Coeliac Disease is an immune reaction to gluten which is found in wheat, rye, barley and oats.
This requires a life long gluten free diet.
Coeliac Disease is not a food intolerance but an autoimmune reaction to proteins (gliadin) in gluten that affects 1 in 100 people across developed countries but is actually higher in Australia with 1 in 70 people having Coeliac Disease.
This is very high, and the disturbing thing is that at least 80% of people with Coeliac Disease actually do not know it- they remain undiagnosed.
Another little known fact is that having IBS (Irritable Bowel Syndrome) means you are more likely to have Coeliac Disease- so before you reduce the wheat in your diet- TEST FOR COELIAC DISEASE FIRST because it is very hard to make oneself put wheat back into the diet after you have taken it out and got improvements. See below for more information.
Years ago, Coeliac Disease was thought to only affect the gut but we now know this is not the case. Coeliac Disease is an auto immune disease that affects many organs in the body including the gut, bone, skin, liver, heart and kidneys, reproductive systems ( in women), neurological system and can cause general issues such as extreme tiredness and fatigue.
What happens when people with Coeliac Disease consume enough gluten, damages occur to the absorptive surface of the small intestine over time. On the gut wall of the small intestine are finger like projections called villi and this is where nutrients and energy in food are absorbed across the gut wall and into our bodies.
Gluten sets off an immune reaction which results in these villi being reduced in size and flattened. Nutrients and energy are malabsorbed which causes the classic gut symptoms known to occur in many people with Coeliac Disease: gut bloating, distension and diarrhoea, stomach pain, wind and ultimately weight loss.
Half of the people with Coeliac Disease do not have these classic symptoms so it can be hard to diagnose. As mentioned above, Coeliac Disease is now known to affect many systems in the body and can cause a huge variety of symptoms from extreme fatigue, headaches, brain fog (concentration and memory problems) to delayed puberty, nausea and vomiting and hair loss.
The only known treatment is a lifelong, strict gluten-free diet.
If you are thinking of taking gluten out of your diet... check for Coeliac Disease first.
It makes sense to check for Coeliac Disease BEFORE taking gluten out of your diet because....
to screen for Coeliac Disease, you actually need to eat gluten daily for at least 4 weeks prior to the test and if you take gluten out of the diet and feel a bit better then you may be reluctant to put the gluten back in to test for Coeliac Disease
if you actually have Coeliac Disease but remain undiagnosed then your long term health can suffer
Undiagnosed Coeliac Disease increases risk of gut cancers, osteoporosis, liver and heart disease, neurological effects and if Coeliac Disease is diagnosed down the track it may have become unresponsive to a gluten free diet.
Blood Test for Coeliac
Blood tests look to see if specific antibodies in the body are increased which is to be expected if Coeliac Disease is present. This test really screens for Coeliac Disease- it does not diagnose Coeliac Disease.
You need to eat enough gluten (at least 2 slices of bread or equivalent wheat products) every day for at least 4 weeks prior to the blood test otherwise the blood tests will be meaningless and a waste of your time.
Note: If you get a negative blood test suggesting you don't have Coeliac Disease it does not mean you will never develop Coeliac Disease - you may need to re-test down the track.
FACT: If you have not eaten enough gluten then you will not have the antibodies or flattening of the villi in the small intestine so Coeliac Disease cannot be diagnosed even though you may have it.
How Much Gluten Do I need To Eat before the Blood Test?
You need to eat at least 2 slices of wheat bread (normal bread) or the wheat equivalent every day for 4 weeks before the blood test is taken. You can eat more than this of course but the minimum amount required is 2 slices of bread. You can eat rye or barley but oats cannot be counted as a gluten food for testing.
Gene tests for Coeliac Disease
You do not need to be eating gluten for the gene test, however gene tests cannot diagnose Coeliac Disease.
FACT: 30% of people in the world carry the Coeliac genes but only 3% (approx) go on to develop Coeliac Disease
It can be useful to rule out Coeliac Disease once and for all.
FACT: If you do not have the Coeliac Disease genes then you will are extremely unlikely to develop Coeliac Disease!
In summary- gene tests do not diagnose Coeliac Disease but can rule it out if you don't have the genes. This is because Coeliac Disease is genetic so if you don't have the genes- you wont develop Coeliac Disease.
Small Bowel Biopsy
If you have high levels of blood antibodies, it means you may have Coeliac Disease, but the only way you can actually diagnose is with a small bowel biopsy performed by a gastroenterologist.
Very small samples taken from your gut will show if the villi projections in your small gut have been flattened which diagnoses Coeliac Disease.
Treating Coeliac Disease
Treatment is a lifelong avoidance of gluten in wheat, triticale (hybrid of wheat and rye), rye, barley and oats (controversial).
Obvious sources of gluten to be avoided are breads, pizza bases, pastry, cakes, muffins, normal sweet and savoury biscuits, breakfast cereals, bread crumbs and general flours but also there are smaller amounts of gluten in the diet that need to be avoided such as wheat starch and thickeners (1400 - 1500) that can often be added to foods.
Alternative grains and flours that do not contain gluten can be used such as arrowroot, buckwheat, corn or maize, maize corn flour, lupin, millet, modified maize starch, polenta, psyllium, rice, sago, sorghum, soy and tapioca.
Test for Coeliac Disease if you are thinking that you may be reacting to gluten
If diagnosed with Coeliac Disease- commence a gluten free diet. I can help you choose a gluten free diet that meets your nutritional needs as well as how to navigate your way through identifying safe foods for your gluten free diet.