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9.4.1 Foods for special diets

First line drugs Second line drugs Specialist drugs Secondary care drugs

Notes:

  • 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 Gluten should not be withdrawn prior to a biopsy or blood test.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).

Notes:
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 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

 

Return to Chapter: 9. Nutrition and Blood

Last updated by: Carol Webb on 07-07-2011 14:00