Coeliac disease

An immune reaction to gluten that damages the gut. Not an intolerance, not a preference, and not optional.

What it is

Coeliac disease suffers from being adjacent to a diet trend, and people with it pay for that in restaurants every week.

It is an autoimmune condition. Gluten, a protein in wheat, barley and rye, triggers the immune system to attack the lining of the small intestine. The surface that absorbs nutrients gets flattened, so absorption fails.

Around one in a hundred people have it. Only about a third are diagnosed, which means roughly half a million people in the UK are damaging their gut without knowing why they feel unwell.

One crucial practical point: do not cut gluten out before being tested. The tests look for the immune response, and removing gluten makes them come back negative.

Signs you might notice

Bloating, wind, diarrhoea or constipation, stomach pain.

Tiredness, and iron or B12 deficiency that keeps coming back despite treatment.

Weight loss, or in children, faltering growth and delayed puberty.

Mouth ulcers. An itchy blistering rash called dermatitis herpetiformis, which is coeliac disease showing on the skin.

And sometimes almost no gut symptoms at all, just anaemia and fatigue.

How it can affect day-to-day life

A strictly gluten-free diet is the entire treatment, and it is harder than it sounds. Gluten hides in soy sauce, stock cubes, some medications and a crumb of shared butter.

Cross-contamination is the part people underestimate. A shared toaster is enough. In a care setting or a school, that is a real risk and it needs a system rather than good intentions.

Untreated, the long-term costs are serious: osteoporosis from poor calcium absorption, infertility, and a raised risk of small bowel lymphoma.

Gluten-free food also costs substantially more, which is a genuine problem on a low income.

Supporting someone well

Take cross-contamination as seriously as the ingredients. Separate toaster, separate butter, separate chopping board, and prepare gluten-free food first.

Read labels every time, including on things bought for years. Recipes change.

Check medicines with a pharmacist. Some tablets use wheat starch.

In a service, put it in the care plan and the kitchen system rather than relying on whoever is on shift knowing. Fiducia Together links the dietary register to meal planning, so an allergen check happens on the plan rather than at the plate.

Do not let anybody treat a small amount as acceptable. It is not a dose-dependent preference, it is an immune reaction.

Where to get help

Ask a GP for a coeliac blood test while still eating gluten. Diagnosis is usually confirmed by biopsy.

Coeliac UK have an app that scans barcodes, which is the single most useful practical tool for this condition.

Ask for a dietitian referral, a bone density scan and annual review.