NHD clinical - coeliac disease

by Fiona Moor Dietetic Manager Derby Hospitals NHS Foundation Trust

Fiona Moor has been managing the dietetic department in Derby for the last 10 years, providing dietetic service to those patients in Southern Derbyshire who have Coeliac disease. Fiona runs specific dietetic-led coeliac clinics, group sessions and holds face- to-face consultations for newly diagnosed patients.

Coeliac disease – what you need to know

A recent Coeliac Watch (NHD Feb pg 27) gave an overview of coeliac disease before talking generally about gluten sensitivity. This article is designed to introduce further facts about the condition and provide some practical advice.

Coeliac disease is one of the most common lifelong disorders. It is a condition of the small intestine caused by the ingestion of gluten, a protein found in wheat, rye and barley based cereal. This results in damage to the villi lining the duodenum. The degree of damage varies from person to person and causes a wide range of symptoms. The prevalence of the coeliac condition varies across the world ranging from 0.5 – 1.0% in Europe to 5.6% amongst the Arab population living in Western Sahara (1). The reason for this wide variation is still unclear, although genetics are thought to play a part.

What causes coeliac disease is still is still unknown, but certain factors make individuals more susceptible: • genetic predisposition

Foods Allowed

Cereals and flours

Baked foods

Dairy products and eggs

Meat, fish and poultry

Fruit and vegetables

Fats and oils

• family history – five to 15 percent of first degree relatives are affected

• increased stress on the body from pregnancy, major surgery, gastrointestinal infection

• other auto-immune disorders (Type 1 diabetes, thyroid problems)

Individuals with coeliac disease can present in a number

of different ways. Those who present in childhood display more typical symptoms of chronic diarrhoea, poor appetite, weight loss and abdominal distension. However, 25 percent of adults diagnosed are over the age of 60 and 10 percent are over 70. Only half of all adults will have diarrhoea, many have non-specific symptoms of anaemia, poor appetite, leth- argy, abdominal bloating, indigestion and nausea. Diagnosis is made through collecting and correctly piec- ing together clinical symptoms, serological tests, histological and genetic evidence.

Gluten-free diet

The only treatment for the coeliac condition is a gluten-

free diet. This requires the removal of the grains wheat, rye and barley and any foods made from or containing them. However, a gluten-free diet is not the same as a zero gluten diet and, in fact, at present it is not possible to test foods for zero gluten; the current detection limit is 20ppm. Foods containing less than 20ppm can be eaten freely within the gluten-free diet. Table 1 gives a general idea of those foods allowed and those to avoid when following a gluten-free diet.

NHDmag.com June '10 - issue 55

150g sweet/savoury biscuits/crackers 200g sweet/savoury biscuits/crackers/crispbreads 250g pasta 500g pasta 2 x 100g-180g pizza bases ¾ 1 1 2 1

25

Foods made from maize, potato, rice, soya and sago.

Gluten-free bread, cakes, mixes, pasta

Milk, cream, most yoghurts, cheese and eggs

All fresh meat, fish and poultry

All types fresh, frozen, canned, dried

Butter, margarine and oil

Prescription products

Whilst taking into consideration foods allowed and not al- lowed it is important to remember the overall nutritional ade- quacy of the diet. To assist with this, specially manufactured foods are available on prescription. Each prescribable item is given a unit value based on the energy and carbohydrate con- tent and cost.

Units of prescribable items:

Prescribable food items

400g bread

400g rolls/baguettes 500g bread mix/flour mix/pastry mix/cake mix 100g sweet/savoury biscuits/crackers

Unit

1

1 2 ½

Foods to Avoid

Products containing wheat, barley, rye and oats. Pasta.

Bread, pastry, cakes and wafers

Artificial cream and low fat cheeses may contain flour

Pies, stuffing, fish fingers, sausages

Vegetables canned in sauces e.g. mushrooms

Suet and some very low fat spreads

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