YOUR GLUTEN FREE LIFE - Wiltshire Health and Care
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YOUR
GLUTEN FREE
LIFE
WWW.COELIAC.ORG.UK 1
CONTENTS 3 Your gluten free life 4 What is coeliac disease? 7 The gluten free diet 8 Shopping 11 Prescriptions 14 Cooking 16 Eating out 18 Managing coeliac disease 21 Balanced eating 25 Tips for parents and carers 30 Frequently asked questions 31 More information 2 WWW.COELIAC.ORG.UK
YOUR GLUTEN FREE LIFE
Joining Coeliac UK gives you • Helpline support
access to nearly 50 years of • Venue guide on our website
trustworthy, proven expertise on
every aspect of living gluten free • Home of gluten free recipes on
and we’re here to help every step our website
of the way. • online publications and leaflets
Changing to a gluten free diet • monthly Food and Drink
can feel daunting at first but the Directory updates
following resources will help
• food alerts
you get your life back on track
and on the way to a happier and • Crossed Grain magazine
healthier you: • Local Groups
• your own Food and Drink Directory • support networks
• Gluten free on the Move • personalised Scrapbook on
smartphone app our website
• Gluten free food checker • a chance to get involved in
smartphone app campaigning and research.
• email newsletters
WWW.COELIAC.ORG.UK 3
WHAT IS COELIAC DISEASE? Coeliac (pronounced ‘see-liac’) How many people have it? disease is a serious illness where Around 1 in 100 people has coeliac the body’s immune system attacks disease, although many people its own tissues when gluten is eaten. are not yet diagnosed with the Some people with coeliac disease condition. Coeliac disease does run may also be sensitive to oats. in families but not in a predictable Gluten causes damage to the lining way. There is a 1 in 10 chance that of the gut, meaning that you cannot close relatives of people with coeliac properly absorb nutrients from food. disease will have the condition Symptoms may also affect other but this means that there is a 90% parts of the body, but coeliac disease chance that a family member will not is not an allergy or food intolerance. be affected. What is gluten? What are the symptoms? Gluten is a protein found in wheat, Everyone is different, but if you barley and rye. have coeliac disease you can 4 WWW.COELIAC.ORG.UK
suffer any of these symptoms food and nutrients are absorbed
when you eat gluten: becomes damaged. Tiny, finger like
projections called villi which line
• stomach pain, frequent bouts of
the gut become inflamed and then
diarrhoea or loose stools
flattened, leaving less surface area to
• nausea, feeling sick and vomiting absorb nutrients from food. People
• lots of gas and bloating with undiagnosed and untreated
coeliac disease can have a wide
• severe mouth ulcers
range of symptoms and nutritional
• feeling tired all the time. deficiencies as a result of the
damage to the lining of the gut.
Diagnosis
Coeliac disease can be diagnosed at How to get diagnosed
any age; either in childhood after The first step in diagnosis of coeliac
gluten containing foods have been disease is a simple blood test. This
introduced into the diet, or later in life. looks for the antibodies produced
Like many autoimmune diseases, in response to eating gluten. It
coeliac disease is more common in is essential that you keep eating
women than men. gluten before and throughout the
testing process, otherwise your
What is dermatitis herpetiformis? body won’t produce antibodies
Dermatitis herpetiformis (DH) is and you could get a false negative
the skin manifestation of coeliac result. Gluten must be eaten in
disease and affects around 1 in more than one meal every day for
3,300 people. It can appear at any six weeks before testing.
age but is not often seen in children
If the blood test is positive you will be
and is most common in people in
referred for a gut biopsy. This means
their fifties or sixties. The treatment
a small camera, called an endoscope,
for DH is a gluten free diet, however
is passed through your mouth and
some people also need a medication,
stomach then into the gut. Small
commonly Dapsone, to help treat the
samples of the gut are collected and
condition. For more information, see
then examined for signs of coeliac
our list of resources on page 31.
disease. For some children, a biopsy
What does coeliac disease do? may not be needed. You can find out
more information at:
When people with coeliac disease
www.coeliac.org.uk/
eat gluten, the lining of the gut where
coeliacdiseaseinchildren.
WWW.COELIAC.ORG.UK 5
WHAT TO DO AFTER DIAGNOSIS
After a confirmed coeliac disease They may also discuss gluten free
diagnosis, it is important to start foods available on prescription.
a gluten free diet. Once gluten has
been removed from the diet, the gut Your GP or consultant can arrange a
will begin to heal and you will usually referral to a dietitian for you. Some
start to feel better within a few weeks. people with coeliac disease can
However, it can take between six be deficient in important nutrients
months and up to five years (and so your dietitian will also discuss
in some cases longer) for the gut ways to achieve a balanced diet.
damage caused by eating gluten to Sometimes this involves taking
fully heal. dietary supplements. After following
a gluten free diet for some time,
After diagnosis, it is important to
absorption of nutrients from food
see a dietitian who can provide
will improve so supplements may
information about the gluten free diet
not be necessary in the long term.
and advise you on changes that need
For advice on this speak to your GP
to be made. You may be asked to fill
or dietitian.
in a food diary so the dietitian has a
good idea of what you normally eat.
6 WWW.COELIAC.ORG.UK
THE GLUTEN FREE DIET
Living gluten free means changing move app, is a guide to the types of
the way you shop, cook and eat out. foods that can be eaten, those that
It also means managing your health can’t and those that need to
better. We will guide you through the be checked.
changes you need to make and our
resources listed at the front of this So, what can I eat?
booklet will help you live gluten free There are many naturally gluten
day to day. free foods such as meat, poultry,
fish, cheese, milk, fruit, potatoes,
What is gluten?
vegetables, pulses, rice and corn.
Gluten is a protein in the grains
Gluten free ‘substitute’ foods
wheat, barley and rye. Most people
including bread and pasta are
with coeliac disease are able to have
also available:
gluten free oats, however some • on prescription in most parts
people may be sensitive to avenin,
of the UK through your GP or
the protein in oats – see page 30 for
pharmacist. Check online at
more information.
www.coeliac.org.uk/
prescriptions-policies
Gluten is commonly found in foods
such as bread, biscuits, pasta and • in the free from range in
cakes but it is also in foods that supermarkets
you may not expect, such as some • from health food shops
sauces, ready meals and sausages.
• by mail order via the internet.
Our Gluten free Checklist, available in
hardcopy or on our Gluten free on the
WWW.COELIAC.ORG.UK 7
SHOPPING Using your Food and Drink We also have an A5 printed Directory version of the Directory that is Our unique Food and Drink published every January and Directory lists over 20,000 foods is sent to all members (unless that can be eaten on a gluten you have previously opted out of free diet. receiving one). Our electronic Food and Drink You will need to make sure you keep Directory on our website and your printed Directory up to date as smartphone apps, Gluten free on products can change and new ones the move and Gluten free food are added each month. Monthly checker, provide information updates are available on our website updated in real time, giving you at www.coeliac.org.uk/fddupdates access to the most up to date and in our monthly email newsletter. information to help you shop. What’s more, our apps have handy barcode scanners so you can simply scan the item to see if it’s suitable for a gluten free diet or listed in our Directory. 8 WWW.COELIAC.ORG.UK
Reading labels Crossed Grain symbol
If you see any of the following on a The Crossed Grain symbol can only
food label you know that the food can be used on food that is gluten free.
be included in a gluten free diet: The symbol is a quick and easy way
• gluten free to help you identify foods and drinks
that are suitable and is used on a
• suitable for coeliacs
wide variety of gluten free brands.
• our Crossed Grain symbol.
The Food and Drink Directory
Gluten free
displays the Crossed Grain symbol
Only foods that contain 20 parts per
next to all products that are licensed
million (ppm) or less of gluten can be
to display it. New companies are
labelled gluten free. Foods labelled
licensed regularly, so don’t forget to
with this term can be eaten by
check the monthly Food and Drink
everyone with coeliac disease.
Directory updates for any additions
Suitable for coeliacs for your paper copy. The Food and
This term can only be used when Drink Directory on our website and
a food is labelled gluten free and the Gluten free on the move app are
contains 20 ppm or less of gluten. updated in real time.
The Crossed Grain
symbol is licensed
by Coeliac UK and
can only be used on
food that is gluten
free. It’s a quick
and easy reference
for you to find food
and drink that is
suitable for you.
WWW.COELIAC.ORG.UK 9
CHECKING INGREDIENTS
Look out for the words checklist can be found in your Food
wheat, barley, rye or and Drink Directory or your Gluten
oats in the ingredients free Checklist.
list. If they have been
May contain statements
used as an ingredient, You may see the following
they must be listed. statements on some foods:
Using the ingredients list • may contain traces of gluten
Cereals containing gluten are
• made on a line handling wheat
allergens and so must, by law, always
be listed in the ingredients list of a • made in a factory also handling
prepackaged product. If there is no wheat.
mention of any grains that contain
Manufacturers use these statements
gluten, such as wheat, barley, rye or
to highlight that there is a risk of
oats in the ingredients list, then this
cross contamination with gluten in
means that gluten has not been used
the making or packaging of a food.
in the recipe.
Use of the may contain statement is
All ingredients used in a food have
voluntary and varies. If you see these
to be listed in the ingredients list
statements on products that you
by law regardless of the amount
want to eat then contact Coeliac UK
used. Ingredients are listed in
or the manufacturer to find out more.
order of weight starting with the
biggest ingredient first. Legislation
that applies to manufactured
foods means there is a minimum
font size and allergens have to be
emphasised in the ingredients list,
for example, by using bold lettering.
When checking lists of ingredients it’s
important to know which ingredients
are gluten free and which contain
gluten. A comprehensive ingredients
10 WWW.COELIAC.ORG.UKPRESCRIPTIONS
Gluten free food is available on bread, flour and flour mixes
prescription for those medically on prescription.
diagnosed with coeliac disease in
Scotland, Wales, Northern Ireland In most parts of the UK, staple
and some parts of England. You gluten free foods are available to
might have seen gluten free help people with coeliac disease
prescribing being talked about in follow a strict gluten free diet. Where
the media as it is a hot topic at prescriptions are provided, the
the moment as the NHS is looking amounts prescribed are based on the
to cut budgets. Coeliac UK has assumption that people with coeliac
been campaigning for gluten free disease will be eating some naturally
prescriptions to continue as a gluten free cereal foods, such as rice,
support for people with coeliac and buying substitute gluten free
disease for those who need it most, products from the supermarket.
but we are increasingly seeing
Clinical Commissioning Groups How do I access prescriptions?
(CCGs) in England restricting or If you live in England, Northern
removing the service. Ireland or Wales, accessing gluten
free food on prescription and making
To see whether your area is changes to your prescription works
prescribing, see our map at in the same way as prescriptions for
www.coeliac.org.uk/prescriptions. medications. The process usually
Once you have been diagnosed with involves you asking your GP for the
coeliac disease you may be able to prescription and then taking it to
get gluten free staple foods such as your pharmacist.
WWW.COELIAC.ORG.UK 11Check online at www.coeliac.org.
uk/prescription-policies to see GPs are allowed by law to
what is available in your area. prescribe where there is
an individual health need.
If you live in Scotland you will be If gluten free prescribing
able to obtain gluten free products in your area has been
directly from your local pharmacist removed or restricted
using the Gluten Free Food Service, and you are struggling to
instead of having to repeatedly go adhere to your gluten free
through your GP. You will need to diet, you can make your
complete a registration form and case for NHS support with
return it to a community pharmacy of your GP based on your
your choice. The pharmacist will be particular needs
able to register you to use the service
and provide more information. Find Prescriptions are free of charge in
out more at www.coeliac.org.uk/ Scotland and Wales but if you live
pharmacyledsupplyschemes. in England you may need to pay for
your prescription. In England, some
How much gluten free food can I people such as children under 16,
access on prescription? adults aged 60 or over and people
The tables on the opposite page on income support receive free
represent the National Prescribing prescriptions. To find out if you
Guidelines; however, CCGs may have qualify, speak to your pharmacist. If
local gluten free prescribing policies. you do need to pay, you may find that
For more information please see www. buying a prepayment certificate is
coeliac.org.uk/prescription-policies. good value for money. More details
The first table gives you a guide to the of this can be found at
recommended amount of gluten free www.nhsbsa.nhs.uk or by calling
foods you may get on prescription. 0300 330 1341.
This is calculated on a ‘unit’ basis.
Your dietitian may be able to give you
The second table shows some vouchers to send off for sample packs
common foods and what makes up from gluten free manufacturers to
a unit. Check your Food and Drink help you decide which products you
Directory or the Coeliac UK website want on prescription. It’s best to try a
for a complete list of gluten free foods range of different products to know
available on prescription. which ones suit you best.
12 WWW.COELIAC.ORG.UKMonthly recommendations
Age and gender Units per month
Child 1 - 3 years 10
Child 4 - 6 years 11
Child 7 - 10 years 13
Child 11 - 14 years 15
Child 15 - 18 years 18
Male 19 - 59 years 18
Male 60 - 74 years 16
Male 75+ years 14
Female 19 - 74 years 14
Female 75+ years 12
Breastfeeding Add 4
3rd trimester pregnancy Add 1
Food chart
Item Units
400g bread / rolls / baguettes 1
500g bread mix / flour 2
200g savoury biscuits / crackers / crispbreads 1
250g pasta 1
500g oats 1.5
300g breakfast cereals 1.5
2 pizza bases 1
100-170g xanthan gum 1
WWW.COELIAC.ORG.UK 13COOKING
Most everyday meals and snacks Use gluten free flours including:
can be prepared with gluten free • rice
ingredients and Coeliac UK’s Home
of gluten free recipes at • corn (maize)
www.coeliac.org.uk/recipes has • tapioca (cassava)
hundreds of delicious gluten free
• chickpea (besan, channa,
recipes for all occasions plus lots
gram flour)
of hints, tips and information about
cooking and baking gluten free. • buckwheat
Simple suggestions to get potatoes
you started • soya
Use a variety of naturally gluten free
foods and plan meals around them,
• millet
including: • gluten free flour mixes.
• fresh, frozen, canned or juiced fruit Since the baking qualities of gluten
and vegetables free flours are different from wheat
• dried or canned pulses flour, there may be a period of trial
and error.
• dairy products
• rice or potatoes (any type) You can use xanthan gum in baking.
This helps gluten free flours to
• meat, poultry, fish, eggs.
behave more like wheat flour. You
Ingredients that contain gluten can can find this in some supermarkets.
usually be exchanged for gluten free
alternatives. Use your Food and Drink
Directory to find suitable options.
Ingredients that contain gluten can usually
be exchanged for gluten free alternatives.
14 WWW.COELIAC.ORG.UKCROSS CONTAMINATION
Maintaining a strict gluten free diet
means you have to make sure you
don’t contaminate gluten free food
with any crumbs of food that contain
gluten. Be careful to avoid cross
contamination by:
• washing down surfaces
before preparing food
• using separate toasters or
toaster bags for gluten
free bread
• cooking gluten free foods
and foods that contain
gluten in separate pans and
with separate utensils.
WWW.COELIAC.ORG.UK 15EATING OUT
We want you to be able to enjoy is a written notice, menu, ticket or
eating out gluten free. Follow these label that is clearly visible, at the
tips for a more relaxed experience. point that you choose your food, to
indicate that allergen information is
Ask to see allergen information
available from a member of staff.
The Food Information for Consumers
Regulation means caterers have
We are working to make things
to provide you with information on
easier for you
any allergens in all the dishes they
We provide training to food venues to
serve. This means that if a recipe
adhere to our Gluten free Standard,
uses cereals containing gluten in the
which ensures that gluten free food is
ingredients, they have to tell you.
prepared and delivered safely. Venues
Caterers can provide allergen that meet this standard are awarded
information in written or oral formats. GF accreditation and can carry our
Where the information is not provided GF symbol. Look out for this symbol
written and upfront, there must when eating out.
be clear signposting to where the
information can be found. Visit www.coeliac.org.uk/
gfvenues for the latest
Businesses choosing to provide
venues we have accredited.
information orally must ensure there
16 WWW.COELIAC.ORG.UKCheck ahead when booking
a venue When you see the Coeliac
Although caterers have to provide UK GF logo you know that
allergen information for dishes they the restaurant is adhering
serve, they don’t have to offer a to the Gluten free Standard.
gluten free meal so it is best to call
ahead or check their website to see The Standard covers all
if they offer gluten free options. If aspects of gluten free
you speak to restaurant staff, explain preparation as well as
why you need a gluten free diet to ensuring training is in place.
ensure you don’t receive food that Find out more at:
contains gluten. www.coeliac.org.uk/
eatingout
Our Venue guide has thousands of
member recommended or places
we have accredited where you can
stay, eat out or take away food that
is right for your diet. You can access
this online or through our Gluten free
on the Move app which has mapping
technology to show our accredited
venues and take you there.
Planning overnight breaks
Before booking, ring the venue to
check that they can provide food for
people with coeliac disease.
You may need to take your own
bread and cereal. If you want your
bread toasted, ensure they can use
a clean grill or a toaster bag as the accredited by
toaster will also be used for breads
that contain gluten. Taking your
own supplies such as gluten free
bread and crackers means you will
Look out for the GF accredited by
not go hungry if the venue’s choice Coeliac UK logo in eateries and on menus
is limited.
WWW.COELIAC.ORG.UK 17MANAGING COELIAC DISEASE
The treatment for • your diet and how you’re getting
on with the gluten free diet is
coeliac disease is a assessed and it is considered
strict, lifelong gluten whether you need specialist diet
and nutritional advice.
free diet.
If any concerns are raised in your
You should be offered a check up, annual review, you should be
which can be carried out by your GP, referred to a specialist for further
consultant or dietitian. If all is going assessment. The specialist will
well, you should be reviewed once a be able to consider the need for
year, or sooner if problems arise. specific blood tests, a bone scan to
During your review, the following is test for osteoporosis and the risk of
recomended: other long term complications and
• your weight and height are other conditions.
measured Blood tests that might be carried
• your symptoms are reviewed out include:
• full blood count
• calcium
• ferritin
• folate
• vitamin B12
• coeliac disease antibodies –
tissue transglutaminase (tTG) or
endomysial (EMA)
• thyroid function tests
• liver function tests.
18 WWW.COELIAC.ORG.UKCOMPLICATIONS ARISING
FROM COELIAC DISEASE
Is coeliac disease linked to People react in
other health problems?
Early diagnosis of coeliac disease different ways to
and following a gluten free diet their diagnosis
helps to minimise the risk of long
term complications.
of coeliac disease
and starting a
Osteoporosis
Due to decreased absorption gluten free diet.
of calcium, adults with coeliac
At diagnosis and follow up, the
disease are at a greater risk of low
decision for recommendations
bone density (osteopenia) and
on DEXA scanning should be
osteoporosis. However, for children
carried out on an individual basis,
with coeliac disease following a
based on assessment from your
gluten free diet, long term bone
local healthcare professional. You
health is likely to be unaffected.
should speak with your local GP or
There is an increased risk of consultant about your case.
osteoporosis as we all get older. For
Coeliac disease is more common
women, these risks are greater after
among people with other autoimmune
the menopause, especially in women
diseases such as Type 1 diabetes and
who have coeliac disease diagnosed
autoimmune thyroid disease.
later in life. Bone health will usually
improve after starting a gluten free Cancer
diet. It is important to stick to the Long term undiagnosed coeliac
diet to minimise the risk of low bone disease is associated with a small
density and osteoporosis. risk of developing certain types of
gut cancer. These types of cancer
Osteoporosis is diagnosed by having
are very rare and are not associated
a Dual Energy X-ray Absorptiometry
with childhood. Getting diagnosed
(DEXA) scan, which measures bone
and sticking to a gluten free diet
mineral density.
reduces the already low risk of
developing this cancer.
WWW.COELIAC.ORG.UK 19Further help Coeliac UK has a network
People react in different ways to their of Local Groups as well as a
diagnosis of coeliac disease and Member2Member programme. If
starting a gluten free diet. For those you are online we have very active
who have had symptoms for years it communities on Facebook and
may be a relief that, at last, you can Twitter, including our popular ‘Gluten
start to treat the problem. For those free Under Thirties’ (GUTs) group
who have not had any symptoms for 18-30 year olds (please visit
you will usually start to see an www.coeliac.org.uk/guts for more
improvement in your overall health information). These give you the
once you’ve started a gluten free diet. opportunity to share experiences and
seek advice whenever you need it.
Most children diagnosed with coeliac
disease soon adapt to a gluten free They can be particularly valuable
lifestyle. It’s important that children if you or your family are finding
fully understand the reasons for it difficult to adapt to a gluten
changing their diet as peer pressure, free lifestyle.
especially among teenagers, can
become a real challenge. You might
find it helpful to seek advice and Join our online communities:
support from other people or families
Facebook “f ” Logo CMYK / .eps Facebook “f ” Logo CMYK / .eps
facebook.com/CoeliacUK
with coeliac disease.
@Coeliac_UK
20 WWW.COELIAC.ORG.UKBALANCED EATING
It is important to eat a healthy,
balanced diet to provide all the energy
and nutrients your body needs.
This will help to maintain health and
wellbeing throughout life and help
reduce the risk of other diseases.
In childhood, energy, vitamins and
minerals are needed for healthy
growth and develpment.
Healthy eating for children
A child’s diet is not simply about
being gluten free. Childhood is an
important time for growth and
development and children need a
good supply of protein and other
nutrients including calcium, iron and
vitamins A and D.
Calcium intake is particularly
important because it is needed for
strong bones and healthy teeth. A
diet that is rich in calcium can also
minimise the risk of osteoporosis
(low bone density) later in life.
The best sources of calcium are dairy
products, such as milk, cheese and
yoghurts. All cow’s milk contains
the same level of calcium, but semi
skimmed milk is not recommended
before two years of age, and
skimmed milk is not suitable for
under fives.
WWW.COELIAC.ORG.UK 21HEALTHY EATING FOR ADULTS
After starting a gluten free diet, you Finding inspiration for gluten free
may find that you put on weight food can sometimes be a challenge
because the lining of the gut heals but we have an online Home of
and absorption of nutrients from gluten free recipes that can help you.
food starts to improve. Your appetite Simply log on to the website and
may also increase because you search a range of delicious dishes
are feeling better. Hopefully, any and varied cuisines. Visit
increase in body weight should even www.coeliac.org.uk/recipes.
out after a few months as your body
adapts to the change.
Your dietitian is best
Eating a balanced diet and placed to assess your
maintaining a healthy weight helps
reduce the risk of diseases such as
diet and give you
heart disease and Type 2 diabetes. tailored advice to
Healthy eating recommendations for meet your individual
weight control on a gluten free diet
are no different to those for people needs. Your GP or
without the condition. It is important hospital doctor can
that you eat a calcium rich diet to
arrange a referral to
maintain healthy bones and reduce
the risk of osteoporosis. a dietitian.
22 WWW.COELIAC.ORG.UKEight simple steps towards a • eat plenty of fibre. Good sources
healthy gluten free diet: include brown rice, high fibre/
multigrain gluten free breads, pulses,
• e
at regular meals based on
nuts and seeds, fruit and vegetables,
starchy carbohydrates such as
and potatoes in their skins
rice, potatoes, yams, millet, quinoa
and teff, and gluten free breads • cut down on salt. Use less in
and pastas. Try to choose higher cooking and read the label of ready
fibre and wholegrain options made foods to help you choose
when you can lower salt versions
• aim to eat at least five portions • a
void drinking too much alcohol.
of fruit and vegetables a day. Men and women are advised
Include a variety as they all contain not to regularly drink more than
different nutrients and can have 14 units per week, and to spread
different benefits these out evenly over three days
or more. For more information
• cut down on foods that are high
about units of alcohol visit
in saturated fat which is found in
www.drinkaware.co.uk
animal products including butter,
fatty cuts of meat and full fat • m
ake sure you get enough
dairy foods vitamin D. 10 micrograms per day
is the recommended amount, but
• limit your intake of sugary foods
a supplement may be necessary
and drinks. Sugar is a main
in the winter months.
ingredient in sweets, cakes, sweet
biscuits and some soft drinks
WWW.COELIAC.ORG.UK 23HEALTHY EATING FOR
CHILDREN
Iron is essential for growth and
development. Good sources are meat,
poultry, fish, green leafy vegetables,
pulses (beans, peas, lentils) and dried
fruit. Iron is absorbed better from
animal sources.
Children’s nutritional requirements
vary according to their age. For • aim to give your child one to two
specific advice speak to your dietitian.
portions of meat or fish, or two to
Seven simple steps towards a three portions of eggs, nuts and
healthy gluten free diet pulses, a day. These foods provide
for children: protein and iron
• base your child’s meals on • limit the amount of sugary foods
starchy carbohydrates such as and drinks to encourage healthy
rice, potatoes, yams, millet, quinoa eating from a young age
and teff, and gluten free breads • there is no need to add salt to your
and pastas child’s food. If you are buying ready
• encourage your child to try lots made foods always read the label
of different types of fruits and to check how much salt it contains
vegetables and aim for at least five and choose lower salt versions
portions a day • make sure that your child gets
• include plenty of milk and dairy enough vitamin D. Infants should
foods such as cheese, yoghurt and have 8.5-10 micrograms per
fromage frais as these are a good day, whilst children between
source of calcium and protein. one and four should have a daily
Provide full fat dairy foods for the 10 micrograms supplement.
under fives, but lower fat versions Children four and above should
can be provided for older children get 10 micrograms per day, with
supplements in the winter months.
24 WWW.COELIAC.ORG.UKTIPS FOR PARENTS AND CARERS
It’s natural for any parent or carer Let them know that your child has
of a child with coeliac disease to be coeliac disease and needs to follow a
concerned about the possible health strict gluten free diet.
or dietary problems their child may
encounter when away from home. Download our schools’ pack at
www.coeliac.org.uk/schools for
Starting school, going to parties and comprehensive information on
getting involved in more food based managing coeliac disease in school,
activities may seem daunting, but to share with the school.
with a little forward planning, there is
no reason why these challenges can’t You can provide them with
be overcome. information about foods that can
be eaten and those that must be
Nursery, playgroup or school
avoided. Remember that young
Starting or changing nursery,
children often make mistakes or
playgroup or school is a big step for
swap food with other children so it is
you and your child. Make sure you
important that staff are vigilant.
provide the adults, childminders or
teachers who are looking after your Letting the staff know what
child with as much information as symptoms to expect if gluten is
possible. This will help to reduce the eaten is a good idea. Also explain
likelihood of problems and make the long term effects of not keeping
sure your child adapts well to each to a gluten free diet, such as
new experience. continued gut damage and poor
absorption of nutrients.
Before your child starts, make an
appointment to see the person
in charge, as well as any relevant
teaching and catering staff.
Check out our schools’ pack for a recipe to
make your own play dough at:
www.coeliac.org.uk/schools
WWW.COELIAC.ORG.UK 25• clarify what foods can be eaten
and what foods need to be avoided
– it may be useful to provide them
with a copy of this booklet and the
Gluten free Checklist.
Playtime
Gluten has to be eaten to cause
symptoms, so using paints, crayons
and glues should not be a problem
unless your child accidently eats
them. As young children will often put
things in their mouth, using materials
made with no gluten containing
ingredients is a sensible option.
Preschool children will often make
art and instruments with dried pasta.
As this may be tempting for small
Below is a useful checklist of things children, it is advisable to use gluten
to cover with your childcare provider: free pasta or supervise the child.
• e
xplain what coeliac disease is and Play dough is not always gluten free.
once a child with coeliac disease However, it is easy to make play
follows a strict gluten free diet they dough using ingredients that don’t
will feel better contain gluten.
• highlight that coeliac disease is Cookery lessons in primary
not contagious nor an allergy, school
emphasising that they will Children often make small cakes or
not suffer a life threatening cookies as part of the curriculum
anaphylactic reaction and, with some forward planning,
• explain what will happen if your there is no reason why your child
child eats gluten by mistake so cannot take part.
they are aware of what to expect.
Cookery lessons in secondary
The most common symptoms
school
include diarrhoea, nausea, tummy
Food technology classes should not
ache and wind
cause a problem for your child and
26 WWW.COELIAC.ORG.UKthere is no reason why gluten free School meal times
foods cannot be used. Speak
There are universal free school meal
to the teacher about using gluten
policies for certain school years
free ingredients.
in schools in England, Scotland
and Wales. In addition, free school
Cross contamination
meals are available to some
Before your child takes part in
children depending on individual
cookery lessons it may be useful to
circumstances, for example the
speak to the teacher about cross
receipt of certain types of benefits.
contamination. Top tips to avoid
cross contamination: If a child is entitled to a free school
• keep all utensils separate during meal, they should not be excluded
preparation and cooking of gluten because they have coeliac disease.
free food
If you want your child to have a lunch
• don’t fry gluten free food in the which is provided by the nursery or
same oil as foods that contain school, speak to the catering staff
gluten about suitable choices and providing
• use a clean grill pan, separate gluten free alternatives. Discuss
toaster or toaster bags when adjustments or alternatives that they
making gluten free toast could make to their normal weekly
menu, and speak to the catering staff
• be careful when preparing gluten
about cross contamination.
free food in a floury environment.
WWW.COELIAC.ORG.UK 27case they swap them for something
For packed lunch that contains gluten. Encourage them
ideas, check out our to double check any food they are
unsure of.
website at
www.coeliac.org.uk/ To avoid your child feeling different
from other youngsters at snack
packedlunches times, you may need to provide
gluten free snacks. Inform staff
Visit www.coeliac.org.uk/schools that these snacks should be stored
to download an information pack on separately to avoid contact with food
school food provision where you are. that contains gluten.
You may prefer to provide your own If you feel you’re not getting the
food which can be heated up or a support that you would like, have a
packed lunch. Make sure your child chat with your local dietitian who may
knows not to swap items in their be able to speak to the school on
packed lunch with their friends, in your behalf.
28 WWW.COELIAC.ORG.UKSchool trips and special occasions automatically expect them to cater
If your child is going on a residential for your child. Discuss your child’s
school trip, call ahead and speak dietary requirements with them
to the cook or person providing in advance.
the meals and talk to the teacher
in charge of the trip to explain your If they are unable to cater for your
child’s dietary needs. child ask what type of food is being
prepared so you can substitute
Pack basic items such as gluten free
similar gluten free versions. Perhaps
bread and crackers so that your child
you could take along gluten free
has some emergency supplies. This
alternatives for everyone to try so
is recommended for any trip away
your child feels included.
from home.
Going to a party
It’s worth bearing in mind that
the party organiser will probably
be very busy on the day, so don’t
WWW.COELIAC.ORG.UK 29FREQUENTLY ASKED QUESTIONS
Can I eat oats? to many brands of breakfast cereals
Oats do not contain gluten but and some other products like
they have a similar protein called chocolate. Foods that contain barley
avenin. Many oats and oat products malt extract in small amounts may
are contaminated with gluten be included in the gluten free diet.
from wheat, barley and rye so it is However, any foods that contain
important to only eat oats and oat barley malt extract will be labelled as
products that are labelled gluten free. containing barley and you will not be
You can find a list of these in your able to tell from the ingredients list
Food and Drink Directory. Gluten how much has been used. If you are
free oats may be introduced to the unsure whether the food is suitable
diet at any time. However, a small check your Food and Drink Directory,
percentage of people with coeliac contact our Helpline on 0333 332
disease are sensitive to avenin and if 2033 or contact the manufacturer.
you have ongoing symptoms whilst
including gluten free oats in your diet, What if mistakes are made?
review their use with your Becoming familiar with your new diet
healthcare professional. after diagnosis is a learning process
and it is likely that you’ll make some
What is gluten free wheat starch mistakes. The reaction to eating
or Codex wheat starch? gluten varies from person to person.
This is a specially made wheat Symptoms don’t tend to happen
starch where the gluten has been straight away; they can take hours or
removed to a safe level. It is added to up to a couple of days to develop and
some gluten free foods available on may last several days, while other
prescription, such as flour and bread, people might not get any symptoms.
to improve their quality and texture. If gluten is eaten by accident,
If Codex or gluten free wheat starch it is unlikely to cause lasting gut
has been used it must be listed in the damage. The important thing is
ingredients list. to stick to your gluten free diet to
prevent further symptoms and help
Can I eat barley malt extract?
your gut heal.
Barley malt extract is a flavouring
that is often added in small amounts
30 WWW.COELIAC.ORG.UKMORE INFORMATION
Our information leaflets are designed We also have a range of services on
to help you manage your gluten free our website to help you support your
diet at all stages of your life, while gluten free lifestyle. Log on to the
providing additional information website and take a look at the:
about your diet and health. • Food and Drink Directory
Please visit our website for a full list • Home of gluten free recipes
and to download your copies.
A selection of the leaflets we • Venue guide
provide includes: • Scrapbook, which you can
• Dermatitis herpetiformis personalise.
• Osteoporosis
Don’t forget our apps,
• Lactose intolerance Gluten free on the move
• Coeliac disease and Type 1 and Gluten free food
diabetes. checker, which you can
download from the App
ASSOCIATED CONDITIONS
ASSOCIATED CONDITIONS
Store and Google Play Store.
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When you have osteoporosis, your bones become What can I do about it?
app now
thin and more likely to break. Your doctor will You can help keep your bones strong by following Eat out with confidence
on your gluten-free
diet
diagnose it by looking at the strength of your a healthy, balanced, gluten free diet rich in calcium. Is it Coeliac Disease?
>
bones, using a measure called Bone Mineral Take our online assessment
If you have coeliac disease you need more calcium
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Density. A BMD below a certain score means
B erk s h i re
Products and Services
Fou r CCGs i n West
Recipe of The Month
re e
ch a ng e t hei r gluten-f
pres cr ibi ng p ol icies
than the average person. Adults with coeliac disease
you have osteoporosis. Chorley & Sout h R
ibble a nd
should have at least 1000 milligrams (mg) of calcium
’s
Greater P reston CCG
cr ipt ion s
rev iew i ng GF pres
It’s associated with coeliac disease because bone every day. You can use the table overleaf to find good
re e
Fight i ng for gluten-f
he
pres cr ipt ion s i n t
Member Benefits s
Offers For You house of Com mon
health relies on calcium, and people with gut damage sources of calcium that are gluten free. Gower Brew i ng Ltd
re ca l l i ng fou r b e ers
is
due
may struggle to absorb calcium. There’s another
to u nde cl a re d wheat
condition called osteopenia, where your BMD is lower How can I minimise the risks? Gluten-f ree foo d checker
app
Foo d & Dr i n k Di rector
y
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than normal, but not as low as in osteoporosis. Lots of factors can reduce the risk of osteoporosis.
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following a gluten free diet. This will allow your gut to
Professionals
Gluten-free & Research
About Us Coeliac Disease
Diet & Lifestyle Work Caterer s A nd
D i a g no si s
T he Sh ap e O f O u r Res t au r ateu r s
Ca mp a ig n Wit h Us M a n a g e me nt
our lives – it’s at its peak in our mid twenties. If, like
iet
T he Glute n-F re e D c es s es
Ab out Co e l i ac D i s
ea s e A nd
2016 - I s O u r Ca mp a ig n S uc M a rket i ng O pp or
t u n it ies
heal and help you absorb more calcium, which is vital
W ho We A re i for m i s Awa re nes s We e k Res ou rc es
D er m at it i s Her p et Fo o d Shoppi ng Hea lt h
It Co e l i ac D i s ea s e? Ca mp a ig n i ng O n T he L aw sion a l
Glute n-F re e A nd Hea lt hc a re profes
W h at We D o d
G et t i ng D i a g no s e P res c r ipt ion s News let ter
Volu nte er For Us I s It Co e l i ac D i s ea
s e? nd
M a nu fac t u rer s A
O u r O rg a n i s at ion no s e d nd D r i n k Ca mp a ig n
O nc e You' Re D i a g E le c t ron ic Fo o d A
many people, you weren’t diagnosed with coeliac
a re
L o c a l Group s Ret a i ler s J oi n O u r Hea lt hc
b er s h ip
for bone health.
News D i re c tor y
Glute n-F re e Gu a r
a nte e t P rofes sion a l Me m
Ta l k To Us
F u nd r a i s e For Us Glute n-F re e P ro duc
Co ok i ng A nd B a k
i ng Ca mp a ig n Cer t i f ic at ion sion a l s
Me d i a Ce nt re ion s A nd Hea lt hc a re P rofes
A s s o c i ate d Cond it rch
Co e l i ac U k 'S Res ea Res ea rch S t r ate g
y c tor y Fa qs
A b out Us Fa qs Compl ic at ion s Re c ip e D at a ba s e Fo o d S er v ic e D i re
F u nd
disease until later, you may not have been absorbing
sion a l
a l Vi sit s Res ea rch P r ior it ies Hea lt hc a re P rofes
F i nd Us Me d ic at ion , Ho s pit Eat i ng O ut Fo o d I ndu s t r y
S upp or t Us For u m
A nd Vac c i n at ion s n it ies P rofes sion a l s Fa qs
Ve nue Gu ide F u nd i ng O pp or t u
More things you can do:
Blo g Our
Co e l i ac D i s ea s e G et I n Touch Wit h
G lute n F re e Fo o d
Che cker C u r re nt Res ea rch
I n Ch i ld re n E ve nt s Com merc i a l Tea m
calcium properly for some time. This puts you more at
App
P rev iou s Res ea rch
My t h s Ab out Com mu n it y
he
C o e l i ac D i s ea s e Glute n-F re e O n T ea rch
G et I nvolve d I n Res
Move App G et I nvolve d Fa qs
qs
Co e l i ac D i s ea s e Fa O u r Res ea rch Con
fere nc e
g a z i ne
Cro s s e d Gr a i n M a Comp et it ion s
risk of having a low BMD, and osteoporosis. regular weight bearing exercise, such as jogging,
ea rch
Ca mp a ig n s A nd Res
•
News let ter s
Fa qs
l
Hol id ay s A nd Tr ave
nt s
S upp or t For Pa re
walking, gardening and dancing
S cho ol Mea l s
n
Adv ic e For Ch i ld re
People with coeliac disease
A nd You ng Pe ople
nd a rd s
Ho s pit a l Fo o d S t a
Ke epi ng Hea lt hy
• avoid smoking
t s A nd
G lute n-F re e P ro duc
need more calcium than others.
S er v ic es
Glute n-F re e D iet
A nd L i fes t yle Fa qs
Us e f u l L i n k s
• avoid drinking too much alcohol
If you were diagnosed with coeliac disease in your
childhood or teens and follow a gluten free diet, your Another thing that can help is vitamin D. This helps
long-term bone health isn’t likely to be affected. you absorb calcium, and is made by your body when
you get sunlight on your skin. In the UK, we can
Your BMD will usually improve after starting a gluten
struggle to get enough from sunlight in the winter
free diet. However, women diagnosed with coeliac
months. That means it’s important to get vitamin D
disease after the menopause find it more difficult to
through our diet. Good sources include oily fish, eggs
improve their BMD. You’re more at risk of osteoporosis
and products like margarine with added vitamin D.
as you get older and this risk increases if you have a
low body weight, smoke or drink too much alcohol. Public Health England and the Scottish Government
have published recommendations on vitamin D
Should I be tested? supplements. They say that vitamin D supplements
Osteoporosis is diagnosed by a bone scan, known as should be considered in the winter months for
a Dual Energy X-ray Absorptiometry (DEXA) scan. This everyone aged 4 years and older.
measures your BMD. Your GP or consultant will help
you decide whether a DEXA scan is necessary.
This information is for guidance only and should not replace advice given
by your healthcare professional.
WWW.COELIAC.ORG.UK 31KEEP IN
TOUCH
Call us: 0333 332 2033
Email us:
generalenquiries@coeliac.org.uk
foodanddrink@coeliac.org.uk
dietitian@coeliac.org.uk
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0333 332 2033
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