Coeliac disease and gluten sensitivity
Having digestive problems can impact your life significantly. There are many causes of digestive problems, one of which is gluten sensitivity.
What is gluten?
Gluten is a protein found in grains such as wheat, rye, barley, oats and triticale (a cross between rye and wheat). Gluten helps to trap air in baked goods, making them light and fluffy. It also acts like a ‘glue’ that helps hold food together. Because of these properties, gluten is often added to many processed foods.
Signs and symptoms of gluten sensitivity and coeliac disease
Some people can develop a range of symptoms after eating gluten such as:1, 2
abdominal pain
vomiting
diarrhoea or constipation
bloating
excessive gas
fatty stools
poor concentration
lethargy
general aches and pains. These can all be a sign of gluten sensitivity or coeliac disease.
What is coeliac disease?
Coeliac disease (pronounced SEE-lee-ak) is an autoimmune disease that causes the immune system to react abnormally to gluten. Over time, this reaction damages the lining of the small bowel. The small bowel is lined with tiny finger-like projections (villi) which help with the absorption of nutrients from our food. In people with coeliac disease, the villi become inflamed and flattened which reduces the ability for nutrient absorption. This can lead to nutritional deficiencies and other medical complications. Coeliac disease may also cause inflammation in other parts of the body. As well as the symptoms listed above, someone with coeliac disease may also experience:
slow weight gain, developmental delays or delayed puberty (in children)
weight loss
fatigue
persistent mouth ulcers
irritability and depression
deficiencies in vitamin B12, folate or iron, including anaemia
thyroid disease
early onset osteoporosis
unexplained infertility or recurrent miscarriages
unexplained neurological symptoms such as peripheral neuropathy.
Coeliac disease affects around 1 in 70 Australians but around 80% of these people are undiagnosed and unaware they have it.
What causes coeliac disease?
Coeliac disease can affect people of all ages. It’s not fully understood why people develop the condition, but it does run in families. About half of the people in Australia are born with one or both of the ‘coeliac genes’ with 1 in 40 going on to develop the condition. For this reason, it’s believed that environmental factors play a part in triggering the condition. Other health conditions that are associated with coeliac disease include:
type 1 diabetes
ulcerative colitis
neurological disorders
thyroid disease
Down syndrome.
First-degree relatives (e.g. parent, sibling, child) of someone who has coeliac disease have an increased risk of developing the condition and should be tested.
How to test for coeliac disease
The only way to know if you have coeliac disease is to be tested. This will usually involve:
Blood tests
Blood tests check for antibodies that may suggest coeliac disease.
Small bowel biopsy
A small biopsy checks for signs of damaged villi. If antibodies are found, you will undergo a procedure called a gastroscopy, where a thin flexible tube is inserted through your mouth and into the first part of your bowel. Small samples of your bowel will be taken and tested. This procedure is done under anaesthetic. If the biopsy is positive, you will be diagnosed with coeliac disease. It’s important to stick to your normal gluten intake before the test.
Sometimes genetic tests may be requested if the results of the biopsy are unclear. A negative test means you can’t have the condition. A positive test only means you have the genes, not that you’ll develop the condition.
What is gluten sensitivity?
If you’re tested for coeliac disease and the results are negative, you likely have gluten sensitivity or gluten intolerance. This means that eating gluten won’t cause serious damage to your small bowel, and you may be able to include small amounts of gluten in your diet. Working with a dietitian can help you work out the right foods to eat to avoid symptoms and ensure you get a healthy intake of essential vitamins and minerals.
Is coeliac disease serious?
Coeliac disease is a serious condition. Left undiagnosed and untreated can lead to chronic inflammation throughout your body, poor nutrition and malabsorption of nutrients.5This can result in an increased risk of bowel cancer, infertility and ongoing health problems.
Treating and managing coeliac disease
There is no cure for coeliac disease. Management involves strictly avoiding gluten by following a gluten-free diet for the rest of your life. This will allow your small bowel to heal and stay healthy. Ongoing blood tests and regular medical reviews may be necessary to check if you have been exposed to gluten.
Foods to avoid with gluten sensitivity?
Maintaining a gluten-free diet is important to manage your condition and prevent complications. It will involve avoiding foods that are known to contain gluten and carefully checking food labels for hidden sources of gluten. Common foods to avoid include:
breads
breakfast cereals including oats
cakes, pastries, biscuits, and crackers
pizza and pasta
foods coated with breadcrumbs or wheat-based batters
wheat-based noodles
couscous, semolina, burghul, spelt
stuffing.
Other foods that often contain gluten include:
wheaten cornflour
custard powder
icing sugar mix
baking powder
soy sauce and other sauces
dressings
yeast extract spread (e.g. Vegemite)
soups, stocks and gravies
malted drinks (e.g. malted milk, Milo)
sausages, hamburgers and marinaded meats
deli meats and other small goods
BBQ chicken
ice cream
confectionery
beer
There is a wide range of gluten-free foods on the market, including gluten-free variations of bread and pasta. Coeliac Australia has a section on their website where you can find more information about a gluten-free diet, how to choose the right foods and tips for eating out. Working with a dietitian can also be helpful when you’re first diagnosed.
Your local MediADVICE Pharmacist is available to help you manage your health. We can provide expert advice and recommend products that may help provide relief when you're not well. If necessary, your Pharmacist will refer you to a doctor for further diagnosis and investigation.
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Disclaimer
General advice only – this information should not replace the information provided to you by your health care professional. If symptoms are severe or persist, please speak to your healthcare professional. Information is current as of date of publishing.