Frequently Asked Questions

Quick answer: Coeliac disease is an autoimmune condition in which eating gluten damages the small intestine. The only treatment is a strict, lifelong gluten-free diet.

Full answer:

Coeliac disease is a chronic autoimmune condition in which eating gluten triggers an immune response that damages the lining of the small intestine. This can interfere with the absorption of nutrients and lead to a range of health problems.

Gluten is a group of proteins found in wheat (including ancient varieties such as einkorn, spelt and khorasan wheat/Kamut), rye, barley and triticale, as well as foods made from these grains. Even small amounts can cause intestinal damage in people with coeliac disease, whether or not symptoms occur.

Coeliac disease can develop in both children and adults. It is neither a food allergy nor a food intolerance.

The only effective treatment is а strict, lifelong gluten-free diet..

Related topics: „About coeliac disease“ · „Gluten-free diet“

Quick answer:

Gluten is a group of proteins found in wheat, rye and barley. In people with coeliac disease, even small amounts can trigger an immune response.

Full answer:

Gluten is a group of proteins naturally found in wheat (including ancient varieties such as einkorn, spelt and khorasan wheat/Kamut), rye, barley and triticale, as well as foods made from these grains. Gluten gives dough its elasticity and helps bread and other baked goods develop their characteristic structure.

In addition to obvious sources such as bread, pasta, baked goods and beer, gluten may also be found in processed meats, sauces, seasonings, ready-made meals and other processed foods.

For people with coeliac disease, even very small amounts of gluten can trigger an autoimmune response and damage the small intestine. It is therefore important to choose safe products and always check the information on the label.

Related topics: "Gluten“ · "Gluten-free diet"

Quick answer:

No. There is currently no cure for coeliac disease, but the condition can be effectively managed. With a strict gluten-free diet, the body can recover, but coeliac disease remains a lifelong condition.

Full answer:

No. There is currently no treatment that can cure coeliac disease or make it safe for a person with the condition to eat gluten.

The good news is that with strict adherence to a gluten-free diet, the lining of the small intestine can gradually heal, symptoms can improve or disappear, and the risk of long-term complications is significantly reduced.

It is important to remember that having no symptoms does not mean that gluten is not causing damage. This is why the gluten-free diet must be followed at all times, without “breaks” or “cheat days”, as even a small amount of gluten can be harmful. 

Related topics: "Treatment“ + „Gluten-free diet“

Quick answer:

Yes. Close blood relatives have an increased risk of developing coeliac disease and should discuss testing with their doctor.

Пълен отговор:

Yes. There is a genetic predisposition to coeliac disease, which means it is more common among members of the same family.

Parents, siblings and children of someone with coeliac disease have a significantly higher risk of developing the condition than the general population. For this reason, international recommendations advise close relatives to discuss testing - and, where appropriate, repeat testing - with their doctor, even if they have no symptoms.

It is important to be tested while still eating gluten,as starting a gluten-free diet before testing can lead to inaccurate results.

Quick answer:

Coeliac disease is diagnosed by a gastroenterologist using a combination of blood tests and, where necessary, a biopsy.

Full answer:

Coeliac disease is diagnosed by a gastroenterologist based on a combination of symptoms, blood tests and, in most cases, a biopsy of the small intestine. In some children, a diagnosis can be made without a biopsy if specific medical criteria are met.

The first step is usually a blood test for specific antibodies, such as anti-tTG IgA, together with a total IgA test. If necessary, your doctor may recommend further tests, including genetic testing (HLA-DQ2/DQ8) or an endoscopy with biopsy.

As diagnosing coeliac disease requires the correct interpretation of test results, we recommend consulting a gastroenterologist first. It is important not to start a gluten-free diet before your consultation, as this may affect the results of subsequent tests.

Quick answer:

Stopping gluten before testing can lead to false-negative results and make it more difficult to reach an accurate diagnosis.

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If you stop eating gluten before the necessary tests are carried out, your body will gradually begin to recover. This can cause antibody levels in the blood to fall and the intestinal lining to start healing, making an accurate diagnosis much more difficult or, in some cases, impossible.

This is why it is important to continue eating gluten until the diagnostic process is complete, unless your doctor advises otherwise.

If you have already started a gluten-free diet without a confirmed diagnosis, do not reintroduce gluten on your own. Speak to a gastroenterologist, who can advise whether a gluten challenge is appropriate and how it should be carried out before testing.

Quick answer:

You will need to start a strict gluten-free diet and have regular follow-up with your gastroenterologist to monitor your recovery, how well the diet is working and any nutritional deficiencies. 

Full answer:

After diagnosis, it is important to start a strict gluten-free diet and have regular follow-up with a gastroenterologist. During the first few months, your doctor may recommend repeat blood tests to check whether antibody levels are falling and whether your body is recovering. A follow-up gastroscopy may also be recommended at a later stage.

Many people are found to have deficiencies in iron, vitamin D, vitamin B12, folate or other nutrients. These should also be monitored and corrected where necessary.

If possible, seek advice from a dietitian who can help you follow a balanced and appropriate gluten-free diet. From the very beginning, it is helpful to understand how to follow the diet correctly, read food labels and prevent cross-contamination. Being well informed is one of the keys to successfully managing coeliac disease.

Quick answer:

Completely avoiding all sources of gluten and preventing cross-contamination.

Full answer:

A strict gluten-free diet means completely avoiding all foods and drinks that contain wheat, rye, barley or their derivatives. This includes not only obvious sources of gluten, but also products in which gluten-containing ingredients are used.

With coeliac disease, there is no “safe small amount” of gluten. Even very small amounts can damage the small intestine, whether or not symptoms occur.

In addition to choosing the right foods, it is essential to prevent cross-contamination during food preparation, storage and serving.

Quick answer:

Wheat, rye, barley, einkorn, spelt and all products made from these grains.

Full answer:

Gluten is naturally found in wheat (including ancient varieties such as einkorn, spelt and khorasan wheat/Kamut), rye, barley and triticale, as well as in products made from these grains. This includes bread, baked goods, pasta, biscuits, cakes and pastries, breadcrumbs and coatings, many snack foods and beer.

Gluten may also be present in foods where you might not expect to find it, such as some processed meats, sauces, ready-made meals, seasonings, desserts and other processed foods.

The safest way to check whether a product is suitable is to read the ingredients list carefully and look for a “gluten-free” label where available.

Quick answer:

Fruit, vegetables, meat, fish, eggs, milk, rice, maize, buckwheat, quinoa, millet and many other foods are naturally gluten-free.

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Many foods are naturally gluten-free and can safely form part of a varied diet. These include fresh fruit and vegetables, unprocessed meat and fish, eggs, milk and most dairy products, pulses, nuts and seeds.

Rice, maize, potatoes, sweet potatoes, buckwheat, quinoa, millet and other similar grains and foods are also naturally gluten-free.

It is important, however, that these foods have not been contaminated with gluten during production, transport or preparation. This is particularly important for flours, grains and packaged products.

Quick answer:

This is the internationally recognised and European legal threshold for the maximum amount of gluten - 20 milligrams per kilogram - that a product may contain to be labelled “gluten-free”. 

Full answer:

In Europe, a product labelled “gluten-free” must contain no more than 20 parts per million (20 ppm) of gluten. This is the accepted European standard and is considered safe for most people with coeliac disease.

Manufacturers should only use this label when the product meets the requirements of European legislation and has been produced under appropriate controls.

It is important to understand that “gluten-free” does not necessarily mean absolutely zero gluten. It means that the amount present is below the threshold considered safe based on scientific evidence, when appropriate production and control measures are in place.

Quick answer:

Cross-contamination occurs when gluten comes into contact with otherwise gluten-free food during production, packaging, storage or preparation.

Full answer:

Cross-contamination occurs when gluten-free food comes into contact with gluten during production, packaging, transport, storage or preparation.

At home, this can happen through crumbs left on kitchen surfaces or by using the same toaster, knife or wooden chopping board for gluten-containing and gluten-free foods. Other hidden risks include shared frying oil, inadequately cleaned cookware and airborne gluten-containing flour that can settle on food and surfaces. 

Preventing cross-contamination is an essential part of managing coeliac disease. It is therefore important to use separate or thoroughly cleaned kitchen utensils and to pay close attention to how food is prepared, both at home and when eating away from home.

Quick answer:

Only oats labelled and certified as gluten-free are suitable. Bear in mind that some people with coeliac disease do not tolerate oats, so speak to your specialist before introducing them or if you have any concerns. 

Full answer:

Oats are naturally gluten-free, but they are very often contaminated with wheat, rye or barley during growing, transport and production. For this reason, regular oats are not suitable for people with coeliac disease. обикновеният овес не е подходящ за хора с цьолиакия.

Only oats that have been specially produced and certified as gluten-freeshould be included in a gluten-free diet. However, a small number of people with coeliac disease may also react to avenin, a protein found in oats themselves. It is therefore advisable to introduce oats gradually and after consulting your gastroenterologist, particularly soon after diagnosis.

Quick answer:

No. Other family members can eat gluten, but strict measures should be taken at home to prevent cross-contamination. Where possible, the safest and simplest option is to keep the home completely free from gluten-containing foods. 

Full answer:

No. People who do not have coeliac disease do not need to follow a gluten-free diet.

Both gluten-free and gluten-containing foods can be prepared in the same household, but care must be taken to prevent cross-contamination. This includes storing foods separately, using clean utensils and cookware, keeping work surfaces clean and organising the kitchen carefully.

A completely gluten-free household remains the safest and simplest option. Other family members can still eat gluten outside the home.

Quick answer:

No. Good kitchen hygiene is usually sufficient, although some items that are difficult to clean thoroughly, such as chopping boards, toasters and heavily scratched cookware, should be replaced or kept separate.

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No. In most cases, there is no need to replace everything in your kitchen.

Metal utensils, pots and pans, as well as glass and ceramic cookware, can be used safely after thorough cleaning.

Particular care should be taken with items that can trap crumbs or are difficult to clean thoroughly, such as toasters, wooden chopping boards and spoons, scratched plastic containers, non-stick baking tins and shared food storage containers.

Quick answer:

Tell the staff that you have coeliac disease and ask how they prevent cross-contamination when preparing gluten-free options.

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Eating out is absolutely possible when a restaurant understands coeliac disease and follows good practices for preparing gluten-free food safely.

When ordering, tell the staff that you have coeliac disease, rather than simply saying that you are “on a gluten-free diet”. Ask whether your food will be prepared separately, whether clean cookware and utensils will be used, and whether there is any risk of cross-contamination.

Don’t be afraid to ask questions. Well-trained restaurant staff should be able to explain how your food will be prepared and what measures they take to keep guests with coeliac disease safe.

Quick answer:

Plan ahead, research places where you can eat safely and carry some gluten-free food with you as a backup.

Full answer:

Travelling with coeliac disease requires a little more planning, but it shouldn’t stop you from travelling and enjoying your trip.

Before you travel, research the food options available at your destination. If possible, choose a hotel or other accommodation with kitchen facilities or experience in catering for people who need a gluten-free diet.

Carry suitable gluten-free food with you for the first few hours of your journey or as a backup on longer trips. When travelling abroad, it can also be helpful to carry a card or short explanation in the local language describing coeliac disease and the foods and ingredients you need to avoid.

Recovery varies from person to person. Some people feel significantly better within just a few weeks, while for others it may take several months - or sometimes longer - for symptoms to improve and the lining of the small intestine to heal.

Recovery depends on several factors, including age, the extent of intestinal damage, any nutritional deficiencies and, most importantly, how strictly the gluten-free diet is followed.

Even if you feel well, it is important to attend regular follow-up appointments and follow your doctor’s recommendations.

Quick answer:

There is no medicine that can neutralise gluten. Rest, drink plenty of fluids and seek medical advice if necessary.

Full answer:

Accidentally eating gluten can cause a range of symptoms, including abdominal pain, bloating, diarrhoea, nausea, fatigue or headache. Some people, however, may experience no symptoms at all.

Unfortunately, there is no medicine that can “neutralise” gluten or stop the immune response once it has been triggered. Treatment is aimed at managing the symptoms: drink plenty of fluids, rest and choose easily digestible gluten-free foods until you feel better.

If your symptoms are severe, last unusually long or occur frequently, speak to your doctor. It may be necessary to identify the cause and check whether you are being repeatedly exposed to gluten.

Quick answer:

No. Damage to the small intestine can occur even without symptoms.

Full answer:

No. Having no symptoms does not mean that gluten is not causing damage.

For many people with coeliac disease, eating gluten does not cause immediate symptoms. However, the immune system can still continue to damage the small intestine. Over time, this may lead to vitamin and mineral deficiencies, anaemia, reduced bone density and other serious complications.

This is why the treatment of coeliac disease is not based on whether or not symptoms occur, but on following a strict gluten-free diet at all times.

Quick answer:

Not following a strict gluten-free diet increases the risk of nutritional deficiencies, anaemia, osteoporosis and other serious complications and associated conditions.

Full answer:

Regular gluten consumption in someone with coeliac disease causes ongoing inflammation in the small intestine, even when there are no symptoms. This can lead to continued damage to the intestinal lining and impaired absorption of nutrients.

In the long term, the risk of complications increases. These can include iron-deficiency anaemia, osteoporosis, vitamin and mineral deficiencies, fertility problems and an increased risk of certain other serious conditions.

Following a strict gluten-free diet is the only proven treatment for coeliac disease. It allows the body to recover and helps protect against these complications.

Quick answer: A diagnosis of coeliac disease alone does not automatically qualify a person for a specific disability percentage under TELK.

Full answer:

A diagnosis of coeliac disease alone does not automatically qualify a person for a specific disability percentage under TELK (Territorial Expert Medical Commission). Under the current Bulgarian Medical Assessment Regulation, gluten enteropathy without malabsorption syndrome or significant deterioration in general health is assessed at 0%, while cases involving malabsorption syndrome and impaired general health are assessed at 60%. The assessment takes into account medical records, the actual level of functional impairment, complications and other medical conditions. Documentation of anaemia, nutritional deficiencies, osteoporosis or other confirmed complications may therefore be important as part of the medical assessment.

Quick answer: The process begins with medical documentation confirming the diagnosis and your current health status, including hospital discharge summaries, test results, specialist reports and records of any related complications.

Full answer: The process begins with medical documentation confirming the diagnosis and your current health status, including hospital discharge summaries, test results, specialist reports and records of any related complications. Your GP or treating physician will refer you for a medical assessment in accordance with the applicable procedure. As the requirements and administrative procedures may change, always check the latest information provided by the relevant Bulgarian authorities before submitting your application. Include all documentation showing not only the diagnosis itself, but also how the condition affects your health.

Quick answer: Yes.

Full answer: Yes. Bulgaria’s National Health Insurance Fund (NHIF) covers dietary foods for special medical purposes for people diagnosed with coeliac disease (ICD-10 K90.0), provided that the current prescribing and dispensing requirements are met. Eligibility is no longer limited to children - the age restriction for gluten-free flour has been removed. The specific products covered and current requirements should always be checked against the latest NHIF list.

Quick answer: Gluten-free flour is prescribed under a protocol for dietary foods for special medical purposes for people with a confirmed diagnosis of coeliac disease (ICD-10 K90.0).

Full answer: Gluten-free flour is prescribed under a protocol for dietary foods for special medical purposes for people with a confirmed diagnosis of coeliac disease (ICD-10 K90.0). According to information published by the NHIF, the protocol falls under Group I C. For adults, the NHIF states that the protocol is issued by a gastroenterology clinic at a university hospital. For children, specific requirements apply regarding the paediatric or gastroenterology department issuing the protocol. Once the protocol has been issued, the current NHIF procedure for approval, prescribing and dispensing must be followed. As product lists and administrative requirements may change, always check the latest NHIF guidance.