Planning for Coeliac Disease and Lactose Intolerance

This lesson covers how to plan nutritionally balanced diets for people with coeliac disease and lactose intolerance, as required by AQA GCSE Food Preparation and Nutrition specification 8585, section 3.2.3. You must understand what each condition is, which foods must be avoided, and how to provide suitable alternatives that still deliver a balanced diet.

---

Coeliac Disease

What Is Coeliac Disease?

Coeliac disease is an autoimmune condition in which the body's immune system reacts to gluten, a protein found in wheat, barley, and rye. When a person with coeliac disease eats gluten, the immune system attacks the lining of the small intestine, damaging the villi (tiny finger-like projections that absorb nutrients).

Over time, this damage leads to:

• Malabsorption of nutrients — the body cannot absorb vitamins, minerals, and other nutrients properly
• Nutrient deficiencies — particularly iron, calcium, folate, and fat-soluble vitamins (A, D, E, K)
• Symptoms — bloating, diarrhoea, abdominal pain, fatigue, weight loss, anaemia, and in children, poor growth

Coeliac disease affects approximately 1 in 100 people in the UK, though many are undiagnosed. It is a lifelong condition with no cure — the only treatment is a strict gluten-free diet.

Exam Tip: Coeliac disease is an autoimmune condition, not an allergy or an intolerance. This is an important distinction — the immune system attacks the body's own tissues (the intestinal villi), which is what makes it autoimmune.

---

Foods That Contain Gluten (Must Be Avoided)

Food	Reason
Bread (standard wheat bread)	Made from wheat flour, which contains gluten
Pasta (standard)	Made from durum wheat
Cereals (many types, e.g. wheat-based cereals)	Contain wheat, barley, or rye
Cakes, biscuits, pastries	Made with wheat flour
Beer and lager	Made from barley
Sauces and gravies	Often thickened with wheat flour
Couscous and bulgur wheat	Made from wheat
Some processed foods	May contain hidden gluten — always check labels

Gluten-Free Alternatives

Gluten-Containing Food	Gluten-Free Alternative
Wheat bread	Gluten-free bread (made from rice flour, corn flour, or potato starch)
Wheat pasta	Gluten-free pasta (made from rice, corn, or buckwheat)
Wheat flour	Rice flour, corn flour (maize), potato flour, chickpea (gram) flour, almond flour
Couscous	Rice, quinoa, polenta
Standard cereals	Gluten-free cereals (e.g. rice-based cereals, gluten-free oats)
Standard soy sauce	Tamari (gluten-free soy sauce)
Beer	Gluten-free beer, cider, wine, spirits

Naturally Gluten-Free Foods

Many everyday foods are naturally gluten-free and do not need to be replaced:

• Rice and rice products
• Potatoes (baked, mashed, roasted, chipped)
• Corn / maize (polenta, tortillas, cornflakes if labelled GF)
• Fruits and vegetables — all types
• Meat, fish, and eggs — unprocessed
• Dairy — milk, cheese, yoghurt, butter
• Beans, lentils, and pulses
• Nuts and seeds
• Oats — if labelled gluten-free (standard oats may be contaminated with wheat during processing)

Exam Tip: When planning a gluten-free meal, do not just list what the person cannot eat — always provide specific alternatives and explain how the meal still meets the Eatwell Guide. For example, replacing wheat pasta with rice pasta in a bolognese.

---

Nutritional Considerations for Coeliac Disease

People with coeliac disease need to be aware of the following nutritional risks:

Concern	Explanation	Solution
Iron deficiency	Damaged villi may not absorb iron properly, even before diagnosis	Eat iron-rich foods (red meat, fortified GF cereals, beans) with vitamin C
Calcium and vitamin D deficiency	Malabsorption can affect bone health	Dairy, fortified GF foods, vitamin D supplements
Fibre intake	Many GF products are lower in fibre than their wheat-based equivalents	Choose brown rice, potatoes with skins, beans, fruit, vegetables
Folate deficiency	Malabsorption of folate (a B vitamin needed for cell division)	Green leafy vegetables, fortified GF cereals, supplements if needed
Reading food labels	Gluten can be hidden in many processed foods (sauces, seasonings, ready meals)	Always check labels for wheat, barley, rye, and "may contain gluten" warnings
Cross-contamination	Even tiny amounts of gluten can trigger a reaction	Use separate cooking equipment, clean surfaces, and avoid shared toasters or butter dishes

---

Lactose Intolerance

What Is Lactose Intolerance?

Lactose intolerance is a condition in which the body cannot properly digest lactose, the natural sugar found in milk and dairy products. It is caused by a deficiency of the enzyme lactase, which is produced in the small intestine and is responsible for breaking down lactose into glucose and galactose for absorption.

When lactose is not broken down, it passes undigested into the large intestine, where bacteria ferment it, producing gas. This causes:

• Symptoms — bloating, stomach cramps, diarrhoea, flatulence, and nausea (usually within 30 minutes to 2 hours of consuming dairy)

Lactose intolerance is not the same as a milk allergy (which involves the immune system reacting to milk proteins). It is a digestive issue, not an immune response.

Exam Tip: Do not confuse lactose intolerance with a milk allergy. Lactose intolerance involves the inability to digest the sugar lactose (due to lack of the enzyme lactase). A milk allergy involves an immune reaction to milk proteins (casein or whey). The treatments are different.

---

Foods That Contain Lactose (May Cause Symptoms)