All you need to know about Coeliac Disease and a Gluten Free Diet Q: What is Coeliac Disease? A: Coeliac disease is a condition in which the lining of the gut is damaged by gluten, a protein found in cereals such as wheat, barley and rye. This results in a failure to
absorb food and is often accompanied by symptoms such as weight loss, diarrhoea, bloating, anaemia and lethargy. Gluten-intolerance causes an inflammatory response that damages the gut. Villi - tiny, finger-like projections that line the gut - become inflamed and then flattened leading to a decreased surface area for absorption of nutrients from food. Because of this lack of nutrients, people with undiagnosed coeliac disease can suffer from nutritional deficiencies such as anaemia. Q: What is Dermatitis herpetiformis? A: Dermatitis herpetiformis is a skin condition in which gluten causes a red, itchy rash to form on the skin. If you have been diagnosed with coeliac disease or dermatitis herpetiformis, the treatment is a gluten free diet. This requires a life-long adherence to alleviate symptoms. However, there is a large range of gluten free foods which can still be eaten and many gluten free foods are available on prescription to help add variety to your diet. Q: What Complications are associated with Coeliac Disease? Having coeliac disease increases the risk of developing other conditions such as: Osteoporosis: Due to decreased absorption of calcium, people with coeliac disease, especially women, are more at risk of osteoporosis. For those diagnosed as children and young adults osteoporosis
is less likely to be a problem as bone mass tends to improve. There is a small increased risk of malignancies such as gut lymphoma in unmanaged coeliac disease. However, once a person has been on a gluten-free diet for three to five years the risk of this cancer decreases to that of a person without coeliac disease. Lactose intolerance (milk sugar) can be more common as the damaged gut is unable to breakdown lactose. This usually resolves once the gut heals properly There is a link between coeliac disease and conditions such as type 1 diabetes and under active thyroid. Q: What Gluten Free Products are available? A: Most leading supermarkets stock gluten free ranges and offer a wide selection of breads, pasta, cakes, biscuits and pastries. Check out the gluten free living section of www.coeliac.org for a comprehensive list of gluten free food manufacturers. Certain special companies also produce gluten-free products available on prescription. These include flour, bread, biscuits, pizza bases and crackers. Samples of prescribable products can be requested from companies online, by telephone or using the starter cards given to you by the Dietitian.
Luxury items such as cakes and chocolate are not available on prescription but there are many different varieties now available in supermarkets or health food stores. After sampling the gluten free products available on prescription you can discuss with your Dietitian an appropriate prescription. If you pay prescription charges, it may be worthwhile to obtain a pre-payment certificate form FP95 available from Post Offices or chemists. Q: How can I join Coeliac UK? The Dietitian will give you a membership form. It is advisable to join as soon as possible and benefit from their varied resources including a comprehensive gluten free food directory. You can also join online at: www.coeliac.org Food Groups Foods allowed Foods not allowed
Cereals and Flour Cornflour Specially manufactured: Gluten free flour Rice flour Potato flour Soya flour Sago Tapioca Cassava Maize Rice: Brown White Wild rice Arrowroot buckwheat quinoa sorghum teff Popcorn Wheat Rye Barley Bulgar wheat Durum wheat Spelt and their associated flours Semolina cous cous malted barley rusks
Food Groups Foods allowed Foods not allowed Breakfast Cereals Bread cakes and biscuits Cornflakes (as listed in the food directory) rice based cereals Gluten free muesli Buckwheat flakes Specially manufactured gluten free: Breads Rolls Biscuits Crispbreads Cakes Crackers Shop bought gluten free cakes Meringues pizza bases Weetabix Shredded Wheat AllBran Muesli Ready Brek check coeliac UK food directory All bread and bread products made using wheat rye barley Croissants Brioche Naan Pitta Ciabatta crispbreads Crackers Cakes Pastries pancakes croutons Chapattis Biscuits Crumpets
Food Groups Foods allowed Foods not allowed Scones Teacakes pizza bases Pasta and noodles Meat, Poultry and Seafood Milk and Milk products Corn pasta rice pasta Specially manufactured gluten free pasta Rice noodles All fresh meat including chicken, lamb, beef, ham, fish and seafood Canned and prepacked meat in it s own juice 100% meat sausages gluten free sausages Tofu Quorn All types of fresh dried condensed evaporated milk Soya milk All fresh and dried pasta and noodles made from wheat flour Meat and poultry in breadcrumbs or batter Meat pies Ordinary sausages burgers Meat pastes Patés Textured Vegetable Protein Artificial cream oat milk
Food Groups Foods allowed Foods not allowed Fresh cream soured cream crème fraiche soya milk goat s milk Most yoghurts and fromage frais Coffee creamers Yogurt and fromage frais containing muesli or cereals Cheese and Eggs Soups, Sauces and Seasonings All Plain natural cheeses cottage cheese cream cheese low fat cheeses Eggs Canned and carton soups,e.g., Baxter s and Heinz have a wide variety (as listed in the food directory) Salt Pepper curry powder herbs and spices (as listed in the food directory) Cheese spread Flavoured cottage cheeses (some GF varieties available check the food directory) Processed cheese Cheese fillers Scotch eggs Some canned and packet soups Packet sauces Sauce mixes
Food Groups Foods allowed Foods not allowed Vinegars: Wine Cider malt vinegar balsamic vinegar Some gravy mixes (as listed in the food directory) Puddings Jelly Milk puddings made with GF ingredients Marks & Spencer/ Sainsbury s/ Tesco Custards Some ice-creams: Haagen Dazs Green & Blacks Lyons Maid, Tesco Soft Scoop Waitrose Ice-creams Sorbets Drinks Tea coffee Fruit Juice fruit squash Mineral water clear fizzy drinks Wine, spirits Liqueurs Some: Stock cubes Gravy mixes Semolina Trifle Some ice-creams custards mousses (as listed in the food directory) Barley waters Cloudy Fizzy Drinks Hot chocolate powder Sports Drinks Beer
Food Groups Foods allowed Foods not allowed cider Cocoa Green and Black hot chocolate jar Complan Buildup Lager Ale Stout Miscellaneous Gelatine Dried Yeast Sodium bicarbonate Food colouring essences artificial flavourings Sweeteners Bovril Gluten free communion wafers Gluten free baking powder (Supercook) Regalice coloured and white Cooking oils, butter and margarine Ice cream cones wafers Meat, vegetable and yeast extracts (as listed in the food directory)
This list is not exhaustive and becoming a member of Coeliac UK and obtaining your own food directory is highly recommended. Some medication may contain gluten, advice about specific products should be sought from a pharmacist. Q: What is Codex Wheat Starch? A: This is a special wheat starch that has had the gluten removed to a trace level which is within the Codex standard. The Codex standard for gluten-free foods was applied to special foods for people with coeliac disease and dermatitis herpetiformis. The standard is set at 20 parts per million (ppm) for products labelled as gluten free. Products with between 20ppm 100ppm cannot be marketed as gluten free but may be marketed for people with celiac disease. Codex wheat starch is used by some manufacturers who produce gluten-free food for prescription as it improves the taste and texture of the food, making it more like the gluten-containing varieties. Whilst the majority of people with coeliac disease can tolerate Codex wheat starch, there are those who are more sensitive and suffer symptoms and gut damage if they eat Codex wheat starch. Q: Can I eat barley, rye and oats? A: Malt extract and malt flavouring are both manufactured from barley and widely used in breakfast cereals, ready meals, soups, confectionery and snack products. The level of gluten from malt extract or malt flavouring used in these products may vary. Products that contain malt extract in smaller amounts can be tolerated by most people with
coeliac disease, e.g., malted rice breakfast cereals and malt vinegar. Some malted breakfast cereals, e.g., malted cornflake products have been shown to have a higher level of gluten than previously realised. These products have been removed from Coeliac UK's Food and Drink Directory as they do not comply with the Codex standard used as the criteria for inclusion. Products listed in the Food and Drink Directory that contain malt extract have a low level of gluten which is within the Codex standard. Rye contains gluten and should be avoided by people with coeliac disease. Research suggests that most people with coeliac disease can tolerate the gluten-like protein found in oats. However some people do react to oats and need to avoid them. In addition, most oat products on the market are contaminated by wheat, rye and barley during processing, e.g., during milling. It only takes a small amount of contamination to make a product unsuitable for someone with coeliac disease. If you want to include oats in your gluten-free diet, we recommend you discuss this with your Dietitian so they can monitor your progress. Gluten Free Recipe Books all available in bookshops or on line: 1. The Gluten, Wheat and Dairy Free Cookbook, Antoinette Savill 2. Gluten Free Cooking, Lyndel Costain 3. Great Gluten Free Baking, Louise Blair 4. Healthy Gluten free Eating, Darina Allen and Rosemary Kearne
Notes Department of Nutrition and Dietetics Barnet Hospital Wellhouse Lane Barnet Herts EN5 3DJ Chase Farm Hospital The Ridgeway Enfield Middlesex EN2 8JL Tel: 020 8216 4731 Tel: 020 8375 1045 Produced by Dietetics Department\Department Resources\Diet Sheets\Coelic Parks January 2008 to be reviewed in January 2010 Translations available on the Trust website: www.bcf.nhs.uk. Select the appropriate language on the homepage under Community Languages