(8) Coeliac disease
Coeliac disease occurs as a result of intolerance to
gluten. This produces intestinal atrophy and symptoms of malabsorption,
such as diarrhoea, failure to thrive and loss of weight. Flatulence, abdominal
distension and feeling tired all the time are also common symptoms. The
patient may have anaemia (due to deficiency of iron or folate). Coeliac
disease used to be thought to occur mainly in infants and children, but
it is now increasingly diagnosed in adults. Moreover, with a prevalence
of at least one in 300, it is no longer a rare disease. More than two
thirds of cases are undiagnosed; this is largely because symptoms may
be non-specific.
- The main treatment for coeliac disease is a strict gluten-free diet.
This means avoiding all foods containing wheat, rye, barley, and, often,
oats.
- Many processed foods contain gluten, so food labels should always
be checked.
- Patients should always be referred to the Coeliac Society for an up-to-date
list of gluten-free manufactured foods.
- Some medicines contain gluten. Even the small amount of gluten contained
in a tablet may lead to return of symptoms in a patient with coeliac
disease. If in doubt as to the gluten content, always check with the
manufacturer.
- A range of manufactured gluten-free foods (eg, bread, flour, biscuits,
pasta) exists, some of which is prescribable under ACBS guidelines.
Be aware of the ranges available so that you can advise on alternatives
where appropriate.
- Apart from being gluten free, the diet should be as normal as possible,
following current healthy eating guidelines and using gluten-free cereal
products to encourage consumption of starchy carbohydrate and fibre.
- Coeliac disease is associated with osteoporosis, due mainly to a reduced
ability to absorb calcium and other nutrients. Compliance with a gluten-free
diet, together with calcium and vitamin D supplements, protects against
further bone loss.
- Coeliac disease is associated with a risk of gastrointestinal tumours;
long-term dietary compliance is protective against this.
- Above all, emphasise the importance of dietary compliance, as difficult
as this may be for some people. Non-compliance is associated with return
of symptoms, nutritional deficiencies and other long-term complications.
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This series of “dietary advice tips” is intended
to be a reminder of the main points to be made by pharmacists when giving
nutritional information to the public. The conditions included in the
series are those where diet is a well recognised risk factor, those in
which diet contributes to the management of the condition, and others
for which patients may welcome sound dietary advice.
Written by Dr Pamela Mason (a pharmacist with a postgraduate qualification
in nutrition)
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