Baked Apples – Gluten free recipe

Baked apple and custard

Baked apple and custard – though personally I prefer cream.

If you’re newly diagnosed as gluten intolerant/celiac, it’s difficult at first to find solutions to the question, “What can I eat?” I’ve come across several people who are finding it difficult to eat enough calories, and because of this, they are losing weight not so much because they want to, but more because of the perennial problem of finding enough gluten free calories!

It’s true that most processed food is off limits if you can’t stomach gluten, but that doesn’t mean you have to go without all the good things in life – and desserts are definitely one of the best!

Well, that’s my opinion, anyway, and I kinda think you wouldn’t be reading this page at all if you weren’t at least partly of the same opinion. Don’t worry I won’t tell anyone about your little secret – let’s just keep it between you and me.

It’s funny, but I have been surfing around looking for desserts, and is it just me, or are they ALL cold? Ok, that’s fine in the summertime, but what about the cold winter months when there’s snow piling up outside and you just don’t seem to be able to get completely warm through, even with the central heating on full blast? That’s the time when you might really miss old fashioned puddings.

Well, although traditional sponge and suet puddings are too complicated to go into details about here, there are some hot puds that are naturally gluten free. Rice pudding, baked custard (not the sort in pastry cases), sweet souffles, stewed fruits and best of all in my humble opinion, baked apples.

Baked apples

Baked apples used to be my absolute favorite dessert when I was a child, and I would make sure I ate every scrap of my main course, to be sure of my entitlement to one of these afterwards. They are so simple to make, and not expensive – especially if you’re using the oven to cook the main course.

You need Bramleys or similar cooking apples. Choose one for each person, and use a corer to remove the core. If you haven’t got a corer, an old fashioned v-shaped potato peeler is another way, you have to go round the core with it, or at the last resort a thin bladed kitchen knife (as you don’t want to cut the apple in half by accident). Make sure there are no little bits of core left inside, as these are not nice to find in your wonderful fluffy cooked apple.

Cut four or five cuts into the skin around the top of the hole outwards like spokes in a wheel, to about halfway down the apple. The apple will expand a little bit when it cooks, and this will stop it exploding! Now put the apples in an oven proof dish and fill the centers up with brown sugar (demerara is ok, but molasses sugar is amazing) almost right to the top. Add a knob of butter on top of the sugar in each apple. The butter will melt and combine with the sugar to make a sort of toffee filling which is gorgeous. But without the butter (or you could use margarine I guess), this doesn’t happen.

You can also fill the apples with dried fruit, such as raisins, instead of the sugar, but you don’t get the toffee filling which I loved so much as a kid. In fact, if it hadn’t been for that, I probably wouldn’t have liked baked apples at all, as I’ve never been keen on cooked apples any other way even in pies.

The prepared apples can just go in the oven towards the bottom along with whatever else you are cooking for the last 20-30 minutes at 180º C (350º F, gas mark 6). When you serve the main course, you can take the apples out and let them cool because they will be very hot, and will stay that way for quite a while.

These are just great with some cream or your preferred topping. If they haven’t had them before, it’s best to warn your family and guests that they are hot, and to eat them carefully so as not to burn their tongues.


The Harvard Food Pyramid

Diabetic, Gluten and Dairy Intolerant on a Budget!

The Harvard Food Pyramid

The Harvard Food Pyramid

Q. How can I follow a balanced diet as inexpensively as possible, when I seem to be intolerant/sensitive to gluten, wheat and lactose and prone to diabetic hypos too ?

[Gluten is the protein part of wheat, and is also found in some other grains, including rye, barley, spelt and a few other closely related cereals. Lactose is the sugar found in milk and most other dairy products.]

A. A difficult diet, but not impossible. It’s not too surprising that you have both diabetes and multiple food intolerances, because all of these seem to have strong links to an auto-immune condition. However, I understand your confusion as to what to eat. A balanced diet is important for everyone, but even more so for diabetics.

A properly balanced diet has to contain some of each of the 3 main food groups: carbohydrate, protein and fat. There are important nutrients that cannot be obtained if you omit fats from your diet, many of them actually called “essential fatty acids”, but there are also fat-soluble vitamins. So it’s probably easiest first to just look at possible sources of each of these groups, and then see where we can go from there.

Carbohydrate

Although the Western diet tends to include mainly wheat-based carbs, there are other sources which aren’t that foreign to our palates. These include sugar and molasses (these are probably off-limits to you, except in very small quantities), fruit of all kinds (which contain sugar in combination with fiber, though some are not usually recommended for diabetics, eg. bananas), potatoes, rice, corn and legumes (vegetables that grow in pods, like peas, beans and lentils). You can also eat gluten free flour, pasta and breads. Carbohydrate is a fast energy source, which is why athletes generally eat a lot of it.

Protein

Protein is mainly for building and maintaining muscles. This means that a protein-rich diet is most important for children, people who work in occupations that involve a lot of exertion or possible injury, and those recovering from serious illness. However, we all need some protein every day to cope with general wear and tear. It’s said that for an average adult in a sedentary job, the minimum requirement of protein is only 25g – less than an ounce, but in my opinion, around 4-6 ounces a day is a reasonable amount. You can obtain protein from meat and fish of all kinds, legumes, nuts, grains and other seeds and products made from these, like tofu. However, don’t overdo soy products as large quantities can have estrogenic effects which are injurious to health in the long term.

Fat

If you can’t use dairy products, most of the fat in your diet is likely to come along with whatever meat you eat. Regular butter contains only trace amounts of lactose, so can be included in your diet in small quantities, if you don’t like the substitute spreads. Clarified butter (ghee) contains no lactose at all, so makes a good cooking fat – and unlike most other options it does not turn into trans fats when heated.

Supplements

As many of the dairy and wheat-based products in our diet are fortified with vitamins and minerals for historic reasons, it’s quite likely that by cutting these out you will experience a loss of essential nutrients in your diet. To avoid bad effects, I advise everybody to take a good one-a-day multivitamin and mineral tablet (look for one that contains selenium, as this is an indication that it is fairly complete) and a high dose fish oil capsule every day. This is especially important for anyone on a restricted diet.

The fish oils will provide omega 3. Don’t be tempted to substitute vegetable-based omega 3 capsules, as recent research has shown that this is not easily absorbed by the body, in contrast with the fish-derived omega 3. However, if you are vegetarian, I’ve heard good reports about algae-derived supplements.

Putting it all together

If you cook for yourself, you will find that by some judicious substitution, you can eat pretty much what you’ve always eaten, apart from pies (as gluten free pastry doesn’t hold together very well and is best avoided).

Traditional meals from the past – when most people ate meat or fish, potatoes and a couple of veg. at every meal – are easy enough, though gravy has to be thickened with a gluten free product such as cornstarch (UK: cornflour).

Singapore rice noodles are one of my favourite foods.

Singapore rice noodles are one of my favourite foods. Photo by AlekhyaDas.

Meals with rice, like Chinese, Indian and other Asian cuisines are usually almost the same, though you need to ensure that if you use soy sauce you make sure it’s a gluten free type (most is made with wheat). Many Far East cultures also make noodles from gluten free grains like rice, buckwheat and so on, which is helpful. Singapore-style rice noodles are absolutely yummy if you like spicy food.

The breads served with Indian food are rarely available gluten free, but poppadoms should be fine – they are made from lentil flour. Pakora is made with gram flour (besan/chickpea flour), but check with the restaurant, as some low quality pakoras may be made with wheat flour.

There are some very good gluten free pastas and noodles, in particular I recommend Orgran brand, but there are others which are ok – and some which are not nice at all!

You can also get gluten free pizza bases and tortillas. Tortillas? Yes, because although these were originally always made from pure corn, most of the ones you find on sale nowadays also contain at least some wheat flour (some contain no corn at all), so look out for genuine, pure corn tortillas if you like them, or buy from gluten free producers.

I offer a wide range of gluten and dairy free food products in my online store. Although not all will be suitable for diabetics, I’m sure a good proportion of them will be.


photo by senapa

Gluten and Depression – How does that work?

photo by senapa

photo by senapa

If you visit online forums about depression or celiac disease, you will probably notice quite a few people saying that depression symptoms improve when they stop eating gluten, and come back with a vengeance when they “get glutened”. Is there an explanation for this?

For a lot of years, there has been anecdotal evidence linking depression with gluten (along with more serious mental disorders, up to and including schizophrenia). The problem is, scientists in general, and doctors in particular pay little or no attention to evidence of this type. However, new discoveries have begun to throw light on what is going on.

Clinical depression appears to be linked with serotonin levels in the brain. This has led to the development of new types of anti-depressants, including SSRIs (Prozac is the most well known brand). These new drugs are not without their problems, however. Although initially hailed as dependency-free and safe, there has been a worrying rise in suicide amongst people taking these drugs, and certain patients have apparently had great difficulty in coming off them.

Serotonin is a natural substance which is produced in the body. This natural production appears to be impaired or reduced in various groups of people, including depressives.

The reasons for this impairment are not yet completely clear. However, 90% of the production of serotonin occurs in the digestive tract. So it begins to make sense that the food eaten might have an effect, either positive or negative, on serotonin production.

A report by Ron Hoggan M.A. & James Braly M.D. examines the relationship between depression and diet. They cite various studies carried out by Christine Zioudrou and later followed up by Fukudome and Yoshikawa. They point to morphine-like substances caused by incomplete digestion of proteins in cereal grains and dairy products (called “exorphins”). It is thought that these exorphins can be absorbed through the intestine, offering a possible explanation for the psychiatric effects experienced by otherwise healthy individuals.

Another report by Alessio Fasano and Carlo Catassi states that there is an “Asymptomatic Silent Form” of celiac disease. The term asymptomatic is a bit of a misnomer, as it refers only to the lack of positive test results. Symptoms of this form of gluten intolerance (which may not all be present) are: iron deficiency, a tendency to depression, irritability, or impaired school performance in children “feeling always tired,” and easy fatigue during exercise, and reduced bone mineral density.

In a lecture he gave in 2002, James V. Croxton, M.A. talked about new discoveries relating to previously ignored cells in the brain called glial cells. These appear to be closely involved in the immune system, and directly affected by gliadin, part of the gluten found in wheat and other cereals.

Gluten-free diets (sometimes combined with dairy-free) have been used for autism, depression and schizophrenia, with some success. Even though the mechanism is still not fully clear, it does appear that there is a scientific basis for a connection between gluten and depression in susceptible individuals.

Further research may bring a cure. For the time being, though the only safe approach is to exclude gluten from the diet entirely.

I offer a wide range of food for special diets in my online shop.


It's no easy task finding gluten free mainstream products

Master of Disguise: How Gluten Hides Where You Least Expect It

Previously published on 100% Gluten Free

It's no easy task finding gluten free mainstream products

It’s no easy task finding gluten free mainstream products

It can sometimes be difficult to spot the gluten hiding in your supermarket. It’s almost as if the food manufacturers are conspiring against us – they wouldn’t do that, surely?

You may find this list a bit depressing, or you can look on it as a challenge!

Here’s a list of 14 places you might not expect to find gluten:

  • Sausages contain breadcrumbs (the bread is one of the ways in which the texture of the sausage is obtained, without including an unacceptably high proportion of fat), except the most high class variety of butcher’s sausage, and even in this case it’s quite likely.
  • Burgers, grillsteaks and similar products generally also include bread or other wheat products in the mixture.
  • Crab sticks and prawnies seem to be made entirely of fish, but if you check the label you will find wheat flour or modified starch listed in the ingredients.
  • Some drinks contain gluten as a thickener, to provide ‘body’.
  • Wheat flour may be a hidden ingredient in ice cream, ketchup, mayonnaise and instant coffee.

  • You often find gluten in low fat versions of products, to make them seem less watery (for example, yoghurt, soft cheese or mayonnaise).
  • Pre-packed grated cheese is coated in flour or modified starch to stop it from sticking together in the packet – this includes the cheese sold with jacket potatoes in takeaways, unless they grate their own (but most don’t).
  • Obviously, anything coated in batter or breadcrumbs contains gluten in the coating. This makes almost every fish product out of bounds for the gluten intolerant, as the ones that aren’t coated are usually packaged in a sauce thickened with flour.
  • Monosodium glutamate, known to Chinese cooks as ‘taste powder’ or ‘ve-tsin’ is manufactured with gluten. This ingredient is very frequently included in factory-prepared goods, but may not be listed on the label – or merely described as a ‘flavor enhancer’.
  • Soy sauce is almost always made by fermenting soy beans and wheat together, so contains gluten.
  • Although wheat germ does not itself contain gluten, because of the process of separation employed in manufacture, it is likely that a small amount of gluten will be present in wheat germ sold in the stores.
  • Malt and malt extract are derived from wheat, and can be a hidden source of gluten. This is sometimes listed as maltase or malto-dextrin.
  • Any alcoholic drink made from grain – beer or whisky, for example, contains gluten.
  • Even medicines may contain gluten, used as a thickener or a binder.

I offer a wide range of food for special diets in my online shop.


Can’t Eat Gluten, Can’t Eat Lactose. What CAN I Eat?

photo by Carsten Schertzer

photo by Carsten Schertzer

More and more people are suddenly finding themselves either unable to handle gluten in their diets, or unable to handle lactose, or both.

It is a known fact that most animals can’t handle cows milk, and that it is quite bad for adult humans to drink, so why is so much of our food dairy based?

For someone who isn’t allergic to lactose, just intolerant and therefore I can handle some dairy products, it’s much easier just to suffer a little discomfort now and then, rather than change your diet. At least, that is what I thought for quite some time, as there really isn’t much out there for a lactose-intolerant person to eat.

What I didn’t know is that I was making myself much worse by continually eating dairy products such as cheese or yoghurt. I noticed a huge change in my health when I stopped eating these products, my asthma was seriously improving, my hay fever was much better and I generally felt much healthier.

However, after only a short time of not eating these products, I felt the cravings and sadly I gave in to them. Dairy products are surprisingly addictive, so once you start eating even a little cheese, you start wanting more. My friend started to notice the change in my health again and politely advised me that I really ought to stop eating dairy products and possibly try a short stint on a gluten free diet.

I decided to pay attention to her and as I was living with her at the time, I was able to live gluten free easily, because she is intolerant to it. Almost right away I noticed a huge difference in my health and wellbeing and I thought to myself, “Is there a connection between the two products?”

I started to ask around my friends and soon found that where one was allergic or intolerant to lactose, they were also intolerant to gluten, at least those who were aware of it were. So I started to look around on the internet and found that my friend had been correct. It is common for celiacs (those intolerant or allergic to gluten) to also have problems with lactose intolerance. I started then thinking, how many people out there are actually aware of this connection, because until my friend pointed it out I had absolutely no idea of this.

So what CAN I Eat?

This is a very good question, and one that sprang almost instantly to my mind. I thought “Wait, how am I supposed to live if I can’t eat gluten or lactose. So many products contain either one or both.” So I began shopping around and straight away noticed how restricted I was in the way of things I could actually eat or buy.

Sure, there are supermarkets that sell a range of “free from” products, but either they taste disgusting or are far too expensive. So, yet again I decided to skip the new diet and go back to my old ways of eating, purely because I was too lazy to actually check the labels or be inventive with food.

Though I didn’t eat dairy, I still ate bread and cakes and things that contained gluten. I soon began to regret my decision and started to suffer terrible burning pains in my throat and other unmentionable symptoms. I thought “Hey, the research is right… I had better stop eating this stuff” and I did.

Now I am finding that my health is dramatically improving, my joints don’t hurt as much and so many things have changed now I have cut both products out of my diet. Don’t be disheartened, there are plenty of foods out there that you can eat, trust me.

More and more people are becoming aware of the growing food intolerances in children and adults and many companies have started selling their “free from” products in supermarkets. If you experience symptoms such as: bloating, nausea, abdominal pain, tiredness, diarrhea, to name just a few, then it may be worthwhile checking to see if you suffer from gluten intolerance.

If you are gluten intolerant, then it may be worth leaving out dairy products, too. You will be amazed at how healthy you feel in just a short time, trust me. Even if you aren’t found to be allergic by your doctor, I would advise just leaving out gluten and dairy for a week or so and see how you feel afterwards. You might be surprised by the results.

[Editor’s note] I offer a wide range of food for special diets in my online shop.


Egg mayonnaise salad with baked potato

Quick and Easy Meals without Gluten

Egg mayonnaise salad with baked potato

Egg mayonnaise salad with baked potato

Someone asked me, “how do i keep my meals easy/simple but without gluten?” Sounds like an easy question, doesn’t it? But if you’re gluten intolerant, you will know it’s not so simple.

In the past, I used to keep some ready meals for when I was in a hurry or too tired to cook, but most of them are off the menu now – apart from the ones I never liked! Pizza, pies and ordinary pasta are also out. I do keep some Orgran rice and corn pasta in the cupboard, which tastes fine, and is as easy to cook as any other pasta. It goes nicely with a bolonaise or tomato and onion sauce, and is also fine with just butter, parmesan and lots of black pepper.

In my kitchen cupboard, I have a packet or two of Corn Thins, in place of bread. These are really tasty, come in various different types (you can get them in brown rice and multigrain varieties as well), and have the advantage that they don’t squeak when you eat them, unlike rice crackers. They also have a taste – so far as I am concerned, rice crackers taste of nothing at all. Corn Thins are good with butter and cold meat, or jam, or honey – anything you would have put in a sandwich – though the fillings are best used as toppings, as trying to eat them in pairs with something in between is very difficult.

Most of the time, when I’m looking for something quick to eat for a main meal, I follow the sort of menus recommended by Dr Atkins (not because I’m trying to lose weight, but because cutting out carbs is similar to cutting out gluten). So this means something like a piece of chicken or a chop or steak, cooked under the grill or in the oven, or even fried. But no coating, unless you’ve bought in something gluten free (Orgran do gluten free breadcrumbs in Rice or Corn varieties).

I also like a grilled mackerel. I get the fishmonger to gut the fish and take the head off, but leave it whole. When I get it home, I open the fish out flat with the skin side up and run the handle of a knife hard along the backbone, then I turn it over and the bones come out fairly easily. A quick wash under the tap and then I put it under the grill with a knob of butter and a squeeze of lemon in the middle, where the bone has left a sort of valley. It only takes about 10-15 minutes to cook, and doesn’t need to be turned over, though I keep brushing the butter and lemon over every now and then.

To accompany the meal, ordinary fresh or frozen vegetables cooked in the normal way are fine, or a nice mixed salad. Unlike real Atkins dieters, I eat carbohydrate with my food, so long as it’s not gluten-based. I like saute potatoes or mash sometimes, and for a real treat, some mushrooms go really well with a bit of fried steak, and can be cooked in the pan at the same time.

If I don’t feel like meat, I might have a jacket baked potato, egg mayonnaise and mixed salad maybe with some shrimp (prawns). This is a very quick meal. I start by putting the eggs on, then when they are cooked I put them into cold water, leaving them to sit for a while, and put the potato in the microwave. As it cooks, I prepare the salad and put it on the plate, peel the eggs, and mash them up with some mayonnaise. Then I put the halved potato on the salad, top with the egg mayonnaise and shrimp and it’s ready. Another thing that goes well with salad is ham slices rolled up and filled with cottage cheese, maybe with a few bits of chopped celery mixed with the cheese filling.

In the winter, one of my favourite lunches is a chunky lentil soup. I put some lentils, some cooking bacon or a ham bone and a few carrots and one or two leeks sliced up (if I’ve no leeks, I cut a couple of onions into quarters instead) into a saucepan, cover with water and a lid, bring to the boil and turn down to a simmer. It only takes 20-30 minutes, and then I eat it. If you prefer it smooth, blend it after it has finished cooking, but I like it just as it is. The occasional bit of leek or bacon makes it more interesting.

I live on my own, so I don’t spend a lot of time in the kitchen. It’s really only when I make a curry (which will do me for 3 days) that I spend a lot of time cooking. For this, I chop a couple of onions, one or two cloves of garlic and half a dozen chilli peppers, fry them gently in a little melted ghee (clarified butter) or oil with about half a tablespoonful of garam masala. When they are soft, I add 2 or 3 chicken portions or the diced meat from a cooked turkey leg, or some diced shoulder lamb, 1 or 2 aubergines (eggplants) sliced about half an inch thick and 1 or 2 sweet peppers, deseeded and cut into chunks (I like these vegetables in curry, as they go quite soft and make a good base). I push everything down and cover with as little water as I can get away with and add in a stock cube and some salt, bring to the boil and cover tightly.

When it comes to the boil I turn it down to a simmer and put my brown rice on to cook (1 cup rice to little bit over 2 cups of water, plus some salt). When that comes to the boil, I turn that down to the lowest flame I can get, and cover it. I keep checking the rice every 10 minutes or so, without stirring. About 10 minutes before I want to eat, I put 2 or 3 carrots into the curry, cut into chunks, as I like them to be fairly crisp. When I think all the water has gone, I use a fork to push the rice to one side to check, and when the bottom of the pan is dry, my dinner is ready.

I don’t usually thicken the curry sauce, but if I did I would use 1-2 tablespoonfuls of rice flour beaten into the gravy over a high heat. If I have any coriander (cilantro), I chop up a handful and stir it into the curry just before serving. Though it’s quite a lot of work, I only have to cook one day in 3 with this dinner, so I don’t mind.

For me, I find this approach to eating gluten free works well, and is quick, easy and hassle-free.


I’m going gluten-free – what can I eat?

Previously published on 100% Gluten Free

Photo by James Petts

Photo by James Petts

Good question.

It would be easier to say what you can’t eat!

But the question is, what can you eat. So let’s start there.

Well, for a start, obviously you can eat meat, poultry and game. That’s unprocessed meat. Avoid burgers, sausages, grillsteaks and similar items, as they almost always contain filler which is wheat based (though the highest quality may be gluten free – check the label for anything like wheat, flour, starch, and in particular monosodium glutamate).

If you like gravy, ketchup or sauce with your meat, take care. These products are almost always made with flour. Gravy granules and powders might be thickened with cornflour, because it mixes with boiling water more quickly than wheat flour, but you do need to check, particularly with the cheaper varieties. Soya sauce (except for the gluten free variety) is also off the menu, because the soya beans are fermented with wheat.

Next on the list: fruit, raw or cooked, but without thickened sauces (custard may be ok, check the label to make sure any thickening is either corn or egg based). You can also have cream, but not if it’s squirty cream containing starch to thicken it.

Vegetables are usually pretty safe. Potatoes, green vegetables and roots are almost always served without any thickening added. Again, if it’s a processed product, check the label! Watch out for coatings and fillers in frozen potato products. If you use packet mash, read the label carefully, best go for the top quality brands.

Salad prepared by your own sweet hands is great. Prepared salads are also fine, so long as you don’t use any dressing packed with it, unless you first check the label to make sure there is no wheat flour, unspecified starch or monosodium glutamate in it. Dressings you buy to put on your salad need to be checked as well. Good quality mayonnaise should be fine – Hellman’s for example – but be careful of low fat varieties of anything, as thickener is often added to make up for the lost viscosity of the oil they removed, and this is usually based on some variant of flour.

Milk, cheese and yoghurt should be fine – but again, be careful of the low fat varieties, for the reasons already mentioned. Also, don’t buy grated cheese, unless you see the deli grate it in front of you, as the pre-packaged variety is coated in – you guessed it – flour.

You can eat gluten-free bread and cakes, but these are mostly ridiculously expensive, and not very nice. A good substitute are Corn Thins from Real Foods Pty, an Australian company. They have a page on their site listing stockists around the world, including major supermarket chains. Alternatively, if you don’t mind eating food that squeaks, you can eat rice cakes. Kallo do a chocolate coated rice cake that is probably very nice, but as I do object to my food squeaking, I haven’t tried them.

As far as takeaways go, you can eat Indian food, but not the breads and chapattis. Poppadoms are fine, though. You need to check that they don’t use any thickening in their food (apart from chickpea or lentil flour), or ask them to make you a version without.

Another takeaway style that you can go for is Chinese – no noodles, apart from rice noodles (sometimes called Singapore hot noodles), and ask them to leave out the “taste powder” (monosodium glutamate). I’m afraid fortune cookies are off the menu as well, although there’s nothing to stop you reading the contents and throwing the cookie away! Like I said earlier, soya sauce must be the gluten free variety, so get them to leave it out and add it yourself at home.

All drinks except for whisky, beer, and malted drinks like Ovaltine, Milo and Horlicks should be fine, but avoid the cheaper varieties of instant coffee, as flour is sometimes used as a filler.

So there you are, a pretty good selection of gluten-free foods you can eat to your heart’s content.

Bon Appetit!


Photo by by Rinina25 & Twice25

What makes you think you’re gluten intolerant?

Previously published on 100% Gluten Free

Photo by by Rinina25 & Twice25

Photo by Rinina25 & Twice25

Awareness of gluten intolerance is rising. Lots of people who have had obvious symptoms, with no really obvious cause are waking up to the fact that they might be a sufferer, as well.

I grew up thinking that regular diarrhea was normal. It’s not, of course, but it’s not something you really chat about, even with your closest friends. It was normal for me, so I just assumed everyone else had the same problem.

It was only a couple of years ago, when I started trying to get an online business going, dedicating almost all my income to the cause, that I started to get other symptoms. I had pretty much reduced my diet to pasta, bread and potatoes, with just a little protein. I started to get serious aches and pains in my bones and joints.

I’ve been interested in nutrition for a long time, so I had come across literature connecting arthritis with gluten intolerance. As I wasn’t suffering from arthritis at the time, the information lay dormant in the back of my mind until the symptoms of possible arthritis flared up. I was hurting, I was online, so I started surfing for data, and found the connection.

It was a bit of a blow, because being able to keep body and soul together for under a tenner a week was quite useful, but I decided to go for it, and cut out gluten completely for a few weeks to see what happened.

My aches and pains went away. The diarrhea stopped pretty much completely. And I started to lose weight, without making any real effort to cut down on calories (which was odd, as I was actually eating more, much more, than I had been for the previous 6 months).

Do you think I was pleased with these results? Of course I was! Even though, as the daughter of a chef and a bit of a gourmet on the quiet, it meant I had to completely revise all my cooking methods, styles and recipes.

I used to like takeaways as well, but almost all of them have flour in some form or other. Luckily, Chinese takeaways almost all sell rice noodles (as well as rice), though they don’t always say so. But if you ask for Singapore rice noodles you will get a very nice noodle dish, made with very fine noodles and spiced with chilli. Yummy. It makes a meal in itself, or you can use it as one part of a Chinese meal.

You can eat almost all Chinese dishes – except the deep fried ones which are mostly coated in batter, chow mien noodles and prawn toast. You also need to ask them not to put monosodium glutamate or soy sauce in your food. But the Chinese are so adept at making food tasty, all this is a small sacrifice.

Indian food is ok, as well, so long as you avoid the breads: nan, chapatis and so on. But you can eat the poppadoms, as they are made with lentils, not flour. Ask them not to thicken your food with flour – but they can use gram flour (made with chickpeas).

As I live in Scotland, I can also get haggis, which is made from oats. Some people who are gluten intolerant can’t eat oats, but I don’t have a problem with them. However, the local chip shops always coat them in batter before they cook them, so I really need to pick that off.

What makes me think I’m gluten intolerant? Well, when I eat gluten, I get nasty health problems that go away when I stop.

What about you?


What is gluten intolerance?

cakes8

photo by Ines Hegedus-Garcia

Gluten intolerance affects a large proportion of the population. Yet many people who may be affected aren’t even sure what it is. This article sets out to explain what gluten intolerance is, how it can affect you, and, just as important, what it is not.

Let’s start by looking at what gluten intolerance is not. This may seem an odd place to start, but many people, even among the medical profession (who should know better) think that when people say they are gluten intolerant they mean they have an allergy to gluten.

Gluten intolerance is not an allergy. Neither are other forms of food intolerance. An allergy involves the immune system. Food intolerances do not. That does not mean that they cannot cause severe illness, just that they are not fixable by anti-histamines or other drugs, and that it’s extremely unlikely that a mouthful of pasta will result in you keeling over instantly (I bet that’s a relief). Unlike an allergy, food intolerance is caused by an inability to absorb or process a particular food correctly, leading to a buildup of certain toxins, which are damaging, but not generally immediately fatal.

So now we’ve got that out of the way, we can look at what gluten intolerance actually is. What it means is that the body is unable to deal with food containing gluten, and because of this it reacts in ways that range from uncomfortable to crippling, and even life-threatening if the cause is not removed.

The problem is that, barring some parts of Asia, almost all of us eat large quantities of gluten every day, day in and day out, and we have done since we started eating “proper” solid food. So if your body is not able to cope with gluten, every day, several times a day, it comes up against this irritant, and over time the situation becomes more and more intolerable.

The most extreme form of gluten intolerance is celiac disease. This is a dangerous disease, and sufferers must avoid all gluten altogether. Unfortunately, although there is a test available, it is not always completely accurate, so there may be people suffering from celiac disease who have not been diagnosed as such.

The rest of us, thankfully, will just get irritable bowel, aches and pains, depression or if we are unlucky, obesity. This is bad enough, for sure. Still, these problems go away if you eliminate gluten (if that’s what’s causing them), whereas celiac disease doesn’t.

Since there are no accurate tests available for gluten intolerance, you need to discover whether you are intolerant or not by experiment. If you suspect you may be, please see my article “How can you find out if you are gluten intolerant?” to learn how to go about this.

Now you know what gluten intolerance is, next time someone says it’s an allergy, you will be able to put them right!

I offer a wide range of food for special diets in my online shop.


Guest Post: A Gastroenterologist’s Personal Journey Down the Gluten Rabbit Hole

photo by James Petts

photo by James Petts

Celiac disease and non-Celiac Gluten Sensitivity (NCGS)

Gluten intolerance resulting in symptoms and illness similar to celiac disease (CD) without meeting diagnostic criteria for CD is a new concept. This concept of non-celiac gluten sensitivity (NCGS) or gluten related disease (GRD) may be a new paradigm that is hard for some people to swallow, especially when I suggest that it affects as much as 10% to 30% of the population.

Wheat gluten as a cause of illness

Gluten ingestion is an avoidable, treatable, and reversible cause of illness in many people. It is contributing to the rising epidemic of autoimmune diseases. Many resist these concepts finding them either unbelievable, unacceptable or both. I believe that their rejection is neither rational nor helpful. It may be reasonable to reject them for cultural or financial reasons though I don’t believe they can legitimately be rejected based on scientific grounds or experience.

Celiac disease not rare and is often missed as a diagnosis

Celiac disease is not rare. CD affects 1 in 100 people in the world. Yet the diagnosis of CD is still frequently missed and/or delayed. It is a common disease that is often undiagnosed or misdiagnosed. It may even be the most common autoimmune disorder. Though the risk is largely genetic, it is preventable by simply avoiding gluten. Autoimmune diseases associated with CD may also be preventable by avoiding gluten.

What doctors remember from medical school about Celiac disease

When I was in medical school over twenty-five years ago, I was taught that CD was rare. In residency we were shown photos of short, emaciated children with skinny limbs and pot-bellies. We were told that their medical history included symptoms of profuse, watery, floating, foul-smelling diarrhea, and iron deficiency anemia. The picture and story was burned into the hard drive of our brains, not necessarily because anyone believed we would see someone with CD in our practice, but because CD was considered rare and odd enough that it was a favorite board examination question. That image and story remains in the mind of most physicians, preventing them from seeing CD in a much broader light.

Blood tests for Celiac disease become available

When I entered subspecialty training in gastroenterology, 13 years ago, specific blood tests for CD were available but still new. We were beginning to order the blood test when classic symptoms of CD were seen without an identifiable cause, or if we happened to sample the small intestine during endoscopy and classic Sprue changes were seen in the intestinal biopsy. CD was still considered somewhat rare. We did not routinely biopsy the small intestine to screen for CD, and genetic tests were not yet available.

Celiac disease is common but gluten sensitivity more common

It wasn’t until Dr. Fasano, a pediatric gastroenterologist from Italy, published a landmark article reporting Celiac disease affected 1/133 people in the U.S that American doctors began thinking more about it. Only recently has it been accepted that family members of people with CD, those with digestive symptoms, osteoporosis, anemia, and certain neurological, skin or autoimmune disorders constitute high risk groups for celiac disease. They have an even higher risk of between 2% to 5%, though most physicians are unaware of these statistics. Every week, using the strict diagnostic criteria, I confirm 2-3 new cases of CD. I also see 5-10 established CD patients. However, for every identified CD patient there are 3-10 who have clinical histories consistent with CD, but who fail to meet the diagnostic criteria. Yet they respond to a Gluten Free Diet (“GFD”). Many have suggestive blood test results, biopsies and or gene patterns but some do not.

Genetic link to Celiac disease and gluten sensitivity

More than 90% of people proven to have CD carry one or both of two white blood cell protein patterns or human leukocyte antigen (HLA) patterns HLA DQ2 and/or DQ8. However, so do 35-45% of the general U.S. population, especially those of Northern European ancestry. Yet CD is present in only 1% of the same population. DQ2 or DQ8 are considered by some experts to be necessary though not sufficient to develop CD. However, CD without those two genes has been reported.

Neurological problems and other gluten related illnesses

Other gluten related diseases including dermatitis herpetiformis, the neurological conditions of ataxia and peripheral neuropathy, and microscopic colitis have been described in DQ2 and DQ8 negative individuals. The DQ genetic patterns found in other gluten related diseases and associated with elevated stool antibody tests indicate that many more people are genetically at risk for gluten sensitivity. Furthermore, the response of numerous symptoms to gluten-free diet is not limited to people who are DQ2 or DQ8 positive.

Gluten free diet is the only treatment for Celiac disease and gluten sensitivity

Most celiac experts agree upon and feel comfortable advising people who meet the strict criteria for the diagnosis of CD: they need to follow a life-long gluten-free diet. Controversy and confusion arises when the strict criteria are not met, yet either patient and/or doctor believe that gluten is the cause of their symptoms and illness.

Wheat-free , yeast-free and low carbohydrate diets are popular but not adequate

Many alternative practitioners advise wheat-free, yeast-free diets, which are frequently met with favorable response to what is really a form of GFD. Similarly, the popularity and successes of low carbohydrate diets require adherence to a diet that has been credited with improvement of headaches, fatigue, bloating, musculoskeletal aches, and an increased general sense of well-being that is self-reported by many dieters. I believe this is because of the low gluten content. Gluten avoidance is clearly associated with improvement of many intestinal and extra-intestinal symptoms such as those listed above.

Many improve after discovering on their own that a gluten-free, wheat-free diet helps

Many also stumble onto this association after initiating a gluten-free diet or wheat-free diet on the advice of friends or family members; dieticians, nutritionists, alternative or complementary practitioners; or after reading an article on the Internet.

Why is there an irrational resistance to gluten-free diet that works?

Within the medical community, there seems to be an irrational resistance to a more widespread recommendation for gluten avoidance. Physicians who maintain that those who fail to meet strict criteria for diagnosis of CD should not be told they have to follow a gluten-free diet will often acknowledge that many of these patients respond favorably to a GFD. Some, however, continue to insist that a GFD trial is unnecessary, unduly burdensome, or not scientifically proven to benefit those who do not have CD. This position is taken despite the absence of evidence that a GFD is unhealthy or dangerous and much evidence supporting it as a healthy diet.

Gluten-free diet is safe, healthy and works!

Those of us who have observed dramatic improvements, both personally and professionally, find such resistance to recommending a GFD to a broader group of people difficult to understand. Considering the potential dangers and limited benefits of the medications that we, as doctors, prescribe to patients for various symptoms, it really seems absurd to reject dietary treatments. Yet, it does not seem to cross most doctor’s minds to suggest something as safe and healthy as a GFD, let alone to, at least, test for CD.

Gluten-free diet changes doctor’s life, health and medical practice

My personal journey into gluten related illness began when my physician wife was diagnosed with CD. I had mentioned to her numerous times over several years that I thought she should be tested for CD. After her second pregnancy she became progressively more ill experiencing, for the first time in her life, diarrhea, fatigue, and chronic neuropathy. An upper endoscopy revealed classic endoscopic findings. CD blood tests were elevated, and genetic testing confirmed she was DQ2 positive. This forever changed our lives and my practice. But the story does not end there.

Irritable bowel syndrome misdiagnosed by doctor

Having diagnosed myself with irritable bowel syndrome (IBS) and lactose intolerance in medical school, I had not considered gluten as a possible cause of my symptoms until my wife turned the table on me and said I should also be tested for CD. My blood tests were not elevated but I was confirmed to also be DQ2 positive.

Enterolab stool testing for gluten sensitivity helpful though not accepted or understood by some doctors

Having observed a good response to GFD in a few of my patients who had elevated stool gliadin antibody levels, I looked critically at the research behind this testing and spoke with Dr. Ken Fine before paying to have my entire family tested through Enterolab. Both my gliadin and tTG antibodies were elevated and I responded well to a GFD. I began recommending stool antibody and DQ genetics to patients who did not meet strict criteria for CD but appeared to have symptoms suggestive of gluten sensitivity. Contrary to some critics’ claims about the stool antibody tests, there are many people who do not have elevated levels. Almost everyone I have seen with elevated levels has noted improvement with GFD, including myself.

IBS and lactose intolerance improves with gluten free diet

Not only did my “IBS” symptoms resolve and lactose tolerance dramatically improve, but my eyes were further opened to the spectrum of gluten related illness or symptoms. I was already aggressively looking for CD in my patients but I began considering non-celiac gluten sensitivity (NCGS) or gluten related diseases (GRD) in all my patients. What I have found is that gluten is an extremely common but frequently missed cause of intestinal and non-intestinal symptoms. Dramatic improvements in symptoms and health can be observed in patients who try a gluten-free diet.

Eating gluten probably not safe if you are genetically at risk for Celiac disease

Since only a fraction of DQ2 or DQ8 positive individuals have or will eventually get CD, does that mean gluten is safe to eat if you have those gene patterns? Even if you do not get CD, does continuing to eat gluten put you at risk for other autoimmune diseases, especially ones linked to the high risk gene patterns? Why do some people with these patterns get CD but most do not? Do some who do not have CD experience symptoms from gluten that would improve with GFD? These questions need to be answered so that people can decide whether they want to risk gluten causing them to be ill, or increasing their risk of CD or other autoimmune diseases.

A new paradigm for gluten sensitivity and Celiac disease

Added to my gluten-free diet, a daily diet of scientific articles on celiac and gluten related disease has revealed that there are many clues in the literature and research indicating the existence of non-celiac gluten sensitivity or a need to broaden our definition of CD. Dr. Hadjivassiliou has called for a new paradigm. He advocates that we start thinking of gluten sensitivity not as an intestinal disease but a spectrum of multiple organ, gluten related diseases. Mary Schluckebier, director of CSA, asks that physicians interested in this area work on forming and agreeing on new definitions for gluten related illness while pushing for more research and cooperation between medical researcher, food and agricultural scientists, dieticians, and food manufacturers.

The larger hidden epidemic of gluten sensitivity is real

Only those who look for NCGS and advise a GFD to those not meeting criteria for CD, are going to see the larger group of people who have a favorable response to a broader application of the gluten-free diet without further research. Those of us who are personally affected by gluten sensitivity or professionally involved in treating individuals with adverse reactions to gluten (or both) should support the research into the broader problem of gluten related illness. I believe that non-celiac gluten sensitivity is real and will be validated in further studies. I am presenting two years of my data at one of our national meetings in October 2007. If you have further questions or interest in this area visit my website and blog.Copyright 2006 © The Food Doc, LLC. All Rights Reserved. www.thefooddoc.comThe Food Doc, Dr. Scot Lewey, is an expert medical doctor specializing in digestive diseases and food related illness, especially food allergies, celiac disease and colitis. Dr. Lewey’s expert reputation as the Food Doc is established by a foundation of formal training in internal medicine, pediatrics, and gastroenterology (diseases of the digestive tract), his personal and family experience with gluten and milk sensitivity, and over two decades as a practicing physician, clinical researcher, author and speaker. Access this expert knowledge on-line today at www.thefooddoc.comArticle Source