Gluten Intolerance – The Coeliac Condition.

By : Lucille Cholerton

There are many names for this condition:- Gluten Intolerance, gluten “allergy”, Gluten enteropathy, Gluten sensitivity, Malabsorption Syndrome, Coeliac Disease, (pronounced see-lee-ack), Coeliac Sprue, the Coeliac Condition, (also spelled Celiac in USA), and Dermatitis Herpetiformis.  Although it goes by many names, it is the SAME condition. Whether someone suffers from, say, three of the milder symptoms, or from one of the major symptoms, the root cause may be the same underlying sensitivity to gluten.

So what is gluten? Gluten is a protein found in wheat, rye, oats and barley.

What damage can it do? In persons sensitive to it, a process of an autoimmune reaction causes flattening and shrinkage of the microscopic finger-like projections in the small intestine called villi. The purpose of the villi is to absorb nutrients from food, and by a process of enzyme activity, digest and break down food particles to a soft consistency so that they can pass through the digestive tract in a texture that makes elimination of waste products easy. When the villi are flattened, digestion of food is impaired, and the full spectrum of vitamins, minerals, trace elements, amino acids, enzymes, fats and water are not absorbed properly.

The Coeliac Condition is hereditary, passed down through the generations, and one has to look to parents and grandparents, children and grandchildren, brothers and sisters for symptoms. If one person in a family is diagnosed there is a 10% chance that other members will be sufferers. What does make it very tricky to diagnose is that every member of the same family may have different symptoms. If one is not diagnosed as a baby, one can suffer minor symptoms all ones life, without realising the underlying cause. This is because there are so many over-the-counter remedies for all sorts of symptoms, and we all tend to treat our minor symptoms with any number of over-the-counter remedies because we do not wish to bother a doctor. Also, we eat such a varied diet that the symptoms can be “masked” for years. It is often only when people have tried an elimination diet that they have discovered their food intolerances.

In the past, doctors have only recognized the condition in people suffering from chronic diarrhoea and severe weight loss. But this has now changed. According to research done both in USA and UK in the last 10 to 15 years, gluten could be at the root of any of the following GROUPS of symptoms.

• Upper respiratory tract problems like sinusitis, “allergy”, “glue ear” in babies, asthma, bronchitis, post nasal drip, headaches and migraine.
• Symptoms related to malabsorption of nutrients like anaemia and fatigue (lack of iron or folic acid), osteoporosis, insomnia (lack of calcium), skin complaints like eczema, urticaria, psoriasis, Dermatitis Herpetiformis (lack of vit A), mouth ulcers, irritability, nervous system complaints,(lack of B vitamins), underweight or overweight (imbalance of utilization of carbohydrates), poor growth in children and babies, (lack of absorption of all nutrients, and impairment of growth hormone), infertility (hormone production impaired because of malabsorption of other nutrients), thyroid imbalance, pancreatic problems, diabetes.
• Bowel complaints:- diarrhoea, constipation, bloating and distention, spastic colon, Crohn’s disease, diverticulitis, stomach cramps, stomach ulcers, ulcerative colitis, IBS, lactose intolerance, gall bladder problems, bowel cancer, stomach cancer, lymphoma.
• Auto Immune System problems:- Rheumatoid arthritis, bursitis, Crohn’s disease, Multiple Sclerosis, Myasthenia Gravis, muscular dystrophy, Sjogren’s syndrome,(when the lymphocytes attack the body’s moisture producing glands), Addison’s disease, Pernicious anaemia (the lymphocytes attack the lining of the stomach where a chemical called intrinsic factor is produced, which is needed for the production of Vit B 12).
• Diseases of the nervous system:- Motor neurone disease, some of the epilepsies, tingling and numbness in the extremities, and, I believe, stammering and stuttering in children and adults.(the myelin sheeth on nerve endings is impaired) – lack of the B vitamins.
• Problems that affect the mind:- depression, behavioural problems in children, ME., ADD, ADHD, Altzheimers disease, Schizophrenia. (A Japanese Professor has discovered that there are no less than 13 opioid reactions that can occur from just 1 molecule of gluten – that is, mind-bending addictive reactions)
• Genetic problems like Down’s Syndrome, Diabetes Type 1 (Mellitus), amongst others.

What are the tests for this condition?

The tests are very new in South Africa. They only became available in October 1998. They are the IgA and IgG antibody tests for gluten or gliadin, which is the fraction of the gluten molecule which causes the problem. All Pathology Laboratories know about these tests. They collect the blood sample and send it to either Johannesburg, Pretoria or Cape Town. The tests are available on ALL medical aids.

The tests have only been available fairly recently overseas as well, but what is so interesting is that since the introduction of these tests, more than 90 people per week in UK are being diagnosed now. It must be strongly emphasized that anyone who is suspicious that they may have one or more symptoms, must go to their doctors immediately for the blood tests. Nobody should eliminate gluten before the tests otherwise the results will be inconclusive.

In Holland and in Italy, children of 2 years old and 6 years old respectively are AUTOMATICALLY tested for gluten enteropathy.  In Italy, too, all pregnant women are ROUTINELY screened for gluten enteropathy. These countries are now finding statistically that instead of 1 in 2000 being sufferers, there are 1 in 200. It is a condition that is far more prevalent than doctors realize. At the Pretoria Technikon there was a study done in 1994 in the Dept of Naturopathic Medicine, where, out of  800 volunteers who suffered  from “allergies”, 287 were found to be gluten intolerant. My guess is that if the blood tests were introduced into South Africa, we would have a similar finding here amongst ALL population groups, and there would be huge savings in medical bills as many diseases would be lessened, in later years. I recommend that before anyone is told to have surgery for tonsilitis, nasal problems, arthritis in any joint, bowel disease, gall bladder, kidney problems, liver disease, thyroid disease, or pancreatitis, or cancer, they should FIRST be screened for the coeliac condition, or gluten enteropathy.

In the past it was thought that the Irish were the most prone to this condition, but it has now been established that if your historical heritage is from UK, Wales, Scotland, the Nordic countries, Poland (Polish Jewish), Italy, South East Asia (Indians), and also the black people from Africa, you could be prone to it. The theory behind this is that in their historical past, all these nationalities ate a staple diet of either potatoes, rice, corn or millet (sorghum) and when wheat and other grains began to be cultivated, that was when the problems started. Dr Joe Murray from the Coeliac Clinic at the University of Iowa says that basically gluten-sensitive people lack an enzyme which he calls glutaminase that digests the protein gluten. He says it is also an Auto Immune reaction whereby the lymphocytes (which normally attack foreign invaders in our bodies) start to attack the body’s own tissue, in this case, the villi are attacked, causing inflammation etc.

Another point to consider in this condition is the fact that once the intestines are in an unhealthy state, it paves the way for other invaders or infections like Candida Albicans (a fungus or yeast) and Giardia Lamblia (a type of parasite). Everyone has Candida inside them, but it is when there is an overgrowth that problems can arise. If anyone suffers from Candidiasis, they must really look into the possibility that they may be suffering from a food intolerance like gluten as well. And conversely, if you are a Coeliac, you must be aware that you may also be suffering from Candidiasis. An excellent book to read on this subject is “The Complete Guide to Food Allergy and Food Intolerance” by Dr Jonathen Brostoff and Linda Gamlin, Published by Bloomsbury Publishing Ltd., 2, Soho Square, London, W1V 5DE.

Also “Candida Albicans” by Jill Jacobs. Your local library will have more on this topic.

What is the GOOD news about this condition?

The good news is that the damage is reversible . The sufferer changes to a strict gluten free diet. Vitamin supplementation may be necessary depending on the types of symptoms suffered. As soon as the gluten free diet is introduced, the villi in the small intestine start to regrow and can then start digesting food and absorbing nutrients again. The diet is a diet for life. In the old days (prior to 1970) it was thought that one would grow out of it. But that idea is no longer valid. It is now recognized that one must adhere to the diet for life if one wants optimum health, and to prevent serious complications later in life like lymphoma or bowel cancer.

How long does it take for symptoms to disappear?

In my own experience and those who come to my support group, it has been found that sinusitis and upper respiratory problems, like post nasal drip etc disappear within 2 to 3 weeks.

Arthritis takes about 4 to 5 months, but it will ease within about 3 weeks. Constipation takes about 2 to 3 months. Diarrhoea eases very quickly, within about 2 weeks. Headaches and migraine ease very quickly, within about 2 weeks. Anaemia and osteoporosis take longer. Tests every 6 months would be advisable. Bone density does increase but it is advisable to have regular bone densitometry examinations. Dermatitis Herpetiformis can take up to 2 years to heal, because deposits remain for a long time subcutaneously until they eventually drain away in the lymph drainage system. Aerobic exercise like brisk walking is of major help in this process. The depression, irritability and behavioural problems ease within 2 to 3 weeks.

Now, what of the diet itself?

First of all, one has to change from wheat based products to corn and rice based items. Rice cakes and Corn Crisps take the place of toast. Mealie Meal and Maltabella Porridge  replace all the wheat based cereals. My recipe for homemade Muesli contains chopped dried fruit, chopped nuts, 3 or 4 different types of seeds, dessicated coconut amongst others. One still has to eat fibre, but let it not be wheat based bran etc! Lots of salads and vegetables and fruit form a large portion of the diet. Pasta must be avoided, though one can buy corn and millet pasta from Health Shops. Instead of  I cup of wheat flour in recipes I substitute 1/3 cup rice flour, 1/3 cup cornflour, 1/3 cup potato starch or potato flour. There are also other flours one can use like chick pea flour, gram flour (made from lentils), tapioca flour and, in USA, bean flours! One has to scrutinize all ingredients in supermarket products very carefully and avoid items with “thickener”, “wheat starch” etc. One can bake homemade bread and cakes and pastries, but there is a lot of trial and error at first, as baked items without gluten are more crumbly and dry. In USA there is a product called Xantham Gum which is used a lot in recipes to bind the ingredients together. I have managed to source a supplier of this product here in South Africa and am now able to sell it through the Support Group. Beer and whiskey must be avoided, except Windhoek Lite and Bavarian Brau which are apparently made using the German method of distillation which is supposed to eliminate the gluten from the fermented grains. Gin must also be avoided. Brandy and wine are fine. Cider is fine. Malt must be avoided as it is made from barley.

So, there you have it!

It is actually a very healthy diet, as one avoids a lot of the processed foods and uses fresh whole foods a lot.  I do hope this has given you some idea of this condition.

I always welcome any enquiries at home 031- 764 2129 or on my e-mail:- lucoll@mweb.co.za

Some recommended books are:-

1. Can a Gluten Free Diet Help? How? By Lloyd Rosenvold M.D.  Pub. by Keats. ISBN 0-87983-538-9
2. The Gluten Free Guide for Southern Africa by Carole Smollan. Pub by Delta Books ISBN 0-908387 76 8
3. The Gluten Free Diet by Dr Peter Rawcliffe & Ruth James, Pub by Vermilion, ISBN 0-09-181511-8
4. The Gluten Free Gourmet by Bette Hagman, Pub by Henry Holt & co, ISBN 0-8050-2324-0
5. Coping with Coeliac Disease by Karen Brody Pub by Sheldon Press, ISBN 0-85969-768-1

For Medical Schools I recommend:-

1. Coeliac Disease Edited by Michael Marsh, DM.,Pub by Blackwell Scientific Pub. ISBN0-632-03097-6
2. Epilepsy and Other Neurological Disorders in Coeliac Disease, Edited by G Gobbi et al., Pub by John Libbey, ISBN 0-86196-537 X

Lucille Cholerton
Nutrition Counsellor
Specialist in Gluten Sensitivity/Coeliac Disease
Gluten Intolerance/Coeliac Support Group
Est. 1995, 1, The Palms, 13, Park Lane,
Kloof, Durban
3610

Lucille Cholerton
Phone 031- 764 2129
Fax 031-2095229
E-mail:- lucoll@mweb.co.za
Web Page:- www.allergysa.co.za