What is coeliac disease?

Coeliac disease is a condition where your immune system attacks your own tissues when you eat gluten. This damages your gut (the small intestine) and therefore reduces the amount of nutrients you can absorb from your diet.

Healthy small intestine Damaged small intestineInflammed mucous layer of the intestinal villi depicting Celiac disease

Coeliac disease is common and affects 1 in 100 people.

Symptoms, diagnosis and treatment

Please note that as of June 2020 diagnosis of coeliac disease in certain patients can be made without an endoscopy procedure.

If you have coeliac disease, eating foods that contain gluten can trigger a range of gut symptoms, such as:

  • diarrhoea, which may smell particularly unpleasant
  • stomach aches
  • bloating and flatulence
  • indigestion
  • constipation

Coeliac disease can also cause more general symptoms, including:

  • tiredness (fatigue) as a result of not getting enough nutrients from food (malnutrition)
  • unintentional weight loss
  • an itchy rash (called dermatitis herpetiformis)
  • problems getting pregnant (infertility)
  • nerve damage (peripheral neuropathy)
  • disorders that affect coordination, balance and speech (ataxia)

Children with coeliac disease may not grow at the expected rate and may have delayed puberty.

Some people living with coeliac disease have no symptoms and find out they have the disease following tests for other medical conditions.

If you think you or your child might benefit from getting tested for coeliac disease you can complete this online questionnaire from Coeliac UK and take it to your GP.

  • Blood tests – checking certain antibodies to help identify people who may have coeliac disease; in some cases this can be enough to diagnose certain patients.
  • Biopsy – some people require an additional biopsy of the small intestine performed through a camera test (called an endoscopy) to confirm the diagnosis if the bloods tests aren’t clear enough.

While being tested for coeliac disease, you’ll need to eat foods containing gluten at least twice per day for 6 weeks to ensure the tests are accurate.

You should also not start a gluten-free diet until the diagnosis is confirmed by a health professional.

The only treatment available is a lifelong gluten free diet.

This is a diet with predominantly no wheat, barley or rye (the 3 main cereals/ingredients that have gluten). Also, if oats are consumed, they need to be labelled as gluten free.

Gluten is therefore found in any food that contains any those three cereals, including:

  • bread and wheatpasta
  • cakes and biscuits
  • breakfast cereals
  • chapati and most types of bread
  • certain types of sauces
  • some ready meals

Following the gluten free diet will help improve symptoms and reduce the risk of long-term conditions including anaemia or osteoporosis amongst other ones. It can be difficult to start with and you will need the support of a dietitian when diagnosing and throughout, if there are any ongoing issues and if you have scheduled follow-ups with the dietitian.

Your GP or gastroenterologist will ensure you are referred to a dietitian who will then give you advice, information and give the support you need to follow the gluten free diet. You can always seek a referral to a dietitian through a health professional at any point.

Audio translations in Sylheti and Urdu

Information about coeliac disease and the gluten free diet.

English transcript

First section of the audio

What is Coeliac Disease?

Coeliac Disease is a lifelong autoimmune condition that can be diagnosed at any stage of life.

People who have coeliac disease have an adverse reaction to gluten, a protein found in predominantly in wheat, rye and barley.

When people who have coeliac disease eat gluten, their body reacts adversely and ends up attacking itself at the height of the small intestine and this leads to gut damage.

Therefore, if gluten is not taken out of the diet permanently, there will be ongoing gut damage that can lead to symptoms and complications.

Some of the main symptoms that can people with coeliac disease can experience are abdominal pain, bloating, constipation, diarrhoea, headaches and migraines, weight loss, lethargy, vitamin and mineral deficiencies amongst other things. However, some people have no symptoms or have minimal symptoms, but they still get the gut damage if gluten is not removed from the diet.

If gluten is not removed and there is ongoing gut damage, long-term this can lead to other complications like small bowel cancer (though the risk is low), osteoporosis, unexplained infertility and long-standing vitamin and mineral deficiencies.

Since coeliac disease is a lifelog condition the gluten free diet needs to be maintained lifelong to protect the gut from getting gut damage. There is currently no cure for coeliac disease. The only thing that is proved to help the gut get back to normal is a permanent gluten free diet.

Second section of audio

What is the gluten free diet?

The gluten free diet is a diet where no gluten is consumed or gluten is consumed to a safe amount, which is very minimal.

In the UK, for a food to be labelled as Gluten Free it has to have less than 20 parts per million of gluten, and this amount of gluten can’t even be seen with the naked eye and is smaller than a crumb.
This is why the gluten free diet for coeliac disease involves a diet where ingredients are gluten free but also the way foods are cooked or processed are gluten free too, meaning that gluten does not come into contact with gluten free foods in the cooking process.

Gluten will be predominantly found in 3 types of grains or ingredients: Wheat, rye and barley.

Therefore, if you are looking out in a supermarket for foods that may have gluten it is useful to look out for all those 3 ingredients. If the food you are going to eat has wheat, rye or barely then it is not suitable for your diet. If a food says it is “Gluten Free” or has a crossed grain symbol then it is safe for you to eat.

Oats can also be consumed as long as they are gluten free. These are tolerated by most people but if you have issues with gluten free oats please contact a health professional. Oats that are not labelled as “gluten free” are not suitable for people with coeliac disease.

If you are looking at packaged food in a supermarket it is important to look out for the ingredients first and if they have no gluten then you should make sure you check how that food has been processed or handled. If it says “made in a factory that handles gluten (or wheat, rye, barley or oats)” it will not be suitable. Foods that say “May contain gluten” will not be suitable either.

To ensure gluten is avoided adequately in the household and when eating out it is important to let anybody know who is cooking for you that you cannot have anything with wheat, rye, barley or contaminated oats and these ingredients need to not be used in the cooking process either. If you use the same toaster, oil, chopping boards and spreads that have touched gluten your food can be contaminated. All you need to do is ensure surfaces, chopping boards, pans, pots, etc are clean before you use them. You can use the same toaster as other people as long as you use a toaster bag that can be bought in supermarkets and oil needs to have not cooked anything in gluten beforehand. Try to avoid any scenario where gluten may come into contact with your food.

There is a lot of useful information and more than 1000 recipes on the Coeliac UK website, which is the charity that supports people living with coeliac disease in the UK. They offer more information about the gluten free diet and have a free helpline you can call if you want any more information about food products, coeliac disease or the gluten free diet. Their number is: 0333 332 2033.

Useful resources

coeliac ukCoeliac UK is the main charity that supports patients with Coeliac Disease in the UK and we would encourage anyone diagnosed with coeliac disease to join them to get up to date information and access to their tools that can help with the gluten free diet.

Coeliac UK have created some video resources by a dietitian that explain what coeliac disease is and how to follow the gluten free diet.

Patient Webinars is website created by dietitians with short and long videos explaining what coeliac disease and how to manage coeliac disease through the gluten free diet.

NHS website explaining what you need to know about coeliac disease.

Cristian Costas, Specialist Coeliac Dietitian at Bradford Teaching Hospitals Foundation Trust, shares some short videos to explain useful information to help understand what coeliac disease is and how to follow the gluten free diet.

Books

Coeliac Disease What You Need to KnowCoeliac Disease: What You Need to Know

Alex Gazzola
This is a practical, readable and formally endorsed by Coeliac UK book. It is packed with useful an evidence-based information for anyone seeking to understand more about coeliac disease and the gluten free diet.

Hassle Free, Gluten Free: Over 100 delicious, gluten-free family recipesHassle Free, Gluten Free: Over 100 delicious, gluten-free family recipes

Jane Devonshire
In her debut cookbook, Jane Devonshire presents 100 delicious recipes guaranteed to make you feel good, and wow family and friends. This beautiful book is published in association with Coeliac UK, celebrating their 50th anniversary.

Vegetarian Hassle Free, Gluten FreeVegetarian Hassle Free, Gluten Free

Jane Devonshire
Having cooked delicious food for her coeliac son and vegetarian feasts for her veggie daughter, MasterChef winner Jane Devonshire presents 100 delicious vegetarian gluten-free recipes, guaranteed to wow a hungry crowd.

Mobile apps

Gluten free food checkerGluten free food checker

Barcode scanner and searcher to tell you if the food you are going to buy in the supermarket is gluten free.

Get it on Google Play or App Store

Gluten Free on the MoveGluten Free on the Move

Find accredited restaurants serving gluten free food.

Get it on Google Play or App Store

Gluten Free Restaurant Card‪sGluten Free Restaurant Cards

Shows what ingredients need to be avoided for the gluten free diet and translates it to different languages.

Get it on App Store

Schär Gluten FreeSchär Gluten Free

Contains recipes, gluten free venues, videos in other languages and more.

Get it on Google Play or App Store

Gluten Free CardGluten Free Card

Explains the dietary requirements of a strict gluten-free diet in 10 popular languages.
glutenfreecard.com

Bradford coeliac newsletter

Want more information to help you with the gluten free diet sent into your inbox? Sign up to our Bradford coeliac disease newsletter.

Our Bradford coeliac disease newsletter has been created by the dietitians in the dietetic-led coeliac service in Bradford Teaching Hospitals NHS Foundation Trust to support people living with coeliac disease in Bradford.

Following the gluten free diet can be difficult and our newsletter has been extremely supportive for many of our patients who have appreciated knowing about more gluten free eateries, new food products in supermarkets as well as recipes to cook at home.

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