Healthy, happy and gluten-free

1. Healthy, happy and gluten-free 06.10.2012 Jacqui Lowdon Paediatric Dietitian, Royal Manchester Children‘s Hospital

2. Why is healthy eating so important? • Life-long gluten free diet • Avoiding wheat, rye and barley (and oats) • Certain nutrients are of particular importance • Calcium • Iron • Folic acid • Fibre • Often weight gain will occur following diagnosis • Maintaining a healthy weight will help to prevent other health problems e.g heart disease, type 2 diabetes and stroke • If overweight, just 5-10% weight loss will significantly reduce risk of major diseases

3. How do I know if I am a healthy weight?

4. Name Präsentation • 10.12.2010 How do I know if I am a healthy shape? • Waist circumference is a better indicator of long term health risks and abdominal fat stores. • Ideally: • Men < 94cm (37”); South Asian men ideally <90cm (35.5”) • Women <80cm (32”)

5. So, what is a healthy, well-balanced diet? Reproduced with kind permission of the Food Standards Agency

6. Name Präsentation • 10.12.2010 A healthy, well-balanced diet • Naturally gluten free • Provide vitamins, minerals & fibre • Aim for at least 5 portions per day • Fresh, frozen, dried, tinned or juices Fruit and Vegetables

7. Name Präsentation • 10.12.2010 A healthy, well-balanced diet • Include at every meal • 50% of energy should be derived from this group • Important provider of energy, fibre, vitamins & minerals • Most obvious source of gluten • A variety of gluten-free alternatives now available, many on prescription • Nutrient enriched where possible • Naturally gluten-free options: rice, potatoes, yam, millet, quinoa and teff Starchy carbohydrate foods

8. Name Präsentation • 10.12.2010 A healthy, well-balanced diet • Important source of calcium • Aim for 3 portions per day; • 1/3 pint milk • Small pot of yogurt • Matchbox-sized piece of cheese • Milk portion within 6-8 cups tea/coffee • Reduced fat options where possible Dairy foods

9. Name Präsentation • 10.12.2010 A healthy, well-balanced diet • Important source of protein vitamins & minerals including iron, zinc & vit B12 • 2-3 portions/ day • Include 2 portions of fish/ week – one of which should be oily • Choose leaner cuts and remove excess fat before cooking Meat, fish, eggs & pulses

10. Name Präsentation • 10.12.2010 A healthy, well-balanced diet • Some fat is essential • choose reduced fat/ sugar options • Limit intake of saturated fat in particular • Choose mono/ polyunsaturated fat spreads & oils instead of butter/ lard • Use healthier cooking methods; poaching, grilling instead of frying • Sugary foods & drinks are often high in calories but contain few essential nutrients • Sweetened soft drinks are a main contributor to sugar intake Sugar & fat

11. Gluten-free foods on prescription

12. Prescription Guidelines for Gluten-Free Foods

13. What is a unit of food?

14. Important Nutrients to consider in a Gluten-Free Diet

15. Fibre • A gluten-free diet can be low in fibre & wholegrains due to the removal of certain cereals from the diet • Two types of fibre: • Insoluble fibre - helps to keep bowel healthy & prevent constipation (wholegrain cereals, fruit & veg, pulses) • Soluble fibre - this may help to lower cholesterol levels & improve blood glucose control (oats, beans, pulses, some fruit & veg)

16. Calcium • People with coeliac disease have an increased requirement for calcium • It is recommended that people with coeliac disease consume 1000 - 1500mg/ day of calcium, minimum 1200mg for post-menopausal women & men over 55 years • Gluten-free sources of calcium include: dairy products, tinned sardines, Leafy green vegetables, dried figs • Some gluten-free products are also fortified with calcium • In some instances calcium supplements may be advised • Vitamin D is also important to absorb sufficient calcium

17. Calcium Content of Gluten-Free Foods 150ml pot of yoghurt Small tin of kidney beans (200g) 4 slices of fresh gluten-free bread

18. Iron • Iron deficiency is common in undiagnosed coeliac disease • Approximately ¼ of adults have iron deficiency anaemia when diagnosed with coeliac disease • Requirements vary with age & gender but are the same as for the general population • Two types of iron: • Haem iron - from animal sources, better absorbed by the body • Non-haem iron - from plant sources, less well absorbed • Some foods can reduce iron absorption e.g. tea (tannins), coffee/cocoa (polyphenols)

19. Iron Content of Gluten-Free Foods 90g of red meat Handful of dried apricots (80g) 90g spinach

20. How to read and understand a food label

21. Example of a Food Label Seite 21 Name Präsentation • 10.12.2010

22. Any questions?