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Coeliac disease is an auto-immune reaction by the body to the protein called gluten in wheat, barley and rye. These common cereals are found in everyday grain-based foods such as breakfast cereals, bread, pittas, bagels, pasta, cakes, crackers, and biscuits.

It’s a digestive disease affecting the small intestine, where most of the nutrients from our food are absorbed.  The immune system is meant to protect us from incoming threats like bacteria and viruses. But in Coeliac disease the immune system gets it wrong and mistakes gluten for a foreign invader, and starts behaving in an inflammatory way to deal with it. 

What causes Coeliac disease symptoms?

When the immune system comes across gluten and mistakes it for a threat, immune cells called T cells trigger the release of cytokines (alarm signalling cells) and white blood cells. These launch into action to protect the body, causing internal redness, heat, swelling, and pain. In the process of reacting to gluten – the immune cells cause collateral damage to the body’s own cells lining the gut. 

The damage has a big effect on how well food is absorbed. This is because the small intestine is where nutrients from broken-down food are absorbed into the bloodstream from inside the food tube, helped by little finger-like projections called Villi, that move the nutrients through. 

When the gut lining’s inflamed, these little fingers become stubbier or even flattened meaning they can’t perform as well. This means people with untreated Coeliac disease can’t absorb all of the goodness from the food they eat.   

This is why someone who finds they have Coeliac disease might also be lactose intolerant. Lactase, the enzyme that breaks down the milk sugar lactose, lives on the villi. If these are damaged, the lactase producing cells are also affected, so you can’t digest milk very well. 

The good new is the gut lining can repair once gluten is cut out – followed by lifelong avoidance of gluten in all its forms. 

Why might you develop Coeliac disease?

The reasons for developing Coeliac disease are not completely understood, except that some people have a greater risk genetically – and when you add environmental factors on top – the combination can trigger the autoimmune response.  Environmental factors might include the quantity and quality of gluten eaten, the state of the microbiome, intestinal infections, and other stressors. 

To develop Coeliac disease, you have to have a mutation, in other words a variation, on a gene called HLA- DQ2, or HLA-DQ8 – but not everyone with those gene variations will go on to have Coeliac disease. 

What are the symptoms of Coeliac disease?

Digestive symptoms of Coeliac disease:

• Bloating  

• Diarrhea or constipation 

• Weight loss 

• Tiredness & fatigue 

A reduced absorption of nutrients might lead on to things like anaemia and bone loss because the body hasn’t been able to get hold of all the vitamins and minerals it needs for energy and bones. 

Symptoms of Coeliac disease beyond digestion:

• Some people might get tingly hands and feet, linked to how the nerves to the body’s extremities can be affected.

• Other people might feel brain fog, have balance issues and be prone to mouth ulcers. 

Testing for Coeliac disease

As a first investigation a GP will act on a case history and order an antibody test.  The first choice test is: 

1. Tissue transglutaminase test. Tissue transglutaminase is an enzyme found in the intestines that plays a role in healing and repairing cells.  In Coeliac disease the body’s own immune cells mistakenly attack this enzyme.  A high number of antibodies number points to Coeliac disease.

2. A further test is an Endoscopy, involving a small camera passed down the throat through the stomach and into the small intestine to look for any signs of the disease in the lining, such as shortening of the villi. 

It’s important not to cut out gluten in the six weeks before tests. You need to include gluten as normal or the results could give a false negative result, if there’s no gluten in the system to provoke antibodies.  

Which foods contain gluten?

• Wheat 

• Barley 

• Rye 

• Oats (sometimes) – due to nearby crop contamination or the protein avenin in oats, that looks molecularly similar to the immune system as gluten. 

Be aware that other grains like couscous, bulgur wheat, chapatti flour and semolina also contain gluten – useful to know if you’re eating out, especially if you’re choosing a superfood salad-type meal. 

A common question is whether spelt bread and sourdough are gluten-free but unfortunately, they’re not.  

Remember to also check food labels as gluten appears in many prepared foods from soy sauce to beer. 

Gluten-free food alternatives

Free-from aisles in supermarkets stock gluten-free flours, breads and cakes, plus wheat-free pasta alternatives. 

Not all of these are healthy because of the long list of additives and fillers that can irritate a sensitive gut.  There are exceptions and it’s worth checking labels – and looking in health food shops for a wider variety of products.  

Non-gluten pasta alternatives include buckwheat, corn, rice and millet combinations.  Lentil, pea and chickpea flour pastas are also available to buy. 

Naturally gluten-free carbohydrate alternatives for a meal base or side serve include: 

• A portion of cooked fluffy quinoa 

• Wild, red or whole-meal rice 

• Buckwheat groats – roasted or natural 

You might also want to go low on dairy for a trial period to help symptoms settle if you’ve been lactose intolerant due to intestinal damage. 

Why it’s important to change your food habits

Rather than over-relying on gluten-free alternatives to wheat-based carbohydrate foods, either at elevenses or for the carbohydrate portion of a meal, make more of vegetables and fruits, nuts and seeds to provide green and root vegetable carbs, and pack out salads.   

A piece of fruit with few nuts or seeds, a yogurt with berries, a hard-boiled egg, a gluten-free cracker with a piece of cheese, are examples of tasty and nutritious alternatives when wondering how to replace gluten-containing biscuits and snacks. 

A word on non-coeliac gluten sensitivity 

NCGS – is when people have Coeliac-type symptoms on eating gluten, mainly wheat, but there is no autoimmune element involved and no damage to the small bowel lining.   

Other grain proteins called a-amylase/trypsin inhibitors (ATIs) have been studied and suggested to play a part in irritating the gut lining in NCGS. 

Need support managing Coeliac disease?

As a registered Nutritional Therapist, I can support you in your Coeliac disease journey, including repairing your gut lining. Working with me one-to-one, you’ll receive personalised recommendations and support every step of the way to get to get your health back on track.

Get in touch using the button below to book a free 20-minute discovery phone call.

Sources  

1. Biesiekierski, J. and Iven, J. (2015). Non-coeliac gluten sensitivity: piecing the puzzle together.  United European Gastroenterology Journal.  

2. Coeliac Disease (2024) Guts UK.   

3. A Guide to Eating Gluten-free (2020). The Institute of Functional Medicine.  

4. Leonetti, E. and Catasi, C.  (2025). The Role of Environmental Factors in the development of Coeliac Disease, What is New?  Diseases.