Coeliac Disease – ‘The Most Under-Diagnosed Disorder In The World

Coeliac Disease – ‘The Most Under-Diagnosed Disorder In The World

The most serious physical reaction to gluten is coeliac disease. It is an autoimmune disorder that causes the immune system to shorten the intestinal cilia resulting in a reduced nutrient uptake. Many coeliacs are not diagnosed until a relatively late age even though they have been showing symptoms for years. Furthermore most people suffering from coeliac disease remain undiagnosed throughout their lives causing the condition to be called the most under-diagnosed disease in the world.

A study published in 2009 in the journal Gastroenterology suggests that the actual number of cases of coeliac disease has grown about 400% since the early 1950s [1]. But people seeking help, diagnosis or medical evaluation in connection with reactions to gluten often find the definitions blurry and the analyses insufficient.

Coeliac Disease and Gluten
Gluten is a protein found particularly in wheat – Gluten exposure in coeliacs causes the immune system to attack both gluten and the intestinal wall

Gluten Intolerance and Public Health

Many countries lack any official acknowledgement of gluten having an impact on public health. Sweden, for instance, has officially acknowledged the problem, and consequently far more cases of gluten intolerance, gluten sensitivity or coeliac disease are diagnosed than in the remaining Scandinavian countries. In 2012, an American study showed that more than 80% of all people suffering from coeliac disease, are not aware of their condition [2].

However, it must be noted that coeliac disease is still a rare disorder, and it may fortunately be remedied by life-long abstinence from gluten [3]. Evidently, however, this necessitates awareness of the disorder, and adequate attention is still not being paid to the drastic effect gluten may have on our health.

The Gluten Molecule

Gluten is a protein found particularly in wheat, but also in rye and barley. Oat contains no gluten as such, but since they are often grown and processed along with wheat, most conventional oat products contain traces of gluten. Gluten may affect the health of anyone and far more people than previously thought react to gluten and have low tolerance for it, but most of them live their lives without realising that their symptoms may actually be caused by intake of gluten.

That said, we don’t all have to start removing gluten from our lives, but many people would probably feel better just by ingesting less gluten. For coeliacs a 100% gluten free diet is the only existing treatment.

In people who cannot tolerate or sufficiently digest gluten, the gluten molecules may, when entering the intestines, cause the white blood cells of the immune system to react inappropriately. These cells may mistake the gluten molecules for unwanted intruders or pathogenic bacteria and consequently attack them.

Coeliac Disease

In people with coeliac disease, the immune response cells do not merely attack the gluten proteins but also the enzyme known as transglutaminase found in the intestinal epithelium. Therefore, gluten exposure in coeliacs causes the immune system to attack both gluten and the intestinal wall and leads to degradation of the microvilli (cilia) of the intestines. This in turn interferes with absorption of vital nutrients from food. It is also the reason why coeliac disease is termed an autoimmune disorder.

Coeliac disease is often accompanied by the development of other autoimmune diseases such as type 1 diabetes or the metabolic disorders Hashimoto’s or Graves’ disease. An increased focus on the possible role of gluten also makes sense in connection with intestinal conditions such as Crohn’s disease or ulcerative colitis.

Coeliac disease is a serious condition and the symptoms often include smelly diarrhoea, abdominal pain and fatigue, but coeliac disease can affect just about every system in our bodies. The symptoms of coeliac disease may be eliminated by living a gluten free life. For this it is important to pay close attention to the reactions that could potentially be caused by consuming gluten. The new guidelines for diagnosing coeliac disease recommend screening for a number of markers as part of the diagnostic process.

Typical reactions to gluten:

  • Bloated stomach
  • Thin, hard or malodorous stools (particularly common among children reacting to gluten)
  • Irritable bowels or indigestion
  • Acid reflux and heartburn
  • Joint, bone and muscle pains and arthritis
  • Metabolic problems
  • Fatigue or anaemia (decrease in red blood cell levels)
  • Vitamin and mineral deficiencies often resulting in fatigue or lack of energy
  • Eczema, psoriasis or acne
  • fluid-filled rashes and dermatitis herpetiformis (Duhring’s disease)
  • Delayed puberty or stunting
  • Infertility and repeated miscarriages
  • Depression and mood swings

Gluten is found naturally in:

  • Wheat flour, whole or cracked wheat, wheat flakes, wheat germ and wheat bran
  • Rye flour, whole rye
  • Graham flour
  • Durum flour
  • Spelt, Farro/Emmer as well as einkorn wheat
  • Bulgar wheat, couscous and semolina
  • ©Kamut (Khorasan wheat)
  • Barley flour, cracked barley and pearl/whole barley

In our new book Gluten Free Secrets you’ll find all the tools you need for a gluten free life. The book offers background information as well as practical advice on how to manage a gluten free lifestyle. Gluten Free Secrets boasts a wide range of wonderful gluten free recipes for great bread, wraps and cakes as well as lunch and dinner dishes. The majority of the recipes are also without dairy, sugar and yeast. The few recipes that include these ingredients all suggest alternatives.

Anette Harbech Olesen

Anette Harbech Olesen has studied diet and nutrition in Denmark as well as the USA. She blogs about food and health issues at www.madforlivet.com and has published a number of books in Danish on subjects such as healthy fats, cancer and food. Gluten-Free Secrets is Anettes ninth book and her first in English. The book is co-authored by Lone Bendtsen who has been baking gluten-free bread professionally for years and is currently managing an organic bakery in Denmark.


With many thanks to Anette for this article and shedding further light on coeliac disease and gluten intolerance. The English version of Gluten-Free Secrets has an anticipated release date of 25th September 2014. It will be available on the Cytoplan website at a date to be confirmed.

If you have any questions regarding this article, any of the health topics raised, or any other health matters please do contact me (Amanda) by phone or email at any time. If you want to be alerted by email when a new post is published simply add your email address in the ‘Get The Latest Post By Email’ in the right-hand column.

Amanda Williams, Cytoplan Ltd
amanda@cytoplan.co.uk, 01684 310099

RELEVANT BLOG LINKS:

Cytoplan Blog: Why Gluten isn’t good for you


[1] Alberto Rubio–Tapia et al “Increased Prevalence and Mortality in Undiagnosed Celiac Disease” Gastroenterology, Vol. 137, Issue 1, Pp 88–93, July 2009
[2] Alberto Rubio-Tapia et al “The Prevalence of Celiac Disease in the United States” Am J Gastroenterol 2012; 107:1538–1544; published online 31 July 2012
[3] Alberto Rubio–Tapia et al “Increased Prevalence and Mortality in Undiagnosed Celiac Disease” Gastroenterology, Vol. 137, Issue 1, Pp 88–93, July 2009


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3 thoughts on “Coeliac Disease – ‘The Most Under-Diagnosed Disorder In The World

  1. Have you ever come across anyone who is on a gluten-free diet, yet still has the symptoms of coeliac disease. I work in a cafe where we prepare and cook wheat products. I wonder if the fact that I am handling wheat products, without ingesting them could still be affecting me?

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