It is often, but not always, associated with the jejunal villous atrophy of coeliac disease. Both conditions are managed with a gluten-free diet. Gluten is present in wheat, rye and barley. Foods containing these cereals or their derivatives are listed in Table 1 . There are also many less obvious food sources of gluten.
Wheat starch is a popular food thickener.
Oats contain a similar protein and are found to be troublesome in some patients. Medical opinion is currently divided, but oats are traditionally excluded from the coeliac diet. Energy intake can fall dramatically as a result of the reduced intake of starchy foods. Dietetic supervision is advisable to ensure an adequate energy intake, and that gluten is not being inadvertently consumed. The requirement for prescribable gluten-free products is often underestimated.