Greer - Gluten Wheat Allergy: Diets to Help: Suitable for Those with Coeliac Disease

Rita Greer, herself experienced in coping with gluten and wheat allergy, recognizes the problems faced by the exclusion dieter. Here is sound practical advice on foods to avoid and also useful sections containing menus and recipes for gluten- and wheat-allergic patients.

This book is intended as a background to the subject, for general interest and to introduce aspects of the special care required in following this kind of diet.

Contents

GLUTEN AND WHEAT ALLERGY AN UNSOLVED MYSTERY

In the West, we have used wheat and, to a lesser extent, rye, barley and oats as a basic pan of our daily diet for thousands of years. It seems odd, therefore, that some of us are unable to cope with such food and that by eating it some people can be made really ill.

Why this should be so remains a mystery. Fortunately for these people, by avoiding consumption of wheat, rye, barley and oats, good health may be enjoyed again. On paper it seems to be a very simple remedy. In real life, which is geared to the ordinary person, quite able to keep healthy while eating those four grains, the situation is more difficult. Fitting a special diet into family life can cause problems, both on the kitchen front and with shopping.

THE DIFFICULTIES OF SPECIAL DIETS

A special diet can be regarded as a fad by many people. Eating out may be so fraught with problems that it has to be largely avoided and this may also be taken to be antisocial behaviour. Very often the diet must be followed for life and cannot be considered in the same way as, say, a weight-reducing diet where breaking the rules merely postpones the effect of the diet. Eating wheat, rye, barley or oats when they should be avoided can lead to adverse reactions and a return to illness.

WHO THIS BOOK IS FOR

Some patients are only adversely affected by a part of the wheat, rye, barley and oats, i.e. the gluten that these grains contain. Others may be affected by the whole of one or more of the grains.

For practical purposes, this book excludes the whole of the four grains. The two main related illnesses which can benefit from this type of exclusion diet are coeliac disease (gluten sensitive) and wheat sensitivity (or allergy). Dermatitis herpetiformis patients are also known to benefit from such dietary measures.

HOW THIS BOOK CAN HELP

This book attempts to answer the kind of questions which the exclusion dieter usually asks when faced with a complete turnabout in eating habits, and to provide practical help and advice in the form of:

• lists of safe and unsafe foods
• suggested menus (including some emergency ones)
• recipes

The author has been involved in a ten-year research programme on gluten-free and wheat-free foods and has also written five gluten-free and wheat-free cookery books. In addition, she has formulated many specialized foods for UK manufacturers and, through cooking regularly for just such a gluten- and wheat-free dieter, has gained valuable practical insight into the problems such people face.

WARNING

In this book, certain brand names of foods are mentioned. This is because, within a whole range of items readily available, such as soy sauces, there are some which contain gluten/wheat (usually the majority) and some which do not. However, manufacturers can change their formulas at any time and it is a sensible policy to check the ingredient list of every food that you buy just to make sure there has been no change. Brand names are only included in this book as a helpful guide where difficulties may arise with shopping.

NOTE FOR WHEAT-FREE DIETERS ONLY

Although wheat-free dieters may be able to tolerate rye, barley and oats, these are rarely found on their own in commercial products; e.g. rye bread usually contains a good proportion of wheat, as do some rye crispbreads. It is essential to check ingredient labels on foods. One product which wheat-free dieters will find useful and very easy to obtain is rye crispbreads. However, if this is too heavily relied upon, the diet can become boring, and crispbread is not a substitute for bread made with yeast.

NOTE FOR THOSE FOLLOWING A GLUTEN-FREE AND LACTOSE-FREE DIET

Some people who are allergic to gluten are also allergic to lactose (found in milk). All the special flours in this book are lactose-free and can be used safely.

Since coeliac disease and gluten/wheat sensitivity are quite different it is as well to look at a few facts about them in simple terms.

Coeliac disease is known by a variety of names such as: non-tropical sprue, idiopathic steatorrhoea, gluten enteropathy. (In the USA, coeliac is spelt celiac.) It is pronounced see-lee-ack. It is not an infectious disease. Diagnosis is usually based on clinical features and a jejunal biopsy. This may be superseded by a much easier test in the next few years. The disease often shows up in infants at the weaning stage but it can be diagnosed at any age.

COELIAC DISEASE

History

Attention was first drawn to this disease as long ago as 1888. The cause remained a mystery and the disease was known as Chronic Intestinal Infection (C.I.I.).

Curiously, children with C.I.I. in Nazi-occupied Holland improved when all Dutch wheat was sent to Germany. When this stopped, the health of the children deteriorated again. It was 1950 before gluten (in the wheat) was finally proved to be the culprit. The condition was by this time named coeliac disease.

Gluten

Gluten is part of the elastic, rubbery protein found in wheat, barley, oats and rye. It is the part of the grain which binds the dough in baking. Flours that do not contain gluten do not behave in the same way and a binder has to be added in order that it may be used for baking. As well as being used for

• bread
• cakes
• biscuits
• pastry

gluten-rich flour is used widely in the food manufacturing industry as a thickener and cheap filler. Therefore, gluten can be present in items such as

• gravies
• soups
• sauces
• pickles
• instant puddings
• sweets
• chocolates

Gluten is added to some flours, particularly for bread making, to make them strong.

Consequences for Health

Much of what we eat, including fat and vitamins, is absorbed through the surface of the small intestine via the villi. These are tiny fronds which line the organ and help to give an absorption area of about ten square metres in an adult. The villi themselves are covered with microvilli (called the brush border) which increase the total area to about 300 square metres and make the small intestine even more efficient.

In coeliac disease, the small intestine becomes so damaged by gluten that the villi become flat and cannot do their job of absorbing nutrients. Not surprisingly, an untreated coeliac fails to thrive and becomes malnourished. After weaning, coeliac children fail to grow satisfactorily and are thin and wasted looking. Patients are weak and listless.

normal villi (fronds)

damaged villi as in coeliac disease

section through villi