Posted by John Duffy MPSI in Features.

This article appears courtesy of John Duffy MPSI of Claregalway Pharmacy. For more information, phone 091 799 754 or pop in and speak with any of the staff. Open Monday–Friday 9am–8pm and Saturday 9am–7pm.

Coeliac Disease—gluten free diet
Coeliac disease is a condition that causes inflammation in the lining of the small intestine (part of the gut).The lining of the gut contains millions of tiny tube-shaped structures called villi. These help food and nutrients to be digested more effectively into the body. But in people with coeliac disease, the villi become flattened as a result of the inflammation. This means that food and nutrients are not so readily digested by the body.

Although there is no once and for all cure for coeliac disease, the symptoms can be kept away by having a diet free from gluten. Also, having a gluten-free diet reduces the risk of developing complications in the future. People with coeliac disease may develop complications such as osteoporosis (thinning of the bones) or immune-related diseases (autoimmune diseases) such as type 1 diabetes or an underactive thyroid. Women may have a baby that has a low birth weight or is born prematurely.

If you have been diagnosed with coeliac disease, you will have to exclude gluten from your diet for life, as the condition is permanent. By removing all sources of gluten from your diet, this will repair the damage caused to the intestines, restoring nutrient absorption and improving any symptoms you may have experienced.


The gluten-free diet
Managing coeliac disease simply involves removing all sources of gluten from your diet. There are sources that might seem obvious. However, there are some foods that might contain hidden sources of gluten.


Reading labels and identifying gluten in foods
By law, if a food contains gluten it must be listed on the label. You may see an allergen advice box saying ‘contains gluten’. Many processed foods contain gluten, as it is used as an additive or foods become contaminated during the production process. Therefore, it is important to check the labels when out shopping.

Avoid products that contain any of the following:

  • Wheat
  • Barley
  • Rye
  • Spelt
  • Oats (contaminated oats)
  • Malt and malted barley (found in breakfast cereals, vinegar, sauces, pickles and confectionery)

Not all foods that are gluten-free will mention this on the label, so always check to see whether it contains gluten. The crossed grain symbol is used by many manufacturers to highlight that a product is gluten-free. Some manufacturers may use their own symbol. Other products may simply state it on the packaging. For example, you may see:

  • Gluten-free
  • Suitable for coeliacs
  • Free from gluten


Foods that contain gluten

Checking the labels is useful when identifying foods that contain gluten. However, it’s helpful to have a general idea of what foods to avoid and what foods are allowed.

Food Group Foods Allowed Foods to Avoid
Cereals and flour Cornflour, polenta, potato, cassava, bean and lentil flour, split pea flour, millet, quinoa, buckwheat, rice (all types), maize, arrowroot, sorghum, teff, amaranth.Breakfast cereals allowed are: Cornflakes®, Rice Krispies®, Coco Pops®, Crunchy Nut Cornflakes®, Frosties®. (Always check the label as some varieties may not be gluten-free.) Wheat, rye, barley, bulgar wheat, spelt, durum wheat, triticale, khorasan wheat (Kamut®), wheat flour, wheat starch, wheat bran, oat bran, semolina, couscous, malt and malted barley, bale.Avoid all wheat-based breakfast cereals and muesli.
Breads, cakes and biscuits Gluten-free products specially manufactured (supermarkets have specialised ranges): eg, breads, biscuits, pizza bases, flour mixes, cakes. Products made from cereals or flours from the allowed list. Products made without flour (check the label for other gluten sources) or with gluten-free flour. All bread and bread products—eg, croissants, bagels, pitta bread, chapatti, naan bread, crispbreads, crackers, matzos, muffins, scones, croutons, pancakes, pizza, yorkshire puddings, wafers and ice cream cones, pastries and pies.
Pasta, rice and noodles All types of fresh rice. Rice noodles (check the label). Gluten-free pasta, corn pasta. Any fresh, dried or tinned pasta, and noodles. Processed rice found in salads or ready meals.
Potatoes All fresh potatoes. Some crisps (check the label). Homemade chips made from fresh potatoes. Processed potatoes—eg, potato salad, waffles, some chips, instant mash, crisps or potato snacks.
Meat, fish and poultry All fresh meat, fish and poultry. Tinned fish- eg, tuna/salmon. Smoked, kippered or dried fish. Gluten-free sausages. Gluten-free fish fingers. Some processed meats or products coated in batter or breadcrumbs. Pies, puddings, suet, stuffing, fish fingers, chicken nuggets, fishcakes, sausages, burgers, haggis, taramasalata, rissoles, Quorn®.
Milk, dairy, eggs and dairy alternatives Natural plain cheese, fresh milk, cream, condensed milk, yoghurts, fromage frais, soya milk, goat’s milk, coconut milk, almond milk, rice milk, dried skimmed milk powder, eggs. Check the labels of processed cheese, low-fat cheese spreads, artificial cream and yoghurts. Yoghurts containing muesli or cereals. Scotch eggs.
Fats and oils Vegetable oil, olive oil, butter, lard, reduced fat/low-fat spreads (check the labels). Suet, some brands of low-fat spreads.
Fruit, vegetables, nuts and pulses Fresh, dried or tinned fruit, vegetables, nuts, beans, pulses and seeds. Check labels of some baked bean brands. Processed fruit and vegetables that are coated in breadcrumbs/or in sauces. Some brands of nuts.
Desserts and puddings Meringues, sorbets, ice creams, jelly, mousses, custard powders, milk puddings made with gluten-free ingredients. Always check labels of these food products. Trifles, sponge puddings, semolina, tarts, and puddings made from flours in the foods to avoid list.
Snack foods Prawn crackers, rice cakes, poppadoms, home-made popcorn, gluten free crisp breads and crackers. Pretzels, Bombay mix, snacks made from flours in the foods to avoid list.
Confectionery, sweets and preserves Sugar, golden syrup, icing sugar, treacle, molasses, jam, honey, marmalade, peanut butter, boiled sweets and jellies. Some chocolate bars, toffees and sweets (always check labels).
Soups, sauces and seasonings Fresh salt and pepper, herbs, spices, vinegars (eg, rice wine, balsamic), homemade fresh soups, gluten-free soups, sauces and seasonings. Malt vinegar, packet soups and sauces, gravies, soy sauce, ketchups, mayonnaise, salad dressings, pickles and chutneys, stuffing and stuffing mixes, stock cubes, bouillon, Worcestershire sauce (some brands may be gluten-free).
Drinks and alcohol Tea, coffee, fizzy drinks, squashes, cordials, fresh juices, milk, some cocoa powders, cider, spirits, wines, liqueurs, sherry, port. Barley drinks or squashes, cloudy fizzy drinks, malted milk drinks, instant vending machine drinks, some milkshakes and sports drinks, beer, lager, stout, ale.
Other Bicarbonate of soda, fresh and dried yeast, marzipan, yeast extracts, tofu, food colourings and flavourings, gelatine. Baking powder, some medicines and vitamins.


Foods naturally free from gluten
If foods are being excluded from the diet, it is important to ensure you are still having a balanced diet to get all the nutrients you need. Foods naturally free from gluten include fruit, vegetables, meat, fish, rice, potatoes, beans, pulses, nuts, eggs, milk and dairy. Sticking to a gluten-free diet can be difficult, so including plenty of these in the diet will make it easier.


Gluten-free alternatives
Living with a diet free from gluten can be difficult, and so there are products available to help keep the diet varied and easier to maintain. These products will also help to provide you with the energy and nutrients you need.

There is a wide range of gluten-free products available. It’s likely that you’ll find gluten-free alternatives of most foods. Products available include the basics such as gluten-free bread, pasta, flour, plain biscuits and cakes, crackers, crispbreads and pizza bases. Luxury products include biscuits, cakes, muesli, muffins, stuffing mix, confectionary, cereal bars, fish fingers, chicken nuggets and other convenience foods.

Many of the supermarket chains have gluten-free ranges. Some companies that provide gluten-free products include:


Oats can be part of a balanced diet in most people with coeliac disease, without causing damage or symptoms. These must be pure, uncontaminated oats and so some products available on supermarket shelves may not be suitable. A list of manufacturers’ products that are safe and free from contamination can be found on the Coeliac UK website and in their Food and Drink Directory.

Oats can be a useful addition to the diet, as they are a valuable source of fibre and improve variety in the diet. This makes it easier to comply with a gluten-free diet. However, oats should be excluded for the first six months after diagnosis. This allows your body to become used to a gluten-free diet. Oats can then be gradually introduced but should be done with the assistance of a dietitian in case you react to pure oats.


Overall balance of the diet
Once you have successfully achieved a gluten-free diet, it is important to consider other aspects of your diet to keep you healthy. A diet in line with the eatwell plate will provide you with all the nutrients and energy you need. After commencing a gluten-free diet, the lining of the intestine will repair, restoring normal absorption of nutrients. This means that deficiencies such as iron-deficiency anaemia should begin to resolve and improve.