03 Dec Gluten, Coeliac Disease and Its Effect on Lactose Consumption
An allergic food reaction sends someone to the emergency room every three minutes on average. (Facts and Statistics | Food Allergy Research & Education, 2018). Identifiable by an inappropriate immune response, food allergies must have an adverse health effect that is reproducible when exposed to a specific food (Cunningham, 2016). When exposed to the specific food the immune system attacks proteins in the food that are normally considered harmless. Cunningham (2016) further states that responses can occur within seconds of the exposure to the trigger food through to 24-48 hours later and the severity of symptoms can be very minimal (itching, hives) to life threatening (throat tightening, difficulty breathing). Similarly, a food intolerance reaction is likened to a food allergy in its symptoms. The body is disturbed by the trigger food however it does not affect the immune system like an allergy does (Dean, 2000). A food intolerance is generally less serious in nature and generally limited to digestive issues (Dean, 2000).
In 2011-12 The Australian Health Survey: Nutrition First Results – Foods and Nutrients identified 17% of Australians aged 2 years or over (or 3.7 million people) reported avoiding a food type due to allergy or intolerance. Although there are many types of allergens the 2011-12 survey revealed that the most common type of food reported causing allergens/intolerance was Cow’s milk/Dairy (4.5%), followed by Gluten (2.5%). Furthermore, The Australian Health Survey also noted that food avoidance due to allergy or intolerance was most prevalent among males aged 31-50 years (17%) and females aged 51-70 years (25%). On a more global scale, researchers estimate that up to 15 million Americans have food allergies, including 5.9 million children under age 18. Additionally, about 30% of children with food allergies are allergic to more than one food (Facts and Statistics | Food Allergy Research & Education, 2018). Notably, up to 75% of the world’s population is estimated to be lactose intolerant to some degree (Facts and Statistics | Food Allergy Research & Education, 2018).
Coeliac Disease (CD), is a chronic autoimmune inflammatory condition of the small bowel triggered by the ingestion of rye, wheat, barley and related cereal proteins in humans that are either genetically predisposed or environmentally effected (Ojetti et al., 2005). In CD, immune cells mistakenly attack the lining of small intestine and can occur when exposed to as little as 10-50mg per day with a single slice of bread containing 1600mg of gluten (Allen, 2015). CD, effects 0.3-1% of Caucasians although Woodward (2015) states that high prevalence also occurs in North African and Middle Eastern Populations. Furthermore, Woodward (2015) also affirms that there are seldom reported cases of CD in oriental or black Africans and that CD is mainly confined to the Northwest of the Indian subcontinent.
Gluten, the protein complex found in the endosperm portion of certain grains, including wheat, rye, and barley and is the generic term used for the protein fraction that is largely responsible for CD (Lundin and Alaedini, 2012). Lundin and Alaedini, (2012) says that the inflammatory response in the small intestine caused by the ingestion of gluten leads to “villous atrophy, crypt hyperplasia, and lymphocytic infiltration”. The official diagnosis of CD is based on symptom history (ability to reproduce), family health history and distinguishing changes found in the small intestinal by way of a biopsy i.e. absence of villi, lymphocytic infiltration and crypt hyperplasia (Lundin and Alaedini, 2012).
Table 1. Some examples of side effects that have been reported in association with Coeliac Disease
SIDE EFFECTS ASSOCIATED WITH COELIAC DISEASE
|Tingling and/or numbness in hands and feet|
(Lundin and Alaedini, 2012)
The introductions of a gluten free diet is currently the only known treatment for not only CD but any diagnosed gluten related disorders (Allen, 2015). Ironically, many of the foods that are gluten-free foods are natural wholefoods that have not been synthetically created or modified. For example all vegetables, fruits, meats, and dairy products that have no added ingredients are all gluten free (Brehm-Curtis, 2015). On the other hand Brehm-Curtis (2015) explains that there are also some food products such as bread that can be altered with substitutes to remove the wheat and gluten and make them a suitable choice for people with CD.
In 2005 a study conducted by Ojetti et al. noted that CD is a common cause of secondary lactose intolerance. Ojetti et al., (2005) found that of all those studied with lactose intolerances, an outstanding 24% had villous atrophy, confirming CD. Those with CD have extensive damage to the gut lining due to the consumption of Gluten and notably the enzyme lactase resides in the brush border of the small intestines meaning that the body isn’t making enough lactase or that the lactase enzyme that is made doesn’t work correctly (Ojetti et al., 2005). In addition, Ojetti et al., (2005) articulates that there is a greater incidence of lactose malabsorption in people effected by CD.
Even with the rising prevalence over recent years and the potentially fatal consequences that have made food allergies a daunting public health issue, there still has not been any developments in effective therapies to completely overcome CD. Thus at this stage, the recommendation to patients suffering from CD are to strictly avoid the allergens/trigger foods and understand the immediate care and actions that need to be taken in cases of accidental exposure (Cunningham, 2016).
At The Chief Life our plans are gluten free and wholefoods based. If you need assistance in understanding how you can continue to enjoy life and food without feeling like you are restricted then reach out to us and we can help you out.
4364.0.55.007 – Australian Health Survey: Nutrition First Results – Foods and Nutrients, 2011-12 2012, Abs.gov.au. viewed 31 May 2018, <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Food%20avoidance%20due%20to%20allergy,%20intolerance%20or%20ethical%20religious%20reasons~600>.
Allen, PJ 2015, ‘Primary Care Approaches. Gluten-Related Disorders: Celiac Disease, Gluten Allergy, Non-Celiac Gluten Sensitivity’, Pediatric Nursing, vol. 41, no. 3, pp. 146-150.
Brehm-Curtis, B. 2015, Nutrition – Science, Issues, and Applications, Greenwood, California.
Catassi, C., Bai, J., Bonaz, B., Bouma, G., Calabrò, A., Carroccio, A., Castillejo, G., Ciacci, C., Cristofori, F., Dolinsek, J., Francavilla, R., Elli, L., Green, P., Holtmeier, W., Koehler, P., Koletzko, S., Meinhold, C., Sanders, D., Schumann, M., Schuppan, D., Ullrich, R., Vécsei, A., Volta, U., Zevallos, V., Sapone, A. and Fasano, A. 2013, Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders, Nutrients, vol 5, no 10, pp.3839-3853,.
Cunningham, D. 2016, Food Allergies: Epidemiology, Symptoms and Therapeutic Approaches, Nova Science Publishers Incorporated.
Dean, T. 2000, Food intolerance and the food industry, CRC Press, Boca Raton
Deng, Y., Misselwitz, B., Dai, N. and Fox, M. 2015, Lactose Intolerance in Adults: Biological Mechanism and Dietary Management, Nutrients, vol 7, no 9, pp.8020-8035,.
Eat For Health – Australian Dietary Guidelines, Providing the scientific evidence for healthier Australian diets 2013, National Health and Medical Research Council, Canberra. viewed 4 June 2018, <https://www.eatforhealth.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf>.
Facts and Statistics | Food Allergy Research & Education 2018, Foodallergy.org. viewed 31 May 2018, <https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics>.
Xyris Software (Australia), Foodworks 9 Premium Edition, Australia 2017
Lundin, K. and Alaedini, A. 2012, Non-celiac Gluten Sensitivity,.
Nutrient reference values for Australia and new Zealand including recommended dietary intakes 2006, 1st edn, National Health and Medical Research Council, Canberra. viewed 5 June 2018, <https://www.nhmrc.gov.au/_files_nhmrc/file/your_health/healthy/nutrition/17599_nhmrc_nrv_update-dietary_intakes_0.pdf>.
Ojetti, V., Nucera, G., Migneco, A., Gabrielli, M., Lauritano, C., Danese, S., Assunta Zocco, M., Nista, E., Cammarota, G., de Lorenzo, A., Gasbarrini, G. and Gasbarrini, A. 2005, High Prevalence of Celiac Disease in Patients with Lactose Intolerance, Digestion, vol 71, no 2, pp.106-110,.
RANGEL, A., SALES, D., URBANO, S., GALVÃO JÚNIOR, J., ANDRADE NETO, J. and MACÊDO, C. 2018, Lactose intolerance and cow’s milk protein allergy,.
Summary | Nutrient Reference Values 2018, Nrv.gov.au. viewed 31 May 2018, <https://www.nrv.gov.au/chronic-disease/summary>.
The Five Food Groups | Eat For Health 2018, Eatforhealth.gov.au. viewed 4 June 2018, <https://www.eatforhealth.gov.au/food-essentials/five-food-groups>.
Woodward, J. 2015, Coeliac disease, Medicine, vol 43, no 4, pp.234-238,.
Yantcheva, B., Golley, S., Topping, D. and Mohr, P. 2015, Food avoidance in an Australian adult population sample: the case of dairy products, Public Health Nutrition, vol 19, no 09, pp.1616-1623,.