Coeliac Disease, sometimes called “Sprue”, is a condition in which the lining of the small intestine becomes damaged when it is exposed to even small amounts of gluten. This is a substance found in wheat, barley, rye, oats and millet. As a result, affected patients absorb food and nutrients poorly, resulting in deficiencies of vitamins, minerals and sometimes protein, carbohydrates and fats. Coeliac Disease is easily treated by scrupulously avoiding the consumption of all gluten-containing products, ie. “A gluten-free diet”. In Australia, Coeliac Disease is relatively uncommon with about one person in 2000 or 3000 having the condition.
What are the symptoms?
There are no specific symptoms of the disease. Diarrhoea, weight loss, nausea, flatulence and abdominal discomfort are common complaints. However tiredness and weakness are also common, usually because of a degree of anaemia. At times, there can be no recognised symptoms at all. Less commonly, mouth ulceration, skin eruptions, recurring miscarriages or infertility can be the presenting features in adults. In children, Coeliac Disease often also causes delayed growth and development, irritability and a poor appetite in addition to gastro-intestinal problems and anaemia. Of course many of the above mentioned complaints are very common in the community and are usually not due to Coeliac Disease. Nonetheless, it is widely accepted now that this condition is under-diagnosed and should be considered in a broader range of patients than has been the practice in the past.
How is the diagnosis made?
If Coeliac Disease is suspected, a gluten-free diet should never be started until the condition has been properly diagnosed. Otherwise, this will interfere with establishing the correct diagnosis. The diet should always be undertaken with medical supervision. Coeliac Disease can only be properly diagnosed by a pathology examination of a biopsy taken from the intestine. Your doctor can take blood tests prior to this procedure to determine whether Coeliac Disease is likely.
Treatment : The Gluten Free Diet
All that is needed is a strict diet that avoids all gluten-containing foods. Medication is rarely necessary. This diet needs to be continued for life because all Coeliac patients remain sensitive to gluten indefinitely. Removing gluten-containing foods from your diet does not cure you of Coeliac Disease. You will always have an intolerance to gluten. This simple measure can transform the lives of people affected by the disease. Gluten is not only found in just breads and cereals. It can even be found in some medication. Therefore, after a biopsy has returned consistent with Coeliac Disease, patients should be seen by a dietician before commencing a gluten-free diet. With dietary compliance patients often have a remarkable clinical improvement and , over time, most of the symptoms which lead to this investigation will revert to normal. State Coeliac Societies are invaluable in providing advice regarding recipes and general support. In addition, they have up-to-date information on the gluten-content of most commercial foods. The diet does cause problems at times, mostly due to expense and difficulties with eating out or going on holidays. Again, the Coeliac Societies and dieticians may be helpful in this regard. In adolescents, in particular, compliance with the diet may be difficult because of peer group pressures. Occasionally constipation and unwanted weight gain can occur as absorption and nutritional status normalise. The following list is intended as a general guide only, and you are advised to consult with your dietician for individual dietary planning.
Foods to Avoid
- Flours Wheat flour, rye flour, millet meal, cornflour made with wheat, custard powder.
- Bread all bread including rye and commercial soy bread, biscuits, pastries, buns, muffins, pikelets, crumpets, croissants, breadcrumbs (unless labelled gluten-free).
- Cereals Breakfast cereals containing wheat, oats, semolina, barley, rye, malt, millet, wheatgerm, wheatbran and oatbran.
- Pasta Spaghetti, noodles, vermicelli, pasta, instant pasta meals (unless labelled gluten-free).
- Fruit Commercial thickened fruit pie filling (unless checked).
- Vegetables Canned or frozen in sauce, commercially prepared vegetable and potato salad (unless checked).
- Meat, Fish, Poultry Foods prepared or thickened with flour, battered or crumbed, sausages, processed meats and fish (unless checked), meat pies and frozen dinners.
- Dairy Products Cheese mixtures, pastes and spreads (unless checked), malted milks, artificial cream, icecream with cone or crumbs.
- Legumes, Nuts Processed varieties of legumes if thickened, textured vegetable protein products.
- Takeaway Foods Hamburgers, pizza, souvlaki, sausages, battered and crumbed food.
- Snacks Packet savoury snacks, some sweets and filled chocolates, liquorice, many frozen desserts.
- Beverages Coffee substitutes, Ovaltine, Milo, Aktavite, drinking chocolate, milk flavourings, malt, ale, stout, most beers.
- Miscellaneous Malt vinegar, soy sauce containing wheat, baking powders, mixed seasonings, beef extracts (eg. Marmite, Promite), sauces, pickles, relish, chutney, salad dressing (unless checked).
Foods to Include
- Rice flour, arrowroot, cornmeal, pure cornflour, soy flour, potato flour, lentil flour, wheat starch, gluten-free baking powder.
- Rice cakes, slice of rice (eg. Snuffer), some ricecrackers (check label), gluten-free bread, biscuits, cakes,rolls, pastries and desserts made from allowed flours. Gluten-free bread, biscuit, cake and muffin mixes.
- Rice and corn breakfast cereals, homemade muesli using allowed ingredients (eg. Sunfarm Ricebran).
- Rice brown, white or fragrant (eg. Sunrice), cornmeal, rice, vermicelli, tapioca, buckwheat, infant rice cereal, taco shells, gluten-free pasta.
- Fruit Fresh, canned, frozen and dried fruits and fruit juices.
- Vegetables Fresh, frozen or canned without sauces, dehydrated, and vegetable juices.
- Meat, Fish, Poultry Fresh, smoked, corned, frozen without sauces, crumbs or batters. Canned meat or fish without sauce or cereal. Ham, bacon, corned beef, gluten-free sausages.
- Dairy Products Block or processed cheese, creamed cheese or cottage cheese, UHT, evaporated, powdered and condensed milk, yoghurt, buttermilk, plain or flavoured icecream, fresh or canned cream.
- Dried or fresh beans, nuts and seeds, peanut butter, gluten-free canned baked beans.
- Steamed rice, grilled fish, chicken, steak, steamed vegetables.
- Plain chocolate, popcorn, jelly, meringue, gluten-free corn chips, rice cakes and slice of rice (eg. Sunfarm).
- Water, tea, coffee, cocoa, milk, cordials, soft drinks, soda water, mineral water, fruit and vegetable juices.
- Tomato sauce, vinegar, honey, jam, yeast extracts (eg. Vegemite), peanut butter, salad dressings without flour, gelatine, gluten-free baking powder and custard powder, gluten-free soy sauce, sugar and golden syrup.
* Note: Gluten-free bread, biscuits and other products are now widely available from supermarkets and health food shops.