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The Gluten-Free Diet

A gluten-free diet is essential for people who have coeliac disease or dermatitis herpetiformis (a gluten induced skin sensitivity). Some people may choose to follow a gluten-free diet for other reasons, although these two diseases are the only ones where a gluten-free diet is considered medically imperative.

Gluten is a mixture of proteins found in some cereals, particularly wheat. It is the gliadin component of gluten which is responsible for coeliac disease. A gluten-free diet is not the same as a wheat-free diet, and some gluten-free foods are not wheat free. Despite a good deal of research, it is unknown how or exactly why gluten harms the gut. It is now considered likely that coeliac disease involves an abnormal immunologic response, rather than an enzyme deficiency as was suggested in the past.

The Vegetarian Society believes that a gluten-free diet is compatible with vegetarianism. Some doctors and The Coeliac Society advise against a vegetarian or vegan diet for coeliacs because they believe it may make your diet too complicated and this could mean it is difficult to comply with. There are no known medical or nutritional reasons why you should not be a vegetarian or vegan coeliac, although the gluten-free aspects of your diet must be the priority for your own health and well-being.

It is possible to follow a gluten-free vegan diet, although you must be extra careful to ensure that your diet is nutritionally adequate. It is essential that you seek the advice of a sympathetic dietitian if you want to follow a vegan gluten-free diet.

Vegetarians may initially find it difficult to establish what foods they can and cannot have. This Information Sheet is designed to help.

A gluten-free diet involves the complete avoidance of all foods made from or containing wheat, rye, barley and usually, oats. Some doctors say oats may be permitted, although The Coeliac Society advise against the inclusion of oats in a gluten-free diet. (see the Cereals Information Sheet for more details of cereals.)

The Coeliac Society publishes a list of gluten-free manufactured products in a booklet which is updated every year. You can check with The Vegetarian Society if you are unsure whether any particular foods on this list are suitable for vegetarians or vegans. Some manufacturers use the gluten-free symbol on their label.

A wide range of specially manufactured gluten-free foods such as, bread, bread mix, pasta, biscuits, cakes, crispbread and flour are prescribable under the NHS. Some groups of people are exempt from prescription charges, children, pregnant women and pensioners in particular. If you are not exempt, it works out economical to buy a "season ticket" type prescription. Some gluten-free products, such as chocolate biscuits, are considered luxuries and are not prescribable, although they can be bought from the chemist.

Nutritional Advice

Coeliac disease leads to severe damage of the gut surface, which can be completely reversed by following a gluten-free diet. Shortly after the diagnosis of coeliac disease, you need to be extra careful to ensure you have a nutritionally adequate diet, as you may have been suffering from malabsorption of nutrients.

Protein

Some gluten-free flours are low in protein, because they have had the gluten removed, which is itself a protein. Specially manufactured, prescribed gluten-free flours usually have milk protein added. Vegetarians can get protein from nuts & seeds, pulses, the non-gluten containing cereals, soya products, milk, cheese and free range eggs. Make sure some protein is included in each meal, and practice protein complementation with the vegetable proteins, for example, combine a nut or pulse dish with a suitable cereal.

Protein is especially important to a growing child, it is essential to seek the advice of your dietitian if you are bringing up a child on a gluten-free vegetarian or vegan diet.

Anaemia

Following diagnosis, many coeliacs sufferers are anaemic. This is usually due to iron deficiency, although it could also be due to folic acid or vitamin B12 deficiency. Your doctor may prescribe an iron supplement for you until your digestive system is back to normal and can absorb iron again.

To ensure a good intake of iron include pulses, lentils, nuts and green vegetables daily in your diet. Avoid drinking tea with meals and instead have fruit juice, which helps the absorption of iron because it contains vitamin C.

Going vegetarian

If you are already a vegetarian or vegan and are advised to follow a gluten-free diet, you do not need to abandon your vegetarianism. If you are recently diagnosed and would like to become vegetarian or vegan, do give your digestive system time to recover before making major changes to your diet, after all, you have a lot to think about in getting used to a gluten-free diet. When you have stabilised, you can gradually change to a vegetarian diet.

Do contact The Vegetarian Society if you have any problems, when making the change to a vegetarian way of living. Also, do contact us if you have any difficulties with health professionals, who are sceptical about your following a vegetarian diet.

Once coeliac disease has been diagnosed, it is recommended that you follow a gluten-free diet for life.

Vegetarian Gluten-Free and Gluten Containing Foods
Food	Gluten Free	Gluten Containing
Cereals, flours, cakes & biscuits	Arrowroot, buckwheat, corn/maize, potato flour, rice, rice bran, rice flour, sago, tapioca, soya, soya bran, soya flour.	Wheat, wholemeal, wholewheat & wheatmeal flour, wheat bran, barley, rye, rye flour, pasta, noodles, semolina, All baked foods made from wheat, rye, semolina, barley & pearl barley.
Dairy products & eggs	Eggs, milk, cream, butter, cheese, curd cheese, coffee whiteners, soya products	Some yoghurts (eg muesli yoghurt), some cheese spreads
Puddings	Tapioca, sago, rice, custard.	Semolina, sponge pudding, pastry, pies, wafers.
Beverages	Tea, coffee, herb tea, fizzy drinks, fruit squash, cocoa, marmite, most alcoholic drinks.	Barley based drinks, barley fruit drinks, malted drinks, beer.
Fruit & vegetables	All fruits & vegetables, unless with certain sauces or cooked with gluten containing foods	.
Nuts, seeds & pulses	All, except certain brands of baked beans and beans with a gluten containing sauce	.
Preserves & confectionary	Jam, marmalade, sugar, honey, treacle, molasses, golden syrup, some brands of chocolate & sweets.	Confectionary containing flour, some brands of lemon curd
Soups & sauces	Gluten-free if thickened with a suitable flour. Many manufactured sauces, stock cubes, and soups contain gluten	.
Miscellaneous	Salt, pepper, vinegar, herbs & spices, tamari, yeast, most food colourings and essences.	Some pepper compounds, shoyu, ready-mix spices, some seasoning powders, certain brands of mustard. Certain medicines may contain gluten.