Coeliac Disease Practical Issues

Article about practical issues when living with coeliac disease.

Coeliac disease (CD) may have an impact on other areas of your life as well.

Holidays and travel

You may feel nervous about travel, especially overseas, but by taking sensible measures there’s no reason why you can’t enjoy a trip anywhere, whether for business or pleasure.

Coeliac UK offers a number of resources, including leaflets on travelling to several dozen countries, with some useful phrases in translation, and there are a number of online sites offering recommendations. The charity carries advertising for many travel companies and hotels in its Crossed Grain magazine, and it can also recommend an insurance policy.

If travelling to Europe, apply for a European Health Insurance Card – see – before you travel. This card entitles you to medical treatment should you need it.

Research

Find out about your destination’s food culture before you travel – some nations use little wheat (countries in the Far East), whereas others use it abundantly (most European nations).

If you’re undecided where to go, bear in mind that although it may seem more logical to travel to a place where gluten grains are rarely used in the cuisine, in reality people in countries in which wheat or rye are common may be more likely to be coeliac-aware. Scandinavian nations, Ireland and Italy are good examples.

Holidaying in the UK or Ireland has obvious advantages. Many hotels are now promoting themselves as ‘gluten-friendly’ (or ‘allergy-friendly’) and actively encourage those with food sensitivities to stay.

Self-catering accommodation is an option, but if you’re travelling somewhere rural check that you have easy access to a supermarket or store offering basic essentials.

Booking

If organizing your travel through an operator, let them know about your requirements – they may be able to make recommendations, and certainly try to accommodate you as much as possible.

When booking flights, specify that you need a gluten-free (GF) meal. Ask whether you can take gluten free food supplies in your luggage – a request that you may need to support with a medical note from your doctor. You may be able to increase your baggage allowance if you explain to the airline in advance. Consider packing toaster bags too.

Some countries have strict quarantine policies. For instance, Australia and New Zealand will allow you to bring certain gluten free staples in your luggage, but you must declare them and be prepared for them to be inspected on arrival.

Travelling

Have some snacks with you for whatever journey you undertake: finding gluten free options at motorway services, stations and airports is not always easy. Good options include homemade sandwiches made with gluten free bread, gluten free crackers, gluten free cereal bars, rice cakes, dried fruit and bananas.

Introduce yourself to cabin crew and remind them you requested a GF meal or snack when you booked.

Food labelling

There is no international agreement on the definition of ‘gluten-free'. The rest of the EU is subject to the same labelling legislation as the UK and Ireland. Here are some terms in various languages to look out for on food products:

  • English: ‘gluten-free’, ‘very low gluten’
  • German: ‘glutenfrei’, ‘sehr geringer glutengehalt’
  • Dutch: ‘glutenvrij’, ‘met zeer laag glutengehalte’
  • French: ‘sans gluten’, ‘très faible teneur en gluten’
  • Italian: ‘senza glutine’, ‘con contenuto di glutine molto basso’
  • Spanish: ‘exentos de gluten’, ‘contenido muy reducido de gluten’
  • Portuguese: ‘isento de glúten’, ‘teor muito baixo de glúten’.

For foods to be labelled ‘gluten-free’ in Australia and New Zealand they must contain ‘no detectable gluten’ (about 5 p.p.m. according to the best detection tests), which is considerably less than allowed elsewhere. Accordingly, you may find GF products there taste different.

According to the Canadian Celiac Association, ‘Gluten-free in Canada means that the food does not contain wheat, spelt, kamut, rye, barley, oats or triticale, or any parts thereof . . . wheat starch is not permitted in a gluten-free diet.’

In the USA, the situation is subject to change. Wheat (but not yet gluten, or other gluten grains) must be declared on food labels, and the Food and Drug Administration is developing a definition for ‘gluten-free’, likely to be roughly in line with the EU’s. Specialist products are of course available.

Outside those nations – in Africa and Asia, for instance – labelling may be less specific and more unreliable.

Remember that a particular brand or product that is safe in your home country may not be so in another nation.

Eating out

The same rules apply as at home. In countries where English isn’t spoken you should still be able to find an English menu. Dietary cards explaining your requirements are available from some organizations if there is a language barrier issue, and may be worth ordering in advance.

Working life

Your coeliac disease should not hamper your working life or career choice – unless, perhaps, you wish to be a beer taster or restaurant reviewer! There are, for instance, plenty of successful athletes who are coeliacs.

Some jobs in which you may eat ‘on the job’ – pilot or flight attendant, for example – may require special provisions for your food, but as these are increasingly provided for passengers, again, there shouldn’t be a special problem.

It is worth telling your employer that you are a coeliac. If you need to take time off for health appointments or if you’ve been ‘glutened’ and need to take a few days off work, your employer is likely to be more understanding if already aware of your condition.

The armed forces

The one exception is working in the armed forces. Those diagnosed with coeliac disease are not recruited because a guarantee to provide for a gluten-free diet (GFD) in the field or on operations is not feasible, according to the Ministry of Defence. Those diagnosed while serving will, where possible, be offered an alternative role or, if not, a medical discharge.

Beauty and grooming

Every day we wash, scrub, cleanse, moisturize, deodorize and condition parts of our body with a selection of gels, soaps, sprays, creams, colours and powders. Some of them may well use gluten-containing grains. How safe are they?

This is difficult to answer as no real research has been done on the subject. You will often hear quoted that a large proportion – up to 80 per cent – of what we apply to our skin is absorbed into the blood. This is exaggerated, and it varies depending on the product and the individual person. Even so, experts say that gluten is too large a molecule to pass through the skin barrier, and therefore should not pose a problem.

Lipsticks and lip balms are perhaps a more valid concern as they come into contact with the mouth, and trace amounts will be absorbed more readily and swallowed. Occasionally these products can contain ingredients derived from the gluten grains. All the major commercial brands of toothpastes and mouth washes avoid gluten-containing ingredients, and the same goes for most ‘natural’ brands of toothpaste, whose packaging may confirm this.

While the risk in the cases of lip products is unclear, but likely to be small, it is understandable that some coeliacs feel that they want to exclude gluten grains totally from their life regardless, and so may choose to adopt a no-wheat policy when it comes to their toiletries.

Product labelling

Although only food, and not cosmetic items, are bound by food allergen directives, and there are no specific rules for labelling gluten, ingredients must by law be listed on personal care products – either on the container or on the packaging. Cosmetics that are small and difficult to label clearly are partially exempt; instead, their ingredients should be displayed close to the item’s point of sale or be available on a leaflet.

That said, botanicals are often in Latin and not English. Here are the ones that matter:

  • Barley – Hordeum or Hordeum vulgare
  • Oat – Avena sativa
  • Rye – Secale cereale
  • Wheat – Triticum or Triticum vulgare.

Grains tend to crop up in products of a thicker consistency, such as lip products, gels, creams and exfoliating scrubs, but occasionally deodorants contain wheat protein.

The notation [+/- …] indicates that the ingredient(s) listed in square brackets may or may not be present – the cosmetic equivalent of a ‘may contain’.

Reactions to cosmetics

Reactions to cosmetics are common, and it is easy to assume that gluten may be a culprit, but it is unlikely.

Contact dermatitis, characterized by red itchy patches of skin, is the most common reaction. It is usually non-allergic and triggered by an irritant such as an abrasive or a detergent. The reaction is delayed not immediate, localized to the site of application, and usually caused by repeated exposure to the cosmetic, rather than one-off use. Those with eczema and very light-skinned people are more susceptible.

Allergic contact dermatitis is rarer. It is often caused by one or more of the many thousand fragrances found in bodycare products, but also by preservatives, ultraviolet filters and emulsifiers. Unlike irritant contact dermatitis, allergic contact dermatitis can spread beyond the site of application. Patch testing by a dermatologist can help identify culprits.

Immediate ‘nettle’ rashes are occasionally reported too, and it is known that these can be caused by hydrolysed wheat protein, among many other substances.

Other non-food exposures

Communion wafers

If you’re a Roman Catholic, you may be concerned about holy communion. Roman Catholic doctrine specifies that the eucharistic wafers must be made from wheat and contain a trace of gluten. Other Christian churches aren’t as strict, and allow wheat-free and gluten free bread. Coeliac UK’s website lists communion wafer suppliers in the UK, and suppliers are also noted in the Coeliac Society of Ireland’s Food List. Those suitable for Roman Catholics are made from Codex wheat starch.

Pet food

Bear in mind that most dog and some cat food contains wheat as a filler. It’s unlikely this will find its way into your mouth, but it is worth washing your hands carefully after handling and cleaning up carefully after your pet has fed.

Envelope gum

This is free from gluten.