9.4.1 Foods for special diets
|First line drugs||Second line drugs||Specialist drugs||Secondary care drugs|
- 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 otherwise they may be investigated by Advisory Committee on Borderline Substances.
- 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 Gluten should not be withdrawn prior to a biopsy or blood test.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 dietitian led coeliac clinic for further advice.
Gluten free products ACBS
- The Formulary only supports the prescribing of gluten free products listed in the Drug Tariff, Part XV (see notes below).
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:
- 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 be cases where crackers are recommended instead of bread for older patients with dental problems.
- 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.
- Dietitians are best placed to assess individual requirements.
- Consider the Eat Well Plate. 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 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/prescriptions
The Formulary does not therefore support the prescribing of ‘luxury' items on the grounds that in addition to above it does not support healthy eating.
2004 Guidelines: Recommended number of units per month per patient:
|Age and sex||Number of units |
|Child 1-3 years ||10 |
|Child 4-6 years ||11 |
|Child 7-10 years ||13 |
|Child 11-14 years ||15 |
|Child 15-18 years ||18 |
|Male 19-59 years ||18 |
|Male 60-74 years ||16 |
|Male 75+ years ||14 |
|Female 19-74 years ||14 |
|Female 75+ years ||12 |
|Breastfeeding ||add 4 |
|3rd trimester pregnancy ||add 1 |
|High PAL ||add 4 |
|Food item ||Number of units |
|400g bread/rolls/baguettes ||1|
|500g mix ||2|
|200g biscuits/crackers ||1|
|250g pasta ||1|
|2x110g-180g pizza bases ||1|
Last updated by: Carol Webb on 07-07-2011 14:00