Coeliac Disease: Symptoms, Diagnosis, and Diet Explained

What is coeliac disease?

Coeliac disease is an autoimmune condition in which eating gluten triggers an immune response that damages the lining of the small intestine.

Gluten is a protein found in wheat, barley, and rye. In people with coeliac disease, gluten causes the immune system to attack the gut, even in very small amounts.

What happens in the gut with coeliac disease?

In a healthy gut, the lining of the small intestine is covered with tiny finger-like projections called villi, which help absorb nutrients from food into the bloodstream.

In coeliac disease:

• The immune system damages the intestinal lining

• The villi become inflamed, shortened, or flattened

• Nutrient absorption is reduced

What is villous atrophy?

Villous atrophy is the flattening or loss of the villi in the small intestine, which significantly reduces the body’s ability to absorb nutrients.

When villi are damaged or completely flattened, the gut cannot absorb nutrients properly. This leads to malabsorption, which causes many of the symptoms and long-term complications associated with coeliac disease.

What are the risks of untreated coeliac disease?

Untreated coeliac disease can lead to nutrient deficiencies, long-term health complications, and an increased risk of certain cancers.

Common complications include:

• Iron deficiency anaemia

• Vitamin B12 deficiency

• Osteoporosis/weaker bones

• Fatigue

• Fertility problems and recurrent miscarriage

• Increased risk of small bowel cancers

Because coeliac disease is an autoimmune condition, gluten exposure can also affect other parts of the body, not just the gut.

Can coeliac disease affect my skin?

Yes. Some people with coeliac disease develop a skin condition called dermatitis herpetiformis.

Dermatitis herpetiformis causes an itchy, blistering rash and is triggered by gluten exposure.

Is coeliac disease treatable?

Yes. Coeliac disease is treatable with a strict, lifelong gluten-free diet.

Once gluten is removed from the diet:

• The immune response settles

• The small intestine starts to heal

• Villi can regenerate

• Nutrient absorption improves

Many symptoms improve or resolve entirely, but even small amounts of gluten can cause ongoing damage, sometimes without noticeable symptoms.

Why is ongoing gluten exposure a problem?

Continued exposure to gluten, even accidentally, can:

• Prevent gut healing

• Worsen nutrient deficiencies

• Increase the risk of complications

• Increase the risk of small bowel cancer over time

This is why strict gluten avoidance is essential, not optional.

Why is dietetic support important in coeliac disease?

Regular input from a dietitian experienced in coeliac disease is essential for long-term health.

Dietetic support helps with:

• Learning how to follow a gluten-free diet safely

• Avoiding cross-contamination

• Reading food labels correctly

• Managing nutrient deficiencies

• Navigating eating out and social situations

Trusted organisations such as Coeliac UK also provide excellent education and support.

What are the symptoms of coeliac disease?

Symptoms of coeliac disease vary widely and can affect both the gut and other parts of the body.

Gut symptoms

• Diarrhoea or constipation

• Bloating, excessive wind

• Abdominal pain or cramping

• Nausea or vomiting

Nutritional and general symptoms

• Deficiencies

• Anaemia

• Persistent tiredness

• Unexplained weight loss

• Mouth ulcers

Other symptoms

• Itchy skin rash

• Tooth enamel issues

• Fertility problems or recurrent miscarriage

• Neurological symptoms such as brain fog, numbness, tingling, poor balance, or coordination

Because symptoms vary so much, coeliac disease is sometimes mistaken for irritable bowel syndrome (IBS) or wheat intolerance.

How is coeliac disease diagnosed?

Coeliac disease is diagnosed using blood tests and, in certain cases, a small bowel biopsy.

Do not remove gluten from your diet before testing.

Removing gluten before testing can lead to false results and delay diagnosis.

If you experience symptoms or have concerns, the first step is to discuss this with your GP.

Living well with coeliac disease

With the right support, people with coeliac disease can live a healthy, symptom free life.

I support people with suspected or diagnosed coeliac disease by providing:

• Clear, evidence-based education

• Practical guidance on the gluten-free diet and changes needed in your diet

• Support with symptoms and nutrient deficiencies

• Help answering day-to-day “is this safe?” questions

Appointments are available for those who would like personalised support.

The Best Gluten-Free Bread for Gut Health

(Dietitian-approved recipe for IBS, coeliac disease, and sensitive guts)

By Deirdre Costello, Specialist Gastro Dietitian, gutgra.com

Introduction

If you’ve ever tried baking gluten-free bread and ended up with a rock hard loaf, you aren’t alone!

As a specialist gastroenterology dietitian, I work with many clients who have coeliac disease, IBS, and other gut health conditions, and one of the biggest challenges they face is finding a gluten-free bread that tastes nice.

This loaf is inspired by the brilliant gluten-free baker, Loopy Whisk.

Why This Gluten-Free Bread Works

• Rice, tapioca, and sorghum flour mimic the structure of wheat while being gentler for digestion.

• Psyllium husk replaces gluten’s elasticity and adds soluble fibre, supporting bowel movements.

• The steaming technique creates a lovely golden crust.

Ingredients

Dry ingredients

• 1 ½ cups (210g) white rice flour

• 1 cup (120g) tapioca starch

• ½ cup (60g) sorghum flour

• 2 tbsp psyllium husk powder

• 2 tsp instant yeast

• 1 ½ tsp salt

Wet ingredients

• 420ml warm water

• 2 tbsp olive oil

• 1 tbsp honey or maple syrup

• 1 tsp apple cider vinegar

Method

1. Activate the yeast: Whisk warm water, honey/maple syrup, and yeast in a large bowl. Let sit for 5–10 minutes until foamy.

2. Combine dry ingredients: In another bowl, whisk together all the flours, tapioca starch, psyllium husk, and salt.

3. Mix the dough: Pour the wet ingredients into the dry mixture, add olive oil and vinegar, and mix.

4. First rise: Cover and let rise for 45 to 60 minutes until doubled in size.

5. Shape and second rise: Transfer to a greased loaf tin and let rise for another 30 to 40 minutes.

6. Preheat the oven to 425°F (220°C). Pop your bread loaf in the oven and place a pan of hot water on the bottom rack and bake for 15 minutes. Remove the water, reduce the temperature to 375°F (190°C), and bake for another 40–45 minutes.

7. Let the loaf cool fully before digging in!

Tips for Success

• Don’t omit the psyllium husk as it adds structure and soluble fibre.

• Store at room temperature or slice and freeze for easy toasting.

• You can add extras like sunflower seeds, chia seeds, or even chopped rosemary.

Gut Health Dietitian’s Note

As a specialist gastro dietitian, I remind clients that gluten-free doesn’t always mean “gut-friendly”, when made right, it can be!

This bread has:

• Fibre for regular bowel movements

• Lower FODMAP content, making it suitable for many with IBS

• Naturally gluten-free, safe for those with coeliac disease

Always check ingredient labels to ensure products are fully gluten-free if you have coeliac disease.

Final Thoughts

Gluten-free baking can be frustrating but it doesn’t have to be!

If you make it, share your bake on Instagram and tag me @gut_gra. I’d love to see how it turns out for you!