Coeliac disease is a serious, lifelong autoimmune condition that affects around one in 100 people, yet many remain undiagnosed. As a specialist gastroenterology dietitian, I often meet individuals who have struggled for years with unexplained symptoms before getting answers. Understanding what the disease is and how to manage it can be life changing.

What is coeliac disease?
Coeliac disease occurs when the immune system reacts abnormally to gluten, a protein found in wheat, barley and rye. In people with coeliac disease, eating gluten triggers an immune response that damages the lining of the small intestine. This damage flattens the tiny finger-like projections (villi) that are responsible for absorbing nutrients such as iron and calcium, leading to malabsorption and a wide range of symptoms.

Symptoms: often hidden and varied
Symptoms can appear at any age and vary greatly from person to person. Digestive symptoms are common and include bloating, diarrhoea, constipation, abdominal pain, nausea and wind. However, many people experience non-digestive symptoms such as fatigue, iron-deficiency anaemia, headaches, mouth ulcers, joint pain, skin rashes, low mood, fertility issues, or poor growth in children. Some people have very mild symptoms, or none at all, despite significant intestinal damage.

How is it diagnosed?
Diagnosis is crucial and must be done before starting a gluten-free diet. Initial testing usually involves blood tests that look for specific antibodies. If these are positive, a referral for an intestinal biopsy is often required to confirm the diagnosis. Removing gluten too early can lead to false results, so it’s important to seek medical advice if coeliac disease is suspected.

Management: strict and lifelong
Currently, the only effective treatment is a strict, lifelong gluten-free diet. This allows the gut to heal, symptoms to improve, and long-term complications to be prevented. Even small amounts of gluten, such as crumbs or cross-contamination, can trigger damage, even if symptoms are not obvious. Ongoing follow-up with a dietitian is essential to ensure nutritional adequacy and food label reading confidence.

What happens if it’s left untreated?
Unchecked coeliac disease can lead to serious health consequences, including osteoporosis, infertility, neurological problems, persistent anaemia, growth issues in children, and an increased risk of certain cancers. Early diagnosis and good dietary management dramatically reduce these risks.

Dietary tips from a dietitian
• Focus on naturally gluten free foods: fruits, vegetables, rice, potatoes, quinoa, eggs, meat, fish, dairy, nuts and legumes.
• Learn to read labels carefully: gluten can appear in sauces, soups, processed meats, chips and a range of snacks.
• Watch for cross-contamination: use separate toasters, chopping boards and spreads at home.
• Don’t rely solely on gluten-free processed foods: they can be low in fibre and high in sugar or fat.
• Check your micronutrients: iron, calcium, vitamin D and B vitamins may need monitoring.
• Visit www.coeliac.org.uk for more information.

With the right support, people with coeliac disease can enjoy a full, healthy and delicious diet. If you suspect coeliac disease, don’t self-diagnose – get tested and seek expert guidance.