How gluten affects people with coeliac disease
Testing for coeliac disease is
only accurate while a person
is still consuming gluten
About one in 70 Australians have coeliac
disease, but research shows just 20% of
those living with the serious autoimmune
condition have been diagnosed. If you have
a client that has mentioned suffering from
symptoms that sound like coeliac disease
(see below), prompt them to ask their GP
about testing for it.
Going ‘gluten free’
‘Non-coeliac gluten sensitivity’ (NCGS)
or ‘gluten intolerance’ describes a set of
symptoms people attribute to dietary gluten,
but the cause and treatment is not well
understood.
Research indicates it is unlikely that
gluten itself is the problem in these cases,
and that the malabsorption of fermentable
sugars (FODMAPs) may be the culprit in
those with Irritable Bowel Syndrome.
Millions of Australians choose to remove
or reduce gluten from their diet. The CSIRO
Healthy Diet Score, published in 2016, found
that 12.1% of Australians avoid gluten and/
or wheat, mostly for the following reasons:
• they have been diagnosed with coeliac
disease
• they have been advised to follow a gluten
free diet for another medical condition
• they find a gluten free diet relieves
symptoms that they experience (many of
these people may have undiagnosed
coeliac disease or malabsorb fructans)
• they believe a ‘gluten free’ diet is a
healthier way to eat.
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The symptoms of coeliac disease vary considerably from person
to person; some can present with quite severe and debilitating
symptoms, while others can be asymptomatic (have no apparent
symptoms).
As well as a number of uncomfortable symptoms, untreated
coeliac disease can result in an increased risk of a number of long-
term health consequences, including osteoporosis, liver disease,
fertility issues and some types of cancer.
Common symptoms can include:
• gastrointestinal symptoms e.g. constipation, nausea, vomiting,
flatulence, cramping, bloating, abdominal pain, and diarrhoea
• fatigue, weakness and lethargy
• iron deficiency anaemia and/or other vitamin and mineral
deficiencies
• failure to thrive or delayed puberty in children
• weight loss (although coeliac disease can affect people of any
size or shape)
• bone and joint pains
• recurrent mouth ulcers and/or swelling of mouth or tongue
• altered mental alertness and irritability
• skin rashes such as dermatitis herpetiformis
• easy bruising of the skin
• low-trauma fracture or premature osteoporosis
• unexplained infertility
• peripheral neuropathy, ataxia or epilepsy
• dental enamel defects.
For more information on symptoms, go to coeliac.org.au/symptoms
If it is suspected that a person may have coeliac disease, testing
by a GP is essential. This will ensure a correct diagnosis is made and
allow the most appropriate treatment to occur.
It is important to note that testing for coeliac disease is only
accurate while a person is still consuming gluten, so if a client intends
to be screened for the disease, they should not eliminate gluten from
their diet beforehand.
Effect on daily living
What does being coeliac mean in day-to-day life, in terms of what
people with the disease can and cannot eat?
A strict gluten free diet is the medical treatment for people with
coeliac disease, so avoiding foods made from wheat, barley, oats
and rye is essential. A little bit of gluten does hurt!
This means foods such as regular bread, pasta, cereals, biscuits
and cakes are off limits. Other ingredients made from these grains
which can be used in processed products, such as sauces, stocks,
gravies, marinades, confectionery, icing sugar mixture and soy milk,
can also contain gluten-derived ingredients.
Manufactured foods that are labelled ‘gluten free’ must contain
no detectable gluten, so these foods are suitable for people with
coeliac disease.
It is important (and makes good nutritional sense) to base a gluten
free diet on less processed, naturally gluten free foods such as fresh
fruit and vegetables, legumes, unprocessed meats, eggs and nuts,
milk and cheese and the range of gluten free grains available.
Although gluten free products are more abundant and affordable
than ever, dining out gluten free remains a challenge for many people
with coeliac disease. While there are many gluten free options
available at food outlets, research has shown that meals may still be
compromised by gluten. It is important to be proactive and ask the
right questions when eating out, courteously of course.
Whether someone has a diagnosis of coeliac disease or FODMAP
malabsorption, a consultation with a dietitian to assess dietary
compliance and nutritional adequacy is important.