Could It Be Coeliac Disease? Understanding the Signs and Getting Answers
An estimated 100,000 New Zealanders are living with Coeliac Disease, including around 30,000 children. That's approximately 1 in 70 Kiwis. Despite this, it is estimated that 70–80% of people with Coeliac Disease remain undiagnosed and are unaware they have the condition (Coeliac New Zealand).
In clinic, we commonly see people who have recently been diagnosed and feel overwhelmed about what to eat and how to manage their condition. We also see many individuals with ongoing digestive symptoms, nutrient deficiencies, or other health concerns where undiagnosed Coeliac Disease may be a contributing factor, and further investigation is warranted.
Gluten Intolerance vs Coeliac Disease: What's the Difference?
Many people use the terms gluten intolerance and Coeliac disease interchangeably, but they are actually very different conditions.
What is Coeliac disease?
Coeliac disease is an autoimmune condition. This means the immune system mistakenly attacks the body's own tissues.
In people with Coeliac disease, eating gluten triggers an abnormal immune response that damages the lining of the small intestine. Gluten is a protein found in wheat, barley and rye, meaning it's present in many everyday foods such as bread, wraps, pasta, cereals, baked goods, and even some sauces, seasonings and condiments.
For someone with Coeliac disease, even tiny amounts of gluten can trigger this immune response. This includes gluten from cross-contamination, such as using the same toaster for gluten-free and regular bread, or preparing gluten-free food on a surface that has come into contact with gluten.
Why does this matter?
The immune attack specifically damages the villi - the tiny finger-like projections that line the small intestine.
These villi have a crucial job: absorbing the vitamins, minerals and other nutrients from the food we eat. Healthy villi provide a large surface area for nutrient absorption, helping your body obtain everything it needs to function well.
When the villi become damaged, nutrients are no longer absorbed efficiently. Over time, this can lead to deficiencies in nutrients such as iron, folate, vitamin B12, calcium and vitamin D, as well as many others.
This is why untreated Coeliac disease can affect much more than just digestion. It may contribute to symptoms and health concerns including:
Iron deficiency and anaemia
Fatigue and low energy
Unexplained weight loss
Ongoing diarrhoea, constipation or bloating
Poor bone health and osteoporosis
Mouth ulcers
Fertility concerns
Delayed growth in children
Skin conditions such as dermatitis herpetiformis
Some people experience significant digestive symptoms, while others have very few obvious gut symptoms at all. In some cases, nutrient deficiencies or fatigue may be the first signs that something isn't right.
How is gluten intolerance different?
Unlike Coeliac disease, gluten intolerance (also known as non-coeliac gluten sensitivity) is not an autoimmune condition and does not damage the villi of the small intestine.
People with gluten intolerance may experience symptoms such as bloating, abdominal discomfort, headaches, fatigue or changes in bowel habits after eating gluten. However, because there is no autoimmune attack on the intestine, gluten intolerance does not cause the intestinal damage or long-term nutrient malabsorption seen in Coeliac disease.
How We Can Support Your Coeliac Journey
Our practitioners can help identify when Coeliac Disease may be contributing to your symptoms and determine whether further investigation is appropriate. We work alongside your GP to support the diagnostic process and ensure you receive the appropriate testing and care.
Nutritional Assessment
During your consultation, we undertake a comprehensive assessment of:
Your presenting symptoms, including their onset, duration and severity
Family history of coeliac disease and other autoimmune conditions
Dietary intake, eating patterns, and any suspected food triggers
Digestive symptoms such as bloating, abdominal pain, reflux, diarrhoea, constipation or nausea
Other symptoms commonly associated with coeliac disease, including fatigue, headaches, brain fog, skin concerns, recurrent mouth ulcers, and changes in mood or concentration
Potential indicators of nutrient deficiencies or malabsorption that may require further investigation
Blood Testing
Coeliac disease can impair the absorption of important nutrients. Where appropriate, we may recommend blood tests to assess for deficiencies commonly associated with coeliac disease, including:
Iron studies
Ferritin
Vitamin B12
Folate
Vitamin D
Zinc
Full blood count
Coeliac Screening
If your symptoms or history suggest coeliac disease, we may arrange appropriate pathology requests.
Screening blood tests commonly include:
Tissue Transglutaminase Antibodies (tTG-IgA)
Total IgA
Endomysial Antibodies (EMA)
It is essential that you continue eating gluten before testing. Removing gluten beforehand can reduce antibody levels and increase the risk of a false-negative result, potentially delaying an accurate diagnosis.
Genetic Testing
In some situations, HLA-DQ2 and HLA-DQ8 genetic testing may also be considered.
These genes are present in almost all people with coeliac disease. However, having one or both genes does not confirm that someone has coeliac disease - it simply indicates a genetic predisposition.
Genetic testing is most useful for people who have already removed gluten from their diet before testing or when the diagnosis remains uncertain after other investigations
Receiving a diagnosis is only the beginning. Learning to follow a strict gluten-free diet while maintaining good nutrition can feel overwhelming, particularly in the early stages. This is where ongoing nutrition support can make a significant difference.
Support for Living with Coeliac Disease
While eliminating gluten is essential, many people are left wondering what they can eat, how to avoid accidental gluten exposure, and how to maintain a balanced, nutritious diet.
One of the biggest misconceptions is that foods labelled "gluten-free" are automatically healthier. While these products are safe for people with Coeliac disease because they do not contain gluten, many are often highly processed and may be higher in refined starches, sugar, fat and salt, while being lower in fibre, protein and essential nutrients.
In clinic, we focus on helping you build a diet centered around naturally gluten-free, whole foods rather than relying solely on packaged gluten-free alternatives. This supports not only digestive health but also helps restore nutrient stores that may have been depleted before diagnosis.
Our support may include:
Identifying naturally gluten-free, nutrient-dense foods
Reviewing food labels and identifying hidden sources of gluten
Educating on cross-contamination risks at home and when dining out
Addressing nutrient deficiencies such as iron, vitamin B12, folate and vitamin D
Creating balanced meal plans that are practical, enjoyable and sustainable
Monitoring your nutritional status and supporting your long-term health
Living with Coeliac disease doesn't simply mean avoiding gluten - it means learning how to nourish your body while protecting your small intestine from ongoing damage. With the right education and support, eating gluten-free can become both nutritious and enjoyable.
If you've recently been diagnosed, are struggling to manage your symptoms, or simply want confidence that you're meeting your nutritional needs, our practitioners can help.