In the past few years, gluten has become a popular topic in the world of nutrition and wellness. Many people have chosen to exclude gluten from their diet for reasons such as weight loss and overall wellness. As so many people have made the decision to remove gluten from their diets, eating ‘gluten-free’ has almost to some become just another ‘health fad’ or label that can be put onto food. However, there is a large proportion of Australians (1 in 70 to be exact) that have a condition called Coeliac Disease, and following a strict gluten-free diet is the only way they can safely manage the disease and avoid adverse health outcomes.
While awareness about the disease is spreading, I feel like there is still some confusion surrounding being gluten intolerant and being Coeliac. As this week is Coeliac Awareness Week I thought it was the perfect time to clear up any confusion.
So, what exactly is Coeliac Disease exactly and how does it differ from gluten sensitivity?
People with diagnosed coeliac disease have a condition that causes damage to the lining of the small bowel when they consume gluten. This damage can result in various gastrointestinal issues and an inability to absorb certain nutrients.
Coeliac disease can occur in all ages and genders, and there is a genetic link to the disease. There are also certain conditions that increase someone's risk of developing Coeliac Disease such as Type 1 diabetes, thyroid conditions, early onset Osteoporosis and liver disease.
People with Coeliac have to remain on a strict gluten-free diet for the rest of their lives. Avoidance of gluten will prevent damage to the small bowel and reduce symptoms.
Gastrointestinal symptoms e.g. diarrhoea, constipation, nausea, vomiting, flatulence, cramping, bloating, abdominal pain, steatorrhea (fatty stools)
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 some people may gain weight)
Bone and joint pains
Recurrent mouth ulcers and/or swelling of mouth or tongue
Altered mental alertness and irritability
Easy bruising of the skin
As you can see, the symptoms of Coeliac disease can present with are fairly diverse. The broad clinical presentation means that coeliac disease is often overlooked - it is estimated that 4 out of 5 Australians remain undiagnosed.
Although symptoms can vary considerably in coeliac disease, everybody with the condition is at risk of complications if they do not adhere strictly to treatment with a gluten-free diet. The long term consequences of untreated coeliac disease are related to chronic systemic inflammation, poor nutrition, malabsorption of nutrients and increased bowel cancer risk, which is why screening for the disease, and not ignoring symptoms is so important.
Testing for Coeliac
As coeliac disease is a serious medical condition with lifelong implications, an accurate diagnosis is essential.
If a gluten-free diet has already been adopted prior to diagnosis, the tests used to diagnose coeliac disease are unreliable and can be falsely negative.
The medical procedure for Coeliac testing involves a patient consuming a diet that contains gluten for 6 weeks, a blood test to identify antibody levels* and if the blood tests are positive, a small bowel biopsy to confirm the diagnosis.
For anyone who experiences depilating symptoms, consuming gluten for six weeks may not be an option. In this situation, HLA gene testing may give more of an indication. Over 99% of people affected by Coeliac disease have specific HLA genes, therefore a negative test for these genes effectively rules out coeliac disease. However, it is important to note that not everyone with the gene will develop Coeliac disease, and therefore a gene test alone cannot solely be used to diagnose a patient.
* Note that blood tests can be less reliable in children under the age of four years, as their antibody levels can fluctuate. It is suggested the antibody tests be performed on two occasions three months apart.
Non-Coeliac Gluten Sensitivity
Know you don’t have Coeliac disease, but notice that eating foods containing gluten results in symptoms, and you feel much better when you remove it from your diet? You most likely have an intolerance to gluten, referred to as Non-Coeliac Gluten Sensitivity. This is where the body struggles to digest gluten, but the reaction does not involve in the immune system. The symptoms of Non-coeliac gluten sensitivity are very similar to the symptoms that patients with Coeliac disease can present with but tend to be specifically digestive.
As with any food that may be triggering adverse symptoms, if you feel better not eating gluten (which many people do), it is best to remove it from your diet and replace it with naturally gluten-free options. However, it is important to note that not all foods that are ‘gluten-free’ are healthy. Many of the commercially produced gluten-free products are actually full of processed ingredients, added sugars, vegetable oils and emulsifiers. The common misconception is that the gluten-free option is always the best, which isn’t true!
For example, if you don’t have coeliac or gluten intolerance and are just wanting to make better choices at the supermarket, you would actually be better off going for a spelt or sourdough bread that only had 3 ingredients as opposed to a processed gluten-free bread which can have up to 30! That being said, there are some incredible gluten-free products now becoming available. It’s really just a matter of being cautious when it comes to choosing which ones you go for and knowing where to source the best products.
Following A Gluten-Free Diet
‘Strict avoidance of gluten’ can be quite a scary statement for someone who has enjoyed a diet containing gluten, but I’m here to reassure you that it isn’t as hard as it sounds. There are some really incredible gluten-free recipes and healthy alternatives that make being gluten-free, whether it’s for coeliac or non-coeliac gluten sensitivity, easy.
The first thing you need to be aware of are the sources of gluten. Common sources of gluten are:
Bread and cereals made from gluten-containing grains
Wheat flour (including spelt)
Wheat pasta, noodles
Semolina, couscous, burghul, stuffing
Wheat biscuits, cakes, pastry, scones
Crumbed, battered and fried foods
Pre-made meat or meat substitutes (sausages, burgers, vegetarian patties, koftas)
Commercially produced sauces, condiments, fillers and thickeners
While gluten does manage to sneak its way into lots of food, there are still so many options and ways to create your favourite dishes. Here is my table of gluten-free alternatives to help you make simple ingredient swaps and start using gluten-free products.
When it comes to eating out, make sure you let the restaurant know your dietary requirements. This is especially important when you are Coeliac. Don’t be afraid to let them know and stress that you are Coeliac, most places are now very accommodating.
If you suspect you or a member of your family may have Coeliac disease and want to find out about testing, or if you have already been diagnosed and want to make sure you are on the right track, reach out. You can make an appointment with me here.