Diagnosis

If there are worrying symptoms or suspicion of coeliac disease, a consultation with a GP is essential. If the suspicion is correct, the patient is referred to a gastroenterologist who orders specialised tests such as anti-smooth muscle endomysium (EmA), anti-tissue transglutaminase (tTG) or anti so-called 'new gliadin' GAF antibodies. These tests are performed from a blood sample and have a significant diagnostic value and are therefore essential for making a diagnosis. All the above-mentioned antibodies are specific markers for coeliac disease, but finding them absent is not the basis for ruling out a visceral disease. Another stage of testing, until recently considered an indispensable part of the diagnostic process, is a small bowel biopsy, which, according to new guidelines, may be omitted if appropriate concentrations of Ema, tTG or GAF antibodies are obtained [2].

It should be borne in mind that a gluten-free diet should not be introduced without prior consultation with a gastroenterologist, as once gluten has been removed from the diet, it will be impossible to ascertain its destructive effects on the body [2].

Gluten-free diet

When a diagnosis of visceral disease is made, the key, and only therapeutic approach, is a diet that excludes gluten products. At this point, it is necessary to point out the difference between gluten allergy and gluten intolerance, as these concepts are not the same. When a gluten allergy is diagnosed, it is necessary to introduce dietary restrictions, to the extent and for the duration indicated by the doctor, which means that there is the possibility of returning to 'normal' eating once the allergy crisis has been resolved. In the situation of gluten intolerance (coeliac disease), it is necessary to realise that a gluten-free diet will be in force for life. To date, no drug has been invented to cure this disease, so the diet is currently the only solution to the problems [2].

What is not allowed?

Gluten-free diet requires absolute elimination of cereal products based on wheat, rye, barley, triticale, spelt, and in Polish conditions also on oats. Oats is a rather debatable cereal in the context of coeliac disease, namely the protein contained therein (avenin) is not the cause of the immune reaction that occurs in the case of contact with wheat or rye, however, in Poland oats are quite heavily contaminated with other cereals, hence its elimination is recommended. Of course, specially prepared products are available on the market, including gluten-free oats [2].

Designation

Products for people with coeliac disease are subject to and dependent on the relevant legislation. According to the guidelines of the Codex Alimentarius Commission (2008) and Commission Regulation (EC) No. 41/2009 of 20 January 2009, it is necessary to maintain appropriate labelling of such products.

First of all, a gluten-free product is one that contains less than 20 mg of gluten per kilogram of food that reaches the consumer. This can be indicated in various ways, such as labelling with the appropriate wording 'gluten-free' or 'gluten-free', as well as with the crossed-out spike mark, which is itself a proprietary mark and must not be used without a licence from the relevant institutions [4].

When considering switching to any diet, it is advisable to recognise the topic and find out whether a particular proposal is suitable for us. This is because nowadays there is a significant increase in gluten-free products and their wider spread and easier availability. Many people eliminate gluten from their diet without medical indication to achieve better weight loss results, but this is neither a healthy nor a safe solution.

As it turns out, when gluten is eliminated from the diet without medical indication, the body loses a lot. Gluten is a mixture of proteins found in many products, and it is very difficult to avoid it in principle - it is the basis of many dishes and products, but by eliminating it from the diet, we get rid of grain products, which are at the bottom of the human food pyramid. This eliminates from the diet ingredients such as fibre, B vitamins, iron, zinc, selenium, folic acid, calcium and a number of natural minerals, and this simply leads to a number of deficiencies in the body. What's more, the products used to make gluten-free products are usually highly processed and often contain more fat (and calories) than gluten products. So what impact does this have on weight loss? Normal, daily consumption of gluten has no effect on weight gain - this is encouraged by other ingredients such as fat or sugar. However, if we undertake the elimination of gluten from the diet without medical indication, we put ourselves at risk of developing secondary coeliac disease - a reaction to a small amount of gluten after a significant break in gluten consumption [5].