Foods to Avoid When You're Gluten Intolerant

Top of the list, of course: wheat, barley, oats and rye, and anything made from them.

The problem is these cereals can hide innocuously in other foods, and they're not always easy to spot. It's a fact of life for the gluten-intolerant: sooner or later (the sooner the better) we all turn into rampant ingredient label readers.

The list of forbidden foods with gluten includes:

• Bread and buns (thus ruling out sandwiches and burgers, unless you forgo the bread and buns)
• Cake
• Pancakes
• Biscuits
• Cookies
• Crackers
• Wafers
• Pizza
• Pasta
• Wheat noodles (mee, mee sua/mian xian, meen)
• Fish cake, fish balls, fish paste, crabstick (if made/mixed with wheat flour)
• Soy sauce (contains wheat)
• Dumplings (like char siew pao/cha shao bao, sui jiao, wantan – there’s wheat in the skin)
• Dim sum (usually encased in wheat skins, but ask – the soybean skin ones are generally OK unless they use wheat flour paste to seal)
• Wheat-based wraps (tortillas, popiah skin if made with wheat)
• Roti prata (roti canai to Malaysians)
• Chapati
• Most breakfast cereals
• Beer (it's made from barley)
• Boiled barley drinks
• Horlicks, Milo, Ovaltine (anything with malt)
• Teriyaki/barbecue sauce (if thickened with wheat or flavoured with malt – read the label)
• Batter-fried items (e.g., sweet and sour fish/chicken/meat, KFC chicken). Tempura items, if made to the traditional recipe, should be coated in a rice flour batter, not wheat flour. But it is always wise to check with the kitchen, since chefs like to get creative with recipes.
• Bread-crumbed items (e.g., chicken cutlets or fish cutlets, that are coated with breadcrumbs)
• Sauces and gravies thickened with wheat flour (especially if you see the word roux, but check with the chef even if you don’t see this)
• Sausages and ham (if wheat is used as a filler – it usually is)
• Western meatballs and burger patties (usually contain breadcrumbs).
  

Soy sauce is usually OK in small amounts for me – apparently the production process breaks down the amount of gluten. Obviously this will vary on the brand of soy sauce, so venture at your own risk.

Rice and rice noodles – like meehoon or mifen – are great, as are rice-only crackers and breakfast cereals.

Beware of pan-fried meats, even if not coated with batter or breadcrumbs. Sometimes these get dusted with flour before they go into the pan, to prevent sticking. A case in point: foie gras may sometimes be flour-dusted before cooking.

Thosai, or dosa, that delicious South Indian thin crêpe of slightly soured batter, is traditionally made with rice and lentil flour only. I love thosai. But as with all items made with a batter, proceed with caution. Most places are fine, but some kitchens may face gluten contamination as all places serving thosai also serve the more popular roti prata as well. All it would take is for the cook to stir the two different batters back and forth using the same spoon without washing in between, and the thosai would turn bad for us GI sufferers.

And do note that noodles in the food stalls tend to be cooked in the same pot of boiling water or stock. So even if you order rice noodles, they may be rendered unsafe if cooked in the same pot of water previously used to cook wheat noodles. Proceed with caution once more.

One more thing. Most chicken rice meals should be safe, especially if you avoid the dark soy sauce it comes with. But I just noticed my favourite stall also chops its lemon chicken on the same board as the regular chicken, and as lemon chicken is always bread-crumbed, there may be residual gluten on the board that gets transferred to your order. Generally, they scrape the board with the cleaver fairly clean between orders, so most times my chicken comes to me free of the offending crumbs. But if the preceding order is for that dastardly lemon bird, stray crumbs may escape the cleaver and adhere to yours, so it's good to be observant and ask that they wipe the board clean if the order before yours is for the crumbed version.

Paranoid? Maybe a little. But I'll take a little obsessive watchfulness over intestinal pain and suffering any day.

And It's Going to Take Some Time...

Back again from another work-related trip, also to Malaysia. It wasn't the easiest time for me. One reason I do hope awareness of gluten intolerance increases in this part of the world, is because people in Southeast Asia don't seem to take it seriously when you say you can't eat gluten.

This time, I thought I took the necessary precautions in order to ensure gluten-free meals the whole trip. But they weren't enough to overcome the sheer ignorance and apathy I had to face.

I remembered well enough to alert the trip planners ahead of time. My colleague in charge of the meals answered brightly "Sure thing! We'll make sure you won't be served wheat or barley!", as though anyone eats just wheat or barley like some kind of a dish on their own. When I pressed on and clarified that that included not just the usual suspects like bread and cake, but also things like soy sauce, beer, batter-fried or bread-crumbed foods, and even imitation crabstick, his reaction on the other end of the line seemed suspiciously like a stunned silence. Yes, young Paduwan, you have much to learn.

As does almost everybody else out there, or so it seems. My meals, as long as they were buffet-style, were OK, as I could just avoid the foods with gluten. Chinese meals, with several courses, were tolerable, as I could avoid the courses with wheat, barley or oats. But catered, fixed meals and communal dinners where I had no control over the menu were a positive nightmare. There was one meal where we were all supposed to cook our dinner ingredients in a Chinese steamboat, that fun communal stockpot in the centre of the table. It's great for social bonding. But it's only fun for me if there's no gluten in it. Going in to dinner, I took one look at the piles of raw wheat noodles laid out all around the steamboat and knew immediately I would have to back out, as any gluten-free ingredient cooked in that same swirling soup as the noodles would mean hours of cramping and pain a couple of days after, not forgetting the accompanying gory output.

With a pained smile, I apologised and excused myself. I went back up to my hotel room and ordered from the room service menu instead. And here's the thing: I shouldn't have had to apologise. I'd made my dietary needs clear only to have them ignored -- if anything they should have apologised to me. And yet just two days later, on a team-building trip outside, I got my pre-packaged meal and had to throw away the accompanying chicken because it was breaded. (No one accepted my offer to take it off my hands.) That kind of waste just makes me feel wretched. There are people starving in the world, and to dump food uneaten is beyond disrespectful.

What really sucks is that the trip organisers went out of their way to ensure the vegetarians in our group had meat-free options all the way, the Muslims had everything halal, and the Hindus had it all beef-free. But my meals were spent dodging dishes and wasting food. Were they ignorant? Or did they just not care?

I heard that one of the planners commented later -- referring to me -- that all Singaporeans are fussy eaters. How snide that sounded, as though they thought I was being pernickety just because I didn't like this or that, that it was just a taste thing, or that it was some kind of new-fangled diet. Listen up people: I don't choose to be fussy about food. I eat this way because to do otherwise would damage my body. Can you knuckleheads comprehend that? If an alcoholic refuses alcohol, or a diabetic sugar, are they just being fussy, or are they doing what they do so their bodies don't break down? It's the same thing for the gluten intolerant. Keep whacking the system with gluten and possible outcomes include severe malnutrition, osteoporosis, even cancer. So keep your comments to yourself and try some common sense please. A little respect for a person in need wouldn't hurt either.

All in all I think I managed to avoid most of the gluten on this trip. Some of the offending substance might have sneaked in during a multi-course Chinese dinner on the first night, but my enzyme pills weakened the impact a bit. They're not a cure, and your intestines still suffer damage, but the symptoms soften from killingly painful to just barely tolerable. So two days after (it seems like the symptoms take two days to reach their peak) I had the painful toilet runs again. But after that, things seemed to settle down a bit.

I missed being away from my regular foods. One food I have noticed that helps out a bit, surprisingly, is cheese. This isn't a cure either, but if you've been hit with only a tiny bit of gluten, I think the casein helps to hold things together somewhat as food passes through your digestive canal, so you have an easier time when the waste emerges. In plainer terms: your gloopy diarrhea turns more solid and easier to evacuate. So if you've had a tiny bit of gluten (say, in some soy), I find some cheese at night seems to help the next day. Do note that it doesn't help if you've had more than just a smidgen of gluten. And no I don't believe it offers any protection. But that there's another tip for coping with gluten in the world.

Oh to have had a slab of cheddar on this trip up north!

Back Again, with a Golden Tip

Yes, I know I've been highly remiss. A month without posting! How time does fly when you're not having fun.

You see, the past few weeks I've been recovering from being glutenized. Yes, it still does happen from time to time, and it seems like the past four weeks have been like a triple whammy of being hit unexpectedly with gluten from sides unseen.

About four weeks ago, I went out to dinner with some friends. As per the usual, I checked with the wait staff and the chef regarding wheat, barley, oats and rye in all that I ordered. All seemed safe, and I exited the restaurant feeling very happy.

Dinner was on a Saturday. Sunday brought with it some tummy rumblings, bloatedness and the beginnings of that grim, "plugged-up" feeling. And on Monday -- there they were again, the sticky, unmoving stools. And it lasted for a few days, before beginning to clear up by the weekend. I realise now that despite my best efforts, people in the dining scene, waiters especially, don't quite know what to look out for when you announce you have to eat wheat-free. I suspect it was not the dishes I ordered, but rather the amuse-bouche that arrived under the radar, as it was the only item whose wheat-free status I hadn't insisted the waiter check with the chef. As it was, when it arrived, and upon my asking, he answered hurriedly "Yes, it doesn't contain wheat... umm, except for this slice of accompanying toast..." It was a small cup of thick soup; I had thought it was thickened with a vegetable puree of sorts, but now...

And then on the following weekend, another dinner with friends. This time it was Chinese food, and I foolishly let a friend order. Among the dishes -- an ominous-looking beef stew, and prawns deep-fried in cereal. (If you don't already know, most western stews are thickened with wheat flour. Chinese ones are less likely to be so, but they do have generous lashings of soy sauce, which does contain gluten. And cereal prawns are usually crumb-coated with oats. Delicious, but deadly for the gluten intolerant.)

I should have known better, but I ate some of the beef, shaken dry of the sauce. And just one of the prawns, scraped as free of the oats they were coated in as much as I could. You see, not eating any of it at all would have been a tremendous loss of face to my friend who had ordered. My fault, for not being clearer about what was off limits for me.

I really should have known better. That dinner was also on a Saturday. Sunday and Monday were spent in bloated, cramping gassiness, stricken again with unmoving constipation.

Then on Tuesday, I had a normal bowel movement. I had a temporary sense of relief, thinking the worst was over, that I hadn't actually ingested that much gluten. How wrong I was!

I know now that it was just my body getting the normal stools, laid down before my gluten attack, out of the way before the main event. Before that Tuesday was over, I had run to the toilet five times, holding my cramping tummy, to sit on the bowl for hours in total. And washing and wiping, washing and wiping after each session, trying in vain to wipe away that which will not be fully wiped away. (Picture the inside of a pipe covered in a sticky sludge, and you'll get the idea why there was always some residue stubbornly overstaying its welcome.)

The next day I had to fly to Kuala Lumpur for business. And if waiters in Singapore are bad, those in KL really are much worse, insofar as understanding of dietary needs are concerned.

"I can't eat wheat."

"You can't eat meat?"

"No, wheat."

"Wit? What?"

"WHEAT. Gandum. Terigu. Mian fen. Gothumai. Atta. Does this contain wheat? Or flour?"

"Er, yes, this has potatoes/rice/liver/vanilla/[add any old gluten-free ingredient here]... so I think you can't eat this right?"

And so on.

So this past week, my diet has been a little erratic. You quiz the restaurant staff, you order food in the food courts and ask that they hold the soy, but really if it's all new terrain you just never know. I just got back to Singapore, and my symptoms over the past few days haven't been that bad, but things aren't really back to normal yet. It could be that an ingestion of gluten takes time to totally clear out from the body, and the length of time depends on the quantity ingested, or the severity of the reaction -- what I mean to say is, what I'm experiencing right now could also be the after effects of my two glutenized weekends previously. But while I really don't know if there was any accidental ingestion of gluten while I was in KL, my gut feeling, ha ha, is that yes there was.

One thing I have noticed -- and here's a tip worth its weight in gold -- the digestive enzyme pills I've been taking really do seem to help. I always have on me my trusty bottle of pills, after reading this tip in Dr. Shari Lieberman's Is Gluten Making Me Ill? You need to take a couple of these, in preparation for any meal that you suspect might sneak a little gluten into your system. Not so effective if taken after said meal, but still better than doing nothing at all.

I took the little green suckers (the brand I buy is "Enzyplex", available at all good pharmacies -- if you know of any other brands do let me know) before that first dinner about four weeks ago. Symptoms after were relatively mild. Relatively. No cramps, but my digestive system was far from normal.

The second weekend, I forgot the pills. And boy did I suffer, cramps and gas and diarrhea and constipation, et al.

This past week, been taking them off and on. And the symptoms are there but milder.

They're not a cure, and you still suffer if you're glutenized, but they do help. A million thanks to Dr. Lieberman. This is one tip I really do treasure.

More tips later...