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[C773]Coeliac Disease In Children

by K Bakhru, K B

The ancient physician, who recognized and recorded the disease, was known as Aretaeus of Cappadocia and was a contemporary of the great Roman physician of that time, Galen. In 1856, Francis Adams translated Aretaeus' writings for the Sydenham Society of Great Britain. The ancient Greek text used the world KOILIAKOS, from which the word coeliac is derived. It means, literally, 'suffering in the bowels'. Aretaeus appears to have understood a great deal about the illness. In his essay on the 'Cure of Coeliacs', he said, 'If the stomach be irretentive of the food and if it passes through undigested and crude, and nothing ascends into the body, we call such persons coeliacs.' He indicated that food made from grains was particularly suspect'... for bread is rarely suitable for giving
[coeliac children] strength'.

In 1888, Dr Samuel Gee wrote a paper on the coeliac condition in which he said: 'To regulate the food is the main part of the treatment ... the allowance of farinaceous foods must be small .., but if the patient can be cured at all it must be by means of diet.

A book was written by Dr Herter in 1908 which investigated the problem of coeliac disease in children. Dr Herter said that, in coeliacs, fats were better tolerated than carbohydrates. It was this contention that coeliacs were sensitive to carbohydrates in general, but grains in particular, that was supported by Sir Frederick Still in his memorial lecture to the Royal College of Physicians in 1918, when he said: 'Unfortunately, one form of starch, which seems particularly liable to aggravate the symptoms, is bread. I know of no adequate substitute.'

Dr Howland, in a far-sighted address to the American Paediatric Society, in 1921, on 'Prolonged Intolerance to Carbohydrates' spoke about the health risks of carbohydrates.

From clinical experience it has been found that of all the elements of food, carbohydrate is the one which must be excluded rigorously; that with this greatly reduced, the other elements are almost always well-adjusted even though the absorption of fat may not be so satisfactory as in health.

He advocated a three-stage diet 'with the most careful observation of the digestive capacity... Bread, cereals and potatoes are the last articles which can be allowed'. He went on to say: 'The treatment is time-consuming but these patients will repay the effort expended on them.' I fear that his entreaty to spend more time on observing the patient, would fall on very deaf medical ears today.

Dr Haas, in 1938, noted that fatty diarrhoea was experienced by coeliacs with even minute amounts of carbohydrate in the diet and hardly any fatty foods. He found however, that bananas were an excellent form of carbohydrate for coeliacs and caused no diarrhoea or other symptoms.

Since 1950, Professor Dicke, Professor Anderson and others have shown that the exclusion of wheat, rye, oats and barley from the diet of coeliac children, and the substitution of gluten-free products, has reduced inflammation in the small intestine and, in most cases, allowed a return to good health. However, if the gluten-containing cereals were incorporated back into the diet, serious health problems followed in a very short time, due to the lining of the small intestine becoming rapidly abnormal.

The primary, and most important, treatment is the elimination of grains containing gluten from the diet. In addition, it may be necessary to severely restrict intake of non-glutinous grains and refined carbohydrate. If these rules are not adhered to, a severe relapse, especially in later life, will generally follow. It is therefore essential to avoid eating any food containing wheat, rye, barley and oats. This covers a fairly wide range of foodstuffs, and it is important to read the labels on canned, bottled and packaged foods to ensure that fillers containing gluten, have not been used. For the coeliac, even small amounts of gluten, in the form of breadcrumbs, batter, gravy, sauces, etc., can cause serious damage to the small intestine.

Because of malabsorption of nutrients, due to intestinal damage, a course of supplements is extremely useful in aiding the body to recover. Many coeliacs are found to be anemic due to deficiencies or iron and folic acid. Calcium deficiency is common and is due partly, to vitamin D deficiency and partly to calcium binding to unabsorbed fatty acids. In general, malabsorption due to coeliac disease, starves the body of most vital nutrients to some degree. Accordingly, it is important to take daily doses of vitamin, mineral and amino acid complexes during the recovery period. If the small intestine of the coeliac has been severely affected, it may always remain delicate. It may well be necessary to continue with some form of nutrient supplementation after recovery, to ensure maintenance of good health.

Some coeliacs may suffer from a lactose deficiency due either to intestinal damage caused by the disease, or reasons such as incorrect feeding during infancy or hereditary factors. It is important that these people exclude milk and milk products from their diet as well as cereals containing gluten. If this problem is not recognized, then a gluten-free diet alone, will not allow a full recovery.

Some sufferers may also have to abstain from refined carbohydrates, such as cereals and sugar, due to the extent of intestinal damage. For these people, essential carbohydrate may be easily obtained from fruit and vegetables, especially bananas. An ongoing diet, along these lines, will save the intestine from further deterioration and ensure a continuing level of health.

Coeliac disease is difficult to diagnose and there is considerable evidence that, due to the over consumption of grains in our society, it is far more prevalent than previously indicated. It is a prime source of multiple allergy illness and toxic overload due to the damage done to the small intestine, where the bulk of food digestion and assimilation takes place. As well as damage to the villi, the intestinal walls can become porous and allow toxic, partly digested food particles into the bloodstream where they will cause allergy symptoms and wreak havoc on the body's immune system.

It has long been suspected that there are many degrees of coeliac disease, not all of which can be diagnosed effectively by use of the biopsy procedure.

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