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Food Surgery - Coeliac Disease

Friday, 15 May 2009

This is the second in our food surgery strand. Today we discuss Ceoliac Disease and foods to include and foods to avoid in order to help alleviate the symptoms of this disease.

Next week we'll be looking at the the importance of Vitamin D in the diet.

10 yrs ago CD was a relatively uncommon disorder with a prevalence of 1 in 1000. (European stats). It is thought to be significantly under diagnosed.

Irish stats are not documented but according to The Coeliac Society, it's between 7 and 9 Irish people in 1,000 are affected by Coeliac Disease. It is estimated that 80% of all newly diagnosed coeliacs are adults.

The 2009 European Coeliac Awareness Day will take place in Beshoff Bros, Mespil Road on Saturday 16th May from 12pm to 8pm. The first 25 families to arrive that day will get free meals - gluten free of course!

And did you know that Coeliacs can avail of tax relief? See below for details.

Aveen Bannon - Nutritionist

What is coeliac disease (CD)?
Coeliac Disease is a permanent condition in which the lining of the small intestine is damaged if certain cereal proteins are ingested. The cereals which must be avoided are wheat, barley, rye and oats. The symptoms of coeliac disease vary from person to person and can range from very mild to severe.

Possible symptoms can include bloating, abdominal pain, nausea, diarrhoea, excessive wind, heartburn, indigestion, constipation, tiredness, headaches to name just a few. Some symptoms may be confused with irritable bowel syndrome (IBS) or wheat intolerance, while others may be put down to stress, or even getting older.

. Coeliac disease results in abnormal immunological reaction to dietary gluten
. causing tissue damage.
. It can present at any age.
. CD in childhood has become increasingly uncommon; this could be due to better weaning practises where gluten is avoided for the first 6 months of life.

There is no cure for CD. It's not a case of eating the correct foods it's more a case of leaving out certain foods, according to the CD society spokesperson, Emma Clarke-Conway.
Foods simply alleviate the symptoms and do not cure it. It was thought that people would grow out of it but they don't.

CD is a very common condition and it is very under diagnosed. If someone deviates from a CD diet, i.e. gluten free diet, they can have several symptoms. Symptoms vary according to sufferers. They can include abdominal bloating, a need to run to use the toilet, etc.,
According to the Coeliac Society, leaving out gluten means sufferers are not injuring their intestines.

What are the symptoms?

. Weight loss
. Diarrhoea
. Bloating
. Abdominal cramps
. Anaemia
. Fatigue
. Failure to thrive in children

What is gluten?
Gluten is a protein found in wheat. It gives dough made from wheat flour its elasticity and therefore its good baking properties. Gluten is also used to describe similar proteins in rye, barley and oats. The prolamins in wheat (i.e. gliadin), rye (i.e. secalin), barley (i.e. hordein) and oats (i.e. avenin) are not identical, although they are closely related in structure. For this reason those with coeliac disease must avoid wheat, barley, rye and oats. There is controversy regarding the avoidance of oats but current recommendations in Ireland state that oats must be avoided unless they are specifically described as gluten free oats.


The only treatment for CD remains a strict lifelong gluten free diet. Once a strict gluten-free diet is commenced, the villi in the gut begin to re-grow and symptoms begin to improve. Assessment with a qualified dietitian is essential to ensure proper avoidance of gluten while maintaining nutritional adequacy in the diet.

To diagnose CD your doctor will look for symptoms of coeliac disease and take a blood test that can identify the presence of serum antibodies to gliadin, endomysium or transglutaminase. A small bowel biopsy remains essential and diagnosis should not be based on symptoms or serological tests alone. A simple non invasive dot blot assay for detection of CD suitable for use by GPs is being developed.
Foods to include to help alleviate the symptoms? *See add info for sample menu.
. Fresh and frozen fruit and vegetables
. Eggs
. All meat: lamb, pork, beef, venison. (except sausages).
. Poultry and fowl
. Shellfish/fish: (except those that have breadcrumbs or coatings)
. Dairy products: milk, plain cheese, some yogurts.
. Pulses, nuts and seeds
. Non-alcoholic drinks: fruit or vegetable juices, soft drinks.
. Alcoholic drinks: wine, sherry, brandy, rum, whiskey, vodka, cider.

There are also gluten free alternatives for breads, pastries, pastas and a gluten free diet can be a tasty healthy diet.

What foods should I avoid?

As well as obvious gluten sources (breads, pastas, noodles, cakes, pizza, sausage meats, some soups and gravies), there are a number of hidden sources. Look out for the following ingredients;

Wheat Rye Barley

Bulgar Oats Most soya sauces

Spelt Pearl Barley Couscous

Cereal Fillers Rusk Most mincemeat

Durum wheat Wheat starch* Packet suet

Farina Semolina Regular baking powder

Hydrolysed vegetable protein Starch and modified starch (unless Codex standard)* Malt malt extract and flavouring

wheat grass and wheat germ oil wheat germ wheat bran

Cross contamination can occur. Tips to avoid contamination include;
. Storing food separately
. Using a separate toaster
. Use a separate chopping board
. Use a separate butter container or jams
. Always inform restaurants that you are suffer from coeliac disease.

If in doubt, leave it out!

If a CD sufferer doesn't follow the diet what can happen?

. Anaemia
. Osteoporosis/ Osteopaenia
. Poor nutritional status
. Impaired fertility
. Dental enamel defects of permanent teeth
. Arthritis or other joint symptoms
. Lactose intolerance
. malignancy

Research has shown that a significant proportion of people on a gluten free diet are not getting enough calcium, iron and folic acid.

How to boost iron intake?
. Include lean red meat in the diet 2-3 times per week.
. Add a slice of lean beef, pork or lamb to a salad or salad sandwich.
. Add raisins and dried apricots to cereals, curries or have as a snack
. Add seeds to your breakfast cereal or a yogurt
. Nuts are a healthy snack whilst providing some iron
. Include pulses in the diet e.g. kidney beans, lentils, baked beans

Folic acid?
Important for women of child bearing age and also at any age to help protect the heart. Folic acid deficiency is a relatively common vitamin deficiency in Ireland as the best sources are green vegetables which are poorly consumed.

Sample Menu.
Examples of healthy GF breakfasts?

. GF Muesli with mixed berries and low fat milk.

. GF Porridge with supermilk and some sliced banana

. Sliced banana, apple, orange and grapes mixed together served with a pot of low fat probiotic yogurt and 2 dsp of linseed.

Healthy GF Lunches?

. Fresh vegetable and lentil soup served with some rice cakes and hummus

. Mixed bean and tuna salad served with spinach leaves, tomatoes, red onion and peppers. Serve with some GF crackers

. Wholemeal GF bread sandwich filled with salmon, chives, avocado, mixed leaves

Healthy GF Dinners?

. Chilli con carne made with lean mince and kidney beans served with boiled rice and a green salad.

. Baked Cod in the oven on a Bed of Ratatouille, serve with sweet potato mash.

. Spicy Salmon, dust salmon fillets with a little Cajun seasoning before cooking to add a little spice. Serve with steamed potato and lots of rich green vegetables

Coeliacs are entitled to Tax Relief on special dietary gluten free products.

'Tax relief in respect of the cost of gluten-free food for Coeliacs is an allowable expense for the purposes of a health expenses claim. A letter from a doctor stating that the individual in respect of whom the claim is made has the condition is acceptable. If receipts are requested, qualifying receipts are not confined to those from a chemist - receipts from shops, supermarkets, etc., in respect of gluten-free food products manufactured specifically for coeliac patients are also acceptable. The quickest and easiest way to claim tax relief for health expenses is to use Revenue's PAYE Self Service. PAYE taxpayers can now claim Medical Expenses over the Internet by logging on to The Revenue Commissioners Website here.'
What this means is that if you save your receipts for any gluten free products that you buy you can claim tax on the total spent.
Tax Relief cannot be claimed for foods that are naturally gluten free, they must be specially made dietary products.
Receipts from supermarkets in addition to receipts from chemists/pharmacies are acceptable.
Please ensure that you only claim for amounts for which you hold receipts.
You do not need to send in your receipts but you must keep them in case your claim is chosen for a detailed examination.
You must keep receipts for 6 years.
As the condition is ongoing a letter instead of prescriptions from your family doctor stating that the individual is a coeliac is acceptable.

Supermarket Receipts
Both Tesco Ireland and Superquinn will provide a Certificate of Expenditure when customers buy gluten free products using their loyalty cards (Clubcard & Superquinn Reward Card).
You must register as a Coeliac with Tesco to receive this annual receipt. You must opt in to receive mailings from Tesco so that under data protection law they can send you the certificate.
It is not necessary to register with Superquinn but you must always use your Superquinn Reward Card when you purchase gluten free products at Superquinn

Coeliac awareness day.
To celebrate a year of catering to Coeliacs, the 2009 European Coeliac Awareness Day takes place on Saturday 16th May in Beshoff Bros, Mespil Road from 12pm, in association with the Coeliac Society of Ireland (CSI). Members, friends and media are invited to celebrate and to swap stories and experiences of being coeliac.


For more info:
Emma Clarke Conway
PR & Communications Manager
Coeliac Society of Ireland
Carmichael Centre
4 North Brunswick Street
Dublin 7
Tel: 01 872 1471
Fax: 01 873 5737