Transcript Coeliac disease - Dr. Schär Institute

Coeliac Disease and
A Gluten Free Diet
Your name and job title
What will be covered?
• What is Coeliac Disease?
• What are the symptoms?
• What causes Coeliac Disease?
• The gluten free diet
• Help with reading food labels
• Important nutrients
• Top tips – cross-contamination and eating away from home
• Take home messages
Coeliac Disease and a Gluten Free Diet
What is Coeliac Disease?
• An ‘auto-immune’ disease
• A life-long intolerance to gluten –
a protein found in wheat, rye
and barley
• When gluten is eaten, an immune response is
triggered, resulting in damage to the delicate
lining of small intestine – the ‘villi’
Coeliac Disease and a Gluten Free Diet
What is Coeliac Disease?
Coeliac Disease and a Gluten Free Diet
What are the symptoms?
• Symptoms include: Diarrhoea, nausea & vomiting, bloating,
constipation, pain and wind…
• Damage to the gut reduces your absorption of important nutrients and
may result in anaemia
• This immune response may also trigger symptoms
outside of the gut:
– Tiredness, headache/ migraine, joint/ muscle pain
Coeliac Disease and a Gluten Free Diet
Dermatitis Herpetiformis
• The skin manifestation of Coeliac Disease
• Much rarer than CD, affecting less than 1 in 3000 people
Coeliac Disease and a Gluten Free Diet
What causes Coeliac Disease?
• Occurs in people with the right genetic profile for the disease
• Affects 1 in 100 people
• Your risk increases to 1 in 10 if you have a close relative with the condition
• Affects more women than men
• Can occur at any stage of life, most commonly diagnosed > 40 years
• Many people with the condition are still not diagnosed
• Closely linked with other autoimmune conditions –
e.g Type 1 diabetes, thyroid disease
Coeliac Disease and a Gluten Free Diet
How is it diagnosed?
• Blood test
– Measures levels of coeliac-specific antibodies
– tTG (tTGA) and EMA
• Endoscopy and biopsy (camera investigation)
• Gluten-containing diet is essential before and during these tests
Coeliac Disease and a Gluten Free Diet
Why do I need a gluten free diet?
• To allow your gut to heal
• To manage symptoms
• To increase your general feeling of well-being
• To encourage normal growth & development (children)
• To reduce the risk of complications,
– including anaemia, osteoporosis (thinning of the bones) & small bowel cancer
Coeliac Disease and a Gluten Free Diet
Where is gluten found?
• Wheat, rye, barley &
contaminated oats and products
that contain these, including:
• Wheat/ rye flours
• Breads, pasta & breakfast cereals
• Cakes & pastries
• Biscuits & crackers
• Batters & thickened sauces
• Beers/lagers and barley water
Coeliac Disease and a Gluten Free Diet
… so what can I eat?
• Many foods are naturally gluten free
• Rice & potatoes
• Fruit & vegetables
• Other cereal grains including corn
(maize), millet and polenta
• Dairy foods & eggs
•
Meat, fish and poultry where gluten
has not be added during processing
Coeliac Disease and a Gluten Free Diet
Foods to check
• Processed/ ready made foods and
dishes may contain unexpected
gluten added as a stabiliser or
binder – always check the label
• Coeliac UK Food and Drink
Directory lists over 10,000 gluten
free products sold in the UK
Coeliac Disease and a Gluten Free Diet
Specialist gluten free foods
• A range of specialist gluten free foods are available in supermarkets,
health food shops, online and on prescription.
• Try a variety of brands to see which one you prefer!
Coeliac Disease and a Gluten Free Diet
Gluten free on prescription
Age
Number of Units
1-3
10
4-6
11
7-10
13
11-14
15
15-18
18
19-59 (Male)
18
60-74 (Male)
16
75+ (Male)
14
19-74 (Female)
14
75+ (Female)
12
Breastfeeding
+4
Pregnancy (3rd Trimester)
+1
Coeliac Disease and a Gluten Free Diet
What is a unit?
Food Description
No. Units
Bread Loaf (400g)
1
Rolls/ Baguettes (100-250g)
½
Rolls/ Baguettes (251-400g)
1
Flour/ Bread mix (500g)
2
Savoury biscuits/ crackers (100g)
1
Savoury biscuits/ crackers (200g)
2
Pasta (250g)
1
Pasta (500g)
2
Pizza bases (2 x 110-180g)
1
Breakfast cereal (300g)
1½
Xanthan gum (100-170g)
1
Coeliac Disease and a Gluten Free Diet
Help with reading food labels
• ‘Gluten Free’: foods that contain less than 20 ppm gluten – enforced by law & safe to eat
– Naturally gluten free foods
– Specialist gluten free foods & prescription products
– Uncontaminated oats
• ‘No Gluten containing ingredients’ will no longer be seen on food packaging
• Coeliac UK Crossed Grain Symbol
Coeliac Disease and a Gluten Free Diet
Allergen labelling law
• Gluten containing cereals (however small the amount) must be emphasised in bold, italics, or
highlighted text within the ingredients list
• Look for: Wheat, Rye, Barley, Oats
• Allergy Warning boxes are voluntary and will be phased out with the new law
….. But you might see allergy advice that directs you to the ingredients list for more information, e.g:
Coeliac Disease and a Gluten Free Diet
Confusing ingredients
• Codex Wheat Starch (gluten free wheat starch) – safe to consume
• Barley Malt Extract/Flavouring – some products using small amounts of this ingredient may be safe
to consume
Tesco own label
Cornflakes
Kellogg’s
Cornflakes
• Malt vinegar – safe to consume
• Oats….
Coeliac Disease and a Gluten Free Diet
Oats
• Oats offer many nutritional and health benefits
• Oats contain a protein called Avenin (similar to Gluten)
• Oats & oat products are often contaminated with gluten
• Uncontaminated oats are tolerated by the majority of people
with coeliac disease
• Only consume oats that are labelled as ‘gluten free’
Coeliac Disease and a Gluten Free Diet
Label Reading Activity
Coeliac Disease and a Gluten Free Diet
Important nutrients: Calcium
• People with coeliac disease may need more calcium.
• Adults should aim to eat 1000-1500mg/day; 300-800mg more than people without
coeliac disease!
• Vitamin D is important for calcium absorption:
– Sunshine
– Oily fish, eggs and fortified margarine/
dairy products
• Supplements can be prescribed for people
with a poor calcium intake/ poor bone health
Coeliac Disease and a Gluten Free Diet
Good sources of calcium
Food
Approx Calcium level
1/3 pint of milk (200ml)
240mg
1/3 pint Calcium-enriched soya/ rice milk (200ml)
240mg
Matchbox-sized piece of hard cheese (30g)
220mg
½ tin of sardines with bones (60g)
220mg
Pot of fruit/ plain yogurt (150g)
210mg
½ tin Rice pudding/ custard (200g)
180mg
4 Dried figs
180mg
Tofu (60g)
180mg
2 slices of calcium-fortified gluten free bread
85mg
Handful of almonds (30g)
70mg
1 serving of spring greens (75g)
55mg
8 dried apricots
50mg
Coeliac Disease and a Gluten Free Diet
Important nutrients: Fibre
•
Fibre intakes in the UK are less than recommended levels
•
People on a gluten free diet may consume even less fibre
•
Fibre helps to maintain a healthy gut, cholesterol and blood sugar levels
•
Good, gluten free sources of fibre include:
– Fresh fruit and vegetables
– Dried fruit
– High fibre gluten free breads, crackers and pasta
– Brown rice
– Nuts
– Beans and pulses
Coeliac Disease and a Gluten Free Diet
Important nutrients: Iron
• Approx 25% of newly diagnosed coeliacs have iron deficiency
anaemia at diagnosis
• Iron is essential to form healthy red blood cells –
carrying oxygen around the body
• Haem iron (more readily absorbed) – red meat
• Non-haem iron (less well absorbed) – green leafy veg, beans,
pulses, dried fruit
Coeliac Disease and a Gluten Free Diet
Top tips: Cross-contamination
• Invest in extra equipment – use a separate chopping board and toaster (or toaster bags) for gluten
free food
• Clean-up well – wipe surfaces, wash hands and utensils thoroughly before handling gluten free food
• Keep gluten free food separate – store gluten free food at the top of the fridge to prevent
contamination, store unpacked/ open gluten free food in sealed bags/ Tupperware
• Use different butter/ margarine & preserves – butter knives can easily transfer crumbs, use coloured
stickers to highlight what is to be kept gluten free
• Don’t re-use/ share cooking oil with those who are not gluten free
Coeliac Disease and a Gluten Free Diet
Top tips: Eating away from home
• Be prepared – keep a selection of gluten free snacks to hand; in the car, at work, in
handbag/ rucksack
• Make extra – cook additional portions of your evening meal to take to work/ eat the
following day, e.g gluten free pasta/ cooked meat for jacket potatoes or salads
• Do your homework- take time to check restaurant websites
for their gluten free offerings, ring ahead to check what
might be suitable… caterers must be able to provide this information by law!
• Don’t be afraid to ask – if you’re not confident that your meal or where it was
prepared is gluten free, ask for more information
Coeliac Disease and a Gluten Free Diet
Take home messages
• The only treatment for coeliac disease is a life-long gluten free diet
• Naturally gluten free foods include: fresh meat, poultry, fish, eggs, dairy foods, fruit, veg, nuts, rice
and potatoes
• Contact gluten free food manufacturers to obtain samples of prescription foods – use prescription
staples to supplement naturally gluten free foods in your diet
• Join Coeliac UK for additional information and support & to obtain a Food and Drink Directory
• Check food labels for gluten containing ingredients – Wheat, Rye, Barley & Oats
• Be careful about cross contamination and ensure that gluten free food is prepared in a gluten free
environment
Coeliac Disease and a Gluten Free Diet
Questions
Coeliac Disease and a Gluten Free Diet