Category Archives: Dietary Restrictions and Modifications

Chile for the Coeliac

Chile for the Coeliac

I was interested to see what gluten-free travel would be like in Chile and here are my tips for the 100% GF traveller to avoid gluten, gluten contamination and stay well.

The Chilean society for gluten intolerance is called Convivir, Fundacion de Intolerancia al Gluten. Use the translate button on your web browser and you will be able to use most of this website. Even without translation the point of sale’’ puntos de ventas’’ section under ‘Links des Interes’ gives a list of shops in Santiago and regional towns where gluten free products can be purchased, in addition to the large supermarkets. A few restaurants are also listed in the relevant section.

Gluten-free breakfast choices include fruit, yoghurt, sliced cheese and egg dishes usually. If you like gluten-free cereal or toast you need to bring your own. Gluten-free street food options are rare as most are wheat -based-  empanadas, sandwiches or even the popular wheat and peach drink! Taking my own lunch and snacks with me each day meant I did not have to search for something to eat. These shopping tips below will help.

Stock up on gluten free alternatives in the larger cities. Look for the ‘’Sin Gluten’’ or ‘’ Libre de Gluten’’ signage/logo on the packaging. Like Australia some of these items are in the health food section along with the sugar-free ‘’Sin Azucar’’ ranges which are not gluten-free so don’t be picking them up by accident. Other items are in the particular aisles such as bread ,cereals or biscuits depending on the shop so look around. Obviously, rice is available in every town but items such as rice cakes, rice/quinoa cakes/corn cakes or gluten free breakfast cereal choices I did not find outside the large cities.

In Santiago I cruised the range of large supermarkets – Lider, Jumbo and Unimark and found that each had slightly different products available. I have attached a range of photos to show you what I found. These were in the Express de Lider on Merced in the fancy area of Bellas Artes(sjown above).

I also downloaded the Convivir list of GF foods (lista de alimentos) and wrote down a few brands to look for in each of the product areas I was interested in before I headed out. Although this list is in Spanish it is easy to translate the food group headings and go from there.

Avoiding contamination: – only buy products with the ingredients clearly listed and a statement advising allergen contamination potential. It will read something like this in Spanish where a range of allergens are listed such as gluten/frutos secos(nuts)/ leche(milk)/ soya(soy)/ sulfitos(sulphites)/sesame(sesame)/mani(peanut) etc. The ingredient list showing GF ingredients  is essential and an allergen contamination statement. The allergen statement will indicate the likelihood of gluten contamination on the production line so study these well and avoid those with the gluten containing grains or gluten listed, see the examples at the end of this article.

Look for the words trigo (wheat), harina de -trigo (wheat flour)-Centeno (rye) -Avena (oats) -Cebada (barley). Gluten is gluten and ‘Gluten Free’’ is Sin Gluten or Libre de Gluten as mentioned.

I found, after checking several supermarkets in Santiago, the following products that I stocked up on.

GF Cereals:- puffed Amaranth , quinoa flakes and quinoa chocolate porridge sachets and a muesli.

GF Bread:- small amounts of Schar range, No Glut or Convida.

GF Snack foods:- some muesli bars/ sweet and savoury biscuits/ and nuts(Lider home brand at Lider supermarkets have an allergen statement that does not include gluten but all other nut/dried fruit brands I saw did, see the photo). I enjoyed some excellent GF vegetable chips by Bika which include beetroot, sweet potato and potato.

Yoghurt- Colun, Fundi and Loncoleche for example display the Sin Gluten logo and were widely available

Some lactose free yoghurt and milk products are available for the lactose and gluten intolerant individual as well and say Sin Lactosa on them in addition to Sin Gluten.

Cold meats: PF brand has items that are labelled Sin Gluten.

Spreads: Being a big peanut butter fan I found this was only available at a couple of large Santiago supermarkets as it was probably provided for expats as it is not eaten commonly by Chileans.

GF Beer: I found this in the Lider Express supermarket in Belles Artes.

Menu Choices/Options

Breakfast:I found that most places I stayed included breakfast in the rate but were without gluten free cereals or bread so I took my own. The fresh fruits, egg and cheese choices were great options and with breakfasts if you are lactose tolerant the milk is usually hot so the quinoa flakes/puffed amaranth I carry with me made a tasty porridge and provided fibre as well.

Snacks: fresh fruit, avocado(palta) or cheese/ham/peanut butter and rice cakes, yoghurt. Some GF muesli bars or biscuits from your stocks.

Lunch: I carried rice/corn/quinoa cakes/crackers and tuna/tomato/avocado/cheese/GF ham and fruit to have for lunch in a little picnic pack that I was grateful I had added to my travel packing. Fresh juices were also often available at street stalls.

Dinners: I used a mixture of restaurant eating and self-catering.

At restaurants there is always rice/potatoes and grilled meats/fish/chicken on the menu so as long as you can communicate the need for items to have been prepared with minimum additions, I kept it to oil and salt in a clean pan, then you will have avoided contamination. The salads available are very plain usually- iceberg lettuce and tomatoes and maybe onion. The dressing choices of oil and vinegar are usually on the table.

Self catering- this was the easiest option I found as fresh ingredients are plentiful and cheap at markets so you can cook GF as normal for a fraction of the price.

Getting your request across in restaurants

I used very simple statements like those shown below at restaurants. I had them written down and they explained 1) the condition and 2) the dish that suits me.

1)  Tengo enfemedad coeliaca y tengo que evitar todo el trigo, centeno, avena y barley y los productos de estos, incluso pequenas cantides

This says: I have Coeliac disease and I have to avoid all wheat, rye , oats and barley and the products of these, even small amounts.

2) Por favour podria tener alguna natural  verduras o ensalada en una olla limpia con nada mas agregado y carne/pollo/pescado cocinada en una sarten limpia con un poco de aceite solamente y nada mas, muchos gracias

This says: Please could I have some natural vegetables or salad in a clean pot with nothing more added and meat/chicken/fish cooked in a clean frying pan with just a little oil and nothing else, thank you very much

You can use translating software to make your own sentence to describe what you would like.

Example food labels – carry your Spanish to English dictionary with you to shop!

Here is a Lider supermarket home brand product declaring gluten and other allergens as ingredients and also that it is made on equipment that processes soy.

 

Here is a label indicating the product is free of gluten as an ingredient and it was processed on equipment handling nuts(frutos secos), soy and sulphites

Enjoy your trip to this amazing country and stay well.

What are the ‘milk’ choices that suit bowel function?

Many people are unsure whether or not they are better off using dairy milk or a dairy alternative. A number of options exist now with more appearing all the time. Dairy milk provides a range of nutrients that other non-dairy milks do not have. Many products add vitamins and minerals to improve the nutrient profile of their product and many don’t so don’t assume you are getting an alternative with a similar nutrient profile.

As a general rule if you are not opposed to drinking dairy milk there are significant nutritional benefits to doing so and lactose-free milk and yoghurt are readily available. There is negligible lactose in hard/yellow cheese such as chedder or parmesan so these can be eaten by those who consider themselves lactose-intolerant.

Lactose-free dairy milk is regular dairy milk with the lactose pre-split by added lactase enzyme so you don’t have to do this in your gut making for easy digestion of this milk. Lactose-free milk meets the digestibility requirement for the low FODMAP diet.

For those who prefer a non-dairy milk there are a range of options that will also meet these digestibility criteria at the serve size listed below though each differs in terms of nutrients like protein and calcium. Take a look at the nutrients per 100 gm on the nutrition information panel and compare the milks you are interested in so you can choose the one with the higher protein and calcium values.

Soy milk made from Soy protein, not whole soy bean  – 250 ml

Almond milk – 250 ml

Coconut milk(UHT) – 125 ml

Macadamia Milk – 250 ml

Oat milk – 30 ml

Quinoa milk – 250 ml

Rice milk-200 ml

Compare the nutrient information for each in the nutrients per 100 gm column on the label to determine how your choice stacks up compared with dairy milk. You may also be surprised at the long list of ingredients on the label of the dairy alternatives that are needed to make these products similar in texture and look to dairy milk.

Some people report that they find A2 milk more digestible than regular milk however it does not meet the digestibility levels required for inclusion on low FODMAP diet lists.

Trying to increase your fibre intake? Try legumes in small amounts in soups

SPICY CARROT AND LENTIL SOUP

2 tbsp Madras Curry Paste

1 tablespoon olive oil

1 onion,diced

1 inch peice of ginger, peeled and finely chopped

1 tablespoon of curry leaves

600gm carrots, peeled and diced

3/4 cup of red lentils

1 litre of stock

1 tin of diced tomatoes

  • heat oil in a heavy base saucepan
  • add onion and LK Paste and cook 2 minutes
  • toss in curry leaves and cook for a minute till aromatic
  •  Add the carrots , stock, lentils and tomatoes and cook for 30 minutes
  • serve with yoghurt if you fancy

Coeliac Disease and Non-Coeliac Gluten Sensitivity

Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.

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Many people the world over find report that they have symptoms ranging from bloating, wind and abdominal distension/pain to diarrhoea and altered bowel habit when they consume a diet rich in wheat-based foods. Wheat (and grain relatives),Rye and Barley contain both gluten and fructans which are both hard to digest for some. It is commonly assumed by most folk that it is the gluten that is the problem because they are unaware of fructans and their potential role.  The assumption is made by these individuals that they have a gluten sensitivity.

The symptoms described above are seen in a range of gut disorders including Coeliac Disease, Diverticular disease or Chrohn’s disease as well as Irritable Bowel Syndrome for example. It is tempting for sufferers to start removing wheat from their diet however the exclusion of Coeliac disease is the important step they miss before doing this. The tests for Coeliac disease will only be accurate if wheat remains in the diet and the body reveals it’s reactions to the wheat in screening blood tests and if required,  biopsies. This will show up as abnormal blood antibody levels which will suggest a biopsy is needed and abnormal biopsy histology results can be discovered if they exist. Without the wheat going through the body the reactions won’t be there in either blood or biopsy and a diagnosis can be missed.

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Once these diseases have been excluded It may be that a trial of a low-wheat/rye/barley diet as part of a more more comprehensive low-FODMAP diet may be used to see if symptoms can be resolved.

It was once thought the exclusion of wheat in non-Coeliacs may aid symptom reduction due to the lower level of fructans. There is now suggestion in the science that it may be a reaction to gluten, different to that shown in Coeliac disease, that may worsen some gastointestinal symptoms in non-Coeliacs and this has been given the term non-Coeliac gluten sensitivity(NCGS).

Watch this space as the story unfolds. Well conducted research trials are few and far between but in the last few years a couple have appeared using subjects with self-reported NCGS that have been well designed to ensure all other causes have been accurately excluded.

The BOTTOM LINE- make sure Coeliac disease is accurately excluded before altering you diet.

If Coeliac disease is confirmed after abnormal blood test results and subsequent biopsy there is a very strict dietary protocol to follow to maintain a 100% gluten-free diet, 99 % is not enough removal for this healing of the gut with this condition.

If excluded the other dietary trials can be started in earnest.

Coffee and digestion – what is the story?

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Some folk with digestive upset swear that coffee does not affect them and others found they had to give up that delicious beverage to reduce some symptoms. Those who experience only constipation find a morning coffee has a beneficial laxative effect.

So your relationship with coffee probably all depends on the type of symptoms you experience.

It is not just caffeine that is the issue so just changing to decaffeinated coffee is not the answer usually. There are a myriad of naturally occurring chemicals in coffee that make it taste as it does and many of these may act on secretion processes in the gut, increase inflammation and intestinal content movement. Remember too that our love of coffee and strong coffee at that has increased enormously in the last five years and many guts are feeling the consequences.

Actual scientific evidence is variable though probably due to the different effects on different gut segments. It is known however that drinking coffee makes stomach symptoms worse in general – it can lead to inflammation of the stomach (gastritis) as well as making reflux (gastro-oesphageal reflux) worse. The laxative effect of coffee makes those with rapid gut transit /diarhoea symptoms worse though as mentioned above constipated individuals benefit from this. Coffee itself is however low in FODMAP’s it may be that you can include some in your daily plan…so again, it depends on your individual symptoms.

I am often asked ‘How do I know if coffee affects my symptoms?’ . The simple answer is to do a two week trial and see what happens, a diary helps. This is not as hard as it sounds as because chances are you are feeling off with digestive symptoms and a if a limited time without coffee could see some improvements most people manage this. If that is too much try just one fairly weak cup per day and have it with food, not on an empty stomach. Alternative hot beverages include black/milk tea , lemon and ginger tea or chamomile tea for example.

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Diet for Digestion-the internet version of dietary restrictions-help!

An internet search for a few minutes on the topic of digestive health suggests your diet is to blame for many of your gut symptoms. The list below shows some of the common food and drink items that are to blame, according to ‘Dr Google”. The internet is a wonderful source of information and mis-information and the dietary restrictions list below came from my brief search on this topic.

Excluding coffee, tea, alcohol, fibre, meat, soy, carbohydrate, dairy/lactose, honey, fruit/fructose, wheat, rye, yeast, legumes, onion, garlic, sugar,processed foods, artificial sweeteners are general results.

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Many people with digestive symptoms start omitting one food or group of foods and when symptoms don’t improve they omit another food group and so on until their diet includes a very small range of foods. Eating such a small range of foods makes meals repetitive and not very enjoyable. Nutrient needs will not be met and over time health deteriorates further.

Is there another way to ease digestive distress?

Yes, get an organised diagnosis plan to exclude underlying disorders and take it from there. An Accredited Practising Dietitian(APD) with a digestion interest will help you put this together and work out which dietary restrictions may be required to manage your symptoms and for how long the restrictions should be followed. If you live in Perth come contact me for an appointment or

 

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Fibre and your Bowel

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The fibre content of your diet refers to the part of what you eat that is the carbohydrate fraction of your diet resistant to the digestion and absorption in the small bowel. Some types of fibre are called polysaccharides, oligosaccharides and lignins. The dietary fibre part of our diet promotes actions that are laxative (increasing movement of bowel contents) ,improve our bodies blood glucose response after eating, lower blood cholesterol as well as promoting the action of gut bacteria to make substances that improve bowel health.

Fibre types vary in the degree to which they will be fermented in the large intestine by the action of the bacteria there so some result in a lot of wind production and others less so. Because of this the use if high fibre diets or fibre supplements to treat constipation may cause bloating and pain if the fibre type is a fermentable one such as wheat bran or psyllium. The low FODMAP plant foods and the non-fermentable fibres found in the Sterculia plant (Normafibe supplement) and Methylcellulose (Citrocel) can improve symptoms of constipation more gently.

Those with diarhoea-dominant bowel symptoms may need a total lower fibre intake and some other dietary modifications to slow the transit of gut contents.

Modifying the types of fibre in your diet can assist to control your bowel symptoms and sorting out which diet and supplement best suit your condition can be very helpful.

 

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What are FODMAPs ?

FODMAP stands for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols!!! These are a large groups of mostly naturally occurring carbohydrates which can be poorly absorbed in the small intestine and fermented in the large intestine by the bacteria there. You may know them by names such as fructose, lactose, Sorbitol, Mannitol or Isomaltose to name a few.

Research suggests limiting the diet in FODMAP-rich foods can reduce the symptoms that plague sufferers of Irritable Bowel Syndrome (IBS) including reducing the altered bowel habit(diarrhoea/constipation or both), bloating, excessive wind and abdominal discomfort/pain. With the help of an Accredited Practising Dietitian(APD) a low FODMAP diet trial can be arranged to suit your individual lifestyle so that you can comply with the recommendations and see if this approach offers you symptom relief.

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