Novel presentation of coeliac disease after following the Atkins’ low carbohydrate diet

Low carbohydrate diets are currently being promoted as an effective treatment for weight reduction. The most popular, the Atkins’ diet, is a worldwide bestseller with over 10 million book copies sold (the earliest being Dr Atkins’ New Diet Revolution). Two randomised clinical trials in obese patients have shown effective weight loss at six months on the Atkins’ diet compared with a low fat calorie reduced diet although the difference was not significant or sustained at 12 months. 4 The Atkins’ diet recommends unlimited protein and fat intake, with carbohydrate intake initially restricted to 20 g/day (5–10% of daily calorie intake), mainly as salad greens and other non-starchy vegetables. In the longer term maintenance phase, the diet remains low in cereal grains (wheat, rye, and barley), which are toxic in coeliac disease. We report three patients seen in the last year who sought medical advice because of symptoms noticed after stopping the Atkins’ diet, which subsequently proved to be due to coeliac disease.