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GLUTEN FREE DIET

What is a Gluten Free Diet ?

The condition called coeliac disease or gluten-sensitive enteropathy is an abnormality of the small bowel affecting both children and adults. It is due to a reaction to a substance called gluten. This is found in wheat and rye. Some patients are also affected by barley and occasionally oats which contain proteins similar to gluten. The diet involves completely avoiding these foods and any other products that may contain wheat, rye, barley or oats. It is important that the diet is discussed with a dietitian on a regular basis. In this way suitable replacement foods can be suggested to be sure that your diet is well-balanced.

What is a Gluten Free Diet used for ?

If you have coeliac disease you will be advised to follow a gluten free diet. Following this diet carefully will completely restore you to health. Your weight loss will be corrected by the exclusion of gluten, as will your tiredness, diarrhoea or anaemia. When a positive diagnosis of coeliac disease is made, it is very important that the diet is continued for life.

How does a Gluten Free Diet work ?

Gluten damages the top layer of the small intestine, by flattening the small finger-like projections called villi. This means that food cannot be absorbed properly. It is the chemical gliadin in gluten which causes damage to the villi but it is still not fully understood why or how this happens.

What does a Gluten Free Diet involve ?

Firstly cut out wheat, rye, barley and oats. This includes ordinary bread, flour, pastry, pasta and noodles, cakes & biscuits and some breakfast cereals. The next and more difficult step is to avoid hidden sources of gluten such as sausages made with bread or baked beans with flour in the sauce. The Coeliac Society produce a Gluten Free Manufactured Products booklet which is a reassuringly long list of products that are gluten free and to be enjoyed. This list is regularly updated as new products come out and recipes are changed. Therefore it is very important to have the latest copy of this booklet and to take it with you when going shopping. There are also special items like gluten free bread, flour, pasta and biscuits which are available on prescription from your family doctor. In the UK, you are entitled to a repeat prescription which should cover 3 months use. Some of the larger companies offer trial introduction food packs which also include information on their range of products. You can then choose your favourite products to have on prescription. Health food shops and larger pharmacists also offer a range of gluten free products. At the time of diagnosis of coeliac disease, a multivitamin plus iron supplement is often prescribed for a few months. This is to correct any anaemia and to aid tissue growth after what has been a period of malnutrition for the body. Once the diet is fully established, it should not then be necessary to continue, since absorption of these essential substances will have been restored.

What to watch out for

The gluten free symbol is no longer used in the UK. This makes it even more important to read labels carefully . Many people with coeliac disease have a big change in their bowel problems. Constipation, due to cutting out wheat and bran, can be avoided by including fruit, vegetables, nuts, soya bran or rice bran and plenty of fluids. There are also high-fibre gluten-free commercial products available. Continued diarrhoea or loose movements suggests that there is some hidden gluten in the diet. If this is a problem, it is important to discuss it with your family doctor or dietitian. It is also not uncommon for people with coeliac disease to rapidly put on too much weight after diagnosis. This happens because one tends to continue to eat the extra large quantities of food which were needed before the condition was diagnosed in order to avoid losing weight. This is something to bear in mind and seek advice before it becomes a problem.

What if a Gluten Free Diet is not followed ?

There is research which has shown that people with coeliac disease are at higher risk of developing bowel cancer than the normal population. However, in a study of a group of coeliac patients checked regularly over a 15 year period, the risk of cancer in those who followed a strict gluten free diet was no greater than in people without the disorder.