What is coeliac disease?
Coeliac disease is an auto-immune disorder, which means that the body produces antibodies that attack its own tissues.
In coeliac disease, this is triggered by eating gluten and results in the lining of the small bowel becoming damaged. This can prevent your body absorbing your food as it should.
There are a variety of symptoms associated with coeliac disease, eg. abdominal pain, abdominal bloating, diarrhoea, constipation, weight loss and tiredness. You may have experienced some of these symptoms however some people do not experience any symptoms and not all symptoms relate to the bowel.
Coeliac disease can present itself at any age and can run in families.
What you need to do
Coeliac disease cannot be cured, but it can be controlled.
By excluding gluten completely from your diet your small bowel will recover and start to function normally again. Symptoms should start to improve within a few weeks.
Please be aware that even small amounts of gluten will continue to cause damage – so the diet needs to be strictly adhered to for life.
What can I eat?
Gluten is found in wheat, rye and barley. Some people may be sensitive to oats. All foods and drinks containing these will need to be avoided.
Your diet will be based on:
- Those foods that are naturally gluten-free – such as meat, fish, potatoes, rice, milk, eggs, cheese, fruit, vegetables, pulses and nuts
- Processed foods that do not contain gluten
- Gluten-free substitute products:
Certain products such as bread, bread rolls, crackers and cereals can be obtained on prescription from your GP. A wide range of gluten free products can be purchased in supermarkets or via mail order.
Some of these substitute products contain something called ‘codex wheat starch’. This is a specially prepared wheat starch from which the gluten has been removed and is suitable for the majority of people with coeliac disease. Only highly-sensitive people would need to avoid it.
There are now three labels to look for which will help you make a suitable choice for your diet:
Gluten-free – this term is now covered by law for the first time and applies only to food which has 20 parts per million (ppm) or less of gluten.
Very low gluten – this term is also covered by law and applies to foods which have between 21 and 100 ppm.
No gluten containing ingredients – this term is not covered by law, but is an important option to give you more choice. It applies to foods that are made with ingredients that do not contain gluten and where good cross-contamination controls are in place.
To be sure that a product is gluten-free, check food labels for ingredient lists, as many foods contain hidden sources of gluten. Use the list of ingredients to check whether or not a food is gluten-free. Manufacturers may use an allergy advice box on packaging to highlight where allergens such as gluten are present, although the use of this box is not compulsory.
You may see the crossed grain symbol on labels which guarantees a product is gluten-free.
Use the Food and Drink Directory from Coeliac UK if unsure.
- A gluten-free diet should also be a healthy diet – a wide variety of foods is essential to achieve a healthy balance.
- Gluten-free meals are suitable for the whole family. However, prescribable products should only be used for the person with coeliac disease.
- Many family meals can be made gluten-free simply by excluding flour and replacing it with cornflour, eg. for thickening gravy, stews, soups and sauces.
- Take gluten free foods with you when you are out and about,
for example, gluten-free crackers or biscuits to ensure you have
a gluten-free snack on hand.
- If you have coeliac disease, you may be at increased risk of
osteoporosis. It is advisable to have a good calcium intake and your dietitian will provide you with advice regarding this.
- The amount of time it takes for someone to feel better on a
gluten-free diet varies from a few days to several months.
The damage to the small bowel can take up to two years to
- Experiment with gluten-free cookery. It takes time to get used
to gluten-free flours and mixes. Many of your favourite recipes can be adapted. Bread, cakes and biscuits freeze well.
Foods to Avoid (*unless known to be gluten-free)
|Wheat and wheat products, e.g. flour, bread, cakes, biscuits and crackers, pasta, pastries, semolina, bran. Rye, oats*, barley, spelt, couscous, bulgar wheat, durum wheat, einkorn, emmer, dinkle, kamut, pearl barley, triticale
Breakfast cereals containing wheat, rye, barley or oats*, e.g. puffed wheat, ‘Weetabix’, muesli*, porridge, branflakes. Breakfast cereals made from rice or corn, eg. cornflakes*, ‘Rice Krispies’*
|Fruit and Vegetables||Croquette potatoes, potato waffles*, hash browns*, baked beans*, instant potato*, vegetables in sauce*, fruit pies and crumbles, frozen potato products, e.g. chips*, roast potatoes*|
|Meat||Meat products, eg. beefburgers*, sausages*, faggots*, corned beef*, pate*, meat pies, pastries, sausage rolls, wafer thin meats*, continental meats*|
|Fish||Fish in breadcrumbs or batter, eg. fish fingers, fish cakes. Fish in sauce*|
|Eggs||Scotch eggs, quiche|
|Dairy products||Milk substitutes*, synthetic creams*, muesli yoghurts, milk with added fibre and oatmilk|
|Fats and oils||Packet suet*|
|Nuts and snacks||Dry roasted nuts*, flavoured crisps*, wheat-based snacks, corn-based snacks*|
|Preserves, desserts and confectionery||All other sweet spreads*, lemon curd*, mincemeat*, Ice cream*, mousses*, packet mixes*, ice-cream cones and wafers, Sweets*, chocolate*, liquorice, seaside rock, chewing gum*|
|Drinks||Barley flavoured squash, fizzy drinks*, malted milk drinks, cocoa*, drinking chocolate*, vending machine drinks, meat extracts*
Alcohol - beers, lagers, ales, stout
|Miscellaneous||Mixed herbs + spices*, mustards*, pickles, sauces and ketchups*, stock cubes, gravy powders + granules*, soups and packet mixes*, baking powder, quorn.
Communion wafers (gluten-free varieties available)
|Cereal products||Rice and rice flour, sago, tapioca / cassava / minoic, potato flour, soya flour, maize, cornflour, polenta, pea starch, sorghum, quinoa, buckwheat, millet/barja, arrowroot, gram/ garam, flour, agar, amaranth, chana, flax / linseed, sesame, mustard, almond, hops, hemp, Arborio rice, gnocci (if made from rice flour and potato starch), urd/urid/urad flour, mung bean noodles, poppadoms or corn soft tortillas (if no gluten containing flours used), paella/ pilaf dishes, Thai wrappers (made from rice powder and tapioca flour)
Gluten-free flour and mixes, bread, biscuits, crackers, pasta, pizza bases, cakes
|Fruit and vegetables||All fresh, frozen, dried and tinned varieties.
Pulses, potatoes, broad beans, falafel (if from chick pea alone)
|Meat||Fresh, plain frozen meat, processed meat, eg. ham, bacon, tongue, offal, tofu|
|Fish||All fresh, smoked, or plain frozen fish. Fish tinned in brine or oil, shellfish
|Eggs||Fresh, plain cooked eggs|
|Dairy products||Milk (fresh and dried), cream, yoghurt (plain and fruit) butter, margarine, low fat spread, cheese, fromage frais, crème fraiche|
|Fats and oils||Vegetable oils, lard, dripping, fresh suet, ghee|
|Nuts and snacks||All fresh and salted nuts, plain crisps, peanut butter, lentils, beans, chickpeas, seeds, hummus|
|Preserves, desserts and confectionery||Sugar, honey, jam, marmalade, golden syrup, treacle, molasses, sweeteners, glucose syrup, dextrose, dextrin, maltodextrin, jelly|
|Drinks||Tea, coffee, fruit squash, fruit juice.
Alcohol - wines, spirits, cider, liqueurs, sherry
|Miscellaneous||Salt, pepper, pure spices and herbs, vinegar (including barley malt vinegar), MSG, yeast/yeast extract (fresh and dried), mustard, bicarbonate of soda, cream of tartar, tomato puree, garlic puree, mint sauce and jelly, fish sauce, coconut milk, gelatine, guar gum, xantham gum, soy lecithin, food colouring, tartaric acid, carageenan, modified starch, malitol|
Can I eat oats?
Many people with coeliac disease can eat oats, but a small number of people are still sensitive to oats. People on a well-established strict gluten-free diet should be able to include oats in their diet without risk to their coeliac status.
The main problem with oats and oat products is that they are often contaminated with wheat, rye or barley during processing.
If you decide to include oats in your diet, you need to ensure that these are free from contamination – see your “Food and Drink Directory” for information on suitable brands.
People with coeliac disease, who are super-sensitive should not use oats.
Children with coeliac disease are advised not to include oats in their diet, unless it has been discussed and agreed with their paediatric consultant.
Avoidance of contamination
It is important that gluten-free foods are not contaminated with gluten during storage or preparation.
Ways to avoid this include:
- Using a separate toaster, clean grill pan or toaster bag for gluten-free bread.
- Ensure surfaces and chopping boards and utensils are clean before use and use a separate bread board.
- Use separate containers for butter, jam, etc., to prevent contamination with crumbs.
- Ensure that any oil for cooking has only been used for gluten-free food.
Dermatitis herpetiformis is a very itchy skin rash, that commonly occurs on the elbows, knees and buttocks but can affect any area of the skin.
It is considered to be the skin presentation of coeliac disease – although the small bowel can also be affected. A gluten-free diet is an essential part of the treatment.
Good sources of iron include e.g. offal, red meat, oily fish, eggs, fortified breakfast cereals, dark green vegetables, dried fruit and nuts.
Your body can make better use of the iron from these foods by eating foods rich in vitamin C such as oranges, grapefruit, blackcurrants, tomatoes, dark green vegetables.
Make sure you eat plenty of high fibre foods, eg:
- Fibre-rich gluten-free products – such as bread, biscuits and crackers
- Use brown rice instead of white rice
- Eat good portions of fruit (including dried fruit), vegetables, nuts and pulses
- Have more jacket potatoes or potatoes boiled in their skins
- Remember to drink plenty of fluid – at least eight cups daily
- Reduce your fat intake by using healthier cooking methods and using lower fat diary products, reduced fat meat products and restricting high fat foods and snacks e.g. pastry and biscuits.
- Cut down on your sugar intake – avoid adding sugar to food and drinks and using artificial sweetener instead.
- Cut down on cakes, biscuits and sweets and use sugar-free squashes and fizzy soft drinks instead of ordinary ones.
- Watch your alcohol intake and ensure you are getting enough exercise.
Eating out when you have coeliac disease can be a challenge, but it is not impossible. It may be worth telephoning in advance to discuss your diet.
You may opt to choose simple food such as meat or fish with potatoes and vegetables. If in doubt about any menu item, do not eat it.
Coeliac UK has information on eating out, including a list of restaurants and hotels that cater for gluten-free diets. If you are visiting friends, tell them about your gluten-free diet in advance.
It is a condition where the body’s bones become thin and more likely to break. It is diagnosed by measuring Bone Mineral Density (BMD), which assesses the strength of bones. People with osteoporosis have a low BMD. Osteopenia describes a condition where BMD is lower than normal, but not as severe as in osteoporosis.
Half of adults with coeliac disease are likely to have low BMD at diagnosis. This is related to long-term malabsorption of calcium as a consequence of delayed diagnosis of coeliac disease.
Regular weight-bearing exercise, a calcium-rich diet, stopping smoking and avoiding excessive alcohol intake are other sensible steps to optimise bone health.
Ensuring a healthy balanced gluten free diet, enriched with calcium is important to help maintain bone health. You may also need Vitamin D supplements to help the absorption of calcium. Good dietary sources of vitamin D include margarine, eggs and oily fish.
For adults with coeliac disease, it is recommended to have at least 1000mg calcium per day. For post-menopausal women and those over 55 years with coeliac disease, the recommended amount is 1200mg per day.
What are good sources of calcium?
|Food per serving||Amount|
|Semi-skimmed milk (1/3 pint)||230mg|
|Skimmed milk (1/3 pint)||240mg|
|Calcium enriched soya milk (1/3pint)||250mg|
|Calcium enriched rice milk (1/3 pint)||225mg|
|Pot of yoghurt (150g)||225mg|
|Pot of fromage frais (100g)||85mg|
|Pot of soy yoghurt (125g)||150mg|
|Portion of cheddar cheese (30g)||220mg|
|2 tinned sardines with bones (50g)||260mg|
|3 dried figs||150mg|
|Small tin of kidney beans (200g)||100mg|
Coeliac UK is the leading charity for people with coeliac disease and dermatitis herpetiformis. Its mission is to improve the lives of people living with the condition through support, campaigning and research.
Coeliac UK membership is free for the first 6 months and gives you the following benefits:
- A new members’ information pack.
- The ‘Gluten-Free Food Directory’ – listing thousands of gluten-free manufactured products updated monthly and reprinted annually.
- A Diet and Health helpline.
- The Crossed Grain magazine three times a year – keeping you
up-to-date on coeliac disease and gluten-free living.
Coeliac UK produce a selection of resources – such as recipe booklets and travel guides. There are also local groups who meet and organise talks, cookery demonstrations and social events.
It is recommended that you join – your dietitian will give you an application form.
They also have an excellent website: www.coeliac.org.uk with links to online activities, including Facebook and Twitter.
Once you have been diagnosed with coeliac disease or dermatitis herpetiformis, you are entitled to receive basic food items, such as bread, flour, pasta, biscuits, crackers and baking mixes on prescription.
A current list of prescription products can be found in Coeliac UK’s Gluten-Free Food and Drink Directory. Prescription of gluten-free foods have been restricted in some areas. Please contact your GP for more information.
Unless you qualify for free prescriptions, you will be charged for each type of gluten-free food that you have. To save money, you may want to purchase a pre-payment certificate – your pharmacist can advise you.
Dependent on how much you use, it may be cheaper to purchase some of these products from the supermarket, chemist or health food shop, especially sweet foods and treats such as cake or fancy biscuits.
For more information contact:
Nutrition and dietetic team at Yeovil Hospital
01935 384 250