Additional diet information
Including gluten free, uncontaminated oat products should be considered on an individual patient basis. All patients should receive regular follow up. Some people with coeliac disease prefer not to include oats in the diet. Coeliac UK always refers people enquiring about including uncontaminated oats in the gluten free diet to their healthcare team for specific guidance based on an individual's level of sensitivity and ongoing management.
The approach recommended by the British Society of Gastroenterology is that gluten free oats may be introduced to the diet at diagnosis.
NICE recommends to explain to people with coeliac disease that;
- they can choose to include gluten free oats in their diet at any stage
- they will be advised whether to continue eating gluten free oats depending on their immunological, clinical or histological response.
As part of a patient’s ongoing monitoring the use of oats should be reviewed.
It is recommended that adults with coeliac disease should have at least 1000 milligrams (mg) of calcium each day. This is based on the British Society of Gastroenterology (BSG), guidelines on the diagnosis and management of adults with coeliac disease (2014).
NICE recommends to explain to people with coeliac disease (and their family members or carers, where appropriate) that they may need to take specific supplements such as calcium or vitamin D if their dietary intake is insufficient.
Public Health England and the Scottish Government provide advice on vitamin D intakes, based on recommendations from the Scientific Advisory Committee on Nutrition. We have information on nutritional deficiencies and supplements including vitamin D supplementation.
We have information for patients on how to achieve the recommended calcium intake.
Vegetarian and vegan diets
Nutrient deficiencies, due to malabsorption, are common in patients with coeliac disease at diagnosis and can persist after commencing a gluten-free diet. Common nutrient deficiencies associated in coeliac disease include iron, calcium, folate, and vitamin B12. These nutrients may be a particular concern for individuals who have other dietary restrictions. For instance, combining a gluten free and vegetarian or vegan diet can increase the risk of these nutritional deficiencies, and it is therefore important to plan meals carefully.
- Iron - Anaemia is a common presentation of coeliac disease. The more restricted the diet the greater the risk of iron deficiency anaemia. Access information for your patients about iron deficiency and good sources of iron.
- Protein - Plant protein can meet requirements when a variety of plant food is consumed and energy needs are met. In more restrictive diets, where variety and energy intake is limited, greater attention must be given to providing an adequate protein intake. This is especially important in pregnant women, infants, growing children and the elderly. A vegetarian diet, including milk and eggs, provides all essential amino acids. People following a vegan diet, where the main protein sources are plant sources, may have greater dietary protein requirements. The consumption of dietary protein from a variety of sources should be encouraged. Access information for your patients about combining a vegetarian and vegan diets with gluten free.
- Calcium - Adequate calcium and vitamin D intakes are important to ensure optimal bone status. Milk and milk products are prime sources of calcium in the diet, therefore eliminating dairy foods can severely restrict calcium intake. We have information for patients on how to achieve the recommended calcium intake, including non-dairy calcium sources.
- Vitamin B12 - Vitamin B12 deficiency may not typically be expected in people with coeliac disease. Absorption is cofactor dependent and occurs in the often unaffected terminal ileum; however, B12 levels are statistically lower in people with coeliac disease compared with controls. The haematological symptoms of vitamin B12 deficiency may be masked by excessive intakes of folic acid. The only reliable unfortified sources of vitamin B12 are meat, dairy products and eggs. The current nutritional consensus is that no plant foods can be relied on as a safe source of vitamin B12 – this includes sea vegetables, Spirulina, or fermented soya products. Good sources of vitamin B12 for vegetarians are dairy products and eggs. It is recommended that vegans ensure their diet includes foods fortified with vitamin B12, such as yeast extracts or vegetable stock, soya milk, textured vegetable protein, and margarines. Not all vegan foods fortified with vitamin B12 will be gluten free.
Undiagnosed or untreated coeliac disease is a frequent cause of secondary lactose intolerance. We have information on lactose intolerance and a downloadable leaflet you can use to help your patients. Read more about managing lactose intolerance.
For patients with diabetes and coeliac disease, blood glucose levels should be monitored closely following coeliac disease diagnosis as insulin levels often need to be altered due to the increased absorption of carbohydrate. Gluten free alternatives to wheat-containing bread, pasta, biscuits and flour have comparable Glycaemic Indeces as their gluten-containing counterparts, and therefore should not necessarily compromise the diet in terms of the glycaemic load. We have information about diabetes and a downloadable leaflet you can use to help your patients.