Coeliac Disease is a condition in which the lining of the small intestine becomes damaged when it is exposed to even small amounts of gluten,which is a protein found in wheat, barley, rye and possibly oats. As a result, affected patients absorb food and nutrients poorly. This can result in bowel symptoms and deficiencies of vitamins, minerals and other nutrients.

Coeliac Disease is successfully treated by avoiding eating all foods containing gluten.This is called a 'gluten-free-diet.  Following a gluten-free diet after the diagnosis of coeliac disease should allow an improvement in symptoms and restoration of health.

How common is Coeliac Disease?

It is relatively uncommon. In Australia about one person in 2000 is diagnosed with the condition, but it may be more frequent than this,maybe 1 in 500.

What are the symptoms?

Coeliac Disease can vary in its symptoms, ranging from many to none at all. There are no specific symptoms of the disease. Diarrhoea, loss of weight, nausea, flatulence and abdominal discomfort are common complaints. Tiredness and weakness are also common, usually because of a degree of iron and/or folic acid deficiency, sometimes resulting in anaemia. Some patients may also be diagnosed following investigation for osteoporosis. Less commonly, mouth ulceration recurring miscarriages or infertility can be the presenting feature in adults.

In children, coeliac disease often causes poor weight gain, delayed growth and development, irritability and a poor appetite, in addition to bowel problems and anaemia. Of course many of the above-mentioned complains 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.

Does it run in families? Yes, it certainly can. About one in ten close family relatives of an affected patient may also have coeliac disease.

What should I do if I think I have Coeliac Disease? You should first approach your general practitioner. A medical history and an examination will be performed and, if thought necessary, further tests will be undertaken to help diagnose the condition. You may be referred to a specialist.

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 gluten-free diet should always be undertaken with medical supervision.

What should I do if someone in my family has Coeliac Disease? Again, your local doctor should be your first contact. There are blood tests available that are useful to screen for coeliac disease. You may like to take this leaflet with you indicating where you have read about the condition.

How is Coeliac Disease diagnosed? Your doctor's assessment and, if appropriate, some blood tests will determine whether coeliac disease is likely. However, the diagnosis can only be properly made by a pathology examination of a biopsy taken from the intestine. Now days, this is quite a simple, safe and painless procedure that does not require you to stay in hospital overnight.

What is the treatment if I haveCoeliac Disease? Coeliac Disease is treated by a strict gluten-free diet. Medication is rarely necessary. The diet needs to be continued for life, because the sensitivity to gluten does not disappear.

Basic information regarding the diet can be obtained from your doctor. A visit to a dietitian is highly recommended for a comprehensive explanation and planning of the gluten-free diet. In addition, the Coeliac Society of Australia and its state branches are invaluable aids. They are self-help organisations for people with coeliac disease and their families and have access to excellent information, including the availability of special gluten-free foods and recipes.

You will need ongoing monitoring of your health through your local doctor, gastroenterologist and/or dietitian. It is usual practice to repeat the biopsy about 6-12 months after diagnosis. It is also recommended to have certain blood tests periodically at the discretion of your doctor. A bone density test should also be performed at the time of diagnosis and thereafter as indicated by your doctor.

Long-term problems associated with failure to adhere to a strict gluten-free diet include increased risk of bowel lymphoma (a type of cancer), osteoporosis, infertility and chronic ill health. The risk of these is no greater than normal when a gluten-free diet is followed.

The Gluten Free Diet

The following list is intended as a general guide only. If you have coeliac disease you are encouraged to consult with a dietitian for individual dietary planning and information about reading food labels.

Note: "check" indicates that some brands contain gluten, others are gluten-free. Ingredient lists of all food products should be checked

Foods to Avoid

Flour Wheat flour, rye flour, barley flour, wheaten cornflour, triticale flour and oat flour**

Bread All bread including wheat, rye and sourdough bread, biscuits, pastries, buns, muffins, pikelets, crumpets, croissants, breadcrumbs (unless labelled gluten-free)

Cereals Breakfast cereals containing wheat, oats**, semolina, barley, rye, malt extract, wheatbran, oatbran**

Pasta and grains Wheaten noodles, pasta, spaghetti, vermicelli & instant pasta meals. Triticale, couscous, bulgur,semolina,Â

Fruit Commercial thickened fruit pie filling,

Vegetables Canned or frozen vegetables in sauce, commercially prepared vegetable and potato salad (unless dressing checked)

Meat, Fish & Poultry Foods prepared or thickened with flour, batter or crumbs, sausages, most processed meats and fish, corned beef, meat pies, frozen dinners.

Dairy Products Cheese mixtures, pastes and spreads (unless checked),malted milks, ice cream with cone or crumbs, soy drinks containing malt(check)

Legumes and nuts Processed varieties of legumes if thickened (unless checked),textured vegetable protein products.

Takeaway Food Hamburgers, pizza, souvlaki, sausages, battered food (e.g.fried fish), crumbed food (e.g. crumbed chicken), stuffed roast chickens.

Snacks Packet savoury snacks, many sweets and filled chocolates, licorice,many frozen desserts, flavoured potato crisps and corn chips (check)

Beverages Cereal-based coffee substitutes, malted cocoa beverages(e.g. Milo® Ovaltine® Aktavite®),barley waters, milk flavourings (unless checked), beer, ale, stout and lager, alcoholic soft drinks containing malt extract.

Miscellaneous Malt vinegar, soy sauce containing wheat, mixed seasonings, yeast extract spreads (e.g. Vegemite®,Marmite®, Promite®), sauces, pickles, relish, chutney, thickened salad dressings, stock cubes, custard powder containing wheat starch, baking powders containing flour, communion wafers.

Foods to Include

Rice flour, pure maize cornflour,cornmeal/polenta, soya flour, potato flour, arrowroot, buckwheat,sorghum,millet, sago, tapioca, lentil flour, baby rice cereal, amaranth, lupin

Rice cakes, corn cakes, some rice crackers (check), gluten-free bread,biscuits, pastries, rolls, breadcrumbs,cakes, and desserts made from allowed flours, gluten-free bread, biscuit, cake mixes

Rice, corn and soy breakfast cereals(check), gluten-free muesli, home-made muesli using allowed ingredients.

Rice, corn, cornmeal, tapioca,buckwheat and gluten-free pastas, rice noodles, rice vermicelli, rice,buckwheat, polenta.

Fresh, frozen, canned or dried fruit,fruit juices.

Fresh, frozen, dehydrated, or canned vegetables without sauces, vegetable juices.

Fresh, smoked, cured, frozen without sauces, crumbs or batters. Canned meat or fish without sauce or cereal.

Ham off the bone (check), bacon,gluten-free sausages.

Block, processed, cream, cottage or ricotta cheese, fresh, UHT, evaporated, powderedor condensed milk, yoghurt (check),buttermilk, fresh or canned cream, plain or flavoured icecream (check)

Dried or fresh beans, nuts and seeds,gluten-free canned baked beans, canned beans or legumes (check)

Steamed rice, grilled fish (check no flour),chicken (no stuffing), steak, Asian dishes without flour or soy sauce, steamed vegetables, baked potato, some chips(check)

Plain chocolate, plain popcorn, jelly, plain potato crisps (check), plain corn chips,plain rice crackers, yoghurt.

Water, tea, coffee, cocoa, milk,cordials,soft drinks, soda water, mineral water, fruit and vegetable juices. Wine (including sparkling and fortified wines), most spirits and liqueurs, cider

Tomato sauce, gluten-free soy sauce, most vinegars, sugar, honey, golden syrup, jam,peanut butter, salad dressings not thickened, gluten-free stock cubes, gelatine, gluten-free baking powder and custard powder, herbs, spices, salt, pepper

Gluten-free breads, biscuits, pastas, cereals and other foods are available from supermarkets and health food stores.** Oats: At the time of writing, oats are not recommended, but are the subject of further research. Consult your dietitian.

This information has been designed by the Digestive Health Foundation as an aid to people who have coeliac disease or for those who wish to know more about it. This is not meant to replace personal advice from your medical practitioner.

This information has been taken from an educational DVD prepared by ANZCRF, Australia and New Zealand Coeliac Research Fund for general practitioner and the public. For further information.