CAROLINE SALISBURY

B.A.,  BSc.,  Grad. Dip. Nut. & Diet.  (Syd.)

Accredited Practising Dietitian

CONSULTANT DIETITIAN

Gluten Free Diet

What is Gluten?

Gluten is a protein found in grains including wheat, rye, oats and barley.  Patients with Coeliac disease are sensitive to gluten which damages the lining of the small bowel.  This damage affects the absorption of food and can lead to symptoms including weight loss, diarrhoea, iron and folic acid deficiency.  A gluten free diet is the only long term treatment for Coeliac disease.  Complete removal of gluten from the diet allows the gut to recover to normal over a period of time.  Even small amounts of gluten are enough to prevent recovery or cause further damage.  Obvious symptoms or damage may not occur at the time of consumption. 

It is important to include a wide variety of gluten free cereal products in a Gluten Free diet.  This can be as simple as adding small amounts of soy, potato flour or rice bran to a dish.  These are important sources of fibre, B group vitamins, zinc and increase the variety of the diet. 

Food Labelling and Gluten

The Australian Standard of Gluten Free foods1 now requires that foods labelled as “Gluten Free” contain no detectable gluten using a sensitive assay.  There is no evidence that inclusion of extracted ingredients causes mucosal damage2 although some patients with Coeliac disease may prefer not to eat products which contain these extracted ingredients.  The Coeliac Society of Australia has changed the category of these products in their ingredient list including glucose syrup, dextrose and caramel colouring.  Under the new standard, it will require careful reading of ingredients on products labelled as “gluten free”if Coeliacs choose to avoid these foods.

Foods may also contain less obvious sources of gluten as there is no requirement for manufacturers to specify the composition of ingredients that contribute less than 10% of a food.  For example, it may be difficult to determine the origin of a soy sauce included as an ingredient in a commercial marinade.  This means that gluten may be “carried over” into the marinade via the soy sauce.  It is best to contact the manufacturer directly to determine the source of these ingredients.

It is essential that all food labels be rechecked regularly since the composition may change.  Avoid any food that is doubtful.

References

1. ANZFA and Aust. Food Council. (1997) Code of good manufacturing practice for the production of gluten free and low gluten foods. 

2. Selby W, Faulkner – Hogg K, Coeliac Disease.  Current Therapeutics, June 1998; 31 – 37.

3. Coeliac Disease – Kim F. Hogg, May 2000.

Which Food is Safe to Eat?

Click on each of the food groups below for specific information –

· Cereal products, flours, baking products

· Bread, biscuits, cakes and pastry

· Vegetables, fruits, legumes, nuts and seeds

· Meat, fish, poultry and soups

· Dairy products, butter, margarine and oil

· Condiments and other flavouring

· Beverages

· Snacks

Cereal products, flours, baking products

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Arrowroot, corn (Maize) flour,                          Wheat, wheat starch, wheat based

Cornmeal, polenta, rice four, potato                              cornflour, semolina, rye flour, triticale,

flour, soy flour, lentil flour, millet.                                   bulgur, couscous, wheatgerm, wheat

Rice (brown, white, wild), sago,                                    bran, oat bran, barley.

tapioca, buckwheat, amaranth, quinoa               Oats – the current recommendation is that

Baby rice cereal.  Rice bran.                                         oats should be excluded from a gluten Psyllium.                                                             free diet.

Soy based Lecithin.                                                      Beware that oats may be listed as gluten

Rice and corn breakfast cereals (malt free)                    free in some countries.

Home-made/commercial                                               Malt, malt extract/maltodextrin (check

muesli using allowed ingredients.                                    sources).

Gluten free pasta made with allowed                             Wheat breakfast cereals, or mixed grain

flours.  Rice Vermicelli.                                     cereals.

Custard powder (check ingredients).                             Macaroni and spaghetti.

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Glucose, dextrose, caramel.                                          Puddings and custard powders made from

Sugar – brown, white and raw.                         unsuitable flours.

Pure icing sugar.                                                           Icing sugar mixtures.

Gelatine.                                                                       Thickener (1400 – 1450) unless checked with manufacturer.

                                                                                    Pre gel starch.

Starch, modified starch unless sources are checked.

Bread, biscuits, cakes and pastry

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Gluten free bread                                                          All gluten containing bread, biscuits, cakes,

                        pastries, pies, crispbreads, crumpets and

                        muffins containing unsuitable flours.

Gluten free biscuits, cakes pastry                                   Foods in batter, crumbs or pastry including

and pancakes.                                                              filo pastry.

Rice crackers, rice cakes, corn cakes                            Breadcrumbs and stuffings.

and corn and rice crispbreads.                                      Wheat based tortillas and burritos.

Gluten free breadcrumbs.                                              Baking powders based on unsuitable flours

Taco shells and pappadums (check                               including wheat.

ingredients).  Corn tortillas.                                           Communion hosts.

Gluten free baking powder.                                           Some commercial yeast may contain gluten.

                                    Decorative toppings including hundreds

Bakers’ yeast (gluten free)                                            and thousands may contain gluten.

Vegetables, fruits, legumes, nuts and seeds

Gluten Free - choose freely                                       Not Gluten Free – do not eat

Fresh, frozen, dried or canned vegetables                      Canned or frozen vegetables in sauce.

and fruits without sauce.                                                Vegetarian products including textured

Vegetable and fruit juices.                                             vegetable protein (TVP).  Check ingredients.

Dried beans such as soya, kidney,                                 Commercially thickened fruit pie fillings.

cannellini, borlotti, chickpeas, lentils and                        Fruit pies with wheat based pastry.

split peas.                                                                     Check ingredients of processed varieties

Tinned beans (check ingredients).                                  such as baked beans.

Nuts and seeds.                                                            Some flavoured beer nuts may contain

Peanut butter.                                                               wheat flour.

Tofu.                                                                            Tofu burgers may contain gluten.

Hydrolysed vegetables protein unless checked.

Meat, fish, poultry and soups                                   

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Fresh, smoked and corned.                                           Meat and fish prepared or thickened with

Frozen without sauce, crumbs or batter.                        flour, batter or breadcrumbs.

                                                                                    Flavoured tunas (check ingredients)

Canned meat or fish without sauce.                               Smallgoods, eg sausages, devon, processed

Ham off bone, bacon, corned beef.                               meats and processed ham.

Gluten free sausages (ensure that the                             Meat pies and sausage rolls.

butcher makes these first to avoid                                  Frozen dinners.

contamination).                                                 Tofu burgers may contain gluten.

Eggs.  Unflavoured tofu.                                                Homemade or commercial soups.

Homemade soups from gluten free                                made with thickeners, stocks, pasta, barley

ingredients.                                                                   or flours containing gluten.

Some commercial soups (check                                    Commercial pizzas.      

ingredients).

Homemade pizzas using allowed

ingredients.

Dairy products, butter, margarine and oil

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Full cream and low fat milks.                                         Malted milk.

Fresh, UHT, evaporated, powered and             Milk flavourings such as Milo.

condensed milk.                                                            Artificial cream.

Buttermilk.                                                                    Ice cream thickeners or flavourings that

Yoghurt and ice cream (check ingredients)                    contain gluten.  Ice cream cones and waffles

Junket.                                                                         Cheese mixtures, pastes and spreads unless

Cream (fresh or canned).                                              checked.

Block, processed, cream and cottage                            Soy milk containing malt.

cheese.                                                                         Watch for contamination of margarine and

Ice cream (check ingredients).                           cutting boards with breadcrumbs.

Milk flavouring if malt and gluten free.

Malt free soy milk and/or those labelled

gluten free.

Butter, margarine and oils.

Condiments and other flavourings

Gluten Free – choose freely                                      Not Gluten Free – do not eat

Vinegar – balsamic, cider, red wine and                        Malt vinegar.

white.                                                                           Commercial mustards, salad dressings,

Some commercial mustards, salad dressings,                 sauces, pickles, relishes, chutneys and

Sauces, pickles, relishes and chutneys may                    salsas should be avoided unless checked.

be suitable.                                                                   BBQ salts and other flavouring mixes may

Soya sauce (check ingredients).                                    contain gluten.

Tabasco sauce.                                                 Yeast extract including Promite, Vegemite

Gluten free stock powders.                                           and Bonox.

Curry paste and powder (check                                   

ingredients).                                                                 

Gluten free gravy.

Tomato paste.  Tahini (sesame seed paste).

Fresh and dried herbs and spices.

Jam, honey, peanut and other nut butters.

Pure maple and golden syrup.

Plain and flavoured gelatine.

Cocoa.

Flavouring essences and artificial sweeteners

(check ingredients).

Beverages

Water, milk, tea, coffee, juice, cordial,              Coffee substitutes, chocolate milk

soft drink Including diet, mineral water,              flavourings such as milo and

cocoa, drinking chocolate (check ingredients)    Akta Vite. Barley based cordial

Wine, sherry, whisky, bourbon, vodka,             Beer, ale, stout

Rum, vermouth, tequila.

Snacks

Plain corn and potato chips                                           Some flavoured savoury snacks

Popcorn, plain and nut chocolate                                   as corn chips may contain gluten

Check labelling on all sweets as they                             Filled chocolates (check ingredients)

may contain starch and starches as                                Licorice

undeclared processing aids.

A typical day’s menu on a gluten free diet

This is a guide to the range of foods you can include in a gluten free diet.  The volume of food will vary for individuals.  Be aware of the need to maintain your fibre intake (aim 25 – 30 g per day) ( See high fibre diet).  Women and children should include 2- 3 calcium rich foods per day.

Breakfast

Gluten free muesli with fresh or tinned fruit and milk

Or buckwheat porridge with dried fruit and milk. 

Gluten free toast with margarine and jam, honey or peanut butter.

Tea or coffee

Lunch

Sandwiches made with gluten free bread with cheese or beef and salad or

Corn tortillas with salad and lean chicken

Tinned or fresh fruit with yoghurt ( check ingredients)

Water, fruit juice, tea or coffee

Main meal

Glass of wine, juice soft drink or water.

Chicken and vegetable stir fry with gluten free soy sauce and rice noodles,

Thickened with potato flour.

Fruit with gluten free custard or ice cream

Snacks

Gluten free rice crackers with cheese and tomato or gluten free biscuits with tea or coffee

Fresh fruit or dried fruit and nuts.

Remember

- read labels well and watch for hidden sources of gluten

- Include a wide variety of gluten free cereals

- Always check that medications and vitamins are Gluten free

- For more detailed dietary information consult an Accredited Practising dietitian. Check with your local health centre or Hospital. Private Dietitians can be found in the yellow pages.

Additional Resources

The Coeliac Society of Australia provides useful information on gluten free diets for patients who have Coeliac Disease, Dermatitis Herpetiformis or medically required gluten free diet.  See Gastronet patient support for contact details.  There are also many local groups outside capital cities.  Contact State offices for details.

An initial membership fee includes an extensive information pack, and a magazine 4 times a year which contains information on health issues, new products and recipes. The Coeliac Society also produces an Ingredient list as a guide to suitable and unsuitable ingredients.  The 4^th edition has recently been released.