Healthy Eating with Coeliac Disease

Name: Dietitian: Hospital: Date:

Devised by the Gastroenterology Interest Group of the Irish Nutrition and Dietetic Institute

This publication may not be reproduced in whole or in part without obtaining prior permission from the Gastroenterology Interest Group

What is Coeliac Disease? Coeliac disease is a common autoimmune disorder, possibly affecting 1 in 100 people. It is caused by an intolerance to gluten. Gluten is a protein found in WHEAT, BARLEY, RYE & *OATS. Gluten is found in foods made with or containing these cereals. Eating foods that contain gluten damages the lining of the small intestine.

In the small intestine there are folds called villi which help to absorb food. In coeliac disease these villi are damaged by gluten so you don‟t absorb nutrients from food properly.

*Oats Oats are much less harmful to coeliacs than previously thought. Pure oats that are not contaminated with wheat, rye or barley are safe to eat for most coeliacs. Details on distributors can be found in the coeliac society‟s food list. Conventional oats widely available in supermarkets are not gluten-free. Oats should not be eaten by newly diagnosed coeliacs. Before introducing oats, you should be symptom-free, well established on the gluten-free diet, with normal coeliac antibodies (from your blood test). This may take 1-2 years after starting the gluten-free diet. Oats must be avoided during any episodes of gastroenteritis.

Symptoms of Undiagnosed Coeliac Disease Diarrhoea / constipation Persistent or unexplained stomach or gut symptoms e.g.

nausea & vomiting Regular abdominal pain, cramping or distension Fatigue („tired all the time‟) Sudden or unexplained weight loss Unexplained iron deficiency anaemia Dermatitis Herpetiformis – a rash on the back / shoulder

areas Mouth ulcers Lactose intolerance Brittle bones or osteoporosis Infertility - male/female Mood changes Other related diseases e.g. Type 1 diabetes mellitus

The Gluten-free Diet The treatment for coeliac disease is a strict gluten-free diet. People generally begin to feel better within two weeks of starting the diet, although some may take up to two years to completely recover. The diet allows the gut lining to heal, absorb nutrients from food & improve symptoms. A gluten-free diet should only be started after coeliac disease is confirmed using a small intestine biopsy. A normal diet should be eaten until this test is done. Common sources of gluten in the diet are: - Bread - Breakfast cereals - Biscuits - Cakes - Pastries - Pasta - Noodles - Pizza base - Sausage meats - Beer Wheat flour is often used in processed or manufactured foods e.g. some brands of dry roasted nuts & liquorice contain wheat flour. Many unprocessed foods are naturally gluten-free including: - Rice - Potatoes - Corn - Fruits & vegetables - Meat / fish / chicken - Eggs - Most dairy products - Pulses - Nuts & seeds

The Coeliac Society

(Tel 01- 8721471. Email info@coeliac.ie. Website www.coeliac.ie) All coeliacs are strongly encouraged to join the coeliac society. The coeliac society produces a book each year listing all foods that are suitable for coeliacs. In addition to reading labels, it is important to always check the book to ensure foods are gluten-free. If you are unsure about the suitability of a specific food, ask your dietitian or the coeliac society to check it out for you before you purchase or eat it.

Gluten-free or Very Low Gluten? The coeliac society‟s food list gives a list of foods that are gluten- free, i.e. contain less than 20 parts per million (ppm) gluten, and a list of foods that are very low gluten i.e. 20 to 100ppm gluten. As a newly-diagnosed coeliac, you should follow a strict gluten-free diet (less than 20ppm). Once you are symptom-free and once your coeliac antibodies are normal, foods that are labelled „very low gluten‟ can be included in your diet. If you are already established on the old gluten-free diet (less than 200ppm gluten), symptom-free and with normal coeliac antibodies there is no need to avoid very low gluten foods. If you have signs of gluten sensitivity, you should follow a strict gluten-free diet i.e. less than 20ppm gluten.

Reading Food Labels When reading labels it is important to avoid the following ingredients:

Wheat, rye, *oats, barley, starch or modified starch (check source-allowed if not made from wheat), cereal

filler, wheat starch, wheat bran, wheat germ, malt, malt flavouring, malt extract

All ingredients that come from a gluten containing cereal (even if only a tiny amount) must be listed by law on food packaging in the ingredients list.

Some food labels may specify that a particular food is gluten-free in an allergy advice or „ contains‟ box. This is recommended by the Food Standard Agency but it is not law. If gluten is not present the product will not necessarily be labelled as 'gluten-free', although some manufacturers are choosing to label in this way. Products labelled as „wheat-free‟ may not be „gluten-free‟ as they may still contain rye, barley, or oats.

Cross Contamination

Cross contamination happens when small amounts of gluten find their way into „gluten-free‟ foods either by accident or carelessness. This can happen during processing or manufacturing, storage, cooking, preparation & serving. Even small amounts of gluten from contamination can cause damage to the gut. It is important to ensure that no ingredients used in gluten-free dishes are contaminated with gluten. If you are unsure whether a product contains gluten, do not use it.

Steps to avoid Cross-contamination: Prepare & cook gluten-free food separately using:

o Clean utensils, including bread board o Use separate oil for frying – oil used for frying gluten-

containing foods (e.g. battered fish) is not suitable o Use your own „gluten-free‟ toaster or toaster bags. If you

are using a grill, ensure it is clean or cover the pan with tin foil

o Ensure clean surfaces – prepare food away from wheat-floured surfaces or floury area. Flour can take hours to settle & can contaminate surfaces and utensils

Use your own separate butter, spread and jam Avoid buying foods from a deli counter or self-service salad

bar Store your gluten-free products in a separate cupboard

Gluten-free Food & Drink Reference (check www.coeliac.ie for updates)

Gluten-free Need to check Gluten-free Food Booklet

Not Gluten-free

Cereals & Flours: Corn, maize, buckwheat, millet, teff, quinoa, soya flour, potato flour, gram flour, polenta are all naturally gluten-free but may be cross contaminated if they are milled in a factory that handles gluten containing flours Sago, rice, ground rice, tapioca, arrowroot are gluten-free Special gluten-free dietary flours & mixes

Cereals & Flour: Cornflour, savoury rice

Cereals & Flour: Wheat, ordinary flour, ordinary breadmix, bulgar wheat, durum wheat, wheat germ, wheat bran, wheat starch, semolina, couscous, barley, malt, malted barley, rye, oats, triticale, kamut, spelt, farina

Bread, Cakes & Biscuits: Special gluten-free dietary breads, cakes, biscuits, rolls, pizza bases

Bread, Cakes & Biscuits: Meringues, meringue mixes, macaroons, rice cakes

Bread, Cakes & Biscuits: Ordinary bread (including naan, ciabatta & chapati) breadcrumbs, biscuits, cakes, croutons, pastries, scones, muffins, pizza bases, buns

Pasta & Noodles: Special gluten-free dietary pasta

Pasta & Noodles: Rice noodles, poppadoms, soba noodles (buckwheat)

Pasta & Noodles: Ordinary fresh or dried Pasta including spaghetti, macaroni, lasagne & egg noodles

Gluten-free Need to check Gluten-free Food Booklet

Not Gluten-free

Breakfast Cereals: Special dietary cereals that do not contain malt extract flavouring, e.g. gluten-free labelled cornflakes / porridge / muesli

Breakfast Cereals: Rice bran, soya bran

Breakfast Cereals: Wheat based breakfast cereals, cereals that contain malt extract flavouring e.g. Kellogg‟s Cornflakes, porridge oatmeal, wheatgerm, muesli (most ordinary breakfast cereals)

Meat & Poultry: All fresh natural meats & poultry, smoked hams, cured pure meats, unprocessed corned beef e.g. silverside / brisket joints, rashers, gluten-free sausages as listed in Coeliac Society Food List

Meat & Poultry: Meat pates, canned or prepacked meats in own juices, burgers, prepacked cooked meats, meat/poultry in sauce, stuffing mix

Meat & Poultry: Meat & poultry cooked in batter or breadcrumbs, breaded or crumbed ham, ordinary sausages & puddings, meat with stuffing, meatloaf, burgers with cereal or breadcrumbs, Cornish pasties

Fish & Shellfish: All fresh natural fish & shellfish, smoked fish, kippered & dried fish, canned fish in oil or brine

Fish & Shellfish: Fish in sauce, fish pate, chowder, prawn cocktail

Fish & Shellfish: Fish fingers, fish in batter or breadcrumbs, fish burgers, fish cakes, fish in pastry

Cheese & Eggs: Plain cheese, cottage cheese, low-fat cheese, eggs

Cheese & Eggs: Cream cheeses, processed cheese, cheese spreads, ready-grated cheese, cheese strings, egg mayonnaise

Cheese & Eggs: Scotch eggs, cheese fillers, breaded cheese

Milk & Milk products: Fresh, dried, condensed, evaporated milk, buttermilk, goats milk, soured cream, natural crème fraiche, natural yogurt

Milk & Milk products: Coffee & tea whiteners, milkshakes, fromage frais, yogurt, aerosol creams, artificial creams, ice-cream, custard

Milk & Milk products: Oat milk, yogurt and fromage frais containing muesli or biscuit, Rice Dream

Gluten-free Need to check Gluten-free Food Booklet

Not Gluten-free

Fats & Oils: Butter, margarine, lard, cooking oils, ghee

Fats & Oils: Low-fat spreads

Fats & Oils: Processed suet

Fruit & Vegetables: All natural, fresh, frozen, canned & dried pure fruits & vegetables, all plain salads without dressings

Fruit & Vegetables: Oven, microwave & frozen chips, instant mash, fruit pie fillings, waffles, coleslaw, potato salad, baked beans

Fruit & Vegetables: Vegetables and potatoes in batter, breadcrumbs or dusted with flour, potato croquettes & waffles, chips from “Fish & Chip” shops, onion rings

Nuts, Seeds & Pulses: All pulses, lentils, most nuts & seeds

Nuts, Seeds & Pulses: Seed mixes, dry roasted nuts, Bombay mix

Nuts, Seeds & Pulses:

Crisps & Snacks: Homemade natural popcorn

Crisps & Snacks: Crisps, processed nuts

Crisps & Snacks: Snacks made from wheat, rye, oats, barley and flavoured with malt extract flavouring

Spreads & Preserves: Sugar, brown sugar, glucose, molasses, jams and marmalades, honey, golden syrup, treacle, maple syrup

Spreads & Preserves: Mincemeat using rice flour, lemon curd, peanut butter

Spreads & Preserves: Mincemeat which includes suet dusted in flour

Soups & Sauces: Tomato puree, pure herbs and individual spices, vinegar, malt vinegar, garlic bulbs

Soups & Sauces: Gravy granules, stock cubes, canned and dried soups, fresh soups in cartons, dried sauces & mixes, table sauces, cooking sauces, stir-fry sauces, mustard, mayonnaise, salad cream, salad dressings, pickles, chutneys, spice blends, curry powder, tomato ketchup, soy sauce

Soups & Sauces: Soups made with barley, broth mix, noodles & croutons, soup made with ordinary flour, spice blends where wheat flour is used as a carrier

Gluten-free Need to check Gluten-free Food Booklet

Not Gluten-free

Desserts & Confectionery: Plain jelly, milk puddings made with gluten-free ingredients

Desserts & Confectionery: Custard, dessert mixes, instant whips, ice-cream & frozen desserts, tinned puddings, sweets, chocolates, chewing gum, mousses

Desserts & Confectionery: Semolina, sponge puddings, tarts, pies, Pick 'n' mix

Drinks: Tea, tea bags, coffee, pure fruit juice, squash, mineral water, minerals, plain Complan, wine, all spirits, cider, sherry, port, Baileys, Bovril, Marmite, Cadbury‟s cocoa, gluten-free beer as listed in the coeliac society‟s food list

Drinks: Liqueurs, drinking chocolate, „economy blends‟ of coffee, milkshake powders, squashes & cordials

Drinks: Malted drinks, barley waters, squashes which contain barley, vending machine drinks, stout, beer, ales, lagers

Baking Ingredients: Gelatine, bread soda, dried and fresh yeast, bextartar, dried fruit, glace cherries, vanilla essences, food colouring, ground almonds, desiccated coconut

Baking Ingredients: Marzipan, icing sugar, cake decorations, baking powder

Baking Ingredients: Ice-cream cones and wafers

Miscellaneous:

Miscellaneous: Tofu, quorn, liquorice, low calorie sweeteners, medications

Miscellaneous: Communion wafers

Eating Out Being a coeliac can make it more difficult to eat out. It can be very daunting at first but with a little homework & preparation it gets easier. Before eating out, phone the restaurant or drop in beforehand to check that they are able to cater for someone on a gluten-free diet. Speak to the chef to:

Check he/she is aware of basic cross contamination so that your meal does not come in contact with gluten during preparation, cooking & serving.

Ask about the suitability of ingredients in your chosen dish.

Ask if a dish can be slightly adapted to be gluten-free. For example, you could ask for your meat without gravy or ask if there is gluten-free sauce available.

Finding a Coeliac-friendly Restaurant: Because a lot of people in Ireland have coeliac disease, many restaurants are familiar with the condition and regularly cater for coeliacs. The coeliac society has a list of restaurants (in Ireland and abroad) recommended by coeliacs themselves. These restaurants have not been vetted by the coeliac society so it is important to still take the same precautions you normally would. www.findarestaraunt.ie has a list of restaurants in Ireland that cater for the gluten-free diet.

Travelling

If you are planning a trip abroad contact the Coeliac Society for an „Eating Out‟ card. Eating out cards are available in different languages and can be given to a waiter or chef in a restaurant. The card explains the gluten-free diet and is very helpful when you are trying to let people know about your condition when eating out abroad. Check if your hotel provides gluten-free meals. Self catering holidays are sometimes easier.

You will need to bring gluten-free foods with you (bread, cereals, crackers, biscuits, gravy). Pack some toaster bags to reduce contamination from toasters. Check travel arrangements. Some airlines or other transport operators will provide gluten-free meals if notified in advance. It is advisable to bring your own food on board in case the airline fails to supply the meal on the day.

Takeaways

The main problem with takeaways is cross-contamination! Unless you can be sure that staff are aware of the coeliac condition & take cross-contamination precautions, takeaways need to be avoided.

Fish & chips: avoid chips if they are cooked in the same oil as battered fish. Taking the batter off fish does NOT make it safe to eat as it will already have been contaminated with gluten.

Chinese: avoid wheat noodles & soy sauce.

Indian: many dishes are thickened with chickpea flour and yogurt which are gluten-free. Rice & poppadoms are gluten-free.

Pizza: some outlets now make gluten-free pizzas.

Sample Meal Plan Breakfast Fruit or fruit juice Gluten-free breakfast cereal Gluten-free bread with spread & marmalade Egg or bacon (if desired) Tea / coffee / milk Lunch Meat / fish / chicken / cheese / egg Vegetable / salad Gluten-free bread / gluten-free crackers / rice

cakes Tea / coffee / milk Dinner Starter

Gluten-free soup Melon / grapefruit / fruit juice

Salad (Caesar or similar) with gluten-free dressing, without croutons

Maincourse Lean meat / fish / chicken / vegetarian alternative

Potatoes / rice / gluten-free pasta Large serving salad / vegetables Gluten-free sauce / gravy / stuffing

Dessert Fruit / jelly / yogurt / meringue / milk pudding

Tea / coffee / milk Snacks Fruit, gluten-free crackers & biscuits, popcorn, nuts,

yogurt

Can I Cheat a Little? Research has shown that coeliacs who follow their diet strictly for two years are less likely to suffer from anaemia & osteoporosis. Some people may not always get symptoms if gluten is eaten but gut damage may still occur. Symptoms are not a good indicator of whether a food contains gluten or not.

Follow-up

You will need regular check-ups to monitor your progress. This is often done by your GP, but sometimes it will be done by a gastroenterologist. You may need blood tests (e.g. Hb, folate ferritin, B12) to monitor nutrient levels and to check that you are no longer producing antibodies that damage the small bowel. Measuring coeliac antibodies (blood test) after 6 months of starting the gluten-free diet & every 6-12 months after that will help your Doctor / Dietitian see how you are recovering. High antibodies can show that there is still some gut damage or that you are not strictly following the diet.

Osteoporosis In coeliac disease important nutrients for bones such as vitamin D and calcium may not be absorbed well. People with coeliac disease must take special care to protect themselves against osteoporosis (thinning of the bones). A gluten-free diet may improve, or at least maintain, bone mineral density.

Dietary Treatment & Prevention of Osteoporosis Follow a strict gluten-free diet to ensure full absorption of nutrients. The recommended daily intake of calcium for adults with coeliac disease is 1500mg/day. You will need to eat at least 5 servings of calcium rich foods per day.

Calcium counter

A glass of milk (200ml) ~230mg A glass of calcium fortified milk (200ml) ~330mg Pot of yogurt (125g) ~ 225mg Portion of cheddar cheese (30g/1oz) ~220mg 2 tinned sardines with bones (50g) ~260mg Tofu (50g) ~250mg 3 dried figs ~150mg 6oz broccoli ~100mg 2 eggs ~100mg 15 dried apricots ~100mg 2oz nuts ~100mg 5oz pulses e.g. chickpeas ~100mg

Low-fat dairy products contain the same amount of calcium as full-fat varieties. Consider a calcium supplement if you cannot take enough calcium from food alone. It is also important to:

Avoid smoking & excessive alcohol intake and to

Take regular weight bearing exercise – e.g. walking, jogging

Vitamin D

Vitamin D is needed to properly absorb and use calcium in the body. It is found in oily fish, cheese, eggs and fortified foods, e.g. margarine; but most comes from the action of sunlight on our skin. Supplements may be needed for elderly people who have little exposure to sunlight and in some ethnic groups. Calcium and vitamin D are available as a combined supplement. Always check with your pharmacist that any medications you take are gluten-free.

Osteoporosis is detected by a DEXA scan. A DEXA scan is recommended if you have two or more of the following: 1) Ongoing symptoms despite following a gluten-free diet for one year or if you are not following the gluten-free diet 2) Weight loss of more than 10% body weight in the past 6 months 3) Body Mass Index (BMI) less than 20 (underweight) 4) If you are over 70 years of age

Iron & Anaemia

Iron deficiency anaemia is a common symptom of coeliac disease, because iron is not being absorbed properly in the gut. Iron is needed to produce healthy red blood cells, which carry oxygen around our bodies and give us energy. It is important that people with coeliac disease take enough iron and keep to a gluten-free diet. Iron-deficiency anaemia can be corrected with a strict gluten-free diet but some people may need an iron supplement.

How to increase your iron intake: Iron is found in many foods. It occurs in two forms:

1) Haem iron – found mainly in red meat, liver and offal meats. Smaller amounts of haem iron are present in animal foods such as poultry meat and fish.

This type of iron is very well absorbed by the body. Pregnant women should avoid liver and other offal products due to the high vitamin A content.

2) Non haem iron – found mainly in fortified foods including

breakfast cereals, breads, green leafy vegetables, pulses, dried fruit, egg yolk, nuts and seeds. The body only absorbs a small amount of this type of iron. You can improve the absorption of this iron by including some vitamin C at meals, for example drinking orange juice with breakfast cereal.

Malignancy Undiagnosed coeliac disease is linked to a small increased risk of non-Hodgkin‟s & Hodgkins Lymphoma & small bowel cancer. This increased risk is mainly during the first year following diagnosis of coeliac disease. After one year the risk falls to a level that is only slightly higher than the normal population.

Your Weight At the time of diagnosis, you may find you have lost weight because you have not been absorbing food properly. Once a gluten-free diet is started, weight gain may occur. Weight gain most frequently happens in the first few years after diagnosis. This is because when you follow the gluten-free diet you feel better, your appetite improves and because the gut is healing you are absorbing more nutrients. The main priority after diagnosis is to follow a strict gluten-free diet, but following a balanced diet & maintaining a healthy weight is important in the long-term. A healthy weight prevents health problems linked to obesity such as heart disease & diabetes. The only way to lose weight is to choose smaller portion sizes, make healthy food choices & exercise more. The Food Pyramid will help you make healthier food choices & provides guidance on portion sizes. Consult with your Dietitian for advice on healthy eating or refer to www.indi.ie

The National Guidelines on Physical Activity for Ireland recommend at least 30 minutes a day of moderate activity on 5 days per week. Moderate activity is defined as increased breathing & heart rate, but you should still be able to carry on a conversation. Examples of moderate activity include brisk walking, gardening, swimming, cycling. See www.getirelandactive.ie for full details.

The Cost of the Gluten-free Diet One of the biggest challenges that people face is the cost of the diet. Gluten-free alternatives are essential to help people stay healthy but come at a much higher cost than a normal diet. You will save money by baking your own gluten-free bread. Shop around at chemists & supermarkets & compare prices. The cost of the diet can also be reduced by using the Medical Card / Drugs Payment Scheme / MED1 form:

Medical Card Medical card holders are entitled to free gluten-free bread, flour mixes, bread mixes, bread rolls, pasta, cornflakes, muesli, porridge, pizza bases (certain brands only). A copy of the GMS list (for medical card holders and the Drugs Payment Scheme) is available at the back of the coeliac society‟s food list.

Drugs Payment Scheme (DPS) Under this scheme, an individual or household pays a maximum of €120 per month for approved prescribed medicines and gluten-free foods used by that person or household in that month. You can register for the scheme by completing the registration form, which is available from pharmacies.

Med1 Form You can get a tax refund on gluten-free foods manufactured specifically for coeliacs that are not covered by the DPS or medical card. It is important to keep receipts for gluten-free foods purchased throughout the tax year. At the end of the year, complete the MED1 form available from the tax office or online www.revenue.ie

Supplementary Welfare Allowance Scheme

Under the Supplementary Welfare Allowance Scheme, some coeliacs may get an additional weekly diet supplement. To get a diet supplement you must satisfy specific requirements set by the HSE. You must be in receipt of a social welfare payment or HSE payment and satisfy a means test. More information can be found on www.welfare.ie

Manufacturers of Gluten-free Products 1) Delicious Gourmet Foods Unit 1 Innishmore Industrial Estate, Ballincollig, Cork Tel: 021 4875780 Website: www.delicious.ie Email: Info@delicious.ie 2) Ecodirect (Store online) Ecodirect Limited, 56 Park West Enterprise Centre, Lavery Avenue, Dublin 12 Tel: 01 6205053 Website: www.ecodirect.ie

3) Gluten Free Foods Gluten Free Foods Ltd, Unit 270, Centennial Park, Elstree, Hertfordshire, WD6 3SS, UK Tel: +44 (0)208 953 4444 Website: www.glutenfree-foods.co.uk Email: info@glutenfree-foods.co.uk 4) Heron Foods Heron Quality Foods Ltd., Knockbrown, Bandon, Co. Cork Tel: 0238839006 / 0238839960 Website: www.glutenfreedirect.com Email: heronfoods@eircom.net 5) Hodgins Sausages Hodgins Sausages Ltd., Dublin Road, Mitchelstown, Co.Cork Tel: 025 24696 Website: www.hodginssausages.com Email: hodginssausagesltd@eircom.net 6) Livwell Ltd PO Box 22, Hull, HU2 0YX, England Tel: (UK) 0845 120 0038 Website: www.livwell.eu Email: info@livwell.eu

7) Juvela Tel: (UK) 08007831992 Website: www.juvela.co.uk Email: info@juvela.co.uk 8) Kelkin Kelkin Ltd, Unit 1, Crosslands Industrial Park, Ballymount Cross, Dublin 12 Tel: 01 4600411 Website: www.kelkin.ie Email: info@kelkin.ie 9) Mulligans Gluten-free Bakery Unit 16-18, IDA Centre, Gloucester Place, Dublin 1 Tel: 01 855 8451 Website: www.mulligans-bakery.com 10) Nutrition Point Limited Dietary Specials, Glutafin & Trufree products Part of the Dr Schär group Units 1-2 Station Court, 442 Stockport Road, THELWALL, WA4 2GW, England Tel: (UK) 01925 865100 Website: www.nutritionpoint.co.uk Email: info@dietaryspecials.co.uk 11) Odlums Merrywell Industrial Estate, Ballymount, Dublin 12 Tel: 01 405 1500 Website: www.odlums.ie Email: info@odlums.ie 12) Ok Foods Ok Foods Ltd, Edenholme Bakery, Lazonby, Penrith, Cumbria, UK Tel: (UK) 01768 898437 Website: www.ok-foods.co.uk Email: info@ok-foods.co.uk 13) Orgran

Website: www.goodnessdirect.co.uk

14) Proceli (Barcelona – Store online) Tel: +34 902 364 334 Website: www.proceli.com Email: info@proceli.com 15) Ultrapharm (Store Online) Tel: (UK) 0845 270 1400 Website: www.gfdiet.com E-mail: orders@glutenfree.co.uk 16) Village Bakery The Village Bakery Melmerby, Edenholme Bakery, Lazonby, Penrith, Cumbria, UK Tel: (UK) 01768 898437 Website: www.village-bakery.com Email: info@village-bakery.com Gluten-free flour, bread, bread mixes, biscuits, pastas & cereals can be obtained in most of the major supermarkets in Ireland, including: Dunnes Stores Marks & Spencer Tesco Super Valu Centra Superquinn

Most health food stores & pharmacies stock gluten-free foods.

Gluten-free Communion Hosts Coeliacs are advised not to receive the normal Host at Communion as it contains gluten. Ask your local Priest for details on receiving Communion from the Chalice or receiving the gluten-free Host. Gluten-free Hosts can be obtained by contacting: Noreen Hegarty (Manager) Alter Bread Supplies Ltd, Northside Community Enterprises, Sunbeam Ind. Park, Millford, Mallow Rd., Cork Tel: 021 4300227 Coeliac Hosts in the Dublin area: Miss Kathleen Thornton, c/o Blessed Sacrament Chapel, 20 Bachleres Waalk, Dublin 1 Tel: 01 8724597

Recipes Refer to www.coeliac.ie or www.odlums.ie for recipe ideas

Additional Notes: _______________________________________________________________________________________________________________________________________________________________ While every effort is made to ensure that all information provided in this diet sheet is accurate, we cannot accept responsibility for any changes in suitability of manufactured products that might arise. We recommend that all products be carefully checked before consumption