Do you have celiac disease?
Celiac disease (gluten intolerance) causes a range of health problems, although doctors have a hard time making the correct diagnosis. 160,000 Dutch people cannot tolerate gluten, only 20,000 know it. How do you find out if you have it and what can you do about it?
In Australia, as many as one in twenty people eat gluten-free, and gluten-free eating is now a widespread phenomenon in the US, Canada and Scandinavia. In the Netherlands too, more and more people are discovering that they have health problems due to eating gluten. These are certain proteins in grains such as wheat, rye, barley and spelt. A third of people have a specific gene that can cause health problems if they eat gluten.
celiac disease
Some people with this genetic predisposition develop the autoimmune disease celiac disease (pronounced: seu-lia-kíe), or gluten intolerance. Whether this happens depends, among other things, on the extent to which they have been exposed to grain products. The more gluten a person ingests, the sooner a gluten intolerance comes to light. Research by Wageningen University shows that the chance of this has increased in recent years. Not only do we eat more pasta than in the past, we also use wheat varieties that contain a relatively high amount of gluten.
Diagnosis often missed
Prof. dr. Dr Chris Mulder, professor of gastrointestinal and liver diseases at the VUMC in Amsterdam estimates that about 1 percent of the Dutch population suffers from gluten intolerance. This percentage is higher for people over 60: 1.5 percent, because the ailment can also only develop at a later age. So far, about 20,000 people have been diagnosed with this. They are the tip of the iceberg: an estimated 140,000 Dutch people are walking around with health problems without realizing that they are caused by eating gluten. The diagnosis is often missed.
Pretty drastic
People can walk around with complaints from gluten for years before it becomes clear what the cause is. “In retrospect, I had suffered from it all my life. As a child I had a round belly, narrow legs and slowed growth,” says Louk de Both (63). He didn’t discover gluten intolerance until he was 44, having undergone numerous tests from childhood.
Anemia and Osteoporosis
In celiac disease, gluten causes inflammation in the mucous membrane of the small intestine. This leads to damage to the intestinal villi, which impairs the absorption of nutrients from the food. The result: deficiencies of especially iron, folic acid and vitamins B and D. In the long term, this causes complaints such as: anemia and osteoporosis. De Both: “When I once again came to ask for sample pills because of my anemia, my doctor suggested a study into celiac disease, because he had just followed a refresher course.” It turned out to be a hit.
Gluten free diet
The remedy is a gluten-free diet. As a result, De Both quickly felt better and gained eight kilos in six months. The gluten-free diet ensures that the damaged mucous membrane in the small intestine recovers slowly. The diet is valid for life, because the intolerance cannot pass. Eating gluten-free is quite radical, because gluten is not only found in bread, cookies and pasta, but also in soup or spreads, for example. In it, they are used as binding and adhesive. Even a trace of gluten can cause symptoms. Work is underway on gluten intolerance drugs, but there is still a long way to go. However, wheat varieties with safe gluten will be developed in a few years’ time.
CVS
Although approximately 20,000 Dutch people are diagnosed with celiac disease, it is estimated by the food manufacturers of gluten-free products that approximately 50,000 people eat gluten-free. Many examples can be found on the internet of people who have not (yet) been officially diagnosed with celiac disease with a blood and/or intestinal test, but who nevertheless choose to eat gluten-free, for example because they suffer from CVS (chronic fatigue syndrome).
Research by Australian scientists published earlier this year shows for the first time that there is indeed a group of people who are gluten intolerant, while they cannot be diagnosed with celiac disease. Also with Yvonne Olsthoorn (50) a blood test in the hospital three years ago did not indicate celiac disease. Subsequently, research via an alternative institute into the effect of three hundred foods did show a reaction to gluten. “As a child I suffered from eczema and later a period of psoriasis. In recent years I had red spots on my hands, which could be very itchy. I also remained overweight after my last delivery.” Although she was not officially diagnosed with celiac disease, she feels much better since she started the diet. The spots on her hands have almost completely disappeared.
Family members
An important clue to gluten intolerance is a close relative with this problem: 10 percent of first-degree relatives also have it. Furthermore, there is a significant overlap with other autoimmune diseases such as rheumatism, thyroid disorders, the Crohn’s disease and type 1 diabetes. As many as a fifth to a quarter of people with rheumatism also have celiac disease.
Vague complaints
Professor Mulder specializes in gluten intolerance in adults. “Many GPs think that celiac disease is a childhood disease. But only one in five people with gluten intolerance discover it before the age of 20. Not only is the condition often discovered late, you can also eat gluten for years without problems and the disease only later in life. develop.”
The problem with making the diagnosis in adults is that the symptoms in children are different. In them, a clear indication of gluten intolerance is stunted growth and spindly legs. Other possible symptoms: chronic diarrhea or constipation, abdominal pain, migraine, fatigue and weight loss. In adults, the symptoms are often more vague. In them, unexplained infertility can be an indication, also in men, as can neurological complaints, such as neuropathy (decreased nerve function, resulting in, for example, a numbness, tingling or burning sensation in fingers and toes) or epilepsy. Adults usually do not have diarrhea or weight loss.
overweight
“A third of my celiac patients even have overweight“, says Mulder. “Because they absorb too few nutrients, they are always hungry and they eat a bag of chips, for example.” He also sees too skinny celiac patients diagnosed with anorexia nervosa and people whose GPs dismiss their fatigue symptoms as psychosomatic .
Gluten intolerance can also be revealed by skin problems. The body then reacts to gluten with blisters and itchy inflammations of the skin, especially on the elbows, buttocks and knees. This ‘skin variant’ of gluten intolerance, dermatitis herpetiformis, is still often mistaken for psoriasis. The confusion is not surprising, because there is a large overlap between psoriasis and celiac disease, as scientific studies have shown in recent years. Gluten intolerance in people over 50 mainly manifests itself in anemia or osteoporosis. Mulder: “If people suffer from anemia, collapsed vertebrae due to osteoporosis and another autoimmune disease such as rheumatism, they should definitely think of celiac disease. Even with mild complaints.”
Better recognizable
Almost everyone with gluten intolerance benefits from a gluten-free diet. In a small group, however, this does not help and the inflammatory reaction in the intestines continues: this is called ‘refractory celiac disease’. This occurs in people over 50 whose gluten intolerance has remained undiscovered for a long time. These people are at risk of developing T-cell lymphoma, a usually fatal form of leukemia.
In recent years, Dutch doctors have been tracking more and more people with a gluten intolerance and – through them – often also family members. Twenty years ago, only eight hundred were known nationally. They still had to bake bread themselves. Nowadays, supermarkets increasingly have a gluten-free shelf and gluten-free products are also available via the internet. They have also become more recognizable: since 2005, the packaging must state whether a product contains gluten.
Fortunately, diet products have also become a lot tastier in recent years, Louk de Both notes. “In the past, bread was dry and tasted like plastic.” Gluten ensures that bread becomes airy and soft. Baking without gluten is an art in itself. The Dutch Celiac Association (NCV), of which De Both is an advisor and chaired until last year, provides baking lessons. Furthermore, in the Netherlands, more and more restaurants offer excellent gluten-free options. There are tips on the NCV site.
Sources):
- Plus Magazine