Coeliac Disease Q&A with The Biting Truth

This month we’re aiming to raise awareness of Coeliac Disease, with the help of our in-house dietitians, Anna and Alex from The Biting Truth, who have answered all the questions you submitted on coeliac disease.

1. What are the signs/symptoms of coeliac disease?

Coeliac disease can vary in its symptoms, ranging from many to none at all. Symptoms can include:

  • Ongoing gastrointestinal symptoms including: diarrhoea, constipation, nausea, flatulence, vomiting, cramping, bloating, abdominal discomfort
  • Unexplained weight loss
  • Prolonged tiredness and weakness
  • Iron deficiency and/or other vitamin and mineral deficiencies
  • Recurring mouth ulcers
  • Recurrent miscarriages or infertility
  • Failure to thrive or delayed puberty

2. What’s the difference between coeliac disease and gluten intolerance?

Coeliac disease is an autoimmune condition where the lining of your small intestine, which is covered in tiny little projections called ‘villi’, becomes damaged by gluten, a protein found in wheat and some other grains. Over time, with continued consumption of gluten, the villi become more and more damaged, leading to reduced absorption of nutrients. Once diagnosed, the only way to manage the disease is to remove all sources of gluten from the diet.

Gluten intolerance (also known as non-coeliac gluten sensitivity) doesn’t involve an immune or autoimmune response, i.e., there’s no inflammation. However, it’s characterised by similar symptoms such as bloating, abdominal pain, wind, lethargy and bowel changes. People with gluten intolerance can usually tolerate small amounts of gluten without experiencing any symptoms (unlike people with coeliac disease). Tolerance varies greatly between individuals; the key to managing symptoms is identifying the tolerance threshold (i.e., how much is tolerated) and being careful not to exceed it.

3. How is coeliac disease usually managed or treated?

The only treatment currently available is a strict gluten-free diet.

A gluten-free diet prevents further damage to the intestinal lining, allowing the villi to heal so that nutrients can be absorbed properly. People with coeliac disease need to be strict in following the diet for the rest of their life, even if they don’t have symptoms. They can’t take a break every now and then to have a bowl of regular pasta or a slice of regular bread.

Ongoing monitoring is also important. The villi usually grow back and return to normal, but this can take anywhere from months to years. Even if they grow back, the individual needs to remain on a gluten-free diet. In this sense, people are only treated for coeliac disease, they are not cured; at least, not yet – doctors are working on it!

If left untreated, people with coeliac disease are at an increased risk of bowel cancer, osteoporosis, infertility, miscarriages and chronic ill health. The risk of all these conditions returns to normal on a gluten-free diet.

4. Do you have any advice on taking nutritional supplements?

We find that nutritional deficiencies in people newly diagnosed with coeliac disease are quite common. The severity and extent of intestinal inflammation influences how someone absorbs nutrients. The most common nutritional deficiencies are vitamin B12, calcium, iron, vitamin D and zinc. If you have diagnosed nutrient deficiencies, your doctor may advise you take supplements.

Keep in mind, once you restore your nutrient levels and your intestines heal, you’ll likely no longer need to take supplements.

We recommend meeting with an Accredited Practising Dietitian who can assess your diet and provide guidance on what to eat to help you meet your nutritional requirements.

5. Which foods contain gluten?

Grains, flours
  • All varieties of wheat (i.e., spelt, kamut, durum, farro)
  • Barley
  • Oats
  • Products containing malted gluten-containing grains e.g., malt barley
  • Rye
  • Semolina
  • Triticale
Cereal products
  • Couscous
  • Egg noodles
  • Lasagne
  • Muesli
  • Noodles
  • Oat porridge
  • Pasta
  • Ravioli/tortellini
  • Udon noodles
  • Wheat-based & mixed grain breakfast foods
Breads, biscuits, cakes
  • Barley bread
  • Crispbreads
  • Croissants
  • Ice cream cones
  • Pizza bases
  • Regular biscuits/cakes
  • Regular bread/rolls
  • Rye bread
  • Sourdough bread
  • Waffles/pancakes
Drinks 
  • Barley drinks
  • Beer/ale/lager/stout
  • Milo & other malt powder beverages
Sauces, spreads 
  • Malt vinegar
  • Vegemite, Promite & Marmite (gluten-free varieties available)

6. Do you have any nutrition tips for someone following a gluten-free diet?

The most important thing to know is that it’s still possible to eat a healthy, balanced diet when following a gluten-free diet.

Here are a few things to keep in mind:

  1. Avoid all gluten. Even very small amounts of gluten can cause ongoing gut damage and/or symptoms for people with coeliac disease.
  2. Be careful of cross contamination. Cross contamination occurs when a gluten-free food becomes contaminated by either direct or indirect contact with a gluten-containing food.
  3. Include gluten-free grains in your diet and choose wholegrain products where possible e.g., brown rice, quinoa, wholegrain gluten-free bread.
  4. Eat a balanced diet that includes foods from all 5 food groups – grains, veggies, fruits, dairy and meats/alternatives.

7. How can I tell if a product is gluten free?

Check the label for the following claims:

  • Gluten free: By law, a product can only be labelled as ‘gluten free’ when it contains no detectable gluten (i.e., less than 0.003%). These products are safe to eat for people on a gluten-free diet.
  • Contains gluten or contains traces of gluten: Sometimes sources of gluten are not written on the ingredients list, but a label will state ‘contains gluten’ or ‘contains traces of gluten’. These products should be avoided by people on a gluten-free diet.
  • May contain traces of gluten: Warning statements such as ‘May contain traces of gluten’ are voluntary and can be used a bit like a ‘get out of jail free’ card by the manufacturer. The use of warning statements in this way can result in the food being eaten by someone ‘at risk’ or in the food being avoided when it’s in fact safe to eat. It’s a good idea to contact the manufacturing company for more information as avoiding all foods with this warning may not be necessary.
  • There are also some handy apps available if that’s your kind of thing:
  • Coeliac Australia app (called ‘Gluten Free Ingredient List’ on iPhone)
  • Find Me Gluten Free
  • FoodSwitch (from The George Institute for Global Health)

Thank you for sharing all of your questions, we hope you’ve enjoyed reading our answers!

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