Coeliac Lifestyle
If you have recently found out you are Coeliac or know someone with Coeliac, this blog post will give you some insight to Coeliac disease and the lifestyle.
Coeliac disease explanation
Coeliac disease is a chronic digestive disorder, which is the inflammation and erosion to the lining of the small intestine. This damage and inflammation is caused by the body’s reaction to gluten causes autoimmune disease. This will be present in people who are genetically predisposed to gluten intolerance and can be triggered by a number of factors; consuming gluten is the most common cause for discovery depending on environmental factors.
Most recent advances in research into genetics identify either one or both genes – HLA DQ2 and HLA DQ8 are present with 99% of people with coeliac. Gluten is a protein found in some grains (wheat, rye, barley and oats), many processed foods, medications, supplements and cosmetics that affect Coeliac disease suffers.
The grains to avoid are:
Wheat:
Rye
Barley
Couscous
Durham
Einkorn
Farro
Graham
Malt
Kamut
Malt
Oats (Discussion further below)
Orzo
Rye
Seitan
Semolina
Spelt
Sprouted barley
Sprouted wheat
Triticale
Udon
Coeliac disease is an autoimmune disease, causing the body’s immune system to attack its own tissue. Stimulating the white blood cells (T cells) that are necessary for a healthy immune system, it destroys the villi in the small intestine and inflames the lining of the small bowel. In doing so, it prevents the body to absorb nutrients from foods into the bloodstream.
According to statistics, approximately 1 in 100 people in Australia have Coeliac disease. You will be at an increased risk level of coeliac disease of you have a family history, type 1 diabetes, liver disease or an autoimmune disease.
Should a person be Coeliac, just a small amount of gluten will cause damage to the stomach and can impair the person’s ability to absorb nutrients. A large issue for Coeliac is cross-contamination from food preparation.
The effects in the body
If you have Coeliac disease, when you consume gluten, your body will respond to this like an antigen and cause the immune system to attack the small intestine. Having an autoimmune disease causing a reaction to gluten can cause the patient’s small bowel damage from eating the protein food in wheat, barley, rye and oats.
This causes inflammation to the villi that line the bowel and cause them to become flattened resulting in villous atrophy. The surface area of the bowel that is available for nutrient absorption is reduced when villous atrophy occurs. This occurs over time when the finger like villi is damaged from the body’s reaction.
This is an attack on the epithelium, which is the lining of the small intestine. The enzymes should be repairing the lining of the small intestine, unfortunately when it is getting attacked; it’s unable to do this. This leads to villous atrophy.
As the nutrient absorption is now lacking, this can cause malabsoption and gastrointestinal symptoms. The body can’t produce the amount of digestive enzymes required which allows the unprocessed food to proceed to the large intestine. This then is not allowing the villi to absorb the nutrients due to the damage.
Healthy Villi
Villi damaged by Coeliac Disease
(Coeliac Australia)
While some people have no obvious symptoms of Coeliac disease at all, others can experience very severe symptoms. They may experience gastrointestinal symptoms, mineral and vitamin deficiencies, fatigue, weight loss or weight gain, joint and bone pain, mouth ulcers, irritability, dermatitis and bruising easy.
Our body’s immune system is our natural defense system for fighting infections. The immune system provides an allergic reaction and attacks to destroy substances like bacteria and viruses foreign to the body’s normal healthy tissues. The immune system can make mistakes and attacks its own body’s cells, causing autoimmune disease. This is what happens when someone who is Coeliac consumes gluten.
Even if you are no showing any obvious symptoms, coeliac disease can still be causing damage to the small bowel when you ingest gluten. Overtime, the villi can begin to heal once gluten has been eliminating from the diet.
In order for the villi to heal, any foods containing gluten should be avoided.
Some levels vitamin and mineral levels will be deficient and in order to get back on track there are a few natural things the coeliac patient can do besides eliminating gluten:
Eat Alfalfa for Vitamin K, which coeliac disease suffers will usually be low in as the body finds it difficult to absorb
Chew food thoroughly
Avoid sugary drinks and foods
Eat fresh unprocessed vegetables and legumes, nuts, seeds
Coeliac and digestion
The digestive process starts with the mouth, receiving the food, grinding the food and mixing it with saliva. Once forced into the oesophagus from the mouth, the bolus travels to the stomach. The stomachs involuntary muscles and the hydrochloric acid help break down the proteins.
The stomach has trouble breaking down the gluten protein with hydrochloric acid. Protein digesting enzymes are secreted in the digestion process, coming from the stomach, walls of the small intestine and pancreas. Usually these digesting enzymes break the protein down into amino acids. While Glutenin is processed easily, Gliadin is difficult for the enzymes to break down and digest. Both Glutenin and Gliadin make up Gluten protein. Proline and glutamine are very difficult amino acids to digest and the body’s enzymes have trouble with gliadin.
The body then digests into long amino chains (oligopeptides) instead of di or tri-amino acids. The body creates a defense against gliadin causing an inflammatory response with gluten in the body. A person with Coeliac disease is then in pain with inflammation and are unable to digest property and the villi unable absorb the nutrients.
The villi are unable to heal while the person with Coeliac disease is still consuming gluten.
Proteins are needed in the body for building and maintaining our soft tissues and muscles, a source of energy and they help regulate or modulate our body processes like enzymes, hormones, antibodies and neurotrasmitters.
Nutritional intake and Coeliac
Due to villous atrophy occurring and your body’s immune system attacking itself, coeliac disease changes the nutritional intake of a person dramatically. If left untreated, the person will have chronic systemic inflammation, malabsorption of nutrients and poor nutrition are the resulting consequences.
The person with Coeliac needs to develop a good understanding of the disease and working with health practitioners and their GP to monitor the symptoms and their levels.
Detecting they have a problem and diagnosis of Coeliac is going to help them bring their levels back to normal and nutritionally where they need to be. Allowing the villi to repair will help the person absorb the nutrients from food and if they stay to the strict diet, they will not have problems.
If they have received good advice and start following this information, possibly from a dietitian to help them receive a high in fibre and nutrient dense diet, stick to the gluten free diet then coeliac should no longer impact the nutritional status of the person.
The first step to having a good nutritional diet is to immediately exclude gluten form your diet, the main grain that cause issues is wheat. Other grains that contain gluten also to be avoided are: rye, barley and oats, malt, brewers yeast.
Some foods a Coeliac suffer can exclude and other options of foods they can eat (in no particular order):
Foods with Gluten to exclude -
Pasta
Bread
Biscuits
Cake
Muffins
Pastry
Cereal
Beer and some drinks
Oats (Porridge)
Gravy
Salad Dressing
Sauces
Fried Foods
Snacks – liquorice, some lollies, chocolates, packet savory snacks, some flavoured potato chips and corn chips
Hot dogs, meat pies, frozen meals
Deli meats
Condiments – malt vinegar, some mustards, relishes, pickles, salad dressings, sauces, gravy and yeast extract from barley
Triticum products – wheat, durum wheat, kamut, spelt and einkorn
Rye
Barley
Oats
Any other processed foods that do not state they are gluten free
Gluten free options – safe to eat -
Arrowroot (Tapioca) flour
Amaranth
Bean and Bean flour
Millet
Nuts and Nut flours
Potato, potato starch
Quinoa, quinoa flakes, quinoa flour
Rice, Rice flour, vermicelli
Corn and corn flour/starch
Flax (linseed)
Sorghum hum
Soy
Lentils and legumes/beans
Unprocessed organic meats
Fish
Fruits
Vegetables
Eggs
Dairy products *
Buckwheat
Millet
Natural Sugars – coconut palm sugar, agave, stevia
Seeds and berries
*Many people with Coeliac disease often have a lactose intolerance so this should be discussed with a health practitioner first. This diary milk could be substituted with Almond or coconut milk as a healthy alternative.
As well as pure wheat, gluten comes in other forms that should not be consumed if Coeliac: wheat starch, wheat bran, wheat germ, couscous, cracked wheat, durum, einkorn, emmer, farina, faro, fu, gliadin, graham flour, kamut, matzo, semolina, spelt.
In order to have a healthy balanced diet, the breakdown of what the body should be ingested are as follows:
55-60% of energy in the human body should be from carbohydrates in the form of sugars and starches.
About 30% of total calorie intake should be from fats with no more than 10% being saturated fats.
Based on the energy required for the person, 10-15% of that should be protein.
Some items to be avoided or check ingredients before consumption or look for gluten free alternative are: Artificial Color, Baking Powder, Clarifying Agents, Coloring, Dry Roasted Nuts with flavour/salt, Emulsifiers, Gravy Cubes, Ground Spices, sauces, miso, juices, Seasonings, Soba Noodles (mostly are not make traditionally with just buckwheat but also contain wheat), Soy Sauce, Stabilizers, Stock Cubes, liquid stock, certain vitamins and mineral supplements, medications and custard powder.
OATS
Based on studies in Australia regarding oats, they are considered a grain that contains gluten.
Currently laboratories can test for gluten to measure gliadin, hordein and seaclain. This test cannot test avanin levels due to the amino acid makeup. Therefore, oats cannot be determined as gluten free due to the inability to determine the presence of the gluten level content.
Whether the oats are pure and have not be contaminated, they are not to be advertised in Australia as gluten free.
Based on studies, not all Coeliac suffers can tolerate oats, therefore the current idea is they should be avoided. After discussions with GP, nutritionists and coeliac patients, they conclude to avoid oats.
GRAINS
A high fibre and nutrient dense plan should be put in place for a coeliac patient. Our fibre comes from plants – wholegrain, fruit, vegetables and legumes/beans, nuts, seeds.
Someone with Coeliac disease will need to look at replacing those gluten wholegrain with other gluten free grains.
Everyone needs to eat grain foods, as detailed about within the Australian standards food guide.
There are some grains that can substitute of which do not contain gluten:
Amaranth
Millet
Quinoa
Sorghum
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Brown Rice
Other gluten free foods replacements not considered grains:
White Rice
Wild Rice
Corn
Chia
Buckwheat
Flax (linseed)
Other areas of the Australian dietary guide wheel or pyramid food groups above can be followed provided the patient sticks with natural foods rather than processed packet foods. Speaking with a dietitian or nutritionist is important to ensure you are getting the essential carbohydrates, lipids, proteins, vitamins and minerals required as a part of your daily diet.
There is a great range of gluten free flour from grains and grain free that Coeliac suffers can use to make breads, cakes and pasta. Here are some great options with Amaranth, Quinoa and Buckwheat being my top choices:
Amaranth flour – high in protein, great balance of amino acids, high in fibre, iron, magnesium, phosphorus and manganese, calcium, pantothenic acid, potassium, protein, vitamin BC and zinc, vitamin C and A.
Quinoa flour – a great amino acid profile – high protein and contains all of the essential amino acids, good source of magnesium, manganese, vitamin B2, Vitamin E, fibre, iron, phosphorus, copper and zinc.
Buckwheat – Containing rutin and quercetin that are two flavonoids with health-promoting actions. Source of magnesium, manganese, fibre, phosphorus, pantothenic acid and high quality protein.
Rice Flour – a source of carbohydrates, some protein but not as high as some others. Brown rice is nutritious with vitamins, minerals and calories and has better protein than wheat in terms of essential amino acids.
Tapioca starch (Arrowroot) – While Arrowroot and Tapioca starch are slightly different; they are interchangeable and quite often packaged as one of the same.
Potato starch – high in carbohydrates, source of vitamin B6, iron, zinc, niacin, potassium, manganese, magnesium, phosphorus, thiamine, vitamin C and fibre.
Almond Meal – Source of monounsaturated and polyunsaturated oils, protein (20%), potassium, magnesium, calcium, iron, zinc, vitamin E
Millet Flour – high in protein, energy-rich vitamin content, hypoallergenic.
Chickpea flour – high in protein, fibre and vitamins
Corn Flour – a good source of thiamine, pantothenic acid, vitamin C, E and folic acid, magnesium and phosphorus. Minimal levels of lysine and tryptophan but a good complex carbohydrate, essential fatty acids and fibre.
Sorghum – similar to wheat but gluten free, high complex carbohydrate, high protein, fibre, source of vitamin B3, B1 and B2, iron and potassium.
General Health and Nutrition
Should you leave coeliac untreated, due to malabsorption of nutrients you are no longer getting the nutrients your body requires daily. Your body is unable to absorb the required nutrients having an effect on the body’s general health.
If the nutrients are passing straight through the body, diarrhea is an obvious cause of malabsorption. The conditions that are related to malabsorption of nutrient’s are – Fatigue, enamel defects in teeth, iron deficiency, Vitamin B12 deficiency, loss of strength, poor growth or failure to thrive, hypoglycemia, pernicious anemia, osteomalacia, osteoporosis, weight loss, inability to gain weight and poor endurance. Should you be diagnosed with Coeliac disease from your doctor, this may have already had an effect on your general health.
Some things you should get checked that may have affected your general heath are:
Vitamin and Mineral deficiencies – Iron, calcium, phosphate, Vitamin D, Zinc, Vitamin B12 folate, magnesium.
Osteoporosis and Steopaenia – you should get a bone density scan if you have coeliac disease
Kidney function – sodium and potassium levels may be low Liver function
Autoimmune diseases may develop – thyroid, graves or hashimotos
Diabetes
For a lot of people, stresses and other lifestyle factors have affect on their general wellness.
Symptoms and Outcomes
As coeliac disease has many symptoms to other diseases, it is hard to diagnose as many people are unaware they have coeliac or do not get a correct diagnosis.
People with Coeliac disease develop other complications due to the body’s response to gluten. Autoimmune disease starts to attack the body and untreated Coeliac disease can cause some serious health conditions and outcomes and long-term risks due to the body not being able to absorb nutrients properly.
Some outcomes from continuing to eat gluten protein and malnutrition are:
Endocrine system – Type 1 diabetes, thyroid disease, Addison’s disease, lack of menstrual periods and Sjogren’s syndrome
Rheumatological – lupus, polyarthritis and rheumatoid arthritis, sarcoidosis
Haematological – Iron or B12 deficiency, chronic thrombocytopaenic purpura
Gastrointestinal – pernicious anaemia, lactose intolerance, pancreatic insufficiency, microscopic colitis and gastrointestinal cancers.
Bone – osteoporosis and premature osteopaenia, rickets or osteomalacia and low trauma fracture
Nervous system – epilepsy, depression, neuropathy, multiple sclerosis
Liver – autoimmune hepatitis, abnormal liver function, primary biliary cirrhosis, primary sclerosing cholangitis
Reproductive System – reoccurring miscarriage, infertility
Skin and Mouth – Mouth ulcers, alopecia, dental enamel defects, dermatitis herpetiformis
Other – down’s syndrome, pneumococcal pneumonia, lymphoma, turner’s syndrome
Some symptoms from untreated coeliac disease:
Gastrointestinal symptoms Weight loss or weight gain Fatigue, weakness and lethargic Iron deficiency Other vitamin and mineral deficiencies Bone and joint pains Delayed puberty in children Reoccurring mouth ulcers and/or swelling of mouth or tongue Altered mental alertness and irritability Bruising of the skin easily GERD – Gastro esophageal reflux disease
Currently, there is no advances in treatment for some with Coeliac, they will remain sensitive to gluten their whole life. Although there is no cure, if they manage a strict gluten free diet, this is the only recognized medical treatment they have to coeliac disease. Vaccinations are in research at the moment to help people adjust to the gluten free diet.
Removing gluten will allow the small bowel lining to heal and the symptoms resolved. It can take a long time for the villi to heal depending on how long this disease is left untreated. Being aware of cross-contamination, if you have a strict gluten free diet, problems should not reoccur.
Of course, this is the hard part – to stick to the gluten free diet. But when you are strict, your body can heal and you start to feel better, healthy. There are some amazing recipes and foods you can make to get all the relevant nutrients and can slowly adjust your lifestyle to suit your needs.
I myself am gluten and dairy intolerant and also have GERD and irritable bowel that limits what foods I can eat and has changed my lifestyle over the last 10 years as I start to take the effects on my body seriously.
You are not alone in this battle for health and wellness as many people suffer from all sorts of intolerances and allergies. You can get on top of any health areas in your life if you eat what is suitable for your body and lead a healthy lifestyle - enjoy fitness and health for the mind.
Reference List:
Balch P A, 2010 Prescription for Nutritional Healing (5th Edition) New York, Penguin Group
Brad-Miller J, March K, Sandall P, 2012 Professor Jennie Brand-Miller’s Low GI Diet for Gluten-free Cooking Sydney, Hachette Australia
Coeliac Australia http://www.coeliac.org.au/coeliac-disease/
Food standards – Nutrition tables & information (April 2015) http://www.foodstandards.gov.au/science/monitoringnutrients/nutrientables/pages/default.aspx
Gazzold, Alex, 2011 Coeliac disease, what you need to know London, Sheldon Press
Llewelyn Bower S, 2014 Celiac Disease New York, Demos Medical Publishing
Marieb E N, 2014 Essentials of Human Anatomy & Physiology (Eleventh Edition) Harlow, Pearson Education Limited
Murray M, Pizzorno J, Pizzorno L, 2005 The Encyclopedia of Healing Foods New York, Atria Books
Wangen S,2009 Healthier without Wheat Seattle, Innate Health Publishing
Whitney E, Rolfes S R, Crowe T, Cameron-Smith D, Walsh A, 2014 Understanding Nutrition Australia and New Zealand Edition (2nd Edition) South Melbourne, Cengage Learning Australia
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