Coeliac disease is a genetic digestive disorder where the body, in general, cannot tolerate gluten.

Gluten is a protein found in grains like wheat, barley, rye and oats, as well as in lesser-known grains such as triticale and spelt.

Specifically, this chronic autoimmune condition is triggered by certain proteins in gluten, such as gliadin (from wheat), hordein (barley), secalin (rye) and avenin (oats).

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When people with coeliac disease eat gluten, their immune system attacks the lining of the small intestine, affecting its tiny finger-like projections called villi.

This leads to poor nutrient absorption and inflammation.

Although gluten intolerance primarily affects the gut, symptoms can extend beyond this organ and are often grouped as either intestinal (like abdominal pain, constipation or diarrhoea) or extra-intestinal (such as fatigue, joint pain or anaemia).

Other symptoms include bloating, weight loss, bone pain and muscle cramps.

People with coeliac disease, as well as those with non-coeliac gluten sensitivity and wheat intolerance, can manage their symptoms by strictly following a gluten-free diet.

Non-coeliac gluten sensitivity is a condition where individuals experience symptom relief after removing gluten from their diet, even though they do not have coeliac disease or a wheat allergy.

In this condition, other ­components in wheat, such as certain proteins (like amylase and trypsin inhibitors) and fermentable monosaccharides, disaccharides, oligosaccharides and polyols, may also trigger symptoms, not just gluten alone.

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However, avoiding gluten is often easier said than done.

Finding safe, gluten-free ingredients that also meet daily nutritional needs can be challenging, especially since many common foods contain hidden sources of gluten.

A key ingredient

The word “gluten” originates from Latin, meaning “glue”.

It gives dough its elastic texture, helping bread rise and form a soft, airy structure.

With such a key role in giving structure to baked goods, removing gluten from flour can affect the texture and quality of such products.

As a result, gluten-free foods often have lower volume, a firmer texture and a tendency to stale rapidly.

They may also lack the unique taste and aroma found in traditional wheat-based products.

Because many consumers still expect gluten-free versions to match the look, feel and flavour of regular bread or cakes, manufacturers often face challenges in meeting these expectations.

This makes the quality of gluten-free foods a major hurdle for those trying to stick to a strict gluten-free diet.

While only a few raw foods naturally contain gluten, it is widely used in many processed foods for its functional properties.

As a result, people who need to avoid gluten must be cautious, as gluten is often hidden in products beyond just bread or pasta.

They must carefully read food labels to ensure the product is truly gluten-free.

Lacking sufficient nutrients

Completely removing gluten from all food products is difficult, which is why defining a safe threshold for gluten contamination in “gluten-free” foods is so important.

Studies have shown that trace amounts of gluten can still be present in gluten-free products due to cross-contamination.

To help protect consumers, the Codex Alimentarius Commission – an international food standards body set up by the Food and Agricultural Organization (FAO) and the World Health Organization (WHO) – has set certain labelling guidelines.

These require the disclosure of common allergens, including peanuts, tree nuts, milk, eggs, fish, crustacean/shellfish, soy, and wheat or cereals containing gluten, as well as ingredients derived from them.

In addition, the use of “may contain” statements on packaging can be a useful way to alert consumers to the risk of unintentional allergen contamination during food production.

Another important factor is that most prepackaged gluten-free products fall short of their gluten-containing counterparts when it comes to nutritional quality.

Unlike refined wheat flours, gluten-free flours are not always enriched or fortified with essential vitamins and minerals.

In fact, many gluten-free foods tend to be higher in fat, sugar or salt, depending on the product type.

This makes following a gluten-free diet especially challenging for people with coeliac disease, as it may lead to deficiencies in important nutrients and an increased intake of saturated fats and carbohydrates.

As a result, coeliac patients are more prone to conditions like anaemia, osteoporosis and poor growth, especially in children.

Studies have also shown that gluten-free diets often lack key nutrients such as fibre, folate, iron, and B vitamins like thiamin, niacin and riboflavin.

If not carefully managed, the diet can lead to imbalances in fat intake and inadequate consumption of essential fatty acids, contributing to long-term health risks.

Dr Tan Bee Ling is a nutritionist and senior lecturer at the Management and Science University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.