Coeliac watch: Coeliac disease & weight by Nicola Johnson

by Nicola Johnson Dietitian, Coeliac UK

Nicola works for Coeliac UK, the leading charity for people with coeliac disease and dermatitis herpetiformis (DH). Her role involves providing information and support on coeliac disease to members of the public and healthcare professionals.

Coeliac disease and weight

Coeliac disease is an autoimmune disease triggered by the ingestion of gluten. Historically, the ‘classic’ picture of coeliac disease has been characterised by malabsorption and the associated symptoms of weight loss, steatorrhoea and chronic diarrhoea. In children, failure to thrive is common. However, it is now well established that coeliac disease can manifest itself as a complex multi-system disorder with a wide range of symptoms with many people having very mild symptoms (1).

Symptoms of coeliac disease

Symptoms of coeliac disease vary greatly between individuals and may appear to be non-specific, like fatigue, headaches, mouth ulcers, depression and joint or bone pain. Symptoms can also include bloating, constipation, wind, diarrhoea, nausea and anaemia. There does not appear to be a clear association between gut damage and symptoms.

Studies indicate that patients presenting for diagnosis with coeliac disease do not have the ‘classic’ symptom profile of an underweight, malnourished person with severe diarrhoea (1). Increasingly, people may be overweight or obese at presentation and the possibility of a diagnosis of coeliac disease should not be discounted on the basis of a person being overweight (1).

A published study by Dickey and Kearney (2006) (2) found that in 371 newly diagnosed patients, the mean body mass index (BMI) was 24.6 kg/m2 (range 16.3 - 43.5). A total of 17 patients (5%) were underweight (BMI <18.5), 211 (57%) were in the normal range, and 143 (39%) were overweight (BMI greater or equal to 25). Out of this group of overweight patients, 48 (13% of all patients) were classified in the obese range (BMI greater or equal to 30).

Weight gain

After being diagnosed with coeliac disease and starting a gluten-free diet, many people may find that they put on weight more easily. This is because the lining of the small bowel begins to heal resulting in improved absorption of the nutrients protein, carbohydrate and fat. In addition, some people may find that once established on the gluten-free diet, they see dramatic improvements in their general health and wellbeing and find that their appetite increases and they start to eat more compared to when they were undiagnosed.

The study by Dickey and Kearney (2) found that of those patients who strictly complied with a gluten-free diet, 81 percent had gained weight after two years of following the diet, including 82 percent of initially overweight patients.

Weight gain in established overweight patients can be a potential cause of morbidity and this highlights the need for a fresh approach to interventions regarding gluten-free diet therapy. Dietitians’ have a key role in educating patients with coeliac disease and there is a need to modify practice in order to accommodate current trends.

Weight management

The main priority has always been to encourage people to maintain a strict, life-long, gluten-free diet. Advising on substitute foods to replace favourite items in the diet is also a key area. However, there is the need to consider weight management and long-term health. Weight management is important as a long term goal, to prevent complications associated with being overweight such as heart disease, stroke and Type 2 diabetes.

Healthy eating recommendations for weight management on a gluten-free diet are no different compared to those for people without coeliac disease. People should be advised to be sensible about losing weight aiming to lose approximately 1–2 pounds (1kg) of weight per week to ensure more sustainable long term weight loss.

A balanced gluten-free diet

• Naturally gluten-free cereals including rice, corn (maize), gluten-free substitute foods like bread and pasta as well as meat, fish, tofu, soya, pulses, eggs, fruit and vegetables can be combined to make up a balanced gluten-free diet.

NEW

Gluten free Wheat free

Mrs Crimble’s fresh white and seeded loaves have all the characteristics and taste of normal bread, you can toast it, make sandwiches, use it in recipes, indeed try it out with the whole family.

mrscrimbles.com