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Coeliac Disease and then the Penny…

Coeliac disease is an immune reaction to dietary gluten which damages your gut lining. Why is it harder for diabetes patients? Balancing diet is more difficult, blood sugar is harder to control and managing both can be frustrating, leading to depression.

Affecting at least one in 100 people, coeliac disease is genetically linked, although not directly inherited, meaning it can run in families but may also be new. It’s more common in people with other autoimmune conditions, such as Type 1 diabetes and immune thyroiditis.

Gluten and the gliadin within it, is a protein found in grains such as wheat, barley and rye which causes the immune reaction. Usually oats are the only tolerable grain, although some people are also sensitive to a similar oat protein, avenin. The body mounts an immune reaction in the cells of the gut lining, resulting in inflammation and flattening of the very fine folds of the gut wall, called villi. This reduces the surface area, limiting general nutrient absorption and causing vitamin or mineral deficiencies.

Symptoms of Coeliac Disease

These range from mild bloating and diarrhoea to severe cramps, nausea, wind or constipation, tiredness, mouth ulcers, weight loss and anaemia. It may at first be mistaken for irritable bowel syndrome (IBS). Later, symptoms of anaemia and even B12 deficiency may cause peripheral neuropathy, with tingling and poor coordination and balance.

The diagnosis is made by a blood test although your GP may also want to check your blood count and vitamin and minerals such as calcium, iron (as ferritin), folate and B12, plus thyroid and liver tests. Occasionally, a gut biopsy is needed. Reduced absorption of calcium risks osteopenia and osteoporosis in adults, so you may need bone scans. Children with coeliac should have a regular specialist review, with height and weight monitoring.

Complications

People with coeliac also have a higher-than-average risk of their spleens not working, so are advised to ensure they are vaccinated against pneumococcus and meningitis A, C, W and Y.

A less-common skin manifestation of coeliac is a rash called dermatitis herpetiformis, presenting as raised red blistering patches, more commonly in the over-50s. The diagnosis isn’t always clear and needs dermatologist review or even a biopsy. It’s managed by a gluten-free diet and also skin creams, such as Dapsone.

The management of coeliac is simply a diet without gluten. Once excluded, the gut slowly recovers over several months or even years. If you have difficulty sticking to the diet, your GP may refer you to a dietitian for specialist advice. Long-term untreated coeliac slightly increases the risk of rare cancers in later life, so it’s important to keep to a gluten-free diet.

Ways to Manage Coeliac Disease

  • TEST – If you suspect coeliac, ask your GP for a blood test to confirm the diagnosis and blood count and mineral level checks to exclude deficiencies.
  • DIET – Gluten-free products are now freely advertised and available from supermarkets. Gluten is found in rye, barley, wheat and related products; couscous, durum, spelt and semolina.
  • SUPPORT – Check Coeliac online for more support and if you have dietary difficulties, ask your GP for a referral to a dietitian.
  • BABIES – It’s thought that eating gluten before the age of six months increases the risk of coeliac, so keep your baby’s diet gluten free before then.

Dietary Fibre Protects You

A large review of many studies, published in the British Medical journal, has shown people consuming high levels of dietary fibre and wholegrains have a lower risk of getting, or dying from, common non-communicable diseases, including coronary heart disease and Type 2 diabetes, than those eating less fibre. This provides convincing evidence for focusing on increasing dietary fibre and replacing refined grains with wholegrains, whatever diet you may follow.

E352 – Coeliac Disease – www.diabetic.today

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