Special Nutrition

Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an inflammatory disease of the upper small intestine which results from the ingestion of gluten in genetically susceptible individuals. This causes damage to the lining of the intestine. In the intestine there are finger-like protrusions called villi which increase the surface area of the intestine and enhance absorption. With coeliac disease these villi are attacked by the immune system and can be eventually destroyed. This greatly reduces the surface area of the intestine which can result in the poor absorption of nutrients such as iron, folic acid, calcium and fat-soluble vitamins.

Gluten is found mainly in wheat and to a lesser extent in rye, oats, and barley. An alternative name for this condition is gluten enteropathy.

Symptoms

There is a range of symptoms. Some symptoms are as non-specific as fatigue, vague abdominal pains, intermittent diarrhoea and slight anaemia. More severe symptoms may be present including alabsorption of food and chronic diarrhoea, anaemia, failure to grow (in the young), abdominal distension, offensive bulky stools, mouth ulcers, unexplained weight loss, painful skin rash, tingling numbness in legs, pains in joints, and muscle cramps.

Diagnosis

The gold standard for diagnosis of coeliac disease is a biopsy from the small intestine. There are also blood tests which screen for antibodies in the blood to gluten or gliaden (the protein in gluten)

Treatment

A gluten-free diet must be followed. Gluten is present in many foods which you need to be aware
of.

Gluten-containing foods

Foods which may contain gluten (check source)

Substitutes

Amaranth Flour - produced from ground seeds. High in calcium, protein and iron. Can combine with high starch flours such as tapioca and potato for baking. It can also be puffed and used as a cereal

Arrowroot - A starchy root that is a useful thickening agent in puddings, sauces, cakes

Buckwheat - Is a good source of vitamin B. Has a distinctive flavour and combines well with other flours in pancakes, muffins, pasta, bread

Potato flour - A good thickening agent and useful for baking. Works well in bread recipes, biscuits, cakes, pasta, and pizza bases, when combined with other flours. As a pure starch it has little flavour

Quinoa - A seed with a mild nutty flavour. High in protein, B vitamins, vitamin E and fibre. Can be combined with rice in making risotto

Rice- Rice flour, flakes, and ground rice can be used in baking biscuits and puddings. Combines well with other flours to make bread, pasta, and pastries

Sago - a good thickener for dessert. No strong flavour

Soya Flour - has a strong flavour which combines well with other flours. Good source of protein, B vitamins and fat

Tapioca - Useful for puddings, fruit pie fillers, custards, soups, stews

Rice bran
Corn
Maize flour
Maize meal
Polenta
Chickpea flour
Pea flour
Lentils
Lentil flour

Oats

There has been much controversy on whether or not people with coeliac disease can tolerate oats. A recent 5 year clinical trial concluded that people with coeliac disease can in fact tolerate oats.

One cautionary note is that during the manufacturing process of different cereals, oats may become contaminated with traces of other grains.