Cereal offender

Going gluten-free is the height of food fashion: you can spot those slavishly following the trend a mile off as they brush away the bread rolls at dinner. These are people who would no more tuck into a baguette than a vegetarian would devour a bloody steak. Some take the strict wheat-free, gluten-free route, citing vague claims that it stops bloating; others, post-Atkins, use it as a socially acceptable way of avoiding carbs.

Gluten is a protein found in wheat, rye and barley. Whatever the reason for avoiding it, according to the latest Mintel report, we are splurging a whopping £48m a year on gluten- and wheat-free products, a figure that is set to quadruple in the next five years. The sad fact is that many people diving down the "free-from" aisles of the supermarket have no sound, health-based reason for doing so.

It seems all the more ironic, therefore, that about half a million people are struggling through life, suffering from the debilitating - in some cases, life-threatening - effects of coeliac disease. Unlike dairy intolerance, which can be due to the lack of a digestive enzyme, or peanut allergy, which involves an allergic response in the body, coeliac disease is an autoimmune problem. This means that the body produces antibodies that attack its own tissue when gluten is eaten.

Four out of five people with coeliac disease do not know they have it, because the symptoms are much more diverse than doctors once thought. In the past, weight loss, accompanied by bloating, gas and diarrhoea, were considered the classic signs. But now it is understood that coeliac disease can trigger anything from hair loss, mouth ulcers, skin problems and joint pain to fatigue, depression and even miscarriages and bone fractures. "It is because the symptoms are so variable that so many people are not being diagnosed," says Emily Kirk, a dietician for Coeliac UK. "You may have bloating and gas, for example, which is put down to irritable bowel syndrome, with no mention of coeliac disease."

Although the symptoms of this disease can be diverse, they all stem from the effect that gluten has on the lining of the intestine. When the small intestine is in full health, its walls are made up of millions of tiny finger-like projections known as villi. These dramatically increase the surface area, allowing nutrients in food to be absorbed properly into the blood. With coeliac disease, gluten damages the villi, leaving a flat surface on the intestine wall that severely reduces the absorption of nutrients. This can rapidly lead to a deficiency in vitamins such as folic acid, which is vital for a healthy heart, reproduction and a happy mental disposition; vitamin B12, essential for a robust nervous system; and calcium, a lack of which leads to an increased risk of osteoporosis and bone fractures. Undiagnosed or poorly treated, coeliac disease can even be associated with certain gut cancers.

While there is no cure for coeliac disease, it can be successfully treated by totally eliminating gluten from your diet. This is more complex than simply popping a few gluten-free biscuits in your shopping trolley: you must be sure you are affected before embarking on the task - a trip to the doctor's is imperative, both for a proper diagnosis and a personalised diet.

Those who feel mild discomfort after tucking into a big bowl of pasta might simply have eaten too much wheat. By overloading your body - with, say a wheat-based cereal for breakfast, a sandwich for lunch, then pasta for dinner - you can create a transient intolerance to wheat. Try to limit your intake to one wheat-based meal a day.

Alternatively, try varying the carbs rather than moaning about a suspect wheat allergy. Rice, potatoes, sweet potatoes and corn are good options, while pulses, such as red kidney beans, lentils and peas, can also act as the nourishing bulk of a meal. 1

COELIAC FACTS