Gluten Free Tips

Archive for the ‘Information’ Category

According to medical journals irritable bowel syndrome is the most common of all bowel
disorders. (Affecting 15% of the population). Also according to the medical journals the
condition has a poor response to treatment.

It has similar symptoms to celiac disease and is often the initial diagnosis being a condition which is better known by doctors.

Typical symptoms are: -

• Digestion problems
• Abdominal pains with or without
• Diarrhoea, with or without
• Constipation
• Changes in the bowel motions, such as hard or pallet like motions
• Loose bowels especially after breakfast
• Chronic tiredness

Elderly members of society , senior citizens suffer from increased incidence of Celiac Disease. A recent report found senior citizens incidence of celiac disease is greater than that of the general population.

STUDY BACKGROUND: Up to 1% of the population suffer from coeliac disease. Data on the prevalence in elderly people is scant. We hypothesized that they would over time have developed obvious symptoms. Clinically silent or undiagnosed disease would thus be relatively uncommon.

AIMS OF THE STUDY: To evaluate the prevalence of coeliac disease in elderly people.

STUDY METHODS: The study comprised 2815 individuals aged 52-74 years. Clinical cases of coeliac disease were recorded. Sera from all Subjects were screened by IgA class tissue transglutaminase antibodies, and seropositive underwent small bowel biopsy.

STUDY RESULTS: Coeliac disease was detected in altogether 60 individuals, in 25 (0.89%) on clinical grounds, and screening found in 35
(1.24%) new biopsy-proven cases. Thus, a total prevalence of 2.13% (95% confidence intervals 1.60-2.67%) was reached. Of the screen-detected cases, 15 had symptoms, albeit mostly mild. Two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer. The total frequency of biopsy-proven coeliac disease and seropositive cases without histological confirmation was 2.45% (1.88-3.02%). CONCLUSION: The prevalence of coeliac disease in elderly people was higher than what has been reported in the population in general. Active case finding by serologic screening is encouraged, since undetected cases may be prone to increased morbidity and mortality.

Knowledge of current food standards, food laws and ingredients are critical for a person with Coeliac Disease whose treatment relies solely on dietary management. They have to take ownership of understanding what ingredients are in what they eat.

For anyone in doubt celiac disease is: -

• A permanent intolerance to gluten – a protein found in wheat, rye, barley and possibly oats.
• affects the small bowel.
• Its treatment requires a life long avoidance of gluten.

Research was recently undertaken in New Zealand to see how people were helped to read food labels and the research found: -

• Forty percent of people had received no label reading education even though it was the most used method for identifying suitable foods.
• The majority of participants stated that they had a moderate confidence of reading food labels. However, when tested on the suitability of specific ingredients, it was evident that
further education was needed.
• Ninety nine percent of people indicated that they would find a label reading resource booklet useful.
• The majority of participants wanted a resource that included practical information put into every day language. They wanted a resource that was visually interesting and small enough to put in a bag to take to the supermarket.

The research project confirms the lack of understanding of people with Coeliac Disease when reading food labels and verifies the need for updated resources in this area.

A label reading resource booklet has been developed based on current information from the New Zealand government and the Manufactured Food Database. It includes information on the current standards, food additives, suitability of ingredients and precautionary warnings. Practical label reading examples have been provided to reinforce the written information.

This resource booklet aims to give people with Coeliac Disease the information required to choose suitable foods for their Coeliac Disease.

The treatment of coeliac disease is exclusively dietary and requires the complete exclusion of gluten. This means avoidance of all sources of wheat, rye and barley. Oats are controversial and may be tolerated in moderate amounts.

The aim of medical advisors is to give first line dietary advice on a gluten-free diet for patients with confirmed coeliac disease or dermatitis herpetiformis. People who are allergic/intolerant to wheat will require different dietary advice.

Practical dietary advice is often given such as: -

The exclusion of gluten means avoiding a wide range of manufactured and processed foods, which imposes considerable constraints on food choice and variety. Food labeling is not always helpful because although ingredient lists on food products can confirm the presence of gluten, they cannot confirm that they are gluten-free.

Gluten may be present via constituents which do not have to be declared or through cross-contamination during processing. Any food in a can, packet or jar or food that has been coated or modified in any way has therefore to be suspected of containing gluten.

Many manufacturers and supermarkets are voluntarily identifying gluten-free products by providing information or a logo on the label. In the UK, the Coeliac Society maintains a continually up-dated database of manufactured foods free from gluten.

Proprietary gluten-free foods such as breads, crackers, biscuits, pasta, flour and flour mixes are prescribabled for people medically diagnosed with coeliac disease or dermatitis herpetiformis. Their use should be encouraged to reduce the risk of dietary imbalance or non-compliance. Luxury items such as gluten-free cakes, chocolate and fancy biscuits are also available but not prescribable to reduce the costs on the NHS.

For some people, food allergies can be very serious. One bite of a cookie with ground peanuts can cause a life-threatening emergency in someone with a peanut allergy, while just the smell of fish can make a highly sensitive person feel ill.

Although these are extreme reactions, it’s no wonder many people worry about food allergies. Unfortunately, because of a lack of good information about severe food allergies, many people are restricting their diet unnecessarily. One allergist found that, out of 23 people who thought they had a food allergy, approximately 4 actually did. Some of those who didn’t have allergies were avoiding so many foods they had become sick and malnourished. Don’t guess. If you suspect you have a food allergy, have it properly diagnosed by a doctor, then obtain nutritional advice from a registered dietitian.

What is a Food Allergy?

People with food allergies have an unusually sensitive immune system. For some reason, swallowing a protein from a particular food causes the person’s own antibodies to rush into action to attack the foreign substance. This starts a chain reaction of chemical changes which cause swelling and irritation in certain parts of the body.

Food allergies are most common in young children. Many infants become sensitive to foods, such as cow’s milk, soy and eggs during their first year of life. Fortunately, most infants outgrow these sensitivities in a year or two.

However, a child with an allergy to peanut or shellfish will not outgrow it. In fact, the symptoms may become more severe each time the child is exposed.

What is a Food Intolerance?

Food can cause problems for people in ways that do not involve the immune system. For example, people with lactose intolerance don’t have enough of the enzyme lactase to digest the sugar or lactose in milk. People with celiac disease cannot digest wheat protein. Other people have trouble with caffeine, chili peppers, horseradish or hot sauce. These food- related problems are called “food intolerances” not food allergies.

It is important to know the difference between food intolerances and food allergies. A person with a milk allergy must avoid all milk protein, even the small amount found in a slice of bread, whereas a person with a lactose intolerance may be able to eat some cheese and drink certain modified milk.

Facts About Food Intolerances

· Milk, eggs, peanuts, nuts, soy, wheat, and fish are responsible for 95% of all actual food allergies. It is rare for people to have two or more food allergies.

· It is usually not necessary to avoid an entire food family. For example, people who are allergic to lobster can often tolerate shrimp and crab. Even children with a life-threatening peanut allergy are rarely sensitive to other legumes, such as soybeans and lentils.

It is possible to eat gluten free at Mcdonalds if you are careful about the types of food you choose and make sure that the Mcdonalds restaurant is following their laid down procedures. As with all things in life it is impossible to give a 100% guarantee and so you will need to exercise due diligence yourself but in general you can eat menu items which are gluten free.

The fries are cooked in a separate frier and are not coated with any substances containing gluten.  Provided that you find the operators are taking care to avoid cross food contamination, for example with the buns, then you will find that they are gluten free and safe to eat.  This previous statement of course excludes any concerns that people may have over the preservatives in McDonalds food and we are not making any comment on this.

Whilst, at first thought, the burger buns would not be gluten free at Mcdonalds this only applies to the bread of the bun and it is possible for you to eat the meat part of the burger served separately as this does not contain any gluten.  This is a great way of allowing a child who needs to eat gluten free to participate in a happy meal or McDonalds birthday party with other children provided that the meat burger does not touch any bread products before or after cooking

The soda, typically Coke or orange fanta are also gluten free as is the milk.

Some obvious foodstuffs which are not gluten free are, as previously mentioned, the bread buns and the chicken nuggets where the coating contains gluten. The ice cream is gluten-free although you need to be careful that there aren’t any additional items inserted in this such as wafers or biscuit products.

For a coeliac, eating out carries risks of gluten contamination in any restaurant and McDonalds carries similar risks. McDonald’s is an international franchise and you need to be careful that you do not assume that every restaurant is run in exactly the same manner, your local McDonalds may be completely gluten-free for the items outlined above but a new franchise established in a small town may not give the same results.  It is better to be safe and ask.  And if the operator is doubtful ask to speak to the manager and if they do not give you confidence then leave the restaurant, the risks are not worth it.

Taken occasionally, or participating in the infrequent children’s party, you will find that you can eat gluten free at Mcdonalds and enjoy yourself in the same way that all non-coeliac customers do.

A Gluten Challenge is often recommended by specialists to their coeliac patients. It confirms the diagnosis of the coeliac condition; however it can be an unpleasant experience for the patient (and the parent!). For this reason, gluten challenges are only recommended for selected patients.

These include :

1. Patients who lack histiological confirmation of their diagnosis, or where the original diagnosis was questionable.
2. Patients who had already been on a gluten-free diet at the time of carrying out the anti-gliadine blood test and/or biopsy.
3. Patients under the age of 2. In babies and toddlers, there may be other intolerances (such as milk), which cause the same side effects as coeliac condition (ie diarrhea, destruction of villi).

Our daughter fell into the last category of gluten challenge candidates. So, in January 2008, after consultation with the gastro-specialist, we embarked on the (dreaded) gluten challenge with our 10-year old.

Here are some Tips and Learnings from our experience :

1. Should you tell them? We took the decision early on NOT to tell our daughter she was consuming gluten. Reasons were two-fold: it would be a struggle for her to eat it (based on our experiences getting her to take medicines!) and we also wanted to rule out any psycho-somatic reaction to the food.
2. Make sure you have a “control sample”. We used her brother, a non-coeliac, for this. As per usual, the 2 children ate the same meal, drank the same drink (apple juice) and had a fromage frais for dessert. In this way you can be sure that the meal consumed by the patient is free from any bacteria, mould or anything else that could cause a stomach upset of food poisoning. The fact that the other (non-coeliac) child is free from symptoms enables one to make a more clear diagnosis of the symptoms which the patient manifests throughout the challenge. If there are no siblings, then I suggest one or both parents partake of the same food as the patient.
3. Including gluten in the diet. How much is the first question….. For adults, the recommendation is the equivalent of 4 slices of bread daily. For children, I would guess that would be around 2 slices of bread daily. Our challenge was further complicated in that we chose not to tell our child that the gluten challenge was being performed on her. We had to carefully choose how to introduce the gluten into the foods. Some of the examples we used were: mixing in regular flour with buckwheat flour pancake mix, mixing in regular pasta with gluten-free pasta, adding flour to soups, casseroles and sauces or gravies, adding soya-sauce to dishes. It is important you label the boxes (I used “XX” ) which contain the “contaminated” products so that you can readily identify them once the challenge period is over.
4. How long for ? For children, it is recommended you perform the challenge for 6 weeks, for adults 2 weeks would be sufficient. However, if the patient becomes so unwell, it is advisable to stick it out for 10 days and then book in a anti-gliadine blood test to confirm the diagnosis. In our experience, our daughter became ill within 3 hours of ingesting the gluten – we could not face 10 days of feeding her gluten! This would have serious consequences for her health if we were to persevere! So, we carefully documented all we did and we booked in an appointment with the gastro-specialist to discuss our findings.
5. Find a support network. In our situation, I was able to discuss and compare notes with a colleague at work, who is a coeliac. She has had “accidents” in the past and she, like my daughter, reacts by vomiting within 3 hours of ingesting the gluten. Her mother, also a coeliac, reacts very different – she is unwell upto 48 hours afterwards, but does not vomit; she has diarrhea and bloating and stomach discomfort instead. My other coeliac contact is a girl, 12 years old, who used to go to my daughters school. She is also doing the gluten challenge this year, in the April school holidays. Unlike my daughter, this girl is aware of the challenge and she is looking forward to trying out all the foods which have been “off-limits” to her for the past 11 years! I look forward to comparing notes and adventures with her mother in April!

Coeliac disease is a condition in which a protein called gluten (a protein found in wheat, barley, oats and rye) damages the jujenum (part of the small intestine) and reduces the absorption of food.

Oats contain a protein similar to gluten, called avenalin. Some individuals with coeliac condition can tolerate oats; however, the majority of oat products are contaminated with wheat, rye or barley and this makes them unsuitable for a gluten-free diet.

If a patient with celiac conditions follows a strict gluten-free diet, the small intestine recovers and returns to normal. The incidence of coeliac disease in the UK is estimated to be 1 in 100, although it is thought that 60% of sufferers go undiagnosed.

A life-long gluten-free diet is the only current treatment for coeliac disease. Sources of gluten can be classified into 2 categories; obvious (like bread, pasta, cakes, biscuits, pastries, and pies) and hidden (binders, fillers, or carriers).  This would include spices, flavorings, rusk inside sausages, and wheat starch (used in ice creams, yogurts and sauces).

Not following a strict gluten-free diet makes coeliacs prone to a number of health problems.  If there is reduced absorption of food, vitamins and minerals by the gut, then deficiencies of certain vitamin and minerals can occur (like calcium,  iron, folic acid and vitamin B12). Reduced levels of calcium in the body increase the risk of osteoporosis in later life. Poor compliance to the gluten-free diet- and the constant damaging of intestinal cells – can increase the risk of intestinal cancer.

A dietician can assist in explaining the gluten-free diet, as well as tips on cooking without gluten and analysing labels for gluten-containing ingredients.  The dietician will also offer practical advice on how to follow the diet.

Coeliac UK, a registered charity for people suffering from coeliac disease, produce information on gluten free foods and offer advice and information on all aspects of the condition. They provide information on local coeliac groups that provide an opportunity to meet with others with coeliac disease.   There are also forums on the Internet which enable communication and exchange of ideas with coeliacs all over the world.

Gluten is present in many cereals and staples.  However, there are also other cereals and seeds that are naturally gluten-free – such as corn, rice, quinoa and buckwheat.  Supermarkets cater for the gluten-free diet.  Labeling has improved over the past 5 years and many supermarkets have dedicated aisles with gluten-free products.

Gluten Free Resturants
Often people search for gluten free resturants in order that they can go out for a family meal and enjoy the occasion without suffering the consequences of being allergic to gluten the next day. If you do conduct such a search you might find that gluten free resturants are hard to find and poorly advertised, and the reason is that all restaurants should be able to serve gluten free food on demand.

When visiting a new restaurant the first thing to do is make sure that your waiter or waitress is aware that a member of your party needs gluten free food. This isn’t an outrageous request, these days many people have some form of food allergy and requests that meals are served lactose free, gluten free, nut free or without other ingredients are common . Your server will most probably look upon the request has an opportunity to deliver good service and reap the rewards by way of a good tip at the end of the meal.

If you are travelling to a foreign country make sure that you take pre printed gluten free restaurant cards with you. These cards should contain an explanation of what coeliac condition intolerances are and what foods are gluten free, spelled out in the local language to avoid any confusion. Once again do not be hesitant in producing these cards in the restaurant as you will find that the waiter appreciates the information presented in their own language to avoid any confusion.

Dealing with the food preparation issues for people with food intolerances is now a standard part of the training for any decent chef. They will understand the need to keep the different types of food separate and use clean cooking utensils to avoiding cross and food contamination.

Once you have found several gluten free restaurants near you make sure that you visit them regularly and that the restaurant understands that you are a regular customer. If you have friends and acquaintances who are similarly gluten intolerant and make sure that you recommend the venues to them. Restaurants will respond very positively to regular customer visits and this will help to maintain their approach to gluten-free food.

Gluten Free Medications
If you have gluten intollerance it is important when you are ill that you have gluten free medications. Being ill is bad enough and can have its own complications without overlaying onto this any further issues which will arise from the introduction of gluten into your system. Remember that, as a celiac, gluten in your system can overload your immune system leading to you becoming ill and this is the last thing you want to do when you have an existing illness.

Make sure that the doctor or pharmacist are aware that you need gluten free medications, this is particularly important if you are not being treated by your own doctor, for example if you are on holiday, or you are visiting a chemists that you have not frequented before. Inform them before the prescription is made up, drugs companies always provide lists of ingredients for their drugs and gluten free alternatives are usually available. This may require a small amount of further research, perhaps a telephone call to the manufacturer or a visit to their website but rest assured that the information will be available as all prescription drugs are regulated and the ingredients have to be listed.

If you are going on holiday it is advisable to take a number of common medications with you taking the varieties that you know to be gluten free. We are not talking of prescription medications such as antibiotics and other more powerful medications but the types of gluten free medication that you or your children might commonly require when on holiday. Stomach upset preparations, headache cures, sleeping tablets or anti-diarrhoea capsules are all things to consider and taking these with you can give you some peace of mind should a member of your family who is gluten intollerant become ill.

On the occasion that you are unlucky and a gluten intolerant member of your family is admitted to hospital when on holiday it is important that they are accompanied by an adult so that the requirement for gluten free medications can be followed through. Medical people are infamous for focusing more on the solution to the illness without taking into account the wider factors and the emotions of the patient. The well person should be able to stress the requirement for gluten-free medications and follow through in that discussion to ensure that the patient does receive these rather than leaving the stress of the discussion to the ill patient, as this will not help them to make a rapid recovery.

If you have coeliac condition you need gluten free medications and in most civilised part of the world this should not be an issue. Be assertive and ensure that and the doctors clearly understand your requirement early in the consultation and you will find that there is no problem.