When stress causes gluten intolerance and how to handle it

Gluten free aisle in a supermarket. Source: Flickr. com.
Gluten free aisle in a supermarket. Source: Flickr. com.

Serendipity is defined as the faculty of making fortunate discoveries by accident. This week has indeed been a case of serendipity.

Recently, I visited some dear friends and, during the course of our animated conversation, they mentioned that their daughter Mary had just discovered that she suffers from coeliac disease, or gluten enteropathy.

According to Mary, she had been feeling ill every time she ate something for so many years that she preferred to starve rather than to suffer the nausea, severe stomach cramps and diarrhoea that usually followed meals. What Mary and her family wanted from me, was information on how to handle her newly diagnosed illness and tips on how she should try to regain all the weight she has lost.

By fortunate coincidence, I received an ADSA (Association for Dietetics in South Africa) e-mail shortly after my visit, which contained an article written by a dietetic colleague called Gabi Steenkamp. In this article, she gives the lowdown on gluten-free foods. Hence the serendipity!

Gabi Steenkamp is one of our leading experts on the glycaemic index (GI) and has written a number of books, together with dietician Liesbet Delport, on "Eating for Sustained Energy".

Gabi's information on gluten-free foods is so relevant and useful that I would like to share some of her advice and tips on eating a gluten-free diet with readers who are struggling with gluten/wheat allergy, sensitivity, or intolerance, or coeliac disease.

Intolerant due to stress

Gabi points out that, while a small percentage of the population suffers from gluten allergy or coeliac disease, many more people have become gluten intolerant due to stress. According to Gabi, stress compromises the integrity of the gut, which can cause gluten intolerance with bloating, cramps and nausea after eating gluten-containing foods.

Gluten allergy/intolerance can produce the following very divergent symptoms, depending on the individual's reaction:

  • Symptoms of the digestive tract – cramps, bloating, winds, diarrhoea.
  • Symptoms of the skin - rash, eczema, itching, swelling or hives ("galbulte" in Afrikaans).
  • Symptoms of the respiratory tract – swelling of the throat, the bronchi and lungs, causing breathing problems and production of mucous.

The gluten-free diet

The safest advice to anyone suffering from gluten allergy/intolerance is to avoid all foods that could remotely contain any wheat, rye, barley, oats, spelt or kamut.

Because we live in a world that runs on processed foods that are loaded with wheat or wheat derivatives, this leaves the gluten-sensitive person with the following foods that he or she can eat:

  • Meat, fish, eggs, milk, yoghurt, cottage cheese, other cheeses, maas or sour/fermented milk, and yoghurt
  • Fresh and dried fruit and vegetables
  • Maize meal, maize grits, sorghum meal (Maltabella) and rice, plus baked products and sauces that have been made with rice, maize flour (maizena), potato flour, soya flour or gluten-free flour
  • Gluten-free bread, which is available at Woolworths, some other supermarkets and health shops
  • Legumes (dry, canned or cooked beans, peas, lentils and soya products like tofu) – always check the processed legume products for added wheat (e.g. sauce thickeners used in canned beans or soya products)
  • Fats and oils

Foods to avoid

  • All wheat/rye bread, rolls, cakes, pasta, biscuits, pastries, tarts, snack foods
  • Most processed foods and ready-to-eat meals
  • All breakfast cereals that contain oats or wheat
  • Foods with labels that list words such as: wheat, gluten, malt, starch, modified starch, thickener, stabiliser, flour, wheat germ, wafer, biscuit, shortcake, food starch, semolina, breadcrumbs, batter, binder, rusk germ, wheat germ, germ oil, whole grain, whole wheat
  • Individuals who are also allergic to bran (which doesn't contain gluten per se), may also have to avoid foods labelled as containing bran, wheat bran, oat bran, digestive bran and miller’s bran.

Gabi’s tips

Gabi has many useful tips for patients with gluten allergy/intolerance. Here are a few:

Baking a) Use gluten-free flour for baking
Use gluten-free flours, namely maizena or corn flour (which is made from maize), maize or mielie meal or corn meal, potato flour, rice flour, soya flour and gluten-free flour.

The following table shows how you can substitute these flours for wheat flour in baking:

VolumeSubstitute flourComment
250mlMaizena or corn flourNot suitable for diabetics
185mlMaize meal/maize/corn mealNot suitable for diabetics
150mlPotato flourNot suitable for diabetics
200mlRice flourNot suitable for diabetics
150mlRice flour plus 80ml potato flourNot suitable for diabetics
250mlSoya flour plus 175ml potato flour 
375mlSoya flour/gluten-free flour 

(Steenkamp, 2009)

b) How much liquid to add to gluten-free flour

Gabi emphasises that when you bake with gluten-free flours, it can be difficult to determine how much liquid to add, so add the liquid slowly until your dough has the right consistency. You may have to experiment until you achieve the right ratio of liquid to gluten-free flour (remember to make a note of the volume of liquid you use for future reference).

c) Preparation of tins

Gabi advises that gluten-free flour mixes tend to stick to baking tins, so you will need to grease the tins with oil and dust them with corn starch (maizena). Another option is to line the tins with wax paper and grease and dust with maizena.

d) Baking times

Bake cakes and breads made with gluten-free flours slowly at a slightly lower oven temperature. Your finished product may not brown as well as a wheat product.

e) Raising agent

When baking with gluten-free flours, you will have to use slightly more raising agent than normal. Gabi recommends using 2 ½ teaspoons of baking powder per cup of gluten-free flour.

f) Storage

Bread and cakes baked with gluten-free flours tend to be very crumbly, so store in the fridge or slice and freeze in portions which can then be defrosted when required.

Sauces and crumbs

To thicken sauces, gravies and puddings, Gabi recommends that each tablespoon of wheat flour should be replaced by ½ tablespoon of corn flour (maizena) or ½ tablespoon of potato flour. To avoid having to use breadcrumbs, use crushed cornflakes or crushed potato crisps instead.

Tips for diabetics

Diabetics with gluten allergy/intolerance should be careful when using gluten-free flours. Except for soya flour, which has a low GI, all the others are high-GI foods. To lower the GI of baked goods made with gluten-free flour, diabetics can use skim or low-fat milk or yoghurt as the liquid in the recipe.

Weight gain

If you have a gluten allergy/intolerance, you may be underweight. I checked some of the liquid meal supplement and energy booster pamphlets in my library and found that the Nestle Nutren 1.0, Nutren Fibre, Peptamen, Nutren Junior and Peptamen Junior liquid meal supplements are gluten-free. Other carbohydrates such as potato starch and corn syrup have been used instead of wheat-based starches to provide carbohydrate in the formulas.

Always check the labels of liquid meals supplements for weight gaining to see that they don't contain wheat.

Contact details:

Contact Gabi Steenkamp on info@gabisteenkamp.co.za. Alternatively, send your questions to DietDoc.

Read more: 

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