COELIAC DISEASE

Coeliac disease affects about one in a thousand people and is frequently diagnosed in childhood.  It is a serious condition which involves special catering considerations.   Luckily there are many gluten-free, coeliac-friendly foods available.

What is coeliac disease?
 Coeliac disease involves a complete intolerance to the protein gluten, found in certain grains.  It means that the child must avoid all sources of gluten.  Gluten damages the wall of the small intestine: nutrients then can’t be absorbed properly, resulting in malnutrition.  Symptoms range from mild to severe and include digestive upsets, mouth ulcers, tiredness, breathlessness, anaemia, diarrhoea and weight-loss.  Coeliac disease is diagnosed via blood tests and confirmed with a small tissue biopsy from the small intestine.  As this is an invasive procedure it is not carried out unless there are definite concerns.  In children coeliac disease leads to ‘failure to thrive’ where the child does not grow sufficiently in height or weight.  If a child drops through two ‘centiles’ on their growth chart over a six-month period and has accompanying cramps and possibly loose bowel movements then coeliac disease should be considered a possibility.  It is usually a life-time condition.  There is also a disease, called tropical sprue, which comes from a bacterial parasite infection picked up in hot countries, resulting in coeliac-like symptoms, but this can be treated with antibiotics.

Coeliac disease is not the same as a food-allergy (which results in hives, swelling or breathing difficulties) or a more generalised ‘intolerance’ to wheat or other grains (which can be unpleasant and involve various symptoms from bloating to headaches but is rarely a serious threat to health).

What to avoid
 Wheat contains gluten while rye, barley and oats contain very similar proteins.  Some coeliacs can tolerate oats, though a parent or school must be very certain of this before giving a child oats – the child’s gastroenterologist will give guidance.  Because these grains, and wheat in particular, are so common in staple and processed foods avoiding them involves careful attention.  Tiny amounts of gluten can set off a full blown reaction in a highly sensitive individual.

Major sources of gluten are: bread, breakfast cereals and muesli, crackers (ie: oat, wheat or rye), pasta, pastry, biscuits, cakes, pies and puddings; in fact any food made with the flour of these grains.  

Manufactured and processed foods very commonly include flour or starch.  These are used as thickeners, binders and fillers in all sorts of processed foods.  Look out for the words ‘flour’ or ‘starch’ on labels though if these are not included it is not guarantee that the food is gluten-free.  Less obvious sources of gluten include:  bulgar (wheat), couscous (usually wheat unless it specifies otherwise), spelt, sprouted wheat and tricale.

It is very easy to trip up.  For instance, an innocuous-looking chocolate could have gluten in it in small amounts.  All sorts of foods can contain gluten especially those with sauces or ‘composite’ ingredients where full labelling is not required.  Cross-contamination also can happen during food manufacturing or storage.

Catering for Coeliacs
Many foods are naturally gluten free:  meat, fish, eggs, cheese, milk, vegetables, fruit, nuts and seeds.  The easiest way to plan meals is to offer plain piece of fish or meat, without sauce (unless you are certain it has been only thickened with potato starch or corn-flour), a non-gluten carbohydrate source such as potatoes, rice, or special gluten-free bread or pasta, and vegetables.  A gluten-free yoghurt or piece of fruit would be a suitable dessert.

Many dishes can easily be made with other grains – for instance polenta cake or millet porridge.  Grains which do not contain gluten are:  corn (popcorn, polenta, cereals like cornflakes, corn starch, corn breach, polenta cake, tacos, nachos – but check these don’t include gluten-grains), rice (rice cakes, cereals like rice crispies, pasta, Japanese rice crackers), quinoa (cooks like rice), millet (porridge, muesli), buckwheat (not wheat despite the name, used in pancakes and pasta), kasha (toasted buckwheat).

Other starchy foods which are all gluten-free include: potato, sweet potato (yam), chestnut flour, sago, tapioca, gram (chickpea flour) and lentil flour (in popodums).

There is a vast range of gluten-free packaged foods available from supermarkets, health food shops and large chemists: they are labelled gluten-free and so eliminate the guess-work.  While these tend to be more expensive a diagnosed coeliac can get some of these on prescription from the doctor.  Gluten-free foods include breads (usually made with rice flour and not hugely palatable), corn cakes (much better), mueslis, cereals, biscuits (which can be good but sugary), and pastas (made from various grains they may have a different texture and cook slightly differently but work well).

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