gluten-free
Gluten-free products: to prescribe or not to prescribe? There has been much debate regarding gluten-free (GF) product prescriptions and some Primary Care Trusts have limited the types of products to the most necessary, such as bread varieties, pasta and flour. Nevertheless, these prescriptions are estimated to have cost the NHS 27million pounds in 2013 (1). Eirini Koutroulis Dietitian
This cost is bound to increase as the number of people being diagnosed with coeliac disease (CD) grows. With this in mind, the following questions arise: Are food prescriptions really necessary? What other alternatives are there to food prescriptions for the dietary management of coeliac disease? Coeliac disease
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Eirini Koutroulis is a dietitian working in the NHS, with experience in media and an interest in research and public health.
CD is an autoimmune disease where the ingestion of gluten results in inflammation of the small intestine and villous atrophy in genetically susceptible people. Some of the symptoms include macroand micro-deficiencies, gastrointestinal symptoms, increased risk of bowel cancer, infertility and growth problems in children. The types of symptoms vary and can be mild to severe, with some people having no obvious signs. It is believed to be present in one in 100 people and increases to one in 10 where a firstdegree family member has the condition (2). Those suffering from other autoimmune diseases, such as Type 1 diabetes and autoimmune thyroid disease, may be at a higher risk of developing CD. Dermatitis Herpetiformis is a skin condition linked to CD and occurs in one in 10,000 people (2). It is estimated
that only 24 percent of people with CD have officially been diagnosed and there has been a fourfold increase in incidence in the UK over the past 22 years (3). Diagnosis
Serological tests and a gut biopsy are required to confirm diagnosis (4). Prior to testing, ≥3 g gluten (two slices of wheat bread) per day must be consumed for a minimum of two weeks to avoid a false negative result (4). Treatment
The only treatment currently available is a strict adherence to the lifelong exclusion of gluten from the diet. This involves not only avoiding gluten in food, but also sterilising surfaces to avoid cross-contamination with gluten-containing products. Gluten is a protein naturally present in wheat, barley, rye and cereal hybrids, such as triticale. Some guidelines also suggest avoiding oats for the first six to 12 months due to sensitivity to the gluten-like protein called avenins (5). The remaining list of naturally GF grains and staple foods is quite long (Table 1), so what are the difficulties in choosing naturally GF foods?
Table 1: List of some naturally gluten-free staple foods and grains
Gluten-free grains and staple foods
Amaranth, buckwheat, cassava, corn, rice, wild rice, potato, gram flour, hemp, maize, millet/bajra, polenta, quinoa, soya, tapioca, teff, urd/urid/urad flour, uncontaminated oats, sorghum All unprocessed meat, diary, fish, vegetables, fruit, nuts, seeds, beans and pulses and uncontaminated products of these foods. NHDmag.com December 2014 / January 2015 - Issue 100
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