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Coeliac Disease



Gluten is a dietary protein found in barley, oats, rye, and wheat. Coeliac disease is when the immune system reacts abnormally to gluten and launches an inflammatory attack against the lining of the small intestine and other body tissues – with damaging effects.

Coeliac disease can occur in people of all ages after middle infancy but diagnosis is usually made between the ages of 40 and 60, with 20% of cases diagnosed even later. Coeliac sufferers usually go undiagnosed and can continue eating gluten for decades because 50% of sufferers have few to no obvious symptoms. Apparent symptoms often vary in presentation and onset so greatly that frequent misdiagnoses of irritable bowel syndrome, gallbladder disease, or various other disorders which may not involve the gastrointestinal tract are made.

Gluten intolerance can surface in genetically predisposed individuals when exposed to a triggers such as gastrointestinal surgery, stress, pregnancy, or viral infection, causing the immune system to react abnormally towards gluten. The enzyme and hormone secretion needed for digestion is reduced by the inflammation damage caused to the small intestine’s wall and the carriers needed to transport nutrients to the bloodstream aren’t produced, resulting in nutrient deficiencies.

 

Signs and Symptoms

If you suffer from unexplained gastrointestinal or extra-gastrointestinal symptoms such as the following, you may be intolerant to gluten:

  • Diarrhoea
  • Bloating
  • Pain
  • Fatigue
  • Anaemia
  • Osteoporosis
  • Epilepsy
  • Neurological disorders
  • Liver disease
  • Gall stones
  • Asthma
  • Schizophrenia
  • Psoriasis
  • Hair-loss (alopecia)
  • Premature grey hair
  • Dental anomalies
  • Weak immune system
  • Hives
  • Red or white inflammatory lesions in the mouth (oral lichen planus)
  • Inflammation of the heart sac (pericarditis), causing chest pain and fatigue
  • Red nodules on the skin (erythema nodosum)

 

Getting a diagnosis

Talk to one of our pharmacists if you think you may have coeliac disease. Diagnosing the condition requires two antibody blood tests, but their accuracy varies depending on disease severity and the laboratory conducting the tests. Human leukocyte antigen (HLA) typing can also help identify coeliac disease. It’s a protein noticeboard that displays “wanted” signs for offending antigens, like gluten, to the body’s immune T-cells, ensuring that the immune system knows which proteins need to be attacked on sight. However, the only fail-safe way to diagnose coeliac disease is by examining a sample of the small intestinal lining taken by biopsy during an upper gastrointestinal endoscopy (a little camera on a tube inserted through the mouth or nose).

 

Treatment & Prevention

There is no known cure for coeliac disease, so a gluten-free diet is the only preventative treatment for those affected. Coeliac sufferers should steer well clear of the offending grains and be careful of any food prepared by someone else - even a tiny amount of hidden gluten may cause a relapse. Read food labels carefully – if it doesn’t say “gluten free” and you’re unsure, contact the manufacturer for confirmation as gluten contamination may be present in some manufacturing processes. A gluten-free diet isn’t easy but, without complete exclusion of gluten from the diet, coeliac sufferers may be at increased risk for health problems, malignancies, and death.

 

Does Not Contain Gluten

May Contain Gluten

Contains Gluten

Foods made from grains (and grain-like plants) that do notcontain harmful gluten, including: Corn in all forms (corn flour, corn meal, grits,etc.). Rice in all forms (white, brown, basmati and enriched rice). Also amaranth, buckwheat (kasha), Montina, millet, quinoa, teff, sorghum and soy.

The following ingredients:
Annatto, glucose syrup, lecithin, maltodextrin (even when it is made from wheat), oat gum, plain spices, silicon dioxide, starch, food starch and vinegar (only malt vinegar might contain gluten). Also citric, lactic and malic acids as well as sucrose, dextrose and lactose; and these baking products: arrowroot, cornstarch, guar and xanthan gums, tapioca flour or starch, potato starch flour and potato starch, vanilla.

The following foods:
Milk, butter, margarine, real cheese, plain yogurt and vegetable oils including canola. Plain fruits, vegetables, (fresh, frozen and canned), meat, seafood, eggs, nuts, beans and legumes and flours made from them.

Distilled vinegar is gluten free. (See malt vinegar under NO below).

Distilled alcoholic beverages are gluten free because distillation effectively removes gluten from wheat. They are not gluten free if gluten-containing ingredients are added after distillation, but this rarely, if ever, happens.

Mono and diglycerides are fats and are gluten free.

Spices are gluten free. If there is no ingredient list on the container, it contains only the pure spice noted on the label.

 

Dextrin can be made from wheat, which would be noted on the label, and would not be gluten free.

Flavorings are usually gluten free, but in rare instances can contain wheat or barley. By law, wheat would have to be labeled. Barley is usually called malt flavoring. In extremely rare instances, neither barley nor malt is specified in a flavoring.

Modified food starch is gluten free, except when wheat is noted on the label, either as “modified wheat starch,” modified starch (wheat) or if the Contains statement at the end of the ingredients list includes wheat.

Oats used to be considered unsafe, but recent research has shown that a moderate amount of special pure oats is safe for most coeliacs. Several companies produce oats specifically for the GF market. They are labeled gluten free.

Pharmaceuticals can contain gluten, although most are gluten free. Check with the pharmaceutical company, especially if you take the medication on a continuing basis.

Processed cheese (spray cheese, for example) may contain gluten. Real cheese is gluten free.

Seasonings and seasoning mixes could contain gluten. Wheat will be noted on the label as required by law.

Soy Sauce is usually fermented from wheat. However, some brands don’t include wheat and are gluten free. Read the label to be sure.

Wheat in all forms including spelt, kamut, triticale (a combination of wheat and rye), durum, einkorn, farina, semolina, cake flour, matzo (or matzah) and couscous.

Ingredients with “wheat” in the name including wheat starch, modified wheat starch, hydrolyzed wheat protein and pregelatinized wheat protein. Buckwheat, which is gluten free, is an exception.

Barley and malt, which is usually made from barley, malt syrup, malt extract, malt flavoring and malt vinegar.

Rye

Breaded or floured meat, poultry, seafood and vegetables. Also meat, poultry and vegetables when they have a sauce or marinade that contains gluten, such as soy and teriyaki sauces.

Licorice, imitation crab meat, beer, most is fermented from barley. (Specialty gluten-free beer is available from several companies.)

 

  

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