Coeliac disease. The Good, the Bad and the Ugly

So it’s official – you’re a coeliac.  A card carrying, villiously challenged, chronically inflamed misery guts.  It’s a huge shock.  But at the same time it’s so stupidly obvious, you wonder just how you missed it all along.

Most people you meet won’t know that Coeliac disease is actually an autoimmune condition, and that at present, it’s the only form of true gluten intolerance that we can prove exists – affecting 1 in 60 females and 1 in 80 males.

But you probably knew that.  And after all the poking, prodding and invading you’ve recently endured, you deserve to hear something positive.  So here’s what I’ve got:

The Good News

Firstly, know that Ryan is batting for you.

ryan gosling sucker punch gluten

He’s going to sucker punch gluten in the neck for you.  And look dreamy while doing it.

The other good news is that now you have the diagnosis, you also have the right to some good old fashioned sanctimonious revelling.  Because it turns out you weren’t a slothful, listless hypochondriac after all.  You were EFFING WELL ANAEMIC all these years (or at least chronically iron deficient), and have the approximate vitamin D level of a mushroom.

Now is the appropriate time to phone your family and shout at them ‘I’VE BEEN FUNCTIONING AT 20% CAPACITY FOR THE LAST FIVE YEARS YOU JUDGEMENTAL, CAKE-EATING JERKS’.  After you’ve got that off your chest, you may also like to add that coeliac disease runs in families, and that any one of them could be next.

< insert evil laugh >

And what about your reputation as a walking, talking, high level environmental polluter?  It wasn’t your freaking fault!  Your insides are a hotbed of over-fed microbes and slaughtered villi, and it’s well time that everyone knew.

Shout it to the rooftops – Facebook it – Tweet it: ‘MY EXCESSIVE BLOATING AND FLATULENCE WERE THE GLUTEN ALL ALONG – I WAS A VICTIM OF THE BLOODY CIVIL WAR INSIDE MY BELLY DON’T YOU SEE?!?’  It’ll feel great – trust me.  And it’ll help you weed out your real friends from the hangeronerers.

Oh crap!  Are you crying now?

Can I just say something obvious at this stage?  Do me a favour and don’t just turn to Dr Google.  He’s not gonna hold your hand and walk you through the supermarket isles.

gluten is... google search

See a dietitian.  A certified glutenopathist. They’ll feel your pain, and the nice ones will probably shed a little tear with you, because they KNOW how much it sucks to be broken on the inside.  It’s just gonna take a pantry overhaul, a PhD in food science and a good twelve months, but you’ll be back baby.

And talk to the official Nerds Of Gluten at Coeliac Australia.  They know their rice malt syrup from their wheat glucose syrup (hooboy yes they do).  And they have apps, and hotlines, and experts, and seminars, and magazines, and even EXPOS dedicated to helping you get this right.

Better? Okay good.

Now most of you have already worked out how simple it is to eat gluten free at home.  No dramas there.  Except for the time when you’ll try making pizza dough on a whim and end up with a kitchen that resembles a white bomb-site and a pizza crust that doubles as a weapon against intruders.

The Not-So-Good News

The crappy news (you knew this was coming) is that popping out for a meal will never be the same again.

Ladies – you have a head start here, as you already possess the innate ability to ask what’s in your food without feeling like a twat.  Blokes – I just have to say right now that I’m really sorry.  Yes it does suck (It sucks Big. Hairy. Balls), but you’re going to have to man up, and start having that conversation.

wheat flour in everything meme

Gluten is a social creature.  It gatecrashes just about every dining occasion from your posh dinner out, to the backyard barbecue. Take that potato chip you’ve just been offered: Better check if it’s coated in starch or hydrolysed vegetable protein (HVP)** from wheat. And that delicious, innocent-looking sausage over there?  Sorry, but you’re you’ll need to do some serious hunting and gathering (coeliac style) before it’s allowed on your plate.

**by the way, please stop freaking out –  HVP sounds very similar, but has absolutely NOTHING to do with Human Papaloma Virus 

Hunting and Gathering the Coeliac Way

1.  Hunt down sausage provider, by systematically questioning everyone present at BBQ

2.  Gather information regarding sausage ingredients, employing specialist bin retrieval tactics as needed

And while you’re hunting and gathering the sausage safety information, you may as well find out what mayonnaise was used for the coleslaw dressing, and whether that tempting pink dip has been laced with breadcrumbs.  Pass on the beer (once again I’m so, so sorry), but accept the wine.  DRINK THE WINE.  It will give you courage.

And you will need courage in the early days, as you adapt to your new life of planning EVERY meal in advance, and having to explain to EVERYONE how you’re not a prat – you just don’t particularly want to poison yourself.

coeliac fad meme

Because my final words of wisdom are that people can be nice, and supportive, and considerate.  But some of them can be assholes about it too.

As a general rule, most punters don’t have a clue what gluten actually is.  And here are some of the types you’re going to have to get used to:

1.  The well-meaning friends who love you but will annoy the crap out of you, when they:

  • Insist on taking you out for Yum Cha, then on realising there’s nothing you can eat, they offer to peel a dumpling for you.
  • Buy you cookies and cream ice cream, and then look horrified when you gently point out the inherent gluten threat from the ‘cookies’ component.  Ask them to bring you a bottle of vodka next time.

2.  The purely annoying people, who:

  • Insist that spelt bread is fine for coeliacs (these are the same people who claim to have cured their own ‘gluten intolerance’ with spirilina shots and kefir).
  • Make quips like: ‘Yeah well we’d all be better off without gluten wouldn’t we? It’s like, really fattening, isn’t it?’ A: No it’s not fattening YOU TWIT. 
  • Slip you the business card of their kinesthesiologist / aromatherapist / spirit healer because apparently they’ll fix you up in a jiffy.

3.  The evil people

  • The clueless, cocky person who says things like ‘C’mon – a little bit won’t hurt’ – at which point you employ a vice like nipple cripple and say ‘okay maybe you’re right, but tell me DOES THIS HURT?
  • The jerk who thinks you’re being uptight for not accepting the sausage in bread (or the sausage put in bread then removed from bread, which is now so cross-contaminated you can sense it acutely with your gluten-detecting spider senses)

And last but not least:

  • EVERY OTHER PERSON AT THE CONFERENCE who is trying to get at the sushi platter you’re so zealously guarding. That’s YOUR freaking sushi man!  It’s like, the only thing you can eat.  Slap those hands away, and jostle if you need to.  Just keep them away from that sushi like your life depends on it.

And get used to it, because from now on, you’re gonna be eating a lot of sushi…

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Paleo? Y/N? A post in defence of cheese

Okay. Are we officially over the Pete Evans / paleo social media shit-storm in Australia? I think it’s safe to say that I’m just about there.  I’m experiencing a severe case of Chronic Paleo Overload Syndrome (CPOS).

The problem is that as a practicing dietitian, it’s in my interests to keep abreast of the whole kerfuffle, and to know what Chef Pete Evans is preaching today to his 300K+ tribe on Facebook. Because you can bet your bokashi that my clients, colleagues, friends and family will be asking me about it.

How long – I wonder – before we’ll be asked to vote ‘for’ or ‘against’, and have our official paleo status stamped on our licence?:

Organ donor? (circle) Y / N.
Paleo? (circle): Y / N.

If you’re thinking I sound a bit paranoid, you may be right (along with premature ageing and a compulsion to stockpile Cherry Ripes, paranoia is a common symptom of CPOS).

But I’m not blogging here to enter into debate over Pete Evans’ recent attacks on the Heart Foundation tick – I think this recent post by a fellow dietitian says it perfectly.  When it comes to our healthy eating guidelines, or the role of fats and carbohydrates in the obesity epidemic, I defer to the extensive grey matter of Dr David Katz, and encourage anyone interested to read his recent thoughts.  And as for the idea that paleo can treat everything from autism to MS –  are you thinking what I’m thinking?..

Image: Getty images - ABC archives

What I am talking about here is the push I’m seeing for paleo to be accepted as a healthier alternative to current evidence-based nutrition guidelines.  And the proliferation of comments from the general public along the lines of:

‘I don’t see the problem with Paleo. It’s just a healthy diet that cuts out processed foods, and surely that’s better for us than eating crap isn’t it?

Most dietitians and public health experts are in furious agreement that there are some really good points to the paleo style of eating.  Engaging in debate about the quality of our food supply and where it comes from.  Stepping away from the supermarket shelves – groaning under the weight of sugary, processed, nutrient-poor foods.  Eating lots of fibrous, nutrient-rich vegetables, nuts and seeds.  Of course these are things we should all aspire to.

But let’s not get so blinded by these positives, that we fail to see the full picture.  The newsflash I have here is that there is a middle ground, which falls somewhere between a diet full of processed rubbish, and going paleo. It’s called eating things that grow in the soil, making your own instead of buying the packet, and developing a healthy relationship with food.

Quite simply – I believe going paleo is throwing the baby out with the bath water.

And this is why:

oats v fruitloops (1)

Paleo would have you think that a bowl of oats (with all that soluble fibre, folate, magnesium, protein and low GI carbohydrate) is no different to a bowl of Fruit Loops.

sandwich v fairy bread (1)

Paleo doesn’t distinguish between a sandwich made with grainy, low GI bread, and a sugar-laden cake made with refined white flour.  It lumps these two distinctly different beasts in together as ‘bad’ foods.  It perpetuates the idea that there is something inherently dangerous about gluten, despite any robust scientific data to this effect (and as a dietitan married to a guy with coeliac disease – I kind of know my research in the area of gluten sensitivity).

dairy and legumes bad

True paleo diets omit legumes and dairy – two incredibly nutrient dense food groups consumed by diverse cultures around our globe.  We’ve been eating these foods for centuries – long before the current obesity epidemic, the rise of food allergies, intolerances and their associated health burden.

There is a tonne of research which shows the benefit of legumes in the diet – probably because they are an excellent source of slow release carbohydrate with a wide range of nutrients and a good whack of fibre.

And dairy?  Slow release carbohydrate again, with quality protein, potassium and an ideal ratio of calcium and phosphorous for bone health.  A high dairy diet may not suit everyone (lactose intolerance and cow’s milk protein allergy/intolerance are known issues), and some prefer not to drink the milk of another mammal for ethical reasons.  But does dairy classify as a toxic food that is inherently bad for all of us?  No.

Please don’t make me live in a world without cheese – I just don’t think I’d cope.

miniature cheese platter

Miniature Cheese Platter – Stephanie Kilgast

So I have an idea.

Let’s start talking about nutrition without the sweeping generalisations and one-size fits all perspective. Let’s encourage a back-to-basics, cut-the-crap approach, without demonising foods we’ve been cultivating and eating without incident for centuries.  Let’s ditch the Facebook slinging match, the before and after shots and the contest for most number of ‘likes’ and ‘shares’.  And while we’re at it, how about accepting that as powerful as our diet is – it is not the cure for every disease or disorder under the sun.

With that in mind, I’ll get back to prepping my utterly non-paleo, yet delicious and healthy dinner.  Legumes, rice, cheese, vegetables – and a sneaky glass of wine on the side.  The perfect salve to my CPOS-riddled brain.

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