Coeliac disease is a common condition where a person is intolerant a protein called gluten. When a person with this intolerance encounters gluten in their diet they will often develop diarrhoea and experience bloating and abdominal pain. The condition is caused by the body attacking itself (known as an auto-immune disease) and requires the sufferer to exclude all gluten from their diet. When a person suffers from a gluten-intolerance their intestines get damaged whenever they eat gluten protein. The surface of the intestines are covered by tiny hair-like growths that help digest food, but in coeliac disease sufferers these hairs are thought to be attacked by antibodies (which mistake them for bacteria) leaving them inflamed and flattened. Absorption of food is limited, and the symptoms of coeliac disease start to appear.
Does eating a gluten-free diet reduce symptoms of coeliac disease?
A gluten free diet removes all traces of the gluten protein from a person’s diet, and is thought to be the most effective way to prevent flare-ups of coeliac disease. This means excluding wheat, barley and rye (and all foods that might contain it) and replacing them with gluten free alternatives.
The 2010 guidance by the British Society of Gastroenterology states that “the treatment of coeliac disease is a lifelong gluten-free diet”.1 The term ‘gluten’ includes all the proteins derived from wheat, rye and barley. Wheat flour is contained in bread, breakfast cereals, pasta, pizza, pastry, biscuits, cakes and sauces. A typical daily diet contains an estimated 10-20 g of gluten, derived from multiple sources and a gluten-free diet therefore necessitates a calculated avoidance of many foods. The Codex standard (used in the UK and Europe) suggests that food containing less than 20 ppm (parts per million) of gluten can be labelled as ‘gluten free’ and that foods containing between 21-100 ppm of gluten can be labelled as ‘very low gluten’. This guidance also points out that patients require regular dietetic support with the opportunity to see a gastroenterologist should further problems arise.1
Further information about gluten-free food and the new law regarding food labelling can be found on the NHS Choice website.2
The 2009 NICE guidelines for coeliac disease state that the disease is present in up to 1 in 100 of the population although only about 10–15% of people with the condition are clinically diagnosed. They say it is important to identify people with the undiagnosed disease so as to provide satisfactory individual treatment and also to improve the overall health of the community.3
A 2005 report by North American Society for Pediatric Gastroenterology, Hepatology and Nutrition states that in order to completely remove gluten from the diet, less obvious sources of gluten must also be identiﬁed and avoided. For example, gluten may be found in products such as beer, soy sauce and stocks.4
A number of studies have been carried out to find out how much gluten could be included in the diet. A 2008 systematic review concluded that “the amount of tolerable gluten varies among people with coeliac disease. Although there is no evidence to suggest a single definitive threshold, a daily gluten intake of 5
Some recent studies indicate that the protein found in oats may not be harmful to most people with celiac disease. [6,7] A 2007 systematic review on coeliac disease and oats concluded that: “coeliac patients can include oats in a gluten-free diet although there may be the occasional patient who is also oats sensitive. Previous conflicting results may have been partly due to contamination of oats by wheat. Lest contamination is present and exceeds the safe threshold, we recommend that coeliac patients should only add oats to their gluten-free diet when they are established on a conventional gluten-free diet, and stop eating oats if they develop any symptoms.”6
Established evidence confirms the benefits of a gluten free diet for people with Coeliac disease. In addition, there is a growing number of studies indicating that most coeliac sufferers can consume a very small amount of gluten each day with little or no side effects, as well as oats (as long as they are uncontaminated with wheat).
Research evidence sources
1 Ciclitira PJ, Dewar DH, McLaughlin S, Sanders D. The Management of Adults with Coeliac Disease. London: British Society of Gastroenterology; 2010.
2NHS Choices. Coeliac disease. London: Department of Health; 2011. Available here
3NICE. Recognition and assessment of coeliac disease. CG86. London: National Institute for Health and Clinical Excellence; 2009. Available here
4NASPGHAN. Gluten-Free Diet Guide for Families. Flourtown (PA): North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; 2005.
5 Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with coeliac disease. Aliment Pharmacol Ther. 2008;27(11):1044-52.
6 Garsed K, Scott BB. Can oats be taken in a gluten-free diet? A systematic review. Scand J Gastroenterol. 2007;42(2):171-8.
7 Haboubi NY, Taylor S, Jones S. Coeliac disease and oats: a systematic review. Postgrad.Med J. 2006;82(972):672-8.