On Coeliac Disease and Gluten-Free Ravioli

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Have you heard of coeliac disease? No? Maybe gluten intolerance? Ah yes, one of those fashionable allergies everyone is talking about at the moment. People keep asking me "Do you really have this, has it been diagnosed by a doctor? You know you should watch out for such and such symptoms and then get tested".

And this is the moment where I start getting annoyed. Yes, I have coeliac disease and have had it for 10 years. I wrote a 200-page dissertation on it. I think I know my way around the symptoms and am on the diet I am on in order to be healthy, not to lose weight (which is hard on a gluten-free diet anyway) or be fashionable. If I had a choice, I'd love to eat normally, like other people, and enjoy some pizza, bread or a beer once in a while.

What I miss the most? Plaited sweet pastry bread, ravioli and being able to easily get a snack when out and about or traveling. Today I'd like to share with you a ravioli recipe that you can prepare either with spinach or, during the season, with wild garlic.

In the USA, gluten-free foods have become a kind of trend, and that begs the question whether the growing market for gluten-free products is a result of gluten-free diets being a fashion trend and having no longer anything to do with metabolic diseases.

But it's no wonder people are sceptical when you say you're gluten-free because there are quite a lot of people with pretend allergies and others who think they can lose tons of weight on a so-called gluten-free diet.

The million dollar global business that is the gluten-free product market has developed because non-coeliacs buy gluten-free foods believing them to be better monitored and healthier.

The US consumer research company Hartman Group found that 93% of gluten-free dieters in the US haven't been diagnosed with coeliac disease but many of them eat gluten-free foods in order to lose weight. However this gluten-free trend in the US has also had the effect of consumers testing different products and restaurants and posting and publishing their findings (Bragg, 2011).

The consequences of these trends are two-fold for coeliacs: on the one hand, gluten-free products are more widely known and therefore a greater variety is sold in a larger number of stores and gluten-free foods have also made their way into restaurants. These are all advantages. On the other hand, this illness isn't taken very seriously any longer. A big disadvantage is the spread of false or distorted information: Producers and restaurants don't know enough about the risks, consider gluten intolerance a trend condition and therefore neglect their duty of care towards actual coeliac customers.

Even minuscule traces of gluten can harm coeliacs. Just a daily dosage of 20mg can already alter the intestinal wall. 50-100mg will effect changes in all coeliac patients. A quick example: a slice of bread contains 2,5g of gluten - this means even a bread crumb can do a lot of harm. The disease presents differently with each patient. Some throw up or get diarrhoea, others experience a decimated immune system which makes them more susceptible to colds and other viruses.

It has to be said that Americans are a little behind when it comes to the transparent and consistent labelling of gluten-free products. A large selection of gluten-free products does not necessarily mean a good range of products, it is only useful if coeliacs can be sure there is no gluten contamination to be found anywhere. In order to prevent any illness or injury to patients, Europe has set the threshold for a certified gluten-free label at under 20mg/kg.

Gluten-sensitive enteropathy is more commonly known as „coeliac disease“, whereby this typically describes the condition when diagnosed in children. For adults, the term „domestic sprue“ is sometimes used.

Here in Austria, the coeliac patient percentage is around 1%, but there is believed to be a high number of undiagnosed cases. Of 10 coeliacs, only one is actually diagnosed.

Coeliac disease is a T-cell mediated autoimmune disease of the small intestine presenting with a variety of symptoms. The condition has the effect that the elastic wheat protein gluten triggers an immune reaction in the small intestine in genetically predisposed individuals, which results in damage to the intestinal wall and malabsorption of food leading to myriad symptoms. Coeliac disease can appear at any age and requires a lifelong and completely gluten-free diet.

The genetic predisposition of this autoimmune disease is demonstrated by the appearance of coeliac clusters in families. But coeliac disease isn't always genetic, it can also require a range of other factors in order to break out. Intestinal infections suffered in childhood and the timing of gluten introduction are being debated in that regard.

Patients with classic coeliac disease, that is the symptomatic form of this illness, present with the full range of symptoms like diarrhoea, bloating and steatorrhoea (fatty stools). Aside from the typical gastrointestinal symptoms, external symptoms like weight loss, loss of appetite, vitamin and iron deficiencies, rickets and osteoporosis can also appear. Failure to thrive and bloated abdomens are the principal symptoms in infants and toddlers. Patients suffering from the classic form of the disease usually also present with considerably elevated coeliac antibodies and notably reduced intestinal villi. As soon as the patient switches to a gluten-free diet, the symptoms abate within only a short period of time.

Coeliac Symptoms

  • Typical symptoms of coeliac disease (intestinal tract): diarrhoea, bloating, extended abdomen, nausea, vomiting, stomach pains, fatty stools (Körner & Schareina, 2010, p. 15).

  • External symptoms: iron deficiency anaemia (pallor), folic acid deficiency, vitamin K deficiency, bone pain.

When coeliac patients are undiagnosed, an intestinal mucosal test immediately shows a very low villi distribution. This so-called intestinal villous atrophy is a typical feature of the disease. When the intestinal mucosal layer is damaged, its surface area is greatly reduced, like a tennis court that has shrunk to the size of a ping pong table when the entire small intestine is affected. This also leads to enzyme impairment.

Photo (c) Julia Stix for Maxima Gourmet Extra, march 2016 issue