Coeliac used to be a disease that was characterised by visible malnutrition and digestive symptoms. Nowadays it’s not uncommon for it to be diagnosed while undergoing health checks for something seemingly unconnected, like anaemia or problems carrying a pregnancy to term, or osteoporosis, or sometimes even lactose intolerance (as the enzymes that produce lactase enzyme are produced in the same part of the intestine).
In some ways, it is now harder to diagnose because up to a third of coeliacs may even be overweight. Equally, it commonly develops later in life.
Though it’s a genetic disease, people generally aren’t born with it. Almost one fifth of Irish people have the genes associated with Coeliac but less than 1% actually develop it.
Though gluten, contained in grains like wheat, barley, spelt and rye, is needed to develop the disease, it’s not the only factor. And it is not uncommon for coeliacs to also have reactions to a number of foods.
Being coeliac is NOT the same as being gluten-intolerant or wheat intolerant. These latter conditions are much more common and sufferers can typically have some low level of exposure without major ill effects. If you are coeliac, you don’t have that luxury. None means none. For coeliacs, not sticking to a gluten-free diet can reduce life expectancy.
Testing typically involves a blood test and a confirmatory endoscopic test in the hospital. Xeliac Pro is a rapid screening test for Coeliac Disease. You can find out if you’re coeliac in half an hour.
Description of test: This test (XeliacPro for professional screening use) gives a positive result if you have antibodies (IgA or IgG) to Tissue Transglutaminase (tTG) that are associated with coeliac disease. If you have an IgA deficiency, which is more common in coeliac patients, the test is positive if you have only IgG antibodies to tTG. The presence of at least one type of these antibodies indicates a high probability that you have coeliac disease. If the test is negative and neither type of antibody has been detected then coeliac disease can be virtually ruled out.
Is the test result correct? This test has been validated against laboratory tests and has been shown to be very reliable, (96.5% sensitivity, 97.3% specificity) when carried out in accordance with the instructions. The test would only give a false negative result in rare cases, such as when the levels of tTG antibodies are very low. Please note however that the test result can be adversely affected if insufficient blood is used or it is dispensed incorrectly.
About Coeliac Disease: Coeliac disease is a serious autoimmune disorder that can develop in people with a certain genetic predisposition. About 20% of people in Ireland have this predisposition. Studies at the Mayo Clinic in the US compared the prevalence of coeliac in the 1950s (by testing frozen blood samples from that period) and determined that it has grown roughly 5 times more common since then. Bread or gluten consumption have hardly increased over this period, but consumption of other potentially problematic foods, including sugars and saturated fats, have. While the precise trigger is not yet known, the increase in coeliac parallels increases in other auto-immune and allergic disease over this period. It is now not uncommon to first become coeliac in later life.
In the US, about 1% of the population is coeliac. Ireland is fast catching up. Once diagnosed, it is likely permanent. It can give rise to a wide range of symptoms such as diarrhoea, abdominal bloating, weight loss, lactose intolerance, skin ailments and signs of malnutrition. Coeliac involves a permanent intolerance to gluten, a group of proteins found in wheat, barley, rye and many other cereals. Exposure to gluten results in an immune response and production of specific antibodies (IgA and IgG) to tissue transglutaminase.
The next step: If you have a positive result, this diagnosis must be confirmed by your doctor. The clinical advice is to adopt a gluten-free diet to avoid the symptoms of the disease. A gluten-free diet will decrease disease symptoms and also the levels of the coeliac disease-associated IgA and IgG antibodies. This has implications for taxation (hospital-confirmed coeliacs can claim tax relief on gluten-free produce in the Republic of Ireland while certain GF produce is available on prescription in Northern Ireland).
If you had a negative result, it is very unlikely that you have coeliac disease. However, no test is 100% effective and it is known that at very low antibody levels (e.g. after weeks of gluten avoidance) the test may give a false negative result, so do not delay seeing a doctor if you have worrying gastrointestinal symptoms - or if the test result is contrary to your expectations. Alternative possible explanations for wheat-related symptoms include non-coeliac gluten sensitivity characterized by presence of non-allergic IgG antibodies against gluten (research at Mass Gen Hospital). Recent estimates (Boston) suggest that for every coeliac, there are ten people who suffer from non-coeliac gluten or wheat-protein intolerance. Treatment involves switching to a low-gluten or gluten-free diet. Review your diet with a nutritional therapist or dietician for other possible causes of symptoms.