Coeliac disease is an autoimmune disorder that affects approximately 1% of the population in the UK. It is an autoimmune response to gluten, a protein found in wheat, barley, and rye. When someone with coeliac disease consumes gluten, their immune system responds by attacking the small intestine, leading to inflammation and damage to the lining of the gut.

Symptoms of coeliac disease can vary from person to person and can include bloating, abdominal pain, diarrhoea, constipation, weight loss, fatigue, and skin rashes. The symptoms can be severe, and the condition can have a significant impact on a person's quality of life if left untreated.

During Coeliac Awareness Week 2023, Coeliac UK is shedding light on the lesser-known symptoms of this disease, which include extreme fatigue, persistent mouth ulcers, unexplained neurological symptoms like ataxia (e.g. balance and coordination problems, slurring speech, and peripheral neuropathy (e.g. tingling, numbness or pain in hands or feet), unexplained anemia, unexplained subfertility in both males and females, and recurrent miscarriages.

The diagnosis of coeliac disease is made by a combination of blood tests and a biopsy of the small intestine. Blood tests can detect the presence of certain antibodies in the blood, which are produced by the immune system in response to gluten. A biopsy involves taking a small sample of tissue from the lining of the small intestine and examining it under a microscope to look for signs of damage.

It is important to exclude the possibility of having coeliac disease if you experience symptoms after consuming foods that contain wheat, barley, rye or oats and suspect that you may be sensitive to gluten. Do not try gluten-free diet as a first course of action because this may affect the accuracy of a coeliac disease test. In order for the tests to produce reliable results, you must continue to consume gluten.

If you have received a negative test result for coeliac disease and other potential causes of your symptoms have been eliminated, you may want to consult with your healthcare team about the likelihood of having non-coeliac gluten sensitivity.

Coeliac disease is characterized by the immune system attacking the body when gluten is consumed, resulting in damage to the gut lining and impaired nutrient absorption.

In contrast, non-coeliac gluten sensitivity manifests as symptoms akin to those of coeliac disease, but the role of the immune system is unclear since there is no production of antibodies and no apparent harm to the gut lining.

Further research is needed to gain a better understanding of non-coeliac gluten sensitivity and the factors that contribute to the risk of developing it. One challenge in this area is the lack of specific diagnostic tests for this condition. Some experts define non-coeliac gluten sensitivity as a relief of symptoms upon adopting a gluten-free diet. However, there is concern that the placebo effect may be at play, and this is not a reliable way to diagnose the condition.

There is ongoing discussion about whether gluten itself is the root cause of the sensitivity or if other components in wheat are responsible. When gluten-containing ingredients are eliminated from the diet, other non-gluten proteins found in wheat, as well as Fermentable Oligo-Di-Mono-saccharides and Polyols (FODMAPs), are also removed. This makes it challenging to determine the exact cause of the symptoms.

The only treatment for coeliac disease is a strict gluten-free diet. This means avoiding all foods that contain wheat, barley, and rye, as well as any products that may have been contaminated with gluten during processing or cooking. Gluten-free alternatives are available for most foods, including bread, pasta, and cereals.

Following a gluten-free diet can be challenging, as gluten is present in many commonly consumed foods, and it can be difficult to identify which foods are safe to eat. However, there are now many resources available to help people with coeliac disease manage their diet, including specialist dietitians and support groups.

It is essential for people with coeliac disease to adhere strictly to a gluten-free diet, as even small amounts of gluten can trigger an immune response and cause damage to the small intestine. Failure to follow a gluten-free diet can lead to complications such as malnutrition, osteoporosis, and an increased risk of certain cancers.

1. Try different gluten-free breads to find the ones you like best. Some companies offer sample packs to help you choose.
2. To avoid cross contamination, use separate spreads and toppings for gluten-free bread.
3. If you're sharing a toaster with gluten-eaters, use a toaster pocket to prevent cross contamination.
4. Opt for natural gluten-free foods to save money and reduce the impact of pricey gluten-free products.
5. Bring your own snacks or packed lunch when you're unsure if gluten-free options will be available.
6. Check for gluten-free nights at fish and chip restaurants, when they use separate oil to prevent cross contamination.
7. Call ahead to ask about food preparation if you're dining out gluten-free.
8. Look for Coeliac UK GF accreditation when eating out; it guarantees safe, gluten-free food and staff trained in coeliac disease.
9. Let your loved ones know about your diagnosis so they can support you in maintaining a gluten-free diet.
10. Join local or online support groups to connect with others who understand the challenges of living gluten-free.

Although a gluten-free diet usually results in an improvement in symptoms for the majority of patients with coeliac disease, about 25% of adults still experience gastrointestinal symptoms despite strict adherence to the diet and complete healing of the intestine. This could be attributed to the fact that coeliac disease and irritable bowel syndrome (IBS) share symptoms such as pain, discomfort, bloating, diarrhea, and constipation. Research indicates that a low FODMAP diet could be an additional treatment option for coeliac patients who continue to experience IBS-like symptoms (1,2).