Treating coeliac disease

Coeliac disease is usually treated by simply excluding foods that contain gluten from your diet.

This prevents damage to the lining of your intestines (gut) that is caused by gluten, and the associated symptoms, such as diarrhoea and stomach pain.

If you have coeliac disease, you must give up all sources of gluten for life because eating foods that contain it will cause your symptoms to return and cause long-term damage to your health. This may sound daunting, but your GP can give you help and advice about ways to manage your diet.

Your symptoms should improve considerably within weeks of starting a gluten-free diet. However, it may take up to two years for your digestive system to heal completely. You will also need to return to your GP for regular check-ups.

A gluten-free diet

When you are first diagnosed with coeliac disease, you will be referred to a dietitian to help you adjust to your new diet without gluten. They can also ensure that your diet is balanced and contains all the nutrients you need.

If you have coeliac disease, you will no longer be able to eat foods that contain wheat (farina, graham flour, semolina, durum, cous cous and spelt), barley or rye.

Even if you only consume a small amount of gluten, such as a spoonfull of pasta, you may have very unpleasant intestinal symptoms. If you keep consuming gluten regularly, you will also be at greater risk of osteoporosis and cancer in later life.

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. A range of gluten-free foods is also available 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 are 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, unless they are labelled as gluten-free versions:

• bread
• pasta
• cereals
• biscuits or crackers
• cakes and pastries
• pies
• gravies and sauces

It is 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)
• potatoes
• rice
• 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 these trace amounts of gluten will not cause any problem. However, there are a minority of people with coeliac disease who are unable to tolerate even trace amounts of gluten, and require a diet completely free from cereals.

For more information see the ‘Codex standard for gluten’ on the Coeliac UK website.

The Coeliac UK website also contains information and advice about living with the condition, including gluten-free recipes.

Oats

Oats do not contain gluten, but many people with coeliac disease avoid eating them because they can become contaminated with other cereals that do contain gluten.

If, after discussing this with your health professional, you want to include oats in your diet, check that the oats are pure and that there is no possibility that contamination could have occurred.

It is recommended that you should avoid eating oats until your gluten-free diet has taken full effect and your symptoms have been resolved. Once you are 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 it is six months old. Breast milk is naturally gluten free and all infant milk formulas are too.

If you have coeliac disease, Coeliac UK recommends that gluten-containing foods be introduced gradually when a child is six months old, and the situation carefully monitored.

Other treatments 

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.

Vaccinations

In some people, coeliac disease can cause the spleen to work less effectively, making you more vulnerable to infection.

Therefore, you may 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.

Supplements

As well as cutting gluten out of your diet, your GP or dietitian may also recommend that you take vitamin and mineral supplements, at least for the first six months after your diagnosis.

This will ensure that you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia (a lack of iron in the blood).

Dermatitis herpetiformis

If you have dermatitis herpetiformis, also known as DH (an itchy rash that can be caused by gluten intolerance), cutting gluten out of your diet should clear it up. However, sometimes it can 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 is likely that this will be a medicine called Dapsone, which is usually taken orally (in tablet form) twice a day.

Dapsone can cause side effects, such as headaches and depression, so you will always be prescribed the lowest effective dose.

You may need to take medication for up to two years to control your 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.