Please note, this is not a medical site, please contact your GP to discuss your symptoms.
What is gluten?
Gluten is a protein which is found in wheat and all
Triticum species of plants which includes
spelt, kamut or durum wheat, rye, and barley, and also any of the cross-bred
varieties from these species. It is known as a ‘storage' protein and its natural
function is to provide the plant seedling with amino acids and nitrogen during
germination. Extensive research has shown that it is the gliadin part of the
protein which is toxic to anyone intolerant to gluten.
In recent years there has been a great deal of uncertainty
around the question of whether oats are a safe food for people with gluten
intolerance, be that coeliac disease or any other condition. There seem to be
two key reasons for the confusion. First, that oat crops, like any other crop,
can be contaminated with other prohibited cereal crops and this can occur
anywhere along the food chain, from the field, during transportation, during
milling, processing and even storage. This contamination (even at low levels) has
meant that when batches are tested for gluten (gliadin) content they give a
positive reading. Second, there are different types of test used to identify
gluten, and some can give a false-positive reading even in uncontaminated
samples of food. Knowing both of these facts has allowed producers and food
manufacturers to bring ‘safe' oat products onto the market and to increase the
choice of foods available to those with gluten intolerance.
What is coeliac disease?
When someone with Coeliac disease eats food which contains
gluten it triggers a reaction from their immune system. The response occurs
within the small intestine and results in a localised attack on the villi - the
parts of the small intestine which are responsible for absorbing nutrients from
our food. When these cells are attacked they are destroyed and this leads to
one of the key dangers of this disease, the inability to absorb sufficient
nutrients from the daily intake of food.
What causes it?
Coeliac disease occurs in people who are genetically disposed
to it and it is globally one of the most common lifelong health disorders. Its
true prevalence is difficult to quantify as it is often clinically atypical or
silent and diagnosis comes through very sensitive screening methods which are
not always available in every country/region. For many years it was perceived
that the disease was far more common in Europe than anywhere else in the world,
however, recent studies have shown that its prevalence in the US, Australia,
New Zealand and Argentina is at a similar level. Furthermore, it is
increasingly being diagnosed in developing countries such as in North Africa
and India.
Studies have also shown that people who already have another
auto-immune disease such as type 1 diabetes and thyroiditis have an increased
chance of having coeliac disease. The diagnosis of coeliac disease usually
comes second, however, what is particularly interesting is that in such
individuals a move to a gluten-free diet can have a significant effect on
improving symptoms of the other condition as well. There are other genetic
diseases, especially, Down's, Turner's and William's syndromes, which also show
a higher prevalence of coeliac disease and patients find that the associated
digestive problems are significantly improved through adopting a gluten-free
diet.
It has been suggested that in developed countries for every
person diagnosed with Coeliac disease there are 5-10 who remain undiagnosed.
Symptoms
One of the biggest factors in the disease being
under-diagnosed is that there are not always symptoms associated with it. That
said, there are certain symptoms which are common when present.
Celiac
disease with classic symptoms:
- Abdominal
distension (bloating)
- Anorexia,
irritability
- Chronic or
recurrent diarrhoea
- Failure to thrive
or weight loss
- Vomiting
- Muscle wasting
- Celiac crisis
(rare)
- Fatigue (lethargy
and tiredness)
Celiac
disease with non-classic symptoms:
- Arthritis
- Aphthous
stomatitis
- Constipation
- Dental enamel
defects
- Dermatitis
herpetiformis
- Hepatitis
- Iron-deficient anaemia
- Pubertal delay
- Recurrent
abdominal pain
- Short stature
Associated
diseases (or possibly secondary to untreated celiac disease)
Autoimmune
diseases:
- Type
I diabetes
- Thyroiditis
- Sjogren's
syndrome
- Others
Neurological
and psychological disturbances:
- Ataxia
- Autism
- Depression
- Epilepsy with
intracranial calcifications
- IgA nephropathy
- Infertility
- Osteopenia/osteoporosis
- Cancer
Genetic
associated diseases
-
Down's
syndrome
- Turner's
syndrome
- William's
syndrome
- IgA
deficiency
Gluten-free
diet
The key
treatment for Coeliac disease is a lifelong gluten-free diet. There is a huge
range of naturally gluten-free foods available to coeliacs such as vegetables,
salads, pulses, buckwheat, fruits, nuts, meat, fish, poultry, cheese, egg, and
milk - all of which can be consumed as part of a normal balanced diet. In
addition there is also a vast range of specially prepared gluten-free foods
which are designed to imitate wheat-based products and so provide safe
alternatives to such things as bread, cakes, biscuits, sauces and so on. For
those who are careful to avoid gluten the biggest reward is that within 12-24
months the lining of the small intestine recovers and returns to normal, and
the antibodies which the body produces (and which attack the gut lining) drop
away. This means that the body not only recovers but can thrive just like
anyone else on a good well-balanced diet.
The Codex
Alimentarius, which is often referred to when talking about gluten-free foods, is
the commission set up by the WHO/FAO to set food standards around the world.
Until recently they had set the threshold for gluten content at 200ppm as being
a ‘safe' level for anyone with Coeliac disease. This meant that for food to be
described as ‘gluten-free' or suitable for Coeliacs it had to be tested and
shown that there were less than 20mg per 100g of food. Now the threshold has
been reduced to 20ppm and any foods which carry the label of ‘gluten-free' must
be proved to comply with this very rigorous standard. (For more information on
how the standard is set please
click here ).
Not
surprisingly there have been a number of studies into whether it is possible to
influence the onset of Coeliac disease in infancy. In those babies who are born
and who are genetically disposed to develop the disease breastfeeding is
thought to delay or reduce the risk of developing coeliac disease. In Sweden,
for example, they now advise mothers to introduce some gluten into the baby's
diet by way of complementary food prior to giving up with breastfeeds. This
advice also holds true for any mother who intends to stop breastfeeding before
the baby is 6 months old. Since switching to this regime the evidence shows
that the risk of Coeliac disease has indeed been reduced.
Wheat
allergy
This is a
different condition from Coeliac disease, and is not a lifelong condition. It
is usually treated in the same way, that is, through a gluten-free diet.
Lactose
intolerance in coeliac disease
People who
are diagnosed with Coeliac disease have also been reported to be
lactose-intolerant owing to the fact that the lactase enzyme (which breaks down
lactose ready for use in the body) is not produced by the villi - the cells
which become damaged and destroyed by ingesting gluten.
Nutritional
balance in the gluten-free diet
Due to the
fact that gluten-free products generally are not enriched or fortified in the
same way that regular cereal products are (think of breakfast cereals and
supermarket breads) and are frequently made from refined flour or starch, they
may not contain the same levels of nutrients as the gluten-containing
counterparts they are intended to replace. It can be very difficult to know whether
patients with celiac disease living on a gluten-free diet are enjoying a
nutritionally balanced diet. What we do know, however, is that certain
gluten-free grains are not only comparable to wheat, barley, rye and so on, but
can, in fact, have a better nutritional content. Good examples are buckwheat
flour, millet flour and teff flour (brown and white). Buckwheat flour is rich
in thiamine, riboflavin, and niacin, and millet flour also has high riboflavin and
niacin concentrations (all higher than in wheat or rye).
Teff flour
is even more of a gluten-free hero and gives a lot of bang for its buck. It is
considered a complete protein because it contains all 8 essential amino acids.
Its high calcium content is a great plus for coeliacs, and phosphorus, iron,
copper, magnesium, potassium, zinc and thiamin are also present in high levels.
One particular amino acid, lysine, is present in significant quantity (far
higher than in wheat or barley and slightly less than rice or oats) and human
studies have shown that a reduced lysine intake can lead to anxiety. According
to animal studies, lysine deficiency also causes immunodeficiency, something
which coeliacs may be particularly mindful of given the profile of the disease.
The iron content of teff is four times greater than that of wheat flour
-another great boon for coeliac sufferers - and is an excellent source of
fibre. If you have diabetes, then teff can be especially useful as it can
assist with controlling blood sugar levels.
Having
Coeliac disease means you become much more aware of your own diet and how
your body functions. You become very aware of what makes you feel good and
energised and what doesn't. Our purpose at Innovative is to be as knowledgeable
as possible about what is good for Coeliacs (and why) and to offer you the best
possible alternatives for a healthy diet.
To download a copy of this information please
click here .
References
This information comes from our own research and
also with reference to ‘Gluten Free Cereal Products and Beverages' edited by
Elke K Arendt and Fabio Dal Bello, University College Cork and published by
Academic Press. For more information on the publication visit
www.elsevierdirect.com
CROSS CONTAMINATION AND ELISA TESTING
Cross contamination is a problem in the food industry and patients need the assurance from manufacturers that they have done everything within their power to provide safe products. The production facility employs HACCP (Hazard Analysis and Critical Control Point) procedures to ensure product integrity, and staff are trained in allergen awareness.
The ELISA (enzyme-linked immunosorbent assay) is one of the most sensitive and reproducible diagnostic technologies available. These assays are rapid and simple to perform, so we can use this method to test for traces of gluten both in our products and on the surfaces of the equipment used to blend and pack the gluten-free products. We hope that this commitment and concern for your safety will enable you to trust our products to provide a truly healthy bakery experience.
PRESCRIPTION FORMS
Contact us on
info@innovative-solutions.org.uk if your GP or pharmacist requires the P.I.P. references to enable you to receive products on prescription, and we will email the form to you. Alternatively, use the link at the side to download the prescription form. The pharmacy wholesalers Alliance Healthcare and AAH now have stocks in their depots thus avoiding the "specials handling" and extra delivery charges.