Understanding Celiac Disease

What is celiac disease?

It is a condition where the body’s immune system reacts to gluten and leads to damage of the small intestine. When an individual eats gluten, it triggers an immune response that damages the lining of the small intestine. If this continues, it makes it more difficult for the gut to absorb nutrients. Gluten is a type of protein that is found in foods made with wheat, barley, rye and oats.

Symptoms of gluten intolerance range from digestive issues such as bloating, abdominal pain, diarrhea and constipation to systemic symptoms like headaches, fatigue and joint pain. If left untreated, nutritional deficiencies such as anemia, weight loss or osteoporosis as well as serious complications such as bowel cancer and autoimmune disease.

Can I be allergic to gluten?

Strictly speaking, there is no such thing as a gluten allergy. However, some people are allergic to wheat. This occurs when an individual has an allergic reaction to foods containing wheat. This can cause symptoms such as nasal congestion, hives, stomach cramps and ,in serious cases, anaphylaxis. It is important to note that while all sources of wheat contain gluten, not all products that contain gluten have wheat.

What is gluten intolerance?

Gluten intolerance, or non-celiac gluten sensitivity (NCGS), is a condition where individuals experience similar symptoms to celiac disease (e.g. abdominal pain, bloating, headaches, joint pain etc.) but without the intestinal damage associated with celiac disease or the immune response associated with a wheat allergy. The cause of gluten intolerance is not well understood. Individuals with gluten intolerance can sometimes tolerate small amounts of gluten whereas those diagnosed with celiac disease cannot.

How common is Celiac disease?

The prevalence of celiac disease in South Africa is unknown. It is estimated that 0.5% of the African population suffers from celiac disease but most people recognize that Celiac disease in both Africa and South Africa is most probably under-reported. Factors that can increase the risk of celiac disease include having a family member with the condition, autoimmune conditions such as type 1 diabetes and rheumatoid arthritis and genetic conditions such as Down’s syndrome.

How is it diagnosed and treated?

Because the symptoms of celiac disease are so varied and similar to gluten intolerance, it is important to confirm the diagnosis. The first step is a blood test to test for certain antibodies. If this test is positive, then the diagnosis is confirmed by assessing a small sample of the lining of the intestine. Treatment for diagnosed celiac disease is lifelong avoidance of gluten. Avoiding foods that contain gluten can allow for the intestinal lining to be repaired and symptoms to improve.

Tips to avoid gluten

– Become familiar with foods that are naturally gluten free. Some examples include fresh fruits and vegetables, unprocessed proteins (eggs, chicken, red meat etc.), rice, potatoes and sweet potatoes, maize meal etc.

– Learn to read food labels. While some products are labeled gluten-free it is valuable to learn to recognize the names of items such as wheat starch, corn flour and wheat maltodextrin that contain gluten.

– Try gluten free alternatives. There are more and more gluten free options that are becoming available such as gluten free breads, oats, flours and pastas.  

– Be aware of cross contamination. Even the smallest amount of gluten can cause a reaction. Keep gluten free foods separate to those containing gluten, use toaster bags to avoid contamination when toasting bread and use separate utensils when preparing a gluten-free meal or make sure they have been well washed if previously used to prepare food that contained gluten.

– Get informed. A registered dietitian can assist in providing more information on how to avoid gluten, teach you about the variety of gluten free options and make sure your diet is nutritious and healthy.

– Get support. Living with any chronic condition is challenging. Finding support in friends, family and others who share the same condition is important for your mental health. The Celiac Association of South Africa and AFSA (South African Allergy Foundation) have support networks for individuals with celiac disease.