Category Archives: Gluten Free Rantings

The gluten-free prescriptions row: so where are my doughnuts?

I’ve been a little busy the last few months with other projects, so haven’t been posting here so much. However, with the recent spate of sensationalist articles courtesy of our dear, well-informed friends over at the Daily Mail, I feel compelled to respond.

First we had the article that claimed that gluten free foods on prescription are costing the NHS £116m a year. The correct figure is actually £28m according to Coeliac UK, who wrote this letter to refute the Mail’s claims and demand a correction (which they did). Turns out the GP quoted in the article was mis-quoted as well.

That wasn’t enough to make the Mail shut up about coeliacs bankrupting the NHS. Far from withdrawing with good grace, they trotted out Dr Max Pemberton (who is not, by the way, an expert on coeliac disease) who wrote  another diatribe today. I don’t know where Pemberton is getting his information from here about all these NHS-funded gluten free cake sprees, but what I want to know is where the hell are my doughnuts? I never saw those on any prescription lists. Is doctors’ pay so bad these days that Pembers is stashing bulk supplies of gluten-free contraband to sell on the black market to coeliacs desperate for a sugar fix?

The usual “food intolerances are bunkum” stuff appears, citing the obligatory anecdote about a “friend” who claims an intolerance to something but then will go right ahead and eat something they like containing the supposed offending ingredient, in this case chocolate biscuits when claiming a lactose intolerance.

OK Max, I kind of agree with you on that one – it annoying. But your chocolate biscuit-munching friend wouldn’t be able to get anything on prescription, so why the hell does your anecdote about her stupidity appear here?

Just to make it crystal bloody clear to Mail readers and anyone else suffering from chronic ignoramusitis, you can’t get prescriptions for gluten free food if you have not been medically diagnosed with coeliac disease. People with gluten intolerances (leaving out the debate about whether intolerances are real, imagined or otherwise) DO NOT GET THEM. I repeat, DO NOT GET THEM. You cannot go to a kinesiologist or have skin/hair/toenail clipping analysis and then demand gluten free food from the NHS.

If you’re coeliac, it’s a postcode lottery as to what you get or whether you get anything at all. Some of it is just so damned awful that those of us with the money to choose won’t bother with it and we’ll go and buy the brands we do like. But given the increased cost and lower availability of gluten free foods, it’s vital to be able to get some staples if you are on a low income or live in a remote area, as Alex Gazzola’s response to the Mail farce points out. And it isn’t our fault that the companies supplying this stuff charge the NHS an arm and a leg. Maybe all the NHS Procurement departments need to join up and negotiate some better deals.

Not to let the Mail off the hook, but there is misinformation coming from Coeliacsville as well. Some coeliacs talk about gluten-free bread and substitute products being “medicine” – well they sure as hell aren’t, but unfortunately giving them on prescription gives this impression. Most of these subsitute products, even if they are fortified, are still full of added sugar and additives to make the shelf life longer. They are often higher in calories than their wheat counterparts. Really, we would be better off getting those nutrients from naturally gluten-free foods and having gluten-free subs as more of an occasional treat. I’m just as partial to the odd gluten-free Genius croissant as anyone, but it sure doesn’t take a genius to work out that they’re not something you should be eating every morning for breakfast.

I saw one coeliac Mail commenter claim that coeliacs don’t absorb nutrients properly and that’s why we need the prescription stuff. While that’s true of undiagnosed coeliacs, most will regain this after a period of time on a GF diet, unless you’re one of the unlucky refractory coeliacs. GF substitute products are not magic foods that can overcome malabsorption – if you are not absorbing nutrients, you won’t absorb them no matter which way you take them in and you will need further treatment.

It’s a bugbear of mine that there isn’t sufficient support and nutrition education for coeliacs post-diagnosis, which leads to some of the above misconceptions. It’s a shame that a diagnosis of CD isn’t seen as an opportunity to help people lead healthier lives, educating about proper nutrition, even gluten-free cooking classes, rather than just shoving a prescription for some nasty white “bread” at us and waving us off, thankful that’s another patient off the gastroenterology list.

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After the fray

I published an article on Monday on the Guardian Comment is Free, on my personal take on the new allergy laws. As a coeliac, it’s something I welcome, as I said in the article. But boy, was there some backlash. One chef even emailed me personally with a link to his blog where he had trashed me and my piece (yep, I know – creepy) and then proceeded to make derogatory comments on Twitter. I do regret that my article didn’t provide enough clarity that my mention of Michel Roux Jr. (as opposed to Albert, who did sign the Telegraph letter) was due to a BBC Food and Drink feature that I’d written about on this blog last year. I saw the Telegraph letter as a continuation of the same dismissive attitude towards those with allergies and illnesses, which is why I made the link.

However, with hindsight, I can see that neither I nor the editors made that clear enough (particularly with the inclusion of a massive photo of Michel Roux Jr!) and I left myself open to accusations of being sloppy or not checking facts. Even when I’d done my “below the line” response and the Guardian had amended the article to mention Albert, rather than Michel, some people just couldn’t let it go. I’m not going to expose the person in question – it’s not my style to trash individuals on a public forum, I’ll leave that to those who don’t have any journalistic ethics. But it has taught me something about resilience, and it has certainly taught me to try and look at what I write with a more dispassionate eye.

Sometimes, as a writer you can get so caught up in things, particularly when you’re passionate about your subject and it affects you personally, that you forget to look at your work with a reader’s eye. As an editor, I’m used to doing this, but it’s harder to do it with your own work.

Now I’ve been on the sharp end, I’m more inclined to be sympathetic with other journalists. We’re human (something I wonder if those people who leave the nastier, more personal comments and tweets actually remember) and we do make mistakes, we don’t always get it right. That’s why having a world below the line is a good thing – it keeps us accountable.

I do engage below the line, because I think it’s part of the deal nowadays, a journalist can’t pretend to know everything and be the last word. I think I’ve got a bit more sympathy with the industry now as well, mainly from reading some of the more reasonable comments and accounts from chefs, servers and restauranteurs and hearing their side.

Yes, I think that some of the celebrity chefs who signed that letter are still being rather precious over it, but I can’t deny that for the ordinary restaurant owner, the new regs might be a bit scary. Nobody wants to get sued, and the vast majority of decent professionals would not want to make someone ill. Although I do think there are still some deniers out there who would happily sneak flour in the food of someone who asks for gluten free, just to prove a point, and that’s why this debate needs to be had. It’s not a bad thing that it’s all coming out in the open – better that than ongoing seething resentment on the part of chefs and diners alike.

Junk Food Kids – never mind who’s to blame, what are we going to do?

I’m not usually one for “shockumentaries”, but I did watch the recent Junk Food Kids series on Channel 4.

The verdict was fairly unanimous – parents are to blame for childhood obesity and soaring levels of dental decay. A victory for the neoliberal cult of personal responsibility and “poor lifestyle choices”.

Although there was negligence, particularly on the part of the parents who didn’t bother with their kids’ dental hygiene (one mother seemingly couldn’t be bothered to get her child to a dentist or insist on her brushing twice a day, because she’d rather watch Peppa Pig) I can’t say that I wholeheartedly agreed that it was all the parents’ fault.

I’d wager there were a few people sat in their living rooms letting off steam about their taxes having to treat kids with obesity related illnesses and dental decay when the parents seem clueless as to how to rectify the situation. But 61.2 of adults are overweight or obese in the UK now. Not all of those adults will have had negligent parents who fed them the wrong foods or let them eat entire tubs of ice cream before a full roast dinner.

It’s the food, stupid.

Even in healthy foods like fruit and vegetables, modern agricultural methods have led to soil depletion, which means that there are fewer micronutrients in the food we eat. The traditional practices of rotating crops and leaving a “fallow field” every growing season in order to restore the soil is all but gone, because of the demands on farmers to grow extra crops. And that’s just the fruit and veg we eat in their natural state. Add in processing, and there’s even less nutrition left.

Our bodies aren’t daft. What do they do when they’re not getting enough of what they need? They tell us we’re hungry, of course. Our bodies don’t tell us we’re full, even though we’ve got the calories we need, because we haven’t got the nutrients. This is why many obese people are actually malnourished. It may not look that way, but obesity is what happens when the food you eat contains a ton of calories without the nutrition.

This is a particular risk among people on low incomes. The cheapest food in the supermarket is often the most nutritionally deficient – think big value bags of chips and chicken nuggets, burgers, pies, fish fingers. All these things are bulked out with low-cost carbohydrate, usually wheat rusk or breadcrumbs, and there’s not much nutrition or fibre to be found in that.

The younger parents on the show were mostly of the same generation as me, and we didn’t get much education about food or cooking in school. If I hadn’t learnt to cook at home, would I have learned things like how to prepare dried beans and lentils, and to make low-cost meals for when I went to university? Not likely. I’d probably have been a Pot Noodle-head.

As well as being cheap, all these processed foods TASTE GOOD. They taste good despite some of them being made from some pretty grim stuff, as Jamie Oliver (not my favourite TV chef due to high irritation levels, but makes many salient points on this topic) explains:

How do you make something pretty horrible taste good? Add fat, sugar and salt. Bingo.

It’s not just because we’re eating too much food in general. We’re eating too much food that kind of isn’t food, really. As Michael Pollan said in his book In Defense of Food – “don’t eat anything your great-grandma wouldn’t recognise as food“.

He might be bang on the money, but for people on low incomes, it’s not quite that simple, because the price of the fresh produce that was the staple of our great grandparents’ diets is out of reach of many low-income families today. And don’t get me started on silly health food crazes and health food preachers – telling a person struggling to make ends meet and coming home exhausted after the night shift that they should be spending their energy trying to get kale and wheatgrass smoothies down their kids for breakfast is probably going to get you smacked round the face, and rightly so.

We need to look at our priorities as well. For example, why are ante-natal classes only focused on breathing exercises and breastfeeding? Kids need looking after long before they’ve popped out and been weaned – why aren’t we teaching new and expectant parents about things like dental care, nutrition, and avoiding supermarket tantrums? In days gone by, maybe you’d have learned that as a new mum or dad from your parents and older siblings, but these days, you’re not as likely to be living round the corner from them to pop in for a bit of advice.

Then there’s retailers. Recent proposed legislation banning junk food advertising before 9pm is a start, but there’s still a long way to go in persuading retailers that they might just have some social responsibility towards their customers. In the majority of mainstream food shops, there’s still chocolate and sweets at kid-height as you walk to the checkout, for example. You could have done the healthiest shop in the world and it all comes undone as your tired three year old spies the Kinder eggs and throws a tantrum worthy of Naomi Campbell – all you want to do is get out of that store away from the glares of other customers, who understandably dislike the decibel level of a screaming toddler, so yep, you buy the egg.

One final word, though, on this subject – if I learned anything from Junk Food Kids, it’s that good parenting is a whole lot of hard work, and if you’re not prepared to put the hard yards in (like turning Peppa Pig off when it’s “teeth time” and dealing with the ensuing meltdown) then you’d probably be better off not having any.

I think I’ll stick to dogs – dental hygiene is as complicated as chucking him a Dentastick and as long as it tastes vaguely like meat, he’ll eat it!

BBC digs heels in over Food and Drink intolerance feature

Despite the widespread objection to the BBC Food and Drink feature on food intolerance that I blogged about earlier this week, the BBC continue to stand by their assertion that they thought the feature was balanced.

Their response was as follows:

This was one of our opinion pieces in which William Sitwell offers his own personal, at times controversial, viewpoint on the subject of food intolerances. He said he believes some are real and dangerous, but that others seem like fads. He makes it clear there are differences and this is his own view point. We did balance what was said by William in his film – during the studio discussion it’s made very clear there is a difference between intolerance and allergies, and the serious nature of such allergies. And if it came across that all food intolerances were to be treated as if they weren’t serious this wasn’t the intention either. We just wanted to discuss how modern day eating habits have changed and the challenges this gives the food industry.

The BBC missed the point that many coeliacs, including myself, made – that they didn’t mention coeliac disease at all, which is neither an allergy nor a food intolerance, but an autoimmune disease. So, they have done nothing to correct the erroneous information that the programme put across – that either you have a faddy fake “food intolerance”, in which case you don’t deserve to be taken seriously by the food industry, or an allergy, which does merit some consideration. Thank you for your concessions, oh great Michelin-star chefs.

I’m disappointed that the BBC didn’t apologise for not mentioning coeliac disease. I felt that any feature on food intolerance or allergy should have done, and should have made it absolutely clear that if you get someone coming into your restaurant saying that they are coeliac and need a gluten free meal, you should be making damn sure that’s what that person gets.

The BBC made a fair point that our eating habits have changed in the present day, and I’m sure this does present a challenge to the food industry. But shouldn’t they be ahead of the curve on this one? The modern kitchen is full of weird and wonderful gadgets to make foams and gels, even flavoured air, and yet they’re saying that it’s cooking gluten free that presents the challenge, when these are some of the greatest foodie innovators in the world?

I’m sorry BBC, I just don’t buy it.

BBC Food and Drink – you’ve got gluten free all wrong

Well, I was quite excited yesterday when I found out that BBC Food and Drink were going to do a section on food allergies and intolerances. I switched on, eager to see some coverage of the issue in the mainstream foodie media.

What greeted me, however, was William Sitwell inflating a bunch of helium balloons, presumably to illustrate the associated “bloated” feeling about which those with food intolerances often complain. He then went on to proclaim “as a child, I was intolerant of carrots” and proceeded to pose the view that the majority of food intolerances are akin to a kid disliking vegetables, i.e. plain old fashioned fussy eating. “We are awash with faddy diets and phony science” he states, in a tone that can only be described as patronisingly sardonic.

Now, I won’t deny that there are some people who will take up the latest dietary fads as readily as Kim Kardashian takes a selfie, but the assertions made on the programme were worryingly ill-informed, from the perspective of someone who has a genuine illness that means a gluten-free diet is not some kind of passing fad or weight loss craze, but a medical need. I’ve said it once, and I’ll say it again, the only treatment for coeliac disease is a lifelong gluten free diet.

I was disappointed to hear such high profile chefs and journalists making such sweeping generalisations of such a complex issue. According to Sitwell, the only “genuine” cause for avoiding a certain food is an allergy, to which the reaction would be evident within minutes. No mention of coeliac disease whatsoever, which affects up to 1 in 100 people in the UK. A coeliac may not react to gluten immediately – in fact, it is rare for someone who has ingested gluten to react like that. The reaction may come within hours, or a day later, when the offending proteins have lodged their way into the digestive system. You might not be choking, fishing for your epi-pen and ringing 999, but you can be pretty darn sick with it – for me, it’s like a bad case of food poisoning. Some people have no reaction, but the damage is still being done even though you can’t see it. Gluten damages the lining of the small intestine, thereby impeding the ability to absorb nutrients from food. So you can see why this might be a little bit of a problem.

I have had varying reactions in eating establishments to requests for gluten free food, from the eye-roll (usually results in them losing my custom pretty quickly) to the completely clueless, to the amazingly helpful and can’t do enough to help. I am aware that it’s an inconvenience for restaurants to have to cater for those of us who can’t always just eat what’s on the menu without question, and therefore I’m super grateful to those who are accommodating. But to hear a top chef like Michel Roux Jr. saying that it “gets his back up” and Monica Galetti chiming in about the inconvenience of getting lists of gluten free people as well as vegetarians to cater for, well, it makes me feel more reticent about dining out and asking for my dietary needs to be met. It makes me less trusting of chefs and restauranteurs – if that’s how they feel about their customers with special dietary needs, how can I trust them to be careful with my food and understand what needs to be done so I can eat there safely and not get sick? When there is such misinformation as this being peddled, how can I get it through to people that I have a real, medical condition that requires a gluten free diet and I’m not just another fussy eater? Should we be required to prove at the door that we’re the real deal? Do I need to graphically describe to skeptical servers and chefs exactly what will happen if they give me gluten, and come back to camp out in their facilities if I get sick to prove a point?

Food and Drink completely missed a trick here, because just because you have a food allergy, medical condition or yes, intolerance (some of them are real, yes indeed – lactase deficiency, anyone?) that you can’t be a foodie and you don’t enjoy food. Most of us want to enjoy the experience of dining out and eating nice food – we don’t go out stalking restaurants in groups to make a hobby out of making the life of restauranteurs harder. How about discussing how restaurants can provide varied menus, that mean that fewer adaptations are needed in the kitchen when someone comes in with an allergy or intolerance, thereby making it easier for busy chefs? How about clear allergen labelling on menus, so people know what they can order and don’t take up the waiting staff’s time having to ask about what they can eat? There are a whole host of ingredients out there that are naturally gluten free, no expensive specialist ingredients required. Would you believe it, there’s more to making great gluten-free food than costly pale packaged-Frankenfood imitations as low on nutrients as they are on taste. You’d think a couple of Michelin-star chefs would be able to knock something up without too much bother, wouldn’t you?

Maybe it’s time for them to retire from the restaurant trade if it’s that upsetting to have to cater for, you know, paying customers. Because if everybody with any sort of different dietary need had to stop eating out, as did their friends, colleagues and families, there wouldn’t be too many of those left to keep the restaurants afloat, would there? After watching this piece of crass and ill-informed television, I can only hold on to the good restaurants that I have visited over the years since my diagnosis, the ones who have welcomed me with open arms and never made me feel like an inconvenience or like I’ve “got their back up”.

As for William Sitwell, I just hope his iron constitution holds up as long as he wants his career in the foodie media to last. And don’t book me a table at Le Gavroche any time soon.

Series 2, Episode 9 of BBC Food and Drink can be seen on BBC iPlayer