Coeliac Disease
An immune reaction to gluten that damages the lining of the small bowel. About 1 in 70 Australians have it, most without knowing. Symptoms range from bloating and low iron to nothing at all.
Test before you quit gluten. Keep eating it (adults about 4 slices of wheat bread a day, children about half) for at least 6 weeks. A blood test comes first; a gastroscopy with small bowel samples usually confirms it. A negative gene test rules it out.
The coeliac ladder
The diet is the treatment. Everything else on the ladder helps you do it well and stay well.
- Step 1 · Self-careStrict gluten-free diet, for lifeNo wheat, barley, rye or oats, and watch for hidden gluten and cross-contamination.
- Works
- Diarrhoea settles in about 4 weeks; the bowel lining heals in about 1 in 3 adults by 2 years, 2 in 3 by 5 years
- Cost
- Gluten-free staples often cost about double
- How long
- For life
- Watch for
- Small amounts still damage the bowel, with or without symptoms
“Just a crumb” still counts. Your bowel keeps score.
- Step 2 · PharmacyCorrect low levelsIron, vitamin B12, folate, vitamin D or calcium, as your blood tests show.
- Works
- Reliably fixes measured shortfalls while the gut heals; not trial-tested as a coeliac treatment
- Cost
- About $10–25 a bottle; some are on the PBS
- How long
- Months, guided by blood tests
- Watch for
- Check supplements and medicines are gluten free
Supplements patch the gaps. The diet fixes the leak.
- Step 3 · Allied healthDietitianLabel reading, hidden gluten, eating out, and keeping your diet balanced.
- Works
- Linked to better diet adherence in studies; no good trials, but low risk and widely recommended
- Cost
- About $100–180 a visit; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- 1–3 visits to start
- Watch for
- Gluten-free junk food is still junk food
Gluten-free doughnuts are still doughnuts.
- Step 4 · SpecialistGastroenterologistConfirms the diagnosis with a gastroscopy and small bowel samples, and helps if symptoms persist despite the diet.
- Works
- Biopsy is the gold standard. When symptoms persist, hidden gluten explains about 1 in 3; most of the rest are other gut problems
- Cost
- Free in public hospitals (waits apply); private gaps vary, often a few hundred dollars or more
- How long
- Day procedure under sedation
- Watch for
- Keep eating gluten until the gastroscopy is done
The camera can’t find what you’ve stopped eating.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Going gluten-free before testingMakes the tests unreliable, and you may need weeks back on gluten to be tested properly.
- “Gluten-digesting” enzyme pillsDon’t protect the bowel and are no substitute for the diet.
- Food intolerance (IgG) tests and hair analysisNot valid for diagnosing anything, including coeliac disease. Proper blood tests and a biopsy are the way.
- Oats without guidanceSome people react even to uncontaminated oats. Only try them with your doctor’s advice.
What you can do
- Ask parents, brothers, sisters and children to get tested: about 1 in 10 also have it, often without symptoms.
- Have blood tests at about 6 and 12 months, then yearly, to check antibodies are falling and levels are normal.
- Adults may need a bone density scan.
- Check medicines and supplements for gluten with your pharmacist.
See your GP if
- Symptoms continue despite a strict gluten-free diet
- You have another autoimmune condition, such as type 1 diabetes or thyroid disease, and haven’t been tested
- A family member has coeliac disease
See a doctor promptly for unexplained weight loss, blood in your poo, trouble swallowing or vomiting that won’t settle. These need checking for other causes.
Common questions
How is coeliac disease tested?
It starts with a blood test. If positive, a gastroscopy (camera test) with small bowel samples usually confirms it. You need to be eating gluten for the tests to be accurate.
Should I go gluten-free before testing?
No. It makes the tests unreliable. Adults need about 4 slices of wheat bread a day (children about half) for at least 6 weeks before testing.
Can people with coeliac disease eat oats?
Some people react to oats even when uncontaminated, and in Australia oats can’t be labelled gluten free. Only try them with your doctor’s guidance.
Should my family be tested for coeliac disease?
Yes. About 1 in 10 parents, brothers, sisters and children of someone with coeliac disease also have it, often without symptoms.
What’s the difference between coeliac disease and gluten intolerance?
Coeliac disease is an autoimmune condition where gluten damages the small bowel, so it needs a strict lifelong gluten-free diet. Gluten intolerance (non-coeliac gluten sensitivity) causes symptoms without that damage, and many people with it are actually reacting to FODMAPs in wheat.
Can coeliac disease start in adulthood?
Yes, it can be diagnosed at any age, and many people are diagnosed in their 40s or 50s. About 1 in 70 Australians has coeliac disease, but around 4 in 5 don’t know yet.
What happens if someone with coeliac disease eats gluten?
Some people get tummy pain, bloating or diarrhoea within hours, and others feel nothing. Either way, gluten causes ongoing bowel damage, which raises the risk of anaemia, thin bones and, rarely, bowel lymphoma. Even crumbs matter.
Helpful resources
- Coeliac AustraliaSupport, helpline, ingredient list booklet and endorsed product list for members (under $1.45 a week). Australia.
- Coeliac UKUK charity with free diet guides, recipes, eating-out tips and a symptom checker.
Evidence and more information
- Healthdirect: Coeliac disease
- Better Health Channel: Coeliac disease and gluten sensitivity
- Coeliac Australia: Gluten challenge fact sheet
- Rubio-Tapia et al: Mucosal recovery in adults with coeliac disease (2010)
- Murray et al: Gluten-free diet and gut symptoms in coeliac disease (2004)
- Beyond Celiac: Non-responsive coeliac disease
maladywise.com/coeliac/