Chapter 2

Understanding Why You Need to Go Gluten-Free

In This Chapter

Working through allergies, intolerances and coeliac disease

Knowing how gluten can affect behaviour

Being tested and understanding the results

Understanding the consequences if you continue to eat gluten

Beginning to heal

P eople start out on a gluten-free diet for a variety of reasons, some good, some not so wise. Whatever your reasons, one thing is certain. You’re not alone. Millions of people around the world are going gluten-free and many of these individuals are seeing improvements in their health. Gluten just doesn’t sit well with some people.

Before we look at why people are doing it, we explore three different conditions — coeliac disease, gluten or wheat intolerance.

So you’re thinking, ‘What exactly does all that mean and can I or can’t I eat pizza?’ Ah, you want to cut to the chase! An easy answer to either one of those questions isn’t always possible.

This chapter explains the ways in which gluten can affect your body, how coeliac disease or gluten intolerance are diagnosed and the difference a gluten-free diet may make to your health.

Looking at Allergies, Intolerances and Coeliac Disease

Food allergy, food intolerances and coeliac disease are three distinctly different conditions, yet many people talk about them as if they were the same. That’s probably because they share a number of common symptoms and are all treated by diet.

Food allergies

Food allergy is estimated to affect about 1 to 2 per cent of the population. It’s the most serious form of reaction to food and can be life threatening. Allergies are specific reactions resulting from an abnormal and exaggerated response to food proteins. Foods that people may be allergic to include milk, egg, wheat, fish and shellfish, peanuts and soy. Most children tend to grow out of milk, wheat and egg allergies by the age of four or five. Allergies to peanuts or fish are less common, but they’re more likely to persist for life.

Allergic reactions occur when the body’s immune system overreacts to a particular substance, believing that it’s harmful. Allergies are usually diagnosed by skin-prick testing, the gold standard for diagnosis.

If someone has a food allergy, he or she should avoid the allergen at all times. Reactions can occur to even minute amounts of allergenic protein, and sensitivity to the allergen can increase on repeated exposure. What may be a mild reaction to the first exposure can become a life-threatening one if the individual is repeatedly exposed to the allergen. In extreme cases, an allergic reaction can cause anaphylactic shock, requiring an epinephrine (adrenaline) injection.

Many food allergies are called IgE-mediated responses to foods. Basically, all that means is that the immune system is overreacting to a food, treating it as a foreign ‘invader’. IgE just indicates a class of immunoglobulin. Immunoglobulins are proteins that the body makes to help fight against things it perceives to be threats. IgE’s main evolutionary role has been to protect the body against parasites, but it also fights other ‘bad guys’, which is what it’s doing when you have an allergic reaction to food. The body creates a specific variation of IgE antibody for each allergen it encounters.

Allergy to wheat isn’t common and only in the case of severe allergy can an asthma attack be triggered. Rare cases of anaphylaxis can occur and these instances are usually exercise induced. An allergic reaction to wheat may include itching and swelling, vomiting, cramps or diarrhoea.

Food intolerance

Food intolerances are not allergies, but reactions to food chemicals. Unlike allergies, intolerances seem to work by irritating nerve endings in different parts of the body, causing side effects. The symptoms of intolerance vary from person to person. Common symptoms may include hives, headaches, mouth ulcers, nausea, bloating and wind, stomach pains, irritable bowel and other bowel symptoms.

Food intolerances can be very unpleasant and distressing, but they don’t generally cause permanent damage to the body (as allergies and coeliac disease do). They don’t involve immune reactions to food proteins or cause any damage to the bowel lining. However, if the bowel is affected, causing nausea or diarrhoea over a long period of time, dehydration, weight loss and deficiencies may result.

People vary in their degree of sensitivity to the chemicals that occur naturally in foods. The most commonly recognised natural food chemicals that cause problems include salicylates, amines and glutamate. Sensitivity to these chemicals can be determined by going on an elimination diet with the assistance of an experienced dietitian.

Additives such as preservatives, antioxidants and colourings are also problematic for some people. In sensitive people, the effect is dose related and depends on how often and how much of the problem component is consumed and on individual sensitivity (or someone’s threshold).

The small amounts of natural chemicals present in a particular food may not be enough to cause a reaction immediately. Each chemical may be present in small amounts in a number of different foods, so it can accumulate in the body over time, producing symptoms once an individual’s threshold is finally reached.

FODMAPs have been found to cause irritable bowel symptoms in those with or without coeliac disease. Don’t be put off by the term FODMAPs — it’s an acronym for fermentable oligo-, di-, monosaccharides, and polyols, which include fructose (a naturally occurring sugar found in fruit) and lactose (the sugar in dairy products). These are poorly absorbed in some people, so they travel through the digestive tract, acting as an excellent food source for gut bacteria. The bacteria in your gut thrive on these components and, as a by-product of the fermentation, produce a lot of gas, which causes the typical symptoms of bloating, distension, wind, abdominal pain and nausea.

Some individuals sensitive to FODMAPs find that removing wheat from their diet helps to improve symptoms. A significant body of evidence now suggests that some psychological therapies help symptoms of irritable bowel disease. Cognitive behaviour therapy and more particularly ‘gut directed’ hypnotherapy with a qualified practitioner have been shown to produce lasting benefits, although the reasons for this are not yet fully understood.

No medical test can diagnose wheat or gluten intolerance or any other food intolerance. The only way to identify intolerance is to go on an elimination diet or a low-FODMAP diet, supervised by a dietitian. The exception is fructose malabsorption, which can be determined by a hydrogen breath test. If food intolerance is diagnosed, you need to decide how strictly you need to avoid the food chemical(s) causing the trouble. It’s a matter of balancing the severity of the symptoms against the difficulty of restricting the diet.

If you’ve made the decision yourself to go on a gluten-free diet, we strongly advise you to see your doctor to discuss your options. A gluten-free diet may mask other symptoms for a time and delay the diagnosis of a more serious problem. Or you may have coeliac disease, but because it hasn’t been medically diagnosed, your doctor may not be monitoring you for other conditions related to coeliac disease, like osteoporosis or thyroid disease.

Coeliac disease

Unlike gluten or wheat intolerance, coeliac disease is well defined. Coeliac disease is a common (yet often undiagnosed) genetic response to gluten. Triggered by eating gluten, the immune system responds by attacking the gluten molecule and, in so doing, also attacks your body cells. This is called an autoimmune response. The disease can develop at any age and it results in damage to the small intestine, which can cause poor absorption of nutrients. Although the damage occurs in the gastrointestinal tract, not all symptoms are gastrointestinal in nature. In fact, symptoms vary widely between individuals and sometimes no symptoms are apparent at all. We cover coeliac disease in more detail in Chapter 3.

Identifying symptoms of coeliac disease

The symptoms of coeliac disease can affect any part of the body. That’s because coeliac disease is multisystemic; although the actual damage is occurring in the gastrointestinal tract — mainly in the small intestine — the symptoms can affect you in many different ways.

The key indicators that raise suspicion of coeliac disease are shown in Table 2-1.

Many people think the most common symptoms of coeliac disease are gastrointestinal in nature — diarrhoea, constipation, gas, bloating, reflux and even vomiting. Here are some of the ‘classic’ — though not the most common — symptoms of coeliac disease:

• Abdominal pain and distension
• Bloating
• Constipation
• Diarrhoea
• Gas and flatulence
• Greasy, foul-smelling, floating stools
• Nausea
• Reflux
• Vomiting
• Weight loss or weight gain

Identifying other symptoms

Interestingly, although coeliac disease affects the gut, most people’s symptoms aren’t gastrointestinal in nature. People more commonly have what are called extraintestinal symptoms. This is only a partial listing that includes some of the more common symptoms:

• Abnormal menstrual cycles
• Ataxia (difficulties with muscle coordination)
• Dental enamel defects and irregularities
• Depression, irritability, listlessness and mood disorders
• Early onset osteoporosis
• ‘Foggy brain’ or an inability to concentrate
• Hair loss (alopecia)
• Headaches (including migraines)
• Joint/bone pain
• Lactose intolerance
• Low blood sugar (hypoglycaemia)
• Low calcium levels
• Mouth ulcers (apthus ulcers) or swelling of the tongue
• Peripheral neuropathy (tingling in the fingers and toes)
• Unexplained fatigue and weakness (due to iron-deficiency anaemia)
• Unexplained infertility
• Vitamin and/or mineral deficiencies

Some people are diagnosed with coeliac disease even though they have no noticeable symptoms — these people are called asymptomatic. They’re usually diagnosed because they have a relative who has coeliac disease and they’re smart enough to know that means they should be tested too, or iron deficiency is detected and they’re tested. (Truly, though, if they read the list of 250+ symptoms, it’s unlikely that they could honestly say they have none of them!) Even though they don’t feel any symptoms, gluten is damaging their small intestine, which can result in nutritional deficiencies and associated conditions. They need to avoid gluten just as much as those with obvious symptoms. These people have it tough, in terms of both diagnosis and treatment. It’s not easy to stay motivated to give up some of your favourite foods when those foods don’t seem to make you feel bad! But after a few weeks on the diet many of them look back and say ‘I didn’t realise there was anything wrong, but now I feel fantastic’.

Spotting symptoms in kids

Kids who have coeliac disease tend to have the ‘classic’ gastrointestinal symptoms of diarrhoea or constipation, although exceptions do occur. They may also have some of these symptoms:

• Abdominal pain and distension
• Anaemia
• Bone pain
• Delayed growth or delayed puberty
• Failure to thrive (in infants and toddlers)
• Inability to concentrate
• Irritability
• Tiredness
• Weight loss in older children

Discovering misdiagnoses and missed diagnoses

Thankfully, as awareness of coeliac disease increases, diagnoses are on the rise and many more people with coeliac disease are discovering improved health on a gluten-free diet. But in the meantime, underdiagnosis is still a big problem. Patients are often misdiagnosed with a variety of conditions before finding out that they really have coeliac disease.

In Europe, the average time between the onset of symptoms and a diagnosis of coeliac disease is six months. In Australia, it takes an average of five years after symptoms develop. In the US, if the diagnosis ever comes, it takes an average of 11 years after symptoms develop. A Reader’s Digest article titled ‘10 Diseases Doctors Miss’ cited coeliac disease as one of the top 10 misdiagnosed diseases. In Australia, only one in five people with coeliac disease is diagnosed.

So why are doctors missing the diagnosis of this common condition? Michelle Pietzak, MD, one of the foremost experts on coeliac disease in the US, offers some ideas:

• Doctors aren’t exposed to it enough at university and during residency training. These are critical periods when doctors’ opinions and future practices are moulded. If they don’t hear enough about it during their training, they’re not likely to look for it after they graduate.
• Some doctors get ‘continuing medical information’ from drug reps, journal articles and conferences. Right now, no drugs for coeliac disease exist, so drug reps aren’t strolling into the doctors’ offices and chatting it up. Nor do many conferences and journal articles bring coeliac disease to the forefront, where it would be more likely to get top-of-mind awareness during the testing procedures.
• Symptoms are vast and sometimes even absent. Symptoms of coeliac disease are often quite varied, affecting many different parts of the body, sometimes all at once. Some people don’t seem to have any symptoms. That makes pinpointing a cause difficult.
• Doctors may think the patients are exaggerating or just plain ‘crazy’. More than one person with coeliac disease has been called neurotic or a hypochondriac because of the symptoms involved. The long laundry list of symptoms may come across as exaggeration or hysteria.
• Routine blood tests don’t pick it up. Full blood counts (FBC) and chemistry panels don’t test specifically for coeliac disease. So although a doctor is likely to order BC and chemistry panels for patients with coeliac symptoms, these don’t offer any hints that a patient may have coeliac disease. An astute doctor, though, will see signs in these panels: Anaemia; low potassium, bicarbonate and protein levels; and high liver enzymes are red flags for coeliac disease.
• Routine endoscopies and poorly done biopsies don’t detect coeliac disease. Some patients think they’ve been tested for coeliac disease because their doctor did an endoscopy. But an endoscopy without a biopsy doesn’t detect coeliac disease. Damage to the gut is only visible to the naked eye in 50 per cent of cases, so a tissue sample is needed for examination under a microscope. Even if doctors do a biopsy, they may miss the diagnosis if they do the biopsy poorly, if they don’t take enough samples or if they don’t take samples far enough down into the small bowel. If you’re confused about endoscopies or biopsies, see the sidebar ‘Guiding you through the opsies and scopsies’, later in this chapter.

Blaming the Bread: How Gluten May Affect Behaviour

Rarely considered a culprit in behavioural issues, gluten is sometimes behind the scenes wreaking havoc on behaviour and moods.

‘Sorry I haven’t been productive at work lately; I’ve been eating too much bread’ sounds a bit ridiculous. But really, it could be the case because some researchers believe bread — gluten — may affect the behaviour of coeliacs in several ways, including ‘foggy brain’, or an inability to concentrate. Some doctors think individuals could be affected in any of the following ways:

• Attention-deficit disorder (ADD) and attention-deficit hyperactive disorder (ADHD) type behaviours
• Autism
• Inability to concentrate or focus
• Irritability
• Lack of motivation

Exploring dietary treatment for autism

Anecdotal evidence (that is, parents and others report it to doctors or researchers) shows that some people with autism improve on a gluten-free, casein-free diet (casein is the major protein found in milk). This seems to be confirmed by some studies, but disproven by others. On the diet, some people show improvement within a week — others within a year. Others show no improvement at all. Of those who report changes in behaviour, the changes themselves vary, too. Some people with autism report an improved ability to sleep through the night, others become more verbal and interactive, and some are completely ‘normalised’ on the diet.

A recent study in the US didn’t find any evidence of a link, but larger and more rigorous studies are needed to clarify this important issue. Getting autistic kids to eat well is a big enough problem without complicating it by eliminating gluten, unless the benefits are clearly established.

It’s well documented that autistic children often have gastrointestinal problems. The effects aren’t due to an allergy or severe reaction to gluten, but a toxin or drug. Although some connection may exist between coeliac disease and autism, the nature of that connection has yet to be established.

Depression and other mood disorders

Clinical depression, bipolar disorder, schizophrenia and a variety of mood disorders can, in rare cases, be associated with or exacerbated by gluten sensitivity and coeliac disease. Some journal articles even list these mood disorders as ‘symptoms’ of coeliac disease. These conditions sometimes improve on a gluten-free diet.

Schizophrenia has been associated with gluten since the 1960s, when it was first noted that a gluten- (and dairy-) restricted diet led to improvement in some institutionalised patients. However, no satisfactory studies have established a convincing connection.

A recent study found that coeliacs and diabetics rated themselves as more depressed and anxious than others. This was seen as related to the difficulties of adjusting to a chronic and restrictive condition rather than directly to the disease. But gluten-free food is much easier to find than in the past and community understanding and tolerance is steadily improving. Now that thousands of people are on a gluten-free diet, they aren’t quite the two-headed monsters they used to be.

Evidence exists that coeliacs diagnosed in childhood have higher than normal death rates, mostly from accidents, suicide and violence. It’s well known that this excess also occurs in people with other chronic conditions such as diabetes or epilepsy. During adolescence, the pressure to conform is enormous and it may be that young people who feel ‘different’ go out of their way to prove themselves with their peers, taking greater risks or acting tough. Teenagers often bitterly resent their diet and may experience anger or depression because the condition is lifelong.

Teenage coeliacs need more monitoring and care than adults, who are more likely to have the life skills to cope with their diet. Life improved for young diabetics with the introduction of sugar-free soft drinks. Fortunately, a far greater range of gluten-free fast-food options is now available, so young people are able to enjoy a night out with friends without feeling excluded or ‘different’ (see Chapter 16 for more details).

Getting Tested

Tests are available to diagnose food allergies and coeliac disease. If neither of these conditions is found, you may have a gluten or wheat intolerance, but this can only be determined by excluding gluten or wheat from the diet. Specific medical tests for intolerance aren’t available. It’s worth remembering that although you may not have coeliac disease at the time (or there may have been only scattered damage to your intestines that wasn’t picked up by biopsy) you could possibly develop it later in life. Gene testing (explained later in this chapter) can help here, because if testing shows that you don’t have the necessary genes, you can almost definitely exclude coeliac disease.

If coeliac disease is suspected, tests are selected to establish whether a gastroscopy and small bowel biopsies are necessary. Blood tests aren’t enough on their own to diagnose coeliac disease, but they can be a good indicator of it.

Testing for coeliac disease — blood tests

Blood tests — also called serological tests — look for antibodies that the body produces when someone with coeliac disease eats gluten.

You have to be eating gluten regularly before blood testing. If you don’t eat gluten, or haven’t eaten it for long enough, your body may not be producing enough antibodies to show up on the tests, and the results may show that your antibodies are in the normal range. Opinions vary on how much gluten you need to be eating and for how long, from one month to four to six months. You need to be guided by your gastroenterologist on this issue. If you have severe symptoms during that time, consult your doctor to see whether you should continue to eat gluten.

The most comprehensive panel of blood tests generally recommended for coeliac screening includes five tests for antibodies. Only one serum tube is required. Endomysial antibody (EMA) (IgA) or transglutaminase antibody (tTg) (IgA) tests are the preferred tests. Antigliadin antibody tests (AGA) (IgG & IgA) are less precise. Sometimes the test results can be misleading because an individual has an IgA deficiency (this occurs in 2 per cent of coeliacs). They’re less reliable in children under the age of four or five.

A range of antibody tests have been developed in order to diagnose coeliac disease. The main (and possibly the only) autoantigen in coeliac disease is tissue transglutaminase (tTg). This enzyme is present in many different cell types. When tissue injury has occurred (as in coeliac disease) this enzyme is released to restore the damaged tissue. The performance of tests measuring antibodies to tTg has improved so much over the past few years these tests are now preferred over earlier tests, which measured gliadin or endomysial antibodies.

If one or more of these tests are positive, the results may indicate coeliac disease. The next step will be an intestinal biopsy to confirm the diagnosis.

Biopsies

Biopsies are considered the ‘gold standard’ for diagnosing coeliac disease, and they’ve come a long way since they were first administered. Back in the 1980s biopsies were done without any sedative or anaesthetic. On one occasion Margaret was halfway through a biopsy procedure when she was told she had to be moved to another room. Clutching the cute little blue gown around her buttocks for some semblance of privacy, she had to walk right through a crowded waiting room with a long tube hanging out of her mouth. She tried for a dignified saunter, but only managed a beetroot-faced scuttle. These days biopsies are far more civilised and not at all unpleasant. When doctors do a biopsy, they do it by way of an endoscopy in order to collect cell samples from the villi, the hairlike structures on the lining of the small intestine. When people with coeliac disease eat gluten, the body launches an attack and ends up attacking itself, blunting the villi. The biopsy determines how much blunting, if any, has occurred.

The endoscopy itself and the clipping of the villi aren’t painful. You’re given a light sedation so you’re not conscious but can be easily awakened. Most people sleep right through the short procedure. The gastroenterologist inserts a tube through the mouth into the oesophagus, to the stomach and finally to the small intestine. Sometimes people have a mild sore throat after the procedure. You wake gradually, have a rest and a cup of tea and you’re free to go — although you’ll need someone to drive you home in case the sedative is still making you drowsy.

Like the blood test (refer to the preceding section), you have to be eating gluten in order for the biopsies to be accurate. Here are a few important things to know about a biopsy:

• As in all surgical procedures, some slight risks are involved. In rare cases, the small bowel may be perforated, requiring further surgery.
• The doctor should take at least four biopsy samples. Coeliac disease can be patchy, sometimes affecting one area but not affecting the area right next to it. Taking several samples maximises the chance that at least one will be from an affected area, if one exists.
• Even mild blunting can indicate damage. People used to think that in order to diagnose coeliac disease, total villous atrophy needed to be apparent, or completely flattened or blunted villi. Today, different degrees of damage are measured by the Marsh rating system and even partial blunting indicates damage.
• For the most part, doctors can’t make a diagnosis by doing an endoscopy alone. Although visual clues can indicate damage due to coeliac disease, biopsies are needed for accurate diagnosis.

The biopsy samples are sent to a pathologist, who then gives the results to the gastroenterologist. You should hear back from the gastroenterologist with the results of your biopsy within a few days.

Genetic tests

Genetic testing can be done by taking a swab from the inside of the cheek (a buccal swab), or from a blood sample. Doctors look to see whether someone has the genes associated with coeliac disease.

Genetic testing is valuable for ruling out coeliac disease, because if you don’t have one or both of the genes HLA-DQ2 or HLA-DQ8, you have a 99.6 per cent chance of never developing coeliac disease. The test isn’t valuable for predicting who will get coeliac disease, though, because lots of people have these genes and never develop it. More information about the genetics of coeliac disease is provided in Chapter 3.

Allergy tests

Some people have IgE-mediated allergy to wheat, other cereal grain proteins or even seeds, such as sesame seeds or poppy seeds, which are sometimes included in bakery products. This can be tested using the RAST test, a blood test that looks for immunoglobulin E (IgE). A skin-prick test is another alternative, and this is usually performed by an allergy specialist or at an allergy centre.

Coeliac disease can be triggered at any age, so just because you tested negative once doesn’t mean you’re ‘out of the woods’ forever. But if you have the gene test and it shows you have neither of the necessary genes for coeliac disease, you can be pretty certain that it will never develop.

I’ve tested positive! Now what?

If you’ve been diagnosed with coeliac disease, you’re lucky! You hold the key to better health: A gluten-free lifestyle. Going gluten-free right away is important. You may have a million questions in your mind at first, but this book helps you find many of the answers. You may make mistakes at first and that’s okay. Learn from them and move on.

Coeliac disease is a genetic condition. If you’ve been diagnosed, your immediate family members should have blood tests and maybe the gene test, even if they have no obvious symptoms. Other relatives who do have some symptoms should let their doctor know coeliac disease is in the family.

Paying the Price if You Continue to Eat Gluten

Some people who have been told they need a gluten-free diet still continue to eat gluten, for a variety of reasons:

• Gluten-free food may be extremely hard to source, particularly if you live in a small country town or remote area.
• You may have little control over the food that’s available to you — some elderly coeliacs in retirement hostels or even nursing homes struggle to get enough gluten-free food to satisfy their needs. In a large family with parents who are barely coping, some coeliac children have to eat gluten-containing foods or ‘do without’.
• Gluten-free bread and other supplies are just too expensive.
• You’re not able to understand how to avoid gluten, because of intellectual, emotional or language limitations.
• You don’t experience unpleasant symptoms and it’s all too much effort.

Continuing to eat gluten when you’ve been diagnosed with coeliac disease increases your risk of developing serious medical conditions down the track. We look at some of these in the following section.

Health and other services are badly needed to find better ways of educating coeliacs and their families or carers, and to ensure that gluten-free food is within reach of all those who need it.

Mild symptoms don’t mean that you have a mild form of coeliac disease or only mild damage to your bowel. When you’ve been told you’re a coeliac, even if you have no symptoms, eating gluten will cause damage.

Looking at associated conditions

Certain conditions are associated with coeliac disease, meaning that someone who has one is more likely to have the other. It’s not always clear which one developed first (except, for instance, Down syndrome, which people are born with).

If you already have one of these conditions but haven’t been tested for coeliac disease, you should be tested, because the fact that you have one of these diseases increases your chance of also having coeliac disease.

Autoimmune diseases

Several autoimmune diseases are associated with coeliac disease, including

• Addison’s disease (hypoadrenocorticism)
• Autoimmune chronic active hepatitis
• Autoimmune diabetes mellitus (type 1 diabetes)
• Crohn’s disease
• Myesthenia gravis
• Raynaud’s phenomenon
• Scleroderma
• Sjögren’s syndrome
• Systemic lupus erythematosus
• Thyroid disease (Graves’ disease and Hashimoto’s disease)
• Ulcerative colitis

Mood disorders

Some of the mood disorders that may be rarely associated with gluten and/or coeliac disease include

• ADD/ADHD
• Autism
• Depression and bipolar disease

Nutritional deficiencies

Because coeliac disease affects the small intestine, nutritional deficiencies are associated. In addition to specific vitamin and mineral deficiencies, people may have

• Anaemia
• Osteoporosis, osteopaenia or osteomalacia

Neurological conditions

Some neurological conditions are associated with coeliac disease, including

• Cerebral calcifications
• Spina bifida (neural tube defects) (in babies born to mothers with coeliac disease who are eating gluten)
• Neurological problems, such as ataxia, neuropathy, tingling, seizures and optic myopathy

Other conditions

Several other conditions are associated with coeliac disease, including

• Cancer (especially intestinal lymphoma) due to untreated coeliac disease
• Down syndrome
• Organ disorders (of the gallbladder, liver, spleen or pancreas)
• Tooth enamel defects

Type 1 diabetes and coeliac disease often go hand in hand. About 10 per cent of people with type 1 diabetes have coeliac disease, but many don’t know it. Some individuals with coeliac disease and type 1 diabetes say it’s easier to manage blood-sugar levels on a gluten-free diet.

The earlier in life you are diagnosed with coeliac disease, the lower your risk of developing osteoporosis.

Living with compromised health

You may feel perfectly healthy. You may be asymptomatic (have no apparent symptoms) or have mild symptoms that you barely notice. But if you have coeliac disease and you continue to eat gluten, you’re undoubtedly compromising your health. Your body is being robbed of important nutrients that it needs to function properly and stay strong. You’re also increasing your risk of developing other serious medical conditions.

Healing Begins on Day One

One of the coolest things about going gluten-free when you have coeliac disease is that you start healing the minute you stop eating gluten. Most people begin to feel better immediately; some take months to improve; and a few feel better initially but then take a temporary nosedive a few months into the diet. (If that happens you may need to check with a qualified dietitian to make sure you’re not eating some gluten by mistake.)

All these are normal responses to your body’s healing process and, in the long run, you can look forward to improved health in ways you may not have even expected. Often people say they didn’t realise how sick they were until they started to feel better. Margaret at last understood how people could actually be cheerful first thing in the morning — she assumed it was normal to feel like a mouldy cabbage when you dragged yourself out of bed. Although most, if not all, of the intestinal damage caused by gluten is reversible, some of the prolonged malnutrition and malabsorption issues, such as short stature and weakened bones, may have long-lasting, if not permanent effects. That’s one of the reasons it’s important to be diagnosed as early as possible — so you can achieve your potential and live life to the full.