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WHAT IS GLUTEN?

Gluten is the protein found in wheat. Similar proteins which are harmful to Coeliacs are present in rye, barley and possibly oats.

Wheat, rye and barley are therefore excluded from the gluten-free diet. Oats may be allowed for some patients, under careful medical and dietetic supervision.

CELIAC DISEASE

Coeliac Disease is a life-long inflammatory condition of the gastro-intestinaltract that affects the small intestine in genetically susceptible individuals.

Gluten damages the lining of the small entestine, reducing its ability to absorb adequate netrients from food, resulting in illness which may resemble malnutrion. The treatment for Coeliac Disaese is a strict gluten-free diet for life.

HOW TO START A GLUTENFREE DIET?

Coeliac Disease is the most common chronic boweldisease and still it is not yet very well known. For a long time it was considered to be a children's disease. Today it is clear that Coeliac Disease can appear at any age. When diagnosed as an adult, full recovery may have been difficult. You may have experienced health problems in childhood or adolescence that were due to the fact that you have the genetic disposition to be a coeliac. There is no way to escape it, it is a part of you like the colour of your eyes.

DERMATITIS HERPETIFORMIS

Dermatitis Herpetiformis is an itchy blistering skin eruption, due to gluten sentivitiy. This sensivity also affects the small intestine in the majority of patients, giving rise to a mild form of Coeliac Disease. The gluten-free diet eventually cures the skin rash as well as being the treatment for Coeliac Disease-it should therefore be continued for life.

WHAT IS NATURALLY GLUTEN-FREE?

Many foods are naturally gluten-free as they do not contain any wheat,rye, barley or oats. For example, all fresh meat, fish, cheese, eggs, milk, fruit and vegetables are gluten-free. However, once such foods are processed or used as ingredients in other foods, great care must be taken to ensure that wheat or other gluten-containing cereals have not been added in the manufacture.

REORGANISATION IN THE HOUSEHOLD

Some changes in the daily habits will have to take place. All members of the family have to be informed about what it means to eat glutenfree. If you have a large kitchen things are easier to organize. You will have to store diet products in a separate drawer to avoid any confusion with other food. Do not cut both normal and glutenfree bread on the same cutting board nor with the unwashed knife. Change the cleaning cloth often; there could be breadcrumbs of it from cleaning the table. Remember to use a seperate mixing spoon while cooking with two different pans.

This advice is important as we know by experience that there is still a very small amount of unwanted gluten intake. Wheat is extremely volatile. Shopping will take some more time: it is important to read labels, to know what each product contains. Please be aware that about 80 % of industrially produced food contains gluten.

OBVIOUS DIETARY SOURCES OF GLUTEN

Wheat is usually milled into flour and therefore any food made from flour, such as ordinary bread, biscuits, cakes, pastries, puddings and pies, will contain gluten.

HIDDEN SOURCES OF GLUTEN

Gluten is also cntained in manufactured and processed foods where wheat flour is commonly used as processing aid, a binder, a filler or as a carrier for flavourings and spices. Contamination with wheat or wheat flour can also occur during cereal production, storage, processing or manufacture.

WHAT IS WHEAT STARCH?

Wheat starch is produced from wheat flour by removing the proteins including gluten. Years ago it was believed that all the protein could be removed. It is now recognised that it is technically impossible to remove all traces of protein and a small amount remains.

There are two types of wheat starch:

  • Commercial wheat starch which is not pure enough to be suitable for Coeliacs.
  • Specially-manufactured wheat starch which complies with the International Gluten-free

Standard (Codex Alimentarius) and can safely be included in the gluten-free diet.

Wheat starch of this purity is expensive and it is most commonly used in products specially-manufactured for Coeliacs, to provide palatable and acceptable bread and flour substitutes.

WHEAT FREE, GLUTEN-FREE DIETS

These may be preferable for a few Coeliacs who appear to be intolerant to wheat starch. This diet contains breads and flours made from naturally gluten-free foods such as maize, potato, rice and soya rather than wheat starch.

WHY?

You will ask yourself this question many times. Even if you are used to managing your life in a normal way, there will probably not be as single day on which you don't think: "I am a Coeliac".

Isn't it strange that the most common staple food should suddenly be toxic for a person?

SUPER-SENSITIVITY

There are a few super-sensitive Coeliacs who do not respond fully to a strict traditional gluten-free diet. Such people may therefore be advised to limit their diets further-not only by omitting wheat starch on the gluten-free, wheat free diet, but also by restricting malt extract and malt extract flavourings. Sensitive Coeliacs should additionally avoid oats and oat products. However, further restrictions should not be undertaken lightly and the Society therefore recommends that highly sensitive Coeliacs should discuss their diets carefully with their Consultant Gastroenterologist and Dietitian.

TEACHING/EDUCATION

Information is the key for understanding Coeliac Disease and its correct treatment. This education can be given by any informed person: by a Coeliac Society, a dietitian or a doctor. The main points of information are

  • the indication of a strict need of compliance
  • the correct keeping to the idet.

There is a good chance to realize a reasonable understanding of the diet. Parents of a diagnosed child want the best chances for their child.

Let them know that the best chance is never feeling pity, but enjoying the knowledge about Coeliac disease and the decision to find a new way towards health and strength. As for adults they are grateful, that this long way full of pain and feeling unhealthy has now ended in a simple word: Coeliac Disease. It would be helpful to have another description for it, because Coeliac Disease is no longer a sickness, due to the benefit of the diet.

SPECIALLY-MANUFACTURED GLUTEN-FREE FOODS

Many specially-manufactured branded glutenfree and wheat free products are now produced. For people medically-diagnosed as having Coeliac Disease or Dermatitis Herpetiformis, basic foods such as breads flour, mixes biscuits, crackers and pasta are available on a doctor's prescription.

COELIAC CONDITIONS IN ADULTS-DERMATITIS HERPETIFORMIS

Adults may have the opinion that it is no more worth changing their habits. The diet appears as an obstacle in life. They have survived until now, why turn things upside down?

Diagnosed adults are lucky: their quality of life may increase through the diet to a normal level. Most of adults, following the diet, are ale to recover completly. This also applies to the patients with Dermatitis Herpetiformis. Dermatitis Herpetiformis is a rather rare chronic skin disease. The glutenfree diet is the way to cure it.

The social aspect is also important: diagnosed coeliacs often lose contact with their surroundings. It may be due to the chronic malobsorption that limits their social life.

Coeliac Disease has a variety of symptoms. The diagnosis of Coeliac Disease is often quite difficult. Specialists should be aware that at least 1 out of 300 persons is a coeliac and consider it in diagnosing. The coeliac's family should be checked as well: the heridity is 10-15% in the same family, higher in twins.

COELIAC CONDITIONS IN CHILDREN

Your child is diagnosed and you will be informed about his diet. You will have to follow the rules and you will bring up a healthy, physically adequate person. You are through the difficult time of the child being diagnosed. You may ask yourself: what is special in brkinging up a CD child "What about their mentality" Will my child have the same abilities as the rest of the children?

Parent's worries about the negative influence of the disease upon the formation of the abilities of the child are, to some extent, justified. Studies carried out by psychologists show that the difference is traced only in children who suffered dehtdration during the first years of their life andstarved due to the belated diagnosis of the disease. Additionally, inadequate mental development was observed in children who didn't keep a strict diet after being diagnosed. Those children who were treated with a strict glutenfree diet were and are developing normally.

Children on the diet have to face many problems Those are mostly problems of communication and not of mental development. Psychological reserach indicates a hyper excitability of CD children, without any exception. If the diagnosis waks delayed or if parents disregard or neglect the diet, problems increase. Some of the children who don't keep the diet can become apathetic. There are suspicions that these disfunctions are not only the result of a damage of nervous cells reacting on starvation and poisoning doue to the wrong nutrition, but that they due to stomach pains and digestion problems Is it only the physical condition that influences the child's emotions?

What are the difficulties of parents up bringing a CD child "Does a CD child need any particular approach" None. Keeping a strict diet, the child will develop normally. But daily diet means numerous difficulties in terms oranisation, restrictions and changes of lifestyle. Too ofter parents are not helped with facing the problems of keeping a strict diet. They get exhausted both phsically and mentally.

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