Gluten Free Tips

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!