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Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance

  • Lifestyle
  • 12 hours ago
  • Balvinder Sandhu

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Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance
When Peter Horan’s daughter was diagnosed with coeliac disease in 2006, he and his wife Karen learned more about the condition and the wide range of symptoms it can cause. This was when he realised he could have the condition too.
I had actually experienced several of the classic symptoms for many years but I never made the connection to coeliac disease,
he shares.

"I got tested, received a positive result and began changing my diet soon after. I started seeing improvements not long after switching to a gluten-free diet."

Jaclyn Reutens, a dietician at Aptima Nutrition, reveals that coeliac disease is an autoimmune condition caused by an immune reaction to eating gluten.
Gluten is a protein naturally found in wheat, barley and rye. Eating gluten triggers your immune system to attack itself, causing damage to the intestinal lining, leading to malabsorption of nutrients,
she adds.
Coeliac disease is not to be confused with having a gluten intolerance, which is also known as non-coeliac gluten sensitivity (NCGS). While it causes gastrointestinal symptoms, it does not cause the same level of damage to the gut as seen in coeliac disease, says Jaclyn.
Also, coeliac disease can lead to serious complications and a strict gluten-free diet is needed. However, a gluten intolerance just requires a reduction of gluten in the diet.
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Dr Lim Chee Hooi, head and senior consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital, says that the incidence of coeliac disease in Singapore is not well-documented. This could be due to the ethnic makeup of our population.
Certain people are more prone to developing coeliac disease due to genetic factors (called HLA-DQ2 or HLA-DQ8) that run in families, especially those with European ancestry, and environmental triggers such as gluten exposure,
says Dr Lim.
Another factor is family history – first-degree relatives of affected individuals have a higher risk, with up to 20% affected,
he adds.

"There is also higher prevalence in individuals with autoimmune disorders like type 1 diabetes and autoimmune thyroid disease."

Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance - Jaclyn Reutens, a dietitian at Aptima Nutrition
Jaclyn Reutens
Credit:Aptima Nutrition
Traditional Asian diets are predominantly rice-based and include other gluten-free products such as bee hoon, kway teow and glass noodles. The exposure to gluten is not as high as compared to Western diets that contain more gluten-containing foods such as pasta, bread and pizza.
Jaclyn says there might be some truth to the belief that coeliac disease is less common among Asians:
What can someone with coeliac disease eat?
Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance - Dr Lim Chee Hooi, Head and Senior Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital Credit: Singapore General Hospital
Dr Lim Chee Hooi, Head and Senior Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital
Credit: Singapore General Hospital
Dr Lim explains that symptoms of coeliac disease can vary widely and include both gastrointestinal and extraintestinal (occurring outside the intestines) manifestations.
Gastrointestinal symptoms include diarrhoea, constipation, bloating, abdominal pain and vomiting; while extraintestinal symptoms could manifest as iron deficiency anaemia, osteoporosis, vitamin deficiencies (B12, D), chronic fatigue, skin rashes and infertility.
He says that coeliac disease is diagnosed through serological (blood) tests and confirmed with a duodenal biopsy, where a small tissue sample is taken from the duodenum, the first part of the small intestine.
Coeliac disease is treated with a lifelong gluten-free diet. Therefore, if you’re entertaining a loved one who has it, it’s important to know what foods you can and can’t serve them. Jaclyn recommends rice-based, carbohydrate foods that do not contain gluten such as potato, sweet potato, quinoa and gluten-free pasta.
Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance - Gluten Free Ingredient
You could also serve protein foods, fruits and vegetables. Jaclyn suggests fried rice, stir-fried bee hoon or kway teow, baked sweet potato, mashed potato, corn chips with salsa, corn thins with cream cheese, rice crackers with hummus or guacamole, carrot and cucumber sticks, meat, fish, baked chicken wings and lots of fruits and vegetables. Or try beans dips, chickpeas and lentils with quinoa salad, nuts and even a cheese platter.
Note that you shouldn't use regular soy sauce as it contains gluten,
Jaclyn points out.

"Cooking with oils, herbs, spices and gluten-free sauces is recommended. Check the food labels as there are hidden sources of wheat, rye and barley."

READ ALSO:
Food Intolerance: Why Our Bodies Reject Certain Foods As We Get Older

The reality of living with coeliac disease
Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance - Karen & Peter Horan
Peter and Karen Horan maintain a gluten-free kitchen at home, as both Peter and their daughter have coeliac disease.
Credit: Karen & Peter Horan
Peter and Karen, both aged 55, maintain a gluten-free kitchen at home, which helps ensure that family meals are always safe and made with gluten-free ingredients.
In most cases, this simply means swapping out one or two items, like using gluten-free soy sauce or pasta,
Karen reveals.

These small changes eliminate the risk of cross-contamination and accidental ingredient mix-ups. By doing this, every meal is safe for everyone in the family, and no one feels excluded.

Our non-coeliac child can eat whatever he wants when he’s outside the home,
she adds.

"If he wants to bring gluten-containing food into the house, he follows clear rules to prevent cross-contamination and stores it in clearly labelled containers."

Peter admits that the bigger challenge comes when eating out.
Before choosing a restaurant, I usually research its ability to handle gluten-free requirements,
Peter explains.

"That often includes calling ahead to ask detailed questions that help me gauge how well they understand coeliac needs. Over time, we’ve found several restaurants that work well for us, but it always takes diligence to avoid mistakes."

And, when the family travels, they tend to stay in hotels with kitchenettes and often return to places they know can safely accommodate their dietary needs.
The couple moved from America to Singapore in 2011 and Karen later founded International Gluten Free & Gluten Free Singapore Support Group. The group organises gluten-free community meet-ups, offers advice on being gluten-free in Singapore and has a list of gluten-free recipes.
Coeliac Disease: A Serious Autoimmune Condition That Is More Than Just Gluten Intolerance - Gluten Recipe
She says that one of the biggest challenges of living with coeliac disease in Singapore is “the general lack of awareness about where gluten is found and how serious the risk of cross-contamination can be”.
The most effective way to truly understand gluten-related issues is often through firsthand experience, such as having a family member or close friend who must follow a strict gluten-free diet,
she says.

But because the diagnosis rate in Singapore (and much of Southeast Asia) is still low, most people simply don’t have that exposure.

The most important thing I want people to understand is that coeliac disease is a lifelong autoimmune condition – it is not an allergy, trend or personal preference,
she adds.

“For someone with coeliac disease, even a crumb of gluten – measured in parts per million – can cause damage. Maintaining strict gluten avoidance is the only treatment.”

Peter wants people to know that coeliac disease is more common than many people realise. In his line of work, meals are often part of events or meetings and he really appreciates it when the organiser takes his dietary needs seriously and researches venues and caterers as carefully as he would.
When someone puts in the effort to accommodate people with coeliac disease, it creates a real sense of inclusion and respect,
he shares.
This article is part of a series on invisible disabilities, an umbrella term that refers to types of disabilities, chronic conditions or medical/neurological conditions that are not immediately apparent to others. We seek to understand more about these invisible disabilities and how we, as loved ones or as general members of society, can better support others going through it.

Also read:

Balvinder Sandhu

Balvinder Sandhu

A published author who lives in Melbourne but stays in touch with her Singapore roots and way of life.

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