What is Coeliac Disease?
Understanding the basics of coeliac disease
❓ What Is Coeliac Disease?
Coeliac disease is an autoimmune condition in which the immune system mistakenly attacks the body's own tissues when gluten is consumed. This immune response damages the small intestine, leading to malabsorption of nutrients and various long-term health problems.
Gluten is a protein found in three types of cereal: wheat, barley and rye. Whilst oats do not naturally contain gluten, cross-contamination during growing, processing, or packaging can lead to trace amounts of gluten being present. Therefore, people with coeliac disease should only consume certified gluten free oats. Gluten is found in obvious foods like pasta, bread, cakes, breakfast cereals, and beer, as well as in less obvious products such as soy sauce, gravy, processed meats, and many sauces.
A useful acronym to remember these forbidden ingredients is ‘BROW’, which stands for Barley, Rye, Oats and Wheat. 👉🏽 Learn more about the BROW ingredients here
🤧 So, Is It an Allergy?
Although it’s often labelled as a type of food allergy, coeliac disease is not actually an allergy, it's an autoimmune disease. It involves an autoimmune response that leads to gut damage, whereas an allergy causes a rapid, immune-mediated reaction. Coeliac disease also differs from gluten intolerance (non-coeliac gluten sensitivity), which does not cause immune responses or long-term damage.
👉🏽 Read more about coeliac disease vs allergies & intolerances here.
🧬 Who Can Get Coeliac Disease?
The exact cause of coeliac disease is not fully understood, and it’s unclear why some people experience mild symptoms whilst others have severe reactions. However, research suggests a combination of genetic and environmental factors play a role. Several factors are known to increase the likelihood of developing the condition, including:
- Family history (first-degree relatives like parents or siblings)
- Other autoimmune conditions (e.g. type 1 diabetes)
- Genetic predisposition (HLA-DQ2/DQ8 genes)
👉🏽 Read more about the causes of coeliac disease here.
🔬 Diagnosis
Diagnosis rates for coeliac disease are improving, but studies show that although around 1 in 100 people are thought to have the condition, only 36% of cases are diagnosed. On average, it takes 13 years to receive a diagnosis, and 1 in 4 people are misdiagnosed with conditions like irritable bowel syndrome (IBS).
This means that approximately half a million people in the UK are living with undiagnosed coeliac disease.
Routine testing for coeliac disease is not currently offered in England, and is usually only recommended for people who:
- Show symptoms of coeliac disease
- Have a first-degree relative with coeliac disease
- Are at a higher risk due to other autoimmune conditions
👉🏽 Read more about diagnosing and testing for coeliac disease here.
🤒 Symptoms
Coeliac disease can cause a wide range of symptoms, from mild to severe, which explains why it's frequently misdiagnosed as other conditions or overlooked altogether. Some people even have ‘silent coeliac disease’, where they show no obvious symptoms despite ongoing gut damage. This means that even if you feel well, untreated coeliac disease can still lead to long-term complications, so it’s important to get tested if you are at risk.
Common symptoms include:
- Gut symptoms - Diarrhoea, bloating, abdominal pain
- General symptoms - Fatigue, anaemia, unexplained weight loss
- Neurological symptoms - Brain fog, headaches, tingling in hands or feet
- Skin - Dermatitis herpetiformis (itchy, blistering rash)
👉🏽 Read more about the symptoms of coeliac disease here.
🚫 Treatment
There is currently no cure for coeliac disease. The only effective treatment is a strict, lifelong gluten free diet, which helps control symptoms and prevents serious long-term complications. Even if symptoms are mild or absent altogether, removing gluten from your diet is essential to avoid serious health issues such as:
- Nutrient deficiencies
- Osteoporosis
- An increased risk of other autoimmune conditions
Once diagnosed, you should have regular reviews with your GP. These reviews help monitor your progress, track antibody levels (e.g. tTG), and check for any complications. Your GP may also offer vaccinations and recommend supplements to support your overall health.
👉🏽 Read more about the treatment and ongoing monitoring of coeliac disease here.
⚠️ Complications
Complications from coeliac disease only tend to affect people who continue to eat gluten or those who remain undiagnosed, which can be common in milder cases. This is why strict adherence to a gluten free diet is essential after diagnosis and why you should get tested if you think you have the condition.
Potential long-term complications include:
- Malabsorption & nutrient deficiencies
- Osteoporosis (weakened bones)
- Infertility and pregnancy-related complications
- An increased risk of certain cancers
It's also important to be aware of the potential mental health impacts of coeliac disease, including anxiety and depression, which may result from both the condition itself and the challenges of following a strict gluten free diet.
👉🏽 Read more about the complications of coeliac disease here.
🫣 What to Do When You’ve Been Glutened?
Accidental gluten exposure can happen, but there are steps you can take to manage symptoms. Here’s a guide to what to do if you’ve been glutened - including tips on how to potentially avoid it in the future.