Digestive troubles can have a major impact on your well-being. One common trigger is gluten sensitivity.
What is gluten?
Gluten is a protein present in grains like wheat, rye, barley, oats and triticale (a wheat, rye hybrid). It traps air within dough, giving baked goods their light, fluffy texture, and serves as a binding “glue” in many processed items.
Signs and symptoms of gluten sensitivity and coeliac disease
After consuming gluten, some individuals may notice:
- Abdominal pain
- Vomiting
- Diarrhoea or constipation
- Bloating
- Excessive gas
- Fatty stools
- Poor concentration
- Lethargy
- General aches and pains
What is coeliac disease?
Coeliac disease (pronounced SEE-lee-ak) is an autoimmune condition in which the body reacts inappropriately to gluten. This immune response gradually harms the lining of the small intestine. Normally, the intestine is covered in tiny finger-like projections called villi that absorb nutrients. In coeliac disease, these villi become inflamed and flattened, impairing nutrient absorption and leading to potential deficiencies and other health issues. Beyond the gut symptoms above, someone with coeliac disease may also experience:
- Slow weight gain, developmental delays or delayed puberty (in children)
- Weight loss
- Fatigue
- Persistent mouth ulcers
- Irritability and depression
- Deficiencies in vitamin B12, folate or iron (including anaemia)
- Thyroid disorders
- Early-onset osteoporosis
- Unexplained infertility or recurrent miscarriages
- Neurological symptoms such as peripheral neuropathy
How common is coeliac disease?
About 1 in 70 Australians have coeliac disease, yet up to 80% remain undiagnosed.
What causes coeliac disease?
Coeliac disease can develop at any age and tends to run in families. Roughly half of all Australians inherit one or both of the coeliac genes, though only about 1 in 40 will actually develop the condition. This suggests that environmental factors also play a role. Other conditions linked with coeliac disease include:
- Type 1 diabetes
- Ulcerative colitis
- Neurological disorders
- Thyroid disease
- Down syndrome
First-degree relatives (parent, sibling or child) of a person with coeliac disease have a higher risk and should consider testing.
How to test for coeliac disease
The only way to confirm coeliac disease is through medical testing. Typically, this involves:
- Blood tests
A sample of blood is analysed for antibodies that suggest coeliac disease.
- Small intestinal biopsy
If blood markers are detected, you’ll have a gastroscopy under anaesthetic. During this procedure, a thin, flexible tube is passed through your mouth into the upper small intestine, where small tissue samples are collected. Specialists look for damage to the villi, the tiny, finger-like structures responsible for nutrient absorption. A positive biopsy establishes the diagnosis. It’s crucial to maintain your regular gluten intake up until testing.
In some cases, genetic testing may be offered when biopsy results are inconclusive. A negative genetic result rules out coeliac disease, while a positive one only indicates you carry the genes, not that you will necessarily develop the condition.
What is gluten sensitivity?
If coeliac tests come back negative but you still react to gluten, you may have gluten sensitivity or intolerance. Unlike coeliac disease, this does not permanently damage the intestinal lining, and you might tolerate small amounts of gluten. Working with a dietitian can help you choose foods that prevent symptoms and ensure you receive an adequate intake of essential vitamins and minerals.
Is coeliac disease serious?
Coeliac disease is a significant health issue. If left undiagnosed and untreated, it can cause chronic inflammation, malabsorption and nutritional deficiencies. Over time, this may elevate the risk of bowel cancer, infertility and other ongoing health problems.
Treating and managing coeliac disease
There is currently no cure for coeliac disease. Effective management requires a strict, lifelong gluten-free diet. Eliminating gluten allows the small intestine to heal and function properly. Regular blood tests and medical reviews help ensure you remain free from accidental gluten exposure.
Foods to avoid with gluten sensitivity
To control symptoms and prevent complications, you must avoid all items containing gluten and read labels carefully. Common sources include:
- Breads, breakfast cereals (including oats), pizza, pasta
- Cakes, pastries, biscuits, crackers
- Foods coated in breadcrumbs or wheat-based batters
- Couscous, semolina, bulgur, spelt, wheat noodles
Other frequently hidden sources of gluten are:
- Wheaten cornflour, custard powder, baking powder
- Soy sauce, sauces, dressings
- Yeast extract spreads (e.g. Vegemite)
- Soups, stocks, gravies
- Malted drinks (e.g. Milo), beer
- Processed meats (sausages, hamburgers, deli meats)
- Ice cream, confectionery
Fortunately, a wide range of gluten-free alternatives, such as breads and pastas, are now available. Coeliac Australia’s website offers detailed guidance on shopping for safe products and eating out. Early collaboration with a dietitian can make the transition to a gluten-free lifestyle smoother.