There is more to the diet than gluten-free. Kathryn Miller, Food Policy Lead Coeliac UK

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1 There is more to the diet than gluten-free Kathryn Miller, Food Policy Lead Coeliac UK

2 Introduction About Coeliac UK Coeliac disease Gluten-free diet Gluten-free; the law Nutritional adequacy Nutritional composition Cost Availability

3 About Coeliac UK Leading Charity for people with coeliac disease Support Information Local support Online tools Campaign Research

4 What is coeliac disease? Affects 1 in 100 people, more common in first degree relatives Autoimmune disease (like Type 1 diabetes, rheumatoid arthritis) Symptoms vary Common ones include: diarrhoea, constipation bloating/wind nausea, vomiting, stomach pain mouth ulcers Tiredness nutritional deficiencies

some people are also sensitive to oats Eating gluten triggers an

5 Coeliac disease Life long, can be diagnosed at any age Triggered by eating gluten Gluten is found in wheat, rye and barley and some people are also sensitive to oats Eating gluten triggers an immune reaction leading to damage to the lining of the small intestine

6 How is it diagnosed? Speak to a GP Blood test Antibodies to gluten Endoscopy with biopsy Damage to the gut lining Must keep eating gluten until testing complete

7 Where is gluten found? x x x x x x x x x Bread and rolls Pasta and wheat noodles Cakes and biscuits Pizza and pizza bases Muesli and wheat-based breakfast cereals Couscous and semolina Beer, lager, stout and ale Soya sauce Some processed foods, such as sausages, soups and some ready meals

8 Naturally gluten-free food Fruit and vegetables Meat, fish and poultry Eggs, milk, cream, cheese, yoghurt Rice, lentils, pulses, corn, soya, potatoes Polenta, tapioca, sago Butters, margarines and oils Nuts and seeds Herbs and spices Wine, cider and spirits

9 The gluten-free diet Substitute products - gluten-free bread (on prescription or Free from) Naturally unprocessed gluten-free foods - meat, fish, milk, cheese, fruit, pulses and vegetables Mainstream processed foods that may be suitable on a gluten-free diet - cooking sauces, ready meals, soups

The law EC41/2009 First ever EU law on use of gluten-free Based on a new, stricter, safer international standard Regulation gave businesses until 1st Jan

10 The law EC41/2009 First ever EU law on use of gluten-free Based on a new, stricter, safer international standard Regulation gave businesses until 1st Jan 2012 to comply Since 1st Jan 2012 products not complying to rules became illegal Gluten-free 20 ppm or less Applies to packaged foods and foods sold loose

11 Ingredients list All ingredients must be listed in ingredients list Must use the words wheat, rye, barley, oats INGREDIENTS Wheat Flour, Water, Wheat germ (5%), Salt, Calcium Carbonate, Soya Flour, Wheat Protein, Vegetable Fat, Emulsifier: E472e (made from Vegetable Oils), Modified Starch, Skimmed Milk Powder

12 Ingredients list from December 2014 The 14 allergens must be emphasised in the ingredients list INGREDIENTS Wheat Flour, Water, Wheat germ (5%), Salt, Calcium Carbonate, Soya Flour, Wheat Protein, Vegetable Fat, Emulsifier: E472e (made from Vegetable Oils), Modified Starch, Skimmed Milk Powder

13 May contain statements Used by manufacturers indicate a risk of contamination e.g. may contain wheat (gluten) Based on guidance from the Food Standards Agency should only be used when, following thorough risk assessment, there is a demonstrable and significant risk of allergen cross-contamination

14 How healthy is the GF diet? Research carried out by Coeliac UK and the Food Standards Agency in 2008 Reviewed the scientific literature on the nutritional adequacy of the GF diet No firm evidence to show that those with CD following a GF diet have inadequate intakes of iron, calcium, and B vitamins Available studies are very limited and generally of poor quality Lack of studies rather than true absence of problems?

Nutritional composition of GF foods Gluten-free breads significantly higher in fat than gluten-containing They were also higher in saturated fat Brands vary some

15 Nutritional composition of GF foods Gluten-free breads significantly higher in fat than gluten-containing They were also higher in saturated fat Brands vary some fresh breads contained over 15g/100g whilst others contained 1.5-5g/100g, comparable to gluten-containing breads Some breads fortified with calcium and other nutrients

Calcium General Population: 700 mg/day Coeliac Disease: increased need maintained at or above 1000 mg/day (BSG, 2014) Half of those diagnosed have low bone mineral

16 Calcium General Population: 700 mg/day Coeliac Disease: increased need maintained at or above 1000 mg/day (BSG, 2014) Half of those diagnosed have low bone mineral density If diagnosed before adulthood bone health less likely to be affected Supplements should only be taken on medical advice Some products like breads fortified

17 Iron Essential part of haemoglobin, red pigment in blood needed to transport oxygen around the body Around a quarter of adults are anaemic due to iron deficient when first diagnosed with coeliac disease Some gluten-free products are fortified with iron

Fibre Removal of grains from the diet can lead to a decrease in fibre intake People who eat more fibre tend to have reduced risk of certain cancers, heart

18 Fibre Removal of grains from the diet can lead to a decrease in fibre intake People who eat more fibre tend to have reduced risk of certain cancers, heart disease, overweight and obesity Can help you feel full Reduces constipation Intakes are low Wholegrains Porridge oats Popcorn Brown rice Wild rice Buckwheat Millet Quinoa

Oats Oats provide increased variety, palatability and specific beneficial effects on cardiovascular health Benefit of oats in the GF diet: soluble dietary fibre (β-glucan)* B vitamins (thiamine,

19 Oats Oats provide increased variety, palatability and specific beneficial effects on cardiovascular health Benefit of oats in the GF diet: soluble dietary fibre (β-glucan)* B vitamins (thiamine, niacin and riboflavin) vitamin E and antioxidants (tocols) good quality protein Oats tolerated by most, but not all those with coeliac disease *EFSA 2011: Oat beta-glucan reduces the cholesterol level in the blood. The lowering of the blood cholesterol level can reduce the risk of coronary heart disease.

20 Gluten-free diet adherence Adherence to the GF diet varies: 20-80% of people admitted to occasional or prolonged lapses 42-91% range for strict adherence Factors affecting adherence to the diet: Knowledge of the GF diet Cost, access, and availability Taste and texture of GF foods

21 Cost of gluten-free food GF staple foods cost significantly more than standard staples GF staples like bread can be 4 times the price Ingredients Cost of ingredients Number of ingredients Processing Dedicated milling and processing Quality assurance and verification Quality assurance Gluten testing Packaging Segregated packing areas Differences in shelf life Transport and distribution Wastage costs Distrubution channels Marketing and advertising Market size Impact of gluten-free lifestylers Product development Relatively new industry New food technology techniques and processes GF staples on prescription addresses the imbalance

22 Availability The GFG basket Shoppers often have to visit more than one store to do their weekly shop Developed basket of essentials Asked retailers to sign up to the Gluten-free Guarantee, to guarantee to stock the GfG basket

23 How was the GFG basket developed? Shopping Habits Survey Member engagement Prescription GF foods Healthy Eating Indicator Shopping Basket HEISB Retailer engagement HCP engagement Fresh bread white Fresh bread other Bread rolls Breakfast cereals Pasta Flour Crackers Cereal bars

Gluten-free Guarantee pledge A commitment from retailers to: Stock a minimum of one variety for each of the 8 items in ALL stores Share with us how they

24 Gluten-free Guarantee pledge A commitment from retailers to: Stock a minimum of one variety for each of the 8 items in ALL stores Share with us how they create their stocking policies around free-from Share the full list of all their stores Work together to better inform our Members on variations in stock

25 Retailer engagement

26 FREED FROM From Campaign 7 years, 7 pledges FREED FROM Hassle GF food in every store Suffering diagnosing the 1 in 100 Anxiety supporting your condition Coeliac disease raising 1 million for research Premium prices affordable GF food Doubt more foods labelled GF Limits GF menu choices

27 Summary Comparable composition Research genetics, cure Readily available GF food Awareness when dining out Person with coeliac disease Improvements in diagnosis rates School meals support Quality of life Better food in hospital Comparable cost Great tasting GF food

28 Thank you for listening

Coeliac disease catering gluten-free

Coeliac disease catering gluten-free About Coeliac UK National Charity for people with coeliac disease and dermatitis herpetiformis Founded in 1968 and is the largest coeliac charity in the world Mission: