Coeliac Disease Dietitian Melbourne

• Do not change your diet: It is absolutely crucial that you keep eating gluten daily; removing it now will allow your gut to start healing, which will cause your tests to return a false negative.

• Step 1 – Serology: Book an appointment with your GP and explicitly ask for a “Coeliac Serology blood test” to check for the active antibodies your immune system produces when it attacks gluten. The following reference ranges may vary.

  • tTG-IgA (Tissue Transglutaminase IgA), the test that looks for antibodies reacting to tTG2 in the gut: Positive: > 20 U/mL 
  • DGP-IgG (Deamidated Gliadin Peptide IgG), the core protein in gluten. altered by tTG2: > 20 U/mL

• Step 2 – Gastroscopy: If your serology results are positive, your GP will refer you to a gastroenterologist for a routine, minor procedure (a biopsy of the small intestine) to officially confirm the physical damage to your gut lining.

• Step 1 – Genetic Testing: Because you are no longer eating gluten, a standard antibody test won’t work. Instead, ask your GP for an “HLA-DQ2 and HLA-DQ8 gene test.”

  • The crucial context: Around 30% to 40% of the general Australian population carry these exact same genes, but only about 1% actually end up developing the disease.

• The “Rule Out” Phase: This genetic test cannot confirm that you have Coeliac disease. However, if the test shows you lack these specific genes, it proves with 100% certainty that you do not have it, and you can explore other causes for your symptoms (like IBS).

• Step 2 – The Gluten Challenge: If the genetic test shows you do carry the Coeliac genes, your doctor or Dietitian will likely guide you through a “gluten challenge” (safely reintroducing gluten into your diet for around 6 weeks) so that you can complete the standard serology and gastroscopy to get a confirmed diagnosis.

• Toasters: This is a top offender. A shared toaster is full of wheat crumbs that will stick to gluten-free bread.
• Utensils and tools: Shared tools and habits are the biggest risks here. Gluten is sticky and difficult to wash off porous surfaces.
• Condiments (“Double Dipping”): E.g the same knife is used for buttering different toasts
• Colanders and Strainers: The tiny mesh holes in colanders trap gluten paste from wheat pasta; it is nearly impossible to scrub them perfectly clean.
• Porous Cookware:
  • Wooden Spoons & Cutting Boards: Wood absorbs gluten and cannot be fully sanitised.
  • Scratched Non-Stick Pans & cast iron: Gluten can hide in the scratches of Teflon/coated pans.
• Baking Ingredients: An open bag of sugar or baking soda can be contaminated if a flour-dusty measuring cup was dipped into it previously.

Commercial kitchens move fast, making separation difficult.

• Deep Fryers: If food cooked in the same oil as breaded onion rings or chicken fingers, the fries are not gluten-free.
• The Flat-Top Grill: Burger buns are often toasted on the same grill surface used to cook steaks, burgers, or eggs.
• Pasta Water: If restaurants gluten-free pasta in the same water used for wheat pasta, it becomes contaminated.
• Buffets: People can use utensils for non-gluten free foods and switch them around.
• Lack of awareness: Some restaurants assume gluten intolerance is a symptom and are unaware of the harm they can cause. Always confirm disease understanding with staff

• Oats: Oats are naturally gluten-free, but they are almost always grown next to wheat and processed on wheat equipment.
  • The Fix: Only eat oats specifically labeled “Certified Gluten-Free.”
• Bulk Bins: Never buy gluten-free grains (like rice or quinoa) from the open bulk bins at grocery stores. Scoops are often shared, and flour dust settles from nearby bins.
• Lentils: Lentils are often rotated in fields with wheat. It is common to find stray grains of wheat inside a bag of dried lentils. They must be picked through and rinsed thoroughly.

Unexpected Non-Food Sources

• Play-Doh: Most modelling clay is made from wheat flour.
• Pet Food: Dry dog and cat food often contains gluten; handling it and then eating without washing hands causes contamination.
• Lipstick/Lip Balm: Some brands use gluten as a binder, which you inevitably swallow.