Coeliac disease: Healthy living with a gluten free diet

Coeliac disease is an increasingly common disorder, with many of us knowing someone affected. Naomi Johnson, a New Zealand registered dietitian in the Human Nutrition Department at the University of Otago, explains what coeliac disease is and how to have a healthy, well-balanced diet if you have the condition.

Try making gluten free muesli from rice flakes, rice bran, dried fruit, nuts and seeds.

What is coeliac disease?

People with coeliac disease (CD) have a physical intolerance to gluten, causing inflammation and damage within the small intestine. This leads to nutrients not being properly absorbed and a diverse range of symptoms.

People may experience bloating, diarrhoea, abdominal pain, mouth ulcers, weight loss, period irregularities, iron deficiency, fatigue, and folate and B12 deficiencies. Children may suffer delayed growth.

People with both diabetes and coeliac disease may have recurrent unexplained hypos and below optimum blood glucose control. Make sure you get individual advice from a dietitian who will ensure you receive a balance of vital nutrients.

Coeliac disease is diagnosed with a small bowel biopsy to assess the extent of damage in the small intestine. An increasing number of people believe they are 'gluten-sensitive', but rather than visiting their doctor, some just change to a gluten free (GF) diet.

It is important that people are properly diagnosed to determine if changes to their diet are required and to get the appropriate treatment, information and monitoring. Once diagnosed, you are entitled to join the Coeliac Society and receive subsidies on certain food items.

Achieving balance

With coeliac disease, you must follow a lifelong gluten free diet by excluding wheat, rye, barley, oats and their derivatives.

This means you cannot eat most everyday breads, cereals, biscuits, pastas and processed foods.

Obtaining sufficient energy, fibre and carbohydrate can be a challenge. But by making some small changes to the foods you eat, you can have a healthy, well-balanced, varied, fibre-rich diet.

Tips and hints for meals

You can make many mainstream meals by substituting GF products for standard items. In supermarkets, you can often find GF foods in the health food aisle.

GF foods available include bread, crackers, flour, baking powder, icing sugar, soy sauce, sausages and baked beans (Watties Lite) and hot cereals for winter. Orgran, Healtheries and Freedom Foods have ranges of rice or corn pasta.

To plan your meal, first choose your carbohydrate portion e.g. rice or GF bread, cereal or pasta. Potato, kumara and corn are also GF.

Read all food labels to ensure there is no wheat, rye, barley or oats listed. But what about undefined 'starch' or 'thickener'?

Maize or cornstarch is fine but if the content is not clear, cast aside. Anything with malt (from barley) including many beers is also off the list.

Breakfast suggestions

GF toast with topping. Be aware: vegemite, marmite and promite contain gluten.
Make GF cereal from rice or soy flakes and rice bran with dried fruit, nuts, seeds and linseeds.
Fresh fruit, yoghurt and low-fat milk smoothie.
Try buckwheat porridge. Soak 1/3 cup rinsed buckwheat in 3/4 cup boiling water overnight in a sealed container. Then top with fresh fruit, linseeds, sunflower seeds and almonds. Use artificial sweetener if desired.

Ideas for main meals

GF bread salad sandwich
Medium baked potato with bean filling, and side salad
Vegetable soup with GF bread roll
Omelette with vegetables or beans
Rice, bean, or rice noodle salad
GF pasta with vegetable, lentil or tomato based sauce
Rice paper wrap with a filling of salad and tuna or chicken
White or brown rice stir-fry with vegetables and lean meat, chicken or fish
Make GF breadcrumbs and use for crumbing schnitzel or fish.

Ways to get adequate fibre

Have at least 3-4 servings each of vegetables and fruit each day and where possible leave on the skins
Add dried or fresh fruit, nuts, whole or ground linseed and seeds to homemade GF bread, GF cereals and salads
Use brown instead of white rice for stir-fries or rice salads
Add vegetables, split peas, lentils, nuts, seeds and beans to soups, pastas, curries, GF bread, salads and casseroles
Have at least one vegetarian meal per week with lots of vegetables and lentils, chickpeas or kidney beans
Snack on plain popcorn mixed with a small amount of dried fruit, nuts or seeds, or a baked potato, rice crackers, corn thins or vegetable sticks with hummus
Make a smoothie with low fat milk, banana and your favourite fruit.

Eating out hints

Call the restaurant in advance to discuss your diet and the menu with the chef. If friends ask you for a meal, let them know what you can and cannot eat.

Choose meat, chicken or fish that is not breadcrumbed or coated with flour
Check ingredients of marinades, sauces, gravies and condiments or ask for the dish without the sauce or dressing
Check soup ingredients – avoid soups such as chowder and minestrone
For brunch, take your own GF bread and ask the staff to toast it
For bring-a-plate functions, take food suitable for yourself
Take a supply of rice or corn crackers – that way you won't go hungry.

Who to contact?

If you suspect that you have coeliac disease, contact your doctor for further information. Once diagnosed, your dietitian will provide you with expert advice on suitable foods.

Juggling both diabetes and gluten free can be a challenge as many gluten free products aren’t necessarily suitable for someone with diabetes e.g. gluten free muffins contain large quantities of carbohydrates. A careful balance is required.

Check out the following helpful websites

Manufacturers’ food database www.mfd.co.nz for a list of GF products
www.sanitarium.co.nz for GF recipes
www.healtheries.co.nz for GF products and recipes
Coeliac Society of New Zealand www.coeliac.co.nz

For GF products

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