A gluten-free diet
When you're first diagnosed with coeliac disease, you'll be referred to a dietitian to help you adjust to your new diet without gluten. They can also ensure your diet is balanced and contains all the nutrients you need.
If you have coeliac disease, you'll no longer be able to eat foods that contain barley, rye or wheat, including farina, graham flour, semolina, durum, cous cous and spelt.
Even if you only consume a small amount of gluten, such as a spoonful of pasta, you may have very unpleasant intestinal symptoms. If you keep consuming gluten regularly, you'll also be at greater risk of developing osteoporosis and cancer in later life.
Read more about complications of coeliac disease.
As a protein, gluten is not essential to your diet and can be replaced by other foods. Many gluten-free alternatives are widely available in supermarkets and health food shops, including pasta, pizza bases and bread. Some GPs may provide gluten-free foods on prescription.
Many basic foods – such as meat, vegetables, cheese, potatoes and rice – are naturally free from gluten so you can still include them in your diet. Your dietitian can help you identify which foods are safe to eat and which are not. If you're unsure, use the lists below as a general guide.
Foods containing gluten (unsafe to eat)
If you have coeliac disease, do not eat the following foods, unless they're labelled as gluten-free versions:
- biscuits or crackers
- cakes and pastries
- gravies and sauces
It's important to always check the labels of the foods you buy. Many foods – particularly those that are processed – contain gluten in additives, such as malt flavouring and modified food starch.
Gluten may also be found in some non-food products, including lipstick, postage stamps and some types of medication.
Cross-contamination can occur if gluten-free foods and foods that contain gluten are prepared together or served with the same utensils.
Gluten-free foods (safe to eat)
If you have coeliac disease, you can eat the following foods, which naturally do not contain gluten:
- most dairy products, such as cheese, butter and milk
- fruit and vegetables
- meat and fish (although not breaded or battered)
- rice and rice noodles
- gluten-free flours, including rice, corn, soy and potato
By law, food labelled as gluten free can contain no more than 20 parts per million (ppm) of gluten.
For most people with coeliac disease, these trace amounts of gluten will not cause a problem. However, a small number of people are unable to tolerate even trace amounts of gluten and need to have a diet completely free from cereals.
Oats do not contain gluten, but many people with coeliac disease avoid eating them because they can become contaminated with other cereals that contain gluten.
There's also some evidence to suggest that a very small number of people may still be sensitive to products that are gluten-free and do not contain contaminated oats. This is because oats contain a protein called avenin, which is suitable for the majority of people with coeliac disease, but may trigger symptoms in a few cases.
If, after discussing this with your healthcare professional, you want to include oats in your diet, check the oats are pure and that there's no possibility contamination could have occurred.
You should avoid eating oats until your gluten-free diet has taken full effect and your symptoms have been resolved. Once you're symptom free, gradually reintroduce oats into your diet. If you develop symptoms again, stop eating oats.
Advice on feeding your baby
Do not introduce gluten into your baby's diet before they're 6 months old. Breast milk is naturally gluten free as are all infant milk formulas.
If you have coeliac disease, Coeliac UK recommends foods containing gluten are introduced gradually when a child is 6 months old. This should be carefully monitored.
The Coeliac UK website provides support for parents.
As well as eliminating foods that contain gluten from your diet, a number of other treatments are available for coeliac disease. These are described below.
In some people, coeliac disease can cause the spleen to work less effectively, making you more vulnerable to infection.
You may therefore need to have extra vaccinations, including:
- flu (influenza) jab
- Hib/MenC vaccine, which protects against sepsis (blood poisoning), pneumonia and meningitis (an infection of the lining of the brain)
- pneumococcal vaccine, which protects against infections caused by the Streptococcus pneumoniae bacterium
However, if your spleen is unaffected by coeliac disease, these vaccinations are not usually necessary.
As well as cutting gluten out of your diet, your GP or dietitian may also recommend you take vitamin and mineral supplements, at least for the first 6 months after your diagnosis.
This will ensure you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia.
If you have dermatitis herpetiformis (an itchy rash that can be caused by gluten intolerance), cutting gluten out of your diet should clear it up.
However, it can sometimes take longer for a gluten-free diet to clear the rash than it does to control your other symptoms, such as diarrhoea and stomach pain.
If this is the case, you may be prescribed medication to speed up the healing time of the rash. It's likely that this will be a medicine called Dapsone, which is usually taken orally (in tablet form) twice a day.
You may need to take medication for up to 2 years to control dermatitis herpetiformis. After this time, you should have been following a gluten-free diet long enough for the rash to be controlled without the need for medication.
Refractory coeliac disease
Refractory coeliac disease is a rarer type of coeliac disease where the symptoms continue, even after switching to a gluten-free diet. The reasons for this are unclear.
It's estimated that around 1 in every 140 people with coeliac disease will develop the refractory form of the condition.
If refractory coeliac disease is suspected, it's likely you'll be referred for a series of tests to make sure your symptoms are not being caused by another condition.
If no other cause can be found and the diagnosis is confirmed, you'll be referred to a specialist. Treatment options include steroid medication (corticosteroids), such as prednisolone, which help block the harmful effects of the immune system.