Celiac disease (gluten intolerance)
People with coeliac disease can’t stand gluten. Gluten is a mixture of proteins that occurs naturally in certain cereals, such as wheat. Eating gluten mainly causes inflammatory reactions in the mucous membrane of the small intestine. But the disease can manifest itself anywhere in the body, such as in the skin, joints and brain.
Coeliac disease is an autoimmune disease and occurs only in people with a genetic predisposition. You can’t cure celiac disease. A lifelong gluten-free diet is the only treatment.
Many products contain gluten, such as bread, biscuits and pasta. That makes following a gluten-free diet complicated. You may also experience a shortage of certain nutrients. It is therefore important to call in the help of a specialist dietician.
What is celiac disease?
Celiac disease is an autoimmune disease caused by the ingestion of gluten. It only occurs in people with hereditary predisposition. Gluten is a mixture of proteins that occurs naturally in certain cereals. Previously, celiac disease was also called gluten intolerance. This is a misnomer because celiac disease is therefore an autoimmune disease and not a gluten allergy or intolerance. A wheat allergy does exist.
How many people have coeliac disease?
About 1% of people have coeliac disease. That amounts to about 170,000 Dutch people. The disease manifests itself at different ages. Symptoms range from typical gastrointestinal symptoms such as diarrhoea and abdominal pain to more vague symptoms such as headache and fatigue. As a result, not everyone who has coeliac disease has been diagnosed. People with a family member with coeliac disease are more likely to have coeliac disease. Celiac disease is also more common in combination with other conditions such as Down’s syndrome and type 1 diabetes.
What happens in the body in case of celiac disease?
In people with celiac disease, the body reacts violently to the intake of gluten. In an autoimmune disease, the immune system makes antibodies to those cells that attack the body’s own cells. This leads to an inflammatory reaction. In celiac disease, gluten consumption mainly causes inflammatory reactions in the intestinal mucosa of the small intestine. The inflammatory reaction in the small intestine damages the mucous membrane. As a result, certain nutrients can be absorbed less well. This could lead to vitamin and mineral deficits and anemia. The symptoms of celiac disease differ per person.
The response of the immune system to the intake of gluten can lead to symptoms such as diarrhoea, abdominal pain, fatigue, depression and weight loss. Due to damage to the intestinal mucosa, certain nutrients can no longer be absorbed properly, possibly resulting in vitamin and mineral deficiencies and anemia. The symptoms differ per person and range from no or vague complaints to very severe complaints. Some symptoms initially appear to be unrelated to the intestinal system, such as headache and fatigue. Sometimes symptoms are confused with Irritable Bowel Syndrome (PDS) or a wheat allergy.
Lactose intolerance is uncommon in people with celiac disease who have just been diagnosed. This usually disappears when the intestinal mucosa is restored. With proper treatment by a specialist dietician, the intestine can usually recover well. A correct diagnosis is therefore important in order to be able to initiate the correct treatment.
In order to know whether someone has celiac disease, blood tests are usually first carried out by the general practitioner. If there are antibodies against your own intestinal cells in the blood, a gastrointestinal liver specialist is referred. The specialist makes the final diagnosis by taking a small intestine biopsy. In children and teenagers, the diagnosis can sometimes be made without biopsy.
Can I follow a gluten-free diet if I suspect I have celiac disease?
It is important that a gastrointestinal liver specialist first diagnoses celiac disease or gluten sensitivity. If you are already eating gluten-free, the blood test is not reliable. This is because no or too few antibodies against gluten are produced. The blood test might show that you don’t have coeliac disease. But it may be that you do have it. So do not start gluten-free eating until the diagnostic process is over. Otherwise, celiac disease cannot be detected in the blood or intestines.
The treatment of celiac disease consists of following a gluten-free diet for life. This is the only treatment for the repair of the small intestinal mucosa. There are no drugs for celiac disease. The condition cannot be cured and you cannot ‘grow over‘ it. By following a gluten-free diet, the intestines can slowly recover and nutrients are absorbed again over time. The course of recovery varies from person to person. The symptoms sometimes decrease after a few weeks, sometimes they can persist for a long time.
It can take up to 2 years for the small intestinal mucosa to fully recover. In a very small group of adult patients, the intestinal mucosa will never fully recover. This is called refractory celiac disease.
Cereals containing gluten include wheat (including spelt), rye and barley. Cereals containing gluten are used in many products, such as bread, crackers, pasta and pizza. It can even be used in disposable dishes based on wheat bran. Some grains do not naturally contain gluten (such as oats and maize), but are almost always contaminated with gluten. Especially when these cereals have been processed into flour, flakes and the like. This is called cross-contamination. Therefore, following a gluten-free diet can be complicated.
Do you want to know where all the gluten is in, and which products are gluten-free? Look for the details of your gluten-free diet with gluten and the gluten-free diet.
Can I eat gluten-free with the Disc of Five?
Even if you follow a gluten-free diet, you can eat according to the Disc of Five. Many healthy products are naturally gluten-free. Products with gluten can often be replaced by gluten-free variants. However, you must be careful not to get shortages of certain nutrients. Many cereal products, such as bread and pasta, contain dietary fiber, iron, vitamin B1 and folic acid. Bread also contains iodine. It is important to get enough of these substances within a gluten-free diet. So choose products that contain these nutrients sufficiently.
Do I have to go to a dietician if I have coeliac disease?
A dietician informs about the composition of a full gluten-free diet. He or she also assists, for example, in searching for gluten-free alternatives and in assessing whether a product is gluten-free. Do not experiment with a gluten-free diet yourself, because there is a chance that you will not get enough nutrients. Are you looking for a dietician near you? Then visit the website of the Dutch Association of Dieticians.
Or find a dietician on the website of the Dutch Coeliac Association (NCV).
What can I do if I have celiac disease and lactose intolerance?
Some people with celiac disease also have (temporary) lactose intolerance. Usually this goes away as soon as the small intestine is restored. For people with lactose intolerance, it is advisable to follow a (temporary) lactose-limited diet and to replace dairy products properly. Check the dietary recommendations for lactose intolerance.
In addition to celiac disease, other diseases and conditions are known in which people get symptoms of eating gluten.
Like celiac disease, dermatitis herpetiformis (Dühring’s disease) is an autoimmune disease. In this condition, the ingestion of gluten causes an inflammatory reaction in the skin, which leads to itchy blisters, bumps or blisters. Not everyone with coeliac disease has dermatitis herpetiformis. Conversely, however, virtually everyone with dermatitis herpetiformis has damage to the small intestine, whether or not accompanied by symptoms. Also for people with dermatitis herpetiformis, following a gluten-free diet for life is an effective way to treat the symptoms. This can also repair the intestinal mucosa and prevent further damage to the intestinal mucosa.
There are people in whom symptoms improve if they follow a gluten-free diet, but in whom celiac disease and wheat allergy is excluded. This is called gluten sensitivity or non-coeliac gluten sensitivity (NCGS). It is very important that a doctor determines beforehand whether there is celiac disease or gluten sensitivity, and that other conditions are excluded.