Do I have coeliac disease?

What is coeliac disease?

Coeliac disease is a genetically predisposed autoimmune disorder causing the small intestine to become inflamed and damaged when gluten is consumed. This results in the villi on the surface of the small intestine, which are tiny finger-like projections that absorb nutrients into our bloodstream, becoming flattened therefore impairing nutrient absorption.

The health implications of coeliac disease relate to conditions associated with nutrient malabsorption. If your small intestine is unable to absorb nutrients you are more likely to suffer from conditions such as iron deficiency, osteoporosis or delayed or slowed growth in children. If coeliac disease is diagnosed in a timely fashion, most negative health outcomes can be avoided.

What is gluten?

Gluten is a protein found in wheat, rye, barley and oats, and therefore anything made using these ingredients. It gives elasticity to foods and helps them hold shape. Individuals who suffer from coeliac disease react to the gluten in these ingredients.

Individuals with coeliac disease must also avoid sourdough bread when it’s made using extended fermentation periods. The belief that the gluten in sourdough bread can be broken down and then more easily digestible for people with coeliac disease is incorrect. It may be more digestible for people with a wheat intolerance, however the bread still contains gluten and therefore will likely trigger small bowel symptoms for individuals with coeliac disease.

Do I have coeliac disease?

You may have coeliac disease if you:

• Are genetically predisposed to coeliac disease,
• Have immediate family with coeliac disease,
• Suffer from other auto immune conditions such as eczema,
• Suffer from symptoms including fatigue, abdominal discomfort, diarrhea, bloating, excessive wind, or
• Suffer from certain nutrient deficiencies such as iron-deficiency anemia.

You could also be asymptomatic and unusual blood results such as low iron may warrant coeliac disease investigation.

If you are in serious pain or discomfort, it’s important to speak to your GP.

How is coeliac disease diagnosed?

A small bowel biopsy is the gold standard for confidently diagnosing coeliac disease.

Often people will have a blood test (coeliac serology) to measure specific gluten antibodies, however this is more of a screening tool as antibody levels are not 100% reliable; it is possible for individuals to be deficient in certain antibodies and younger children can have fluctuating antibody levels. A biopsy is required to diagnose coeliac disease and confirm positive blood tests.

Gene testing is also possible in situations where a blood test and biopsy are inconclusive. Positive gene tests then must be supported by a biopsy. Although you may be genetically predisposed to have coeliac disease, this does not necessarily confirm that you have it.

It is important to remember that you must be eating gluten for six weeks prior to a small bowel biopsy to ensure accurate diagnosis. It sounds counterintuitive, however if you stop eating gluten, the small intestine may repair, making the inflammation hard to see.

Is there a cure?

Unfortunately, there is no cure for coeliac disease. However, the condition can be managed via a strict lifelong entirely gluten free diet, including the avoidance of even a trace of gluten not visible to the human eye. Complete avoidance of gluten should result in the small bowel healing, however, consumption of even small amounts of gluten will result in continual damage to the small bowel.

Tips on managing coeliac disease

Due to an increase in demand, gluten free foods are increasing in quality and availability and the understanding of food service staff around how to manage coeliac disease is also improving. However, this is a serious medical condition and you should never assume food will be prepared in a particular way. Here are a few tips to help you, or someone you live with, to manage coeliac disease:

1. Read food labels very carefully to see if the food contains gluten or wheat, rye, barley or oats.
2. Before going out for lunch or dinner look at food menus ahead of time to ensure you select an appropriate venue
3. Ensure you explicitly explain to food businesses your dietary requirement and do not be afraid to ask questions
4. Purchase your own basic household utensils and food items that are often shared with others to avoid cross-contact of gluten, such as chopping boards, toasters and spreads such as butter.
5. Take care when purchasing products from bakeries and avoid cross-contact with food containing gluten, equipment or utensils
6. Where possible make gluten free meals for family and friends to avoid cross-contact.
7. Prepare gluten free food first and set it aside before preparing other foods.
8. Store gluten-containing foods below gluten free foods to avoid spillage that could contaminate gluten free foods.
9. Speak openly and honestly with your friends and family and ensure they understand the serious nature of coeliac disease and the level of cross-contact that must be avoided.

For more information on coeliac disease, visit Coeliac Australia.

Try these gluten free recipes:

- Oregano chicken with asparagus lentil salad & pea puree

-Nicoise salad

-Sweet potato shepherd’s pie