Coeliac disease with dairy intolerance, eczema, IBS
Gluten-Free, Dairy-Free Diet
Two exclusions at once — wheat protein and milk protein — without losing calcium, fibre or the pleasure of eating.
- Core restriction
- No wheat, barley or rye; no milk from any animal
- Difficulty
- ●●●●●
- Check a food
- Open the food checker
A gentle reminder. This guide is for learning, not a prescription. Therapeutic diets interact with medication and conditions, so it's worth talking to your doctor or a registered dietitian before you begin.
A tidy few pages with the food lists, meal plan and reminders — good for the fridge door or the first appointment with your dietitian.
How it works
Gluten is the storage protein in wheat, barley and rye. In coeliac disease it triggers an immune response that flattens the small-intestinal villi; in non-coeliac gluten sensitivity it produces symptoms without that damage. Either way the only treatment is complete removal.
Dairy is removed for a different reason. Some people react to lactose, the milk sugar, because the enzyme that digests it sits on the very villi coeliac disease damages — which is why new coeliac patients so often cannot tolerate milk at first. Others react to the milk proteins casein and whey, which is a separate, immune-mediated problem.
Doing both at once is common because the two often travel together, and because the same foods carry both — bread, pastry, breaded fish, creamy sauces, most convenience meals. Secondary lactose intolerance frequently resolves after six to twelve months of gut healing, so dairy is sometimes retried later.
Nutrition at a glance
Nothing here is about macros — the numbers that matter are the ones dairy and wheat were quietly supplying.
- Gluten ceiling
- <20 ppm
- The legal gluten-free threshold; in coeliac disease, treat it as absolute
- Calcium
- 700-1000 mg/day
- Two to three fortified or high-calcium foods daily
- Protein
- 0.8-1.0 g/kg
- Easy to miss if plant milks replace cow's milk
- Fibre
- 25-30 g/day
- Gluten-free breads are usually much lower than the wheat versions
- Iodine
- 150 mcg/day
- Dairy is the main source in many countries — check your salt or supplement
Nutrients that often run short
- Calcium
- Vitamin D
- Iodine
- Vitamin B12
- Fibre
- Iron
- Riboflavin
These are the ones worth planning for — through food where you can, and through a supplement your clinician suggests where you can't.
Key cautions
None of this is meant to frighten you off. These are simply the things that most often catch people out on this diet — the ones worth raising at your next appointment.
- Talk to a clinician
Test for coeliac disease before removing gluten
Both the antibody test and the biopsy need gluten in your diet to be accurate. Cutting it first means either a false negative or a six-week gluten challenge later.
- Worth testing
Calcium and vitamin D
Removing dairy without a deliberate replacement is the fastest route to low intake. Ask for a vitamin D level, and a DEXA scan if you have had coeliac disease for years.
- Worth testing
B12, iron and ferritin
Untreated coeliac disease impairs absorption, and dairy removal takes out a B12 source. Worth a blood test at diagnosis and annually after.
- Keep an eye on
Hidden gluten in medication and supplements
Lactose and wheat starch both turn up as tablet fillers. Your pharmacist can check specific brands for you.
- Keep an eye on
Retry dairy after the gut heals
Lactose intolerance secondary to coeliac disease often resolves in six to twelve months. Keeping dairy out forever, by default, costs you nutrition for no benefit.
Used for
- Coeliac disease with secondary lactose intolerance
- Non-coeliac gluten sensitivity alongside a cow's milk protein intolerance
- Cow's milk protein allergy in children, where wheat is also being trialled
- IBS where both wheat and dairy come up as triggers
- Eczema and chronic urticaria, under dietitian supervision
- Dermatitis herpetiformis, where gluten removal is the treatment
What to eat
Eat freely
Naturally free of both
- Fresh meat, poultry and fish
- Eggs
- Rice, quinoa, buckwheat, millet
- Certified gluten-free oats
- Potatoes and sweet potatoes
- All fresh vegetables
- All fresh fruit
- Beans, lentils and chickpeas
Dairy replacements
- Fortified soya milk — closest to cow's milk for protein
- Fortified oat or almond milk (certified gluten free)
- Coconut yoghurt with added calcium
- Olive oil and avocado in place of butter
- Nutritional yeast for a savoury, cheesy note
Calcium without dairy
- Tinned sardines with the bones
- Calcium-set tofu
- Kale, bok choy and broccoli
- Fortified plant milks
- Almonds and sesame / tahini
- Dried figs
Eat with care
Read the label every time
- Oats — buy certified gluten free, and introduce slowly
- Processed meats and sausages, which often use rusk or milk powder
- Soy sauce, most of which is brewed with wheat — use tamari
- Stock cubes, gravy and 'natural flavouring'
- Chips and fries cooked in shared fryers
- Vegan cheeses, which vary enormously in nutrition and taste
- Medication and supplements, where lactose is a common filler
Best to skip
Gluten grains
- Wheat, spelt, kamut, farro, durum
- Barley and malt
- Rye
- Regular bread, pasta, couscous, pastry
- Most breakfast cereals
- Beer brewed from barley
Dairy
- Cow, goat and sheep milk
- Cheese of every kind
- Butter and ghee
- Yoghurt, cream, ice cream
- Whey and casein protein powders
- Milk chocolate
Common hidden sources
- Breaded or battered anything
- Creamy soups and sauces
- Malt vinegar and malt extract
- Communion wafers
- Some crisps and seasoning blends
Three days of meals
Day 1
- Breakfast
- Certified gluten-free oats cooked in fortified soya milk with blueberries and a spoon of almond butter.
- Lunch
- Rice bowl with grilled chicken, roasted peppers, cucumber and a tahini-lemon dressing.
- Dinner
- Baked salmon with new potatoes, green beans and olive oil.
- Snack
- An orange and a small handful of almonds.
Day 2
- Breakfast
- Two eggs scrambled in olive oil, wilted spinach, gluten-free toast.
- Lunch
- Lentil and vegetable soup with a gluten-free roll.
- Dinner
- Stir-fried beef with tamari, broccoli and rice noodles.
- Snack
- Coconut yoghurt with added calcium and a sliced pear.
Day 3
- Breakfast
- Smoothie with fortified soya milk, banana, frozen berries and a scoop of pea protein.
- Lunch
- Jacket potato with tuna, olive-oil mayo and a big salad.
- Dinner
- Chicken thighs roasted with lemon and rosemary, quinoa, roasted courgette.
- Snack
- Two dried figs and a few sesame crackers.
Getting started
- 1
Get tested for coeliac disease before you cut gluten, not after. The blood test and biopsy both need gluten in your diet to be accurate, and re-challenging later is miserable.
- 2
Swap one meal at a time. Breakfast is usually the easiest to convert and the hardest to get wrong.
- 3
Learn three label words — wheat, malt and whey. Most accidental exposures hide behind one of them.
- 4
Sort out calcium in week one. Two to three fortified or high-calcium foods a day replaces what dairy was giving you; shake the carton, because the calcium settles.
- 5
Choose fortified soya milk if protein matters to you — almond and rice milks are mostly water by comparison.
- 6
In a shared kitchen, get your own toaster, butter-substitute tub and colander. Crumbs are the usual culprit.
Common mistakes
- Assuming gluten free means healthy. Many gluten-free breads are low in fibre, low in protein and high in starch.
- Dropping dairy and never replacing the calcium, iodine and B12 it was quietly supplying.
- Buying almond milk for a child and treating it as a milk substitute — it has a fraction of the protein.
- Forgetting that oats need to be certified, and that some people with coeliac react to oats anyway.
- Never retesting dairy. Secondary lactose intolerance often fades once the gut heals.
- Overlooking non-food sources: lipsticks, medication fillers, playdough and communion wafers.
FAQs
Do I have to avoid lactose-free dairy too?
It depends why you are avoiding dairy. If the problem is lactose, lactose-free milk and hard cheeses are usually fine. If the problem is casein or whey, lactose-free products still contain both and are not a workaround.
Is a trace of gluten really a problem?
In coeliac disease, yes. The 20 parts-per-million threshold used for gluten-free labelling exists because even small, repeated exposures keep the immune response running. In non-coeliac sensitivity most people have a personal threshold and traces matter less.
Which plant milk is closest to cow's milk?
Fortified soya. It is the only common plant milk with comparable protein, and fortified versions match cow's milk for calcium. Pea-protein milks are a close second.
Can I get enough calcium without supplements?
Usually, yes — but it takes planning. Fortified plant milk, calcium-set tofu, tinned fish with bones and brassicas will get most adults there. Ask for a check if you also avoid soy.
Will this help my eczema?
Sometimes, and it is worth a supervised eight-week trial if dairy is a suspected trigger. But eliminating two food groups on a hunch, indefinitely, does more harm than good — set an end date and review.
Stacking with other diets
- Sits neatly on top of the gluten-free guide — read that one for coeliac specifics, then remove dairy on top.
- Pairs easily with low FODMAP, since lactose is a FODMAP and wheat is a fructan source.
- Compatible with AIP, which already excludes both, and with the Feingold-style diet.
- Conflicts with the low oxalate diet on almonds, tahini and spinach — the very foods usually recommended for calcium here. Use calcium-set tofu, bok choy and fortified milk instead.