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Gluten free diets: Treatment, symptoms, advice and help

Why is it used?

A gluten free diet is used in a condition called Coeliac Disease. Although called Coeliac Disease, it is not actually a disease, but a condition in which the lining of the small intestine is damaged by a protein called gluten. The treatment is to avoid any food containing gluten. A skin condition called dermatitis herpitformis also responds to a gluten free diet.

Who would require the diet?

There are approximately 50,000 people, who have been diagnosed with Coeliac Disease. Many more are yet to been diagnosed, as the incidence of Coeliac Disease is increasing. There are also an increasing number of diabetics who may also have Coeliac Disease, but at present the number is still quite low. Diagnosis is normally by a blood test and confirmed by a jejeunal biopsy, which shows the lack of the normal finger-like villi.

What is the diet and how does it work?

The diet requires the avoidance of gluten and gluten-containing foods. Gluten is the term that everyone is familiar with, but it is in fact the avoidance of gliadin, which is the offending component in gluten that is important.

In principal it sounds easy just avoid foods with gluten present. The problem is that gluten is found in so many foods, that it makes the diet more difficult to keep to.

Gluten is found in the cereals of wheat, rye and barley, so it is important to avoid these. Wheat is used for breads, cereals and pasta, which form a major part of a normal diet.

Cereals which are allowed are rice and rice flours, corn or maize, cornmeal, polenta and cornflour, arrowroot, amaranth, buckwheat, millet, quinoa, sorghum, teff, sago, tapioca, cassava, and the flours of potato, beans and chickpea (gram).

Some cereals that are closely related to wheat should also be avoided, such as kamut, spelt, triticale, as these also contain gluten. Bulgar wheat, durum wheat, semolina and couscous are also forbidden.

Although oats do not contain the offending gliadin, they have been omitted from the diet of Coeliacs. However, recent evidence suggests that oats may be allowable for most Coeliacs; those who are 'super sensitive' or have not responded to a gluten free diet should still avoid oats. Only moderate amounts are allowed, and the suggested allowance should be less than 50g of oats per day. Coeliacs should firstly consult their Dietitian and Gastroenterologist before starting to take oats. This is particularly the case for children.

Coeliacs should also be aware of the risks of cross contamination of cereals and therefore exercise caution with many foods. The food that they may be eating may be naturally free of gluten, but there is always the possibility that it may be cross-contaminated during manufacturing.

Because Coeliac Disease is a recognised medical condition which responds very well to diet, there are a number of gluten free foods which are available on prescription, such as breads, bread mixes, flours, pasta, pizza bases and plain biscuits. The family doctor will be able to prescribe these. In addition there are also a number of luxury foods that can be bought, but these are more expensive than conventional foods.

Will the diet harm me?

No, the diet is not harmful, but it should be followed strictly as it is known that Coeliacs who tend not to be so careful in keeping to the diet are more likely to suffer cancers of the gastrointestinal tract.

What else do I need to know?

The starch from wheat may be used in food processing. A food product may be made of non-gluten containing foods such as milk, eggs, meats or fish, but the ingredients may include starch. There is no obligation for manufacturers to list the source of the starch on their ingredients<