Coeliac Disease and Food
It is accepted by the medical profession that coeliac disease is caused by food intolerance. Feighery writes in the BMJ that coeliac disease is an inflammatory disease of the upper small intestine and results from gluten ingestion in genetically susceptible individuals. Treatment consists of permanent withdrawal of gluten from the diet, which results in complete remission (3). This has been the view since 1952 when Anderson et al published a paper identifying gluten as the cause of coeliac disease (1).
However, as Gottschall tells us, prior to 1952, coeliac disease was being treated as a carbohydrate intolerance problem by a specific carbohydrate avoidance diet. She argues that the gluten free diet does not work for all sufferers because of the continued use of carbohydrates (4).
It does seem to be the case that straightforward avoidance of gluten does not work for everyone.
An Australian study (2) set out to explore why some people with coeliac disease continue to have symptoms even when following a gluten free diet. Thirty nine adults who had persistent gastrointestinal symptoms despite adhering to a gluten free diet were evaluated. They discovered that 22 (56%) were consuming a gluten free diet as defined by the WHO/FAO Codex Alimentarius (Codex-GFD), in which foods containing up to 0.3% of protein from gluten-containing grains can be labeled as 'gluten free'. The remaining 17 were following a 'no detectable gluten diet' as defined by Food Standards Australia.
All 39 followed the 'no detectable gluten diet' during the study. For 5 of the 22 who made the change in diet symptoms disappeared and were reduced for a further ten. Food elimination diets were then tried with 31 of the participants leading to further improvement for 24 (77%). Three common problems were soya, amines and salicylates. They argue that if symptoms persist after following a 'no detectable gluten diet' then other food sensitivities should be explored.
For information on elimination diets and testing of foods please see the articles on food intolerance and/or the Food Intolerance Handbook.
(1) Anderson CM, French JM et al. Coeliac disease: gastrointestinal studies and the effect of dietary wheat flour. Lancet 1952;1:836-842.
(2) Faulkner-Hogg KB, Selby WS, Loblay RH, Morrow AW. . Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999;34(8):784-9
(3) Feighery C. Coeliac Disease. BMJ 1999;319:236-39.
(4) Gottschall E. Whatever happened to the cure for coeliac disease? Nutritional Therapy Today 1997:7(1):8-11.
(2) Faulkner-Hogg KB, Selby WS, Loblay RH, Morrow AW. . Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999;34(8):784-9
(3) Feighery C. Coeliac Disease. BMJ 1999;319:236-39.
(4) Gottschall E. Whatever happened to the cure for coeliac disease? Nutritional Therapy Today 1997:7(1):8-11.