At my clinic, we treat celiac disease, an autoimmune disorder that’s triggered by eating gluten. Gluten is a protein found commonly in wheat, rye and barley. If patients with celiac disease consume food with gluten, their immune system flares up by damaging the small intestine. By damage, it means experiencing digestive symptoms like diarrhoea, vomiting, abdominal pain and bloating.

People with one autoimmune disorder are more likely to get another autoimmune disorder. This is especially more so with celiac disease. In fact, compared to the general population, patients with celiac disease are at 15% more risk of developing one or more autoimmune disorders. The thing here also is that many people with celiac disease may even not know they have it. This is because the damage done to your intestine happens at a very slow rate, and sometimes symptoms are so generic and varied that it can take a few years to get a proper diagnosis. In some instances, about as many as 20% of people may be undiagnosed.

It’s important to note that celiac disease is not the same as gluten intolerance. While both conditions display a sensitivity towards gluten and exhibit similar symptoms, people with non-celiac gluten intolerance do not get damage to their small intestine or show any immune responses. I should also mention that a common question I get is on the difference between celiac disease and a food allergy. Well, a person with a wheat allergy experiences itchy or watery eyes or breathing difficulties upon consuming wheat. Someone with celiac disease, on the other hand, experiences symptoms more serious like abdominal pain and cramps, nausea and even nervous system symptoms.

Getting diagnosed early

It’s important to get a confirmed diagnosis as soon as possible as not only do you want to protect your small intestine and start making diet changes for a better quality of life, you want to avoid risking getting another autoimmune disease. For people with celiac disease, the later the diagnosis, the higher the chance of developing another autoimmune disorder. The most common autoimmune diseases associated with celiac disease are Type 1 diabetes and thyroid disease. This is because these disorders have similar immunological and genetic linkages with celiac disease. Other serious conditions and cancers may also be associated with celiac disease.

Based on the research, I would say that those diagnosed from ages 2-4 have a 10.5% risk; 16.7% for ages 4-12; 27% for ages 12-20; and 34% for those over 20. As you can see, the percentages triple depending on the period of diagnosis.

We don’t know yet what specifically triggers autoimmune disorders in the first place. For reasons not completely understood, about 75% of patients with autoimmune diseases tend to be women. What we do know however is that autoimmune disorders tend to run in families and might be linked to certain genes. So if you have a family member with celiac disease, you have about a 1 in 10 chance of getting it.

Managing your risks with a strict diet

By adhering to a strict gluten-free diet, you can heal the damage to your small intestine, prevent further damage and lower the risk of cancers and other diseases. This means eliminating all if not most cereals, grains, pasta and processed foods. As for oats, most doctors and dieticians in the past would advise against it, but there has been evidence that suggests a moderate amount is fine so long as the oats do not come into contact with wheat gluten during processing and are labelled as “gluten free”.

Fresh food like meat, fruits, vegetables, fish and rice without additives are all things you can consume. There are also many places in Singapore where you can find gluten-free bread and pasta. When shopping at the supermarket especially, always remember to read food labels — look out for terms like “gluten-free”, “without gluten”, “free of gluten” and “no gluten”.

I find that food that labelled gluten-free (e.g. certain kind of pastas) tend to be more expensive than food that are naturally gluten-free (e.g. meat, fish). But with practice and some help from a dietician, you’ll find it easier to lead a cheaper and easier gluten-free life stocked with yummy and natural options!

References

  1. Lundin, K. E., & Wijmenga, C. (2015). Coeliac disease and autoimmune disease-genetic overlap and screening. Nature reviews. Gastroenterology & hepatology, 12(9), 507–515. https://doi.org/10.1038/nrgastro.2015.136
  2. Buysschaert M. (2003). Coeliac disease in patients with type 1 diabetes mellitus and auto-immune thyroid disorders. Acta gastro-enterologica Belgica, 66(3), 237–240.