From bread rolls to eye rolls: coeliac disease
You may be new to the GF life or one of the unlucky ones who can’t remember the sweet sweet taste of a simple bread roll, have always lived with the complication that is dining out and have forever envied those who needn’t worry about a “may contain” statement.
Approximately 1 in 70 Australians have coeliac disease and around 80% of them go undiagnosed.
Let’s chat about gluten, coeliac disease, the impact on the gastrointestinal system, cross contamination, reading labels, dining out and the inevitable eye-rolls from someone at the dinner party.
Gluten & Coeliac Disease
Coeliac disease is a chronic, inflammatory, autoimmune condition that occurs in genetically susceptible individuals, where the body abnormally reacts to gluten causing damage to the villi of the small intestine. Gluten is a term used to collectively describe the proteins in wheat, barely and rye (and oats*), the two main proteins affecting coeliac disease are gliadin and glutenin.
The sequence of gluten proteins are so tightly bound that they are highly resistant to gastric, pancreatic and intestinal proteolytic digestion, meaning that the normal chemical process responsible for breaking down food is already difficult even in those who do not have coeliac disease.
*A note on oats: oats don’t specifically contain gluten however they do contain a protein with a very similar molecular structure that can produce a comparable response to gluten consumption in those with coeliac disease.
The Digestive & Immune System
The small intestine is where the majority of nutrients are absorbed, it is lined with a mucosal barrier that is made up of enterocytes, villi and tight junctions. This barrier allows the passage and absorption of nutrients and at the same time prevents undesirable substances from entering the bloodstream.
For those with coeliac disease the ingestion of gluten leads to gliadin disassembling and impairing the tight junctions, resulting in inflammation and increased permeability of the gut lining. This means that the mucosal barrier is less effective at absorbing nutrients and preventing toxins and metabolic waste to enter the bloodstream, contributing to signs and symptoms of coeliac disease (see below).
Gliadin then passes through the now not-so-tight junctions, which activates T-lymphocytes (a white blood cell of the immune system). This cascade produces high levels of pro-inflammatory cytokines that leads to the immune system producing antibodies against gliadin and tissue-transglutaminase. An auto-immune reaction against tissue-transglutaminase is driven by gliadin and is only present in those with coeliac disease. Anti-tissue-transglutaminase is often the first serology test that will indicate potential for coeliac disease, this means to ensure an accurate result it’s important to consume at least 3 grams gluten 6-8 weeks prior to testing.
Signs & Symptoms of Coeliac Disease
Gastrointestinal symptoms ~ diarrhoea, constipation, bloating, gas, distention, pain, discomfort
Malabsorption of vitamins: predominantly iron, folate, calcium, vitamin D
Inflamed skin: rash, acne, dermatitis, psoriasis
Weight loss
Joint pain
Migraines
Lactose intolerance
Chronic fatigue
Fibromyalgia
Coeliac disease is associated with other autoimmune conditions such as type 1 diabetes mellitus and autoimmune thyroid diseases. Small studies have also shown that people with coeliac disease are twice as likely to develop endometriosis and people with endometriosis are significantly more likely to develop coeliac disease.
If you’re experiencing any of the above, I would love to support you in identifying the underlying causes and creating a plan tailored to your presentation.
Cross Contamination
When I was initially diagnosed with coeliac disease I read a blog that told me I needed a second toaster and to throw out all of my chopping boards as tiny little gluten remnants could live in the cervices of where a knife had probably once cut a nice fluffy loaf of sourdough from Sonoma.
Apartment living, Sydneysiders could agree that there’s not enough bench space for two toasters so here are some tips to reduce cross-contamination in your kitchen:
Always use separate chopping board/cutlery/crockery when preparing food
Get used to using the grill to toast your bread
Have a negotiated GF side of the butter dish, and hope your significant other sticks to it
Reading Labels
If you’re new to the gluten free life you’re about to spend twice as long at the supermarket just reading the labels. Here’s my advice & what’s worked for me:
Do not consume:
“contains gluten”
“may contain gluten”
“contains wheat, barley or rye”
“processed in facilities that package gluten containing products”
Depends on your personality type:
No statement on gluten but also no wheat, barley or rye listed in the ingredients
Would probably eat:
No statement on containing gluten, no gluten in the ingredients list with a “may contain” statement on other allergens i.e “may contain nuts, soy etc.”
Go wild:
“gluten free”
Fresh produce
Just, no:
“gluten friendly” – read on.
Dining Out
Cafes and restaurants are becoming increasingly aware of including GF items on their menus, however it’s not as seamless as BC (before coeliac) here are my tips to eating out:
Check the menu online prior to attending
Insert a note upon booking
Get comfortable asking questions and double-checking
Trust your gut, if you’re not satisfied with the answer perhaps clarify or move on
Be kind to hospitality staff :)
Eye-rolls from the Dinner Party
To some it may seem like you’re being difficult and it’s a tad annoying to manage the cross contamination particularly if someone else is preparing meals for you. In my experience, it is best to remain grateful while ensuring you’re confident in what you’re eating. Those accidental intakes are worse, and the effects are longer-lasting than any eye-roll. Always BYO gluten free bread when attending someone else’s home.
There’s no such thing as Gluten-Friendly
Perhaps more of an indulgent rant but can we please ban the term “gluten friendly”, there’s nothing friendly about gluten to a coeliac. Too many times have I read a menu online, seen “GF”, decided to attend only to see in the fine print that “GF” = gluten friendly when in fact there’s nothing friendly about the gluten.
If you’ve recently found out you have coeliac disease, are a GF veteran or suspect that you’re reacting to something in your diet I would love to support you in identifying the underlying cause and restoring your gut health.
Lastly,
What did the doctor advise his coeliac patient to do? …. Get bread rest.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601386/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437500/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571667/
https://pubmed.ncbi.nlm.nih.gov/23681421/
https://pubmed.ncbi.nlm.nih.gov/21840904/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231157/
https://www.coeliac.org.au/s/coeliac-disease