If you are a coeliac, is a gluten free diet enough?

So if you do have coeliac disease (see post http://entirewellbeing.com/coeliac-disease/ for more information on this condition), do you just simply cut out gluten and everything will be alright?

If only it were that simple……..

Although the majority of newly diagnosed coeliacs will experience substantial improvements in their symptoms within the first few weeks of cutting out gluten, research shows that between 10 and 15% of coeliacs continue to experience health problems even when following a gluten free diet. These are called ‘non-responsive coeliacs’. This might be (and often is) explained by unintentional gluten contamination (it is very easy to get ‘glutened’ – and it only takes one eighth of one teaspoon of a gluten flour to reignite the immune response and ‘contamination’ can also come from hundreds of non food items including shampoos and cosmetics). However, between 1 and 5% of coeliacs develop what is called ‘refractory coeliac disease’ (RCD) where any gluten (even levels found in foods termed ‘gluten free’ e.g. bread) cannot be tolerated. This is a very serious sub category of coeliac disease and can lead to significant health problems if not managed appropriately.

Excluding unintentional contamination and RCD, the other key reason for symptoms not improving on a gluten free diet is ‘cross reactivity’.

Research shows that there are a number of other food proteins that can cause the immune system to react in a similar way to gluten, thereby potentially perpetuating chronic inflammation and the destruction of the villi (the finger like protrusions in the small intestine that are damaged by coeliac disease). We know that around 50% of all coeliacs cross react with casein in dairy. Other cross-reactive gluten free foods include oats, yeast, rice and corn (consumption of these foods are actively encouraged as a coeliac). Maybe this is why only 8% of adults with coeliac disease experience complete healing of the villi on a gluten free diet and why there is evidence of poor vitamin status in coeliacs who have been on a gluten free diet for 10 years?

In summary simply excluding gluten from the diet is not good enough. If you are a coeliac some of the key questions that you should be asking yourself include:
1) Might I be exposing myself to gluten contamination from my environment (e.g. skin care products and cosmetics)?
2) What gluten ‘cross reactive’ foods might I also be reacting too?
3) How much damage has been done to the digestive system (prior to diagnosis) and what extra support do I require to help repair this damage?
4) What impact has coeliac disease potentially had on my overall nutrient status?

These questions and more can be answered by working with a suitably skilled and knowledgeable functional practitioner.

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