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.


How To Live With Gluten Intolerance

noglutenIt takes a while to learn how to live with gluten intolerance, but it doesn’t have to be too difficult. Not that you should do it if you don’t have to.

Many popular foods are off limitsMany people suffer from embarrassing wind, chronic pain from stomach upsets, muscle cramps or joint pains, or other seemingly unshakable complaints that seem to have no cause. Surprisingly often, eliminating gluten from the diet results in a marked improvement – even the complete elimination – of ailments of many years’ standing. Even certain mental disorders, such as schizophrenia, have been found often to improve under a gluten-free regime.

Gluten intolerance is also known as gluten-sensitive enteropathy, coeliac disease, non-tropical sprue, coeliac sprue, primary malabsorption and ideopathic steatorrhoea.

Symptoms of gluten intolerance

NOTE: This list is not exhaustive. You don’t need to have all the symptoms – if all sufferers had all the symptoms, it would not be so often unrecognised, and there would not be so many people walking around unaware that they are gluten intolerant. So, if you have one or two of the symptoms listed, you may be gluten intolerant. If you have more than two, you are a strong candidate for gluten intolerance, and four or more indicates you are a very strong candidate indeed.

  • flatulence
  • abdominal distension
  • irritable bowel
  • stools (‘poos’) which are pale, bulky, greasy and smelly
  • diarrhoea
  • headache
  • nausea and vomiting
  • poor appetite and drowsiness after eating
  • muscle cramps and spasms
  • bone or joint pains
  • anaemia, with weight loss
  • any of the above symptoms flare up under stress
  • obesity
  • rarely, oedema (puffy swollen legs) or constipation

Undiagnosed, the condition can lead to neurological disorders, intestinal ulceration and even intestinal cancer. Other medical conditions which may be linked to gluten intolerance include: Autism, Depression, Dermatitis Herpetiformis, Diabetes, Infertility, Multiple Sclerosis, Regional Enteritis, Rheumatoid Arthritis, Schizophrenia and Sjögren’s Syndrome.

Diagnosing gluten intolerance

Because gluten is an insoluble antigen, gluten intolerance cannot be demonstrated by skin testing. Most of the methods available to doctors involve more or less intervention. However, if you wish to avoid time-consuming, uncomfortable and potentially expensive procedures, it is possible to diagnose by means of an elimination diet. You need to take into account that many people who are gluten intolerant are also intolerant to lactose in milk, so to test for gluten intolerance, it is necessary to eliminate both gluten and dairy products for a period (say, two to three weeks). If the symptoms recede, reintroduce a small amount of gluten to the diet, but not dairy products. Then, if symptoms return, stop gluten again for a couple of weeks before reintroducing dairy products.

Watching out for unexpected gluten

Gluten is found in wheat, rye, triticale, and to a lesser extent in oats and barley. You might think, then, that so long as you avoid pastry, bread, pasta and similar products made from flour, you would be safe. You would be wrong.

Gluten is used in many products that don’t look as if they contain flour. In fact, in many cases, even looking at the label will not alert you to this, unless you know what to look for. One way in which wheat and wheat products may be described is as starch: modified starch, food starch, modified food starch, and similar descriptions. But often ingredients noted merely as ’emulsifiers’ or ‘stabilisers’ are also wheat-derived.

Some examples of hidden gluten:

Most people know that the British sausage contains breadcrumbs – except the most high class variety of butcher’s sausage, and even in this case it’s quite likely (the bread is one of the ways in which the texture of the sausage is obtained, without including an unacceptably high proportion of fat).

Burgers, grillsteaks and similar products almost always contain gluten – and I’m not talking about the bun!

Crab sticks are a product that on the surface looks as if it is made entirely of fish. Turn the pack over, though, to look at the label and 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, unless they grate their own (but most don’t).

Obviously, anything coated in batter or breadcrumbs contains gluten in the coating.

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 ‘flavour enhancer’.

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.

Any alcoholic drink made from grain – beer or whisky, for example – is a hidden source of gluten.

Even medicines may contain gluten, used as a thickener or a binder.

Living without gluten

Nowadays, there is a good number of gluten-free products on the supermarket shelves, but obviously the range is pretty small in comparison with what is available to gluten-tolerant shoppers, and usually expensive, as well. For example, a loaf of gluten-free bread will most likely set you back up to ten times the price of the standard product – and to my mind, it is not ‘toothful’; the texture just isn’t right, due to the lack of the elastic properties which the gluten normally provides.

I’m gluten-intolerant myself, and have spent a bit of time trying to find good products. One I definitely recommend is from Real Foods Pty in Australia: Corn Thins. These are very tasty, definitely a big step up from the ubiquitous rice cakes (which to my mind taste more like polystyrene than food – and they SQUEAK!). Corn Thins come in several varieties and they’re nice with jam, with sliced meat, or whatever you like. For availability, check out their website at www.cornthins.com. Tesco’s used to sell them, but now you will probably have to go to larger Morrisons or Sainsburys to find them in UK supermarkets.

And if you’re out and about and fancy a coffee, some branches of Starbucks sell a very acceptable gluten-free chocolate cake.

Here’s my book, a collection of more than 250 Gluten Free Recipes.