The glass-half-full approach to a restricted diet

03/10/2013 By 6 Comments

VegetablesA few days ago I got a panic-stricken email from a lady who had just been diagnosed with a salicylate intolerance. She had been looking at a clutch of websites that listed all the foods that contained salicylates. There was nothing left that she could eat!

A salicylate intolerance is particulary trying as salicylates are very common, especially in all those wonderfully healthy fruits and veg – but the reaction will be recognised by anyone who has been told, all of a sudden, to cut out all gluten or all dairy from their diet. Omigod! What am I going to eat?….. And, even more depressing – will I ever be able to eat anything nice again?….

But, as all of you who have got beyond that stage will know, once you get your head around a restricted diet, it ceases really to be that restrictive. As Ruth Holroyd who writes the What Allergy? blog and who is allergic to dairy, nuts, soya, tomatoes, celery and coriander and intolerant to wheat, too many eggs and herbs points out, if only people would ask her what she can eat rather than what she can’t they would realised that, even if you cut that lot out, there is an awful lot of food left out there to eat.

So, how about approaching a restricted diet from the other end – not what you can’t eat, but what you can? The glass half full?

I therefore suggested to my panic-stricken salicylate intolerant that she print herself out comprehensive tables of each type of food –  you can find lists all over the web. Then that she take a nice new green highlighter and a nice new red or pink one and, using the list of foods she had been given that she had to avoid, highlight them in red or pink – but then, far more important, highlight all the other foods that she can eat in green.

She would be amazed how much green she would end up with on her list – and  how cheering an effect that would have on her general mood. I know this seems as bit like going back to kindergarten but, not only does it help to dispel the gloom about how many foods you are not allowed but it alerts you to how many you are allowed, how many of them might be really delicious and how, actually, eating this new diet could be quite exciting….

Good luck – and happy highlighting!!

Incidentally, for those who do have a salicylate intolerance, the Salicylate Sensitivity website has excellent lists of  foods rated as ‘negligible, low, moderate, high and very high’ which are also rather encouraging as, with the exception of the fruits and the condiments/sauces lists, the ‘negligible’ and ‘low’ columns are usually as long, if not longer than the ‘high’ and ‘very high’!

 

Filed Under: Dairy-free, Food, FreeFrom Food, Gluten-free Tagged With: , , , , , , , , , , , , , , ,

Food allergies considered as disabilities

02/25/2013 By Leave a Comment

Cook with spoon Many American universities, unlike those in the UK, require students living on campus to ‘participate in a meal plan’. This, in the case of Lesley University in Massachusetts, has brought them into conflict with the 2009 amendments to US disability law that now class ‘episodic impairments that substantially limit activity’ as disabilities. Coeliac students claimed that by preventing them eating (by not providing them with food that they can safely eat) the university was preventing them from accessing their educational program.

Students at Lesley University had complained that there were not enough gluten-free foods on the menu for them to eat a reasonable diet – students at other universities had claimed that they have lost weight because there were not enough gluten-free options on the menu. Finally, after three years of discussions with the Justice Department, the university has agreed both to serve gluten-free foods and to ‘make other accommodations for students who have coeliac disease’.

While this is, obviously, very good news for coeliac student in the US, it could have wider implications for those suffering from food allergies, also recognised and diagnosable food based illnesses. While it is unlikely that the disability amendments could be stretched to accommodate people walking into a restaurant or café off the street, they could well be called in support of a food allergic or coeliac eating in any kind of ‘works’ canteen or in any establishment where the ‘in house’ provision of food is seen as necessary or as an accepted ‘perk’ of the job.

Certainly a very positive step in the right direction as far as food allergics are concerned.

(For a more detailed report on this case see MSN News – January 2013)

Filed Under: Allergies, Coeliac/celiac disease, Dairy-free, FreeFrom Food, Gluten-free Tagged With: , , , , , , , , , , , , ,

Gluten-free food on prescription – again…

02/20/2013 By 1 Comment

I realise that I am coming rather late to the most recent prescription charge furore –  set off by the article in the BMJ’s Drugs and Therapeutics Bulletin suggesting that providing gluten-free food for coeliacs on prescription is bureaucratic, inefficient and outdated – see the reports on the BBC,  in the Daily Telegraph and in the MailonLine a week ago.

Just over a year ago many of the same arguments were rehearsed when Oxfordshire PCT put out a consultation document on withdrawing prescription gluten-free food. This is what I said then – and I do not think anything has really changed:

Oxfordshire PCT are currently  creating serious waves within the coeliac community with a consultation document on withdrawing funding for prescription gluten-free food for coeliacs. Their reasoning runs as follows:

• There is now a wide range of gluten-free foods in supermarkets, eg, gluten-free pasta, pizza bases, cakes and breads
• There is a good choice of various makes of gluten-free food
• The cost of gluten-free foods is not as high as it used to be
• Non-wheat, barley or rye based foods that provide carbohydrates are readily available, eg potatoes and rice.
• The NHS does not provide prescription food for other groups of patients whose diseases are associated with, or affected by, the the type of food they eat.

They also point out that their PCT is under financial strain because the population of Oxford is growing, more people are living to an older age, the cost of medicines are rising etc etc etc. What they do not say, although of course it is also true and certainly adds to the strain on their finances, is that whereas 30 years ago, when the gluten-free food on prescription was introduced, less than one in 300 people were diagnosed as coeliac, the number has now risen to somewhere between in in 70 and 100 –  a 200% increase in the number of coeliacs to be fed.

All the points that they make about the availability of gluten-free food also happen to be true. There is a very much wider range of it available in a very much wider range of outlets, its price is dropping (although it remains significantly more expensive the gluten-filled food) and there are plenty of alternative carbohydrates available to coeliacs or anyone else who chooses not to eat gluten. It is also true that the gluten-free food that is on offer in retail outlets can often (though absolutely not always) be better quality and more appealing than what you can get on prescription.

So, if have to pay for your prescription, although shop-bought gluten-free food may still cost you slightly more, the extra cost may not be that significant and the choice and convenience could be a good deal greater.

The rub, and the concern, is for those who do not pay for prescriptions – babies and children, pregnant or lactating women, the elderly, those with specific physical disabilities and those on benefits of various kinds. For them, getting gluten-free foods on prescription may be the only way that they will be able to get them as they may not be able to afford to pay the extra premium for them in the shops. If they are not able to get gluten-free food on prescription, although they could, in theory, achieve a gluten-free diet by using other cheap carbohydrates such as potatoes, and lots of culinary imagination, the chances are that they won’t and that they may therefore damage their health more or less seriously by eating foods which contain gluten. The corollary to that is that, in the long run, they will cost the health service more as their condition will become worse and they will need more care and medication.

So should prescription g-f food be available only to those who are entitled to free prescriptions? In principle, that seems a sensible way to go. But, will the drop in volume mean that it may not longer be commercially viable for those companies currently supplying the NHS to continue to do so and that they therefore will turn purely to the retail market?

Alternatively, should those who currently are entitled to free prescriptions for g-f food just be given extra money instead to cover the cost of buying their  g-f food in the retail sector? This would certainly be a cost effective option for the NHS but, what guarantee is there that the money would actually be spent on gluten-free food? When money is short, paying the electricity bill may seem more important that buying gluten-free food.

Maybe a possibility could be some version of Green Shield stamps which could be provided for those coeliacs who would have received gluten-free food on prescription which they could exchange, in major supermarkets and other participating stores, for gluten-free foods, and only for gluten-free foods?

I am not saying that this is the answer, but as the availability of gluten-free food increases and as the price drops providing it as a standard prescription food becomes more and more questionable. While just dropping it may not be the answer, some creating thinking is definitely needed.

Since then…. Coeliac UK has been quoted as worrying about the complexities of implementing a voucher scheme through supermarkets. However, in this digital age when every supermarket already runs a number of complex ‘loyalty’ schemes, I cannot see that it would be beyond fairly basic technical competence to incorporate a discount for registered coeliacs into the mix. The pressure is obviously growing, so maybe everyone concerned need to look at the possibilities somewhat more seriously.

 

Filed Under: Coeliac/celiac disease, Conventional Medicine, Food/Health Policy, FreeFrom Food, Gluten-free Tagged With: , , , , , , , , , ,
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