Overall, the UK is a very gluten-free friendly country with many chains of restaurants catering for the gluten-free diet around the country. Seriously Good Food has been working with some of the major chains, and there has been an explosion of Gluten-Free items available in restaurants – either marked on the menu or on a separate ‘allergy’ menu that lists common allergens. The map shows just a few of the restaurants Seriously Good Food supply; more will be added as soon as we can.
What is coeliac disease?
If you have recently been diagnosed with coeliac disease, don’t panic! – here are answers to the most commonly asked questions, along with advice on what to eat and what to avoid. Coeliac (pronounced seeliac and spelt Celiac in America) disease is often misunderstood. It is frequently regarded as an allergy or simple food intolerance, but it is actually a lifelong auto-immune disease affecting the gut and other parts of the body. The body’s immune system reacts to the gluten found in food, making the body attack itself when gluten is eaten. Gluten is a protein found in wheat, barley and rye, and oats may also affect some people. Gluten is a collective term for the protein found in the cereals wheat, rye and barley and is toxic for people with coeliac disease. It is what gives bread its elasticity and cake its spring. People with coeliac disease are sensitive to gluten when it is eaten. The small intestine is lined with small, finger-like projections called villi. These play a crucial role in digestion, as they increase the surface area of the small intestine and allow essential nutrients to be absorbed into the bloodstream. However, for people with coeliac disease, when gluten comes into contact with the villi, it triggers a response by the immune system, which attacks the villi. The villi very quickly become damaged and inflamed, and therefore key nutrients are not absorbed from any food we eat. This results in a range of different nutritional problems and symptoms with varying severity.
What are the symptoms?
There are a variety of gastrointestinal symptoms such as cramps, bloating, flatulence and diarrhoea. It is quite common for these to be confused with irritable bowel syndrome (IBS) and only later to be identified as coeliac disease. Research shows that 1 in 100 people in the UK have coeliac disease, but only 10-15% of them are currently diagnosed.
Typical symptoms of coeliac disease
The symptoms vary in terms of severity. Most stem from the malabsorption of nutrients and include diarrhoea, fatigue and iron deficiency, but there is a range of other symptoms, such as:
- Abdominal pains
- Weight loss (but not in all cases)
- Mouth ulcers
- Hair loss
- Skin rash
- Defective tooth
- Problems with fertility
- Recurrent miscarriages
Diarrhoea is a common symptom. Yet, it is important to note that sufferers can present many and varied symptoms: some may have a normal bowel habit or even tend towards constipation, children may not gain weight or grow properly. At the same time, adults may find they lose weight. Malabsorption may also leave people tired and weak due to anaemia caused by iron deficiency.
In fact, rather than suffering from bowel problems, some people with coeliac disease approach their doctor because of extreme tiredness (due to chronic, poor iron absorption) and psychological problems such as depression. There can also be malabsorption of calcium, resulting in low bone density and sometimes even fractures (as a result of osteoporosis). Bone and muscle pain can also be a problem. Ulcers in the mouth or a blistering, itchy skin rash, mostly on the elbows and knees (called dermatitis herpetiformis), are also symptoms of coeliac disease.
Undiagnosed coeliac disease can result in infertility in both men and women, and there is also an increased risk of miscarriage.
How do I get diagnosed?
First, if you suspect you may have coeliac disease, don’t worry! Just remember, it is entirely manageable with a controlled diet. In fact, if you are one of the many undiagnosed people with coeliac disease, you’ll probably be pleased to find out that you really do have a condition and, better yet, that there is a course of action to make you well again.
There is a clear procedure for diagnosing coeliac disease. The first thing to do is talk through your symptoms with your doctor, who can perform a simple blood test. This test looks for antibodies, which your body produces in response to gluten. It is essential to follow your normal gluten-containing diet leading up to the test, as you need to have the antibodies in your blood for a test to work, and these will only be there if you have been eating gluten. It is quite common for people to go undiagnosed if they have followed a gluten-free diet for days or weeks, as the immune system will be producing fewer antibodies. This will give a false, negative result to the test. To get an accurate result, it is important to consume food that contains gluten in at least one meal a day, for a minimum of six weeks, before a blood test.
If the test is positive, it is recommended that people then have an intestinal biopsy, which examines the appearance of the villi in the small intestine under a microscope, to check for damage.
This will confirm the diagnosis, which you need before you start on a lifelong gluten-free diet. Again, the biopsy of the small intestine must be done whilst you’re following a gluten-containing diet. If you are already following a gluten-free diet when you have your biopsy, it might show a completely normal intestinal lining, or you may have an inconclusive result.
What is the treatment?
Coeliac disease is treated with a gluten-free diet, so wheat, barley, rye and any derived ingredients must all be avoided. The most obvious sources of gluten in the diet are pasta, cereals, bread, flour, pizza bases, pastry, cakes and biscuits. In addition, oats can often be contaminated with other grains. Although most people are able to tolerate uncontaminated oats without a problem, some people with coeliac disease may be sensitive and should avoid them. Uncontaminated oats are available but should be tried under the supervision of your healthcare team.
Following a strict gluten-free diet allows the intestines to heal and begins alleviating symptoms in most cases. Depending on how early on the gluten-free diet is started, it can also eliminate the increased risk of osteoporosis and cancer of the small bowel.
Gluten -Free Foods
- All fresh meat and fish
- All fresh fruit and vegetables
- Fresh herbs and individual spices
- Polenta (ground cornmeal or maize)
- Dried peas, lentils, pulses and beans
- Rice and wild rice
- Rice bran
- Rice noodles
- Plain nuts and seeds
- Dairy products – milk, cream, natural yoghurt, cheese
- Soya and plain tofu
- Golden syrup
- Maple syrup
- Jams and marmalade
- Pure oils and fats
- Kinds of vinegar
- Tomato purée
- Vanilla essence and extract
- Fresh and dried yeast
What can I eat?
There are plenty of foods that are naturally gluten-free and should be included in your diet. In particular, carbohydrate-rich foods such as potatoes, rice and maize do not contain gluten. In addition, all fresh meat, poultry and fish, all fresh fruit and vegetables, fresh herbs, individual spices, dried pulses, rice noodles, potatoes, plain nuts, eggs, dairy products, sugar, honey, oils and kinds of vinegar, vanilla essence and extract and fresh and dried yeast are suitable. In fact, the gluten-free diet has the potential to be one of the healthiest diets around because of the increased emphasis placed upon eating fresh, natural and unprocessed food. Furthermore, if undiagnosed coeliac disease has resulted in the poor absorption of vitamins and minerals, a gluten-free diet should soon restore these to healthy levels and lead to a feeling of health and wellbeing.
More and more manufacturers are producing gluten-free substitute foods, such as gluten-free bread, crackers and pasta, some of which can be just as good as their gluten-containing equivalents. Coeliac UK, the national charity for people with coeliac disease, publishes a Food and Drink Directory annually, which is a list of nearly 10,000 gluten-free products.
Living with Gluten Free
Demystifying Gluten Free
Since March 2010, Coeliac UK, the national charity for people with coeliac disease, have been kind enough to allow me to be their Food Ambassador.
I am very honoured to accept Coeliac UK’s Food Ambassador’s role and continue supporting the work of the Charity. I’m also passionate about improving knowledge in the food industry and the necessity for more gluten-free cooking as more and more people are diagnosed.
To this end, over the last few years, Bea Harling and I have been working very hard to raise the awareness of Coeliac disease, and as a result, we have created some great products that bring a rich variety of tastes but without gluten.
Our products are for both home use and the catering industry, so keep a close eye on this page for more announcements, but for now, we are very pleased to announce the first of our range of Seriously Good Gluten-Free™ baking mixes.
What about contamination?
The tiniest amount of gluten can cause problems for people with coeliac disease. Dry gluten-containing ingredients like flour and breadcrumbs are high-risk ingredients for contamination and cross-contamination when you are producing gluten-free meals. It is a good idea to keep gluten-free foods separate in the kitchen to make sure you avoid contamination with gluten from other foods.
Some of the replacement Gluten Free ingredients to use in your recipes;
An ever-increasing variety of gluten-free baking products are available from health food shops and in the free-from aisle of major supermarkets. Some gluten-free products are also available on prescription.
A very fine white starch; lightens the crumb in baking and will hold a nice structure to sponges and flour-based products. Arrowroot can be substituted for potato starch and cornflour in recipes.
Arrowroot will set clearer than cornflour, but apart from that, it is similar.
Helps to give a light and airy texture to baked products. Its raising properties come from a mixture of an alkali, bicarbonate of soda and an acid, cream of tartar. When the dry powder is mixed with water, bubbles of carbon dioxide are produced and expand during baking, to provide aeration to sponges, pastries and biscuits. Make sure you check the label, as some baking powders are not gluten-free: a filler is added to absorb moisture in the powder.
When used in a creamed margarine-based sponge it will give a very light end result. Once your mixture is ‘wet’, the powder is activated, so don’t leave it standing long before baking.
White rice flour has a slightly gritty texture and is ideally combined with other flours for cooking because of this sandy texture. Good for all-purpose, light and mild flavoured baked goods.
Brown rice flour is ground from the whole rice kernel with some of the bran, so it has more protein, fibre and is a little darker in colour.
Sorghum flour can be used instead of brown rice flour for a finer texture: Sorghum is a whole grain, milled to a light tan-coloured flour; not for delicate paler cakes, but higher in protein and fibre than brown rice flour.
Chestnut flour has a mildly nutty flavour, slightly sweet and delicate with a fine, smooth texture. It is fairly difficult to get hold of and can be expensive, but you can buy online and at certain health food stores.
Chestnut flour is high in starch, lower in fat and calories than other ‘nut’ flours. Chestnut flour can be added in small amounts to other flours, to give you a nice texture and character to the end result.
Nut Flours from whole or blanched almonds, hazelnuts etc. tend to be ground more coarsely, lend background flavour and a denser, fudgy texture to chocolate cakes and bakes.
Generally speaking is a combination of oils, fats and milk, emulsified together. For me, the emulsification process stabilises the fats and makes them very versatile to use with fabulous end results.
When mixed with a little lard will shorten the pastry making it crisper and with good favour.
I’ve tried a variety of different types but have found that Stork margarine gives the best results.
Cornflour is milled from maize into a fine white powder and has a bland taste that makes it ideal for baking.
It needs to be added to other flours to get a better overall texture. It lightens the crumb and helps with the crispness in baking, like cookies.
I always use easy-blend dried yeast, normally a 7g (¼ oz) sachet. Make sure you check the use-by date as out of date yeast sometimes fails to rise or rise correctly.
An Italian staple made by grinding corn to make a rich yellow flour.
It has a slightly sweet flavour and can be used to make cakes as well as a gluten-free flour mix.
It comes in various guises, cornmeal, fine cornmeal, polenta, coarse polenta, fine polenta, polenta, all are polenta, again it is the grade that you will need to look at, some are very coarse.
Is hygroscopic, meaning it attracts moisture and is fabulous for keeping sponges, biscuits and cakes soft and moist. It comes in liquid form and you can buy it in most supermarkets.
Potato Starch is a pure white, very light, fine starch powder, with a neutral flavour. It is ground from the dehydrated starch of potatoes (rather than from the whole potato as with potato flour. Potato starch will help to give a light and airy texture to baked products.
Potato starch should not be confused with potato flour, which is a different product. As you might expect potato flour has a distinctive potato flavour and a heavy texture. A little goes a long way.
Potato flour can be made from cooked potatoes, dried and ground. Or processed from dried raw potato.
Soya flour is a high protein flour. It is best combined with other flours to form an alternative to wheat flour. It is particularly good in bread, as the protein helps to produce a good structure.
A fine, light flour, made from the starch extracted from the cassava root. (also called manioc). Tapioca helps bind gluten-free recipes, adds crispness to crusts and can have a useful ‘chew’ to the texture. Sometimes baked goods lack the mouthfeel you get from wheat flour.
Xanthan is a natural gum made by fermenting corn sugar with friendly bacteria. The bacterium used is Xanthomonas campestris, hence the name xanthan gum.
When added to gluten-free flour mixes, Xanthan gum helps to replace the gluten ‘stretch factor’ and is used as a thickening agent.
Using too much will produce a heavy, gummy texture, so measure carefully. It needs to be combined with your gluten-free flour mix before adding any liquid.