NHS Greater Glasgow and Clyde      

Key messages

Coeliac Disease

Recommended Daily Allowance  [RDA}
Vitamin A (and beta-carotene), * European RDA is 800 micrograms.
* Good for eyesight, growth, appetite and taste.
* Food sources include liver, fish-liver oil, carrots, green leafy vegetables, egg yolks, milk products, yellow fruit.
Vitamin B1 (Thiamin), * European RDA is 1.4 mg
* Good for nervous system, digestion, muscles, heart, alcohol-damaged nerve tissues.
* Food sources include liver, yeast, rice, wholemeal products, peanuts, pork, milk.
Vitamin B2 (Riboflavin), * European RDA is 1.6 mg
* Good for growth, skin, nails, hair, eyesight
* Food sources include milk, liver, yeast, cheese, green leafy vegetables, fish.
Niacin (formerly known as B3),* European RDA is 18 mg.
* Good for converting food into energy, building red blood cells.
* Food sources include liver, whole grains, eggs, avocado, peanuts, fish, meat.
Pantothenic acid (formerly known as B5), * European RDA is 6 mg.
* Good for converting food into energy, natural anti-stress remedy, fatigue, allergies, asthma, psoriasis.
* Food sources include fresh fish, liver and chicken, mushrooms, cauliflower and potatoes, whole grains, yeast, dried beans and peas, avocado, oranges and bananas, peanuts, pecans and hazelnuts, milk, cheese and eggs.
Vitamin B6 (Pyridoxine), * European RDA is 2 mg.
* Good for preventing skin conditions, nerve problems, protein and carbohydrate absorption.
* Food sources include fish, bananas, chicken, pork, whole grains, dried beans.
Biotin (formerly known as B8), * European RDA is 150 micrograms.
Folate, folacin, folic acid (formerly known as B9), * European RDA is 200 micrograms.
* Good for production of red blood cells, and preventing birth defects.
* Food sources include carrots, yeast, liver, egg yolks, melon, apricots, pumpkin, avocado, beans, rye and whole wheat, green leafy vegetables.
Vitamin B12 (Cobalamin), * European RDA is 1 microgram.
* Good for making red blood cells, formation of the nerves.
* Food sources include fish, liver, beef, pork, milk, cheese and eggs. Vegans are recommended to ensure their diet includes foods fortified with vitamin B12. A range of B12 fortified foods are available. These include yeast extracts, soya milks, vegetable and sunflower margarines, and breakfast cereals.
Vitamin C (Ascorbic acid), * European RDA is 60 mg.
* Good for immune system, protection against viruses and bacteria, healing wounds, reducing cholesterol, cell lifespan, preventing scurvy.  Also a natural laxative.
* Food sources include citrus fruit especially kiwi, berries, tomatoes, cauliflower, potatoes, green leafy vegetables, peppers.
Vitamin D (Calciferol), * European RDA is 5 micrograms.
* Good for bones and teeth.
* Food sources include cod-liver oil, sardines, herring, salmon, tuna, milk, sunlight.
Vitamin E (Tochopherol), * European RDA is 10 mg.
* Good for anti-oxidant properties.
* Food sources include nuts, soya beans, vegetable oil, broccoli, sprouts, spinach, wholemeal products, eggs.
Vitamin K (Phylloquinone), * No European RDA.
* Good for blood clotting and bones.
* Food sources include liver, egg yolk, cheese, broccoli, leafy green vegetables.
The Department of Health also recommends that everyone in the UK should eat at least five portions of fruit and vegetables per day.
Some very simple changes can be made that will lead to a healthier and more balanced diet with little effort required.  Generally, achieving a balanced diet will mean taking the following steps:
* Eating more starchy foods.  Starch is a good energy provider and adding it to a daily diet can help to reduce fat intake and increase fibre.  Starch can be found in foods such as bread, potatoes, rice and pasta.
Eating more fruit and vegetables.  Fruit and vegetables contain a large amount of the vitamins and minerals the body needs to function at its best.  They are also very low in fat and are therefore helpful to those trying to lose weight.  Specific fruits and vegetables have many other healthy properties and contain specific nutrients.  The Department of Health recommends that both adults and children eat at least five portions of fruit and vegetables per day.  A new 5-a-day logo can now be found on food products to guide consumers.
Reducing fat intake.  Saturated fat is unhealthy in large quantities.  It can raise cholesterol levels in the blood and lead to heart disease.  Fat intake can be reduced without too much effort by choosing leaner cuts of meat and lower fat varieties of food.  For example, low fat spread contains less fat than butter and skimmed or semi-skimmed milk is healthier than whole fat milk.
* Reducing salt intake. Chose foods with ‘reduced salt’ or ‘no added salt’. Tinned fish, vegetables and pulses are often in salted water, so it is a good idea to wash them before use. Try adding other seasonings such as herbs, spices, garlic and lemon juice to food, for flavour. Sodium content, rather than salt, is usually listed on the nutritional information of most foods. A lot of salt is more than 1.25g (0.5g sodium) per 100g.
* Drinking less alcohol.  The British Nutrition Foundation advise men to consume under four units of alcohol per day, and women to stick to less than three units per day.  Excess drinking can increase the risk of some cancers, heart and liver disease.  It may also lead to obesity and accidents.  One unit of alcohol is a single 25ml measure of spirit, a small glass of medium strength wine or half a pint of lager.

Key Messages
Promote 5 portions of fruit and vegetables a day

Ideally, fruit and vegetables should make up about a third of our daily food intake. They contain high levels of essential vitamins and minerals, and can be high in fibre and low in fat.ONE portion = 80g = any of these:
* 1 apple, banana, pear, orange or other similar sized fruit
* 2 plums or similar sized fruit
* ½ a grapefruit or avocado
* 1 slice of large fruit, such as melon or pineapple
* 3 heaped tablespoons of vegetables (raw, cooked, frozen or canned)
* 3 heaped tablespoons of beans and pulses (however much you eat, beans and pulses count as a maximum of one portion a day)
* 3 heaped tablespoons of fruit salad (fresh or canned in fruit juice) or stewed fruit
* 1 heaped tablespoon of dried fruit (such as raisins and apricots)
* 1 cupful of grapes, cherries or berries
* a dessert bowl of salad
* a glass (150ml) of fruit juice (however much you drink, fruit juice counts as a maximum of one portion a day)
To increase someone’s intake of fruit and vegetables, recommend:
* adding dried fruit to breakfast cereal
* drinking a glass of fruit juice or eating half a grapefruit for breakfast
* having salad for lunch, or fruit salad for dessert
* vegetable stir-fries for dinner
* ensuring they have at least two types of vegetables with their dinner
* snacking on fruit rather than crisps or chocolate – suggest exotic or unusual fruits to add variety.
Promote a healthy diet: eating more fruit, vegetables, bread and cereal and less meat, fat, salt and sugar products.

Lower alcohol intake

Discourage use of salt-containing effervescent tablets where suitable alternative available.

Promote a good ante-natal diet including folic acid supplements link
Promote breast feeding and WHO weaning guidelines Link to Breastfeeding / Weaning

Support subgroups where diet is an important factor in the treatment of medical conditions and disease.

 COELIAC DISEASE
Coeliac disease is caused by an intolerance to gluten, which is a protein found in wheat and rye. Similar substances are found in barley and possibly oats. Coeliac disease was formally considered to be rare, but now, the incidence is considered to be as high as one coeliac in 100 people, although far fewer than this are diagnosed.

In a coeliac patient, gluten damages the lining of the small intestine, which greatly reduces the capacity to absorb adequate nutrients from food, thus predisposing to malnutrition.

Coeliac symptoms can manifest themselves at any age, but according to the Coeliac UK most coeliacs are diagnosed between the ages of 40 - 50 years.

Coeliac patients may be acutely and severely ill with weight loss, vomiting and diarrhoea, or they may have chronic symptoms such as tiredness, lethargy and breathlessness. The typical presentation would be a mixture somewhere between these extremes. Adults may have a history of abdominal or intestinal upsets, or they may suddenly develop the condition at any time. Anaemia, abdominal discomfort, mouth ulcers and weight loss are also common features.

A coeliac baby would be well until after the introduction of gluten containing solids, then would develop bulky, offensive-smelling stools and become irritable and lethargic.

The condition cannot be cured and the only treatment available to return the intestine to normal is to follow a gluten-free diet. Sometimes vitamin or mineral supplements may be required at the initiation of therapy.

It is strongly recommended that a person with coeliac disease should keep strictly to the gluten-free diet for life.

A large number of gluten free products such as bread, pasta, flour, pizza bases etc. are available on prescription.
For further information on gluten free foods

Glutafin www.glutafin.co.uk
Juvela   www.juvela.co.uk  
Schar    www.schaer.com
Lifestyle Healthcare Ltd  www.gfdiet.com  

COELIAC U K
Coeliac UK (formally The Coeliac Society) exists to help those who have been medically diagnosed as having the Coeliac Condition or Dermatitis Herpetiformis. A range of leaflets is available, free of charge.

For further information contact.
Coeliac UK
Suites A-D Octagon Court
High Wycombe
Bucks HP11 2HS

Helpline 0845 305 2060      www.coeliac.co.uk 

Scottish Diet Action Review Report
http://www.healthscotland.com/uploads/documents/2262-SDAP_Review_Report_Sept_2006.pdf

WEIGHT MANAGEMENT

Obesity can lead to serious chronic illness such as type 2 diabetes, hypertension, and hyperlipidaemia -  major risk factors for cardiovascular disease.
In Scotland the incidence of individuals who are overweight or obese is growing. The 2005 Scottish Health Survey estimated that 3/5ths of men (60%) and almost 2/3rdsof women (65%) were overweight and around 26% of men and 22% of women were actually obese. This marks a rise in levels of obesity from 16% and 17% respectively in 1995.
The two major lifestyle factors associated with the growth of obesity are physical inactivity and poor diet. Any advice given to an individual regarding weight management should consider these factors.

Body Mass Index (BMI)
Dieting and Managing Weight Loss
Weight Management and Smoking
Exercise
Community Nutrition and Dietetic Services
Key Messages

Body Mass Index (BMI)
BMI is an internationally recognised measure of body weight. However, it is inappropriate as a measure for pregnant women, children or those with an athletic build.
It is calculated by dividing weight in kilograms by the height in metres squared kg/m2
Alternatively multiply the weight in pounds by 703 and divide by the height in inches squared.
It is easier to use this calculator

Link to BMI calculator

 This table suggests the course of action you should take for a BMI value.

Dieting and managing weight loss

It is important to approach losing weight realistically and sensibly. Weight reducing diets should aim to reduce weight by no more than 10% in a 3 month period. Then an individual should have break from dieting for 3 months during which time the new reduced weight is maintained.
Faddy diets which concentrate on a limited number of food groups are difficult to maintain as the individual becomes bored and should be discouraged. Similarly ‘crash dieting’ can lead to spectacular failure with the bored and frustrated dieter rebounding to a position of higher weight gain!

There are many excellent slimming clubs advocating good balanced diets which aim to support sustained weight loss.

Scottish Slimmers www.scottishslimmers.com

WeightWatchers   www.weightwatchers.co.uk  

Weight management and smoking

Weight gain need not be an inevitable consequence of smoking cessation. On average weight gain is in the region of 6 to 8lbs. However, many smokers report higher weight gain than this.

3500kilocalories extra to dietary requirements will give a weight gain of 1lb.

Stopping smoking can reduce the metabolic rate by up to 200 kilocalories per day and if the quitter also increases their calorific intake with snacks and sweets as a cigarette substitute it is easy to see how quickly this can happen.

Quitters need to be advised to limit snacking, eat a healthy diet and increase their exercise regimen.

Community Nutrition and Dietetic Services

Community Dietitians have three main functions: clinical treatment, health promotion activity, and support and training of others.
 
They are available to see patients referred for therapeutic dietary advice for a range of conditions, either for individual clinic appointments, domiciliary visits if essential, or in a group setting.  Any members of the health or social care team may make an initial referral. 
 
Health promotion activity takes place to encourage a healthier diet in the population, liaising with health care staff, community groups, local authorities, and other agencies as required.

Useful links
Scottish Slimmers www.scottishslimmers.com  
WeightWatchers   www.weightwatchers.co.uk
Scottish Executive Health Living  www.healthyliving.gov.uk
British Heart Foundation  www.bhf.org

Key messages
Obesity can lead to serious chronic illness
The two major lifestyle factors associated with obesity are physical inactivity and poor diet.
If someone is trying to lose weight, recommend they start by eating a well-balanced diet but eating 500 less calories per day. Introducing or increasing the amount of exercise is also helpful.
Weight gain need not be an inevitable consequence of smoking cessation
Refer to GP promptly if person has noticeably lost or gained weight for no reason.