What is it about ?
Gluten intolerance or celiac disease is an autoimmune disease where antibodies are formed against a protein found in gluten. It is not a allergy. Gluten is a component of seeds (wheat, rye, barley, oats, malt and spelled). In celiac disease, the lining of the intestine is damaged by eating foods containing one of these grains. This disrupts the digestion of food, resulting in malabsorption of some nutrients. Thus, deficiencies including iron, calcium and vitamins can develop.
What is its frequency?
The figures are quite variable: from 1 in 100 to 1 in 200. These figures are explained by the fact that many people have no symptoms. If we only count symptomatic people, then the number is lower. We would detect more people by screening everyone. First-degree family members (parents, brothers, sisters, children) of people with celiac disease are at greater risk of developing the disease. Celiac disease is more common in the presence of other autoimmune diseases such as type 1 diabetes and disturbances in thyroid function.
The disease is usually diagnosed in adults between 30 and 50 years old and in children over 10 years old; in younger children, celiac disease is rarer. Nevertheless, the disease can occur at any age from the moment one begins to eat cereals.
How to recognize it?
Usually, there are no complaints, and celiac disease is picked up by chance during a gastrointestinal exam for another symptom. The disease is associated with a variety of symptoms:
- Gastrointestinal symptoms: stomach aches, odorous diarrhea or on the contrary constipation, bloating;
- Skin problems : itchy blisters on the elbows, knees and buttocks (dermatitis herpetiformis), canker sores in the mouth;
- Consequences of deficiencies in certain nutrients: growth disorders in children, delayed puberty, weightloss, bone decalcification, anemia due to iron deficiency, anemia due to folic acid deficiency, abnormalities in the dental enamel.
How is the diagnosis made?
Since there are usually no complaints, celiac disease may be caught by chance during a gastrointestinal exam for another reason. If you have symptoms, your doctor will think about this diagnosis based on those symptoms. He will test for specific antibodies in the blood. He can only be certain of the diagnosis after a gastrointestinal examination (gastroscopy) where a tissue sample (biopsy) from the small intestine is taken and analyzed in the laboratory.
What can you do ?
The basis of treatment is a gluten-free diet. It is important to do the diagnostic tests before starting this diet, because with the gluten-free diet the antibodies disappear from your blood and the lining of the intestine is repaired; The diagnosis therefore becomes more difficult.
Gluten is found in all foods prepared with wheat, rye, barley, oats, malt and spelled (bread, pizza, pasta, cookies, cakes, pies, breadcrumbs and crackers) . But also where you don’t expect it, such as soups (starches, vermicelli), sauces, certain candies and sweets, ice cream and certain beers. It is not always easy to find your way around. The assistance of a dietitian or a nutritionist doctor can therefore be useful to you. He will give you lists of food products, indicating the brands that are allowed.
Gluten-free diets are all the rage. Many people follow such a diet, even if they do not suffer from celiac disease.
There is a wide range of gluten-free products, and you can find them in the usual grocery stores. According to a 2009 European Union directive, a food is considered gluten-free if it contains less than 20 mg of gluten per kilogram. From a content of 20 mg and up to 100 mg per kilo, the packaging indicates the words “very low gluten content”.
You can of course also make bread and pastry with the permitted varieties of flour.
In restaurants, it is best to signal in advance that you need to eat gluten-free.
With a gluten-free diet, the symptoms go away pretty quickly. Skin lesions may take 1 to 2 years to heal. But if you stop the diet, the symptoms return immediately. It is therefore essential to continue the gluten-free diet.
What can your doctor do?
After the diagnosis is made, the doctor will monitor the progress of the disease. He will check if you are suffering from a deficiency in certain nutrients (for example iron) by appropriate questions and possible additional examinations such as a blood test (anemia due to iron deficiency for example). Supplements will be prescribed to you if necessary.
It will also check if you have other illnesses such as type 1 diabetes or thyroid disorders. Because if the diet does not provide relief, the symptoms are usually due to these conditions. These must obviously be treated as a priority.
You have the right to an intervention from the mutual insurance company for an adapted diet. This is a flat rate paid automatically every month after agreement from the medical adviser of the mutual insurance company. The documents must be completed by a specialist doctor.
Unfortunately, there is no medication to treat the cause of celiac disease.
Want to know more?
- Live gluten-free! – Belgian Society of Cœliaquie asbl
- Reimbursement – Medical nutrition: Special food used at home in the case of celiac disease or dermatitis herpetiformis – INAMI – National Institute for Sickness and Invalidity Insurance
Are you looking for more specialized help?
- Find a registered dietitian – Professional Union of French-speaking dieticians
- Find a nutritionist doctor – Belgian Society of Nutritionist Doctors