Coeliac disease

What is coeliac disease

Coeliac disease is digestive disorder where the immune system responds abnormally to gluten intake in the diet and this causes malabsorption of not only the gluten but other nutrients too.

The inability to digest gluten (wheat protein) causes inflammation and damage to the walls of the small intestine and in particular to the villi (the little finger-like tissues that help the food to be absorbed), which become eroded and then flattened, causing the inability to absorb any nutrients in untreated coeliac disease.

Foods that contain gluten:

• Barley
• Oats
• Rye
• Triticale (combination of wheat and tye)
• Wheat (has the highest amount of gluten) – includes durum, faro, kamut, semolina, spelt

All types of wheat have the highest amounts of gluten and because of this, can do the most damage to the villi and thus the small intestine, so should be avoided in people with coeliac disease. The other grains (barley, oats, rye) may cause less damage to the small intestine than wheat, but research shows that they still do damage and should also be avoided by the person with gluten intolerance to avoid symptoms associated with coeliac disease.

Facts about coeliac disease

• Celiac disease causes an immune response in the intestines to the gluten proteins present in wheat that are eaten
• Coeliac disease affects the absorption of many nutrients, but if it affects the absorption of calcium and other vitamins and minerals associated with bone health, it can lead to osteoporosis if the condition is left untreated (or poorly treated)
• People that get coeliac disease generally have this condition for life, but it can be successfully managed in order to have a good quality of life
• The medical name for coeliac disease is coeliac sprue
• Coeliac disease was first observed in the first century AD, but was officially confirmed as a dietary related condition around the 1940’s
• Statistics indicate that approximately 1-2 people in every 1000 in Australia have coeliac disease, but the numbers of people with this condition could be as high as 1-2 in every 100 people in Australia
• Coeliac disease is more common in Western Europe and in Celtic populations, but is also very common in Sweden, Italy, Australia, America and Austria too
• Incidence of coeliac disease around the world is estimated at around 1% of world population
• Coeliac disease is a permanent abnormality of the gastrointestinal system
• Coeliac disease is rare in Japanese or Chinese people
• People with coeliac disease have a higher risk for developing lymphoma (a cancer of the lymph tissues)
• Coeliac disease is also written celiac disease (American spelling)
• Many people with irritable bowel syndrome (IBS) find that following a low or no gluten diet helps reduce their symptoms, quite significantly in some cases

Symptoms of coeliac disease

General symptoms of coeliac disease

• Abdominal pain/cramps
• Diarrhoea
• Food intolerance
• Lethargy and weakness
• Loose stools
• Mood swings
• Nausea
• Other gastrointestinal problems
• Poor weight gain (especially in children)
• Reflux
• Vomiting

Other symptoms

Other symptoms (and health conditions) associated with coeliac disease, especially when it is continuing and possibly poorly treated are:

• Damage to the nervous system
• Damage to the bones and skeletal system resulting in bone pain
• Decreased fertility in both men and women (or even total infertility)
• Deficiencies in certain nutrients – calcium, folic acid, iron, vitamin B12, vitamin D
• Depression
• Dermatitis herpetiformis – which is an autoimmune disorder that causes a rash all over the body
• Insulin-dependent diabetes mellitus (IDDM)
• Iron deficiency anaemia or vitamin B12 deficiency anaemia
• Lymphocytic colitis – an inflammation of the bowel that is the cause of watery diarrhoea
• Menstrual abnormalities in women
• Muscle weakness and unsteadiness
• Osteoporosis – entirely due to the malabsorption of calcium and in part, vitamin D too

Deficiency symptoms

Deficiency symptoms in children can start as soon as they are weaned from breast (or formula) milk to solids containing any type of cereals (wheat, rye etc).

Deficiency symptoms in children may include the following:

• Abdominal pain or cramps
• Anaemia (usually in older children)
• Constipation
• Deficiency in various essential nutrients, especially of calcium, folic acid, iron, vitamin B12, vitamin D
• Diarrhoea
• Distended abdomen (bloated stomach)
• Lethargic and lacking in energy
• Failure to grow as expected
• Moody and irritable
• Muscle wasting
• Pale, smelly stools
• Rickets – due to vitamin D deficiency (while this is rare in Australia, it does still occur infrequently)
• Vomiting

Causes of coeliac disease

Basically a genetic intolerance to gluten is the cause of coeliac disease.

Specifically it is the proteins in gluten (gliandin and glutenin) that causes the abnormal immune response in some people, where their immune cells attack the gluten protein as a foreign substance. This intolerance to gluten causes the immune system to view the gluten protein as a toxic substance and the reaction of the immune system (to get rid of the gluten that is ingested) is to damage the lining and villi of the small intestines, which causes malabsorption of nutrients.

Some people are born with the gluten intolerance and it manifests as coeliac disease and its associated symptoms at young age.

On the other hand, some people have a latent form of coeliac disease which does not manifest early in life. It only starts when it’s triggered by an infection of the gastrointestinal system. This then turns the latent gluten sensitivity to coeliac disease.

People with latent coeliac disease are healthy until the trigger for this condition occurs.

Prevention of coeliac disease

Non-preventable risk factors

Coeliac disease may not be unpreventable in certain circumstances:

• Genetics – many people that have coeliac disease are genetically predisposed to it, so if any immediate family members have this condition, there is a higher risk for any siblings to develop it. Research suggests that there is a certain gene which is known to be associated with development of coeliac disease – HLA (human leukocyte antibody) locus DQ2
• Gut infection – a bacterial or viral infection of the intestines is a known risk factor to trigger coeliac disease in people who have a latent form of this condition. This means they have the faulty intestinal genes but are healthy and have no sign of this disorder until the gut infection triggers something in these genes and this causes coeliac disease to manifest
• Gluten intolerance – people who have an overt intolerance to the gluten proteins (mainly gliandin but also glutenin) have a much higher rate of developing coeliac disease, which is very difficult to prevent

Preventable risk factors

While coeliac disease cannot generally be prevented, there may be ways to reduce worsening of symptoms or to potentially try to prevent latent coeliac disease from happening:

• Limit gluten in the diet – it is quite imperative to reduce gluten intake to reduce symptoms of coeliac disease. While this will not cure the condition, it is the only way to manage symptoms. This is especially the case for people who have any type of other digestive disorder (especially irritable bowel syndrome or leaky gut syndrome) who often do much better on a gluten-free diet, by experiencing less symptoms

Other conditions associate with coeliac disease

People with the following health conditions are more at risk of developing coeliac disease, are associated with coeliac disease, or have less symptoms when following a gluten-free diet:

• Dermatitis herpetiformis – this is a rare skin disorder which manifests as blistering, itchy skin patches that are gluten-sensitive and will only get better with medication and a gluten-free diet. this condition is also called Duhring’s disease
• Insulin-dependent diabetes mellitus (IDDM) – coeliac disease is diagnoses in about 5% of people with IDDM
• Irritable bowel syndrome – people with irritable bowel disorder (IBS) generally feel much better and have less incidence of symptoms when they follow a gluten-free diet
• Leaky gut syndrome – people with leaky gut syndrome generally feel much better and have less incidence of symptoms when they follow a gluten-free diet
• Lymphocitic colitis – this disorder causes inflammation of the bowel and can be related to coeliac disease because a gluten-free diet can reduce symptoms of this condition

Complications of coeliac disease

There are a number of complications associated with coeliac disease, ranging from serious to potentially life threatening:

• Anaemia – very severe cases of coeliac disease, especially in those people whose condition has been left untreated for a long time can cause iron-deficiency anaemia due to the malabsorption of iron from food in the diet. This is due to the inability of the intestines, which are very damaged and inflamed (especially the villi, which may be completely flattened and unable to absorb the iron) and this causes problems in the intestine’s ability to absorb the iron. Another cause of anaemia is due to vitamin B12 deficiency
• Fertility problems – women who have untreated coeliac disease have a much higher risk for fertility problems or miscarriage. Once a gluten-free diet is used to manage symptoms, this greatly increases fertility and reduces incidence of miscarriage in women with coeliac disease. Men who have untreated coeliac disease have a much higher risk for fertility problems with a reduction in sperm count or viable sperm. Once they start a gluten-free diet, this can be reversed
• Lymphoma – a very serious complication of coeliac disease is the higher risk of developing B-and T-cell lymphoma anywhere in the body and this could be due to the malfunctioning of the immune system, which is being triggered to respond to gluten as if it is a toxic substance, so it may start to be unable to recognise real threats (such as changes to DNA which causes cancer)
• Neuropathy – some people with coeliac disease can experience neurological symptoms in the peripheral limbs (arms, legs) which can cause them to lose their balance and even have pins and needles symptoms. most people’s symptoms can be improved with vitamin B12, as well as a general multivitamin, but in some cases, this neuropathy can be due to gluten ataxia which is serious problem with the brain and spinal cord that is thought to be caused by damage from the gluten protein and no dietary supplementation is known to help
• Nutrient deficiencies – iron is not the only nutrient which may be in short supply due to the intestine’s inability to absorb it, there are a number of other nutrients which are not being properly absorbed and this could cause a number of nutritional deficiencies and health conditions associated with them. The fat soluble vitamins (vitamin A, vitamin D, vitamin E, vitamin K) may not be getting absorbed properly due to the inability of the intestines to absorb fats properly, which are necessary for the absorption of these vitamins. In addition to this, a number of other vitamins and minerals may not be well absorbed either. The malabsorption of these vitamins and minerals can cause a range of adverse health effects
• Osteopaenic bone disease – in very severe cases of coeliac disease or in severe undiagnosed forms of this condition, calcium may not be getting absorbed properly and this could increase risk for bones becoming weaker, which ultimately can cause osteoporosis if the deficiency in calcium continues long term

When to see a doctor about coeliac disease

People who have any of the symptoms associated with coeliac disease should see a doctor for proper diagnosis to confirm this condition (or to rule it out and confirm another diagnosis).

It is important to see a doctor and not self-medicate, because coeliac disease can cause major damage to the intestines and can cause complications if left untreated for a prolonged period.

People with existing coeliac disease need to see their doctor (and registered dietician) on a regular basis, to monitor their condition, to ensure they are not suffering from complications and to help with dietary management.

People with existing digestive disorders such as leaky gut syndrome or IBS need to see their doctor as they may have less symptoms and feel better on a gluten-free diet.

Diagnosis of coeliac disease

It is important to have coeliac disease correctly diagnosed, to prevent further damage to the small intestines and also to prevent nutritional deficiencies and the conditions associated with these deficiencies.

Initial diagnosis of coeliac disease

• Medical history – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your diet, your family medical history (if anyone else has similar symptoms or other gastrointestinal disorders)
• Physical examination – the doctor (or gastroenterologist) will examine your abdominal area for pain or discomfort, as well as examining other parts of your body if needed (your hands, eyes and mouth)

Further tests

Once the doctor (or gastroenterologist) has reviewed the medical history and determines that further investigation is warranted, the following tests can be ordered depending on the symptoms:

• Blood test – there are specific tests that can be ordered
  • EMA – this tests the blood to determine if there are any endomysial autoantibodies (these are antibodies the immune system produces against gluten), this is the very latest in testing for coeliac disease
  • FBC – full blood count (including iron stores, vitamin B12 and haemoglobin levels) to determine if anaemia is present
  • Calcium – to determine if calcium levels are low and need further testing for bone density
  • Vitamin D – to determine if vitamin D levels are low and need supplementation
  • Other nutrients – some other nutrients may be tested, but are usually not, only in special circumstances extra tests are needed
• Stool test – this test can be done if required (when there are a lot of abnormal stools) and consists of taking samples of the stools for three days in separate containers, which will be tested for fat malabsorption or other abnormalities

Other tests

Depending on symptoms, the following diagnostic tests may also be ordered, to either rule out any other underlying conditions or to test for degeneration of bones due to malabsorption problems:

• Endoscopy – a gastroenterologist performs this test and it involves having a telescopic tube (small and flexible with a camera and light at the end) being inserted into the mouth, down the eosophagus, into the stomach and then through the first part of the small intestine to get a better view of it and determine level of coeliac disease, and to take a sample of the small intestine (a biopsy). The gastroscopy is usually performed under light sedation and takes only about 10-15 minutes to be completed
• Bone density test – this may be ordered if the blood tests (or observational symptoms) show that there is a deficiency of calcium. This test determines the levels of calcium in the bones and is much like having an x-ray (taking about 5-10 minutes to complete)

The Bone Density Test is covered by Medicare (in Australia) for the following groups of people:

• Aged over 70 years (male and female)
• Being diagnosed with osteoporosis (any age)
• Having at least one fracture due to osteoporosis (any age)
• People taking corticosteroids long-term (any age)
• Women under 45 who have not had any periods for at least 6 months

Conventional treatment of coeliac disease

Conventional treatment is based on removing all gluten from the diet and using alternative means of cereals. This usually involves consultation with a dietician who can help to formulate a healthy eating plan without any gluten (no wheat, oats or rye).

The gluten-free diet needs to be followed for life. A registered dietician is the best source for helping to develop a gluten-free diet and assist with implementation.

Gluten-free living requires strict adherence to the special diet and can be difficult at first as it requires a lot of planning, research and guidance.

Some people may have recurrent outbreaks of symptoms and this is usually treated by:

• Corticosteroids – medications such as Prednisone are used to reduce the inflammation in the small intestine if a gluten-free diet is not working well

If coeliac disease is still causing problems (even when following a gluten-free diet and taking the corticosteroids), it could be due to lymphoma (tumour of the white blood cells in the small intestine) and this needs to be treated appropriated (chemotherapy and/or radiotherapy).

Proper diagnosis is required by a medical doctor who can order appropriate tests to determine severity of symptoms and progression of this disease.

Alternative / complementary treatment of coeliac disease

Alternative treatment is the same as initial conventional treatment of coeliac disease – following a gluten-free diet for life. It is best to see a qualified naturopath who has studied and specialises in nutrition, or a registered dietician who can develop a treatment plan just for you.

Herbs

There are a few gentle herbs which can be helpful in reducing symptoms associated with this condition:

• Chamomile – an excellent carminative, which helps the digestive system by relieving flatulence, plus it has calming and soothing properties. Chamomile tea is gentle and easy on the digestive system
• Peppermint oil – many studies show that peppermint oil is very effective at reducing spasm in the intestines and so are often prescribed by gastroenterologists for people who have crampy type gastrointestinal pains. Peppermint tea is also useful, but not as effective as the concentrated oil. Some people though, are not able to tolerate the peppermint oil and experience side effect symptoms from trying it – your doctor will advise you if this is suitable for you
• Slippery elm powder – this mucilaginous herb can help to relieve symptoms as it coats the intestinal walls and prevents further damage, pain, symptoms and soothes the intestinal mucosa

Vitamins

Several vitamins are useful in reducing the severity and recurrence of symptoms:

• B vitamins – all of the B vitamins may be especially malabsorbed and this could cause a deficiency which can lead to further adverse health effects
• Folic acid – the B vitamin folic acid may be especially malabsorbed and could contribute to the development of anaemia if a deficiency is serious enough
• Vitamin A – it is very common for people with coeliac disease to be unable to properly absorb fats and therefore fat soluble vitamins such as vitamin A. In addition to this, vitamin A is required to help maintain healthy mucous membranes in the small intestines (but all through the digestive tract) and it also helps the immune system function more effectively
• Vitamin B12 – one of the B vitamins, vitamin B12 may be especially malabsorbed and could contribute to the development of anaemia if a deficiency is serious enough
• Vitamin C – the antioxidant vitamin C is required by the intestines to reduce the damage from this condition and to help the immune system function more effectively in general
• Vitamin D – it is very common for people with coeliac disease to be unable to properly absorb fats and therefore may be deficient in fat soluble vitamins such as vitamin D which require fat for their absorption
• Vitamin E – it is very common for people with coeliac disease to be unable to properly absorb fats and therefore may be deficient in fat soluble vitamins such as vitamin E which require fat for their absorption. In addition to this, vitamin E is a potent antioxidant and deficiency of this vitamin may decrease immune system function
• Vitamin K – it is very common for people with coeliac disease to be unable to properly absorb fats and therefore may be deficient in fat soluble vitamins such as vitamin K which require fat for their absorption

Minerals

Several minerals are useful in reducing the severity and recurrence of symptoms:

• Calcium – the mineral calcium is really necessary to ensure that bone health is maintained properly. People with coeliac disease often have malabsorption of many minerals and it is vital that adequate levels of calcium are absorbed properly to prevent bone loss and ultimately osteoporosis
• Magnesium – the mineral magnesium is necessary to relax the smooth muscles that surround the small and large intestines and enable them to function properly when moving food through. Magnesium is also excellent for enabling the digestive tissue to be less inflamed
• Zinc – the mineral zinc is vital for helping any damaged tissue heal properly and quickly, plus it is vital for the immune system to function effectively and may help to effectively reduce severity and duration of symptoms

Other nutrients

There are several nutrients that are beneficial in reducing severity and recurrence of symptoms:

• Carnitine – in the form acetyl-l-carnitine, helps to heal the stomach and intestines very effectively and quickly (and this effect is enhanced so that it works even better when used in combination with zinc)
• Digestive enzymes – bromelain and other digestive enzymes are excellent at helping the stomach and intestines digest and absorb the nutrients in food properly
• Essential fatty acids – help to reduce inflammation in the body and which can reduce severity and duration of symptoms. The most effective essential fatty acids (EFA) are the omega 3 fatty acids, DHA and EPA and also the omega 6 fatty acid, gamma-linolenic acid (GLA) , which have been shown in many studies to reduce inflammation, especially when taken together in a ratio of 1:1 or 2:1 (ratio of the omega 3:omega 6 fatty acids)
• Glutamine – the conditionally-essential amino acid glutamine is an excellent nutrient for the stomach and small intestine as it helps the intestines function more effectively. In addition, glutamine also helps the white blood cells of the immune system function more effectively too. Glutamine is also needed to make the non-essential amino acid and neurotransmitter GABA, required for mood regulation and relaxation, so this is another way GABA can help to reduce symptoms
• Glutathione – the non-essential amino acid glutathione is an excellent antioxidant for the gastrointestinal tract and especially helps the immune system function more effectively, which helps reduce symptoms
• Probiotics – the live cultures in probiotics help to populate the gastrointestinal tract with “friendly” bacteria that will help with digestion and absorption and reduce some of the symptoms associated with this condition by reducing “bad” bacteria and ensuring proper digestion and absorption of nutrients occurs more effectively

Dietary modifications

There are a number of dietary modifications which should be adhered to help prevent recurrence of symptoms and reduce severity of symptoms:

• Avoid beer and other ales – as they contain gluten or wheat components, which need to be avoided in people following a gluten-free diet
• Drink organic cabbage juice – the juice of cabbage contains “substance U” which has proven ulcer healing properties and it can provide relief for symptoms by healing the mucosa of the intestinal wall, which means it can help reduce (and even prevent) symptoms
• Eat more garlic and onion – these are helpful for improving the function of the immune system in general
• Eat more oily fish – these fish have a higher omega 3 content which provide high dietary levels of the the essential fatty acids which are required to help reduce inflammation in the small intestine. The best fish to eat are: salmon, sardines, trout, mackerel and tuna and the fresher and wilder, the better
• Increase fibre – eat more fresh/raw fruit and vegetables and other non-gluten fibres every day to help the gastrointestinal tract function more effectively by strengthening its functionality. Increase intake of fibre gradually to avoid worsening of symptoms
• Read all food labels – it is vital to read all food nutrition labels to see if there is any gluten in the produce; usually most products will state if it is gluten-free, but if they do not, take care not to use any products with thickeners as they will be gluten based
• Remove all gluten from the diet – all grains (other than millet, corn, chickpeas and brown rice) must be removed from the diet to prevent and reduce symptoms

Lifestyle modifications

There are many changes which can be made to help relieve symptoms of coeliac disease:

• Relaxation – it is really important to help the immune system (and in fact, the whole digestive system too) calm down by engaging in some form of relaxation, such as meditation, tai chi, yoga

Alternative treatments

There are no other alternative treatments recommended for treating coeliac disease.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with coeliac disease

Coeliac disease requires some diligence in maintaining a specific gluten-free diet, together with some supplementation to help heal the digestive system and reduce severity and duration of symptoms. The following are the strategies most recommended to achieve this:

• Antioxidants – there are a number of antioxidant supplements that are especially recommended for helping reduce symptoms and increase healing capacity (carnitine, glutamine and lipoic acid)
• Avoid cigarette smoke – people who smoke have to give up. This is just another reason to help with the decision to stop smoking. Cigarette smoke causes a number of problems with digestion and should be avoided. People who do not smoke should avoid exposure to second hand smoke from people who smoke around them
• Avoid foods containing gluten – this is probably the most important strategy for avoiding flare-up and worsening of symptoms. If foods are prepared fresh, from scratch, then it is unlikely to find any gluten. When processed foods are purchased, it is very important to read labels as they will have information about the gluten (or not) content in the food. The foods most likely to contain gluten are: wheat, rye, oats, barley, beer, biscuits, crackers, baked goods, some packaged herbs/spices, packaged meals, ice cream, salad dressing, deli meats, chips, packaged soups and sauces
• Dietician – current medical advice recommends that a person who has been diagnosed with coeliac disease should be monitored by a registered dietician who can advise on best foods to eat to prevent worsening of symptoms and help improve quality of life
• Digestive and pancreatic enzymes – the digestive and pancreatic enzymes are released by the digestive to help digest foods that are eaten so that their nutrients can be absorbed through the bloodstream. Digestions starts mainly in the stomach and ends in the small intestine. The digestive and pancreatic enzymes help to increase the amount of food digested by reducing the load on the digestive system and this reduces the amount of undigested foods that may escape into the bloodstream and cause the immune system to respond with an allergic reaction
• Essential fatty acids – the essential fatty acids, especially the omega 3 (DHA/EPA) and omega 6 (GLA) are vital for a properly functioning gastrointestinal system as they reduce inflammation that may be associated with this digestive disorder and this reduces severity and duration of symptoms. The best way to get adequate levels of the essential fatty acids is to eat 3-4 servings of oily fish each week and ensure it is deep ocean, wild fish (not farmed). The fish with the highest levels of omega-3 fatty acids are: mackerel, salmon, sardines, trout, tuna. People who cannot eat fish should try a supplement with balanced levels of each of the essential fatty acids and ensure it has been tested for mercury
• Exercise regularly – physical activity is a must for anyone with a digestive disorder as it helps to increase blood and lymphatic circulation. This helps to eliminate any toxins or unwanted substances more quickly out of the body. Exercise also increases the endorphins released and reduces stress
• Fibre – increasing the amount of fibre in the diet is vital for ensuring healthy digestion. The best types of soluble fibres is psyllium, which helps the intestinal flora digest food properly. The best ways to add psyllium or slippery elm to the diet are in: smoothies, milkshakes, sauces, yoghurt, breakfast cereal, muesli, dips. Suggested dosage is up to 2-3 teaspoons per day, but add it gradually if fibre hasn’t been an integral part of the diet previously, start with 1/2 teaspoon for a few days and add another 1/2 teaspoon every 4 days until at the 2-3 teaspoons a day level
• Gluten free diet – a strict gluten free diet needs to be followed for life (probably) to reduce the allergic reaction to the gluten protein when it is ingested. Many processed foods contain gluten, so nutrition labels need to be read very carefully to ensure that there is no hidden gluten in the food bought. Recent research suggests oats should also be avoided on a gluten-free diet as it causes inflammation to the intestines, which may further exacerbate symptoms. Alternatives to gluten are: rice, corn, millet, quinoa, buckwheat, chickpeas, legumes
• Limit alcohol – it may be necessary to reduce drinking any alcohol while the intestines and the rest of the digestive system are in the process of healing and this is because alcohol is known to irritate the intestines
• Organic – another strategy to reduce the stress on the gastrointestinal system is to avoid foods which are not grown organically (without the use of pesticides and other chemicals and antibiotics). This helps the digestive system because it does not have to also try to detoxify the chemicals in the food in addition to trying to digest foods normally (which is not occurring in this condition). Not only this, but studies show that organic food has higher levels of all their nutrients than food not grown organically
• Probiotics – the “good” bacteria may be in short supply in the digestive system which could be contributing to the symptoms. Acidophilus and other probiotic bacteria are required to help re-populate the intestines with “good” bacteria, which help to properly digest foods and reduce the amount of undigested food that escapes the gut. People who are not lactose intolerant should also include yoghurt that has live cultures
• Reduce stress and relax – prolonged and unrelenting stress is not good for healthy digestion. While stress is not known to cause leaky gut syndrome, it certainly can make symptoms worse because it causes the parasympathetic nervous system to remain in stress mode, which means digestion and absorption is not effective as the nerve that controls it prevents it from happening properly
• Slippery elm – the herb slippery elm is necessary for intestinal health as it is required to heal the intestinal mucosa by providing a mucilaginous layer over the intestinal wall, which reduces the stress on the intestines and helps to heal the intestines more quickly
• Smaller meals – eat smaller meals to help reduce the load on the digestive system, which is not working properly and cannot handle larger meals, which can cause worsening of symptoms when the stomach and intestines struggles to handle the large amount of food eaten. Aim to have around 6 smaller meals each day
• Supplements – certain supplements may be required to help in the healing process by reducing the load on the intestines and reduce symptoms. The fat-soluble vitamins may especially be required because this digestive disorder causes a problem with fat digestion, magnesium to help relax the strong muscles that surround the intestines and also the B vitamins which are needed for healthy nervous tissue and nerve impulses
• Support group – it is advisable to join a support group for people who have coeliac disease, which can provide diet tips, lifestyle tips, information about supplements and a lot of useful information to help improve quality of life

Caring for someone with coeliac disease

The best way to help a partner with coeliac disease is to be supportive and sympathetic, but also the following can be helpful too:

• Avoiding smoking inside – people with coeliac disease need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Eating smaller meals – help your partner to eat smaller meals by joining them in eating smaller meals, as this helps support your partner a great deal. Cooking and eating smaller meals is one way to help reduce the load on the digestive system by reducing the amount of food that needs to be digested and absorbed
• Encourage a healthy diet – a healthy diet is one which has adequate amounts of fresh fruit and vegetables, wholegrains, legumes, protein and healthy fats and has little or no processed foods
• Encourage exercise – going for walks (or joining a gym together) with your partner is a great way to bond. Exercise helps to improve circulation, reduces stress and encourages better health overall
• Gluten free diet – to help your partner feel less isolated in their often restrictive diet, it may be useful to ensure that all meals prepared in the home are gluten free. This serves two purposes – it gives your partner your support and it also saves time in cooking two different types of meal by just cooking the one

Friends

People who have a friend who has coeliac disease can support their friend by the following:

• Gluten free dinner parties – if you invite your friend to a dinner party, try to ensure there is gluten-free food that they can eat. The best way to do this is to ask what foods are off limits for them and ensure to let them know beforehand which foods they should avoid. Gluten is added to many processed foods so always ask
• Discourage alcohol – if your friend has coeliac disease, they should be limiting alcohol intake as it can cause a worsening of symptoms, so try to make your social meetings ones that are alcohol free

Parents

Parents of a child who has coeliac disease can support their child by:

• Avoid smoking inside – people with coeliac disease need to be away from any cigarette smoke, as it can exacerbate their symptoms
• Cooking smaller meals – this is one way to help reduce the load on the child’s digestive system by reducing the amount of food that needs to be digested and absorbed
• Gluten free – ensure all meals cooked for the whole family are gluten free, as this can help your child feel less isolated in their restrictive diet. Always read nutrition labels on foods purchased as there can be gluten hidden in many processed foods
• Probiotics – introduce some probiotics to the child’s diet, preferably in powder form as it can be more easily assimilated into other foods, but the tablets can also be taken if this is not successful
• Psyllium – this soluble fibre is excellent for the whole digestive system as it helps to ensure the correct motion in the intestines, it helps to create proper stools in the colon and it also prevents constipation. Add a little psyllium to smoothies, breakfast cereal, muesli, but ensure it is eaten quickly as it can become gel-like and thick very quickly. Always ensure your child drinks enough water when adding psyllium fibre to their diet
• Slippery elm – find creative ways to add slippery elm to foods (smoothies, breakfast cereal, muesli) in the child’s diet. Slippery elm is one of the herbs most beneficial for any type of digestive disorder, but especially one in which there is irritation and damage to the intestinal wall and the intestinal mucosa

References

• Barker JM, Liu E. Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr. 2008;55:349-65
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Last reviewed and updated: 14 May 2024