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.