Many people suffer from chronic pain from stomach upsets, muscle cramps or joint pains, or other seemingly unshakable complaints that seem to have no cause. Surprisingly often, eliminating gluten from the diet results in a marked improvement - even the complete elimination - of ailments of many years' standing. Even certain mental disorders, such as schizophrenia, have been found often to improve under a gluten-free regime.

Gluten intolerance is also known as gluten-sensitive enteropathy, coeliac disease, non-tropical sprue, coeliac sprue, primary malabsorption and ideopathic steatorrhoea.

Symptoms of gluten intolerance

NOTE: This list is not exhaustive. You don't need to have all the symptoms - if all sufferers had all the symptoms, it would not be so often unrecognised, and there would not be so many people walking around unaware that they are gluten intolerant. So, if you have one or two of the symptoms listed, you may be gluten intolerant. If you have more than two, you are a strong candidate for gluten intolerance, and four or more indicates you are a very strong candidate indeed.

• abdominal distension
• irritable bowel
• stools which are pale, bulky, greasy and smelly
• diarrhoea
• headache
• nausea and vomiting
• poor appetite and drowsiness after eating
• muscle cramps and spasms
• bone or joint pains
• anaemia, with weight loss
• any of the above symptoms flare up under stress
• obesity
• rarely, oedema or constipation

Undiagnosed, the condition can lead to neurological disorders, intestinal ulceration and even intestinal cancer. Other medical conditions which may be linked to gluten intolerance include: Autism, Depression, Dermatitis Herpetiformis, Diabetes, Infertility, Multiple Sclerosis, Regional Enteritis, Rheumatoid Arthritis, Schizophrenia and Sjgren's Syndrome.

Diagnosing gluten intolerance

Because gluten is an insoluble antigen, gluten intolerance cannot be demonstrated by skin testing. Most of the methods available to doctors involve more or less intervention. However, if you wish to avoid time-consuming, uncomfortable and potentially expensive procedures, it is possible to diagnose by means of an elimination diet. However, many people who are gluten intolerant are also intolerant to lactose in milk, so to test for gluten intolerance, it is necessary to eliminate both gluten and dairy products for a period. If the symptoms recede, reintroduce a small amount of gluten to the diet, but not dairy products. Then, if symptoms return, stop gluten again for a couple of weeks before reintroducing dairy products.

Watching out for unexpected gluten

Gluten is found in wheat, rye, triticale, and to a lesser extent in oats and barley. You might think, then, that so long as you avoid pastry, bread, pasta and similar products made from flour, you would be safe. You would be wrong.

Gluten is used in many products that don't look as if they contain flour. In fact, in many cases, even looking at the label will not alert you to this, unless you know what to look for. One way in which wheat and wheat products may be described is as starch: modified starch, food starch, modified food starch, and similar descriptions. But often ingredients noted merely as 'emulsifiers' or 'stabilisers' are also wheat-derived.

Some examples of hidden gluten:

Most people know that the British sausage contains breadcrumbs - except the most high class variety of butcher's sausage, and even in this case it's quite likely (the bread is one of the ways in which the texture of the sausage is obtained, without including an unacceptably high proportion of fat).

Crab sticks are a product that on the surface looks as if it is made entirely of fish. Turn the pack over, though, to look at the label and you will often find wheat flour or modified starch listed in the ingredients.

Some drinks contain gluten as a thickener, to provide 'body'.

Wheat flour may be a hidden ingredient in ice cream, ketchup, mayonnaise and instant coffee.

Grated cheese may be coated in flour or modified starch to stop it from sticking together in the packet.

Obviously, anything coated in batter or breadcrumbs contains gluten in the coating.

Monosodium glutamate, known to Chinese cooks as 'taste powder' or 've-tsin' is manufactured with gluten. This ingredient is very frequently included in factory-prepared goods, but may not be listed on the label - or merely described as a 'flavour enhancer'.

Although wheat germ does not itself contain gluten, because of the process of separation employed in manufacture, it is likely that a small amount of gluten will be present in wheat germ sold in the stores.

Malt and malt extract are derived from wheat, and can be a hidden source of gluten.

Any alcoholic drink made from grain - beer or whisky, for example - is a hidden source of gluten.

Even medicines may contain gluten, used as a thickener or a binder.

Living without gluten

Nowadays, there is a good number of gluten-free products on the supermarket shelves, but obviously the range is pretty small in comparison with what is available to gluten-tolerant shoppers, and usually expensive, as well. For example, a loaf of gluten-free bread will most likely set you back up to ten times the price of the standard product - and to my mind, it is not 'toothful'; the texture just isn't right, due to the lack of the elastic properties which the gluten normally provides.

I'm gluten-intolerant myself, and have spent a bit of time trying to find good products. One I definitely recommend is from Real Foods Pty in Australia: Corn Thins. These are very tasty, definitely a big step up from the ubiquitous rice cakes (which to my mind taste more like polystyrene than food - and they SQUEAK!). Corn Thins come in several varieties and they're nice with jam, with sliced meat, or whatever you like. For availability, check out their website at www.cornthins.com to find suppliers in your area.

And if you're out and about and fancy a coffee, some branches of Starbucks sell a very acceptable gluten-free chocolate cake (I know for sure the one in Edinburgh's Waterstones does).

Happy Cooking!

2005 Frann Leach