Parenting Australia

Coeliac disease (gluten intolerance) and wheat allergy

Coeliac disease (also called nontropical sprue, celiac sprue, gluten intolerant enteropathy, or gluten sensitive enteropathy) is a condition in which there is a chronic reaction to certain protein chains, commonly referred to as glutens, found in some cereal grains. This reaction causes destruction of the villi in the small intestine, with resulting malabsorption of nutrients.

There is clear evidence of a family tendency toward celiac disease. 5-10% of the first-level relatives (parents, children, and siblings) of diagnosed celiacs may develop celiac disease. The disease affects both sexes, and it can begin at any age, from infancy (as soon as cereal grains are introduced) to later life (even though the individual has consumed cereal grains all along). The onset of the disease seems to require two components: genetic predisposition (two specific genetic markers, called HLA subfactors, are present in well over 90% of all celiacs in the US), and some kind of trigger. The trigger may be environmental (as in overexposure to wheat), situational (perhaps severe emotional stress), physical (such as a pregnancy, an operation), or pathological (a viral infection).

Once thought to be a childhood disease that would be outgrown, recent evidence indicates that it is not uncommon for the symptoms of celiac disease to disappear during late childhood or adolescence, giving the appearance of a cure. Unfortunately, damage still occurs during these years of apparent health, and later in life these celiacs may find they have suffered considerable damage to the small intestine, and have for years deprived themselves of important nutrients.

Products

The common list of forbidden grains is: wheat, rye, barley and oats.

Unfortunately, there are variants that go by other names. Durum and semolina are names for certain kinds of wheat that have been bred for specific uses. Both spelt and kamut are versions of wheat. (Other names for these: spelt, Polish wheat, einkorn and small spelt).

Bulgur is wheat that's been specially processed.

Triticale, a grain crossbred from wheat and rye, is definitely on the toxic list.

Corn (maize) is one of those grains that is not thought to cause damage to the villi in celiacs. It is tolerated by most celiacs.

Of the common grains, rice is the favorite as it rarely troubles anyone.

Aside from corn and rice, there is a wide variety of other grains that are used in gluten-free cooking.

The following can be used and milled into flour: amaranth*, buckwheat* (or kasha), chickpeas (garbanzos), Job's tears (Hato Mugi, Juno's Tears, River Grain), lentils, millet*, peas, quinoa*, ragi, sorghum, soy, tapioca, teff*, and wild rice. Many of these flours are available in health food stores. Some (like rice flour) may be available in grocery stores.

To improve the texture of gluten-free baked goods, most cooks use one or more of the following: xanthan gum, guar gum (though this sometimes has a laxative effect) or methylcellulose. These can be obtained either through health food stores or specialty cook's stores.

Gluten-free oils popular in cooking include: corn, peanut, olive, rapeseed (canola), safflower, soy, and sunflower.

Treatment

There is no prescriptive drug celiacs can take to effect a cure. In fact, there is no cure, though there is every opportunity for celiacs to lead normal, healthy lives by following a diet that contains no gluten. This means avoiding all products derived from wheat, rye, barley, oats, and a few other lesser-known grains.

Extra vitamins may be taken, if necessary, but the only way for a celiac to avoid damage to their intestinal villi and the associated symptoms, is by maintaining a gluten-free diet.

Symptoms

There is no typical celiac. Individuals range from having no symptoms (asymptomatic or "latent" forms of the disease) to extreme cases where patients present to their physicians with gas, bloating, diarrhea, and weight loss due to malabsorption.

In between these two extremes lie a wide variety of symptoms in adults that include:

* Diarrhea
* Constipation
* Steatorrhea (fatty stools that float rather than sink)
* Abdominal pain
* Excessive gas
* Any problem associated with vitamin deficiencies
* Iron deficiency (anemia)
* Chronic fatigue
* Weakness
* Weight loss
* Bone pain
* Easily fractured bones
* Abnormal or impaired skin sensation (paresthesia),
* Including burning, prickling, itching or tingling
* Odema
* Headaches
* Peripheral Neuropathy (tingling in fingers and toes)

In children, the symptoms may include:

* Failure to thrive
* Paleness
* Irritability
* Inability to concentrate
* Wasted buttocks
* Pot belly with or without painful bloating
* Pale, malodorous, bulky stools
* Frequent, foamy diahoria

In addition to all of these, dermatitis herpetiformis, a disease in which severe rashes appear (often on the head, elbows, knees and buttocks) is related to celiac disease.

Reactions to ingestion of gluten can be immediate, or delayed for weeks or even months.

The amazing thing about celiac disease is that no two individuals who have it seem to have the same set of symptoms or reactions. A person might have several of the symptoms listed above, a few of them, one, or none. There are even cases in which obesity turned out to be a symptom of celiac disease.

Wheat allergy

Wheat contains many different proteins. As with all proteins, some people will show allergic reactions. Wheat allergy, however, is very rare.

Don’t self-diagnose

Since the symptoms of other conditions can closely mimic coeliac disease, correct diagnosis can only be made by showing that the bowel lining is damaged. This is done by endoscopy (through the mouth) with small bowel biopsy. During this procedure, the small intestine is examined with a slender instrument (endoscope). Small samples (biopsies) are removed for examination under a microscope. It is important for the integrity and accuracy of the biopsy that you don’t put yourself on a gluten free diet prior to the procedure. Coeliac blood tests are used for initial screening and the accuracy of these is also dependent on normal gluten ingestion.

Where to get help

http://www.coeliacsociety.com.au - The Coeliac Society provides support and information on the disease, the gluten free diet, ingredients, where to buy, cooking and recipes, overseas travel, education and research material etc. Specific resources for children requiring a gluten free diet are also available.

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