People affected by coeliac disease and those with gluten or wheat intolerance can experience similar symptoms – but they’re vastly different conditions, as Coeliac Australia’s Penny Dellsperger explains.
- Coeliac disease is an immune-based condition in which the body responds abnormally to gluten, a protein found in wheat, rye, barley and oats
- Gluten intolerant non-coeliacs who experience similar symptoms, though less severe or harmful, may choose gluten free eating in order to reduce discomfort
- If left untreated, coeliac disease can cause chronic ill health and increase the risk of developing other autoimmune diseases, osteoporosis, fertility problems and cancer
- The only treatment for coeliacs is avoidance of foods containing gluten
- Once the gluten free diet is established and the body has a chance to heal, there should be no ongoing nutritional issues that will impact a client’s ability to exercise.
Recent years have seen a meteoric rise of all things gluten free. From steadily expanding ranges on supermarket shelves to increased options on restaurant menus, those who avoid consuming gluten certainly have more choice than was once the case. While some steer clear of gluten because they say they feel better for doing so, others have to ensure they never eat it because they have the serious health condition coeliac disease. So, what’s the difference?
Coeliac disease is an immune-based condition in which the body responds abnormally to gluten, a protein found in wheat, rye, barley and oats.
In coeliac disease, this immune response to gluten causes inflammation and small bowel damage that can lead to malabsorption, anaemia and nutrient deficiencies.
A strict gluten free diet is currently the only treatment for coeliac disease. By adhering to a gluten free diet, inflammation and damage will repair, allowing symptoms to resolve and reducing the risk of any long-term complications.
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.
How gluten affects people with coeliac disease
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 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. diarrhoea, constipation, nausea, vomiting, flatulence, cramping, bloating, abdominal pain, 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.
So, does having coeliac disease affect a person’s energy levels, or how they work out with their personal trainer or on their own?
It is common for people newly diagnosed with coeliac disease to suffer from malabsorption, osteoporosis or osteopenia, peripheral neuropathy, ataxia, iron deficiency anaemia or nutritional deficiency – so these are things to keep in mind when designing an exercise program. Once the gluten free diet is established and the body has a chance to heal, there should be no ongoing nutritional issues that will impact exercise performance.
When a person with coeliac disease accidentally consumes gluten, a variety of symptoms is possible – from a mild headache in some, to symptoms like those of acute food poisoning in others. If this occurs, the best approach is to rest, rehydrate and seek medical support from a pharmacist or GP if necessary.
Treat coeliac disease seriously!
Coeliac disease is a serious medical illness, not a dietary fad. Untreated, coeliac disease can cause chronic ill health and increase the risk of developing other autoimmune diseases, osteoporosis, fertility problems and cancer.
Coeliac Australia’s current awareness campaign aims to increase the diagnosis rate of coeliac disease. It highlights the range of possible symptoms beyond the typical ‘gut’ issues and encourages those at risk of coeliac disease to take a quick online self-assessment at coeliac.org.au/assess
If risk factors for coeliac disease are identified, clients can download a letter to take to their GP with details of their assessment results and links to Coeliac Australia’s resources.
Any symptoms should be thoroughly investigated before any dietary change to ensure a correct and timely diagnosis. A gluten free diet should never be trialled or started prior to screening for coeliac disease as the accuracy of testing relies on the consumption of gluten. More information can be found at coeliac.org.au/diagnosis
Additional support sub heading
Coeliac Australia is the leading provider of evidence-backed information on coeliac disease and the gluten free diet. Coeliac Australia offers professional and patient membership which provides a range of tools and resources to help individuals best adhere to a gluten free diet. Clients can find out more at coeliac.org.au/join-now
Coeliac Awareness Week (13-20 March, 2020) & Gluten Free Expos
In 2020, 80% of those affected by coeliac disease live with their symptoms undiagnosed. Coeliac Australia urges those who think they may be at risk to complete an online risk assessment at coeliac.org.au/assess
Coeliac Australia run their annual Gluten Free Expos throughout the year in Perth, Melbourne, Sydney, Brisbane and Adelaide – although many 2020 events have been postponed. You can find out more information at glutenfreeexpo.com.au
An Accredited Practising Dietitian specialising in coeliac disease, Penny is Coeliac Australia’s Health Advocacy Officer and has been with the organisation for over 14 years. She is involved with food regulation and resource development, and provides an advisory service to assist members, the food industry and health professionals. coeliac.org.au/join-now / https://www.facebook.com/CoeliacAust / https://www.instagram.com/coeliacaus/