Coeliac disease (pronounced ‘seel-ee-ak’) is an immune-mediated medical condition resulting from an abnormal reaction to dietary gluten, the protein component of wheat, rye, barley and oats. The immune response causes systemic inflammation and damage to the tiny, finger-like projections (villi) that line the small bowel, reducing the surface area available for nutrient absorption and often causing gastrointestinal symptoms (e.g. vomiting, diarrhoea, constipation, bloating, etc.).
People of all ages, both male and female, who have a genetic predisposition to develop coeliac disease, can be affected. The genes most often associated with coeliac disease are HLA DQ2 and HLA DQ8. However, only 1 in 40 of the people who have one or both of these genes will develop coeliac disease, as other genes and environmental factors also play an important role in triggering the condition. The genetic basis for the disease increases the risk of immediate family members also developing coeliac disease.
Research findings indicate that approximately 1 in 70 Australians have the condition, with approximately 80% of these currently undiagnosed. This means that approximately 330,000 Australians have coeliac disease but don’t yet know it.
Currently, the only treatment for coeliac disease is a strict lifelong gluten-free diet. Removing gluten from the diet allows inflammation to subside, the small bowel lining to heal, resolution of symptoms, and the improvement of long term health outcomes.
Coeliac disease & associated conditions
Many medical conditions occur at a higher frequency in people with coeliac disease, due to either a genetic link or the malabsorption of nutrients. Another reason for the increased risk is systemic inflammation. When the immune system reacts to gluten, inflammation occurs in the small intestine. Still, it can also occur in various other organs, such as the skin, joints, bones, liver, pancreas, thyroid gland, nervous system, and reproductive tract.
Longstanding inflammation contributes to disease complications, particularly when coeliac disease remains undiagnosed or untreated for an extended period of time. Such complications can include osteoporosis, infertility and liver disease. This is why early diagnosis and treatment is so important.
Coeliac disease & osteoporosis
The connection between coeliac disease and osteoporosis is the chronic inflammatory process that impairs the body’s ability to lay down new bone. Additionally, damage to the small bowel can lead to poor absorption of dietary calcium and vitamin D, which are needed for bone strength and to aid in calcium absorption, respectively. When the required level of calcium in the blood is not maintained, more is taken from the bones than can be replaced, causing bones to weaken.
Children with untreated coeliac disease are more likely to have impaired skeletal development, and their bones may not reach optimal bone mass due to the reduced absorption of calcium and vitamin D.
With the risk of osteoporosis higher than seen in the general population and often occurring earlier in life, it is recommended that all adults have a bone density measurement when first diagnosed with coeliac disease, with scans repeated as necessary. Medicare provides a rebate for a scan every two years for those with coeliac disease, classified as a proven mal-absorptive disorder.
Some patients present with fractures or low calcium levels, and subsequent investigations diagnose coeliac disease, despite the absence of gastrointestinal symptoms. Other patients are led to a diagnosis of coeliac disease because of other symptoms and are subsequently found to have osteopenia or osteoporosis when the routine bone density scan is performed. Commencement of a gluten-free diet will often result in a significant increase in bone density and strength. Timely diagnosis and treatment of coeliac disease are important to increase the positive impact of the gluten-free diet on bone density.
Temporary lactose intolerance can affect some people with coeliac disease. While the gluten-free diet allows the lactose intolerance to resolve in most people, it’s important that daily calcium requirements continue to be met while managing lactose intolerance (especially if you also have osteoporosis). Consult your doctor and dietitian to ensure your gluten-free diet is balanced and adequate.
Article kindly supplied by Coeliac Australia, the national registered charity supporting Australians with coeliac disease and associated conditions requiring a gluten-free diet. They provide membership and a range of support and information services to enhance the lives of people with coeliac disease, raise vital funds for research and create awareness of coeliac disease and the gluten-free diet within the medical profession, food services industry and the broader community. For more information, phone 1300 458 836 or visit www.coeliac.org.au