June 15, 2015

 

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Are you gluten sensitive or do you have coeliac disease?

How do you tell the difference?  Please see great animated short movie at the bottom of this page which explains the differences in an amusing but very clear format

Gluten sensitivity is associated with unpleasant symptoms after eating wheat or food containing gluten found in wheat, barley, rye and oats. Some people may feel their problems relate solely to wheat, others solely to gluten, and others to both. In practice, it can be difficult to make this distinction. There are varying degrees of gluten sensitivity which causes a number of allergies and symptoms. 

Symptoms can include: stomach/abdominal pain, bloating, diarrhoea or constipation, gastric reflux, heartburn, fatigue, weakness and lethargy, lack of growth, iron deficiency, dermatitis, eczema or bad skin, infertility, sinus problems, osteoporosis, moody, lack of concentration, sleeping problems and many more. 

What is coeliac disease

Coeliac disease is a permanent, autoimmune disorder caused by an intolerance to gluten which is found in wheat, barley, oats and rye. This intolerance to gluten causes the body to produce antibodies which damage the lining of the small bowel and make it impossible for the body to absorb vitamins, minerals and other nutrients from food. Both genetic and environmental factors play important roles in coeliac disease and coeliac disease is hereditary.

In 2015, it is estimated that 60,000 to 70,000 of kiwis have coeliac disease (1 in 70), however up to 80% of those are unaware they have the condition.

Symptoms

There are no specific symptoms of coeliac disease. Listed below are some of the symptoms which may occur alone or in combination: 

Most Common in Adults:

  • Diarrhoea – This may begin at any age and is often present for years prior to diagnosis. It may first appear after other illnesses (e.g. gastroenteritis) or abdominal operations.
  • Fatigue, weakness and lethargy
  • Anaemia – iron or folic acid deficiency are the most common. The anaemia will either not respond to treatment or will recur after treatment until the correct diagnosis is made and a gluten free diet is begun.
  • Weight loss
  • Constipation – some are more likely to experience constipation rather than diarrhoea.
  • Flatulence and abdominal distension
  • Cramping and bloating.
  • Nausea and vomiting
Less Common in Adults
  • Easy bruising of the skin
  • Ulcerations and/or swelling of mouth and tongue
  • Miscarriages and infertility
  • Low blood calcium levels with muscle spasms
  • B12, A, D, E and K vitamin deficiency
  • Skin rashes such as Dermatitis Herpetiformis
  • Altered mental alertness.
  • Bone and joint pains
Common in Children

Symptoms do not occur until gluten is introduced into an infant diet – later onset is also possible.

  • Large, bulky, foul stools
  • Diarrhoea or constipation
  • Poor weight gain
  • Weight loss in older children
  • Chronic anaemia
  • Retarded growth
  • Abdominal distension, pain and flatulence
  • Nausea and vomiting
  • Irritability

Treatment

Coeliac disease is treated by a lifelong gluten free diet. By specifically removing the cause of the disease, this treatment allows all abnormalities, including the lining of the small bowel to recover completely. As long as the diet is adhered to strictly, no problems should occur.  An initial few weeks on a gluten free diet which also has a low cow’s milk content (to lower the lactose sugar intake) may be warranted as this will allow the bowel lining to recover and replace its normal quantity of the enzyme lactase, which splits or digests lactose sugar prior to absorption. In a small number of coeliacs the enzyme lactase may slowly recover and the need for low or no cow’s milk content in the diet may persist for some time. 

How to eat gluten free

So you’ve been diagnosed, and told to eat a gluten free diet. What does that mean?

It means avoiding foods that contain wheat, barley, oats, rye or any of their derivatives. This seems like a daunting task at first, but once you know what you’re doing, it’s easy.

Over the last few years there has been a huge increase in the range, quality and availability of gluten free products in New Zealand so we are no longer as limited as we once were.

Learning to read food labels

It is vital you learn to read food labels if you don’t already.

Rule 1 - Try to choose food labelled gluten free or foods carrying the Crossed Grain logo (as licenced by Coeliac New Zealand)

Rule 2 - If you don’t see wheat rye, barley, oats or gluten on a food label then there are no ingredients derived from gluten-containing grains and the product is gluten free.

Rule 3 – Exceptions to Rule 2 There are some ingredients derived from wheat which are so highly processed that they contain ‘no detectable gluten’ due to processing. These include caramel from wheat, dextrose from wheat, glucose syrup from wheat and maltodextrin.

Rule 4 - If in doubt, leave it out

Naturally gluten free foods

Many foods are naturally gluten free. These include: fruit, vegetables, salad, rice, potato, corn, plain meat (not sausages), fish, eggs, cheese, milk, and most yoghurts, pulses (peas, beans and lentils). You can eat all of these on a gluten free diet. Also foods that state they are gluten free, or carry our Crossed Grain logo (as below), are safe to eat on a gluten free diet.

Examples of foods which may contain gluten

Baked beans, cereal, sausages, marinated meat, imitation seafoods, dry roasted nuts, some ice-cream/desserts, fish and chips, chips/crisps, pasta sauces, mince sauces, soups, sauces, gravy.

Examples of foods which contain gluten

Unless specified gluten free these types of foods are NOT gluten free: Burger buns, bread, cakes, biscuits, croutons, soy sauce, stuffing, luncheon meats, sausages, saveloys, cocktail sausages, beer, bagels, cheesecake (the biscuit base), wraps, doughnuts, buns, spaghetti, pasta, most cereals, dried packet soup, pizza, pies, crackers, gravy. Unless these foods state they are gluten free, they are not to be eaten on a gluten free diet.

Understanding food standards

There are two food standards endorsed by Coeliac New Zealand and Coeliac Australia that are suitable for people with coeliac disease.

By far the most common standard is the FSANZ standard however some products are now also available in New Zealand and Australia under the Codex Standard.

FSANZ* gluten free standard – must contain no detectable gluten and no oats or malted gluten containing cereals or their products.   All products labelled GLUTEN FREE or with equivalent wording must adhere to this code.

The Codex standard (international standard for gluten free)-  a product can contain up to 20 parts per million (ppm) of gluten. This standard is considered safe for coeliacs by our consultant Gastroenterologists.  It is depicted in New Zealand and Australia by the Crossed Grain symbol with no wording regarding ‘gluten free’ or equivalent on the packaging.

  The Crossed Grain logo is owned and licensed by Coeliac New Zealand to manufacturers who meet strict criteria and can under licence display the symbol on their packaging and marketing materials.

This symbol represents safety and assurance to you and eliminates the need for label reading. It is displayed on products labelled as gluten free (FSANZ standard) and also under the Codex standard. 

Next steps:

Joining Coeliac New Zealand gives you access to lots of detailed information and resources about living with coeliac disease. It also allows you access to support groups throughout the country where you can talk to other people in the same situation as yourself – it can really help you find your feet!

- Talk with your GP about accessing gluten free products on prescription.

- Ask your doctor or specialist to refer you to a dietitian as they will be able to give you individual advice tailored to our needs.

- Checking out local supermarkets and the internet for gluten free products. Many supermarkets stock a range of specialist gluten free foods. The range of available products has increased over the last few years, and varies between stores. Products may be kept in a specialist 'free-from' aisle, or placed among other foods, or sometimes even both - so make time to investigate! You may have to visit more than one shop to get a good idea of what's out there.


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