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Coeliac Disease - Where do I start ?


In this Part 1 of a series of articles, Kyann Calvi, Accredited Practicing Dietitian, presents symptoms, common irritants and some practical advice on managing and educating potential Coeliac Disease sufferers.

Coeliac Disease - Where do I start ?

The word ‘Coeliac’ is derived from the Greek word koiliakos, which means ‘suffering of the bowels’. Coeliac Disease (CD) is a medical condition caused by an intolerance to gluten, a protein mostly found in wheat, rye and barley. For unknown reasons, the body’s immune system identifies gluten as a ‘foreign body,’ and as a result damage is caused to the small bowel. Along the walls of the small bowel are villi, or small finger like projections

that help to absorb nutrients during the normal process of digestion. In CD these finger like projections become flattened, reducing absorption of nutrients from food and increasing the likelihood of vitamin and mineral deficiencies including iron, folic acid and calcium.

Some people with CD experience obvious signs and symptoms and others don’t.

Signs and symptoms of CD are varied and can include:

  • Tiredness (fatigue or lethargy)
  • Anaemia (low iron levels)
  • Stomach discomfort - Bloating and or flatulence (wind)
  • Frequent bowel motions
  • Weight loss or difficulty gaining weight
  • Mouth ulcers



DO I HAVE COELIAC DISEASE?

A diagnosis should never be made on the basis of symptoms alone! It’s important to initially have a screening test - a blood test that measures antibodies to gluten, followed by a small bowel biopsy. Be careful not to start the gluten free (GF) diet until you have a bowel biopsy or you might get a false negative result. If you have a first degree relative with CD it’s a good idea to have a screening test even if you don’t experience any symptoms.

At present the only treatment for CD is a lifelong GF diet. In order to achieve a GF diet there are a number of essentials that people with CD should be aware of.

EDUCATION: A good knowledge of both GF foods and sources of gluten is fundamental to achieving a true GF diet. After diagnosis your gastroenterologist should refer you to an Accredited Practising Dietitian (APD) who works in the area of CD. Your APD will assess your current intake and begin education on the GF diet.

HIDDEN SOURCES OF GLUTEN: In processed foods gluten may be hidden in a number of forms, for example, some starches and thickeners, malt and malt vinegar, hydrolysed wheat protein or textured vegetable protein derived from wheat, rye or barley. Examples of commercial foods that may contain gluten are soy sauce, flavour sachets, sandwich spreads and icing sugar mixture. A session on how to read labels is a must when you are first diagnosed to help you identify the products that are safe to eat. Medications can also include gluten – always check with your GP and/or pharmacist.

NUTRITION: The good news is that you can still achieve a healthy well balanced diet when eating GF foods.

NETWORKING: Often when people are first diagnosed with CD they feel overwhelmed and isolated. My advice is to join the Coeliac Society in your state or area. The society can provide invaluable advice and resources with respect to living with CD, and help you to establish a great support network.

SHOPPING: Shopping and cooking needn’t be a dilemma. Fresh meat/chicken/fish or tofu without seasoning or marinades, fruit, vegetables, legumes, rice, raw nuts and seeds, herbs, oils and most dairy products are gluten free. Many GF foods can be found in the regular sections of supermarkets, and with the large range of specialty GF bread and cereal products on the market, people with CD rarely have to go without.

FIBRE: When you cut out gluten you usually cut out a lot of fibre – so it’s important to consume high fibre GF foods, and of course make sure you drink enough fluid. Some examples of high fibre GF foods are listed in the table below.

Table 1. High Fibre Gluten Free Foods
Type of Food High Fibre Option
*Legumes, fruit & vegetables may be preserved in sauces or marinades, or ingredients in condiments such as chutneys and spreads that may contain thickeners or other ingredients derived from gluten. It’s extremely important to check the label before purchasing any product!
GF Breads Wholegrain, Multigrain or Fruit loaf

GF Breakfast Cereals Muesli or cereal with added psyllium

Rice or GF Pasta Brown or Wild Rice
Corn or vegetable based pasta

GF Crackers & Biscuits Wholegrain/Multigrain/Corn rice cakes, crackers or crispbread

Legumes *All dried and tinned legumes including lentils, chickpeas, kidney beans, 3-bean mix etc.

Fruit *Fresh, tinned and frozen – with skins on where possible

Vegetables *Fresh, tinned and frozen – with skins on where possible

Seeds and Nuts All raw, unsalted & unflavoured



COOKING & FOOD PREPARATION

GF foods can be very different to wheat containing foods, and baking may require some practice! It’s the gluten component that gives baked items their light ‘fluffy’ texture, so most gluten free breads, cakes and slices are quite heavy and dense. There are many GF recipe books available to help you get started. Alternatively normal recipes can be modified by substituting GF ingredients for gluten containing ingredients. Usually this is a process of trial and error.

CROSS-CONTAMINATION:When gluten from foods comes into contact with GF foods it can cause cross-contamination – rendering the GF food unsafe to eat. In Australia oats are generally processed on the same equipment as wheat and for this reason oats and oat products are NOT considered to be GF. Here are a few hints to prevent cross-contamination at home:

  • If meals are prepared for other members of your household not on a GF diet, be sure to prepare GF foods first or use a separate preparation area with separate utensils, crockery & cutlery for GF meals.
  • Be especially careful with margarine, butter and spread containers to avoid contamination with breadcrumbs.
  • Toasters are a trap for breadcrumbs; it is recommended to use a separate toaster or grill for gluten free bread.

EATING OUT: It’s important to advise people in advance of your special dietary requirements (friends, restaurants, airlines etc.), and wise to take a GF snack with you when dining away from home to ensure you have some provisions in the event of catering mix ups.


This article has briefly addressed some of the issues that people with CD are faced with. Consultation with your APD or GP is recommended.

If you wish to see an APD in your area you can go to the Dietitians Association of Australia website www.daa.asn.au and click on ‘Find an APD’ by highlighting Coeliac Disease next to ‘Area of Practice’. Alternatively you can call your local hospital or check the yellow pages under ‘D’ for Dietitian. For people living outside Australia contact the Dietitians Association in your country.


Kyann Calvi is an Accredited Practicing Dietitian who specialises in Coeliac Disease, Food Intolerance and other gastrointestinal disorders such as Irritable Bowel Syndrome. She has several years experience in major hospitals throughout the Eastern states of Australia and now works in private practice locations in the Eastern suburbs of Melbourne, including the Surrey Hills Medical Centre and Croydon Sports Injuries & Spinal Clinic.

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