Get taste buds tingling the gluten-free way
Quinoa salad. Photograph: Cyril Byrne
The word “coeliac” is derived from the Greek word koiliakos, which means suffering in the bowels. The condition was first described more than 1,800 years ago in the writings of the Roman physician Aretaeus of Cappadocia.
Coeliac disease (pronounced see-lee-yak) is an autoimmune disease characterised by a permanent intolerance to gluten, a protein found in wheat, rye and barley.
Most people with coeliac disease can eat oats, but many oat-containing foods are produced in the same place as foods containing wheat, barley and rye, and cross-contamination makes them unsafe. A small number of people are sensitive to pure oats, many gluten-free options are now available.
There are still others who may experience sensitivity to gluten without actually having coeliac disease. However, for the majority of the population, gluten is not an issue.
Following a positive blood test, the most conclusive way to diagnose coeliac disease is by having a biopsy taken from the small intestine. Those diagnosed have no choice but to eat a gluten-free diet, to avoid significant malabsorption and malnutrition.
Continuing to eat gluten will result in the immune system responding by damaging the villi in the small intestine, preventing the absorption of vital nutrients such as iron, folate, calcium and vitamin D. The only treatment is adherence to a gluten-free diet and, thankfully, drugs are not required, which means the individual has almost complete control over the condition.
The thought that “a little gluten is okay” is a serious myth. Even very small amounts of gluten can be damaging to people with coeliac disease. It is also important to point out that “wheat-free” is not always “gluten-free”, and that reading labels must become a habit for anyone with coeliac disease.
Another misconception is that “coeliac disease is rare”. It is in fact significantly under-diagnosed and is thought to affect one in 100 people. The Coeliac Society of Ireland reports that for each person diagnosed, there are likely to be five to 10 people who remain undiagnosed. This is why you may have heard the condition referred to as the “silent disease”.
The classical presentation of coeliac disease is in fact pretty rare. It’s usually more insidious with less obvious symptoms such as anaemia, tiredness, breathlessness, osteoporosis, skin rashes, abdominal discomfort, bloating and cramping, unexplained weight loss, mouth ulcers, tooth enamel problems, numbness or tingling in the hands and feet, and infertility.
Some of these symptoms may be mistaken for irritable bowel syndrome, so it’s easy to see why the condition can go unnoticed.
The risk of the disease is increased in people with a family history of it, with a prevalence of at least 10 per cent in first-degree relatives and approximately 2 per cent in second-degree relatives. So it’s important that all family members get tested even if they have no symptoms, as it is possible to have coeliac disease with no symptoms at all. Even then, it can still damage your health if it goes untreated.
Traditionally, it was thought that coeliac disease was a paediatric disorder, but symptoms can occur at any age. The peak age of onset is in fact 40-50 years, which may surprise a lot of people. It’s thought that the incidence of symptomatic coeliac disease has declined in children as a result of changes in infant-feeding practices.