Coeliac Disease

Coeliac disease is a common but often under-diagnosed autoimmune condition triggered by gluten, a protein found in wheat, barley, rye, and oats. In individuals with coeliac disease, the body’s immune system mistakenly reacts to gluten by attacking its own tissues. This immune response causes inflammation, leading to damage in the lining of the small intestine and impairs the body’s ability to absorb nutrients in the small intestines. Symptoms can include abdominal discomfort (like IBS symptoms), iron deficiency anaemia, osteoporosis, fertility challenges, and even an increased risk of lymphoma. As a serious condition, early diagnosis and effective management are crucial to prevent symptoms and long-term complications. Approximately 1 in 70 Australians have coeliac disease. However, only 20% of this number are diagnosed. This means many Australians who have coeliac disease don’t yet know it.

How can a dietitian help me?

An Accredited Practising Dietitian can provide invaluable support for transitioning to a gluten-free diet. This includes offering resources, education on reading food labels, recipe modification, menu planning, and guidance to improve overall diet quality. With tailored advice, a dietitian can help you navigate the challenges of adopting a strict gluten-free lifestyle, minimising unnecessary stress and costs by equipping you with the knowledge of which foods are safe to eat.

By starting a strict gluten-free diet, you take the first step toward preventing long-term health complications associated with unmanaged coeliac disease. These complications can include osteoporosis, liver disease, infertility, and an increased risk of developing other autoimmune conditions. Early diagnosis and adherence to a gluten-free diet significantly reduce the risk of these issues, helping you maintain your health and well-being for the future.

How is Coeliac Disease diagnosed?

Coeliac disease diagnosis involves two key steps:

1. Blood Test: This initial test screens for the presence of tTG-IgA and DGP antibodies. A positive result suggests the likelihood of coeliac disease.

2. Gastroscopy and Biopsy: If the blood test is positive, a gastroscopy is performed. During this procedure, a small tissue sample (biopsy) is taken from the small intestine and examined under a microscope for signs of damage.

Genetic testing is also available (HLA-DQ2 and HLA-DQ8) however if this is positive then above process is still necessary to confirm a diagnosis.

The importance of Gluten when testing for Coeliac disease.

Both the blood test and biopsy rely on detecting either antibodies or intestinal damage caused by gluten consumption. For accurate results, gluten must be present in the diet during testing. If you are already following a gluten-free diet, these tests will likely yield negative results, even if you have coeliac disease.

My GP has sent me for Coeliac disease blood test how much gluten do I need to be eating?

Coeliac Australia recommends that individuals who have removed gluten from their diet should resume a gluten-rich diet for at least six weeks before undergoing diagnostic testing (blood test or biopsy). The specific daily gluten intake should be discussed with your doctor, but a reasonable target is approximately 10 grams of gluten per day. For children, this amount can be halved to 5 grams per day.

10 grams of gluten is roughly equivalent to four slices of wheat bread. The gluten content in a single slice of wheat-based bread can vary between 2 and 4 grams. Below are some approximate equivalents to a slice of bread containing 2–2.5 grams of gluten:

• ½ cup wheat-based cereal

• 1 Weet-Bix

• ½ cup cooked wheat-based pasta

• ½ English muffin

• ½ large bread roll

• 4–5 crispbreads (e.g., Vita-Wheat, Salada)

• 8–10 crackers (e.g., Water Crackers, Jatz)

• 2 small sweet biscuits (e.g., Scotch Finger biscuits) (1)

During this gluten challenge, wheat-based, gluten-containing foods should be consumed daily. It is important to note that barley, rye, and oats are not recommended for this process. As symptoms may arise during the gluten challenge, regular consultation with your doctor is advised to manage any discomfort or complications. An Accredited Practicing Dietitian can help with modifying a gluten challenge to make it more gentle on your gastrointestinal symptoms by including gluten containing breads and cereals with reduced Fructan content (fermentable sugars found in Wheat, Rye Barley and Oats).

What about living with Coeliac disease and Diabetes?

It is estimated that 5-10% of individuals with type 1 diabetes may also have coeliac disease. While some people with type 2 diabetes can develop coeliac disease, the two conditions are not connected. (2) Gluten-free food products can sometimes be higher in carbohydrates, an Accredited Practicing Dietitian can assist in selecting the right foods to meet your dietary fiber needs that also support blood glucose control. 

Source:
1. Coeliac Australia. (n.d.). Gluten Challenge Guidelines. Retrieved from https://coeliac.org.au/health-professionals/gluten-challenge

2. Taczanowska, A., Schwandt, A., Amed, S., Tóth‐Heyn, P., Kanaka‐Gantenbein, C., Volsky, S. K., Svensson, J., & Szypowska, A. (2020). Celiac disease in children with type 1 diabetes varies around the world: An international, cross‐sectional study of 57,375 patients from the SWEET registry. Journal of Diabetes, 13(6), 448–457. https://doi.org/10.1111/1753-0407.13126