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Opinion: Hold the gluten please! Why we all need to understand coeliac disease

The demand for gluten-free foods is ever-increasing and many are wondering what the gluten-free craze is about. Dr Edel Keaveney fills us in …

Dr Edel Keaveney

When is gluten a problem?

GLUTEN IS A protein found in wheat, rye and barley grains, and oats that are processed near these grains. ‘Obvious’ sources of gluten are bread, breakfast cereals, pasta, cakes, biscuits and beer. Many processed foods contain wheat, so gluten can ‘hide’ in sauces, soups, soy sauce, stock cubes, crisps and processed meats as well.

So what can this protein do? Well, gluten can damage the gut in people who have coeliac disease, meaning important nutrients do not get absorbed properly. The result can be nutrient deficiencies, anaemia and osteoporosis. Bloating, diarrhoea and constipation are some of the gut symptoms which can be experienced. Less obvious symptoms like mouth ulcers, skin rashes and fertility problems are also signs of coeliac disease.

About 1 in 100 people have coeliac disease and there is no known cure. The only proven treatment is a very strict, lifelong, gluten-free diet. If you think coeliacs can get away with the occasional bite of a regular biscuit, forget it! Cheating is not advised; allowing tiny amounts of gluten to sneak into the diet mean letting oneself in for a bout of diarrhoea, vomiting, or other nasty symptoms that can last days. Even using the same breadboard and toaster for gluten-free and ‘normal’ bread is a no-go. All coeliacs, regardless of whether their reactions are quite mild or very severe, should completely avoid gluten to protect long-term health. Fortunately, following a gluten-free diet heals the gut and eliminates symptoms.

Unfortunately the clinical diagnosis of coeliac disease is still quite low. The Coeliac Society of Ireland recently carried out a survey of members with the disease and found:

  • 42% received a misdiagnosis prior to a confirmed diagnosis
  • 39% said it took over one year for a positive diagnosis 
  • 23% said it took up to ten years or more for a positive diagnosis

Recently, celebrities are popularising the gluten-free diet claiming it alleviates everything from weight gain to spotty skin. In reality, non-coeliacs who eat gluten-free may find they lose weight or feel better if knock-on effects of following the diet mean the biscuits or cakes they usually reached for are replaced by fruit or other healthy snacks. There is no evidence that the lack of gluten per se causes these effects. It’s certainly not the case that everyone needs to eat gluten-free.

What food is gluten-free?

A lot of foods are naturally free from gluten like meat, fish, eggs, fruit, vegetables, dairy products, potatoes, rice, maize, quinoa and buckwheat. Supermarkets sell specially produced gluten-free products like flour, bread, pasta, cakes etc. However, gluten-free living is restrictive and more difficult for people averse to cooking from scratch. Price is a factor too; buying gluten-free can cost up to twice as much.

Looking around the burgeoning ‘free-from’ sections in supermarkets today it is hard to believe that tinned gluten-free bread was the only option for coeliacs back in the ’70s. Keeping up with sampling the new brands entering this niche market with innovative food products is now almost impossible. A huge array of gluten-free bread, crackers, breakfast cereals, pastas, cakes, biscuits and handy packs of gluten-free porridge for microwaving don the shelves.

Irish companies are setting the stakes high with many winning taste awards for gluten-free goodies, and more launching new products which have frenzied gluten-free’ers dashing to get their hands on gluten-free wraps, crisps, and cookies to name but a few. Supermarkets are innovating too, by marketing less costly own-brand gluten-free products and having celebrity chefs championing the cause with tasty gluten-free recipe ideas online.

Thankfully for coeliacs, the Coeliac Society of Ireland is an excellent resource for information and support. Anyone can be a member and benefit from their advice on how to source, store and prepare gluten-free foods. Each year they produce a ‘coeliac bible’ listing foods suitable for coeliacs to eat. New food laws mean that later this year any menu options that contain gluten will actually have to be clearly labelled, which is great news for coeliacs.

Eating out, gluten-free style

It’s wonderful that awareness is increasing and many outlets are highlighting menu items which are gluten-free and offering gluten-free bread, sandwiches, pizza bases, sauces etc. This means eating out is getting less stressful for coeliacs. Everyone from kitchen to floor staff in restaurants needs to be knowledgeable to advise consumers whether or not foods and drinks contain gluten. If in doubt, it’s better if false assurances aren’t given! It is paramount staff understand that even tiny amounts of gluten are not safe for coeliacs.

This can be tricky for businesses to get right. Waiting staff are puzzled when their suggestions to remedy mistakes by picking the croutons off a salad, or pulling out the wafer stuck in otherwise gluten-free ice-cream aren’t adequate. But, as even a crumb of gluten can make a coeliac ill, dishes accidentally containing gluten have to be re-prepared.

As a coeliac, I find travelling an utter nightmare. From visiting well-meaning aunties who dowse my ‘gluten-free’ stir-fry in soy sauce (contains gluten), to attempting to decipher food labels in foreign tongues, staycations are more tempting. What about when hunger strikes in mid-air? Some air lines are highlighting in-flight snacks like fruit-salad and olives as being suitable; I’m just not sure this goes far enough to quash my appetite, especially when ‘normal’ fellow passengers are chomping on oozing panini’s and the like. Something else which would be great to see is some air time on cookery shows being devoted to gluten-free cooking. Let’s face it, demand for gluten-free is here to stay so the more people capable of rustling up suitable dishes the better.

Full details of events taking place nationwide during Coeliac Awareness Week, as well
as any information you may need in relation to gluten free living, including recipes and tips, can be found at www.coeliac.ie.

Dr Edel Keaveney is a nutritionist, coeliac and member of Coeliac Society of Ireland.

Read: Gluten-free product allowance cut for coeliacs

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Dr Edel Keaveney

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