Mario Caruana, a registered dietitian-nutritionist, who has been diagnosed with coeliac disease, has said that currently there are various restaurants that state they have gluten-free menus but not all adopt the stringent rules that keep contamination levels to the bare minimum.

International Coeliac Day was marked on Friday. Dr Caruana’s comments come after this newspaper interviewed Candie Borg Cardona, who has also been diagnosed with the condition, who stated that even a crumb with traces of gluten can make a person who is celiac sick, pointing out that most restaurants failed to bake food for gluten free diners separate from gluten induced foods. In a bid to create awareness, she created a factsheet for restaurants to follow and posted it on her blog, ‘Coeliac Hub’, and Facebook page. A highlight of the interview was that fifteen years ago, those with coeliac did not know whether to eat the box the gluten free products are stored in or the products since they tasted the same.

Dr Caruana, who emphasised that individuals diagnosed with the condition should not be referred to as sufferers since gluten free products have improved over the years and the diet may be both healthful and enjoyable, said that as things stand, the only treatment for this condition is a life-long gluten-free diet.

“Strict avoidance of wheat, rye, and barley and their derivatives will result in intestinal healing and relief of symptoms for the majority of individuals,” he explained.

Although the diet ultimately brings about greater well-being, “it requires a significant amount of effort and commitment”, he said, “especially in the beginning”.

“One cannot describe it as a ‘suffering’ as products and knowledge in the culinary area of gluten-free living has very much improved in the last years”.

“Nonetheless, it is a challenge as one needs to always be sure that there is no contamination of the food being consumed,” he said, an issue which arises when one eats out or is travelling overseas.

What are the symptoms and how does one get tested?

Dr Caruana said that symptoms may be present with various nutrition or malabsorption-related problems such as unintentional weight loss, bloating and gas, ongoing fatigue, lactose intolerance, diarrhoea or constipation and iron deficiency anaemia. Others may have non-intestinal manifestations such as osteopenia or osteoporosis, infertility, neurological problems and dental enamel abnormalities.

“Another presentation of coeliac is dermatitis herpetiformis, a symmetrically distributed blistering and itchy rash appearing primarily on buttocks, elbows and knees.

“On the other hand, other individuals may be only mildly symptomatic or asymptomatic (no particular symptom) at diagnosis. Since all these symptoms are common to many other conditions, it is imperative that a doctor makes a preliminary diagnosis through a blood test usually by checking anti-tissue transglutaminase antibodies (tTGA). If blood tests and symptoms suggest coeliac  disease, a biopsy of the small intestine is performed to confirm the diagnosis.

Turning to his profession, he said that he has been a registered dietitian for the past 10 years.

“My curiosity and interest on how nutrients in food affect our body was the main drive for me to choose this career. It was only around three years ago that I was diagnosed with coeliac  disease, with the main symptom being fatigue.

“Having been trained as a dietitian to offer dietary advice to this population, being involved with local and foreign coeliac  associations and being an active team member of a local company retailing gluten-free food, has given me a lot of knowledge on the condition and products available.

“However, I must admit that once you live with the condition, it is then when one gains a real insight and deal with the challenges that a gluten-free diet offers,” he said.

In a bid to give courage to others who have been diagnosed with the condition, he said that “the gluten-free diet is simple in principle, however, completely eliminating all foods and ingredients containing wheat, rye, barley, and most commercial oats can be very challenging.

“In addition to the obvious sources of gluten like breads, pastas, and most common breakfast cereals, gluten is often found in a wide variety of products such as seasonings, sauces, soy sauce, marinades, salad dressings, soups, prepared meats and candy.

“Individuals with the condition not only need to know which foods and ingredients to avoid, but also how to integrate the diet into their day-to-day work and family lives.

“This includes mastering label reading and becoming familiar with sources of gluten-free foods and basic gluten-free cooking methods,” he said.Simply dropping gluten-containing foods from the diet may result in an unbalanced diet lacking in certain nutrients.

In addition, he said that specific strategies for eating in restaurants and while travelling away from home, as well as how to prevent cross-contamination of gluten-free foods with gluten-containing foods and ingredients are important.

“The nutritional adequacy of the diet can vary considerably among individuals with coeliac  disease.

“Implementing the diet requires significant change and commitment from patients and comprehensive diet education from a skilled dietician.

“Periodic follow-up with a registered dietician, and participation in national support group activities (such as those organised by the Malta Coeliac Association) can improve dietary compliance and quality of life for individuals diagnosed with this condition.