Usually our bodies let us know if something is not quite right. The obvious signs that we are having issues with gluten relate to the response going on in our gut – bloating, abdominal pain, diahorrea and/or constipation are all reasons we might get tested for coeliac disease.
Symptoms that are harder to pin down are reduced mental alertness, headaches, nausea, fatigue, and lethargy. Not only can these be attributed to a number of medical conditions, they have become a normal part of our busy lives, with eating on the go, unbalanced meals and late nights. If the cause is coeliac disease, these symptoms are likely to be a result of reduced nutrient absorption and inflammation. People sensitive to gluten often report a similar set of symptoms to those with coeliac disease.
Interestingly, some people with coeliac disease have no symptoms, or at least not noticeable or consistent ones. They only get sent off for testing if on-the ball health professionals notice unexplained anaemia, infertility, osteoporosis, or abnormal liver function. Coeliac Australia considers these to be red flags for coeliac disease screening, in addition to a family history of coeliac disease and/or the presence of other autoimmune disease e.g. type 1 diabetes, autoimmune thyroid conditions.
“Get tested for coeliac disease before you change anything. Cutting out gluten before getting tested can result in unreliable results.”
If gluten may be an issue for you and you’re thinking about cutting it out to see how your body responds, the unanimous advice from the experts is to go straight to your GP and get tested for coeliac disease before you change anything. Cutting out gluten before getting tested can result in unreliable results.
How is gluten intolerance diagnosed?
- Your GP will send you off for some blood tests: one is a Gene (HLA) test to see if you have the HLA DQ2 or DQ8 genes, associated with over 99% of coeliac disease. A positive test shows you are susceptible to coeliac disease
- The other test is Coeliac Disease Serology for IgA and IgG antibodies, which indicates whether your body has been launching an immune response to gluten. A positive result indicates coeliac disease but requires confirmation by small bowel biopsy. A negative result may mean you do not have coeliac disease or that your gluten intake has been too low to produce a reliable result.
- Once coeliac disease is suspected, you will be referred to a gastroenterologist for a small bowel biopsy, which evaluates if there is damage to the lining and absorptive surface of the small intestine.
If you are diagnosed with coeliac disease then the advice is follow a strict gluten free diet for life, even if your symptoms are minimal.
If all tests come up negative but your symptoms improve once gluten is eliminated, then gluten sensitivity is diagnosed. Although you need to follow a gluten free diet, everyone has different levels of sensitivity. You may need to be strict to manage symptoms or you may get away with a little bit of gluten here and there.
The road to living with without gluten
Seeing a dietitian can help you navigate this new world of gluten free, which involves reading food labels and understanding the less obvious sources of gluten. For people with gluten sensitivity a dietitian can asses if FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) might be playing a part in your symptoms.
Who can help?
- Your local GP can arrange the initial blood tests and refer you to a Gastroenterologist if you should need a small bowel biopsy or if your diagnosis is unclear.
- A dietitian can provide specific dietary advice to help you navigate a gluten free diet. The Dietitians Association of Australia has a list of accredited dietitians on its website – daa.asn.au
- Coeliac Australia offers practical information and support. Visit coeliac.org.au
Think you might have a problem with gluten? Here are the steps to take for a diagnosis of your symptoms.