Did you love pizza before your diagnosis? No worries, there is a pizzeria claiming to serve gluten free pizzas in every corner. Do you miss those yummy gluten filled cupcakes? Just join a local social media group … Continue reading
Today, I read an article slash advert in a local magazine called Cibus, that was distributed with today’s Sunday newspaper. It was titled, ‘This summer, go gluten free!’. The title itself sparked my curiosity and encouraged me to read more with … Continue reading
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.
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
- 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.
The surfaces are properly cleaned, and utensils used are only for the mixture of the dough and the oven.
Baking trays are only used for Gf pizzas.
We have a dedicated oven during our busy times, other times normally no.
We use gammon when requested, our tomato sauce is certified gluten free.
We also tell our clients to bring what ever items they need- such as goats cheese etc!
We are ”recommended” by the coeliac association, though not certified (Candie’s note: we do not have certified gluten free restaurants in Malta).
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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So here we go again.
It’s funny how I tend to forget what the pain of accidentally ingesting gluten is like every time. For me, symptoms are very specific and only occur with gluten exposure. So I am lucky enough to know that the cause is gluten beyond doubt.
As I was lying on my bed this afternoon, trying not to focus on the pain I got thinking. It is not all bad.
In most auto-immune conditions, the trigger is unknown, but thanks to the work of doctors and scientists in the last century, the trigger of coeliac disease has been identified as gluten. In my article titled A little history about coeliac disease, I explained that before the introduction of the famous banana diet by Sidney Haas in 1924, the only treatment was introducing food in stages to the coeliac patient over a period of months to years. Just think of the pain the patients with coeliac disease had to endure on a daily basis at the time. Not to mention the complications they suffered as a result of untreated coeliac disease. It wasn’t until the second world war that Dutch pediatrician Willem Karel Dicke, MD noted that his paediatric patients improved when wheat was excluded from the diet and replaced with rice and maize flours. The discovery was due to the shortage of wheat grain during the war years in Holland. These children deteriorated again when wheat was re-introduced post war.
We are lucky that we know that we should avoid gluten. Even an episode of accidental gluten exposure only causes temporary discomfort for people who have been diagnosed with coeliac disease. By knowing our trigger to ill health, we have a chance to prevent complications and to improve our life expectancy to the same as the general population. We also have the chance to reverse some of the damage that occurred from years of gluten exposure. I say some, because although the intestine will eventually heal, the systemic effects of years of malabsorbtion might not all be fully reversible depending on the age of diagnosis.
Even people with silent coeliac disease are now being diagnosed, something that was impossible in the past due to lack of awareness that coeliac disease can manifest with atypical or no symptoms, and due to the fact that it was still unknown that certain groups of people are at a higher risk of developing the condition. Thanks to screening programmes whereby people with a family history of coeliac disease, other autoimmune conditions, type 1 diabetes, IBS, anaemia of unknown cause and symptoms of coeliac disease amongst others are tested, more cases are being diagnosed. There still remains a high percentage of undiagnosed people who suffer from coeliac disease, but this is improving with greater awareness and diagnostic criteria.
With regards to diagnosis, antibody blood tests have become more specific and sensitive. An endoscopy is a much milder and easier way of viewing one’s insides and taking a biopsy than previous methods that caused much more discomfort and were not as accurate. We also now know the genes that are associated with coeliac disease. Genetic tests are available, and are useful to rule out coeliac disease or to know if one has the gene/s that give them the potential to develop coeliac disease.
As I am typing this out I am already feeling a little better about myself. At least I know that I will feel better soon because I know what it is that makes me ill. And although complex, expensive and at many times inconvenient, a gluten free diet is just that. A diet. Not too bad as a treatment for a serious auto-immune condition.
The power of positivity….
How do you feel about this?
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Have you noticed how many restaurants are offering gluten free pizza on their menu? And have you noticed that many of these restaurants are not dedicated to preparing gluten free pizzas only?
This can be very risky for a person with coeliac disease or other gluten related disorders due to the high risk of cross contamination.
Although a pizza cannot be guaranteed to be gluten free unless only gluten free foods are prepared in the kitchen, there are steps that can be taken to minimise the risk, even in restaurants that offer both gluten containing and gluten free pizzas on their menu. Some establishments in several countries are already taking measures to ensure the safety of their customers by implementing extraordinary measures to avoid cross contamination.
Here are 10 tips for the preparation of gluten free pizza.
- CHEF CLOTHING The person who will prepare the gluten free pizza must be wearing clothes that are not contaminated with gluten containing flour, or a disposable apron/overall must be worn over the clothes.
- CLEAN HANDS The persons who will be handling the food must wash their hands thoroughly before handling gluten free food items, and must wash them every time gluten free food is handled.
- USE A SEPARATE AND UNCONTAMINATED WORK AREA FOR GLUTEN FREE FOOD PREPARATION. If this is not possible, the work surface must be thoroughly cleaned before gluten free food is prepared.
- EQUIPMENT: the machinery, equipment, accessories and ingredients necessary for the production of gluten-free pizza must be absolutely distinct and separate. Food items must be covered with plastic wrap or closed in a container and utensils must be kept in a separate cupboard to guarantee that they will not be contaminated.
- ONLY USE GLUTEN FREE FLOUR TO ROLL OUT PIZZA DOUGHS Although this can be costly due to the price of gluten free flours, it can greatly decrease the cross contamination risk by keeping the kitchen free from wheat flour.
- A SEPARATE OVEN IS PREFERABLE: pizzas containing gluten should not be cooked in the oven at the same time as gluten free pizzas. Either make sure that the gluten free pizza is placed in the oven separately, or have a dedicated oven for gluten free pizza. This solution means that it is not necessary to interrupt the production of pizzas containing gluten in order to cook the gluten-free one(s), thus also avoiding lengthy waiting times, besides guaranteeing that no contamination takes place during cooking.
- USE BAKING PANS WITH HIGH SIDES: if there is only one oven available, it is necessary to stop cooking pizzas with gluten and the gluten-free pizza must not be placed directly on the base of the oven. The gluten-free pizza must be isolated from flour by cooking it in a baking pan with high sides.
- PREVENT ALL TYPES OF CONTAMINATION: even passing utensils containing flour over gluten free pizzas increases the risk of cross contamination.
- INGREDIENTS FOR PIZZA TOPPING: all ingredients for topping pizzas must be gluten free and must be kept in separate containers. Hands must be washed thoroughly before touching pizza toppings and clean utensils must be used to prevent contamination of the ingredients with floury hands or utensils.
- SERVING THE PIZZA Serve the pizza without slicing it to prevent the risk of using contaminated utensils. Each pizza can be served with a clean cutter for the client to use themselves. Use an identifying marker to show that the pizza is gluten free like a different coloured plate or a flag/sticker to avoid mix ups when the pizza is served.
Finally, it is important to be honest. If any of the above criteria cannot be met, explain to the customer so that he/she can make an informed decision about whether they feel it is safe for them to dine at your establishment or not.
Special thanks goes to S. Bugeja of Alfresco restaurant, B’Bugia, Malta for his feedback regarding gluten free pizza preparation.
This article that I wrote was published on The Sunday Times, on the 18th of May, 2014 for coeliac awareness week.
Published on this blog with permission from The Sunday Times.
Gluten-free – the latest cliché in the world of trendy diets. The current popularity of this diet can be largely attributed to bestsellers like ‘’Wheat Belly’’ by Dr. William Davis, and ‘’Grain Brain’’ by Dr. David Perlmutter. Unfortunately these books and much of the anti-gluten propaganda is based on little or no scientific literature. It is a combination of celebrity doctors, popular bloggers and clever marketing strategies that are fuelling the anti gluten sentiments in the general population.
Usually, the first thought that pops into somebody’s head when the word gluten is uttered, is ‘’bread and pasta’’. Gluten is found in wheat, barley, rye and their derivatives. Although gluten is found in yummy breads and cakes, it is also hidden in many unlikely foods like imitation meats, stock cubes, deli meats, sauces, chocolate, ice cream and in so many other processed foods. A gluten free diet is not as simple as eating a burger without a bun. A person who requires a gluten free diet, will become an excellent gluten detective, scrutinizing every label and questioning every person who prepares their meals. Even a trace of gluten can make people with true gluten related medical condition ill.
So, should perfectly healthy individuals follow a gluten free diet for improved well-being or other reasons? That is a personal decision, but I urge you to continue reading before you embark on this lifestyle change.
If anybody eats healthy and unprocessed foods, increases their intake of foods rich in nutrients and fibre, and couples this with regular exercise, they will definitely help to prevent a myriad of health problems. But a gluten free diet that includes highly processed substitute foods is definitely not the way to go. Although gluten itself does nothing for the body, it is found in grains that are high in fibre like wheat. The gluten free diet tends to be lacking in fibre, iron, calcium, thiamine, riboflavin, niacin, and folate if one is not careful. Gluten free products are also packed with sugars and preservatives and are often higher in calories. So substituting gluten containing products with their gluten free counterparts will definitely not improve health or help a person to lose weight
I have seen so many claims about the negative effects of gluten in perfectly healthy people that it is difficult to list them all. Some examples are that gluten causes auto-immune diseases, brain dysfunction, neurological disorders, and even cancer. It is claimed that gluten is inflammatory and that it wreaks havoc in your system in every way imaginable.
The truth is that gluten has been proven to have many negative effects, but only in a small percentage of the population who suffer from certain gluten related medical conditions.
Gluten cannot be tolerated by 1% of the population who suffer from coeliac disease, people with a coeliac related skin condition called dermatitis herpetiformis, and others who have been diagnosed with non-coeliac gluten sensitivity, previously known as gluten intolerance.
Coeliac disease is not an allergy or food intolerance. It is actually an auto-immune, multi- system condition that is triggered off when even a tiny amount of gluten is ingested. Surprisingly, adults with coeliac disease rarely present with classical manifestations such as diarrhoea, weight loss and abdominal pain or bloating. Most present with atypical symptoms, most commonly anaemia. Other symptoms can include constipation, mouth ulcers, recurrent fractures, bone and joint pain, infertility, neurological problems and many others. Repeated ingestion of gluten or a late diagnosis can lead to serious side effects and health problems.
Gluten sensitivity is a recently accepted medical condition in which sufferers test negative for coeliac disease or wheat allergy but have improved symptoms with the removal of gluten from their diets. Although symptoms are similar to those of coeliac disease, no long term damage appears to occur if gluten is ingested.
So what should be done if you suspect your symptoms are related to gluten consumption?
It is important to continue eating gluten until you visit a doctor and get tested for coeliac disease and wheat allergy for accurate results. The gold standard for coeliac disease diagnosis is a simple blood test, followed by an endoscopy if the blood test is positive. If you have stopped eating gluten but wish to be tested for coeliac disease, speak to your doctor.
Some might argue that if a person feels better on a gluten free diet, they should just go ahead and start a gluten free diet. However, it is important to get tested to eliminate the possibility of other health problems, and to distinguish between coeliac disease and non-coeliac gluten sensitivity. People with coeliac disease have an increased risk of other auto-immune conditions and long term complications if a strict gluten free diet is not followed for life. It is also genetic, so family members would need to get tested. Regular follow up, and care of complications would be needed.
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