THE GLUTEN FREE DIET FOR COELIAC DISEASE AND DERMATITIS HERPETIFORMIS

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1 THE GLUTEN FREE DIET FOR COELIAC DISEASE AND DERMATITIS HERPETIFORMIS Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 What is Coeliac Disease? Coeliac disease is an autoimmune disease. This is where the immune system attacks its own cells and tissues by mistake. Coeliac disease is thought to affect 1 in 100 people. The autoimmune response is triggered by gluten and similar proteins found in wheat, rye, barley and oats. This response harms the small bowel. This affects how food is broken down and absorbed. Symptoms include:- diarrhoea abdominal pain wind bloating weight loss tiredness anaemia mouth ulcers bone and joint problems irritability depression Some people report they do not have symptoms. However you still need to follow a gluten free diet for your long term health. If coeliac disease is not treated: The gut will become damaged. Nutrients are not absorbed properly. You will be more at risk of developing a shortage in one or more nutrients. This is linked with poor bone health, anaemia and some cancers. The treatment for coeliac disease is a gluten free diet for life. What is Dermatitis Herpetiformis? Dermatitis herpetiformis is an autoimmune skin condition linked with coeliac disease. It is less common than coeliac disease. Dermatitis herpetiformis presents as a persistent itchy rash. It is managed by lifelong gluten free diet and medication. The symptoms of coeliac disease and dermatitis herpetiformis will settle in most cases once the gluten free diet is established. Coeliac UK Coeliac UK was set up to help people with coeliac disease and dermatitis herpetiformis. It is advised you join Coeliac UK. Membership costs per year for adults over 16 years old. There are concessionary and group membership options.

3 Page 3 of 8 You can join online or call Website Coeliac UK produce Crossed Grain magazine 4 times a year. This provides advice, recipes, articles and updates. They have regional members groups. You may be sent details about these when you register with Coeliac UK. Group information is available on the website. Every year Coeliac UK publish a Food and Drink Directory. This lists manufactured gluten free products. It is updated monthly by Coeliac UK. Only use an up-to-date list as manufacturers often change ingredients. The information which follows should be used with the Food and Drink Directory to make sure your diet is gluten free, varied and pleasing. What is a gluten free diet? Gluten is a protein found in wheat, rye and barley. The gluten free diet avoids all foods that contain or may have come into contact with wheat, rye or barley. Gluten is mainly present in foods made from particular types of flour (including bread, biscuits, pasta, cakes and pastry). It can also be found in other foods that you may not expect, such as sauces, soups, yogurts, burgers and ready meals. Some foods are naturally gluten free. The table below is an outline. A more detailed Coeliac UK checklist is available on their website at Naturally gluten free Rice, buckwheat, amaranth, quinoa, soya, tapioca, ground almonds, corn (maize), millet, polenta. Corn pasta, rice pasta, plain rice noodles All meat and fish with no added ingredients (coatings/flavourings). Plain tofu and plain soya mince or textured vegetable protein. Eggs, cheese, cream, milk, butter, margarine, cooking oils, ghee, lard. All fresh, frozen, tinned fruit and vegetables. Vegetables pickled in vinegar. Not naturally gluten free Wheat, rye, barley, malted barley, couscous, semolina, wheat bran, bulgar wheat, durum wheat. Wheat pasta, noodles Meat or fish in breadcrumbs/batters. Burgers, sausages, pates, meat pies. Textured wheat protein and quorn. Any dairy products which have added flavourings, fibre, sauces. Suet. Any fruit or vegetables in batter, breadcrumbs, flours, flavourings. Foods to check You need to check foods which are naturally gluten free but have been prepared with other ingredients. These include foods in sauces or gravies, foods with coatings, batters, flavourings and foods which have been dried. This is because gluten-containing starches are used as processing aids (binders and fillers or bulking agents). The Food and Drink Directory lists gluten free brands. This is helpful when planning ahead.

4 Page 4 of 8 Gluten harms the gut of people with coeliac disease. Making an occasional mistake and accidentally eating or drinking something that contains gluten will be unlikely to cause long term damage. However you may experience some symptoms. It is important to remember that strict compliance is needed for your long term health. Can I eat oats? The protein in oats is like gluten. Some people with coeliac disease or dermatitis herpetiformis also react to this protein. It is often advised that oats and oat products are initially avoided. Oats and oat products can be contaminated by wheat, rye or barley during processing. These foods are not suitable for a gluten free diet. Your doctor or dietitian can advise when it is safe to eat pure, uncontaminated oats. Use your Coeliac UK Food and Drink Directory to make sure they are pure and uncontaminated oats. Where can I get gluten free products? Gluten free substitute foods are available from a range of sources: Supermarkets i.e. Free From ranges Health food shops Pharmacies Mail order/internet Gluten free products on prescription: Ask your doctor or dietitian for information on what is available. The Coeliac UK website provides information about gluten free foods on prescription. What is the Codex standard? People who need to follow a gluten free diet will become familiar with the term Codex standard. There is a level of gluten that research shows is safe for people who need a gluten free diet. This level is allowed in products labelled gluten free or very low gluten What is Codex wheat starch? Codex wheat starch has been processed to have most of the gluten removed to the level of the Codex standard. Many gluten free foods (e.g. bread, pasta, biscuits, crackers) use Codex wheat starch.

5 Page 5 of 8 How can I make sense of food labelling? From 2012, all pre-packed products had to meet new labelling laws for gluten free foods and those with very low levels of gluten. This includes all items derived from gluten such as barley malt extract. Some labels will include the word gluten, for example wheat gluten. These are defined as: Gluten free have to be less than 20 parts gluten in one million. Very low gluten have to be less than 100 parts gluten in one million. Both gluten free and very low gluten products are safe for most people with coeliac disease. Coeliac UK has a logo known as the Crossed Grain Logo. Products with this label are approved by Coeliac UK. What is barley malt extract? Malt and barley malt extract are used as flavour enhancers by food and drink manufacturers. Many products containing malt or barley malt extract do so in small amounts which meet the Codex standard. These products are listed in Coeliac UK s Food and Drink Directory. Breakfast cereals Many breakfast cereals use barley malt extract as flavouring. However, many are safe for people on a gluten free diet. This is because the amount used is low enough to meet the Codex standard. Use the information and Coeliac UK Food and Drink Directory to check the product is safe. Cross contamination Food and drinks that are gluten free are easily contaminated. For example: Gluten free bread and bread containing gluten toasted in the same toaster. Using contaminated knives in sauces and spreads. Away from the home contamination can happen: Where food is prepared e.g. restaurant kitchens, factories. Shops where the food is sold loose e.g. the deli. It is important to keep gluten containing and gluten free food apart. Avoid foods which may be contaminated with gluten. Tips to avoid cross contamination Use toaster bags, separate toasters or clean grill pans.

6 Page 6 of 8 Make sure that work surfaces are cleaned well. Use separate chopping boards. Make sure cooking oils have not been used to cook gluten containing foods. Eating away from the home and takeaways Take a packed lunch. Use Coeliac UK. They have lists of approved food outlets. Call ahead! Food outlets can let you know if they have a gluten free menu. You may be able to take in your own products that they can then prepare (i.e. pizza bases/pastas). Find out if chips are fried in the same oil as batters/breadcrumbs. Avoid soy sauce in Chinese food outlets. If going on holiday abroad let the travel agent know. They can then make sure your hotel and airline know you need gluten free options. Phrase cards are available in different languages from Coeliac UK. Do I need to take vitamin and mineral supplements? When newly diagnosed you may be lacking in some vitamins and minerals. Your doctor or dietitian may provide dietary advice and/or advise supplements if appropriate. A gluten free diet is a healthy and balanced diet if you.. Eat a variety of different foods. Have a portion of starchy carbohydrate foods as part of each meal. Suitable options are gluten free bread, gluten free cereals, gluten free pasta, rice or potatoes. Include high fibre options where possible. Aim for at least five portions of fruit and vegetables each day. Foods high in fat and sugar should be eaten only occasionally and in small amounts. Eat less salt by adding less to cooking and at the table. Use herbs and spices to add flavour to food. If you continue to have problems with the gluten free diet then more help may be needed. Contact your G.P, district nurse or dietitian or specialist nurse for more advice.

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8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MED143 Publication date August 2015 Review date August 2016 Department Nutrition and Dietetics Location Stepping Hill Hospital