Coeliac Disease

What is coeliac disease?

Coeliac disease (CD) is a condition affecting the small bowel, damaging the lining and preventing absorption of food nutrients.

CD affects about one percent or one in every hundred people.  An immune reaction to gluten (proteins in wheat, rye, barley, triticale and oats) is responsible for the inflammation and damage to the small bowel.


Symptoms of CD may include:

  • Weight loss
  • Diarrhoea
  • Abdominal pain
  • Anaemia.

When the small bowel is damaged, nutrients from our food aren’t absorbed properly into the body. Fortunately, avoiding these grains means the immune reaction stops, the small bowel heals, and symptoms improve.

Very small amounts of gluten can cause damage to the intestine, with or without obvious symptoms. People with CD must avoid gluten for the rest of their lives.

Since removing gluten causes the bowel to heal, it is important that you do not trial a gluten-free diet before you are tested, because the test results will not be accurate. To correctly diagnose CD you must eat the equivalent gluten content of four slices of bread each day (for adults), for four to six weeks before testing.

A screening blood test with your GP can show whether or not coeliac disease is likely to be present, but a small bowel biopsy performed by a Gastroenterologist is necessary to accurately diagnose coeliac disease.

Gluten is found in large amounts in:

  • Wheat (spelt, durum, atta)
  • Rye
  • Triticale

And in small amounts in:

  • Oats
  • Ingredients made from the above grains e.g. malted barley, wheat starch, maltodextrin.

The above grains need to be replaced with gluten-free grains such as:

  • Soy
  • Buckwheat
  • Rice
  • Sorghum
  • Maize/corn
  • Amaranth

Nuts, seeds, legumes, meat, fish, milk, cheese, fruit and vegetables are all gluten-free in their whole form.

Choosing the right foods and making sure that your diet is well-balanced can be difficult without professional help. It is essential that people with CD understand where gluten can be found in foods and what to look for on a food label.

It’s especially important for young children diagnosed with CD to see a health professional, since problems with nutrient absorption can affect their growth and development.

Without a properly maintained gluten free diet, people with CD are at greater risk of osteoporosis, and due to the inflammation within the bowel, higher rates of cancer are also common. A repeat small bowel biopsy is needed when people are symptom free and then throughout life.

An Accredited Practising Dietitian (APD) can help you to identify the different types of foods to include and avoid whilst still allowing you to enjoy a varied and nutritious diet.

FODMAPs and IBS: What’s the deal?

You may have heard of FODMAPs in the media, and thought to yourself, what on earth is a ‘fod-map’ (or ‘food-map as a friend called it!)? And what does it have to do with your gut?

What are FODMAPs?

FODMAPs were discovered by Sue Shepherd, and the research team at Monash University have been leading the way in research relating to IBS, and the role that FODMAPs plays in symptoms.

FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. When these carbohydrates are poorly absorbed in the small intestine increased water can be drawn into the gut. This can result in diarrhoea in some people, whilst for others, the carbohydrates travel to the large intestine where they are fermented by bacteria, producing gas. This gas can lead to symptoms of irritable bowel syndrome, including bloating, constipation, flatulence, pain and nausea. Common high FODMAP foods include garlic, onion, apples, milk, mushrooms, bread and chickpeas (among a whole range of others).

Who needs to worry about them and why?

Are you sick of feeling embarrassed in meetings because you need to pass wind? Looking like you are 3 months pregnant (but you aren’t)? Or needing to know where every bathroom nearby is, just in case you need to make an emergency stop? If this sounds like you, you may be suffering from IBS.

At present, approximately one in seven Australians suffer from this difficult condition. IBS can be defined through symptoms of cramping, abdominal pain, bloating, wind, constipation and diarrhea. It is a chronic condition, meaning long term management is required, though symptoms and severity often change over time. Symptoms can often worsen in times of stress. Research indicates that following a low FODMAP diet is the most effective way of managing IBS, with three in four people finding an improvement in symptoms.

What is the process?

Through reducing consumption of high FODMAP foods, symptoms of IBS can clear up in a matter of weeks. This is referred to as following a low FODMAP diet. It is important to remember that a strict low FODMAP diet is a diagnostic tool; it is not recommended to be stuck to long term. Once it has been determined that FODMAPs are causing grief, moving through a series of food challenges is essential, to help determine which FODMAPs are an individuals’ triggers

Why not just stay low FODMAP?

Most people do not react to all the high FODMAP groups of foods. Identifying these means that we can re-introduce the groups of foods that weren’t a problem, then determine tolerance levels of those that were. This is recommended for the following reasons:

  • Most people with IBS can maintain good symptom control with reintroduction of some high FODMAP foods. This makes it easier to make informed choices when not in control of food choices, and better management of symptoms on a daily basis.
  • Avoiding unnecessary restrictions helps to ensure a nutritionally adequate diet.
  • Many high FODMAP foods are also high in prebiotics. These provide food for the healthy bacteria that are found in your gut. Long term avoidance of these may affect the health of your microbiome.

What if a low FODMAP diet doesn’t work?

Other things can trigger symptoms of IBS. These include fatty foods, spicy foods and caffeine. Stress also plays a key role in symptom management; managing stress levels regularly helps with reducing symptoms.

If you are suffering from IBS, trialling a low FODMAP diet may be a life changer for you.

My doctor said I’ve got diverticular disease, what should I eat?

Diverticular disease affects the large bowel, it causes small pockets or pouches to stick out beyond the bowel wall.

Damage to the bowel wall is common in older Australians. One in two people over  70 have ‘pocketing’ (diverticula). This ‘pocketing’ of the bowel wall (diverticular disease), is found during routine check ups, or in procedures like colonoscopies.

Mostly, people have no symptoms or problems with diverticular disease. However some people with diverticular disease have:

  • Pain
  • Bloating
  • Constipation
  • Diarrhoea
  • Blood in their stools.

If you have these symptoms they should be investigated to rule out other, more serious problems.

Diverticulitis is the acute and painful condition caused by an infection to these pockets and can result in:

  • Severe pain
  • Nausea
  • Loss of appetite
  • Bleeding and changes in bowel habits.

Diverticulitis is usually treated very successfully with antibiotics and some people never experience another attack. If you have more than one attack of diverticulitis there are risks of further problems.

Research has shown that diverticular disease is more common in people whose diet is lower in fibre. So there is another reasons to eat plenty of fibre-rich foods, as recommended by the Australian Guide to Healthy Eating – it may reduce your chances of developing diverticular disease.

A high fibre diet is also recommended for those who already have diverticular damage to their bowel wall.  Including fibre-rich foods will reduce the chance of the acute condition of diverticulitis.

A high fibre diet includes:

  • Plenty of fruit including skins and seeds
  • Vegetables
  • Wholegrain breads and cereals.

Fibre adds bulk to faeces, making them easier to pass. It is also important to drink plenty of fluids, at least two litres per day, to ensure the stools are moist and soft. Some people with diverticular disease use a fibre supplement such as psyllium to ensure their stools are easy to pass.

During inflammation or diverticulitis you may need to try a lower fibre diet until the swelling goes down. Once resolved you can then go back to your high fibre diet.

For personal assistance with modifying your diet because of diverticular disease contact an Accredited Practising Dietitian (APD).