Dietary Treatment

Dietary Treatment

1. 1. Lifelong strict Gluten Free diet: to normalise mucosa for improved nutrient absorption.

   • Reduces anemia risk
   • Prevent long term complications eg oesteoperosis.
     • Osteoperosis: Inc PTH and Inc Ca+i in blood = bone loss.
       • Lack Ca intake following diagnosis
         • Poor compliance with GF diet
       • Need 1500mg Ca/day (BSG 2010)
         • DXA Bone Density Scan
     • Intestinal Malignancy: Stick to GF diet, risk of cancer after 5yrs same as general popn

2. Life-long GF diet means :

   • Exclude Rye/wheat/barley
     • Oats controversal- mix with wheat flour at mills.
     • Found in foods containing wheat or wheat flour
       • bread, cakes, biscuits, pasteries, pies
         • Processed Foods- Wheat used for dusting/ breadcrumbs
     • Oats controversial: contaminated with wheat from factory process. Reintroduce 6-12months

3. Can enjoy balanced diet with GF foods

   • Natural foods: fruits/ veg
     • Meat / fish
   • Potato/ rice
   • GF bread, cake, pasta mixes
     • Available on prescription:
       • Important as fortified with ca, fibre, B viitamins + give variety to diet
         • Issue: Consider storage, organised for repeat prescriptions
           • Need cooking skills - baked from scratch
             • Time consuming- interfere with compliance
       • At diagnosis check for malnutrition + anaemia: need supplementation for Fe, Vit D, Ca due to malabsorption
   • Dairy products + Eggs
     • Butter/ marg/ oils
   • Safe cereals: Sorghum, Maize, Rice
   • For inc fibre: use rice Bran

4. Other issues patients need to know:

   • Package food labelling: GF not same as zero gluten.. Codex standards
     • contains <20ppm safe amount of gluten to eat
     • Very low gluten products contain 21-100ppm [not GF]
     • Hidden gluten in pre prepared meals, sauces, beer/larger
   • Coeliac UK: Info and Food + Drink Directory
   • Practical Issues: Refreshing bread in toaster or oven to release moisture and improve taste/ seprate toasters
   • Consider needs of age groups!:
     • Preschool Kids: PlayDoh, playgroups/nurseries, parties, eating same meal as a family
       • Children: ensure parents cope with parties, school dinners. Child need to take own GF bread- routine
     • Teenagers: Less adult supervision, eat out more need knowledge and snack more
     • Adults: Be prepared at work etc, aware of work canteen
     • Elderly: Support to change habit of a lifetime
     • Depression and low mood common

5. Main Nutritional Issue

   • Malabsorption: impaired macronutrient absorption
     • Negative calorie +pr balance= catabolic response + lose weight
   • Nutrient deficiency of Fe,folate, B12, fat soluble vits EDK
   • oesteoperosis