Blog


Coeliac disease is an autoimmune condition where the small intestine is chronically inflamed, and nutrients from food may not be absorbed properly. This is due to a permanent allergy to gluten in the diet (present in wheat, barley and rye), which activates an abnormal mucosal immune response. Coeliac disease is treated effectively in the majority of patients by sticking to a 100% gluten-free diet indefinitely. Although a gluten-free diet is an effective treatment in most patients, a significant minority develop persistent or recurrent symptoms. Difficulties sticking to such a diet have led to the development of non-dietary therapies, several of which are undergoing trials in human beings.

Coeliac disease is common: in the UK, 1 in 100 people have it, and numbers are rising. It is more common in individuals with a first-degree relative (ie a parent or sibling) with the condition and in people from or with close relatives from Ireland and Finland. Patients with conditions such as type 1 diabetes, microscopic colitis, autoimmune thyroid disease, Down’s syndrome and Turner syndrome are at a higher risk of having coeliac disease.

The diagnosis may be considered in people with iron deficiency anaemia, low folate or vitamin D, chronic fatigue, in pre-menopausal women with osteoporosis, or in those with recurrent abdominal bloating, loose stools, constipation or weight loss. 

In patients with symptoms suggestive of coeliac disease a blood sample may be taken to look for special proteins or antibodies (anti-transglutaminase) that develop in patients with untreated coeliac disease. These are accurate in most cases (about 90%) but the “gold standard” diagnosis requires taking small samples (biopsies) from the small intestine at upper gi endoscopy and looking at these under a microscope to look for the characteristic signs of villous atrophy and an excess of inflammatory cells (lymphocytes). This test may be needed in patients who do respond to a gluten-free diet.

Coeliac disease is not to be confused with non-coeliac gluten sensitivity, which may present with similar symptoms but in the presence of normal blood tests and small intestine, and may improve on a gluten-free diet. Interestingly, a recent study found a subset of individuals with chronic fatigue syndrome may have sensitivity to wheat and related cereals in the absence of coeliac disease and may respond to dietary restrictions. There is still research to be done.

Advice on gluten free diet and what alternative foods can be eaten to maintain a balanced diet is best obtained from a state-registered dietician with experience in coeliac disease. Your GP (or a consultant gastroenterologist) will be able to make a referral for this advice if required.

For more information, please contact Dr Adam Harris.



Following a month of indulgence, many decide to make lifestyle changes in January. Some try dietary restriction (eg ’Veganuary’) or reduce their total caloric intake, while others abstain from alcohol (eg ‘Dry January’) or jumpstart new exercise regimes. There are even some heroes among us making several changes at once. While it is advised that individuals take proper care of themselves year round, it is appreciated that this does not always happen.

Of topical interest therefore is that intermittent fasting proves beneficial for weight loss in both animal and human studies. As humans, we have not evolved to consume three large evenly-spaced meals throughout the day (plus snacks). This is a symptom of modern life and is due to an abundance of resources. Rather, we went for short stretches of time without food. We still needed to perform, to hunt prey and escape predators, but we did so in a fasted state.

Two methods of intermittent fasting in humans provide evidence-based weight loss, specifically the 5:2 regime (fasting 2 days per week), and daily time-restricted feeding (leaving, for example 18 hours between dinner and breakfast the next day, ie a 6-hour eating period). Comparatively, intermittent fasting seems to provide greater health benefits than a simple reduction in daily caloric intake, and might be considered the method of choice for effective weight control, metabolism of energy, and improved health across the lifespan.

Healthcare professionals may not understand how to prescribe intermittent fasting regimes. Patients may also be unwilling to start one. This may be due to several unpleasant short-term effects, such as increased levels of hunger and irritability, and decreased concentration. Ideally, a patient would ease into the plan over a number of months, in order to minimise any unpleasant effects. This allows time for the body to adjust. The following plans can be considered for 5:2 intermittent fasting and daily time-restricted feeding, respectively:

5:2 Intermittent Fasting

    • For month 1: 1000 calories 1 day per week
    • For month 2: 1000 calories 2 days per week
    • For month 3: 750 calories 2 days per week
    • For month 4: 500 calories 2 days per week

Daily Time-Restricted Feeding

    • For month 1: 10 hour feeding period 5 days per week
    • For month 2: 8 hour feeding period 5 days per week
    • For month 3: 6 hour feeding period 5 days per week
    • For month 4: 6 hour feeding period 7 days per week

A new year provides a convenient opportunity for a fresh start, and widespread participation and media coverage provides a sense of camaraderie between friends, family and colleagues. This may increase the odds of success, and if nothing else, at least everyone is miserable together. If you still find yourself feeling unsatisfied with any lifestyle changes you may have made in January, then what about trying ‘Fasting February’?

For more information, please contact Dr Adam Harris.



At West Kent Gastroenterology, we work hard to provide our patients with top-class care. You will enjoy friendly, fast and modern treatment by a highly experienced gastroenterologist. We carefully review patient satisfaction and feedback, and at West Kent Gastroenterology we are continuously making improvements to our services, ensuring the highest level of care possible.

Clinic Locations

Nuffield Hospital
Kingswood Road, Tunbridge Wells, TN2 4UL

Spire Hospital
Fordcombe Road, Tunbridge Wells, Kent, TN3 0RD

Sevenoaks Medical Centre
London Road, Sevenoaks, Kent, TN13 2JD

Twitter

@dradamharris - 6 days

The wrote to all gastroenterologists last night recommending that all non-emergency endoscopy stop i…

@dradamharris - 1 week

UK Government issued new guidance for 1.5m most vulnerable people living with chronic illness to reduce risks from…

© 2020 West Kent Gastroenterology Ltd.

Designed and Developed By