea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the more common symptoms in children.

Some of the most common symptoms generally include: tiredness, anaemia, diarrhoea, abdominal discomfort, weight loss, vomiting and mouth ulcers.

Unfortunately, some people present no symptoms at all. While this may sound like a good thing, such people are still at risk of the complications associated with the disease. The longer a person goes undiagnosed and untreated, the greater the chance of developing malnutrition and other complications. Anaemia, delayed growth and weight loss are signs of malnutrition, because the body is just not getting enough nutrients.

In addition, increased incidence of rheumatoid arthritis, diabetes mellitus, autoimmune thyroid disease, sarcoidosis, vasculitis, pulmonary fibrosis, osteoporosis, infertility and other diseases of the gut have been reported in coeliac patients.

How is coeliac disease treated?

Unfortunately, there is currently no known cure for coeliac disease. However, the primary treatment, which is usually very successful, is to remove all sources of gluten from the diet. This approach is also effective in cases of dermatitis herpetiformis.

Concern has surrounded oats containing gluten (as some people with coeliac disease are also sensitive to oats), but studies have shown that consumption of a moderate amount of oats does not worsen dermatitis herpetiformis or celiac disease.

A gluten-free diet is a lifelong commitment, and adherence to a strict diet is difficult to achieve; gluten is present in various foods that are consumed on an everyday basis. Improvement of symptoms can also take several months and requires patience and staying-power. Having said that, a well-planned diet can deliver excellent results.

Nutritional supplementation, in conjunction with a well-balanced diet, is also recommended for patients on a strict gluten-free diet. This will help to ensure that they are receiving the broad spectrum of nutrients (such as vitamins and minerals) that they need. In particular, nutrients-fortified gluten-free meal shakes can be a safe, easy and effective way to achieve this.

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Fibre for digestion

What is dietary fibre?

Dietary fibre, “bulk” or “roughage” (a complex carbohydrate) is the part of plant-derived foods that can’t be completely broken down by digestive enzymes in the human digestive system. Instead, it travels through the gut largely untouched, when it arrives in the colon where it may or may not be fermented by gut bacteria or micro flora. This is in direct contrast with most other nutrients, which are fully digested and used in other parts of the body during the digestive process.

Fibre is probably not something you think about too often, unless you suffer with chronic constipation or other symptoms of poor digestion on a regular basis. However, it plays a very important role in helping to maintain, not only a regular digestive system, but also a healthy body, for everyone.

As mentioned above, fibre is derived from plant sources, such as fruit, vegetables and grains, and contributes to digestive regularity, toxin elimination and is a key ingredient to a healthy, varied and balanced diet. Most people consume different types of fibre daily, without realising it. However, the quality of this fibre will vary greatly.

It is important to remember that fibre is about much more than just eating unprocessed bran, as is sometimes promoted by cereal companies. Bran has the potential to irritate many people’s guts, producing bloating, excessive wind and anal discomfort.

Soluble and insoluble fibre

Dietary fibre is often categorised according to its solubility, as soluble or insoluble fibre. In other words, whether it dissolves or not. Both types of fibre are found in different proportions in fibre foods.

What is soluble fibre?

Soluble fibre, essential for healthy digestion, is fibre that dissolves in water; a soft fibre that absorbs water as it moves through the digestive tract. It is made up of sticky substances like gums and pectin, which form a gel-like substance in the presence of liquid.

It is found in fruit, vegetables and other plant-based foods, and is probably best known for its cholesterol-lowering effects and ability to regulate blood sugar levels. When soluble fibre absorbs water, it turns into a gelatinous substance which is then fermented in the colon to produce short chain fatty acids. Soluble fibre is thought to bind with cholesterol and prevent it from being reabsorbed into the bloodstream. This helps to lower the amount of cholesterol in the blood, therefore reducing the risk of heart disease.

This type of fibre is a fermented source of nutrition, which means that it is acted upon by the normal bacteria in your intestines, which helps to break down the carbohydrates in your colon. One of the benefits is that your stomach stays fuller longer, providing a feeling of fullness.

Especially good sources of insoluble fibre include beans and other legumes, whole grains and certain fruit and vegetables (such as apples, citrus fruits and strawberries, and peas and lentils).

What is insoluble fibre?

Insoluble fibre, resistant to human digestive enzymes, is not digested by the body and it does not dissolve in water. It acts like a sponge, absorbing water and moving solid waste out of the intestines. In this way, it promotes regularity and softens stools

It is mainly found in wholegrain foods (such wheat bran, brown rice and couscous), root vegetables (such as carrots, parsnips and potatoes), celery, cucumbers and courgettes, fruit with edible seeds, beans, pulses and lentils, nuts and seeds. 

Constipation is a serious and chronic problem for many people of all ages in today’s fast-paced, fast-food society. Stress, low-fibre diets, lack of exercise, certain medications, very little insoluble fibre in the diet and dehydration all often result in continuous bowel problems. Toxic bowel material needs to be passed every day. Otherwise, if allowed to build up in the colon, it can lead to a range of bowel disorders and diseases.

Ironically, constipation can be a side-effect of a high-fibre diet if fluid intake isn’t also increased. This is because fibre acts like a sponge and absorbs water.

Why is fibre good for you?

Diets that are high in fibre have been shown to be beneficial in a number of ways, from supporting digestive health and regularity, to helping to eliminate toxins from the body. High fibre diets also help to regulate blood sugar levels, lower cholesterol levels and keep you feeling fuller for longer, thereby also supporting natural weight loss and a healthy heart.

Your daily diet should ideally contain between 25 – 30 grams of high quality fibre.

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