Coeliac disease - a pain in the gut

It's a lot easier to eliminate gluten from your diet these days. There's a growing awareness, more medical research and, as a result, a whole industry dedicated to producing gluten-free food.
Speaking of the industry, the annual Gluten-free Food and Allergy Show in Auckland this month, then later in Wellington and Christchurch, showcases more than 100 coeliac-friendly food companies to thousands of visitors.
Most cafes and restaurants have gluten-free options, but as one gluten-intolerant sufferer, Pippa Brown, says, it's still not easy living gluten-free.
"It's hard carrying around a suitcase of special food and looking for the word coeliac in a language I am not familiar with. Or when I stay at people's places, I have to be prepared to at least take gluten-free bread. If I eat out with a group and know where I'm going I will ring ahead and ask for something to be gluten-free," she says.
"It is embarrassing to always have to ask if the hot chocolate has gluten in it or if a cafe has gluten-free bread."
Pippa eliminated gluten from her diet seven years ago and says she's not the slightest bit tempted when a piece of cake is on offer.
"It's not worth it. I'd feel sick for two to three days. I'd still go to work but my stomach would churn and I'd constantly feel ill."
She reacts to even small amounts of gluten but describes her condition as moderate; she knows of others who are left bed-ridden for days if they stray from their gluten-free diet.
In more severe cases, eating food containing gluten can cause infertility, insomnia, moodiness and fatigue.
However, for most sufferers small and occasional exposure to gluten is okay. Repercussions of eating a biscuit can vary in severity, and include symptoms similar to irritable bowel syndrome like diarrhoea, constipation, abdominal pain and bloating.
Intolerance differs from coeliac disease. Gastroenterologist Malcolm Arnold explains the disease is an allergy and that those with it have to completely eliminate food containing gluten from their diet.
The disease is permanent, hereditary, and sufferers are at risk of developing nutritional deficiencies if their diet is not sufficiently managed.
Dr Arnold says during an allergic reaction the immune system reacts "in an aggressive way" to gluten.
It stimulates the production of antibodies that cause villi - the small finger-like protrusions that line the gut - to shrink, reducing the ability to absorb some nutrients, minerals and vitamins from food.
"You can live a normal life if you stick to the diet. But if you're not strict on your diet the villi will shrink again ... and your gut's not able to absorb specific nutrients for example, folic acid and iron in red meat. It's very very uncommon, but coeliac disease can kill you if you have not sought medical assessment because you're deficient in nutrients," says Dr Arnold.
Without adjusting their diet, people with coeliac disease lose or struggle to put on weight, can become anaemic, suffer nutritional deficiencies and have a heightened risk of lymphoma and small bowel cancer.
Genetics play a "significant part", says Dr Arnold and it pays for family members of sufferers to get checked as some people show no outward signs of having the disease, while internally the gluten is damaging their intestines.
For most, a simple blood test is enough to alert a medical practitioner to the likely diagnosis of coeliac disease, although a more accurate result should be obtained with an intestinal biopsy.
Dr Arnold says there is a common misconception that gluten is "bad" for general health. It's naturally present in wheat, barley, oats and rye. "There's no evidence of it being a nasty thing, unless you have one of the conditions."
Food labelling and greater awareness has helped sufferers avoid gluten, but there are ways gluten-containing food can sneak into people's diets. Simply using a toaster that is used for regular bread can contaminate gluten-free slices, and likewise the supposed safe option of hot chips can become contaminated by gluten from battered and crumbed fish if it's cooked in the same oil.
Pippa has altered her lifestyle since being diagnosed, but the health benefits offset the inconvenience.
"I had always felt unwell with non-specific symptoms, but when I took gluten out of my diet, the change was dramatic."
She not only had more energy, but the constant nausea and chronic fatigue disappeared. The change was almost instantaneous, she says.