A gluten allergy or intolerance or a diagnosis of coeliac disease need not spell disaster. Simply follow dietitian Caitlin Reid's expert advice on everything you need to know about leading a gluten-free life.
These days it seems everyone has a food allergy or intolerance, with gluten – a protein found in wheat and other grains – being the latest 'problem food'. Although the words 'allergy' and 'intolerance' are often used interchangeably to describe a collection of uncomfortable symptoms, the two are quite distinct conditions.
An allergy is due to an overactive immune system and can be diagnosed with a blood test. While a true wheat allergy is quite rare, an intolerance, which causes similar symptoms without an immunological response, is more common. There's also coeliac disease, which is due to an abnormal immune response, but is often incorrectly explained as an intolerance. When coeliacs eat foods containing gluten (a protein found in certain grains), the gluten causes uncomfortable symptoms such as bloating, gas, abdominal pain, fatigue and diarrhoea, and damages the lining of the small intestine (known as villi). This damage decreases the ability of the small intestine to absorb important nutrients and can result in serious illness, particularly if the condition goes undetected for many years.
Coeliac disease affects one in 100 Australians, but health experts believe it is under-diagnosed and we could be seeing much higher numbers in the future thanks to an increased awareness about diet in general and better diagnostic methods.
Although coeliac disease is a genetic condition, the symptoms sometimes aren't apparent until adulthood and may be triggered by environmental factors. If you experience any of the symptoms we've mentioned after meals, it's a good idea to see your GP to rule out coeliac disease. Your doctor will recommend a blood test and, depending on the result, a small bowel biopsy will be carried out to confirm the diagnosis. In coeliacs, the lining of the small intestine, which normally looks similar to shag carpet, is instead flattened.
Diet is the answer
If you've been diagnosed with coeliac disease, following a strict gluten-free diet will eliminate the symptoms and can even reverse the damage done to the small intestine. Unfortunately, eating even a small amount of gluten can bring on the symptoms again, so the changes you make to your diet need to be permanent ones.
Gluten is found in a number of grains, including all varieties of wheat (spelt, durum, kumat, dinkel), rye, barley, oats, triticale and all derivatives of these products, such as malt and couscous. Foods such as barley, rye, wheat breads, wheat pasta, wheat- or oat-based cereals, biscuits, cakes and pastry products are among the many products that contain gluten.
Gluten can also be present in many other commercial foods including yeast extracts and dressings. While the thought of giving up some of your favourite foods can seem daunting, it's important to focus on all the great foods you can still enjoy. The trick is to find out as much as you can about a gluten-free diet, be on the lookout for great gluten-free recipes and experiment until you find what suits you.
Since December 2003, food labelling laws in Australia have made it a requirement for products containing gluten to be declared on labels at all times – whether it is present as an ingredient, a food additive or a processing aid. 'Contains gluten' is an example of what to look for on a product label.
If there is a possibility that the food may have been contaminated with gluten, such as when a gluten-free product is made on machinery that also made a gluten-containing product, a declaration such as 'may contain gluten' must also be made. Foods that display the words 'gluten-free' contain no detectable gluten.
Hidden sources of gluten
Always read the food labels as gluten may be present in some of these ingredients:
Beer, stout, lager, ale
Dressings, gravies and sauces
Icing sugar mixture
Margarine (may contain breadcrumbs)
Powdered drink flavourings
Sausages and processed meats
Yeast extract spreads
When eating out at a restaurant or even ordering takeaway, food that doesn't contain gluten can become contaminated by other gluten-containing foods, unless separate workstations, utensils and cookware is used. A perfect example is when you order hot chips, which are gluten-free. However, if they are cooked in a deep-fryer that is also used to fry fish rolled in flour, the gluten from the flour can contaminate the chips, and for some people this small amount of gluten is enough to cause problems.
Besides asking what ingredients a dish contains, it's best to check with the waiter or even the chef how the food is prepared. It's also worth remembering that soy sauce can contain gluten, which may go unnoticed in the kitchen. It's a good idea to call a restaurant beforehand and ask about gluten-free options.
If you're eating at a friend's house, ask your host how they prepared the meal and what ingredients it contains to be sure it's gluten-free. Or better still, talk to them a day or so in advance and give them a few tips and ideas for preparing a gluten-free meal.
Cooking without gluten can seem a little daunting at first, but these handy hints will make it easier for you.
Get rid of wheat flour
Replace wheat flour in your favourite recipes with gluten-free flours or flour substitutes. Gluten free flours can be found in the health food aisle of your supermarket and are carefully formulated to give the best results.
Make your own 'flour'
Make your own gluten-free flour by combining:
2 cups rice flour, 2/3 cup potato flour and 1/3 cup tapioca flour; or
equal parts soya flour and maize cornflour; or
equal parts soya flour and potato flour; or
1/2 soya flour, 1/4 potato flour and 1/4 rice flour.
Mix flours together thoroughly.
Make xanthum gum, guar gum or pre-gel starch your new best friends
Simply taking gluten out of a baking recipe will make your delicious baked goodies crumble. To improve the texture of your food and reduce crumbling, add xanthum gum, guar gum, or pre-gel starch to your recipes. For more information, contact the Coeliac Society 02 9411 4100 or visit www.coeliacsociety.com.au.
Use gluten-free thickeners
Use any of the following thickening agents to replace a tablespoon of wheat flour:
1 1/2 teaspoons maize cornflour
1 1/2 teaspoons potato flour
1 1/2 teaspoons arrowroot starch
1 1/2 tablespoons white or brown rice flour
1 1/2 teaspoons quick cooking tapioca
1 1/2 teaspoons sweet rice flour
Increase the rise
You may need to add more raising agents (such as baking soda or baking powder – check the label for gluten-free varieties) when using gluten-free flours.
Gluten foods that must be avoided
When reading the food labels of products, look out for these gluten-containing foods:
Brewer's yeast extract
Hydrolysed wheat protein
Modified wheat starch
Textured wheat protein
Glucose (from wheat)*
Glucose syrup (from wheat)*
Glucose powder (from wheat)*
Hydrolysed vegetable protein
Modified maize starch
Modified potato starch
Modified tapioca starch
*Gluten is not detectable in these ingredients, even if derived from wheat.
The Coeliac Society of Australia. www.coeliacsociety.com.au. Accessed January 2008. Green PH, Jabri B. 2003. Coeliac disease. Lancet 362:383-391. Shepherd SJ, Gibson PR. 2006. Understanding the gluten-free diet for teaching in Australia. Nutrition & Dietetics. 63:155-165.