3 myths and the truth about coeliac disease and diabetes.

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People with type 1 diabetes have a higher risk of coeliac disease. Both conditions are autoimmune disorders. According to Coeliac UK between 2 and 10% of people with coeliac disease will also have type 1 diabetes. Some people with type 1 diabetes have silent coeliac disease, which means that no symptoms are apparent. It can also be easily missed because symptoms of feeling unwell may be attributed to the diabetes. Experts agree that all people who suffer from diabetes 1 should be screened for coeliac disease. 

 

Type 1 diabetes is usually diagnosed in children and young adults. It is not the diabetes your grandpa developed when he turned 80. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. 

 

 

Common Myths:

1. People with coeliac disease have an increased risk of diabetes 2.

Diabetes 2 is non insulin dependent diabetes. It is the most common type of diabetes and is the type of diabetes that is diagnosed in late adulthood. The bodies of people with diabetes 2 do still produce insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is insulin resistance. There is no link between coeliac disease and type 2 diabetes. The risk of diabetes 2 in people with coeliac disease is the same as for the general population. The risk factors for diabetes 2 are being overweight, lack of exercise, high blood pressure, family history, age, and others. These risks are the same for coeliacs and non coeliacs.

 

2. Sugar in gluten free foods causes diabetes 2 in people with coeliac disease.

This might be partially true. A diet that is high in sugar can contribute to weight gain, which combined with other risk factors increases the likelihood of developing diabetes 2. But this is not limited to people with coeliac disease. It is the same for the general population. If a person with coeliac disease does not have diabetes 1, the international health recommendations apply. Eat a healthy balanced diet and increase your activity levels to avoid health problems. Just make sure your diet is gluten free.

 

3. People with coeliac disease and diabetes 1 should follow a sugar free diet.

When a person with diabetes 1 and coeliac disease is established on a gluten free diet, absorption of nutrients from food will increase as the intestine heals. This will affect blood sugar control. It is important to follow advice from a healthcare team regarding possible changes in insulin requirements. However, many people think that they can eat all gluten free food as long as it is sugar free. This is a myth. In reality sugar can be consumed by people with diabetes as part of a healthy diet in cooking and baking. High sugar foods are not healthy for anybody and will not help with glucose control, but sugars are not prohibited. Sadly, many gluten free products are high in sugars. Try to limit the consumption of high sugar foods, but that is not enough. 

 

The Facts:

If a person has diabetes and coeliac disease these points are important to remember: 

  • Eat regularly and do not skip meals. Try to include a starchy carbohydrtae with every meal. Carbohydrates are important to control blood sugar levels. Follow the advice of a dietitian with regards to how much carbohydrates to include in your diet as this varies depending on age, activity level and weight. 
  • Include foods with a lower glycaemic index. The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose levels. Foods with a low or medium GI raises blood glucose less than foods with a high GI. Fat and fiber tend to lower the GI of a food. As a general rule, the more cooked or processed a food, the higher the GI (although there are exceptions). This means that gluten free highly processed packed products tend to have a high GI index and will raise blood glucose levels fast. Low GI foods that are gluten free include basmati rice, naturally gluten free grains, gluten free pasta, gluten free multigrain, wholegrain or seeded bread, sweet potato, corn, yam, beans, peas, legumes, lentils, most fruit, and non starchy vegetables. 
  • Eat a healthy diet and maintain a healthy weight.
  • Aim for 5 servings of fruit and vegetables per day
  • Avoid diabetic foods and drinks. The ‘suitable for diabetics’ label is a gimmick. These foods contain the same amounts of fats and calories and have a laxative effect that can affect blood glucose levels.

All naturally gluten free!

All naturally gluten free!

And finally…

Include plenty of naturally gluten free foods in your diet. Do yourself a favour and limit the packaged highly processed gluten free junk. And don’t forget to exercise!

 

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Sources and further reading:

https://www.coeliac.org.uk/coeliac-disease/associated-conditions-and-complications/type-1-diabetes/

 

http://www.diabetes.ie/living-with-diabetes/educational-articles/diabetes-and-food/coeliac-disease-and-type-1-diabetes/

 

http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html

 

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Can I still have alcohol? What is safe on a gluten free diet?

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I often see people ask if they can drink alcohol on a gluten free diet. Since I do not drink alcohol myself, I usually keep scrolling whenever I see this question asked on coeliac support groups. However, there are a few myths going around on the topic so I thought I would just clear the issue for anybody who is interested.

 

First of all, you can drink alcohol if you are on a gluten free diet. But not all alcohol is gluten free.

 

  • According to Coeliac Australia (2), all alcohol is gluten free with the exception of beer. On their website they state that this means anything from bourbon to tequila, sparkling wines, spirits, port, sherry and even cider, in moderation, is safe as part of a gluten free diet.

 

  • Coeliac UK  state that people with coeliac disease should avoid barley squashes, beer, lager, stout and ales unless they are specially made gluten-free beers and lagers. Cider, wine, sherry, spirits (whiskey, vodka, rum, gin, tequila), port and liquors are safe for people with coeliac disease (3).

 

As a rule of thumb alcohol that is made through a brewing process is not gluten free. It is important to only drink beers that are labelled ‘gluten free’- these are the only beers that should be considered to be gluten free despite claims by various people that other beers could be gluten free.

 

Some people think that if a hard alcohol is made from wheat, barley or rye they are prohibited. The truth is that if the distillation process is done correctly. it actually removes all of the gluten. However, according to Anderson (2014) (1) not all makers of alcoholic beverages distil enough times to purify their beverages completely. In addition, some add in a little of the grain “mash” (which does contain gluten) following distillation to improve colour and flavour, and there’s always the possibility of cross contamination from gluten grains in the manufacturing facility following distillation.

 

 

So what should we do?

If you are newly diagnosed, you might want to take small amounts of alcoholic beverages that are derived from gluten and assess your reaction. If anybody is still worried about drinking alcohol that has been made from gluten containing grains, there is potato based vodka, rum and tequila. And there is always wine, and gluten free beer.

 

 

Sources:

(1) http://celiacdisease.about.com/od/copingwiththediet/a/AlcoholicDrinks.htm

(2) http://www.coeliac.org.au/faqs/

(3) https://www.coeliac.org.uk/gluten-free-diet-and-lifestyle/gf-diet/

 

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Come on, I dare you. Get your head out of the sand!

head-in-the-sand-300x201

Lets get our head out of the sand. Until we do, there will be no progress.

 

 

I have had a terrible week. As many of you know, I have a facebook page called The Coeliac Hub that I use to raise awareness and share information about gluten related disorders. My blog posts are shared on that page.

 

My first issue started when I decided to start a campaign to make gluten free pizzas free from gluten here in Malta. Although most were thankful, the feedback I received from restaurants could have been more detailed. But I know that they all read the guidelines and hope that some change will be made for the better to safeguard our health. However, the response I got from members of the gluten free community was a little surprising. I received a few private messages and other comments to the effect that I should be grateful  that so many restaurants are willing to cater for us, and that I should not undermine this by placing unrealistic demands on restaurants. Some messages were worded more nicely than others. Shocked? I was.

 

Then just yesterday, I was yet again disappointed by many members of the gluten free community here in Malta.  Here is a brief recount of the story.

 

A company recently started selling a huge amount of packaged products labelled as gluten free and bearing the crossed grain symbol. For those of you who do not know what the crossed grain symbol is, it is a a registered trademark at a national and European level, as well as in the United States. Coeliac UK owns the worldwide copyright for the symbol. It can only be used with a licence, and products have to be tested to be either gluten free (< 20ppm of gluten) or to contain very low gluten (<100ppm of gluten).  Unfortunately, although these products may (or may not) have been gluten free, they had never been tested for ppm of gluten. Hence, the gluten free label should never have been used. They also had no licence to use the crossed grain symbol. A better option would have been to state that the products contain ‘No gluten containing ingredients’ which means that although ingredients are gluten free, and efforts have been made to minimise cross contamination, the product is not labelled as gluten free due to lack of testing. This label is adopted my many companies including Thorntons chocolates here in Europe. It is then up to the consumer whether to buy these products or not.  The company’s attention was brought to the issue, and although the crossed grain symbol was removed, they continued to use the ‘gluten free’ label’.

 

For people with coeliac disease or gluten sensitivity the ‘gluten free’ label is almost sacred- it should be immune to question or criticism. A gluten free label shows us that we can consume a product safely because it has been tested to have a very low level of gluten that most people with coeliac disease can tolerate. In Europe and the US this is 20ppm of gluten. To use the label irresponsibly is a huge offence in my book.

 

The appropriate authorities got to know about this issue and the products were recalled for a very short time until they were tested. They were thankfully found to be gluten free according to the manufacturer.

 

Happy ending? Yes- it is wonderful that the products are gluten free actually.

 

However, I cannot help being dismayed by the response from the manufacturer in question as well as from people with coeliac disease themselves. Rather than offering an apology for misusing the gluten free label and crossed grain symbol, they proceeded to publicly express their anger that people were out to harm their buisness by bringing the issue to the attention of authorities. They also claimed that various damaging statements were written about them. If there were, I never read them. However, what worried me is the response they got from fellow members of the gluten free community. There were responses that their products have always tasted wonderful (what has that got to do with anything?), that they have a Maltese product and that we should support them (Maltese, Italian, Australian- makes no difference- the issue is the gluten free label), and many other comments praising the company and thanking them. The company also claimed that many people who approached them were disgusted by the actions of people or groups who asked for their products to be tested.

 

Where is our pride? Do we even know how important these issues are? EU legislation as well as similar legislations worldwide have been put into effect to protect us from getting ill. On the other hand, if a restaurant claims to serve gluten free food but has no knowledge about cross contamination issues and what gluten is, why should we be thankful?

 

Lets get our head out of the sand. Until we do, there will be no progress.

 

Feedback from the gluten free pizza campaign.

pi

 

A few weeks ago I started a campaign called Making ‘gluten-free’ pizza free from gluten. 

 

I wrote a list of steps that should be taken to minimise the high risk of cross contamination in restaurants that offer both gluten containing and gluten free pizzas on their menu. Unfortunately, until now, there are no dedicated gluten free restaurants in the Maltese islands. The said list was sent to 20 restaurants around the Maltese islands.  I was informed that all these restaurants make both gluten free and normal gluten pizzas by members of various coeliac/ gluten free Facebook groups. I asked every restaurant to send me feedback regarding the steps they take to avoid cross contamination, thus ensuring a safe dining experience for people with gluten related disorders.

 

I must insist that since I have not actually seen the kitchens and working areas in these restaurants, I can only report the feedback that I received or didn’t receive. I cannot recommend any of these restaurants due to the lack of detail I was given.

 

No feedback received:

  • La Cuccagna, Sliema.
  • Fontanella Tea Garden, Mdina.
  • Fratelli la Bufala, Sliema.
  • Menqa l’Antika, Marsalforn, Gozo.
  • Paparazzi, Il- Gzira.
  • Sapori Cafe’, Birkirkara.
  • Tal-Kaptan, Qawra.

 

Simply said thanks but never gave feedback when I asked for it again:

  • Pebbles/ Cafe’ del Mar, Gozo.

 

Was told that it was forwarded to the food and beverage manager- no subsequent feedback received:

  • Seabank hotel. 

 

Said that they would get back to me but never did:

  • Dell’Etna, Marsaskala
  • Il-Veduta, Rabat
  • Parapett, St Julians

 

Feedback received:

  • Alfresco restaurant, Birzebbugia

- This is the most thorough description I was given by any of the 20 restaurants I contacted. The owner also gave feedback that helped me compile the list of tips to avoid cross contamination. This feedback was sent to me even before I started the campaign. This owner is honest and actually tries to ensure a safe dining experience for us by informing himself about coeliac disease and gluten related conditions and participating in discussions about our needs. Again, I must insist that I can only recommend based on what I have been told, having no experience with gluten free pizzas in Malta except the ones I prepare at home.

  1. The surfaces are properly cleaned, and utensils used are only for the mixture of the dough and the oven.

  2. Baking trays are only used for Gf pizzas.

  3. We have a dedicated oven during our busy times, other times normally no.

  4. We use gammon when requested, our tomato sauce is certified gluten free.

  5. We also tell our clients to bring what ever items they need- such as goats cheese etc!

  6. We are ”recommended” by the coeliac association, though not certified (Candie’s note: we do not have certified gluten free restaurants in Malta).

  7. Our pizzas are popular , and we seem to be doing the right thing, as we listen to our clients needs and when delivering the GF pizzas are sealed and placed on top of the complete order , otherwise in a separate delivery bag.

  • D Kalkara Regatta, Kalkara

We prepare the pizza bases at home. We do this to avoid any possible contamination from our restaurant kitchen.

I was told that they would get back to me with more detail, but I still have not received feedback.

 

  • Giardino Mediterraneo

Although I received no feedback in response to the campaign, I was previously told by the owner that a separate workplace and oven are reserved for the gluten free pizza preparation.

 

  • Luzzu restaurant, Qawra- stated that they are very careful. No further details given.

 

  • Mezzaluna, Bugibba

We take extra care in the area we prepare our gluten free food, and we also use different equipment to make our pizza dough which includes bowls/pans etc. We also use a special pizza stone where we lay the gluten free pizza to avoid any contact with the oven surface.

I questioned the owner further about how this extra care is taken in the preparation of gluten free food due to the fact that they have a small kitchen that can be easily contaminated with gluten flour. This was the reply:

We prepared the base of the gluten free pizza before the service to avoid cross contamination.

 

  • Stone Crab, Gozo.

Basically we make the bases of the gluten free pizza in a workplace where no other normal dough is processed. Then when it comes to cooking, our pizza oven has two compartments. One is used for the normal pizza and the other for the gluten free pizza and to be more sure that nothing is mixed up, we do not put the pizza on the brick directly but also put it in a dish first so there will surely be no contact with other non gluten free pizza.

 

As you can see, preparing a gluten free pizza in a restaurant that is not a dedicated gluten free facility involves alot of effort and extreme care. I will end this post with a reply was from a restaurant owner who actually does not prepare gluten free pizza in his restaurant. This was my favourite reply. I will not name the restaurant.

We were probably the first restaurant to offer a range of Gluten Free items on our main menu about 6 years ago. All our staff are trained to deal with coeliac disease sufferers and we take the matter very seriously to avoid any form of cross contamination. It is for this reason that we DO NOT offer Gluten Free Pizza. We also warn our many coeliac customers to be cautious of any restaurants that say they offer Gluten Free pizza because this can only be prepared in a very large kitchen with a separate Pizza oven located in an isolated area away from the main (normal) pizza preparation areas. Or else the restaurant must serve ONLY GF pizza, which would be financially difficult. To be honest I think you should be very wary of any restaurants who claim to offer GF pizza, and recommend you ask them to show you their kitchen and preparation practices before promoting their services to coeliac disease sufferers. The consequences for the customer could be very serious if a particular restaurant isn’t taking all necessary precautions.
 

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