Dr Rupert Ransford Dietary Advice

Diets and Coeliac Disease

Coeliac Disease is a very interesting condition as it one of the only medical conditions that can be treated by diet alone. The changes in the lining of the small intestine can usually be completely reversed by a gluten free diet. The diet however must be strict as even very small lapses can result in the symptoms returning. The diet is usually also life-long so an accurate diagnosis is essential to ensure the strict diet is worthwhile.

The blood tests for Coeliac Disease (tissue transglutaminase or endomysial antibodies) are very helpful but are not 100% accurate and a biopsy of the small bowel (duodenum) is therefore recommended. This can be done using a telescope (Upper GI Endoscopy) and takes only about 10 minutes. Biopsies are taken through the telescope of 2 -3 mm only in diameter and analysed in the laboratory to make a diagnosis.

Once the diagnosis is made then a formal Dieticianís assessment and treatment plan is needed as there are many foods and drinks that surprisingly contain gluten. Some patients are extremely sensitive to any gluten and even cross-contamination in the food manufacturing process can cause a recurrence of symptoms. Some patients also find oats difficult to tolerate but about 90% of patients can take oats once they have been on a gluten free diet for six months.

Iron deficiency anaemia

Coeliac disease can cause iron deficiency anaemia and a large research study in Herefordshire demonstrated that 1 in 10 patients with iron deficiency anaemia had Coeliac Disease after testing. Many patients had been anaemic for a number of years with some even being anaemic for twenty years before the Coeliac antibody tests were done and the cause found to be underlying Coeliac disease. Shortages of folic acid, vitamin B12 and calcium can also occur and there is an association with osteoporosis. There is now good experience in diagnosing and treating Coeliac Disease and with improvements in gluten free foods in the supermarkets, the condition is well worthwhile looking for and diagnosing accurately.

There is extensive and useful information from the Coeliac Society of the UK and their website is recommended, as, unlike many others on the internet, the Coeliac UK website information is checked by Doctors and Nurses and regularly updated.

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DR RUPERT RANSFORD MRCGP MD FRCP
Consultant Gastroenterologist
NUFFIELD HEALTH, HEREFORD HOSPITAL, VENNS LANE, HEREFORD HR1 1DF