Is it Coeliac Disease?

coeliac disease - boy feeling ill

1 person in every 100 has coeliac disease.

And most of those people don’t know that they have it. Symptoms can easily be misdiagnosed as something else, and on average it takes 13 years for someone to finally get a diagnosis of coeliac disease.

This year’s Coeliac UK Awareness Week (9-15 May) is focusing on raising awareness, improving diagnosis rates, and finding the estimated 500,000 people in the UK who are living with symptoms but aren’t yet diagnosed.

What are those symptoms? Typically, they are gut symptoms, but not exclusively. The most commonly reported symptoms are:

  • diarrhoea or constipation (yes, it could be either)
  • nausea: feeling sick and vomiting
  • stomach pain and cramps
  • bloating and gas
  • feeling tired all the time
  • ‘brain fog’
  • anaemia
  • weight loss (sometimes, but not always)
  • regular mouth ulcers
  • skin rash
  • and, in a very young child, failure to thrive.

It is important to know that:

  • not everybody shows all the symptoms, and some people don’t show any
  • if a member of your close family has coeliac disease, then your chances of having it are increased
  • and people with other autoimmune conditions such as diabetes and thyroid disease are also more likely to have coeliac disease – and should be tested.

Does that sound like you, or someone you know? Talk to your doctor, and have a look at Coeliac UK’s symptom checker.

Raising awareness of coeliac disease: Awareness Week 2016

To try to raise awareness, and get more people to find out whether they have coeliac disease, Coeliac UK are organising a range of different events, from mud runs to country walks, and social media thunderclaps to pop-up events. Some of these are happening during Awareness Week, such as the charity walks…

Interested in walking in some of the most beautiful countryside in England and Wales on 7/8 May? There are five walks of different lengths.

If you can put a team together, and raise some sponsorship money to go towards Coeliac UK for campaigns, support and research, the first 20 teams to raise £100 will generate a matching £100 from debbie&andrew’s. (This is part of debbie&andrew’s CSR programme: sponsoring grass-roots fundraisers for causes that promote rural values and countryside life. It works in this case because people are being sponsored to walk in the countryside, and debbie&andrew’s make gluten free sausages, available from all large supermarket chains here in the UK).

Find out more about Awareness Week 2016.

Surprise: it’s a box of gluten free doughnuts

gluten free doughnutsDo you miss doughnuts?

I’ve been meaning to post an update on the gluten free doughnuts from Borough22 that I mentioned a while ago. You may remember that I’d tasted these as part of judging for the Free From Foods Awards earlier this year, and been impressed by the cinnamon doughnuts.

I ordered a box of 6 (one each of sugared, cinnamon, vanilla glazed, raspberry & pistachio, raspberry, and nutella) as a surprise for Coeliac Daughter to try on a visit home back in February.

Unfortunately, there was a problem at the delivery depot, and they didn’t arrive as planned, but Ryan at Borough22 arranged for a delivery of doughnuts to her university address instead (excellent customer service) – so I didn’t get to see her enjoying the doughnuts, but I did get a steady stream of updates and photos via social media.

I had told her there was a parcel coming, but not what was in it…

Coeliac daughter said via social updates (over a period of time, and probably with a mouth full of doughnut!):

They’re so cool!
Sooo yummy!
Yummiest thing in a long time..
So good.

Her favourites were the cinnamon one and the sugared one, so another time we might order a mixed box of those, rather than of all 6 flavours – or maybe some mini doughnuts.

And 6 doughnuts is a lot for one person to get through. If they’d been delivered to home, of course, I’d have been able to help out! I’m not sure what the solution to this is—other than sharing with friends—as the postage costs would be excessive for a couple of doughnuts. But I was delighted that she enjoyed them so much.

These doughnuts are: gluten free, dairy free, egg free, soya free and vegan. You can order them online, or buy them in a few places in London (oh, those lucky Londoners).

And, if you are interested to read another view on these doughnuts (and one that made my eyes prickle), go and read the review at 7 Years to Diagnosis.

***
Update: Ryan tells me that the doughnuts freeze well, and defrost within an hour, so there’s no need for greedily eating all the doughnuts immediately. Good to know!
***

On Dairy: why choose goats milk?

goats

I was recently sent some samples of a range of goats milk cheeses by Delamere Dairy, so I thought I should find out more about why people choose to use goats milk rather than cows milk.

It turns out that there are lots of reasons that people swap to goats milk products rather than cows milk products.

One of the members of my family used goats milk instead of cows milk for years because of asthma (yes we are the classic atopic family, with—between us—asthma, eczema, psoriasis, hayfever, and coeliac disease) but making the swap is also recommended for some people with eczema, catarrh, or with some digestive disorders.

For some people who are intolerant to cows milk, it appears that it is one of the proteins in cows milk – A1 casein – that is causing the problem, rather than lactose. Although there are some breeds of cow that don’t produce A1 casein—and A2 milk can be bought as a specialist product in most supermarkets here in the UK these days—most cows used in standard mass dairy production are A1 producers. (Note: both A1 milk and A2 milk contain lactose, so A2 milk is not an option if you are lactose intolerant or have a milk allergy).

Goats milk contains only A2 casein, which means that for some people, goats milk is much less inflammatory than cows milk – so if you’re trying to avoid the A1 casein, goats milk products are a good choice.

And although goats milk contains lactose, it seems some people with lactose intolerance can handle goats milk. It is thought that this may be because goats milk is more digestible – it has less casein, smaller fat globules, and very slightly less lactose, than cows milk.

And if that’s not enough, it turns out that goats milk is very high in potassium and calcium, as well as tryptophan – so it works very well to help people with sleeping problems…

And some of us just enjoy the taste.

So what about those samples?

I’ve always been a goats cheese fan so was expecting to enjoy these cheeses. But I didn’t know they offered so many varieties, so my first thought on opening the package was surprise. I particularly enjoyed the goats cheese and honey log (handily ready-sliced into portions, though I will confess to have eaten rather more than a portion…) and the Greek cheese (like a feta).

Unfortunately, though goats milk, goats milk butter and some goats cheese are generally available in supermarkets, it looks as though these two varieties are only available from Booths, Ocado and Wholefoods at the moment. Shame that there isn’t national coverage in supermarkets… but Ocado is particularly good for free from shopping, so perhaps I’ll just place an order sometime soon.

Find out more:
Lara Briden on A1 milk
Steve Carpers guide to dairy products
FoodsMatter on A2 milk

Surprisingly Successful Gluten Free Hot Cross Buns

easter-baking

Coeliac Daughter is home from university for the holidays, and fancied baking at the weekend. So, it being nearly Easter, she decided to have a go at making gluten free hot cross buns.

We’ve tried making hot cross buns before, and never been very successful, but this recipe worked surprisingly well. The original is available on the UDI site, but we made some amendments based on what we had available…

Ingredients for gluten free hot cross buns

  • 3 1/4 cups gluten free flour mix – we used Dove’s plain white flour, available from supermarkets here in the UK.
  • 4 tablespoons sugar
  • 2 1/2 teaspoons yeast
  • 2 1/2 teaspoons xanthan gum
  • 1 teaspoon cinnamon
  • 1 teaspoon salt
  • 1/2 teaspoon each: ginger and nutmeg
  • 1 1/2 cups milk
  • 3 eggs
  • 4 tablespoons melted butter
  • 2 teaspoons pure vanilla extract
  • 1 cup of dried fruit or other goodies – we used 1/2 cup sultanas and 1/2 cup of chocolate chips to create two different kinds of buns, but I think that dried cranberries would be nice too
  • 1/4 teaspoon instant yeast
  • 1 tablespoon water
  • Egg wash (Mix 1 egg with 1 tablespoon milk)

Icing:

  • 1/2 cup icing sugar
  • 2 teaspoons water.

Directions

Mix all the dry ingredients (except for the dried fruit or chocolate chips).

Mix all the wet ingredients and then add them to the mixed dry ingredients.

Split the dough into two bowls and fold the sultanas into one half, and chocolate chips into the other half. (Of course, if you just want to make one batch in a single bowl, that’s fine).

After mixing dough thoroughly, cover the bowl(s) and refrigerate for a couple of hours. (The UDI instructions say overnight but we couldn’t wait).

When you are ready to start again, dissolve 1/4 teaspoon of instant yeast in 1 tablespoon of water, and stir half into each bowl – or, or course, all of it into the one bowl, if you’ve not split yours into two.

Grease or line two 8″x8″ cake tins and place 9 balls of the dough into each one. We only have one 8*8 cake tin, so used that for half the dough and put the other half into an 8″ round cake tin – and it worked perfectly well.

Smooth out the tops of the buns and brush with the egg wash.

With a sharp knife, slice a shallow cross in the top of each bun. Let them prove (stand in a warm room or cool oven, covered with a clean teatowel) for about 15 minutes. Preheat the oven while they are proving.

Now bake the buns at 180C for about 30 minutes in the centre of the preheated oven and bake, turning during baking if needed, until the buns are golden brown and firm to the touch. Allow the buns to cool for about 10 minutes in the pan before transferring them to a wire rack to cool completely.

While the buns are cooling, mix together the icing sugar and water with a fork until the icing is smooth.

Once the buns have cooled, ice a cross on each bun. Traditionally, this isn’t done with icing, but with a flour and water paste – but the icing does add a dash of sweetness to the buns which I rather like.

Don’t forget the gluten free Simnel cake either – we’re going to make one later this week…

On Dairy: Secondary Lactose Intolerance

damaged villi lactose intolerance

Newly diagnosed with coeliac disease, cut out gluten completely, but still having trouble digesting dairy products? You could be suffering from secondary lactose intolerance.

Lactose intolerance can have a genetic cause:

  • congenital: the ability to digest lactose could have been absent from birth
  • developmental: the ability to digest lactose could have diminished over time

Or lactose intolerance could be caused by a disease that damages the lining of the small intestine—such as coeliac disease. This is called secondary lactose intolerance.

When people who have coeliac disease eat gluten, it damages the villi – the lining of the small intestine. The lining of the small intestine is covered in tiny hair-like ‘bumps’ or fronds, called villi, and each of these has smaller fronds, called microvilli (or the brush border). These produce enzymes which help absorb nutrients.

Eating gluten causes an immune reaction which shortens, or even flattens, the villi, resulting in a decrease in the digestive enzymes – and these enzymes include lactase, which helps digest the lactose found in milk. If you don’t have enough lactase, you can’t digest lactose, resulting in those all too familiar symptoms of nausea, diarrhoea, stomach pain and bloating.

Once you’ve stopped eating gluten, and the gut starts to heal, the villi – and microvilli – will regenerate. For most people with secondary lactose intolerance, this will mean that they can digest milk products again. It often takes six months to a year, and can take two years.

(Be aware that lactose intolerance is not the same as a milk allergy. )

Secondary lactose intolerance: treatment

Assuming that it is lactose intolerance, what should you do while you’re waiting for your villi to regenerate?

Lactose is found in milk from cows, sheep and goats (as well as from humans), so cutting out these milks is an obvious response. But people vary: some may be able to have a small amount of milk, while others find even a small amount triggers symptoms.

And don’t just cut out lactose completely without consulting your GP or dietitian for advice, because you may miss out on other essential nutrients, such as calcium, potassium, magnesium, zinc, and vitamins A, B12 and D.

In addition, there does seem to be evidence that you can eat some cheese (but not milk) even if you are lactose intolerant. Studies show that many people can tolerate a small amount (10-12g) of lactose daily – and the amount of lactose in milk / yoghurt and cheese varies:

  • 6 ounces of low fat plain yoghurt contains 13g lactose
  • 6 ounces of low fat Greek yoghurt contains 4g lactose
  • ½ cup of low fat cottage cheese contains 3g lactose
  • 1 ounce of cheddar cheese or other hard cheese contains under 1g lactose.

Try (a small amount to start with of) hard cheese such as cheddar or gruyere. The reason for choosing hard cheese is that in the cheese-making process, starter cultures of bacteria are added to milk that turns lactose into lactic acid. Starter cultures are usually used to make aged cheeses, not fresh ones.

Dieticians also suggest eating yoghurt, hard cheese or a small amount of milk as part of a meal, rather than on its own, because that will help.

But be aware that milk products appear in all sorts of other foods, so you might get up to the limit that you personally can tolerate without even realising it. So always check the label! (Just like looking for gluten, really).

In the EU, manufactured foods will clearly list if milk or an ingredient derived from milk is contained in the product. But if you are not in the EU, you will need to look out for:

  • Milk powder / skimmed milk powder
  • Milk drinks / malted milk drinks
  • Cheese / cheese powder
  • Butter
  • Margarine or other low fat spread (unless it says it is dairy free)
  • Yoghurt / fromage frais
  • Cream / sour cream
  • Casein / caseinates / sodium caseinates / hydrolysed casein
  • Milk solids
  • Non-fat milk
  • Whey / Whey syrup sweetener
  • Milk sugar solids
  • and, obviously, lactose.

Find out more:
Treatment of lactose intolerance: NHS UK
Dairy intolerance: Allergy UK
Dairy allergy/intolerance: FoodsMatter
List of lactose percentages: SteveCarper.com
Lactose intolerance: NYDailyNews
Cheese and lactose intolerance: CheeseSnob