Gluten-free living: Practical solutions for the busy family

Dietitian Bronwen King has useful shopping and cooking advice for people who need to avoid gluten.

A member of your household has just been diagnosed with coeliac disease. Your life is hectic enough as it is without having to learn a whole new way of selecting and preparing food. You think of all the foods you won’t be able to use and start to melt down.

This scenario is all too familiar for New Zealanders as more and more of us are diagnosed with coeliac disease. Put simply, this disease means you are sensitive to gluten (the main protein found in wheat and several other grains) and have to eliminate it totally from your diet for life. This is where the problem lies; so many products on our supermarket shelves contain flour or other forms of gluten, even those we least expect (like stock cubes!). Learning which foods you can safely use, and how to adapt recipes to be gluten-free, is the key to staying sane.

Getting started

Before you rush ahead and make changes, make sure you really do have coeliac disease. A suggestion by an alternative health therapist is not enough to turn your life upside down. A small bowel biopsy organised by your doctor is necessary to confirm a diagnosis. Then you can begin your journey towards living gluten-free.

Step 1: Identify foods you can eat

What is gluten?

Gluten is a protein that occurs naturally in some grains, particularly wheat, rye, triticale, barley and possibly oats. There is conflicting research about whether oats can be eaten safely on a gluten-free diet; for this reason oats are usually grouped with the grains containing gluten.

Grains containing gluten are used as ingredients for a wide range of prepared and commercial foods. Wheat flour alone is found in thousands of products. Any product containing even tiny quantities of gluten must be totally avoided by people with coeliac disease; it is not a matter of ‘a tiny amount won’t harm’.

Foods containing gluten

While it is obvious certain products contain gluten (breads, pastries, cakes, muffins, biscuits, cereals and pasta), there is a large number of products where it is not so obvious. There are several ways to learn about which foods contain gluten:

• Visit a dietitian. They will talk you through any concerns and point you in the right direction with food. This is a very important first step for anyone newly diagnosed with coeliac disease.
• Contact the Coeliac Society of NZ (see www.coeliac.co.nz). This society aims ‘to improve the awareness and understanding of the disease within our community and to promote and improve the quality and supply of gluten-free foods available through the food chain. As well as useful advice about gluten-free foods, it also lists eating establishments throughout New Zealand that serve gluten-free food.
• Explore the gluten-free section of your supermarket. Because of increased demand for gluten-free foods, most supermarkets have a section devoted to them. Products include bread, muffin, pastry and pancake mixes, flour, stock powder, soy sauce and many other alternatives to commonly used foods containing gluten.
• Read food labels. All food labels must contain an ingredient list. Once you know what to look for, this is another way to check if the product contains gluten. Avoid products containing:
  – wheat, flour, wheat starch, wheat germ, wheat bran, enriched wheat flour, bulgar, spelt, durum, couscous, semolina
  – oats, oatmeal, oat bran, oat flour, rolled oats
  – rye, rye flour
  – triticale, triticale flakes
  – barley, barley flour, barley flakes
  – cereal, flour, bran, some types of hydrolysed vegetable protein, starch, hydrolysed plant protein (often found in stock cubes), modified food stach, cornflour made from wheat
  Food additives listed as numbers can be worrying. Most of these do not contain gluten, but modified starches (1400-1450) are of most concern; if they contain gluten it should be specified on the label.

Gluten-free grains, flours and their products

• Corn
  Corn-based breakfast cereals
  Polenta
  Unflavoured popcorn
  Taco shells, unflavoured corn chips
  Cornflour made from corn or maize
• Rice
  Rice
  Rice flour
  Rice breakfast cereals
  Baby rice cereals
  Rice bran
  Plain rice crackers / cakes
  Plain rice noodles
• Other grains and flours
  Wild rice
  Sago
  Tapioca
  Buckwheat
  Potato flour
  Arrowroot
  Millet
  Amaranth
  Quinoa
• Flours made from legumes
  Soy flour
  Yellow split pea flour
  Chickpea flour

Products that may contain gluten

• Baked beans/creamed corn
• Baking powder
• Crumb coatings for meat, fish or poultry
• Sausages
• Processed meats
• Soups
• Stock cubes/powder
• Sauces
• Gravies
• Dressings/mayonnaise
• Products containing malt such as breakfast cereals, malted milk drink powders
• Maltodextrin (this can be made from rice, corn, potato or wheat starch)
• Cornflour (check it comes from corn rather than from wheat)
• Custard powder
• Curry powder
• Mustard
• Cocoa, drinking chocolate, cooking chocolate
• Beer, lager
• Some beverages
• Some modified starches or thickeners
• Coffee substitutes

At the end of the day, we are reliant on manufacturers to tell us if there are gluten-containing ingredients in a product. If in doubt, contact the manufacturer, your local Coeliac Society or a dietitian.

What’s left to eat or drink?

There is a tendency amongst people newly diagnosed with coeliac disease to focus on and grieve for the foods they cannot have. While that’s natural, a more positive approach is to focus on the foods you can eat. There is a whole world of delicious gluten-free ingredients that can make for a very satisfying diet.

Once you have identified the foods you can eat, the next challenge is to put them together in a way that is satisfying, delicious and nutritious. This means understanding the new gluten-free ingredients you are substituting and how they work.

Eating out

Because of increasing interest in gluten-free foods, more and more cafés and restaurants are providing gluten-free options and clearly identifying them in menus. If gluten-free options are not identified, don’t be afraid to ask; most chefs are only too happy to keep customers happy. The Coeliac Society of New Zealand has a comprehensive list of eating places that provide gluten-free options.

Step 2: Learn to cook the gluten-free way

Wheat flour

The greatest challenge to cooking without gluten is finding a suitable replacement for wheat flour. This is because wheat flour gives particular properties to foods which can be difficult to achieve with gluten-free substitutes.

There are three key functions of wheat flour in recipes:

1.  Structure

It’s the gluten in wheat flour that makes it so ideal for bread and other baked products. Liquid added to flour causes the gluten molecules to join together to form a rubbery elastic mass. This mass has the capacity to stretch and rise due to the action of baking powder or yeast. As such, it provides a structural framework on which other ingredients are held. Flours without gluten do not provide the same elastic matrix for the structure and textures we associate with bread and baked goods.

For one cup of wheat flour in baking, substitute:

• 1/2 cup soy flour plus 1/2 cup either potato flour, cornflour or arrowroot
• 1/2 cup soy flour plus 1/4 cup potato flour plus 1/4 cup rice flour
• 1/2 cup rice bran plus 1/4 cup rice flour plus 1/4 cup arrowroot

2.  Thickening/binding

Flour is often used to thicken or bind products such as soups, stews, batters or sauces. In most cases cornflour, arrowroot or potato flour can be used instead.

For two tablespoons of wheat flour, substitute: 1 tablespoon cornflour, arrowroot or potato flour

3.  Coating

Flour is often used to coat products like fish or schnitzel before dipping in egg and crumbs. It forms a good base for the egg and crumbs to cling to. Corn or rice flours work well as a substitute here.

For 1/2 cup of wheat flour, substitute: 1/2 cup cornflour or rice flour

Wheat flour substitutes

Cornflour

While this should be made from corn or maize, many versions are actually made from wheat. Check the label to ensure you buy the genuine article. Cornflour is best used for:

• Thickening; because cornflour has greater thickening ability than wheat flour, when substituting use half as much (1 tablespoon cornflour for 2 tablespoons flour)
• In baking; while not good by itself as a substitute for flour in baking, a combination of cornflour plus another gluten-free flour such as rice or soy flour works well. It is good used in sponge cakes.

Rice flour

This can be used in muffins, biscuits and some cakes. Recipes may require more liquid and may take longer to bake and the end result is slightly drier and more granular.

Soy flour

This has a strong taste when raw but this flavour is largely lost during cooking. It is best combined with cornflour in biscuits, chocolate cakes and fruit cakes.

Potato flour

This is very good as a thickener. It also works well combined with cornflour in biscuits or sponges.

Step 3: Put it all together

Once you know the foods you can use and understand how to prepare them, the next stage is putting them all together in a way that is tasty and healthy. Here are some meal ideas:

Breakfast

• Rice-based cereal with fresh fruit and yoghurt
• Gluten-free toast topped with poached egg, grilled tomatoes and mushrooms
• Pancakes made with gluten-free flour, fresh fruit and yoghurt
• Gluten-free toast topped with tuna and tomato
• Fruit smoothie made with low-fat milk, fresh fruit and yoghurt
• Porridge made from polenta or rice flakes, topped with dried fruit and nuts and served with trim milk

Lunch

• Baked potato topped with ham, cheese, pineapple and spring onions
• Poached egg on gluten-free toast, topped with avocado and tomato slices
• Lentil and vegetable soup with gluten-free roll
• Vegetable frittata with salad

Dinner

• Stir-fried chicken, beef or pork with vegetables and rice noodles
• Grilled lamb chops on potato and kumara mash with tomato and cucumber salad
• Gluten-free pasta with bacon, tomato and olive sauce and salad
• Spicy dhal and rice
• Smoked chicken and avocado salad
• BLT sandwich using gluten-free bread

Something sweet

• Fruit salad
• Fruit yoghurt
• HFG orange and almond cake
• Dried fruit and nuts
• Fresh melon or pineapple
• Gluten-free fruit muffins

How to adapt recipes

Identify the ingredients containing gluten in the recipe and substitute with a gluten-free equivalent. Here are some examples:

Date and walnut loaf

1 cup boiling water
1 cup (180g) dates, chopped
1 teaspoon baking soda
2 tablespoons low-fat spread
1 egg, beaten
1/2 cup chopped walnuts
3/4 cup brown sugar
1 1/2 cups plain flour – replace with 3/4 cup soy flour, 1/3 cup rice flour and 1/3 cup potato flour OR 1 1/2 cups gluten-free baking mix
3 teaspoons baking powder – use gluten-free baking powder

Beef schnitzel

4 (around 500g) beef schnitzels
2 tablespoons flour – replace with cornflour or potato flour
1/2 teaspoon salt
1 egg, beaten
1 cup dried breadcrumbs – use gluten-free version of fine polenta
2 tablespoons oil

Chicken curry

1 tablespoon oil
2 garlic cloves, crushed
1 onion, chopped
1 teaspoon grated fresh ginger
1 tablespoon curry powder – use gluten-free version
1 teaspoon chicken stock powder – use gluten-free version
1 cup water
500g chicken breast
1 tablespoon plain flour – replace with 2 teaspoons cornflour or potato flour
2 cups green beans (fresh or frozen)

HFG tip

Experiment with gluten-free baking mixes from your supermarket. The more you use them, the more confident you’ll be.

Coeliac disease – not just a pain in the gut?

Gut problems – bloating, diarrhoea, pain and vomiting – are accepted as the main symptoms of coeliac disease. But there’s another view that coeliac disease may cause other problems too, suggesting many sufferers may be going undiagnosed.

Christchurch paediatrician Dr Rodney Ford’s book, The Gluten Syndrome: Is Wheat Causing You Harm?, challenges the mainstream view by suggesting coeliac disease is not the only health problem caused by gluten  intolerance. Dr Ford believes gluten-free diets can resolve eczema, tiredness, lethargy, constipation, diarrhoea, behavioural problems and even headaches. However, without scientific trials to back this view, Dr Ford’s theory has received little support from the medical community.

Still, recognition of the widespread problems caused by coeliac disease is growing. A recent review published in the Journal of the American Dietetic Association acknowledged that a number of non-gastrointestinal health problems, such as neurological and fertility problems, may be caused by coeliac disease. It’s also possible for these symptoms to be present for a considerable length of time before coeliac disease is diagnosed. In fact, individuals with significant non-gastrointestinal symptoms and only mild gut problems on average suffer for 10-12 years before their condition is diagnosed.

So while Dr Ford’s ‘gluten syndrome’ theory remains unproven, the acknowledgement by the medical community that coeliac disease has widely varying symptoms and is difficult to diagnose suggests there is indeed more to this problem than meets the eye.

The bottom line

Despite the fact you need to take more care when switching to a gluten-free diet, it’s not the end of the world. There is a huge variety of tasty and nutritious foods that make gluten-free eating achievable and enjoyable. Once you are familiar with foods you can eat and feel comfortable in choosing, preparation and presentation, the rest is plain sailing. And don’t forget the benefits you will receive from the extra food and nutrition knowledge you gain on your journey!

Gluten-free dinner recipes

• Poached chicken with chilli, lemon and mint
• Roasted eggplant and kumara stew
• Pork steaks with apple and walnut slaw
• Peppered steaks with caramelised onions and herbed potatoes
• Lentil and ginger stew

Or search under Nutritional requirements/Gluten-free in this website for many more coeliac-friendly recipes.