09 February 2007

Gluten sensitivity

Gluten sensitivity is probably one of the most frustrating dietary conditions to deal with on a day-to-day basis. This article gives some tips on dealing with this condition.

Gluten sensitivity or coeliac disease is probably one of the most frustrating dietary conditions to deal with on a day- to-day basis. Coeliac disease is characterised by abnormal sensitivity to gluten, a protein, which is mainly found in wheat.

Consequently this condition is more common in countries where wheat is the staple cereal and the incidence is much higher in countries such as Ireland and the USA, than in Africa where maize and millet historically formed the basis of the diet. In South Africa, maize meal is currently being supplanted by bread as a staple food in rapidly urbanising populations, so that we may well find the incidence of coeliac disease increasing in the population at large and the black population in particular.

Vulnerable groups
Coeliac disease usually occurs in children just after they are weaned (between 9 months and 3 years) and in adults between the ages of 30 and 40.

Children with gluten sensitivity usually fail to thrive in the second year of life. They develop bloated tummies, lose weight and muscle tissue (wasting), and produce large, pale bulky stools. These children are also unhappy and very lethargic, with little or no appetite. Younger children develop diarrhoea more often than their normal counterparts, while older children suffer from anaemia, rickets and growth retardation.

Tiredness is the main symptom adults with coeliac disease complain of. They also tend to suffer from diarrhoea, and anaemia caused by a lack of iron and folic acid deficiency. Many patients do not have any gastrointestinal symptoms such as diarrhoea or bloating and their sensitivity to gluten is usually only identified when their anaemia is being diagnosed. Because of poor absorption of calcium and fat-soluble vitamins, adult patients may develop osteoporosis and a vitamin K deficiency. Other symptoms include skin lesions, swelling of the ankles, depression and poor muscle coordination.

Dietary treatment
The most important treatment for coeliac disease or gluten intolerance is removal of all gluten from the patient’s diet. Gluten is not only found in wheat, but also occurs in barley, rye and oats. Consequently all foods that contain any one of these cereals must be excluded from the diet for the rest of the patient’s life. Not all patients are sensitive to oats, so although oats must be excluded initially from the diet after a patient has been diagnosed with gluten sensitivity, oats can be reintroduced at a later stage to test if the patient reacts. If none of the characteristic symptoms reoccur, then oats can be used by the specific patient who is not sensitive to this cereal.

It is vitally important to stick to a gluten-free diet ever after, because failure to comply with the diet can predispose patients to an increased risk of lymphoma (cancer of the lymph glands) and osteoporosis (progressive loss of calcium from the skeleton leading to bone fractures).

Wheat, wheat everywhere...
The reason why I said that coeliac disease or gluten sensitivity is such a frustrating condition, is that in our modern world with all its thousands of processed and convenience foods, you will encounter wheat at every turn.

If you are sensitive to wheat, barley, rye and oats, then you not only have to avoid the obvious sources of these cereals (breakfast porridges, ready-to-eat cereals, bread, pasta, cakes, pastry, biscuits and pies), but you also need to be on the lookout constantly for wheat in packet soups, sausages and processed meat products, frozen meat and fish products which contain wheat flour as a binder or coating (crumbs), tinned foods which contain sauces thickened with wheat flour, condiments, sauces, and confectionary.

Survival strategies
Stick to your diet, no matter what temptations you encounter.

Read every single food label to check if the product contains one of the forbidden cereals. If in doubt, then don’t buy the product.

Concentrate on the following foods:
Maize meal porridge, corn flakes, rice crispies and puffed rice, milk, yoghurt and dairy products like cheese, cream and butter, meat, poultry, fish, bacon, eggs, plant oils, margarine, fresh and dried fruit, fruit juices, and fresh vegetables, nuts and seeds, rice and potato, homemade gravy made with maizena or cornflour, custard made with maizena, soups made with meat and vegetables thickened with cornflour, rice flour or peas and lentils, cooked dry beans, peas and lentils, salad dressing thickened with cornflour, puddings made with jelly, fruit, and milk thickened with maizena, rice flour or gelatine, rice cakes, gluten-free bread, Mexican tacos which are made with maize, jams, jelly, hard boiled sweets, special gluten-free confectionary and potato, rice and maize chips and snack foods.

A ray of hope
A few years ago individuals with gluten sensitivity or coeliac disease in South Africa had very few commercially manufactured food products to choose from. Luckily there are a number of food companies that now produce gluten-free foods. I did a small survey about 2 months ago and was pleasantly surprise to find that some supermarkets stock gluten-free rice cakes in a variety of flavours (plain, blueberry, carob), health bars (muesli crunch, seed, peanut and raisin, carob, just fruit), chocolates, certain types of ice-cream, oriental snacks and snacks made with rice or maize. Shop around and you will find a reasonable variety of foods that are free of gluten to make your diet more interesting. - (Dr I.V. van Heerden, DietDoc)

Any questions? Ask DietDoc


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Allergy expert

Dr Morris is the Principal Allergist at the Cape Town and Johannesburg Allergy Clinics with postgraduate diplomas in Allergology, Dermatology, Paediatrics and Family Medicine dealing with both adult and childhood allergies. obesity and diabetes societies and runs a trial centre for new drugs.

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