As a dietitian I encounter many people who experience ongoing symptoms that could be associated with coeliac disease - but they put off being tested. People are often reluctant as they put their symptoms down to general irritable bowel syndrome which they may have dealt with for years, or are worried about a positive result which means changing their diet for good.
This is completely understandable, but soon after a formal diagnosis many people are relieved to say goodbye to some of their embarrassing symptoms and welcome their new found energy levels.
Too many people don’t want to go through the tests and are happy to just omit the major sources of gluten in their diet. This may lead to restricting foods unnecessarily if they don’t have coeliac disease. On the other hand, small amounts of gluten may be consumed leading to health complications if they do have coeliac disease.
Coeliac disease is not as benign as other food intolerances. Although some people may have a non-coeliac gluten intolerance, ignoring the warning signs and symptoms of coeliac disease may increase risk for serious health complications. So let’s have a look at what coeliac disease is and why we are encouraging screening.
What is coeliac disease?
Coeliac disease is an autoimmune disease that occurs when the immune system reacts abnormally to gluten.
Gluten is the protein found in wheat, oats, barley, rye and triticale (triticale is a cereal grain created by cross-fertilisation of wheat and rye).
If people with coeliac disease eat gluten, small bowel damage can occur. This can lead to signs and symptoms such as:
- Poor nutrient absorption resulting in fatigue and certain nutrient deficiencies such as iron deficiency
- Gastrointestinal symptoms such as abdominal pain, bloating or distentionflatulence, diarrhoea, constipation or steatorrhoea (floating, fatty stools)
- Weight loss, and
- Bone pain.
Eating gluten (even the smallest amount) may lead to long-term, serious health complications such as lymphoma, osteoporosis and infertility in women.
Small bowel damage and the development of long-term complications can occur even if signs and symptoms are not experienced. This is an important reason to be formally tested if you feel there could be any chance that you gave coeliac disease.
Who gets coeliac disease?
Coeliac disease does not discriminate against age or gender and unfortunately, there is not currently any means of prevention. However, you do need a genetic predisposition to develop coeliac disease.
If you already have an autoimmune disease such as type 1 diabetes, have a family history of coeliac disease or are experiencing any of the above signs and symptoms, you should be screened.
What’s involved in screening?
The first step of screening involves a simple blood test. The purpose is to identify elevated coeliac antibodies (elevated due to the immune systems reaction to gluten). If the results are positive, a biopsy of the small bowel is required to confirm a diagnosis of coeliac disease. It is important that gluten is not restricted prior to screening.
When a diagnosis of coeliac disease is unclear or difficult to determine, gene (HLA) testing can be used. Although a small biopsy is still required to diagnose coeliac disease, a negative test for the HLA DQ2 and HLA DQ8 genes can correctly out rule coeliac disease. This test can be performed on a blood test or cheek (buccal) scraping ordered through your GP.
How can coeliac disease be managed?
Currently the only way to effectively manage coeliac disease is to follow a strict gluten free diet for life. Gluten is found in wheat, oats, barley, rye and tricticale, therefore foods containing these must be avoided and substitutes found.
Some naturally gluten-free foods include rice, quinoa, sago, tapioca, buckwheat, soy, arrowroot, fresh fruit, vegetables, legumes, nuts, meat (except most processed meats), poultry, fish, most dairy foods and fats and oils.
Some foods containing gluten such as wheat-based pasta and breads have been manufactured to have the gluten removed. If any of these food products are labeled ‘gluten free’ you can be sure that they contain no detectable gluten.
Some products will also have the ‘crossed grain logo,’ which means they are endorsed by Coeliac Australia and are tested to be suitable for people with coeliac disease.
To help you identify major and hidden sources of gluten, the ingredients list on a food label is an important tool. If any ingredient in a product is derived from wheat, oats, barley or rye then this must be declared on the ingredients list.
If you would like more information on coeliac disease, including screening for and managing the condition with a gluten free diet visit the Coeliac Australia website and book an appointment with your GP if you have identified any signs or symptoms of coeliac disease.