Coeliac disease is a medical condition where gluten (a protein found in wheat, barley, rye, oats and triticale) causes inflammation of the small intestine lining (part of the digestive system). This inflammation leads to “flattening” of this lining which decreases the surface area through which the body can absorb nutrients from food. Thus, people with coeliac disease are less able to absorb the nutrients they need.

 

The lack of nutrients being absorbed by the body can lead to people feeling generally unwell and/or further conditions such as anaemia (lack of iron), osteoporosis (lack of calcium) and weight loss. When gluten is removed from a coeliac’s diet, the small intestine lining is gradually restored and normal absorption of food occurs over time.

The classic symptoms of coeliac disease are related to the gastrointestinal system that is damaged and include diarrhoea or constipation, bloating, abdominal pain and flatulence (wind). These symptoms are mainly due to the unabsorbed food being passed through to the large intestine (bowel) and reacting with the bacteria living there.

 

However, there is a great variation in the severity of people’s symptoms from the condition. Some people only experience mild symptoms, while others suffer more severe symptoms which may interfere with daily life. And it is now also known that many people with coeliac disease have less obvious symptoms such as fatigue or in fact have no symptoms at all. These people may be considered asymptomatic. However, it is important to note that recent research undertaken by Sue Shepherd, a Melbourne dietician, shows there is no correlation between the severity of a person’s symptoms and the amount of damage to the small intestine. That is, people who experience only mild symptoms or no symptoms at all, may still have significant damage to their small intestine lining leading to the malabsorption of nutrients. Similarly, people who experience severe symptoms may only have less damage to the small intestine. Thus, people with diagnosed coeliac disease should adhere to a gluten free diet, regardless of the symptoms they experience.

Coeliac disease is genetic. People with coeliac disease are born with particular genes that may lead to the onset of the disease after the introduction of gluten in the diet. However: 

As coeliac disease is genetic, research shows that about 10% of first degree relatives have also been found to have the condition.

The most accurate test for diagnosing coeliac disease, is a biopsy (small sample) taken from the small intestine and examined for any inflammation and subsequent damage to the lining.

 

A gluten free diet should not be undertaken prior to having medical tests, as the body may start to repair itself and tests may be negative for coeliac disease. Blood tests can assist in the diagnosis of coeliac disease, by checking for the presence of specific antibodies that may be produced in the reaction to gluten. However, research shows that these blood tests do not prove if coeliac disease is present. That is, people with positive blood tests, in some cases do not have the condition. Similarly, people with negative blood tests have been shown to have the disease once a biopsy is completed. The blood tests can give an indication of whether a biopsy should be undertaken.

If you are diagnosed as having coeliac disease, the only treatment available is to maintain a life long gluten free diet. Once a gluten free diet is consumed, the small intestine lining will gradually repair itself over time. The symptoms experienced as a result of coeliac disease should also decrease over time, although it varies by how much and it what timeframe. Some people feel better within weeks of instituting a gluten free diet, for others it may take longer for symptoms to abate. This variation depends on a number of factors including how severe the symptoms were, the amount of damage to the small intestine and if the person has any other medical conditions.

 

A gluten free diet means avoiding foods with wheat, barley, rye, oats and triticale. This includes obvious foods such as bread, pasta, biscuits, cakes and pizza. However, there are many hidden sources of gluten in manufactured products which are also important to avoid. For example, wheat starch and thickeners based on wheat are present in many processed foods. Even products made primarily from rice or corn may contain wheat. So it is important to read the food labels of all items to ensure no wheat, barley, rye, oats and triticale are present. There is no safe level of gluten for people with coeliac disease because of the potential damage to the small intestine lining. For information on reading food labels, see the previous article on Cooking for Family and Friends.

 

See also the Coeliac Society for more information.