Get taste buds tingling the gluten-free way

The word "coeliac" is derived from the Greek word koiliakos, which means suffering in the bowels. The condition was first described more than 1,800 years ago in the writings of the Roman physician Aretaeus of Cappadocia.

Coeliac disease (pronounced see-lee-yak) is an autoimmune disease characterised by a permanent intolerance to gluten, a protein found in wheat, rye and barley.

Most people with coeliac disease can eat oats, but many oat-containing foods are produced in the same place as foods containing wheat, barley and rye, and cross-contamination makes them unsafe. A small number of people are sensitive to pure oats, many gluten-free options are now available.

There are still others who may experience sensitivity to gluten without actually having coeliac disease. However, for the majority of the population, gluten is not an issue.

Following a positive blood test, the most conclusive way to diagnose coeliac disease is by having a biopsy taken from the small intestine. Those diagnosed have no choice but to eat a gluten-free diet, to avoid significant malabsorption and malnutrition.

Absorption
Continuing to eat gluten will result in the immune system responding by damaging the villi in the small intestine, preventing the absorption of vital nutrients such as iron, folate, calcium and vitamin D. The only treatment is adherence to a gluten-free diet and, thankfully, drugs are not required, which means the individual has almost complete control over the condition.

The thought that “a little gluten is okay” is a serious myth. Even very small amounts of gluten can be damaging to people with coeliac disease. It is also important to point out that “wheat-free” is not always “gluten-free”, and that reading labels must become a habit for anyone with coeliac disease.

Another misconception is that "coeliac disease is rare". It is in fact significantly under-diagnosed and is thought to affect one in 100 people. The Coeliac Society of Ireland reports that for each person diagnosed, there are likely to be five to 10 people who remain undiagnosed. This is why you may have heard the condition referred to as the "silent disease".

The classical presentation of coeliac disease is in fact pretty rare. It’s usually more insidious with less obvious symptoms such as anaemia, tiredness, breathlessness, osteoporosis, skin rashes, abdominal discomfort, bloating and cramping, unexplained weight loss, mouth ulcers, tooth enamel problems, numbness or tingling in the hands and feet, and infertility.

Some of these symptoms may be mistaken for irritable bowel syndrome, so it’s easy to see why the condition can go unnoticed.

The risk of the disease is increased in people with a family history of it, with a prevalence of at least 10 per cent in first-degree relatives and approximately 2 per cent in second-degree relatives. So it’s important that all family members get tested even if they have no symptoms, as it is possible to have coeliac disease with no symptoms at all. Even then, it can still damage your health if it goes untreated.

Any age
Traditionally, it was thought that coeliac disease was a paediatric disorder, but symptoms can occur at any age. The peak age of onset is in fact 40-50 years, which may surprise a lot of people. It's thought that the incidence of symptomatic coeliac disease has declined in children as a result of changes in infant-feeding practices.

Coeliac disease is a permanent, lifelong condition. If gluten is introduced back into the diet, the immune system will react and the gut lining will become damaged again. Fortunately, adherence to a gluten-free diet that’s nutrient dense can help heal intestinal damage and promote overall good health and wellbeing.

As diet is the cornerstone of treatment, consulting a qualified dietitian in the field can be of enormous help, especially for the the newly diagnosed coeliac.

Switching to a gluten-free diet is a big change and, like anything new, it takes some getting used to. You may initially feel deprived, but try to stay positive and focus on all the foods you can eat. As the saying goes, when life gives you lemons, make lemonade; just make your lemonade gluten free.

Quinoa Tabbouleh

Serves 4
Ingredients
100g quinoa
400g cherry tomatoes, mixed colours
4 scallions
2 bunches flat leaf parsley
1 bunch of mint
1 cos or 2 little gem lettuces

For the dressing:
Juice of a lemon
½ tsp ground cinnamon
¼ tsp ground allspice
3-4 tbsp olive oil
Salt and pepper

Method
1. Rinse the quinoa and then cook it in boiling water for about 8 minutes till tender. Drain well and place on a flat bowl or plate and stir through the dressing ingredients. Leave to cool.
2. Cut the tomatoes into halves and add to the quinoa and stir through. Leave to stand for a couple of minutes.
3. Thinly slice the scallions and chop the leaves of the parsley and mint. Add these to the quinoa and tomatoes and mix well. Taste, and season with salt and pepper.
4. Separate the leaves of the lettuce, wash and dry them well.
5. Serve the tabbouleh in the lettuce leaves as a starter or as part of a mezze.

Meatballs in Tomato and Ginger Sauce
This is a very easy recipe from Maire Dufficy and a favourite with everyone. Serve with baked potatoes or quinoa and a big crisp green salad. I freeze the meatballs and sauce separately and successfully.

Serves 4
Ingredients

Meatballs
450g minced beef or lamb (I used beef)
1 large onion, finely chopped, sautéed in oil till golden and cooled
1 tbsp scallions, chopped
1 tbsp rapeseed oil with chilli
Black pepper

Tomato and ginger sauce
2-3 cloves garlic
Piece of ginger, the size of your thumb, chopped
2 tbsp cider vinegar
1 tbsp brown sugar
1 tin chopped tomatoes
Black pepper
Handful chopped coriander

Method
1. Mix the mince, onion, scallions, chilli oil and seasoning well together. With wet hands shape into small meatballs the size of a very large walnut. Fry the meatballs in a large pan with a little oil until nicely browned. Set aside while you make the Tomato and Ginger Sauce.
2. Put the garlic, ginger, cider vinegar and brown sugar into the processor and whizz for a minute.
3. Pour the mixture and the tin of tomatoes into a saucepan and bring to the boil. Reduce the heat, add the meatballs and simmer gently for 10 minutes.
4. Season and add coriander just before serving.

Paula Mee is lead dietitian at Medfit Proactive Healthcare and a member of the Irish Nutrition and Dietetic Institute. medfit.ie Tweet @paulamarymee