What is Coeliac Disease?
Coeliac Disease (CD) is an intolerance to gliadin, a protein in gluten. Gluten is what makes grains ‘stretchy’ (think of kneading bread dough and how elastic it becomes). Some people have a genetic predisposition to react to gliadin, causing the absorptive surfaces in the small intestine (villi) to flatten and not absorb food properly. CD, though an intolerance to gluten, is considered an auto-immune disease (where the body’s defence system attacks itself) and a person with CD may be more likely to have other auto-immune conditions. One small study found 51% of coeliacs had other immune diseases, the most common being type 1 diabetes. Interestingly, the same study sited only 24% had classic coeliac symptoms.
The 2 main tests for CD are a blood test that looks for antibodies to gliadin and a biopsy of the small intestine. However it is recommended you eat gluten containing foods for 6 weeks before being tested to get an accurate result. For people who have already experienced the wonders of being gluten-free and healthy again, this can be agonising.
The only treatment for CD is a totally gluten-free diet. Even traces of gluten can flatten the villi again, usually taking weeks to recover.
What are some of the symptoms of Coeliac Disease?
Keep in mind that perhaps a 1/3 of people with condition do not experience classic or even minor symptoms. The majority will experience gut pain and change in bowel habits (chronic diarrhoea, smelly stools, gas, weight loss) when they eat gluten. However as a result of the malabsorption of nutrients that occur a whole range of non-gut related symptoms can occur.
These may include:
recurrent and slow healing infections
unexplained anaemia (low iron)
failure to thrive in infants
pain in the joints
tingling or numbness in the legs (from nerve damage)
pale sores inside the mouth,(aphthus ulcers)
painful skin rash (dermatitis herpetiformis )
tooth discoloration or loss of enamel
reproductive issues (miscarriages, infertiltiy)
missed menstrual periods (often because of excessive weight loss)
Gluten containing foods:
The grains that contain gluten
Wheat: eg most breads, noodles, pasta, couscous, cakes, biscuits, muffins, tabouli, pancakes, pastry, breadcrumbs (eg: schnitzel), bran, ingredient listed as “flour”
Spelt, semolina, durum, kamut (all varieties of wheat)
Oats – eg: most muesli, anzac biscuits, porridge (however – oats are very low in gluten and the issue may be cross-contamination when oats are processed)
Barley – some coffee substitutes, added to soups and stews
Malt – eg: most malted milk and chocolate drinks, soy milk (except those labelled “malt free”) malt/brown vinegar (and lots of pickled foods), beer
Seitan eg: most Chinese ‘mock’ meats
Watch out for gluten hidden in some of these products
Soy sauce (wheat)
Thickeners (in sauces, some commercial mayonnaise)
Some lollies and candy bars
Most breakfast cereals
Sausages and luncheon meats
Fried and ‘grilled’ fish (usually dredged in flour)
Some types of whisky, gin, vodka (as well as bourbon and beer)
Casseroles and other dishes where meat or fish has been rolled in flour and fried.
Baby foods, formulas and cereals
Packet soups and stocks
Sauces and gravies
Some mustards and curry powders
Some ice blocks
Ice cream cones
“starch” or “modified food starch”
MSG (glutamic acid can be made from wheat, soy or corn but rarely is the source mentioned on the label)
Note: eating out can be hazardous. It is not unusual for meat or fish to be floured then fried in most restaurants. There is also the risk of cross-contamination. Kissing someone who has just eaten gluten can also set off the condition (think about a few crumbs hanging around after eating a sandwich, beards and mustaches can also harbour all sorts of morsels). However the good news is there is an increasing awareness about gluten intolerance and Melbourne has some dedicated allergy friendly stores and restaurants (see links below). Now most supermarkets have a range of gluten-free products in the health food aisle.
Some good alternatives
Check the health food isle at your supermarket (or a wholefoods store) for items labelled “gluten free” including flours, muesli, pasta etc.
Flours – rice, potato, soy, lentil, chickpea, buckwheat, arrowroot, cornflour/cornstarch
Rice cakes/crackers (plain)
Taco shells, corn chips (plain)
Tamari (instead of soy sauce)
Apple cider or balsamic vinegar
Wheat allergy versus Coeliac Disease
Food allergies are common and not everyone who reacts to wheat is gluten intolerant/coeliac. Many different food allergies and intolerances can cause similar gut symptoms such as bowel changes, bloating, colic, gas, mood changes, fatigue and trigger atopic allergies such as eczema etc.
As wheat is usually eaten as flour (ie: a highly processed form of the grain) and over eaten in the modern diet, it is not surprising that it is such a common allergy. You may be born with a (non-coeliac) sensitivity to wheat or acquire it after a gastrointestinal bug (such as giardia or “Bali belly”), a period of stress or from over exposure. Less commercially used forms of wheat such as spelt may be tolerated in small doses (such as in a rotation diet) as well as non-wheat but gluten containing whole grains. But you may find if you eat your alternative flour too frequently you may become sensitive to it, bringing back your old symptoms.
Testing for food intolerances (other than CD) is controversial. The most commonly used medical test – RAST (skin prick test) is notorious for delivering both false positive and false negative results. Kinesiology, Vega, Thera and other ‘naturopathic’ tests have also given varied responses. As an allergy (a permanent response, causing an antibody-antigen reaction) is different from an intolerance (which may also occur all the time or only in certain circumstances) even an accurate allergy test won’t prove an intolerance. However the most reliable test for a food allergy that I have found is an IgG antibody test, such as the 93 food panel test. You will need to eat the suspect foods for at least a week before doing the test. Unfortunately it is not covered by medicare and is quite expensive.
Though not full proof, one home remedy for detecting a suspect food allergy is the pulse test. Take your resting pulse as a baseline. 10 and 20 minutes after eating the food take your pulse again. If in either of these 2 tests it is raised by more than 10 beats per minute, these foods should be considered potential allergies or intolerances.
Whenever you remove one food, or a group of foods, from your diet the key to good health is to diversify what you are able to eat. If you cut out gluten, explore cooking with quinoa, millet, rice, beans, lentils and as many vegetables as possible.
More coeliac-friendly links than you can poke a stick at!
Gluten-free in Melbourne
Silly yaks a dedicated coeliac café in Northcote (which even makes gluten-free beer!)
S.Komatsu a new gluten-free restaurant in East Melbourne (I’ve seen no reviews yet, leave your feedback in the comments if you’d like to tell us about it)
More eating links from the Victorian Coeliac Society
Allery Block is a store in Carlton specialising in allergy-free products. It also has online shopping.
Coping with being gluten-free
A massive amount of gluten-free links