🌾 Men's Health

Coeliac Disease: Gluten Intolerance

Gluten intolerance in Nigerians — more common than thought

Coeliac disease is an autoimmune condition triggered by gluten (a protein in wheat, barley, and rye) that damages the small intestine lining and prevents nutrient absorption. It was previously thought rare in Nigerians, but increasing use of wheat-based foods (bread, pasta, pastries, noodles like Indomie) has made it more relevant. Many Nigerian cases are missed or misdiagnosed as IBS, food poisoning, or 'stomach disorder'. The only treatment is strict lifelong avoidance of gluten.

Signs and Symptoms

✓ Chronic diarrhoea: loose, pale, bulky stools that may float (steatorrhoea — fat malabsorption)

✓ Abdominal bloating, cramping, excessive gas

✓ Unexplained weight loss and malnutrition despite eating

✓ Fatigue and weakness from multiple nutrient deficiencies

✓ Iron deficiency anaemia not responding to oral iron supplements

✓ In children: failure to thrive, delayed growth, distended abdomen, irritability

✓ Atypical presentations: mouth ulcers, bone pain (from calcium malabsorption), infertility, peripheral neuropathy

Risk Factors

Family history: first-degree relative with coeliac disease (10–15% risk)
Type 1 diabetes (10× increased risk of coeliac co-occurrence)
Down syndrome, Turner syndrome, Williams syndrome
Autoimmune thyroid disease
Increasing wheat consumption in urban Nigerian diets
HLA-DQ2 or HLA-DQ8 genetic variants (necessary but not sufficient to develop coeliac disease)

When to Seek Help

InvestigateUnexplained chronic diarrhoea lasting more than 4 weeks, iron deficiency anaemia not responding to supplements, unexplained weight loss, or infertility — request coeliac screening

PaediatricianChild with failure to thrive, chronic diarrhoea, distended abdomen, or unexplained anaemia — coeliac disease must be excluded

After diagnosisJoin a gastroenterology clinic for ongoing monitoring of nutritional status and adherence to gluten-free diet

Tests & Diagnosis

🧪 Anti-tTG IgA (tissue transglutaminase antibody)

Best first-line blood test; highly sensitive and specific for coeliac disease; also check total IgA level (IgA deficiency gives false negative)

🧪 Anti-EMA (endomysial antibody)

Highly specific confirmatory blood test; more expensive

🧪 Total serum IgA

Must be checked alongside anti-tTG — IgA deficiency (1:500 people) causes false-negative results; if deficient, use IgG-based tests

🧪 Upper GI endoscopy with small bowel biopsy

Gold standard — biopsies from duodenum show villous atrophy (flattening of finger-like projections); must be done while still eating gluten

🧪 FBC, iron, ferritin, B12, folate, calcium, vitamin D

Multiple deficiencies are typical due to malabsorption

Treatment Options

Strict gluten-free diet (GFD) — the only treatment

Permanently avoid all wheat, barley, rye, and contaminated oats; careful reading of labels; intestinal healing takes 6–24 months on strict GFD

Nigerian gluten-free staples

Naturally gluten-free: rice, yam, cassava, plantain, millet, sorghum, maize, beans, groundnuts — all traditional Nigerian staples are safe

Avoid

Bread, pasta, noodles (Indomie), semolina, wheat flour (including Nigerian biscuits, pastries, chin-chin made with wheat flour), soy sauce, malt drinks

Nutritional rehabilitation

Replace identified deficiencies: iron, folate, B12, calcium, vitamin D — with supplements and monitoring until intestine heals

Cross-contamination awareness

Even small amounts of gluten cause mucosal damage; use separate cooking utensils; avoid shared cooking oil used for wheat foods

Frequently Asked Questions

Is coeliac disease the same as wheat allergy?

No — wheat allergy is an IgE-mediated allergic reaction (immediate symptoms) and is different from coeliac disease (autoimmune, delayed mucosal damage). Both require wheat avoidance but are distinct conditions.

Is coeliac disease common in Nigeria?

True prevalence in Nigeria is unknown but increasing wheat consumption is increasing case detection. Cases are often missed due to atypical presentations and limited awareness among healthcare providers.

Can I eat Indomie noodles if I have coeliac disease?

No — Indomie noodles are made from wheat flour and contain significant gluten. They must be completely avoided. Rice noodles or plantain-based alternatives are safe.

Will I get better if I avoid gluten?

Yes — most people experience significant improvement within weeks to months on a strict gluten-free diet. Intestinal damage fully heals in most adults within 1–2 years, and nutrient deficiencies correct with time and supplements.

How do I diagnose coeliac disease if I'm already gluten-free?

Do NOT stop gluten before testing — gluten must be present for the antibodies and biopsy to show positive results. If already gluten-free, a gluten challenge (eating 2–3 slices of bread daily for 6 weeks) is needed before testing.