By Carin Clegg, Paediatric Dietitian and Fitness Professional
In clinic, I see many people who have already taken foods out of their diet without the expertise of an Accredited Practising Dietitian to educate and guide them. Consequently:
- symptom management is not optimal long term
- people have beliefs around foods that are not true
- the diet is over–restricted and/or the wrong foods are taken out or kept in
- a lot of time and energy has been wasted on restricting the diet
- there are nutrition deficiencies.
A common dietary restriction I see is gluten free. Gluten free is so well known because of the increased diagnosis of Coeliac Disease over the last few decades combined with requirement by food labelling laws to keep people informed and safe.
Regarding allergies, food labelling laws in Australia require the foods which are more commonly known to cause severe allergic reactions in people to be declared on the food label. This includes wheat and products made with wheat such as bread and other bakery products, pasta, cous cous, flours and breakfast cereals. Other names or varieties of wheat include atta, burghal, bulgar, durum, einkorn, emmer, farina, farro, freekeh, triticale, spelt and kamut. In the case of a wheat allergy, even traces may need to be excluded if one has a severe reaction such as anaphylaxis.
Food labelling laws in Australia require foods to be labelled regarding their gluten and oat content because gluten, and sometimes uncontaminated oats (specifically the gluten–like avenin protein in oats), cause damage in the small bowel of people with Coeliac disease. A strict gluten free diet is the treatment. Gluten containing grains include wheat, barley and rye.
In Australia, a food can be labelled ‘gluten free’ if there is no detectable gluten in the food or the ingredients have not been derived from foods containing gluten or oats. Because of such sensitive testing, down to less than 3 parts per million (ppm), Australians have the strictest gluten free laws. In Europe, gluten free is 20ppm. So, people living with Coeliac Disease in these countries eat a low enough gluten level to not cause harm to health, whilst many people in Australia seemingly worry over such tiny amounts of gluten in their diet unnecessarily.
It is essential if Coeliac disease is suspected that a blood test and a small bowel biopsy be done with adequate amounts of gluten in the diet. If the biopsy shows small bowel damage a gluten free diet is recommended and repeat blood test and biopsy in 6 months later is required to diagnose or rule out Coeliac Disease. It is important to note that there can be other causes for small bowel damage such as but not limited to infectious enteritis (eg giardiasis) enteropathy related to drugs or acquired immune deficiency, eosinophilic enteritis, malnutrition and bacteria overgrowth.
People who are not diagnosed with Coeliac Disease or a wheat allergy but find food upsets their body are likely food intolerant. People who have a wheat intolerance are likely to react to more than 3 different food triggers, although wheat tends to be a major trigger, particularly gut symptoms. Often people with food intolerance have other symptoms such as rashes or hives, sinus problems, headaches or migraines, reflux, sleep disturbance, poor concentration, fatigue or mood changes to name a few.
Whether you have a wheat intolerance or not, it is a great idea to have a good variety of grains in your diet, for good nutritional health and to make eating with people with food issues easier for all.
Rye and barley tend to be better tolerated if you are wheat intolerant. Rye breads are delicious and barley goes well in a soup or salad.
Oats tend to be well tolerated by people with wheat intolerance so you need not give up your porridge or muesli! You could even make porridge from polenta (cornmeal), quinoa or rice.
Other gluten free grains to include in your diet are:
- rice (white brown, wild) and rice noodles: think stir fries, curries, laksas, pilaffs, fried rice, risottos, paella, soups and casseroles
- corn or polenta
- amaranth, buckwheat, quinoa and millet: great substitutes for rice and to put with rice or even in a salad.
So, before you make any changes to your diet, go see your Dietitian! They will:
- conduct a nutrition assessment
- give dietary education on your condition, diet and testing
- advise on appropriate dietary modification according to medical advice or evidence–based practice
- assist with identifying food triggers quickly and accurately
- ensure foods are not avoided unnecessarily, particularly for a long time
- ensure nutritional adequacy, preventing deficiencies and chronic disease
- provide ongoing guidance and support with dietary changes.
- work with you to help you manage diet–related symptoms and conditions optimally.
Carin Clegg is the Director of Bright Diets and is a Paediatric Dietitian and Fitness Professional with an interest in environmental sustainability. Carin wants everyone to be clever about their eating to feel happy, healthy and vibrant! Contact Carin on 0407 492 278 or via www.brightdiets.com.au