How to Complete a Gluten Challenge while remaining Low FODMAP (with Seitan Recipe)

How to complete a gluten challenge while remaining Low FODMAP - NOTFROMAPACKETMIX

Updated on 28.01.17

For reasons that I have mentioned before, it is crucial to get tested for Coeliac disease (CD) before you begin any elimination diets that cut out the gluten containing grains – this includes the low FODMAP diet, which eliminates wheat, barley and rye for the two month elimination period due to their fructan content. Oats also contain a protein called avenin, which is very similar to gluten and can also cause issues in overly sensitive individuals. There are many reasons why it’s important to be correctly diagnosed (which includes ruling possible differential diagnoses out) but I’ll expand on the most relevant to fructose malabsorption (FM) or the low FODMAP diet.

What is the difference between Coeliac disease and non coeliac gluten sensitivity?

Coeliac disease is an autoimmune condition in which your body’s immune system reacts to the plant-protein gluten (found in wheat, barley, rye and their derivatives) in such a way that your small intestine lining becomes the target, causing damage to your small bowel and villous atrophy. Villous atrophy in turn leads to a reduced surface area for nutrient absorption, which can contribute to malnutrition, malabsorptive disorders, osteoporosis and many other secondary complications, such as an increased risk of certain cancers. To rule CD in or out, a blood test to check for tissue transglutaminase antibodies is performed and followed up with an endoscopy to confirm any damage to the small intestine.

Non coeliac gluten sensitivity (NCGS), on the other hand, is not as well understood. It is the label given to those who test negative for CD, yet are still apparently affected by gluten. One study suggests that it is not the gluten in the grains but the fructans (acting alone or in combination with the gluten) that are causing sufferers to be symptomatic. Other research hints that it might be an innate immune response, rather than the adaptive immune response of CD, which causes the reaction to gluten-full foods and leads to symptoms that are very similar to those experienced by Coeliacs. Because there is no science-based standardised test to check for NCGS, the diagnosis is one of elimination – other conditions, like CD or a wheat allergy, are ruled out but you find you still improve on a gluten free diet – and NCGS is the possibility that is left.

If you do in fact have undiagnosed CD or NCGS, the low FODMAP diet isn’t anywhere near strict enough to be considered safe for you, as after the elimination phase comes the reintroduction phase, in which you are encouraged to test out foods higher in fermentable carbohydrates – this includes offending grains, which will just make you sick again. If you have CD, you must limit your gluten exposure to basically nothing (less than 20 ppm in the USA is considered safe), so even a contaminated chopping board or deep fryer could make you sick, let alone testing out a full slice of bread. If you have already been diagnosed with CD, you can skip those foods, saving you time and gut hurt… or any of your other symptoms that are caused by gluten.

Furthermore, if you have undiagnosed CD or NCGS, once you have finished the elimination phase and begin to test out wheat, rye and barley, you’ll realise that they bring on symptoms (either IBS or other) and you won’t know whether FM or CD is behind them – and to test for CD, you need to have gluten in your system for an established autoimmune reaction to be visible. If you haven’t been eating gluten, any damage from CD, or any sign of the relevant antibodies, will begin to disappear, meaning that you may test negative, regardless of whether you have active Coeliac disease or not. This is called a false negative result.

How to complete a low FODMAP gluten challenge

If, for one reason or another, you find yourself having been on a long term gluten free diet, yet needing to test for Coeliac disease, there is unfortunately no other way to confirm the diagnosis than to complete a gluten challenge. Instructions vary slightly but, in general, it is recommended that every day, for somewhere between six to twelve weeks (ask your gastroenterologist what they would prefer), you must consume the equivalent of four slices of bread if you’re an adult, or two slices of bread if you’re a child.

Given that:

  • The average bread slice weighs approximately 30 g,
  • Bread is typically at least 10% gluten by weight.
  • This means that the average slice of bread contains approximately 3 grams of gluten.
  • Extrapolating from the number of slices necessary for the gluten challenge, the gluten requirement works out to be 12.0 g of gluten for an adult and 6.0 g of gluten for a child, daily.

After writing the previous post, it seems almost hypocritical to tell you that I had to complete a three month gluten challenge in 2014. You can read my diagnosis story here but, long story short, I tested negative to Coeliac disease (both the antibody blood test and endoscopy) back in 2006 but then tested positive for fructose malabsorption. However, after eating largely gluten free (I didn’t worry about minute levels of contamination), I found myself, at the beginning of 2014, experiencing worsening IBS symptoms and extreme fatigue/brain fog. Ev even asked if I was broken. Now, I felt pretty certain that the culprit was the spelt flour (non-sourdough) that I had been consuming, after reading that it was low FODMAP – note, only sourdough spelt is considered low FODMAP, I had just read inaccurate information. However, the question stood: was it the fructans or the gluten that was causing this relapse?

I know that many people out there would happily re-eliminate the spelt flour and move on with their lives – but I’m not one of them. If there’s a question, I’m the type of person who needs to know the answer. So, I spoke to my GP, who referred me to a gastroenterologist and I began a twelve week gluten challenge. However, I know that fructans in wheat (and to some extent, rye) make me sick – what was I to do? The answer to your low FODMAP gluten challenge question is: SEITAN.

Seitan is a vegan protein/meat replacement that is made from vital wheat gluten, which is normally 75-80% gluten – and coincidentally, registers as low FODMAP. Now, let’s do some maths… stand back.

  • An adult needs to consume 12.0 g of gluten per day, a child 6.0 g.
  • Let’s assume that the vital wheat gluten (gluten flour) was only 75% gluten, to be safe. However, if you can get a more pure version of it, do so, as the more gluten it contains, the less likely it is to contain any FODMAPs.
  • 12.0 g / 75% = 16.0 g, so an adult would need to consume 16.0 g of the vital wheat gluten, daily, to ensure we are getting at least 12.0 g of low FODMAP gluten. A child would obviously only need to consume 8.0 g.
  • The recipe below is in grams, to keep it simple: 240 g of VWG will give fifteen 16.0 g servings or thirty 8.0 g servings.

You could just pop your seitan chunks like a form of medicine and be done with it but it was fun to experiment with it in cooking and I probably ended up consuming more than the 12.0 g of gluten on the days when we did so… which might have contributed to my gut’s unhappiness and the fatigue.

Seitan with Italian Herbs and Spices

Based off Bob’s Red Mill’s basic seitan recipe.

Seitan Dough

  • 250 ml FODMAP friendly stock or water
  • 1 pinch asafoetida
  • 1 tbsp. dried oregano
  • 2 tsp. salt
  • 1 tsp. pepper
  • 1 tsp. dried rosemary
  • 1 tsp. dried sage
  • 240 g gluten flour/vital wheat gluten

Broth

  • 1.5 L of water
  • 1/4 cup soy sauce

In a large pot (I cannot emphasise this enough, seitan balloons!) bring the broth mixture to a boil.

Meanwhile, mix the gluten flour, herbs, salt and pepper together in a large bowl. Slowly add in the stock and stir/knead until it’s a sponge-like dough. It should be tacky to the touch but not wet. Tip it out onto a well floured bench (use more gluten flour) and knead it for a minute or two, until it becomes tougher and more elastic.

Cut it into sixths, then roll them out into logs and divide each one into twenty. There you go, you now have 120 pieces and four pieces equals one daily serving of gluten for an adult.

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Place the seitan dough in the boiling water and boil for one hour. Watch how it expands – I needed to swap saucepans halfway through.

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After boiling, the seitan still isn’t good to eat. At this point, I like to think of it as “raw” meat. The flavour is nice, thanks to the spices, but the texture isn’t great. Spread the seitan out on a tray to dry, then use it in stir fries, pan fry it, bake it – it all works.

Baked seitan:

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Pan fried seitan with mirepoix as a dipping sauce:

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For those who were just curious, I hope you found this piece interesting. For those who have fructose malabsorption or IBS and need to complete a gluten challenge – good luck. I didn’t find it fun, in terms of fatigue, but I hope you fare differently.

After getting back to a normal diet (still no active Coeliac disease, phew), I have learnt that I can cope with a bit of gluten every now and then, so it’s clearly not as big of an issue for me as the fructans are. Luckily, that means that I can still enjoy (proper) sourdough breads in moderation. Yum.

This post is intended for educational purposes only. Please run anything that I have written here by your doctor or dietitian (etc) to make sure it is suitable for your individual case.

In terms of FODMAPs, vital wheat gluten is generally considered low but it is not recommended for consumption during the elimination phase of the low FODMAP diet. As always, it’s best to not need to do a gluten challenge at all, by testing for gluten/wheat related conditions before an elimination diet has begun but this isn’t always possible, for a variety of reasons.

Unfortunately, you might react during a gluten challenge (that’s the point, after all); this method just minimises the chance of that reaction being due to the fructans in wheat as much as possible.

FODMAP Friendly Christmas Recipe – Gingerbread House & Biscuits

Gingerbread House Title Image 2

One of my favourite things about Christmas – apart from friends and family – is getting to play with food.

Not in the way your Mum always told you off for but by being creative. I’m not a talented creative person like some of my friends are but I like to dabble in sewing and one day I will finish that scarf I started to knit… So yeah, an excuse to make something pretty with a deadline means I get to play but also will get it done. Win, win.

Gingerbread is one of my favourite things – combining ginger, golden syrup and biscuits = the best thing ever. Since I’ve been doing my best to cut down on sugary baked goods, I haven’t baked much over the last couple of months except when required to for an event but it’s Christmas so whatever – screw the diet for the next two weeks and I’ll deal with the aftermath later 🙂 We’re dog-sitting two extra dogs at the moment, so I’m going on my fair share of dog walks, anyway.

Notes:

  1. Gingerbread recipes tend to use one or a combination of different syrups – golden syrup, maple syrup, treacle, molasses or even corn syrup (mostly from American websites that I’ve seen). Pure maple syrup is hard to find and quite expensive in Australia but treacle and golden syrup are easy to get – people tend to tolerate these quite differently, though, so I am listing them as possibilities and you can use whichever you know is safe for you.
  2. Gluten free flours are expensive, so if you are not cooking for a coeliac then I recommend making the recipe in halves – half GF and half normal flour. This will save you some money and, if you use the normal flour as the walls of the house, it will give the structure added strength.
  3. If you can’t tolerate wheat because of the fructans but you can still have gluten, I would recommend using gluten powder, rather than xanthan gum, to really add some strength – this is more important if you are making a house, rather than gingerbread biscuits. I would try 1/2 a cup of gluten powder to replace the same amount of flour and work from there. Possibly a combination of xanthan gum and gluten might be best but I haven’t tried this.
  4. If you have any cracks in the slabs of gingerbread that you cut, just use royal icing or melted chocolate to either stick them back together or as a reinforcement along the inside face of the slab.
  5. Royal icing involves uncooked egg whites, so if you are making this for a pregnant woman or an immuno-compromised person, I would stick to melting dark or milk chocolate for assembling the joins of a house. Other sources recommend using meringue powder in this situation but having never used it, I don’t know what the ingredients are and how fructose friendly they would be.
  6. If you malabsorb lactose, then I would stick to the royal icing, rather than the chocolate… unless a lactose free chocolate exists that can melt well – I honestly haven’t ever looked into it.

Gingerbread

Adapted from Ruby M. Brown’s Cakes, Muffins and Loaves to suit my tastes and be a little more fructose friendly.

  • 250 g unsalted butter/coconut butter, softened
  • 175 g castor sugar (or 200 g dextrose)
  • 2 whole eggs
  • 1 tsp. vanilla extract
  • 1/3 cup golden syrup
  • 700 g GF plain flour
  • 1-2 tsp. xanthan gum (add in 1, then the second if consistency isn’t correct) – alternatively, substitute 1/2 cup of GF flour for 1/2 cup of gluten powder
  • 11/2 tsp. baking powder
  • 2 tsp. ground ginger
  • 1/2 tsp. ground cloves
  • 1 pinch salt

Cream the butter and sugar until light and fluffy, then add in the eggs, vanilla and syrup of your choice. Mix until well combined and smooth. Sift the dry ingredients into a separate bowl and then gradually add them in, alternating with mixing, until the batter is complete. This will be much stiffer than a cake batter, more like a cookie dough but not quite.

To make your life easier, wrap the dough in plastic wrap and refrigerate it for 30 minutes before rolling it out.

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To make biscuits

Preheat your oven to 190 C/375 F. Roll the dough out on a lightly floured bench until it is approx 1 cm thick and then cut with a knife or cookie cutters. Place them on a lined baking tray and bake for 15-20 minutes, until golden brown and firm yet soft on top – if you bake them until they are hard on top then they will be like rocks once they have cooled.

To make a house

Preheat your oven to 190 C/375 F and lay out baking paper on the bench (if your biscuit tray has raised edges like mine does) or if you have a completely flat baking sheet, just lay the baking paper on that. Spread a column of the batter along the length of the tray and place wax paper on top, then roll it out to make it as rectangular as possible. Believe me, the more accurate you are with this, the more of the end product you can work with to cut out the walls and roof pieces later on.

You can see from this picture that I didn’t do a particularly good job of it and I had to make another half batch to make the front and back walls.

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Bake for 20 minutes, until golden brown and firm-ish in the middle – a little bit of softness is okay, as it will continue to harden while cooling – but you don’t want it to be completely hard while baking or it will be a crumbly rock once cooled. Have paper cut outs of your house pieces ready to go, because it is easier to cut without cracks forming when it is fresh from the oven and still retains some softness.

Let the pieces cool for a day to harden completely, otherwise they might crack while you are trying to assemble the house. Other shapes to try could be a Christmas tree or a bell shape, with four pieces.

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Royal Icing

The following gave me plenty of icing to construct and decorate my house, however the rule of thumb is 1 egg white to 1 cup of icing sugar.

  • 2 egg whites
  • 1 tsp. vanilla extract – optional
  • 2 cups of icing sugar (or 3 3/4 cups icing sugar, 1/4 cup dextrose)
  • Food colouring of choice – optional

Softly beat the egg whites and vanilla extract in the bowl of your stand mixer and then add in the icing sugar gradually until the mixture becomes smooth and shiny. Beat it on a high speed for at least 5 minutes, until the mixture is able to form stiff peaks. Transfer it to an icing bag (or a zip lock bag with the corner snipped off) to pipe the icing accurately. It stores well in an air tight container for 1-2 days, after which I find it is too hard to use anymore. If you just need to leave it on the bench for an hour or so, cover it in a damp cloth to help it retain its moisture, as it forms a crust and hardens when it is exposed to air.

Softly beaten eggs.

Softly beaten eggs.

Royal icing.

Royal icing – you can see the stiff peak that has formed.

Assembling a gingerbread house

  • Gingerbread shapes
  • Royal icing
  • A large, flat platter to build the house on
  • 2 sets of hands, preferably

Pick one side wall and one end wall and pipe icing onto the base of each piece and also the corner that will meet. It makes life so much easier if there is one person to pipe icing and another to hold the pieces in place until the icing has set but it’s not crucial.

Continue to construct the house. You should start with a side wall and the rear facing wall and then let them dry completely. Next, ice and stick the bottom and adjoining side of the front panel and hold it in place until the icing has set. Make sure the joins are all at right angles, so that all the pieces fit together as they should. Finally, ice and stick the remaining side wall in place and let the walls completely dry for a couple of hours before contemplating sticking the roof pieces in place – houses can collapse.

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I mentioned in the notes section that you can reinforce pieces with either royal icing or melted chocolate allowed to set – this can be quite useful for the inside faces of the roof pieces, as they will have quite a bit of downward force going across them eventually, both from gravity and all the lollies you will be decorating it with. Now, as I was doing this to a roof piece that had a visible crack running through it from moving while still warm and soft (my bad), I carelessly wiped the spatula away from me and pulled the piece in two… whoops. I glued it back together with the icing and threw in a couple of wooden skewers cut to size for good measure. This roof isn’t going to collapse on my watch.

Whoops. This is why you should be careful.

Whoops. This is why you should be careful.

Reinforced roof piece

Reinforced roof piece.

Once the walls are dry and you have reinforced any possible cracks (and let that dry as well), pipe icing along the tops of the wall pieces and lay the roof slabs down. The shallower the angle of your roof, the less likely they will be to slip down before the icing dries.

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Once more, let this dry completely before you use the remaining icing to decorate and stick on the lollies of your choice. The photos I’m posting are of the last two houses I made – in Australia Christmas 2010 and in Seattle Christmas 2013. You can see the difference in lolly varieties in the two countries and also an improvement in my icing skills, although they still leave much to be desired.

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Melbourne – Christmas 2010

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Melbourne – Christmas 2010

Seattle - Christmas 2013

Seattle – Christmas 2013

Finally, demolish the house. The best part of all!

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Eat and Let Eat – The Pros and Cons of Eliminating Foods? Everyone has an Opinion

I’ve read a few blog posts and media website articles lately that I find concerning – both as a person dealing with a digestive issue and a normal human being. My fructose malabsorption (FM) is definitely not as extensive as many people with whom I have spoken over online forums, or as dangerous as an anaphylactic reaction but it is there and it has impacted my life, for better and worse, over the last 8 years since I was diagnosed.

  • The first article I read was a little tongue in cheek, and complained about those with “fake” gluten allergies making a joke of it, so that wait staff/chefs don’t take real allergies quite as seriously as they should, or would, if this were not the case. That’s fine, I get it. So many people are eating gluten free now, and not all for the right reasons.* It’s understandable that those who go gluten free because it’s the latest fad might slightly tick off those who have no choice in the matter – a Coeliac friend of mine ends up in the hospital on antiemetics if she is exposed to gluten and has told me that she doesn’t understand those who chose the lifestyle over a more accessible diet without a decent reason.
  • The second article was downright depressing to read from the stand point of “one of those” customers with a food intolerance. I already feel guilty enough going to eat out at restaurants, knowing I’ll have to ask extra questions and take a little longer to decide what to order, without someone with no expertise deciding if my issues are worthy of their attention. The amount of times I get looks that tell me I’m crazy for not eating an apparently random assortment of foods keeps growing and is a large reason why Ev and I have found a couple of restaurants that suit us and we’re sticking with them.
  • The article that frustrated me the most, however, was this charmer by Mia Freedman. I understand that she was trying to make light of all the recent health related diet fads but she did so in a way that belittled those of us who deal with dietary restrictions that we would more than happily give up.

What is really depressing about most of what I read is that both the articles and the comments sections demonstrated such a lack of understanding of those with both diagnosed and un- or self-diagnosed issues. I suppose I should expect no less from the second article, but an article written by (I assume) a Coeliac would, you would think, have a little more empathy for those who are also dealing with intolerances and possibly garner an audience of like-minded people. Personally, I can tolerate gluten – which means that rye and spelt have opened up as options to me, if my FM can tolerate the fructans (it can, in reasonable amounts). However, I still cannot eat wheat, due to the amount and type of fructans present – yes, FM is a complicated beast.

I would think that most people, like myself, had a long-ish road to diagnosis, after which it took another couple of months before I was really “getting” the fructose friendly diet. It took my parents and I about six months of looking, after a couple of years of an increasingly irritable bowel that one day just got worse than my tolerance level for it. Other stories I have heard have spanned about ten years or more of inexplicable symptoms before a diagnosis was reached! The more exotic your intolerance – or the more inept your doctor – the longer the road is, generally speaking. From this I would assume that we might exercise a little more tolerance of those who are just starting out and maybe don’t quite understand their particular diet just yet. Maybe they don’t have a particular diet (FODMAPs, GAPS etc) that they are following but they have realised that certain foods don’t sit well with them. Intolerances come in all shapes and sizes; if these lucky people only need to cut out a few things in order to feel well again then great, good for them. I’m jealous but I’m not going to call them out for drinking a beer when it has gluten in it, if they are only “trying to watch their gluten” and have decided that this beer fits in with their tolerance level.

I believe in proper diagnosis but this is not always possible. A variety of factors play into this situation:

  • Finances
  • Availability of testing procedures
  • The knowledge base of your health professional
  • The test might aggravate your symptoms past a level you are comfortable with

If somebody told you that they felt better after cutting out wheat or gluten, yet could not have the test due to one of the above reasons, does that make their report of their symptom improvement any less valid than a Coeliac reporting on the benefits of cutting out gluten? No, it does not. We all know our own bodies and we have the ability to judge just what we are happy dealing with and what we will change if possible. Changing symptoms through diet is one of the easiest ways to go about it. It might take a little getting used to but it is more often than not preferable to taking medications that can have unwanted side effects. What I’m trying to say is that if we don’t know the details, who are we to judge? And even if we did, we still can’t know or understand how much the individual is affected by the food; we’re not sitting with them in the toilet, or suffering through their cramps with them at work or home – for those who are lucky enough to have dodged this bullet, it’s not just the cramps or the “runs” that we have to deal with, the initial symptoms also lead to fatigue, frustration, nutritional deficiencies and more.

The second article, for all its short comings, does raise a good point that was discussed at length in the comments section – if you are intolerant of something, and you decide that you do want to eat out (which you have every right to), set yourself up for success. If you have Coeliacs, an Italian restaurant might not be the best idea. Anaphylactic to shellfish? I’d probably steer clear of a seafood restaurant. It is of course up to you to decide what level of risk you are happy with but I can understand a waiter at an Italian restaurant might be a tad miffed if you start having a go at him regarding their lack of gluten free options. They don’t have  to cater for us, though I’m certainly glad that most of them try to. But by making a choice like this and harassing a waiter, you will only give everyone with a food intolerance a bad name. If you graciously explain your situation and keep everything civil, it will all work out for you in the end – even if you have to go elsewhere – and for food intolerant people everywhere who would like to eat out. If we are easy going to deal with as a whole, hopefully the stigma surrounding us will cease to exist.

As someone with a relatively unknown intolerance (over here in the USA, anyway – FM is gaining a good knowledge base in Australia), I experience a lot of disdain from waiters when I try to explain that it’s not gluten, it’s something else in wheat that upsets my gut. Whenever I ask about wheat in a restaurant, the response is, “gluten free?” To which I always feel obliged to say, “No, I’m not a Coeliac but I can’t have another substance in wheat called ‘fructans.'” Why  do I feel as though I have to explain the intricacies of FM to everyone? It would be easier to just answer a simple, “yes” to that question but there is an underlying feeling of guilt at lying. But why? My reason for avoiding wheat is just as valid as the next. I have even heard of other fruct mals being told that nobody is allergic to onion, so they must be faking it. Believe me, I’m not going to go into a restaurant and be difficult on purpose. Why would I avoid one of the most widely used flavours (and for good reason, onion is delicious) without cause?

Because of this, I rarely eat out, except for at a couple of trusted restaurants. It’s too difficult. I don’t like to cause trouble for my gut or my fellow diners. It’s easier to have dinner parties at our home, even with our tiny kitchen added into the equation. Sometimes, however, I do take risks – and sometimes they pay off. But not always. When this happens, lack of education is normally to blame, rather than malice – the beauty of this is that the education/knowledge problem can be solved. I was at a chocolate festival in Seattle earlier this year and I was religiously checking the ingredients in what I was tasting. One seller talked about her “all natural chocolate.” Of course I asked what sugars were added to sweeten it, apparently none? Great, I’ll try some. After I’d finished my bite she went on to talk about the organic agave syrup that she used! I let her know – as gently as I could after a frustrated outburst – that agave is a sugar, as is honey or maple syrup or any other natural syrup (as well as the processed varieties. The point being, in case you don’t have FM and don’t know, agave is incredibly high in fructose, with very little glucose – a terrible sweetener for a fruct mal to use. Cue the looks of disbelief from the chocolatier.

The fact that I continually need to justify why I’m avoiding agave, wheat or pears – such a wide range of foods that it seems I’m making it up – frustrates me. I wish FM was as well known and consistent as a lactose or gluten intolerance, then the name would be enough. We are often written off as just being difficult due to the extreme range of foods high in fructose and fructans. Add into the equation the rest of the FODMAPs that many others cannot tolerate and eating out can seem virtually impossible. It’s not just wait-staff either, friends and family (I’m very lucky with mine but not everyone else is) want to know exactly why you can’t eat certain foods and what will happen. My friends will know I’m not shy when it comes to talking about bodily functions (a health degree will do that to you) but it’s easy to tell when someone is truly interested or if they’re deciding for themselves whether they think my intolerance is real – or as other people have experienced – if their reactions aren’t so severe that they can sneak an unsafe food into the meal. I’m very lucky to have only experienced genuine fructose related mishaps when others have cooked for me – and it doesn’t bother me at all, because at least they tried.

It really is a basic act of respect to accept that someone cannot eat a food, for their own reasons. Vegetarians don’t – or shouldn’t – get harassed for eating salads at a BBQ. Why should we be harassed for being picky eaters? As Mia Freedman so delightfully put it, we “bang on about it.” I’m sorry (actually, I’m not) but you just asked me why I’m not eating/can’t eat such and such. For some intolerances, there is no simple answer. While I make every attempt not to bore people, I do feel like I am doing a good thing in restaurants by giving my little FM spiel to the wait staff. FM is so unrecognised in the US that it needs all the publicity help it can get. If someone is just newly diagnosed, they might be so excited that they finally know why they’ve been so ill that they can’t help telling their friends; they might also be so frustrated and depressed with the seemingly restrictive new diet that they’ve been put on that they need to vent. Either reason is acceptable and part of friendship is listening when it’s needed. On the other hand, I can completely understand that those who are overly zealous and trying to convert people who don’t need it to their chosen diet or lifestyle may be considered annoying. If someone asks for help in loosing weight/IBS/fatigue etc, by all means suggest what has worked for you. If you see someone scoffing a slice of Pavlova, don’t start telling them how bad sugar is for them; they might have just been at the gym.

Empathy and understanding are required by all to handle situations, such as those in restaurants, which might and sometimes do blow out of proportion. The same goes for people with different types of allergies or intolerances. As I said, my FM is generally easy for me to manage. And I’m certainly glad that I’m not so sensitive that I can’t be in the room with an apple, as some with peanut allergies cannot be near an open jar of peanut butter. I will not puff up, my airways do not swell closed and I don’t need to carry an epipen with me at all times. However, while I am lucky that my reaction to fructans aren’t too bad, my reaction to excess free fructose can be extreme. The last three times I consumed apple, the cramps were so bad that I fainted twice – luckily in the computer lab at uni and at home – and almost fainted once – in the middle of NYC, luckily with a couple of very understanding friends. While abdominal cramps due to carbohydrate fermentation in my gut isn’t life threatening, if I fainted while driving or alone in the street? What then? It could definitely get dangerous.

I have never understood why we have to be competitive with our allergies. Is this a contest that we really want to win? Because it’s not really winning at all. This occurs mainly on websites, where users can hide behind their computer screens, which I suppose removes the human element to our online interactions but I like to think that I would talk to someone in the same way that I type to someone, much as I do on here. This allergy superiority needs to stop, we need to support each other and be glad when one group/condition reaches heightened awareness, as it can only mean good things for all the rest. Should the Coeliacs out there be so mad at those with a gluten intolerance, or who are “watching” their gluten? I don’t think so, because without the vocal minority, the awareness about gluten wouldn’t be as widespread as it is now; they have actually done them a favour. Those who don’t believe in intolerances and allergies have and will always exist and whether you choose a diet for medical or “other” reasons will not change that.

Next time someone orders a beer after eating gluten free finger foods, just smile and sip on your wine. It tastes better, anyway.

* In my humble opinion, the wrong reason for going gluten free is that you’re doing it because a magazine article told you to, without looking into it any further. GF diets can and do help many people but if they’re not done properly (i.e. you rely on packaged, processed GF foods) then they can do more harm than good.