Dietary Considerations for Gluten-free Diets in Individuals Affected by Coeliac Disease

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Current evidence does not show that nutrient deficiencies are of concern in individuals diagnosed with Coeliac disease (CD) and following gluten-free diet.

However, malabsorption may occur in individuals with ongoing Coeliac disease who have not been yet diagnosed and treated with the diet. Accordingly, deficiency of the following nutrients may be present:

      – Essential Fatty acids (Omega-3 and Omega-6)
      – Iron
      – Vitamin D
      – Vitamin K
      – Calcium
      – Magnesium
      – Zinc
      – Folic Acid

Once a gluten-free diet is established and the healing of the gut lining is noticed, the absorption of nutrients and nutritional status start to improve (gut healing process takes between 6 months to 5 years).

OSTEOPOROSIS

Low Bone Mass Density (BMD) affects 50% of men and 47% of women at diagnosis of Coeliac disease which is a result of impaired absorption of calcium and vitamin D. Gluten-free diet was shown to increase BMD and to slow down the process of bone loss. Therefore, it is recommended that individuals with diagnosed Coeliac disease should have a higher intake of calcium (1000 mg daily) compared with the general population (700mg a day).

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FIBRE INTAKE

As a gluten-free diet leads to the cutting out of cereals made of wheat, rye and barley which are a good source of fiber, it is essential to incorporate foods in the daily menu, which are rich in fibre and naturally gluten-free. Healthy options include but are not limited to:

      – Fruits
      – Vegetables
      – Pulse
      – Beans
      – Seeds
      – Nuts
      – Gluten-free oats, Quinoa, buckwheat, millet

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IRON

As the majority of iron in the UK population is derived from cereals, cutting them off on a gluten-free diet may require paying particular attention to ensure sufficient intake of this important nutrient. Good sources of iron include meat (predominantly beef and poultry), seafood (oysters and shellfish), fish and plant-based foods such as leafy green vegetables, legumes and beans. To increase the absorption of iron (coming from plant-based sources), a good idea is to have iron-rich foods with sources rich in vitamin C, for example orange juice or fresh juicy oranges.

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THE MARKET OF GLUTEN-FREE

The ‘free from’ market is constantly increasing in numbers with the forecast set to reach £551 million by 2019. The ‘free from gluten/wheat’ is expected to account for approximately 50% of all free from sales. A wide range of gluten-free products is becoming very tempting not only for coeliacs but also for regular consumers.

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Unfortunately, a high number of gluten-free products besides lacking gluten, are also deficient in important nutrients. This is particularly true for refined or processed ingredients of gluten-free products such as rice starch, tapioca, potatoes. Moreover, whole grains take more time to digest, which means gradual release of sugars into the bloodstream, which prevents blood sugar spikes. Many gluten-free products are not only lacking whole grains but are also high in calories and have a high sugar content, which can leave an individual feeling hungry shortly after eating with potential risk of weight gain. Apart from this, gluten-free products are more expensive compared to their gluten-containing counterparts. All in all, choosing gluten-free products may not only put your health at risk in a manner of speaking, but may also be a drain on your wallet. That’s why it is highly recommended that individuals on a gluten-free diet should prepare their meals with as little processed ingredients as possible. The list of some naturally gluten-free products can be found below:

      – Fruits and vegetables
      – Meat, fish and poultry
      – Cheese, cream, milk, yoghurt
      – Eggs
      – Rice, lentils, pulses, corn, soya, potatoes
      – Polenta, tapioca, sago
      – Buckwheat, millet, oats (gluten-free)
      – Butters, margarines, oils
      – Nuts and seeds
      – Herbs and spices
      – Wine, cider and spirits.

Aleksandra Jagiello

Clinical Nutritionist

 

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