Staying Healthy

Are you cheating?

Someone out there is searching for information about what happens if they cheat on their gluten free diet … is it you?

I know this because the searches are appearing on my logs. If it is you – don’t!

Possible excuses:

“Just one won’t hurt” – yes it will. You may not feel any different or experience any symptoms, but the gluten will be damaging your intestines with long term effect and increased risk of many Bad Things, such as infertility, osteoporosis and cancer.

“But it’s my birthday” – even more reason to treat yourself well, surely!

“Don’t be mean, let him share the cookies/cake” (said of a diagnosed child) – this isn’t a fad diet imposed by some mean mother, but a medical necessity. Would you knowingly offer a child food containing poison?

“I know other coeliacs who eat this” – more fool them, then.

“Just don’t tell the doctor” – hello? Whose body is it?

“It says low-gluten” – yes, but low isn’t the same as no, is it?

I know it needs a lot of willpower. In a sense, the lucky ones are those who experience unpleasant symptoms very soon after eating the Bad Stuff, because they have an immediate connection with reasons not to do it.

Just don’t do it. If you are medically diagnosed as requiring a gluten free diet, then stick to the diet. Cheating is only cheating yourself of good health.

Foods to avoid if you are avoiding gluten

We’ve discussed what you can eat: what can’t you eat?

Short answer: wheat, oats, barley and rye.

Medium answer: wheat, barley and rye – recent studies indicate that some coeliacs can tolerate contamination-free oats in small portions. Best to check with your consultant or dietician, and perhaps get fully back to normal before trying oats. We’re not giving oats to our daughter yet – though she’s been diagnosed for 10 years.

Long answer: look out for the following ingredients …

  • barley
  • pot barley
  • scotch barley
  • bran
  • breadcrumbs
  • bulgar
  • cereal extract
  • couscous
  • cracked wheat
  • durum wheat
  • farina
  • flour
  • gluten
  • kamut
  • malt
  • modified starch
  • oat bran
  • oats
  • oatmeal
  • porridge oats
  • rolled oats
  • rusk
  • rye flour
  • semolina
  • spelt
  • triticale
  • vegetable protein
  • vegetable gum
  • vegetable starch
  • wheat bran
  • wheat germ
  • wheat flour
  • wholemeal flour
  • whole-wheat
  • wheat

Most of these items are rarely seen on ingredients labels. You will quickly get used to what is and what isn’t going to be OK to eat. Sausages, for instance, almost always contain rusk. Burgers sometimes do. And labelling is getting better.

And then there is malt. Malt extract is widely used as a flavouring – especially in breakfast cereals – and is only present in tiny amounts. It comes from barley, and you should definitely avoid pure malt extract, or malted drinks. But you may be OK to eat malt extract in the tiny amounts in – for example – breakfast cereals. If you are unsure, avoid it.

Some people must also avoid wheat – not just the gluten within the wheat. Wheat free is not the same as gluten free! Rye bread, for instance, might be wheat free because there is no wheat in it, but not gluten free, because there is gluten in rye.

Some gluten free breads and other products contain wheat with the gluten removed to CODEX Alimentarius standards (i.e. very low amounts remaining – less than 200 parts per million). If you must be wheat free, you should avoid these CODEX products because they still contain wheat. It is possible, if your symptoms are not disappearing, that you are a sensitive coeliac and should also avoid these CODEX products.

The list of things you can eat is much longer than the list of things to avoid. Unfortunately, the bad things are widespread, and you must check everything until you are used to the diet. And then check some more, because things change:

New! Improved! New Recipe! Now 90% fat-free!

isn’t always a good thing.

Foods you can eat and avoid gluten

You’ve got a diagnosis, and they said “Don’t eat anything containing wheat, oats, barley or rye – avoid all gluten”.

OK – but what does that mean? What can you eat?

Your first thought might be ‘oh, that’s not so bad – only four things to avoid’ but after a trip to the supermarket, and looking at some labels, you might be thinking ‘I’m going to starve’.

Luckily, the truth is in-between, and you may end up with a healthier diet than when you were eating gluten, because you’ll probably eat more fresh and home-prepared food.

So – what can I eat?

  • Cereals and grains: rice, millet, maize, quinoa, tapioca, sago, buckwheat, teff and sorghum
  • Meat fish and eggs: all are basically fine – just check any coatings, sauces and spices you add, and check wafer-thin meats too (sometimes wheat flour is added to make them ‘peel apart’)
  • Dairy products: milk and most cream, cheese and yoghurt – check any added ingredients, and check ready-grated cheese (sometimes wheat flour is added to stop the slivers of cheese sticking together)
  • Flours: rice, corn, potato, maize, gram, soya, chickpea, sorghum, tapioca and chestnut flours are all OK
  • Fruit: all fruits are naturally gluten free – check ready-made pie fillings, though
  • Vegetables: all vegetables are naturally gluten free – check any coatings, sauces and spices
  • Fats: you can eat butter, margarine, oils, lard and dripping (if you want!) but avoid suet and check low-fat spreads
  • Breakfast cereal: tricky one – check carefully, and avoid any containing wheat, oats, barley or rye. You might also want to avoid malt extract
  • Bread, crackers and crispbreads: avoid all the conventional ones, and eat only those labelled as gluten free, or those you’ve made yourself and know to be gluten free
  • Cakes, pastries, cookies and biscuits: avoid all the conventional ones, and eat only those labelled as gluten free, or those you’ve made yourself and know to be gluten free
  • Pizza and pasta: avoid all the conventional ones, and eat only those labelled as gluten free, or those you’ve made yourself and know to be gluten free
  • Soup and sauces: check every time, in case wheat flour has been used to thicken a soup or a sauce
  • Pies, quiches, flans and tarts: avoid all the conventional ones, and eat only those labelled as gluten free, or those you’ve made yourself and know to be gluten free
  • Puddings and desserts: check every time – meringue, jelly and most icecreams and sorbets will be fine, but unless specifically labelled gluten free, cheesecakes, pies etc will not be good for you
  • Snacks: nuts, raisins and seeds are all naturally gluten free, but check any added coatings and check all packets of crisps (chips) and other savoury snacks – we’ve been caught out by these before, especially when the recipe is changed
  • Sweets (candy): check every time – chocolate is usually OK to eat, but not if it covers a biscuit! All sorts of unexpected sweets contain wheat, such as Smarties, here in the UK, and licorice
  • Alcohol: wine, spirits, liqueurs and cider – avoid real ale, beer, lager and stout (unless specifically labelled as gluten free)
  • Soft drinks: coffee, tea, juices, cocoa, fizzy drinks and most squashes – but check that they don’t contain barley or ‘cloud’, and don’t drink from vending machines
  • Spices and seasonings: pure salt, pepper, herbs, vinegar – check spices and mustard powder for added flour.
  • Spreads and preserves: jam, marmalade, honey, Marmite (UK only – check in other countries), nut butters
  • Pickles and dressings: check every time
  • Cooking ingredients: yeast, bicarbonate of soda and cream of tartar – check baking powder for added flour

There – that’s not so bad, is it? Lots to choose from, and you’ll soon get in the habit of checking food labels and asking for the recipe. The next thing to worry about: cross-contamination. More on that soon …

What’s that gluten thing you’ve got?

Newly diagnosed?

You may have been so bemused by the announcement – or so deep in the ‘brain-fog’ that can come with a diet full of gluten – that you didn’t quite catch the words the doctor used. Or perhaps you need to explain it to someone else … again. We had just that experience over Christmas, when a relative who can use the word cancer quite freely about himself couldn’t manage to talk about our daughter’s health. Or perhaps he’d just forgotten.

The condition is called coeliac disease here in the UK, or celiac disease in the US, and it is pronounced SEE-lee-ak in both cases (emphasis on the first syllable). Sometimes it is known as gluten-sensitive enteropathy, or coeliac sprue, but it is all the same thing, and not fun at all.

Sometimes people debate the term – is it desirable to call it a disease when its not contagious, and (when it is properly controlled by diet) you feel perfectly healthy? An alternative is to say coeliac condition, but that can sometimes sound a bit vague. Another issue is the ‘suffering’ word. Do you say ‘I suffer from coeliac disease‘? Again, this may not be true, if you are maintaining a strict diet, as you may not be suffering at all. Apart from doughnut deprivation, of course.

We tend to go for ‘she is a coeliac‘ if the situation comes up – along the lines of ‘he’s a diabetic‘.

Occasionally, people call it coeliacs, as in ‘I’ve got coeliacs‘, which I understand, but which grates on me personally – but that’s just the pedant and the proof-reader coming out in me. ‘I’ve got pedantics‘.

Celiac/Coeliac disease and diabetes

We’ve been aware that there is a link – or at least an association – between coeliac disease and diabetes, and a study in Denmark recommends that all children with type 1 diabetes should be screened for coeliac disease. (see Diabetes Care, November 2006, reported by Reuters).

The doctors conducting the research in Denmark identified 269 patients under 16 with type 1 diabetes, and screened them for coeliac disease – finding that over 12% had both coeliac disease and diabetes. This is significantly more than the 1% we are usually quoted by Coeliac UK.

Happily, the identified children were put onto a gluten free diet, and after two years their symptoms resolved, their weight rose and height increased (though only in those under 14 – which goes to show that early diagnosis is important).