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The Western diet really is a killer – it is official

The Western diet really IS a killer.

The typical Western diet, high in fat and sugar, really does lead to an early grave, new research suggests.

A study of more than 5,000 civil servants found those who ate the most fried and sweet food, processed and red meat, white bread and butter and cream doubled their risk of premature death or ill health in old age.

It adds to evidence that ‘Western style food’ is the reason why heart disease claims about 94,000 lives a year in the UK – more than any other illness.
The findings published in The American Journal of Medicine are based on a survey of British adults and suggest adherence to the diet increases the risk of premature death and disability later in life.

Lead researcher, Dr Tasnime Akbaraly, of the National Institute of Health and Medical Research in France, said: ‘The impact of diet on specific age-related diseases has been studied extensively, but few investigations have adopted a more holistic approach to determine the association of diet with overall health at older ages.’
She examined whether diet, assessed in midlife, using dietary patterns and adherence to the Alternative Healthy Eating Index (AHEI), is associated with physical ageing 16 years later.

The AHEI is an index of diet quality, originally designed to provide dietary guidelines with the specific intention to combat major chronic conditions such as heart disease and diabetes.

Dr Akbaraly added: ‘We showed that following specific dietary recommendations such as the one provided by the AHEI may be useful in reducing the risk of unhealthy ageing, while avoidance of the “Western-type foods” might actually improve the possibility of achieving older ages free of chronic diseases.’
The researchers analysed data from the British Whitehall II cohort study and found following the AHEI can double the odds of reversing metabolic syndrome, a range of disorders known to cause heart disease and mortality.

They followed 3,775 men and 1,575 women from 1985-2009 with a mean age of 51 years.
Using a combination of hospital data, results of screenings conducted every five years, and registry data, investigators identified death rates and chronic diseases among participants.

At the follow up stage, just four per cent had achieved ‘ideal ageing’ – classed as being free of chronic conditions and having high performance in physical, mental and mental agility tests.

About 12 per cent had suffered a non-fatal cardiovascular event such as a stroke or heart attack, while almost three per cent had died from cardiovascular disease.
About three quarters were categorised as going through ‘normal ageing’.

The researchers said participants who hadn’t really stuck to the AHEI increased their risk of death, either from heart disease or another cause.

Those who followed a ‘Western-type diet’ consisting of fried and sweet food, processed food and red meat, refined grains, and high-fat dairy products, lowered their chances for ideal ageing.

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IBS and menopause

When Does Perimenopause Usually Start and End?

Perimenopause is the term for the months and years that lead to menopause. It begins with the first signs or symptoms of menopause. For some women, this is as early as their thirties. By their mid-forties, most women notice at least occasional signs that their estrogen is beginning to decline. Officially, perimenopause ends with the diagnosis of menopause, which is when you’ve had twelve consecutive months without a period. The day after you have not menstruated for one full year, you are considered postmenopausal. The day before your menopause day, you are premenopausal. The average women experiences menopause at the age of 51. The normal range is from 40 to 58 years old.

Perimenopausal and Menopausal IBS symptoms

An increase in gastrointestinal (GI) symptoms, including bowel discomfort, abdominal pain/discomfort, bloating, gas and alterations in bowel patterns, has been reported during premenses and menses menstrual cycle phases and the perimenopause period in women with and without irritable bowel syndrome (IBS). Dr. Margaret M. Heitkemper, Ph.D., of the Department of Biobehavioural Nursing and Health Systems at the University of Washington in Seattle, conducted a review of scientific literature about the possibility that fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome. During perimenopause (and menopause), the gastrointestinal tract slows down, which contributes to constipation, and constipation may cause hormonal imbalances.

Author Dawn M. Olsen, founder of the Menopause A to Z website, explains if a woman going through menopause is also dealing with stress, constipation and indigestion can worsen, especially if she overeats, eats certain foods or eats too quickly. Not drinking enough water may lead to dehydration and contribute to constipation. Constipation can be problematic, because daily bowel movements are essential to eliminate waste from the body and may be crucial for maintaining hormonal balance as women go through menopause.

It has been theorized that this increase in symptoms at the time of early menopause is due to the lessening of the levels of sex hormones that occurs at this time, in much the same way that women experience an increase in IBS symptoms in the days surrounding the onset of menstruation. There is a well-established relationship between these sex hormones and digestive symptoms, most likely due to the fact that receptor cells for these hormones are located throughout the digestive tract. Thus, the changing hormonal levels of menopause do have an effect on IBS, but what that effect is is not completely clear. The evidence to date currently provides only conflicting and incomplete evidence about the change in IBS symptoms during and after menopause.

Many women in menopause develop acid reflux or gastroesophageal reflux disease, known as GERD. This condition occurs when the lower part of the esophageal sphincter does not close properly, allowing stomach contents to reflux or leak back into the esophagus. One of the main symptoms of GERD is persistent heartburn caused by acid regurgitation; however, some women who have gastroesophageal reflux disease do not suffer from heartburn. Women may experience a burning or choking sensation in the throat, chest pain, trouble swallowing and morning hoarseness. Mary Infantino, RN, Ph.D., Director of the Graduate Nursing Program at Long Island University in New York conducted a study in 2008 on gastroesophageal reflux symptoms in perimenopausal and menopausal women. The research found that perimenopausal and menopausal women had higher percentages of GERD diagnoses than premenopausal women and that menopausal patients had significantly more upper gastrointestinal discomfort. Dr. Infantino’s research found that menopausal women were nearly three times more likely to have GERD symptoms, suggesting a hormonal link between menopause and gastroesophageal reflux disease.

To conclude, studies have shown that the drop in hormones after menopause results in reduced severity of IBS symptoms; after age 50, the severity of IBS symptoms in women and men is identical. Women in postmenopausal age groups have significantly less severity overall for IBS abdominal pain, bloating and have a higher quality of life scores compared to younger women with IBS. The theory that the drop in hormones from menopause directly correlates with improved IBS symptoms is further supported by studies finding that hormone replacement therapy in menopause is associated with an increases risk of IBS flares.

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Probiotics value

So let’s take an example of a typical popular probiotic supplement being marketed today,

Bottle A
This good quality product is £13.00 for 30 capsules, each capsule containing 2 billion live bacteria. The total number of probiotic bacteria in the bottle is 60 billion, making each billion bacteria cost £0.21. In other words, each capsule costs almost almost 50 pence!

Bottle B
A larger size of 120 capsules for $39.95 yields a total of 240 billion bacteria in the whole bottle, bringing the per billion bacteria price down to £0.17 per billion.

Bottle C
By contrast, a bottle of Custom Probiotics CP-1 at £39.98 has 90 capsules, each with around 70 billion bacteria per capsule, making the total number of probiotic bacteria in the bottle 6300 billion, more than 100 times the total in bottle A. This gives a per billion bacteria price of less than half a penny.
Compare this with 21 pence per billion bacteria!
Bottle A – 21 pence
Bottle B – 17 pence
Bottle C – less than half a penny

It is a no-brainer!

The term ‘probiotic’ is derived from the Greek, meaning ‘for life’. Probiotics are currently defined as ‘live microorganisms which, when consumed in adequate amounts, confer a health benefit to the host’. Common descriptions for probiotics include ‘friendly’, ‘beneficial’ or ‘healthy’ bacteria.

Probiotics play a key role in human nutrition and health in balancing the intestinal microflora naturally. Probiotics have been used therapeutically to modulate immunity, improve digestive processes, lower cholesterol, treat rheumatoid arthritis, prevent cancer, improve lactose intolerance, and prevent or reduce the effects of atopic dermatitis, Crohn’s disease, ulcerative colitis, IBS, diarrhoea, constipation as well as Candida and urinary tract infections.
Qualities of an effective probiotic dietary supplement include the following:
Must be of human origin
Exert a beneficial effect on the host
Be non-pathogenic and non-toxic
Contain a large number of viable cells
Be capable of surviving and metabolizing in the gut
Remain viable during storage and use
Be antagonistic to pathogens.

Probiotic bacteria are generally, though not exclusively, lactic acid bacteria and the best researched strains include Lactobacillus acidophilus, L. casei, L. bulgaricus, L. plantarum, L. salivarius, L. rhamnosus, L. reuteri, Bifidobacterium bifidum, B. longum, B. infantis and S. thermophilus.
The most common probiotic supplements on the market today will include one or more of the above strains, and will fulfill most or all of the seven criteria listed above for effectiveness.

Probiotics should be ingested regularly for any health promoting properties to persist. It is possible to manipulate the composition of the intestinal microflora in adults through dietary supplementation with probiotics. This concept is gaining popularity throughout the world. A state of balance within the microbial population within the GI tract is called “eubiosis” while an imbalance is termed “dysbiosis”. For optimum “gut flora balance”, the beneficial bacteria, such as the gram-positive Lactobacilli and Bifidobacteria, should predominate, presenting a barrier to invading organisms.

Around 85% of the intestinal microflora in a healthy person should be good bacteria and 15% bad bacteria. The greater the imbalance, the greater the likely symptoms. In addition, the greater the imbalance or dysbiosis, the greater the number of beneficial bacteria required to correct that imbalance. In cases of dysbiosis, such as, for example, candida overgrowth, or after antibiotics, low doses of probiotics make little difference. It is only the higher doses of around 100 billion bacteria per day that are able to effect a significant change within a short period of time.

To use an analogy, using small doses (under 20 billion bacteria per day) to correct a dysbiosis is like invading a very large country with a very small army – the chances of success are slim. One of the reasons for this is that a dysbiotic gut has a pH level that is hostile to good bacteria, so small numbers do not survive. Large numbers (100 billion plus) are able to change the pH level quickly to one that supports good bacteria. Continuing the analogy, this is like invading a very large country with a very large army – the chances of success are much higher! Probiotics, being able to lower the pH in the intestinal tract, may also be able to interfere with the enzymatic activity of the bad bacteria and yeast organisms. A healthy and well balanced intestinal microflora provides protection against a broad range of pathogens, including certain forms of Clostridia, Escherichia Coli, Salmonella, Shigella and Pseudomonas, as well as yeasts such as Candida albicans.The use of probiotics may be the most natural, safe and common sense approach for keeping the balance of the intestinal ecosystem.

Probiotics can modulate the composition of the intestinal microflora. The survival of ingested probiotics in different parts of the gastrointestinal tract differs between strains. As a result of their concentration in the lumen, they contribute to transient modulation of the microflora ecology, at least during the period of intake. This specific change may be seen in the GI tract for a few days after the start of consumption of the probiotic preparation, depending on the dosage of the strain in question. Results show that with regular consumption, the bacteria temporarily colonise the lower intestine. Once consumption stops, the number of probiotic microorganisms quickly falls. This applies to all probiotic supplements available in the market today.
Custom Probiotics CP-1

Our five-strain Adult Formula CP-1 capsules have a total bacterial count of at least 50 billion microorganisms per capsule at date of expiration. The count at date of manufacture can exceed 78 billion bacteria per capsule. This is independently verified by certified laboratory analysis. Upon request, we will be pleased to share with you the most recent independent laboratory test results, that indicated 69 billion per capsule.

Adult Formula CP-1’s high bacterial count, broad-spectrum formulation and high viability of friendly bacteria all contribute to its effectiveness. It is dairy free, hypoallergenic, and does not contain any artificial colours, flavours, preservatives, sugar, gluten or FOS. Our custom probiotic powder formulations range from 100 to 400 billion micro-organisms per gram, the highest potency of any probiotic formulation available in the market today.

We do not use prebiotics, such as fructooligosacharides (F0S) or inulin, in our formulations, with a view to eliminating possible adverse reactions by highly allergic and sensitive individuals, such as those suffering from Candida or inflammatory bowel disease (IBD) patients. Most FOS in today’s market contains 5-40% free sugar. We suggest getting FOS from vegetables such as onion, garlic, asparagus, dandelion, artichokes and leeks, which have many additional health promoting and nutritional benefits.

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Antacids – storing up trouble?

Recent research suggests that antacids, which are the world’s most popular drugs, can double the risk of pneumonia. This is because these drugs suppress gastric acids allowing viruses and bacteria in the upper GI tract to migrate into the respiratory tract. The study’s findings were similar for proton pump inhibitors and H2 antagonists, both of which lower acid production in the stomach. (The Dutch researchers want doctors to avoid prescribing antacids to elderly patients, particularly those with a history of respiratory problems.)

As well as digesting food in the stomach, the acid acts as a natural defensive barrier that kills pathogens that we ingest with our food. The weakening of stomach acid with antacids allows viruses and bacteria to pass down into the gut, where they can cause a wide range of IBS-like symptoms, such as diarrhoea, constipation, bloating, wind and abdominal pain.

Antacids are thought by the medical profession to have no serious side effects, and so are freely available over the counter, and used for heartburn and reflux as well as stomach and duodenal ulcers. Those with magnesium in them are available only on prescription; these may have a laxative effect, while those made with aluminium may cause constipation. Aluminium hydroxide should be taken in moderation because the aluminium can enter the blood stream, and there may be a link with osteoporosis and Alzheimer’s, particularly if it is taken for a long time. For all that, antacids generally have fewer side effects than the newer generation of anti-reflux drugs (or histamine-2 receptor antagonists, as they’re formally known) like ranitidine and omeprazole. H2 blockers are used to treat stomach and duodenal ulcers, especially those due to arthritis painkillers like non-steroidal antiinflammatory drugs. Also prescribed to relieve heartburn and indigestion, they are known to cause insomnia, depression, blurred vision, severe headaches, irregular heartbeat, nausea and vomiting, diarrhoea, hepatitis and other liver disorders and, rarely, impotence or blood disorders. Omeprazole can cause chest pain, liver failure, mental disturbances, stomach pain and, again, nausea and vomiting. Proton pump inhibitors are also considered benign, but require a prescription. The most common side effects are diarrhoea, nausea, constipation, flatulence, abdominal pain and headaches.

Paradoxically, neutralising stomach acid only causes the stomach to produce more to compensate, which means you continue to take the stuff indefinitely. It also tends to reduce the availability of digestive enzymes, so you don’t digest your food as well as you should. This allows undigested proteins to proceed into the gut, producing toxic amines that act as a substrate for bad bacteria, encouraging them to proliferate. These toxic amines have also been linked with carcinogens in the gut.

The term ‘heartburn’ is an umbrella term for common gastro-intestinal discomfort variously described as indigestion, fullness, gaseousness, abdominal distension, burning pain in the upper abdomen, chest or behind the breastbone. It is common for heartburn to have a burning quality to the pain, hence the name. Mild heartburn is annoying, but severe heartburn can be frightening, feeling as if a hole is being burned through your stomach.

There are a number of potential causes of heartburn. Common causes of heartburn that are easy to remedy are overeating, eating too fast, drinking too many caffeinated drinks, eating too much refined carbohydrate and smoking. Also avoid carrageenan, a seaweed used as a food stabiliser. Other more complex causes of heartburn can be various medicines (hormones as in the birth control pill, progesterone, diazepam and nitroglycerine).

Persistent heartburn from a particular food may indicate an allergy to that food. Food allergies stimulate histamine release, which stimulates stomach acid production. The most common offenders are dairy products, wheat, eggs, corn, beef, soy and some citrus fruits. Using a non-aluminium natural alternative for heartburn and reflux, like Refluxin, which forms a foamy raft on top of the stomach’s contents to avoid reflux may be preferable. Infection with the bug Helicobacter pylori in the stomach may cause heartburn and ulcer type pains. Doctors think that H. pylori may be the cause of up to 95% of stomach and duodenal ulcers. If you think this is a possibility, you can ask your GP for a blood test. The natural remedies Helicobactrin, Colostrum, and Lactoferrin all have a good track record with H. pylori, and do not give the negative side effects associated with the traditional medicines detailed above.

Sufferers of duodenal ulcers may find drinking a large glass of tepid water half an hour before eating helpful. This allows the production of alkaline compounds in the duodenum, which act as a natural barrier to the acid as the stomach empties into the duodenum.

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Celiac Guide

Celiac Disease

Celiac disease, sometimes also termed Celiac sprue or Gluten enteropathy, is a genetically influenced condition that results from eating gluten. More specifically, it is an ailment whereby the lining of the small intestine, called the intestinal mucosa, is chronically damaged by gluten proteins and their interaction with the immune system. It is identified by small intestinal villous atrophy that resolves when gluten is withdrawn from the diet. The illness may become apparent at any age, from infancy to old age, may remain asymptomatic, and may only be detected incidentally. Gluten is a group of proteins derived from wheat, barley and rye but not from oats, rice or maize. Alpha-gliadin is the most toxic portion of gluten.

The Celiac Iceberg

The condition is grossly under diagnosed, but we know that when actively looked for, incidence rates are between 1 in 100 to 200 people. There is a phenomenon called the Celiac Iceberg, and at the tip of the iceberg are those that are diagnosed with Celiac disease. There is a larger portion, nearly half, below them who have what is known as silent disease. More than half of all biopsy-proven Celiacs have no abdominal symptoms at all at the time of diagnosis, even though intestinal damage has been occurring for years. One might argue that if there are no symptoms, one should leave the patient alone with no intervention. Tragically, however, as discussed in many medical journals, the first signs of a problem in those with silent Celiac disease may be cancer. Finally there is a still larger base portion with latent disease. That is to say that if they were tested for antibodies for tissue transglutaminase (a marker for Celiac disease), they would test positive, but demonstrate no pathology, and yet years later Celiac disease may develop fully.


The symptoms associated with Celiac disease are many and varied, which is one of the reasons why it goes un- or misdiagnosed so often. The malabsorption resulting from Celiac disease causes diarrhoea and weight loss, although some recent commentators note an increasing number of untreated patients who are normal weight or overweight. Inability to absorb fats causes steatorrhoea, with bulky, pale, foul smelling stools that float in water due to their high fat content. Anaemia caused by iron deficiency is common, and the malabsorption of calcium and Vitamin D increases the risk of developing osteoporosis.

Patients may complain of abdominal pain and tiredness, while around 10% of patients present with neurological complaints, ranging from mild peripheral neuropathy to more severe central nervous system disturbance.

A small number of people present with a blistering rash, typically on elbows and buttocks, called dermatitis herpetiformis, which is associated with antibodies to tTG reacting with a form of this enzyme in dermal cells.

Possibly as a result of chronic inflammation, people with uncontrolled Celiac disease are at increased risk of developing intestinal neoplasms, particularly intestinal lymphoma. This risk is substantially reduced by strict adherence to a gluten-free diet.

All these signs and symptoms disappear when gluten is omitted from the diet, and reappear if it is reintroduced.

The American Journal of Gastroenterology notes that currently physicians do a poor job of diagnosing Celiac disease: only 50% of patients consider that they were diagnosed promptly; 27% consulted two or more gastroenterologists before diagnosis; and only 30-50% consider their Consultant knowledgeable about diagnosis and treatment.

Diseases and conditions associated with Celiac disease

  • Liver diseases
  • Irritable Bowel Syndrome
  • Microscopic colitis
  • Lymphocytic gastritis
  • Crohn’s disease
  • Ulcerative colitis
  • Dermatitis herpetiformis
  • Alopecia areata
  • Type 1 diabetes
  • Autoimmune thyroid disease
  • Addison disease
  • Arthritis
  • Osteoporosis
  • Sjogren syndrome
  • Chronic fatigue syndrome
  • Neuropathy
  • Chronic fatigue syndrome
  • Cerebellar ataxia
  • Iron deficiency
  • Epilepsy (with occipital calcifications)
  • Hyposplenism
  • Idiopathic dilated cardiomyopathy
  • Down syndrome
  • Autoimmune myocarditis
  • Turner syndrome

The incidence of concomitant Celiac disease occurring with most of these conditions is high enough (>5%) to warrant screening for Celiac disease in these patients. Screening should also be considered for first degree family members.


Small Intestinal Biopsy

The biopsy is simply a sample of the cells in the intestinal wall, an area that has a swift turnover of cells, and heals itself quite rapidly. In many, although not all cases, the intestine will appear perfectly normal after a couple of weeks on a strict gluten free diet.

The biopsy is taken by use of an endoscopy. This is a process whereby a small tube is passed down the throat, through the stomach, and into the small intestine. Tiny tissue samples are then taken from the intestinal wall for subsequent examination under a microscope. A normal biopsy will show many finger like projections from the surface of the intestinal wall. These are called villi, and increase the surface area of the intestinal wall available for absorption of nutrients. At least four biopsies should be taken, as villous atrophy is occasionally patchy. If the biopsy shows villous atrophy, crypt hyperplasia and increased intra-epithelial lymphocytes, and a gluten free diet leads to an improvement on a second later biopsy, then Celiac disease is the diagnosis.

Gluten challenge

This involves eating multiple daily servings of gluten rich foods, and then gauging the body’s reactions. This process is often undertaken by patients who have been on a gluten exclusion diet for a prolonged period of time. Dr James Braly notes that if a patient has already been on a gluten free diet, and the intestinal wall has started to heal, it can take a long period of time for sufficient damage to reappear in a biopsy.

Endomysium Antibody (EMA) testing

Endomysium is connective tissue found in the sheath of certain muscle fibres, and antibodies against this tissue are found in 90% of Celiacs who are consuming gluten; the antibodies disappear quite quickly after the exclusion of gluten. This test demonstrated that Celiac disease was an autoimmune problem by definition, since the antibodies attacked endomysium. The detection of these antibodies by immunofluorescence has a reported 85-98% sensitivity and 97-100% specificity.

Tissue Transglutaminase (tTG) Antibody testing

This type of test is fairly new on the scene. Transglutaminase is an enzyme that forms a part of endomysium and is involved in the repair of tissue. The tTG test identifies about 98% of those who have Celiac disease. It is commercially available as the Biocard Celiac Test. The detection of these antibodies using an ELISA assay is more sensitive but less specific than EMA (particularly in Down’s Syndrome and autoimmune disease).

IgA anti-gliadin antibody tests have moderate sensitivity but poor specificity, and their use is limited to the evaluation of symptomatic children under the age of two years.

Rectal Challenge

This delightfully titled test is a procedure that can be carried out in a doctor’s surgery, giving a clear result in a matter of hours. The test involves taking a biopsy of the rectal mucosa. Then gluten slurry is placed into the biopsy site, and another biopsy taken four or more hours later. Computer analysis will identify any immune reaction to gluten. The obvious criticism of this test is that it is both embarrassing and uncomfortable.

Management of Celiac disease

The recommended treatment is a gluten free diet (GFD) for life. Symptomatic improvement is reported with 70% of patients within two weeks. 85% of all patients respond to a GFD, although histological resolution may take 3-12 months. There is also now good evidence that this decreases the risk of small intestinal malignancy.

50% of patients with Celiac disease have secondary hypolactasia at diagnosis. Dairy products should be continued, and if they cause a problem, then ingestion of other foods high in calcium should be encouraged; alternatively use of a good bio-absorbable calcium supplement is recommended.
Iron and folate supplements are needed if there is a deficiency.

Gluten Free Diet (GFD)

A gluten-free diet means not eating foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. The foods and products made from these grains are also not allowed. In other words, a person with Celiac disease should not eat most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with Celiac disease can eat a well balanced diet with a variety of foods, including gluten-free bread and pasta. For example, people with Celiac disease can use potato, rice, soy, amaranth, quinoa, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from health food stores and supermarkets.

Checking labels for “gluten free” is vital, since many corn and rice products are produced in factories that also manufacture wheat products. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers. Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods.
The gluten-free diet is challenging. It requires a completely new approach to eating that affects a person’s entire life. Newly diagnosed people and their families may find support groups to be particularly helpful as they learn to adjust to a new way of life. People with Celiac disease have to be extremely careful about what they buy for lunch at school or work, what they purchase when food shopping, what they eat at restaurants or parties, or what they grab for a snack. Eating out can be a challenge. If a person with Celiac disease is in doubt about a menu item, ask the waiter or chef about ingredients and preparation, or if a gluten-free menu is available.

Gluten is also used in some medications. One should check with the pharmacist to learn whether prescribed medications contain gluten. Since gluten is also sometimes used as an additive in unexpected products, it is important to read all labels. If the ingredients are not listed on the product label, the manufacturer of the product should provide the list upon request. With practice, screening for gluten becomes second nature.

Foods to avoid

Grains, flours and breads
Wheat, rye, barley and possibly oats, millet and buckwheat. Beware of anything with malt added, as this is usually barley malt.

Fruit and Vegetables
All tinned fruit and vegetables should be considered suspect until you are sure that they do not contain preservatives, stabilisers, emulsifiers and a food starch with gluten in it.

Avoid luncheon meats, prepared sausages, breaded meats and tinned meats containing preservatives.

Avoid cheeses that contain preservatives, such as cheeses spreads and dips, unless you are sure that the preservative does not contain gluten.

Drinks and juices
Do not drink any instant coffee, tea, drinking chocolate or ground coffees that contain grain. Avoid all beers, ales and anything made from grain like whisky, bourbon and most liqueurs. Check processed fruit drinks in case they use a preservative containing gluten.

Salad dressings
Unless you are certain they are gluten free, avoid all commercial salad dressings.

Most tinned soups, soup mixes and gravy in powdered or cubed form are not gluten free.

Products prepared with grains are not allowed, as are ice cream and cones containing gluten, along with all commercial cake mixes and biscuits.

Watch out for curry powders, dry seasoning mixes, ketchups, mustards and horseradishes, chewing gum, vinegars, margarines, soy sauces made from wheat or MSG, and white pepper.

For comprehensive information on the GFD, including recipes, click here.