Coeliac Disease

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, ergo a gluten-free diet. In Australia, Coeliac Disease is relatively uncommon with about one in two or three thousand having the condition

Despite there being no specific symptoms of the disease, diarrhoea, weight loss, nausea, flatulence and abdominal discomfort are common complaints. Tiredness and weakness are also common. Other symptoms that are presenting features in adults, although less common, include mouth ulceration, skin eruptions and recurring miscarriages or infertility. In children, Coeliac Disease often 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 not necessarily 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.

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 a 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.

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 glutencontaining foods from your diet does not cure you of Coeliac Disease. You will always have 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 medications. 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 in the gluten content of most commercial foods. The diet does cause problems at times, mostly due to expense and difficulties eating out or going on holidays. Again, 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.

Gluten-free bread, biscuits and other products are now widely available from supermarkets and health food shops. Below is a table outlining which food products you should include and avoid in your gluten-free diet.

Flours

AVOID Wheat flour, rye flour, millet meal and corn flour made with wheat and custard powder.

INCLUDE Rice flour, arrowroot, cornmeal, pure corn flour, soya flour, potato flour, lentil flour, wheat starch and glutenfree baking powder.

Bread

AVOID All bread including rye and commercial soya bread, biscuits, pastries, buns, muffins, pikelets, crumpets, croissants and bread crumbs (unless labelled gluten-free).

INCLUDE Rice cakes, slice of rice, some rice crackers (check label), gluten-free bread, biscuits, cakes and rolls, pastries and desserts all made from allowed flours, gluten-free bread, biscuit, cake and muffin mixes.

Cereals

AVOID Breakfast cereals containing wheat, oats, semolina, barley, rye, malt, millet, wheat germ, wheat bran and oat bran.

INCLUDE Rice and corn breakfast cereals, homemade muesli using allowed ingredients.

Pasta

AVOID Spaghetti, noodles, vermicelli, pasta meals (unless labelled gluten-free).

INCLUDE Rice - brown, white or fragrant, corn meal, tapioca, buckwheat, infant rice cereal, taco shells, gluten-free pasta.

Fruit

AVOID Commercial thickened fruit pie filling (unless checked).

INCLUDE Fresh, canned, frozen and dried fruits and fruit juices.

Vegetables

AVOID Canned or frozen in a sauce, commercially prepared vegetables and potato salad (unless checked).

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

Meat, Fish and Poultry

AVOID Foods prepared or thickened with flour, battered or crumbed, sausages, processed meats and fish (unless checked), meat pies and frozen dinners.

INCLUDE Fresh, smoked and corned, canned meat or fish without sauce or cereal, ham, bacon, corned beef and gluten-free sausages.

Dairy Products

AVOID Cheese mixtures, pastes and spreads (unless checked), malted milks, artificial cream, icecream with a cone or crumbs.

INCLUDE Block or processed cheese, creamed and cottage cheese, UHT, evaporated, powdered or condensed milk, yoghurt, buttermilk, plain-flavoured ice-cream and fresh or canned cream.

Legumes and Nuts

AVOID Processed varieties of legumes if thickened, textured vegetable protein products.

INCLUDE Dried or fresh beans, nuts and seeds, peanut butter and gluten-free canned baked beans.

Takeaway Foods

AVOID Hamburgers, pizza, souvlaki, sausages, all battered and crumbed food.

INCLUDE Steamed rice, grilled fish, chicken, steak and steamed vegetables.

Snacks

AVOID Packet savoury snacks, some sweets and filled chocolates, liquorice, many frozen desserts.

INCLUDE Plain chocolate, popcorn, jelly, meringue, gluten-free corn chips, rice cakes and slices.

Beverages

AVOID Coffee substitutes, Ovaltine, milo, aktavite, drinking chocolate, milk flavourings, malt, ale, stout and most beers.

INCLUDE Water, tea, coffee, cocoa, milk, cordials, soft drink, soda water, mineral water and fruit and vegetable juices.

Miscellaneous

AVOID Malt vinegar, soy sauce containing wheat, baking powders, mixed seasonings, beef extracts (eg. Marmite, Promite), sauces, pickles, relish, chutney, salad dressing (unless checked).

INCLUDE Tomato sauce, vinegar, honey, jam, yeast extracts (e.g. vegemite), peanut butter, salad dressings without flour, gelatin, gluten-free baking powder and custard powder, gluten-free soy sauce, sugar and golden syrup