Could It Be Coeliac Disease? Understanding the Signs and Getting Answers
An estimated 100,000 New Zealanders have coeliac disease, with about 30,000 of those being children. This means roughly 1 in 70 Kiwis are affected. However, as many as 70% to 80% of these individuals remain undiagnosed and are unaware they have the condition (Coeliac New Zealand).
In clinic, we often see individuals who have either recently been diagnosed and are stuck with where to go next, or individuals who are living with undiagnosed Coeliac Disease.
Not Just an Intolerance to Gluten
There is a huge difference between gluten intolerance and Coeliac Disease. Coeliac Disease is an autoimmune condition (meaning your immune system mistakenly attacks your own cells).
The ‘mistaken attack’ that occurs with Coeliac Disease is an abnormal immune reaction against gluten. Gluten can is found in many, everyday foods - including bread, wraps, pasta, mixed spice packets, and condiments. This ‘mistake attack’ can also occur from cross-contamination with gluten-containing foods (your gluten-free toast using the same toaster as gluten-containing bread).
This autoimmune reaction that occurs specifically damages your villi (tiny projections that line the walls of the small intestine). The villi have a very important role in our digestion - and that is to absorb vital nutrients from the food that we consume.
If the villi is damaged, that means the vital nutrients such as iron, folate, vitamin B12, vitamin D and other nutrients are unable to be absorbed.
How Do I Know If I Have Coeliac Disease?
There are many symptoms that can manifest if you are living with Coeliac Disease. They range hugely, from mild to severe discomfort, and are not just limited to symptoms experienced after gluten consumption.
Some of the keys sign that we look for are:
Digestive discomfort: Bloating, Gas, Abdominal Pain
Bowel Motility Issues: Constipation and/or Diarrhoea
Nausea, Vomiting
Chronic Low B12 and/or Iron
Fatigue, pale, weakness (low iron, B12)
Skin Irritation
Unexplained Weight Loss
Recurrent Mouth Ulcers
Headaches/Migraines
Poor Growth in Children
How We Can Support Your Coeliac Journey
While Clinical Nutritionists and Naturopaths cannot diagnose coeliac disease, we can help identify individuals who may benefit from further investigation and work alongside your GP to support the diagnostic process.
A formal diagnosis of coeliac disease must be made by a medical practitioner.
Nutritional Assessment
Through the consultation Process, we undertake a comprehensive assessment of:
Your presenting symptoms, including their onset, duration, and severity
Family history of coeliac disease and autoimmune conditions
Dietary intake and eating patterns, including any suspected food triggers or dietary restrictions
Digestive function, including symptoms such as bloating, abdominal discomfort, altered bowel habits, reflux, or nausea
Other symptoms commonly associated with coeliac disease, including fatigue, headaches, brain fog, skin concerns, and changes in mood or concentration
Potential indicators of nutrient deficiencies and malabsorption that may require further investigation
Blood Testing
We can recommend comprehensive nutritional testing 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 coeliac disease is suspected, we can start to explore primary screening blood tests, including:
Tissue Transglutaminase Antibodies (tTG-IgA)
Total IgA
Endomysial Antibodies (EMA)
It is essential that gluten is still being consumed before testing, as removing gluten beforehand may lead to false-negative results.
Genetic Testing
Some individuals may benefit from HLA-DQ2 and HLA-DQ8 genetic testing.
These genes are present in almost all people with coeliac disease. However a positive result does not confirm coeliac disease.
Genetic testing is most useful when someone has already removed gluten from their diet or when diagnosis remains unclear.
Support for Living with Coeliac Disease
One of the main concerns we have regarding the lack of support for individuals living with Coeliac Disease is the limited understanding surrounding gluten-free labelled products.
Gluten-free products are often perceived as being the "healthier" alternative. However, this is not always the case. While these products are safe for people with Coeliac Disease because they do not contain gluten, many are highly processed and can contain long lists of ingredients, including various additives and preservatives.
It is important to understand that "gluten-free" does not automatically mean "nutritious" or "healthy." Many gluten-free alternatives may be higher in sugar, fat, and salt, and lower in fibre and essential nutrients compared with their gluten-containing counterparts.
For individuals newly diagnosed with Coeliac Disease, there is often little guidance on how to identify naturally gluten-free, nutrient-rich foods and how to build a balanced diet beyond simply avoiding gluten. Greater education and support are needed to help people make informed choices about gluten-free products and maintain their overall health and wellbeing.