Welcome back to another blog post inspired by my recent podcast mini-series called “cracking the gluten code: coeliac disease and non-coeliac gluten sensitivity”.
Todays article focuses on coeliac disease and aims to increase your knowledge and understanding of the condition.
The article covers episode 1 of the podcast and talks all things Coeliac Disease, including detailed information about the condition, myth debunking and lots of helpful insights into testing and the diagnosing processes.
Prepare for an in-depth exploration, including an overview, statistics, and intriguing data that will enhance your understanding of this autoimmune condition.
You can also check out The Gut Be Good Podcast and YouTube episodes by clicking here.
See the content list below for quick links to relevant sections within this article:
Introduction
Defining coeliac disease
Immune response and intestinal damage
Impact on nutrient absorption
Symptoms of coeliac disease
Prevalence and demographics
Worldwide statistics
Conclusion
Ready to embark on your gut health journey?
Final message
Sources
Introduction
Thank you for being here today. Let’s begin and dive into the complexities of coeliac disease by uncovering some of the lesser-known aspects of its pathophysiology.
By the end of this article your knowledge and understanding of coeliac disease should be markedly improved!
Listen to the Spotify podcast or YouTube podcast version of this blog post.
Click the links to head to those platforms directly or find them on this page of my site.
Defining Coeliac Disease
Firstly and most importantly, Coeliac Disease is not an allergy or intolerance. It’s a profound and lifelong autoimmune condition which – at the moment at least – there is no cure for and only one treatment, which is a lifelong gluten free diet.
To comprehend the intricacies of this autoimmune condition, you need to understand how the body’s immune response works in CD and why it struggles in distinguishing friend from foe within the body.
Immune Response and Intestinal Damage
The “battleground” in coeliac disease, or the “problem area”, we might call it, is the small intestine. It’s here that an immune response within the body is triggered from when gluten contained within foods enter the small intestine and are detected by the body’s immune system.
This response is solely in response to the presence of gluten, but unfortunately in the cross-fire, the body’s defence system attacks not just gluten, but the intestinal tissues (the mucosal layers) as well, causing damage to its structure and ability to work effectively.
The culprits are antibodies and immune cells mistakenly attacking the body’s own cells, leading to this mucosal damage.
Impact on Nutrient Absorption
But why does it matter if the small intestinal tissues get damaged?
Well, the small intestine’s role in digestion is compromised as a result of this sustained damage because the mucosa (which is responsible for nutrient absorption) cannot then work effectively and absorb plenty of nutrients from the food you eat.
The entire surface of the small intestine is covered in finger-like projections called villi, which are essential for maximizing the surface area for nutrient absorption from foods (one persons small intestine laid flat would be the size of a tennis court, so yes, it’s big!).
When these villi get damaged because of the body’s immune response towards gluten in Coeliac Disease, nutrient absorption becomes significantly affected.
If left untreated (i.e. not following a gluten free diet), the result is malabsorption (poor absorption of nutrients) which can potentially lead to malnutrition (lack of nutrients within the body).
If malabsorption or malnutrition occurs, iron deficiencies and other vitamin deficiencies may be seen, which is why doctors may run tests for these deficiencies alongside a coeliac disease test: it’s a precautionary measure to reduce the risk of false negative coeliac disease test results.
Although, it isn’t part of the NICE guidelines in coeliac disease testing to under-go iron level checks alongside first line coeliac disease testing – consider it to be done on a more “case-by-case basis”, and tends to be carried out at a medical professional’s own discretion.
You can find an A-Z guide for foods you can eat which are gluten free here, in my other article.
Symptoms of Coeliac Disease
Coeliac Disease manifests through a range of symptoms, from gastrointestinal issues to extra-intestinal manifestations. Recognizing the diverse array of symptoms, including silent and asymptomatic forms, is crucial for understanding and diagnosis.
There’s a number of commonly associated symptoms with coeliac disease, and these are gastrointestinal symptoms like diarrhoea, stomach pain, bloating and gas, fatty stools, and even constipation, nausea and/or vomiting.
However, there’s also the extra-intestinal symptoms too, including tiredness, mouth ulcers, tooth enamel problems, sudden or unexpected weight loss, a number of vitamin and mineral deficiencies, (but most notably, iron, vitamin b12 and folic acid),
There’s also the potential for symptoms such as repeated miscarriages, liver abnormalities, neurological problems such as ataxia (which is poor balance, or loss of co-ordination) and peripheral neuropathy, (which is tingling or numbness in the hands and feet).
It’s also been found that 1 in 4 people with coeliac disease will develop the itchy and blistering skin rash called dermatitis herpetiformis.
As you can see, there’s a lot of symptoms and some of them seem rather vague. There’s also a chance that you won’t have many or any of these symptoms, as is the case in silent coeliac disease, or asymptomatic coeliac disease.
In individuals with asymptomatic coeliac disease, it’s important to note that the immune response by the body and subsequent damage to the small intestine that occurs as a result of eating gluten foods is still present, and the only treatment is the same as with symptomatic coeliac disease: a lifelong, gluten free diet.
In this article you’ll find a Q&A style guide to understanding gluten free living, which will also be helpful to you.
Use the content list below for quick links to relevant sections:
Introduction
Defining coeliac disease
Immune response and intestinal damage
Impact on nutrient absorption
Symptoms of coeliac disease
Prevalence and demographics
Worldwide statistics
Conclusion
Ready to embark on your gut health journey?
Final message
Sources
Prevalence and Demographics
Increasing Prevalence
When we examine data from 2020, the National Institute for Health & Care Excellence (NICE) notes an increased prevalence of Coeliac Disease over the last 50 years.
Despite potential improvements in diagnostic tools, 70% of new cases are diagnosed in individuals over the age of 20.
This suggests that diagnosing processes, awareness and tools to diagnose CD within GP practices is falling short, and we need to be doing more to recognise the condition earlier.
Onset Peaks
In Coeliac Disease data by NICE (2020) it was also found that there are two peaks of onset for CD. The first one is around 2 years of age as gluten is introduced into the diet, while the second is between the second and third decades of life, in your twenties or thirties.
However, the timing of gluten introduction into the diet doesn’t seem to directly impact the risk of developing the condition.
Meaning, whether gluten is introduced at 6 months, 8 months, 18 months, or even later, there’s no current correlation between this and development of CD. This suggests a person might have predisposing factors which cause or increase the likeliness of developing CD instead.
Predisposing Factors
While the exact cause of Coeliac Disease remains unknown, studies have proven that genetic predisposition plays a crucial role. Having a first degree relative with CD for instance, means there’s a 10% lifetime risk of developing the condition yourself. That’s still considered to be quite low risk, as of course with that, there’s also the 90% chance of never developing the condition.
The specific genes that run in families, and which increase the chances of developing Coeliac Disease are the Human Leucocyte Antigen genes, sometimes called disease association genes.
If a person has any of the Human Leucocyte Antigen (HLA) genes, particularly three influential types, the likelihood of developing Coeliac Disease is increased in this person.
People with coeliac disease are, in nearly all cases, found to have at least one of these three most commonly associated HLA genes. It’s so rare in fact, for someone with coeliac disease to not have at least one of these HLA types, that only 1% of all people with coeliac disease would fall into that category.
The is a useful test when wanting to rule out coeliac disease, because if the test comes back and it’s negative for all HLA types, meaning you don’t have any, the risk of having coeliac disease is so minimal at that point that you can almost rule it out completely.
Genetic testing, although not part of NICE guidelines, can therefore be valuable in assessing risk. You might be offered genetic testing depending upon your circumstances although most people won’t be offered this as standard.
It’s worth speaking to your medical professional about under going this test to see if it’s worth doing in your unique case.
You could also opt to under go this test yourself at home with certain at home tests available online.
Worldwide Statistics
Global Perspectives
It’s estimated that about 1.4% of people worldwide have Coeliac Disease, with quite big variations in prevalence across countries. Some particularly notable rates can be seen in countries like Finland and Italy, with Finland having been found to have the highest prevalence at 1.9% of its population, and Italy closely behind it at 1.6% of it’s population.
The UK statistics show a 1 in every 100 individuals as having coeliac disease.
Further to this, it’s thought that 1 in 4 people with CD in the UK are misdiagnosed as having IBS, which means there’s about 36% of all people with CD in the UK with a formal diagnosis of CD while the remaining 64% with CD in the UK go un-diagnoses or misdiagnosed.
Rising Diagnosis Rates
The good news for the UK though specifically is that diagnosis rates have been rising year on year. In 2020 it was estimated that 36% were diagnosed compared to only 24% back in 2011.
This hopefully shows that the UK are moving in the right direction at least for recognising signs and symptoms of coeliac disease.
In contrast, the US lags behind the UK with a diagnosis rate as low as 17%.
Other than visiting a medical professional for CD testing, there are some at home options as well.
You can see my comparison of the best coeliac disease at-home test kits plus my final recommendation for one here in this other article of mine here.
Demographic Trends
We also know that Coeliac Disease is diagnosed more frequently in women than men, with a 2:1 ratio.
There is also data to show that CD diagnoses are more prevalent in children compared to adults.
Conclusion
In this overview of Coeliac Disease, we’ve delved into its complexities, prevalence, and diagnostic trends and I do hope you’ve found it helpful!
As we wrap up this exploration into the intricate world of Coeliac Disease, it’s evident that understanding this autoimmune condition goes beyond surface knowledge. We’ve delved into the immune response and intestinal battleground, the consequential impact on nutrient absorption, and the myriad symptoms that can manifest.
The prevalence and demographics of Coeliac Disease bring to light not only the increasing rates but also the importance of timely diagnosis, especially considering the two peaks of onset and the potential for misdiagnosis. The global perspective emphasizes the need for awareness and recognition across various countries.
Predisposing factors, such as genetic links, offer insights into the complexity of this condition, highlighting the importance of genetic testing in assessing risk. Despite the unknown exact cause, these factors contribute to the uniqueness of each individual’s journey with Coeliac Disease.
As we navigate this landscape of statistics and insights, it’s crucial to recognize the progress in diagnosis rates, especially in the UK, while acknowledging the work that still needs to be done, particularly in the US.
Over here you’ll find a helpful 40 product price guide including 7 major supermarkets in the UK for cheaper gluten free living. See which supermarket was the cheapest over all.
Use the content list below for quick links to relevant sections:
Introduction
Defining coeliac disease
Immune response and intestinal damage
Impact on nutrient absorption
Symptoms of coeliac disease
Prevalence and demographics
Worldwide statistics
Conclusion
Ready to embark on your gut health journey?
Final message
Sources
Ready to embark on your gut health journey?
Join my email list for exclusive insights, subscribe to the Gut Be Good Podcast, and follow The Gut Be Good YouTube channel for more in-depth discussions and helpful (but also, fun) videos!
Keywords: Coeliac Disease, Gluten Sensitivity, Autoimmune Condition, Gluten-Free Diet, Immune Response, Intestinal Damage, Nutrient Absorption, Symptoms of Coeliac Disease, Prevalence and Demographics, Global Perspectives, Predisposing Factors, Genetic Testing, Worldwide Statistics, Rising Diagnosis Rates, Demographic Trends
Final message:
Remember, empowering yourself with knowledge and seeking professional guidance are paramount in navigating the complexities of diagnosis and ensuring the appropriate steps toward better health.
Remember, I’m always here to help!
Get in contact here if you need me.
Gemma x
DISCLAIMERS & DISCLOSURES
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Please see my full disclosure for further information – DISCLOSURE
& my full Disclaimer for further information – DISCLAIMER
Any advice offered within this article is meant for educational purposes only and should not be used as a sole resource for understanding the medical conditions discussed within. Any changes made to your diet, lifestyle and general well-being should be discussed with your GP or similar healthcare professional who is aware of your unique medical history and not made according to advice provided within this article or anywhere else on this website.
While the utmost care has been taken in devising the information residing on this website, it is your sole responsibility as the reader to utilise the information as you see fit and by reading the information present on this website you accept personal responsibility over any health outcomes related to you and your condition which occur as a direct or indirect result of using the information on this website in any way.
Always Check Ingredients Labels for Allergen Information before consuming a product.
This is important in case there are changes in manufacturing since the date of publication of this article.
It’s also a good idea in general, especially if you have allergies rather than intolerances/sensitivities to certain ingredients to check ingredients labels before consuming a product.
Sources:
Ben Houmich T, Admou B. Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects. International Journal of Immunopathology and Pharmacology. 2021;35. doi:10.1177/20587384211008709
Caio G, Volta U, Sapone A, et al. Celiac disease: a comprehensive current review. BMC Med. 2019;17(1):142. Published 2019 Jul 23. doi:10.1186/s12916-019-1380-z
Ludvigsson JF, Bai JC, Biagi F, et al, Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology Gut 2014;63:1210-1228.
Mayo Clinic. (n.d.). Celiac Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220
NHS Inform. (n.d.). Coeliac Disease. Retrieved from https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/coeliac-disease/coeliac-disease/
Parzanese I, Qehajaj D, Patrinicola F, et al. Celiac disease: From pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017;8(2):27-38. doi:10.4291/wjgp.v8.i2.27
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