The prospect of following a gluten-free diet can be daunting. Bread, pasta, pastry, cakes and biscuits all traditionally contain gluten and can be hard to omit from your diet. But it's easy to make gluten-free versions that taste just as good. Cookery writer Darina Allen tells how.
Around one in 100 people in the UK are estimated to have coeliac disease, a medically diagnosed, life-long condition that affects the gastrointestinal tract. The only way people with coeliac disease can control the symptoms, which range from vomiting and weight-loss to tiredness and breathlessness, is by cutting gluten out of their diet permanently.
Although this may at first seem drastic, it is important to reduce the risk of serious complications, such as osteoporosis - and there is still a wealth of wonderful food to be enjoyed. The biggest lifestyle change involves taking care when buying processed foods (even the slightest trace of gluten can make someone with coeliac disease ill).
Cookery writer and teacher Darina Allen has worked closely with fellow chef, Rosemary Kearney, who has coeliac disease, to develop great-tasting gluten-free recipes for everyday staples such as bread and pastry. BBC Food put your questions about coping with coeliac disease to Darina who responded with a wealth of practical tips and gluten-free recipes suitable for people with coeliac disease or anyone choosing to follow a wheat-free diet.
Coeliac disease is an autoimmune disease that results in a permanent intolerance to gluten. Gluten is the protein that is found in a number of grains including wheat, barley and rye. Some people with coeliac disease are also sensitive to oats.
The reason eating gluten makes people with coeliac disease ill has to do with the villi, which are finger-like projections in the small intestine. The villi increase the surface area of the intestine for the absorption of food and nutrients. In a normal person these stand on end, but in an undiagnosed coeliac they become flattened and thus reduce the surface area of the intestine. If a coeliac adheres to a strict gluten-free diet permanently, then the flattened villi will return to normal.
However, if the diet is broken, typical symptoms can include chronic tiredness, lethargy, headache, nausea, vomiting, bloating, cramps and diarrhoea. If the diet is consistently broken, even if there aren't any symptoms, there is still the risk of more serious conditions such as anaemia, osteoporosis, gut lymphoma (cancer) and problems surrounding fertility and pregnancy.
If someone suspects they are wheat-intolerant, they should discuss their symptoms with their GP. The GP can take a simple blood test to identify coeliac disease. The GP will then refer the person to a hospital specialist, a gastroenterologist, for a biopsy of the gut. By removing wheat from the diet before testing you could mask coeliac disease without treating it. Wheat intolerance is quite rare, is more likely to affect young children and may be a temporary problem, unlike coeliac disease which is permanent. Associated symptoms of wheat intolerance may include eczema and other skin irritations but it does not affect the immune system. Coeliac disease, on the other hand, is known as an autoimmune disease because the presence of gluten in a coeliac's diet causes an immune reaction.
If someone suspects they are suffering from wheat intolerance or coeliac disease, they must consult their doctor before they consider altering their diet. Under no circumstances should they attempt self-diagnosis.
Naturally gluten-free cereals include rice flour, tapioca flour, potato flour, cornflour, cornmeal, soya flour, gram flour, teff flour and buckwheat flour. There are a number of others but these are the most widely available. One should ensure they are buying good quality brands, which have meticulous policies regarding cross-contamination. Coeliac UK produce a Food and Drink Directory that lists gluten-free flours without risk of contamination.
There's a great deal of controversy as to whether oats are suitable for coeliacs. Some coeliacs may be able to tolerate a small quantity of pure oats while others may not. The difficulty is obtaining pure oats that are totally free from contamination by wheat either in the field or in the milling process. A coeliac's healthcare team should give individual advice about oats in their diet. Coeliac UK Food and Drink Directory lists pure uncontaminated oats.
All pre-packaged foods bought in the UK are covered by the current EU-wide food labelling legislation. This means that any deliberate ingredient included in a product that is derived from a gluten-containing cereal must appear on the ingredients list, regardless of the amount used.
Manufacturers can use the terms ‘wheat', ‘rye', ‘barley' or ‘gluten'; some will use both eg ‘wheat gluten'. This information will be found on the ingredients list and/or allergy advice box; it must be declared in the ingredients list, whereas the allergen advice box is only a recommendation. It is important that anyone following a gluten-free diet check both the ingredients list and allergy advice box.
Coeliacs, and anyone shopping or cooking for a coeliac, need to be extremely cautious and aware of the foods they are purchasing so that they can be certain that they are safe to eat. Coeliac UK provides a directory of gluten-free Food and Drink, but food manufacturers can change the ingredients in their products, so it's essential to update your directory monthly via Coeliac UK.
There are many products that are naturally gluten-free and these should be included in your diet. These include all fresh meat, poultry and fish, all fresh fruit and vegetables, fresh herbs, individual spices, dried pulses, rice, rice noodles, potatoes, corn, plain nuts, eggs, dairy products, sugar, honey, pure oils and vinegars, vanilla extract and fresh and dried yeast.
There are many items available in your supermarket suitable for coeliacs – it just may take a little longer to find them. Follow the list below and you'll be surprised at how many items are available. Many supermarkets have special sections for those with dietary conditions such as coeliac disease and have a wide range of special dietary products.
It's gluten that gives bread its elasticity and cakes their spring. Therefore, gluten-free breads will not display the same characteristic as ‘normal' bread. Gluten-free flours are a little more difficult to work with than regular flours are, but it's just a matter of getting used to cooking with them.
One product that greatly aids gluten-free baking is xanthan gum. This product will, to some extent, replace the elastic qualities that gluten-free flours lack. Adding a little to your gluten-free flours will make the bread less crumbly. It's available in specialist health food stores and in some supermarkets.
The gluten-free white soda bread recipe works very well, as does the banana bread and the sweet fruit scones. We've been very pleased with the feedback we've received about these recipes and many coeliacs can't believe they are able to eat bread with such a light texture and which doesn't resemble a brick!
Some gluten-free companies (Juvela, Glutafin) also produce a fresh bread, which you may find more appetising than the vacuum-packed bread products.
We have a terrific recipe for both sweet pastry and savoury pastry. Many people have tasted it and not realised it was gluten-free. It can be rolled out very easily and is delicious when baked. To prevent it from being crumbly (something often associated with gluten-free pastry) we have added xanthan gum to the gluten-free flours before the butter is rubbed in. Xanthan gum, as stated before, is an invaluable aid for gluten-free baking and should be in the store cupboard of every person with coeliac disease.
Gluten-free cakes work very well. They are very light and delicious. We have a number of cake recipes including Ballymaloe chocolate almond gateau. Ground almonds are used in this recipe and as a result the cake is really moist and irresistible. Other cakes use ground cornmeal or a mixture of rice flour and ground almonds. We've found it's best to use a mixture of flours along with ground almonds so that the cakes remain moist when baked. Unfortunately we do not have a doughnut recipe that we are happy with - yet! - but we will keep practising, and so can you!
One of the quickest and most simple dishes to make is gluten-free pasta tossed in a little fresh pesto with parmesan freshly grated on top – delicious! Polenta is also wonderful for coeliacs and can be used in a number of ways – either serve it soft with a delicious stew or sauce, or pour it into a swiss roll tin and allow it to set. When it's set, cut it into slices and chargrill – it's great to have as a starter, just like bruschetta, with a number of toppings such as roasted peppers or tapenade.
Quinoa and millet can also be tossed through salads and used as a substitute for bulgar wheat when making tabbouleh or instead of couscous in any recipe. Millet flakes are also great in gluten-free granola or in gluten-free muesli.
Beers, lagers, stouts and real ales must definitely be avoided by coeliacs. However there are a number of gluten-free beers and lagers now on the market. Wine, champagne, port, sherry, ciders, liqueurs and spirits, including whisky, are all gluten-free (as the term 'gluten-free' is used by appropriate UK bodies). Of course, as with everyone, coeliacs should only consume alcohol in moderation.
Eating out in a restaurant should be a pleasurable experience - there's no point going if you'll spend the entire meal worrying whether everything's okay. Don't ever feel you're being overly fussy by enquiring whether something is suitable. It's better to take a few moments to speak to the restaurant in advance and then to eat in peace, than to be buckled over in pain later that night as a consequence of eating something that wasn't suitable.
I think that in order to reassure yourself, it's best to ring the restaurant in advance, explain your condition and, ideally, speak to the chef. He/she should be able to guide you as to what would be suitable. An obliging chef may even make something especially for you. You must be sure that the restaurant is entirely sure of what goes into each dish. This is fine if it's a good restaurant that only uses fresh ingredients. However, other restaurants may use ready-made sauces and this is where problems may arise.
They must be able to get confirmation from their supplier as to whether the sauce, or other product, is suitable for coeliacs. You should stress to the chef that it is not a 'fad' diet and explain that even the smallest amount of flour can cause damage. You have to be sure there is no risk of cross-contamination with regular flours. For example, if the restaurant provides gluten-free bread, it should not be cut on the same chopping board as regular bread. Ask if the soups or sauces have been thickened with roux, or if the fish has been dredged in flour, for example. Even the waiting staff must be aware of the coeliac condition and not serve the guests regular bread by mistake.
If you do know of a good 'coeliac-friendly' restaurant in your area, spread the word. There's definitely a niche market there and coeliacs would be only too grateful if they could be sure that what they're eating is suitable.
Darina Allen runs the Ballymaloe Cookery School in Ireland which she founded in 1983. She has written a number of cookery books and lectures and travels extensively. She has also appeared on BBC Two's Saturday Kitchen.
Rosemary Kearney has a degree in food science and runs her own catering business. She suffers from coeliac disease and now runs annual cookery courses for coeliacs at the Ballymaloe Cookery School.
Updated May 2007
The information and advice contained in this article are intended as a general guide to healthy eating and are not specific to individuals or their particular circumstances. All content within this article is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Food website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. Always consult your own GP if you're in any way concerned about your health.
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