Allergy diet - gluten free

Aim

To provide a diet that excludes all products containing the cereal protein gluten.

Characteristics

This diet avoids all foods containing wheat, rye, barley, oats, spelt and triticale. All products should comply with the requirements for ‘gluten free’ per Standard 1.2.7(12) and Schedule 4 in the Australia New Zealand Food Standards Code (i.e. that foods must not contain detectable gluten, oats or oat products or cereals containing gluten that have been malted, or products of such cereals).

Indications

• Coeliac disease
• Dermatitis herpetiformis

Nutritional adequacy

This diet can be nutritionally adequate but may be low in dietary fibre.

Precautions

Gluten can be found in prepared and commercial products – read product labels carefully. All packaged food must declare if an ingredient is derived from a gluten containing cereal (per Standard 1.2.3(4) of the Australia New Zealand Food Standards Code). This will allow gluten derived ingredients to be identified on food labels. If any ingredient is derived from wheat, rye, barley or oats, it will be declared on the food label. Foods that are naturally gluten free (e.g. fresh meat, fruit and vegetables) and all products labelled gluten free are suitable. Products that use ‘Precautionary Allergen Labelling’ such as may contain gluten or manufactured on the same line as products containing gluten are not suitable. Sauces can be thickened with gluten-free products (such as xanthan gum or gluten-free cornflour) instead of wheat starch. Particular care is needed in food handling and preparation to avoid cross-contamination.

Manufacturers are not required to declare when glucose syrup is wheat derived if detectable gluten levels in the glucose syrup do not exceed 20ppm. Please refer to Coeliac Australia Glucose syrup derived from wheat fact sheet for more information.

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All plain cooked beef, lamb, pork, poultry, fish and eggs Sausages containing allowed ingredients – check labels Hot main dishes containing allowed ingredients (e.g. casseroles made with gluten free cornflour or gums, meat dishes with gluten free soy sauce, etc.) – check labels	Hot mains dishes containing gluten derived ingredients (e.g. casseroles thickened with flour or wheaten cornflour, crumbed meat or fish, pizza, pies, pastries, etc.) – check labels
Sauces, gravies	Sauces and gravies containing allowed ingredients (e.g. gluten free soy sauce, gluten free gravy, etc.) – check labels	Sauces and gravies containing gluten derived ingredients (e.g. soy sauce, gravy thickened with flour or wheaten cornflour, etc.) – check labels
Starchy vegetables / pasta / rice	Plain boiled, roasted and mashed potato, sweet potato and pumpkin Rice and polenta Gluten free pasta and noodles (e.g. rice noodles) Starchy vegetable dishes containing allowed ingredients	Starchy vegetables, pasta or noddles containing gluten derived ingredients (e.g. scalloped potato, seasoned wedges, regular pasta, wheat noodles, couscous, etc.)
Vegetables	All plain fresh and cooked vegetables All other vegetable dishes containing allowed ingredients – check labels	Vegetable dishes containing gluten derived ingredients (e.g. vegetables in white sauce and cauliflower au gratin) – check labels
Soups	Soups containing allowed ingredients (e.g. clear soups made with gluten free stock cubes, soups thickened with gluten free flours, rice, gluten free pasta, lentils, pulses, etc.) – check labels	Soups containing gluten derived thickeners, cereals or grains (e.g. barley, noodles and pasta)
Sandwiches	Sandwiches made on gluten free bread with gluten free fillings (e.g. plain cooked beef, lamb, pork, poultry, fish, eggs, cheese, canned tuna, salmon, gluten free ham, fresh vegetables or fruit, etc.) and gluten free spreads (e.g. butter, margarine, etc.) – check labels	Sandwiches made on gluten bread with gluten derived fillings and/or spreads (e.g. salami, Vegemite™, etc.)
Salads, dressings	Salad ingredients and commercial dressings containing allowed ingredients (e.g. plain cooked beef, lamb, pork, poultry, fish, eggs, cheese, canned beans, tuna, salmon, fresh vegetables, fruit, gluten free mustard, etc.) – check labels	Salads and commercial dressing containing gluten derived ingredients (e.g. pasta salad, processed meat, etc.) – check labels
Breads, cereals	Gluten free breads Plain rice cakes Gluten free breakfast cereals (e.g. Freedom Foods muesli, rice and corn-based cereals without malt ingredients derived from wheat or barley) – check labels Psyllium, buckwheat, millet, amaranth, sorghum, quinoa and wild rice	All other breads or bakery items containing gluten derived ingredients (e.g. croissants and crumpets) Breakfast cereals containing gluten derived ingredients (e.g. rolled oats, regular muesli, bran cereals, semolina, wheatgerm, etc.)
Spreads	Spreads containing allowed ingredients (e.g. butter, margarine, jam, honey, peanut butter, Mighty Mite®,etc.) – check labels	Spreads containing gluten derived ingredients (e.g. Vegemite™ and Marmite™)
Hot breakfast choices	Hot breakfast choices containing allowed ingredients (e.g. eggs, tomatoes mushrooms, gluten free sausages, etc.) served with gluten free bread	Hot breakfast choices containing gluten derived ingredients (e.g. sausages, spaghetti, pancakes, etc.) – check labels
Fruit	All fresh fruit Commercial fruit-based products containing allowed ingredients – check labels	Commercial fruit-based products containing gluten derived ingredients
Yoghurt	Yoghurts containing allowed ingredients – check labels	Yoghurts containing gluten derived ingredients
Desserts	Desserts containing allowed ingredients (e.g. custard without gluten-based thickeners, creamy rice, jelly, ice cream, sago, tapioca, etc.) – check labels	Desserts containing gluten derived ingredients (e.g. cakes, puddings, custards made with commercial custard powder, fruit pies, pastries, crumbles, etc.) – check labels
Milk and cheese	Plain milk Plain soft and hard cheese Other milk and cheese items containing allowed ingredients (e.g. gluten free soy milk, etc.) – check labels	Milk and cheese items containing gluten derived ingredients (e.g. malted milk, soy milk, soy cheese, etc.) – check labels
Beverages	Beverages containing allowed ingredients (e.g. tea, coffee, water, fruit juice, vegetable juice, cordial, carbonated drinks and gluten free drinking chocolate) – check labels	Beverages containing gluten derived ingredients (e.g. drinking chocolate, beer and fermented drinks) – check labels Oral nutritional supplements labelled low in gluten or gluten low* – check labels
Biscuits	Gluten free biscuits – check labels	Biscuits containing gluten derived ingredients
Miscellaneous	All miscellaneous items containing allowed ingredients (e.g. salt, pepper, cream, tamari, wine vinegar, arrowroot, sugar, gluten free sweetener, nuts, seeds) - check labels Highly purified wheat products (e.g. glucose syrup, caramel colour (150), dextrose, gluten free icing sugar mixture and gluten free confectionery) - check labels	Other miscellaneous items containing gluten derived ingredients (e.g. beverage whitener, malt vinegar, icing sugar mixture and sushi) – check labels Enteral nutritional supplement labelled low in gluten or gluten low* – check labels

* Note - Some oral and enteral nutritional supplements cannot be classified as compliant with the “Allergy – gluten free” diet specification. This is because of the different definitions for gluten free worldwide. Most of our commercial oral and enteral supplements are manufactured overseas (where ‘gluten free’ is defined as <20ppm) and may not comply with the Australian definition of ‘gluten free’ (i.e. no detectable gluten).

However, it is recognised that this can cause challenges within the clinical setting when a patient requires a high energy nutritional supplement (e.g. 2kcal/mL). The ACI Nutrition Standards & Diet Specifications Reference Group in consultation with Coeliac Australia and the NSW Food Authority has provided the following recommendations:

1. Nutritional supplements that do not comply with the Australian definition of ‘gluten free’ (i.e. no detectable gluten) should not be prescribed for patients/consumers who are diagnosed with coeliac disease.
2. If nutritional supplements that do not comply with Australian ‘gluten free’ requirements are needed for medical treatment and no alternative substitute is available, it is highly recommended the prescribing clinician:
   1. discusses the possible risk of contamination with the patient/consumer and/or their carer/guardian
   2. obtains consent
   3. documents this in the patient’s medical records.

References

1. Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
2. Faulkner-Hogg K, Hodge L, Swain A. Coeliac disease. Aust Family Phys. 2009;38(10):785-6.
3. Coeliac Australia. Catering for those with coeliac disease. Waitara: Coeliac Australia; 2018 [cited 21 March 2018].
4. American Dietetic Association (ADA). Nutrition care manual. Chicago: ADA; 2009 [cited 17 March 2010].
5. Iowa Dietetic Association and Maher AK (Editor). Simplified diet manual. 11th ed. Ames: Wiley-Blackwell; 2012 [cited 21 March 2018].
6. Food Standards Australia New Zealand (FSANZ). Schedule 9 – Mandatory advisory statements. Majura Park: FSANZ; 2018 [cited 21 March 2018].
7. FSANZ. Standard 1.2.3 – Information requirements – warning statements, advisory statements and declarations Majura Park: FSANZ; 2018 [cited 21 March 2018].
8. FSANZ. Standard 1.2.7 – Nutrition, health and related claims. Majura Park: FSANZ; 2018 [cited 21 March 2018].

Change log

Change date	Section updated	Change
September 2022	Precautions	Corrected a typo error. Paragraph two, line one 'wheat derived if detectable glucose...' glucose replaced with gluten