It is estimated that 1% of the European population are coeliacs.
A significant percentage of patients (75%) remain undiagnosed due, for the most part, to the fact that coeliac disease has for years been linked exclusively to its classic signs and symptoms. However, the recognition of other atypical ways it can affect people, leading to fewer or no symptoms, combined with the greater and better use of the available complementary tests, has revealed the existence of different types of coeliacs.
Coeliac Disease (CD) is a multi-systemic autoimmune disease caused by gluten and related prolamines and suffered by genetically susceptible individuals. It is characterised by the presence of a variable combination of: gluten-dependent clinical manifestations, CD-specific antibodies, haplotypes HLA DQ2 or DQ8 and enteropathy.
Gluten is a protein found in the seeds of many cereals such as wheat, barley, rye, triticale, spelt and some varieties of oats, as well as their hybrids and derivatives.
The grain of these cereals contains gluten but also other elements such as starch, germ and bran which, if extracted through a technological process and under exhaustive controls, could be used as ingredients in gluten-free foods.
The main problem is that these cereals are present in a large number of foods, anything from bread to beer, and many processed foods may also contain gluten or traces of gluten.
Symptoms of Coeliac Disease
The most common symptoms are: weight loss, loss of appetite, fatigue, nausea, vomiting, diarrhoea, bloating, loss of muscle mass, growth retardation, mood swings (irritability, apathy, introversion, sadness), abdominal pains, meteorism, treatment-resistant iron deficiency anaemia. However, in both children and adults the symptoms may be atypical or absent, making diagnosis difficult.
Diagnosis and manifestations
Through a careful clinical examination and a blood test, which includes the serological markers of coeliac disease (anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies) it is possible to reach a conclusion on the suspected presence of the disease.
Recent understanding of the different clinical forms of coeliac disease (classical, atypical, silent, latent, potential, etc.) has demonstrated that a clinical or functional diagnosis of coeliac disease cannot always be made. As a result, for a completely accurate diagnosis of coeliac disease it is essential to perform an intestinal biopsy. This biopsy involves the removal of a tissue sample from the upper small intestine to see whether or not it is damaged. To perform this test gluten the patient must not be on a gluten-free diet.
The only treatment that currently exists for Coeliac Disease is a gluten-free diet for life. Gluten is a protein found in the seed of cereals such as wheat, barley, rye, and derivatives and some varieties of oats. Gluten lacks nutritional value, but has a high technological value. It is responsible for the elasticity of doughs made from flour, giving breads and baked doughs their spongy consistency.
A gluten-free diet should not be started before the disease has been diagnosed by a specialist, as this would make the diagnosis difficult.
To follow a proper gluten-free diet, it is advisable to take into account the following points:
It is better to consume natural or generic products, that is, those that are gluten-free by nature.
It is not advisable to consume unpackaged products since they are at greater risk of cross contamination.
Products labelled with the statement "very low in gluten" should not be consumed, even if they are accompanied by the following claims: “Suitable for people with a gluten intolerance", "Suitable for coeliacs", "Made specifically for people with a gluten intolerance", or "Made specifically for coeliacs". These products contain between 20 and 100 ppm of gluten and according to experts are not suitable for coeliacs. For coeliacs, the only statement that matters is: GLUTEN FREE.
Currently there are products made with modified wheat starch on the market that contain less than 20 ppm of gluten and are suitable for people with coeliac disease.
When purchasing processed or packaged products it is advisable to check the list of ingredients on the label, or look them up in the list of gluten-free foods from FACE.
Extreme caution should be taken when handling food in bars, restaurants, and canteens. For example, they may use the same oil for products both with and without gluten, and a legume dish made with sausages that contain gluten cannot be offered to a coeliac, even if the sausages are removed from the final dish.
In homes where someone is a coeliac, it is advisable to eliminate wheat flour and breadcrumbs that contain gluten and instead use gluten-free flour and/or breadcrumbs and mashed potato flakes to batter or bread food and thicken sauces. This means that the food cooked there can be consumed by everyone, including coeliacs.
Celiac associations are thereto help so please contact them if you have any questions or problems.
If you are unsure whether or not a product contains gluten: DON’T EAT IT