Gluten-free bread – the safe option for many Australians. Photo by Ben Atkinson-James.
Many Australians suffer from coeliac disease, but about 80 per cent of them remain undiagnosed.
These days Instagram is flooded with colourful accounts full of gluten-free goodies that are made and endorsed by the trendy social media moguls you’ll most likely find in the gluten-free aisle at Woolies. The gluten-free fan base has certainly grown in the past few years, paired with the rise of açai bowls, goji berries, and kale smoothies. It’s all gluten-free fun and games, but did you know… some of the selective eaters – and an unknown number of the population – actually have an autoimmune disease, one of the most under diagnosed medical conditions across the world: coeliac disease.
What is coeliac disease?
Coeliac disease affects, on average, approximately one in 70 Australians, but around 80 per cent of this number remain undiagnosed. For this majority, continual gluten consumption can be seriously detrimental to their health. Gluten is a protein found in wheat, barley, rye, and oats, which the small intestine cannot digest effectively. With gluten consumption, the lining of the bowel [called the villi] becomes inflamed and compressed. As the bowel’s surface area shrinks, due to villous atrophy, there is less area in the small intestine for nutrient absorption. Calcium, iron, folic acid, and fat-soluble vitamins, as well as other sugars, fats and proteins are difficult to absorb in a damaged bowel.
The body’s absence of vital nutrients can create health problems stemming from malabsorption. These range from iron deficiency, anaemia, and teeth defects to infertility, depression, miscarriage, and various cancers.
Fiona Keogh, a naturopath at BioCeuticals told The Newsroom, “Coeliac is an autoimmune condition, where the body treats gluten as a foreign protein and destroys the bowel breaking it down.”
Coeliac disease is twice as common in women as in men, and particularly significant in Caucasians compared with other races. A person who develops coeliac disease must have been born with the genetic predisposition – one or both of the genes HLA DQ2 and HLA DQ8. It is thought that environmental and lifestyle factors can trigger those genes to “turn on”.
Professor Dianne Campbell, head of Paediatric Allergy and Clinical Immunology at The Children’s Hospital at Westmead, says “We all have millions of gut microbes and their makeup is influenced by where and how we live – it varies depending on which country you live in or whether you live on a farm, for instance.”
The theory is that, living in the Western world, you have a higher chance of being a “coeliac” because better hygiene and a cleaner ecosystem create fewer challenges for our immune systems to overcome. That hygiene hypothesis, and Western overuse of antibiotics, are thought to compromise the development of our immune systems because they now lack practice. According to the US National Library of Medicine, caesarean delivery may also be linked with the development of coeliac disease by children.
The symptoms
According to Coeliac Australia, coeliac disease can present symptoms similar to irritable bowel syndrome, including gastrointestinal issues such as diarrhoea, cramping, bloating, constipation, nausea, vomiting and flatulence, as well as fatigue, weakness and lethargy. In children, weight loss or failure to gain weight is often common, which can accompany a failure to thrive or delay puberty. People may present with symptoms that are severe, moderate or mild, or they can be asymptomatic, with no symptoms at all.
Oral disease and dental enamel defects are further adverse effects of immune-mediated damage and calcium deficiency. Sufferers experience tooth discolouration, poor enamel formation, and pitting or banding of teeth. Some of these defects are more apparent in the adult teeth but they can develop before seven years of age.
17-year-old Jessie Leeming has been suffering from coeliac disease since he was a baby. He was diagnosed at 18 months and eight upper baby teeth had to be removed by the time he was four. “I had a calcium deficiency. All my baby teeth rotted because my stomach wasn’t absorbing nutrients. I couldn’t have any form of gluten. However, if I did digest gluten I wouldn’t be able to stand or walk,” he told The Newsroom. “I’ve been hospitalised three times since diagnosis.”
Today, though, things are better – the last time he had a bad reaction was October last year. “Lately I haven’t had any reactions when I digest it so I’ve been having it two to three times a week,” says Jessie. “I take into consideration the long-term effects but because I’m not having severe reactions, I can continue to eat it.”
The diagnosis
“Failure to thrive is what’s detrimental if [coeliac disease] isn’t picked up early,” Fiona Keogh says. “A child will be missing milestones and have delayed growth because he or she isn’t getting the nutrition needed to thrive.
“If they aren’t diagnosed in the early stages of childhood, they are usually diagnosed in adulthood. Adults go to naturopaths complaining they feel tired and anaemic; they go searching for a reason why they feel so bad, and then we realise they are coeliac.”
Blood tests for diagnosis have often proved to be misleading. Gene testing is also an ambiguous method of diagnosis as it only rules out those who do not carry the genes associated with coeliac, and many unaffected Australians can carry some of the common genes that a coeliac would have. An endoscopy is the ultimate procedure to establish that a person sufferers from the condition: a gastroenterologist will remove a small section of the intestine for analysis and observe any gluten-induced damage.
A strict, lifelong gluten-free diet is the best and simplest treatment for coeliac disease. However, coeliacs are also prone to suffer other autoimmune diseases such as type 1 diabetes, thyroid diseases, and Addison’s disease (progressive anaemia).
A gluten-free diet
Gluten is present in everyday foods such as bread, breakfast cereals, cakes, biscuits, pasta, certain meat products, pastry, and crumbed or battered foods.
The Australian Standard of Gluten-Free Foods, requires that food products now labelled “gluten-free” must have undergone a gluten-sensitive examination to check that they actually are. Some products such as wheat glucose syrup and caramel contain ingredients that are naturally rich in gluten but become gluten-free during processing.
The key to a trouble-free life as a coeliac is to consume products that carry the Coeliac Australia endorsement logo, or are labelled “gluten-free”. Otherwise, an analysis of all food labels to ensure they do not contain wheat, rye, barley, or oats is required.
Coeliac disease is easy to work with and early diagnosis of the condition is beneficial for long-term health. One perk of being a coeliac is that you can join the rest of the groovy hipsters in aisle one and look cool (whether you feel it or not). – Olivia Grace-Curran
Top photo by Ben Atkinson-James. Photo of cupcakes from Frederic Bisson’s Flickr photostream.
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