Information about Coeliac Disease

What is coeliac disease?

Coeliac disease is a condition in which the lining of the becomes damaged when it is exposed to even small amounts of – a protein found in , , and . As a result, affected patients absorb food and poorly. This can result in bowel symptoms and deficiencies of , minerals and other nutrients. Coeliac disease is successfully treated by removing all foods containing gluten from the diet. 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.

Biopsy of normal intestine of coeliac intestine How common is coeliac disease?

It is relatively common. In Australia it is estimated to affect about one in 100 people. 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, , 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 also be diagnosed following investigation for . Less commonly, mouth ulceration, recurring or 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 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. Does it run in the family?

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

Digestive Health Foundation

An information leaflet for patients and interested members of the general public prepared by the Digestive Health Foundation SIXTH EDITION 2012 What should I do if I think I have It is usual practice to repeat the biopsy after 12 months’ coeliac disease? diagnosis, and the following tests are also recommended: You should first approach your general practitioner. • Full blood count A medical history and an examination will be performed • Iron, B12, folic acid test and, if thought necessary, further tests will be undertaken • function test to help diagnose the condition. You may be referred to a • Calcium, phosphate, , zinc, PTH test specialist. • Liver function test.

If coeliac disease is suspected, a gluten-free diet should A bone mineral density test (DEXA scan) should also never be started until the condition has been properly be performed at the time of diagnosis and thereafter diagnosed. Otherwise, this will interfere with establishing as indicated by your doctor. the correct diagnosis. The gluten-free diet should always be undertaken with medical supervision. Long-term problems associated with failure to adhere to a strict gluten-free diet include increased risk of What should I do if someone in my bowel (a type of ), osteoporosis, infertility and chronic ill health. The risk of these is family has coeliac disease? no greater than normal when a gluten-free diet is Again, your local doctor should be your first contact. followed. There are blood tests available that are useful to screen The gluten-free diet for coeliac disease. You may like to take this leaflet with The following list is intended as a general guide only. you indicating where you have read about the condition. If you have coeliac disease you are encouraged to How is coeliac disease diagnosed? consult with a with experience in coeliac disease for individual dietary planning and information Your doctor’s assessment and, if appropriate, some about reading food labels. blood tests will determine whether coeliac disease is likely. However, the diagnosis can only be properly Gluten-free , biscuits, , cereals and other made by a pathology examination of a biopsy taken foods are available from supermarkets and health food from the intestine. Nowadays, this is quite a simple, stores. safe and painless procedure that does not require an Note: * indicates that some brands contain gluten while others are overnight stay in hospital. gluten-free. Please check the package label. What is the treatment if I have Foods to Avoid Foods to Include coeliac disease? . Wheat, rye, barley, , potato, lentil Coeliac disease is treated by a strict gluten-free diet. and and soy flour; pure Medication is rarely necessary. The diet needs to be flour; and flour cornflour, continued for life, because the sensitivity to gluten made from wheat cornmeal/ polenta, does not disappear. varieties including arrowroot, , dinkle and , Basic information regarding the diet can be obtained kamut. Wheaten , , from your doctor. A visit to a dietitian is highly cornflour. sago, tapioca, recommended for a comprehensive explanation baby rice cereal, and planning of the gluten-free diet. The Dietitian’s , lupin, and Association of Australia can provide you with contact . details of specialist via the website & All wheat, rye and Rice cakes, corn www.daa.asn.au, or call 1800 812 942. In addition, the baked sourdough bread; cakes and some rice state branches of the Coeliac Society of Australia are goods biscuits, pastries, crackers*; gluten an invaluable resource. They have access to excellent buns, muffins, free bread; biscuits, information, including the availability of special gluten- pikelets, crumpets, pastries, rolls, free foods and recipes for people with coeliac disease croissants and breadcrumbs, cakes and their families. It is worthwhile to inform your breadcrumbs and desserts made friends, family and colleagues that you have coeliac (unless labelled from allowed ; disease and explain how it is managed. It is also gluten-free). gluten-free bread, important to let your pharmacist know you have biscuit and cake coeliac disease as some medications (prescribed and mixes. over the counter) can contain gluten.

You will need ongoing monitoring of your health through your local doctor, gastroenterologist and/or dietitian. Foods to Avoid Foods to Include Foods to Avoid Foods to Include

Cereals Breakfast cereals Rice, corn and soy Takeaway Hamburgers, pizza, Steamed rice, containing breakfast cereals*, food souvlaki, sausages, grilled fish (check wheat, oats, gluten-free muesli, battered food no flour), chicken , barley, home-made muesli (e.g. fried fish), (no stuffing), steak, rye, malt extract, using allowed crumbed food (e.g. Asian dishes without wheat , and ingredients. crumbed chicken), flour or soy sauce, oat bran. stuffed roast steamed vegetables, and Wheaten noodles, Rice, corn, cornmeal, chickens, pies and baked potato, some grains pasta, spaghetti, tapioca, buckwheat, sausage rolls. chips*, most sushi vermicelli & instant polenta, quinoa and (check fillings). pasta meals; millet; buckwheat triticale, , and gluten-free Snacks Packet savoury Fruit juices and and pastas; rice noodles snacks, and fresh, frozen, canned semolina. and rice vermicelli. filled chocolates, or dried fruit. licorice, many Fruit Commercial Fruit juices and frozen desserts, thickened fruit pie fresh, frozen, canned flavoured potato filling*. or dried fruit. crisps and corn chips*. Vegetables Canned or frozen Fresh, frozen, vegetables dehydrated, in sauce, or canned commercially vegetables Beverages Cereal based Water, tea, coffee, prepared without sauces; coffee substitutes, cocoa, milk, cordials, vegetable and vegetable juices. malted cocoa soft drinks, soda potato salad*. beverages (e.g. water, mineral water, Milo®, Ovaltine®, fruit and vegetable Meat, fish & Sausages, most Canned meat or Aktavite®), barley juices, wine poultry processed meats fish without sauce waters, milk (including sparkling and fish, corned or cereal, ham flavourings*, beer, and fortified wines), beef, meat pies, off the bone*, ale, stout and most spirits and frozen dinners; bacon, gluten-free lager, alcoholic liqueurs, cider, foods prepared sausages; fresh, soft drinks gluten free beer. or thickened with smoked, cured or containing malt flour, batter or frozen products extract. crumbs.. without sauces, crumbs or batters. Misc. Malt vinegar, soy Tomato sauce, sauce containing gluten-free soy Dairy Cheese mixtures, Block, processed, wheat, mixed sauce, most products pastes and cream, cottage or seasonings, yeast vinegars*, sugar, spreads*, malted ricotta cheese; fresh, extract spreads honey, golden syrup, milks, ice cream UHT, evaporated, (e.g. Vegemite®, jam, peanut butter, with cone or powdered or Marmite®, salad dressings *, crumbs, soy drinks condensed milk; Promite®), sauces, gluten-free stock containing malt*. yoghurt*, buttermilk, pickles, relish, cubes, gelatine, fresh or canned chutney, thickened gluten-free baking cream, plain or salad dressings, powder and custard flavoured icecream*. stock cubes, powder, herbs, custard powder spices, salt, pepper. Legumes, Coated and Dried or fresh beans, containing wheat nuts & seeds seasoned nuts*, nuts and seeds, starch, chicken textured vegetable gluten-free canned salt*, baking protein products. baked beans, canned powder*. beans or legumes*. Coeliac Societies Digestive Health Foundation

Coeliac Australia The Digestive Health Foundation (DHF) is committed to promoting www.coeliac.org.au better health for all Australians through education and community Ph: 1300 GLUTEN (1300 458 836) health programs related to the digestive system. Email: [email protected] The DHF is the educational arm of the Gastroenterological Society NSW/ACT of Australia (GESA). GESA is the professional body representing the specialty of gastrointestinal GI and . Members of the Ph: 02 9487 5088 Society are drawn from physicians, surgeons, scientists and other Email: [email protected] medical specialties with an interest in gastrointestinal disorders. GI disorders are the most common health related problems affecting QLD the community. Ph: 07 3356 4446 Email: [email protected] Research and education into are essential to contain the effects of these disorders on all Australians. SA/NT Ph: 08 8336 1476 Further information on a wide variety of gastrointestinal conditions Email: [email protected] is available on our website – www.gesa.org.au

VIC/TAS Ph: 03 9808 5566 Email: [email protected]

WA Ph: 08 9451 9255 Email: [email protected]

®Copyright: Digestive Health Foundation February 2012 32999 Digestive Health Foundation This leaflet is promoted as a public service by the Digestive Health c/- GESA Foundation. It cannot be comprehensive and is intended as a guide PO Box 508, Mulgrave VIC 3170, Australia only. The information given here is current at the time of printing but Telephone: 1300 766 176 Facsimile: (03) 9802 8533 may change in the future. If you have further questions you should www.gesa.org.au raise them with your own doctor.