9.4.1 Foods for special diets

Some gluten free products can be prescribed on an FP10 for gluten-sensitive enteropathies including steatorrhoea due to gluten-sensitivity, coeliac disease and dermatitis herpetiformis. Prescriptions must be endorsed ACBS.

The diagnosis of coeliac disease is increasing. The gold standard for making the diagnosis is duodenal biopsy as blood tests may give false positives. However, false negatives are rare so blood tests may be a useful screening test. Gluten should not be withdrawn prior to a biopsy or blood test. Refer to gastroenterologist or specialist dietician led coeliac clinic for further advice.

Gluten free products ACBS

The availability and prescribing of gluten free foods has risen steadily with some patients requesting more than others. To date there has been no real guidance on maximum quantities permissible on prescription. However Coeliac UK (www.coeliac.org.uk) has recently issued guidance for healthcare professionals in response to the growing cost pressures of these products and includes the following:

  • The number of units recommended in the 2004 guidelines should be treated as the 'norm' unless there are exceptional circumstances. The details of these guidelines are available on the following link: www.coeliac.org.uk/healthcare-professionals/
  • Staple foods such as breads (including fresh bread), pasta, flours, crisp breads and pizza bases listed by the ACBS should remain available.
  • Cake mixes should no longer be available and sweet biscuits should only be considered in exceptional circumstances on clinical advice due to fact they are not staple foods and their use is not consistent with healthy eating recommendations.
  • There may also be cases where biscuits are recommended for individuals who are underweight or additional units are recommended in patients with additional calorie requirements.
  • Dieticians with special interest in coeliac disease are best placed to assess individual requirements.
  • Consider the Eat Well Plate (click here). In addition to gluten-free food, patients should eat natural carbohydrate foods such as rice and potatoes. Gluten-free substitute foods should only provide 15% of the total energy required.

The Formulary does not therefore support the prescribing of 'luxury' items on the grounds that in addition to the notes above it does not support healthy eating.

Patient information leaflet: Gluten free diet

Recommended number of units per month per patient:

Child 1-3 years: 10 units

Child 4-6 years: 11 units

Child 7-10: 13 units

Child 11-14 years: 15 units

Child 15-18 years or Male 19-59 years: 18 units

Male 60-74 years: 16 units

Male 75+ years or Female 19-74 years: 14 units

  • In 3rd trimester of pregnancy add 1 unit, breastfeeding add 4 units. High PAL add 4 units

Female 75+: 12 units

Example units
  • 400g bread/rolls/baguettes = 1 unit
  • 500g mix = 2 units
  • 200g biscuits/crackers = 1 unit
  • 250g pasta = 1 unit
  • 2x110g-180g pizza bases = 1 unit

Please refer to the Coeliac Society UK: Gluten-free foods: a revised prescribing guide

 

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