Malnutrition is a common nutrition issue in our community. Malnutrition is a condition where a person's diet does not adequately provide nutrients for optimal growth, health and development.

Malnutrition can manifest in several ways, including muscle wasting, stunted growth in children, nutrient deficiencies and overnutrition (as in, obesity).

Coeliac Disease & Malnutrition

Coeliac disease leads to malnutrition mainly through its impact on nutrient absorption in the small bowel. Here’s a breakdown of how this happens:

1. Small Intestinal Damage: In coeliac disease, the ingestion of gluten - a protein found in wheat, barley, rye, oats and triticale - triggers an autoimmune response. The inflammation from it causes consequent damage to the lining of the small intestine, particularly the villi that absorb nutrients from food.

2. Villous Atrophy: The immune response damages the villi, leading to atrophy (shrinking) and flattening. When the villi become damaged, their surface area is significantly reduced, impairing the person's ability to absorb nutrients effectively.

3. Nutrient Malabsorption: Damage to the villi causes the small intestine to become less efficient at absorbing certain nutrients including vitamins A, D, E, and K,  minerals including calcium, iron and magnesium, and macronutrients including proteins and fats. Nutrient malabsorption malabsorption can lead to deficiencies and a range of health issues.

4. Symptoms and Complications: The malabsorption of the abovementioned nutrients can cause various symptoms and health complications, including diarrhoea, abdominal pain, weight loss, fatigue, anemia, and a reduction in bone mineral density (osteoporosis). If left untreated, over time, such deficiencies can lead to more severe health problems, including growth delays in children and increase the risk of other conditions.

Nutritional Management of Malnutrition in Coeliac Disease

Consume Foods with Caloric Density:

• Full-Fat Dairy & Alternatives: Opt for full-fat, gluten free dairy products like yoghurt, milk and cheese, and/or alternatives like coconut milk or almond milk.
• Nut Butters: Peanut butter, almond butter and other combination nut-based spreads are high in healthy fats and calories.
• Avocados: Rich in healthy fats and calories and can easily be incorporated into many dishes.

Include Protein-Rich Foods:

• Eggs: Nutrient-dense and versatile, excellent for adding protein and calories.
• Lean Meats: Beef, chicken & turkey are excellent good sources of protein and calories.
• Fish and Seafood: Include fatty fish like tuna & salmon, which provide both protein and healthy fats.

Include Healthy Fats:

• Nuts and Seeds: Incorporate a variety of nuts (e.g., peanuts, cashews, walnuts, almonds) and seeds (e.g., chia, flax) into your diet for added nutrition.
• Olive Oil: Use in cooking and as a dressing to add extra calories.

Choose Whole Grains and Gluten-Free Options:

• Gluten-Free Bread & Pasta: Look for gluten-free versions that are fortified with vitamins and minerals.
• Gluten-Free Grains: Incorporate gluten-free grains such as brown rice, quinoa and millet, which provide both calories and essential nutrients.

Fortify Your Meals:

• Homemade Soups: Use rich cooking stocks or bone broth as a base and add gluten free grains and protein sources.
• Smoothies: Blend nutrient-dense fruit & veggies like spinach, fruits, gluten free protein powder, nut butters and full fat dairy/alternatives.

Small, Frequent, Balanced Meals:

• Aim for a Balanced Plate: Ensure each meal includes a mix of carbohydrates, proteins and fats for balanced nutrition.
• Eat Regularly: Aim for multiple small meals throughout the day to increase the amount of calories consumed.

Use a Nutritional Supplement:

• High Energy High Protein Supplements: Some gluten-free nutrition shakes or powders on the market can help increase caloric intake. Click here to view the GFNation range.
• Vitamins and Minerals: Consider gluten-free alternatives if you have deficiencies. Always read the label for a 'may contain gluten' statement.

Monitor and Adjust:

• Consult an Accredited Practising Dietitian: A clinician who specialises in Coeliac Disease can tailor a plan to your specific needs.
• Track Your Progress: Monitor your weight and nutritional intake regularly to see if adjustments are required, and keep your dietitian involved in follow up.