Dietetic information

The gluten-free diet forms the treatment for coeliac disease. The diet however, is not as straight forward as it seems. Everyone with coeliac disease is different in terms of their level of sensitivity to trace amounts of gluten, so people with coeliac disease need individual dietetic assessment and monitoring.

Codex Standard for gluten

The current WHO/FAO standard for 'gluten-free' in the UK is 200ppm or less of gluten, as set out by Codex Alimentarius (1). This level of gluten is tolerated by the majority of people with coeliac disease.

Codex wheat starch

Codex wheat starch is specially manufactured wheat starch that has been washed to remove the gluten to a trace level within the Codex standard.

Codex wheat starch is used by some manufacturers who produce gluten-free food for prescription sales as it improves the taste and texture of the food, making it more like the gluten-containing varieties.

Whilst the majority of people with coeliac disease can tolerate codex wheat starch, there are those who are more sensitive and suffer symptoms if they eat products containing it, and so need to choose products labelled 'gluten-free/wheat free' .

It is accepted that there is also likely to be an 'additive effect', which means that large amounts of products containing codex wheat starch eaten on a regular basis may trigger symptoms in more sensitive people.

Malt extract

Malt extract and malt extract flavourings are prepared from barley.  They are widely used in small amounts in the food industry as flavour enhancers.  For example they are often contained in most brands of breakfast cereals, malt vinegars and many other branded manufactured products.
 
The quantity of malt extract or malt flavouring used in these products may vary. Products that contain malt extract in smaller amounts can be tolerated by most people with coeliac disease e.g. malted rice breakfast cereals and malt vinegar. However these products will still have to be labelled as containing barley.

Foods products listed in our Food and Drink Directory are guaranteed by the manufacturer to comply with the Codex standard for gluten.

Oats

Many studies have been carried out on oats in the gluten-free diet over recent years and most researchers have come to the conclusion that pure oats are non-toxic to people with coeliac disease (2,3).

However, the vast majority of oats and oats products on the market are contaminated with wheat , barley and rye, so the choice of safe products is very limited (4).

There is some evidence to suggest that some people with coeliac disease may even react to pure, uncontaminated oats (5).

Pure oat products that are not contaminated with wheat, barley or rye are listed in Appendix III of our Food & Drink Directory.

Suitability for including pure uncontaminated oats in the gluten-free diet should be considered on an individual patient basis, and patients should be closely followed up.

Coeliac UK always refers enquirers about including uncontaminated oats in the gluten-free diet to their health care team for for specific guidance based on an individual's own level of sensitivity and on going management.

Additional considerations

There are no specific nutritional guidelines for people with coeliac disease, although there is a higher recommendation for calcium of 1000mg per day for adults with coeliac disease. For postmenpausal women and men over 55 years of age, the recommended calcium requirement is 1200mg per day.

Certain areas do need additional consideration, such as following diets with additional restrictions such as vegetarian and vegan diets and those diagnosed with both coeliac disease and diabetes. It is essential that patients with these additional considerations are followed-up on a regular basis to ensure nutritional adequacy of the diet.

The new allergen labeling directive is now mandatory. It is essential that patients are fully aware of what labels mean so that they can safely chose gluten-free foods.

References

1Codex Alimentarius Commission (1983) Codex Standard for
‘Gluten-Free Foods’. Codex stan 118-1981 (amended 1983).
ftp://ftp.fao.org/codex/standard/en/CXS_118e.pdf

2 Janatuinen EK et al. No harm from five year ingestion of oats in coeliac disease. Gut 2002;50:332–335.

3 Hogberg L et al. Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut 2004;53:649–654.

4 Thompson T. Contaminated oats and other gluten-free foods in the United States. Journal of the American Dietetic Association 2005;105:348.

5 Lundin KEA et al. Oats induced villous atrophy in coeliac disease. Gut  2003;52:1649–1652.