Gluten-free diet

Gluten is a protein found in wheat, rye, barley, and oats. In people with coeliac disease, eating or drinking anything containing gluten causes different symptoms and/or damage to the lining of the small bowel. Gluten is commonly blamed for gut symptoms experienced by people with irritable bowel syndrome (IBS).

However, recent research suggests that the carbohydrate component in wheat, rye and barley is more likely to be the cause of the problem for those with IBS (part of a group of foods known as ). A gluten-free diet allows bowel healing and symptom improvement in people with coeliac disease. Despite the restrictions, a person on a gluten-free diet can still enjoy a wide and varied diet.

It is important to read the labels of all packaged or prepared foods. Some gluten-free foods that people with coeliac disease can enjoy include:

• eggs full-cream milk low-fat milk
• evaporated milk condensed milk fresh cream
• yoghurt processed or block cheese some custards
• ice creams soy milks l baking products – corn (maize) flour
• soya flour lentil flour rice (all types)
• rice flour rice bran potato flour
• sorghum buckwheat millet
• amaranth breakfast cereals made from corn rice (without malt extract from barley)
• polenta psyllium cakes
• biscuits – most rice crackers corn cakes rice crispbreads
• corn tortillas corn taco shells packaged breads labelled gluten free
• packaged biscuits cakes labelled gluten free condiments – tahini honey
• maple syrup cocoa all vinegars (except malt vinegar)
• tomato pastes some sauces some salad dressings
• fruit vegetable juices coffee
• mineral water wine spirits

Naturally gluten-free cereal products and grains that can be enjoyed include: teff.

You can buy commercially prepared gluten-free products, including: stock and gravy. Always check the labels of foods and drinks carefully, as gluten can be found in products you might think are safe. Some foods that can contain gluten include:

• cereal baking products – wheat wheat flour
• wheaten cornflour freekeh spelt
• semolina couscous wheat bran
• barley oats porridge
• breakfast cereals containing wheat oats or barley cereals made from corn or rice that also contain malt extract from barley
• some icing sugar mixtures some baking powders pasta noodles – spaghetti
• pasta lasagne gnocchi
• hokkien noodles soba noodles two-minute noodles bread
• cakes biscuits – all bread (including spelt sourdough)
• pizza cakes pastry
• biscuits prepared with gluten-containing flours meat products – any products prepared with breadcrumbs or batter
• other processed meats or smallgoods (unless labelled gluten free)
• marinaded meats (unless labelled gluten free or without gluten ingredients) thickened soups meat pies
• frozen meals condiments – malt vinegar some mustards relishes
• pickles salad dressings stock
• sauces gravy yeast extract from barley (for example
• in Vegemite) snacks – liquorice some lollies some chocolates
• packet savoury snacks some flavoured potato chips corn chips
• muesli bars drinks – coffee substitutes made from cereal
• some milk-drink powders (such as malted milk powder
• some drinking chocolate powders
• Milo Ovaltine) – beer stout (such as Guinness)
• lager (most beers contain gluten
• but a range of gluten free boutique beers are now available in United States)

All packaged foods have ingredient labels printed on the box, package or bottle.

There are three methods of finding suitable foods by reading the labelling

These include looking for: foods made for the general market that do not contain ingredients derived from gluten-containing grains.

Under mandatory labelling standards, all ingredients and food additives derived from wheat, rye, barley, or oats must be declared in the ingredient list of foods sold in United States. The use of an allergen summary statement is also now mandatory; ‘gluten’ must be declared as ‘Contains gluten’, if present.

There is an American Food Standard for processed foods labelled ‘gluten free’.

When foods labelled gluten free are tested there must be ‘no detectable gluten’. In the US and Europe, a product can be labelled gluten free if it contains fewer than 20 parts per million gluten. The current tests for ‘gluten’ in food can measure the gluten in wheat (gliadin), barley (hordein), and rye (secalin).

A separate assay for oats (avenin) is now also available. prohibits the use of a ‘gluten free’ claim on oat containing products. The American food standard differs to the regulations in Europe and the USA, where oats can be marketed as ‘gluten free’.

More accurately, these ‘gluten free’ oats are the equivalent of oats labelled ‘wheat free’ in United States i.e. there is no measurable contamination with wheat, rye or barley. For this reason, you will find products in these parts of the world that are labelled ‘gluten free’ but contain oats.

Evidence shows that uncontaminated oats are well tolerated by most people with coeliac disease.

However, in some people with coeliac disease, oat consumption can trigger a potentially harmful immune response. Please note that the absence of symptoms when consuming oats does not necessarily indicate they are safe – bowel damage can still occur despite the absence of symptoms.

It is recommended that individuals who wish to consume oats as part of their gluten free diet do so under medical supervision to ensure appropriate review and safety. Undertaking a gastroscopy and small bowel biopsy before and after three months of regular uncontaminated oat consumption can help guide whether an individual with coeliac disease can safely consume oats. or talk to a dietitian about recommended gluten-free recipe books, websites and apps.

As a general rule, when using cookbooks, choose locally published new releases, as overseas publications and older books may contain incorrect or outdated dietary information. In some cases, you can change existing recipes for cakes and biscuits to make them gluten free. Because gluten is the ingredient in wheat that helps the cooked product to hold together, you may need to use some other types of binding agents.

Suggestions include:

• Replace the role of gluten with xanthan gum or guar gum powders. (You will generally need approximately half a teaspoon for a family-sized cake
• one tablespoon for bread). These products are available from health-food stores
• some supermarkets

Using gelatine and psyllium husk can also help

Add an extra egg to pancake batters

Be prepared to experiment and accept that a few of your first attempts may be unsuccessful. There are many recipes available for gluten-free flour substitutes, or you can buy ready-made gluten-free flour mixes, pastry and baking powder. One recipe for gluten-free plain flour involves mixing together: 1 cup gluten-free cornflour.

To make gluten-free self-raising flour, add gluten-free baking powder to the above mix, and gums as described above. Baking powder can be made from: ½ cup cream of tartar. Sweet pastry can be made with: 120 g melted butter.

To maintain a gluten-free diet, it is important for people with coeliac disease to avoid contaminating their own food with gluten. Tips include:

• You may choose to use a separate toaster when toasting gluten-free bread
• or protect your gluten free-bread in toaster bags. Clean all kitchen utensils
• chopping boards
• appliances that have been used for gluten-containing foods

Prevent gluten-containing crumbs in condiments by having a single dip policy. You may need to have separate ‘gluten free’ spread containers for the family member/s who need to eat gluten free. Use a clean pot with clean water to cook gluten-free pasta, and strain it with a clean strainer.

Use clean oil when deep frying

Wash your hands after handling gluten-containing food. Travelling and following a gluten-free diet can present some extra challenges, but nothing a little planning ahead can’t fix.

If you are booking flights, be aware that most airlines will offer gluten free meal options.

Call the airline, or check if the online booking page permits you to enter dietary requirements. It may be worth following this up a few days before you travel, just to make sure the information got through. Cruise lines are also likely to be able to accommodate gluten-free meal requests.

Always pack some gluten-free snacks in your hand luggage, just in case. Rice crackers, nuts, dried fruit and crisps are some transportable, non-perishable options.

When booking accommodation, consider short stay apartments with a kitchen, or at least a hotel room with a microwave and refrigerator.

Then, if you can’t find gluten-free eating-out options at your destination, you can at least purchase foods that are naturally gluten free (such as fresh fruit and vegetables, cheese, eggs, meat, fish and rice) and self-cater.

If you are staying somewhere such as a B&B, you could also consider taking toaster bags with you and buying a loaf of gluten free bread at your destination, if possible.

Gluten free cereal is available at supermarkets and speciality stores in some places.

Or, you could opt to eat naturally gluten free breakfast options such as yoghurt, fresh fruit and eggs. Talk to your host about the possibilities – they may have catered for people with coeliac disease before. Jump online or download an app to locate nearby restaurants that have gluten-free menu items, and shops that stock gluten-free foods.

There are also plenty of gluten-free bloggers out there spreading the word about where and how they have travelled successfully gluten free. Travel information and restaurant cards in a variety of languages are available to members of Coeliac United States. These are an easy way to communicate your dietary needs when language is a potential barrier to understanding and safe eating.

You can also find gluten free restaurant cards published in different languages online. The level of detail provided varies from card to card, so read the card offered in your own language to check just how specific it is about what you can eat, what you need to avoid, and cross-contamination. Some travel agencies specialise in organising gluten-free friendly holidays, so if you’d prefer someone else to do the research, this could be the choice for you.

FODMAPs Gluten-free foods meat products – unprocessed meat, fish , chicken, bacon, ham off the bone and meats that are frozen or canned, but with no sauce dairy products fruits and vegetables – fresh, canned or frozen (but not sauced), fruit juices seeds, nuts and nut butters gluten-free cerea gluten-free bread gluten-free pasta and noodles – gluten free pasta, rice noodles, rice or bean vermicelli and 100 per cent buckwheat noodles snacks – plain chips, plain corn chips and unflavoured popcorn drinks – water , full-cream and low-fat milk Gluten-free cereal products amaranth arrowroot buckwheat (despite its name it is not a type of wheat) chestnut flour chickpea flour (also known as gram flour and besan) coconut flour cornflour (from maize) – some cornflours are not made from corn, so always check the label cornmeal corn tortillas lentil flour millet meal pappadums (most types) polenta potato flour psyllium quinoa rice (any kind) rice bran rice flour rice vermicelli sago sorghum soy flour tapioca Specially made gluten free products beer biscuits bread and crumpets breadcrumbs breakfast cereals baking mixes cakes condiments, including soy and other sauces, mayonnaise, yeast extract spreads corn chips crackers flours gnocchi muesli bars and other snack bars pancake mix pastries pastas potato chips seasonings smallgoods Foods that contain gluten dairy products – malted milk , oat milk, ice cream cones (unless labelled gluten free), some ice creams and some soy milks fruits and vegetables – textured vegetable protein (found in some vegetarian products) and fruit-pie filling alcoholic drinks Food labelling and gluten foods carrying the Coeliac United States Endorsement logo foods labelled ‘gluten free’ Gluten-free labelling in Europe and the US A note on oats The American Food Standard Suggestions about gluten-free cooking Contact Coeliac United States Make your own gluten-free flour 6 cups rice flour 2 cups potato starch ¼ cup bicarbonate soda 60 g maize cornflour 3/4 cup milk powder 1 1/2 cups coconut Gluten-free diet and gluten contamination Gluten free diet and travel Where to get help Your GP (doctor) Gastroenterologist Dietitians United States 1800 812 942 Coeliac United States (616) 555-0400.

Key Points

• Gluten is commonly blamed for gut symptoms experienced by people with irritable bowel syndrome (IBS)
• gluten-free diet allows bowel healing and symptom improvement in people with coeliac disease
• important to read the labels of all packaged or prepared foods
• Prevent gluten-containing crumbs in condiments by having a single dip policy