Health and Fitness FACT SHEET SERIES: COELIAC DISEASE AND GLUTEN INTOLERANCE 29 March 2017 Studio Pilates Background Coeliac Disease is a life long inflammatory condition that affects the small intestine. It occurs when a person’s immune system reacts to a protein called gluten. Gluten is found in cereals such as wheat, rye, barley, spelt and triticale. The treatment for Coeliac Disease is a strict gluten-free diet for life. Gluten Intolerance is not as severe as Coeliac Disease, but is much more common. A person with Gluten Intolerance will not usually end up as diabolically ill from eating gluten as an actual Coeliac patient will, but are still definitely better off without it. They may be able to eat small amounts of gluten, but end up with a stomach ache, or bloating and sluggishness or tiredness, and just generally feel much better without eating gluten when possible. Symptoms When a person with Coeliac Disease eats a food that contains gluten, the gluten damages the lining in the small intestine, reducing it’s ability to absorb nutrients. Common symptoms of Coeliac Disease include chronic constipation, diarrhoea, anaemia, weight loss in older children or adults, and poor weight gain in young children. However symptoms may be less obvious and some people can have Coeliac Disease without being aware of it. Sources of gluten Obvious sources of gluten in the diet are those foods containing wheat, oats, rye, barley, spelt or triticale. For example most breads, breakfast cereals, crispbreads, porridge, rye bread and soups with barley will contain gluten. Wheat flour is a very common ingredient in food, and care must be taken to avoid pastas, biscuits, cakes, pastries, puddings and pies that contain wheat flour. Hidden sources of gluten Being aware of hidden sources of gluten is the most difficult part of the gluten-free diet to manage. Gluten is contained in many manufactured and processed foods because wheat flour is commonly used as a processing aid, binder, filler, thickener or as a carrier for flavourings and spices. Trace amounts of gluten may also be contained in ingredients derived from wheat, barley, oats or rye. See the table for more information. *Oats do not contain gluten, however are often processed in factories where other gluten-containing grains are processed, and the risk of contamination is high. Very sensitive people may react to oats while others may be able to include them in their diet. Cooking tips It is possible to make your recipes gluten-free by changing the flours. Follow the tips below to assist you in choosing which gluten-free flour to use for different recipes, and how much to use. Soya flour can be used in most baked products. Cornflour (from maize flour) and potato starch work well in biscuits and sponge cakes. Cornflour (from maize flour) is best used in recipes where a small amount is required. When larger amounts of cornflour are used, as in scones, the end product is crunchy and granular. Substituting rice flour or any other gluten-free flour for part of the cornflour in a recipe will improve the texture of the baked product. Rice flour can be used along with cornflour in baked products. It may need more liquid than the usual recipe suggests. Potato starch can be used as a thickener. Eat a wide variety of nutritious foods The diets of people with Coeliac Disease can sometimes be low in certain nutrients such as fibre, iron, calcium, and the vitamins folate, B1 (thiamin) and B12. This is due to either malabsorption prior to diagnosis and/or the nature of the foods selected when following a gluten-free diet. To boost your daily fibre intake, incorporate the following tips: Use buckwheat in pancakes, as a stuffing in vegetables and when making meatballs. Make your own muesli with rice flakes, buckwheat, soya bran, sunflower seeds, nuts and fruit. Sprinkle rice bran and soya bran onto gluten-free cereals and use in cooking. Use brown rice instead of white rice. Eat legumes. These include kidney beans, haricot beans, soya beans, chickpeas, 3 bean mix, borlotti beans and butter beans. Try them in soups, casseroles, salads and patties. Eat plenty of fruits and vegetables (retain skin where possible eg. potatoes, fruits). Iron is best obtained from animal sources such as lean red meats, offal, pork chicken, fish, seafood. Other foods that contain iron include eggs, legumes, tofu, dried fruit, nuts and vegetables (particularly green leafy varieties such as spinach, broccoli, cauliflower and cabbage, beans and peas). A source of vitamin C should also be consumed at the same meal as vegetable sources of iron to maximise absorption. Good sources of vitamin C include capsicum, broccoli, cabbage, cauliflower, tomatoes, potatoes, strawberries, citrus fruits, kiwi fruits, rockmelon and fruit juices. Folate can be obtained from lean meats, chicken, orange juice, leafy green vegetables, legumes, peas, eggs, fresh fruits. Good sources of thiamine are lean meats, chicken, orange juice, leafy green vegetables, legumes, peas, eggs, fresh fruits. Good sources of vitamin B12 are lean meats, chicken, fish, eggs and milk. Join the Coeliac Society A lot of useful information on about the gluten free diet, ingredients, where to buy gluten free food, recipes and cooking, eating out, overseas travel and research is available from the Coeliac Society of Australia and the individual state Societies. Visit their website http://www.coeliac.org.au/ for more information. If you have Coeliac disease or suspect you may be Gluten Intolerant, you should see an Accredited Practising Dietician for more individualised advice.