Individuals with celiac disease should consume a strict gluten-free diet for life. Their diet should not contain any of the following;
Any food products or drinks than may contain the above ingredients should also be avoided.
The following foods are safe for individuals with celiac disease as long as they are free from gluten contamination:
Wheat is a very common ingredient of our diet. Contamination of other food products with wheat is common. For example, the preparation of corn flour on the same machine that makes wheat flour (aata) may lead to gluten (from wheat) contamination. Therefore, corn flour made on such a machine will not be safe. Even a small amount of gluten can lead to serious health problems. The person may not sometimes feel any symptoms after eating a contaminated food item; it can still cause damage to the intestines. If ingestion of contaminated products continues, further complications may occur. When buying food items, the ingredients list should be checked to ensure that they do not contain any gluten. If there is any doubt about contamination, it is best to avoid the food or drink in question. A gluten-free diet is costly and can be complicated to follow. A consultation with a skilled dietitian is essential to go over the details of a gluten-free diet.
CAUTION: Testing of gluten in foods is complex. The consumers are responsible for ensuring that the food products manufactured in Pakistan that claim to be “gluten-free” are following the proper standards of gluten-free certification. There are some vendors in Pakistan who are marketing wheat flour (aata) as “Diet” and Gluten-Free”. These claims are absolutely false and misleading as there is no “gluten-free” wheat flour. These flours and products made from them should not be consumed by people with celiac disease.
Celiac disease is all about living gluten-free. However, this requires knowledge when selecting the appropriate foods for consumption. All people with celiac disease know which grains to avoid i.e. wheat, barley and rye. However, when it comes to buying ingredients for cooking or purchasing packaged foods, the matter gets complicated. There are many processed food products used in cooking which contains hidden sources of gluten. This can pose a serious threat to the health of those with celiac disease. Unlike industrialized countries, people of Pakistan are more challenged by the problem of label reading due to lack of adequate laws regarding proper labelling. Also, in other countries there is better level of awareness among the manufacturers and consumers when it comes to gluten-free foods. Why is label reading so important for people on a gluten-free diet? The answer to this question is manifold, and can be illustrated with some examples.
This product says Corn Flakes. The first impression by any consumer is that the product is made from corn, a grain that should be safe for those on a gluten-free diet. However, the story becomes quite different when one reads all the ingredients. The product contains malt which is made from barley. Therefore, the product is not gluten-free and not safe for consumption by individuals with celiac disease. The same is true of many other brands of locally manufactured Corn Flakes.
Let us take another example:
The product is named Rice Flakes. Rice is a gluten-free grain and should be safe for those consuming a gluten-free diet. However, the ingredient list of the product reads, “Rice flur, malt, sugar and salt”.
Malt is made from barley, which contains gluten. Therefore, this product would not be suitable for those on a gluten-fre diet. Many items used in foreign countries are gluten-free but they are not in Pakistan even if the same name is used for them. For example, in the USA, Modified Food Starch is considered to be gluten-free as it is derived from corn, rice, or potato. However, in Pakistan there is a strong possibility that Modified Food Starch is made from wheat.
Label reading can be quite frustrating in the beginning but if learned properly it becomes easier. Whenever buying food products, make sure the following points become part of your buying habits: Always read the label first, even if the product is a candy or a cold drink. Make sure that you understand each and every ingredient. If an ingredient is unfamiliar, try to research and if unsure, it is best (and safe) to leave the product. Read the label every time while buying a product even if you have checked the ingredients previously. The manufacturers keep changing the ingredients of the product without warnings. While going through the list of ingredients on the label, some will be familiar to you while others may not be. Try to memorize some of the common ingredients so that it is easy to recall them the next time you read the label. A mobile phone app called Gluten Free 24/7 is a useful resource to get instant information on the gluten-free status of ingredients.
Any product containing the following grains or flours should NOT be consumed as they contain gluten:
Derivatives of these grains e.g. “malt” or “organic malt” are made from barley. Malt is sometimes also called barley malt. (“Rice malt” is safe but one should check it out to make sure it is in fact rice malt. If it says just malt, do not consume)
Some of the items are considered to be gluten-free in UK and North America as the manufacturers use gluten-free ingredients while making them but in other parts of the world especially in Pakistan, these items are doubtful. If all the ingredients are not clearly mentioned there is a good chance that it will contain gluten and therefore should be avoided.
Hydrolyzed vegetable protein can be derived from different protein sources. If they are derived from wheat they are obviously not safe. However, if they are derived from corn or soy they should be fine. If the source of the Plant or Vegetable is stated, for example, "Hydrolyzed Corn Protein", then it is gluten-free. If the source is not stated, it is best to avoid it.
Soy sauce is usually made from wheat or roasted barley, but there are many foreign brands which make it only from soya beans. Unless the ingredients are mentioned clearly, it should not be used.
Not all food starch contains gluten but, unless you know what kind of starch it is, i.e. corn starch or wheat starch, it is best to avoid it
Sometimes starch fillers are added to yogurt and soft cheeses.
Most cereals contain some form of gluten, especillay in the form of malt.
Look for starch fillers, soy sauce, hydrolyzed vegetable protein and pasta.
It is also used as a thickener or binding agent and is usually made from corn, potato, tapioca or rice. In some cases it is made from wheat. Therefore, unless the source is clearly mentioned, it should be avoided.
Maltodextrin is derived from various starches like rice, potatoes and corn. The vast majority of maltodextrin is derived from corn and is safe. In North America, maltodextrin is usually made from corn; however, it may be derived from wheat in some cases. This is important for people with celiac disease, since the wheat-derived maltodextrin may contain traces of gluten. Wheat-based maltodextrin is used in Europe and North America. However, it is highly processed and purified (more than modified food starch). When tested, wheat-based maltodextrin was found to contain very low levels or no gluten, therefore, it is allowed on a gluten-free diet. If wheat is used to make maltodextrin, it will appear on the label. Even so, the maltodextrin will be essentially gluten-free.
Following items are gluten-free. However, when buying products containing the following ingredients it is still possible that there could be gluten contamination. Caution should be exercised in this case.
Agar is obtained from algae and can be used as an alternative to gelatin for making jellies and desserts. It is unlikely to be cross contaminated with gluten.
Almond is often ground and used as an alternative to flour in bakery products.
Amaranth is a plant used to make cereal alternatives.
Basin or Gram flour is made from chick peas.
Buckwheat is used to make flour and noodles. Although there is word “wheat” in the name, buckwheat is gluten-free.
Carageenan is used as thickener, stabilizer, or emulsifier.
Cassava/Manioc/Tapioca is a plant/vegetable used as a cereal product. Tapioca is the beady starch extracted from the root of the cassava (manioc) – used for puddings or as a thickener
Chestnut is also ground and used as flour
Corn or maize (called makai in Urdu) is a grain from which flour/starch and other products are made.
Flax/Linseed are seeds that can be added to muesli.
Hemp – flour and seeds used in bakery products and muesli
Millet (called bajra in Urdu) is a cereal or grain often used in gluten-free muesli
Mustard can be in the form of flour, powder, seeds and oil
Polenta is made from boiled cornmeal
Potato – can be used to thicken sauces and soups – flour/starch used in baking
Pulses (Beans, Lentils) can be ground to Make flours, and can be used in a variety of dishes.
Quinoa is a pseudo cereal – it’s seeds are used in muesli and baking.
Rice – all types, e.g. wild, Arborio, aromatic, basmati, black and red.
Sago is a powdery starch extracted from sago palms, can be used as thickener or cereal product.
Sesame are available as oil and seeds.
Sorghum is a grain which can be used as a source of syrup.
Soya flour used in gluten-free bakery products.
Tapioca – see Cassava.
Teff is a grass with very small seeds – its flour can be used in baking.
Urd/Urid/Urad is flour made from lentils.
People on gluten-free diet sometimes feel that reading labels restricts their choices of foods. On the contrary, becoming knowledgeable about label reading will, in fact, improve choices as people can select products more easily and reduce the risk of eating foods that are cross contaminated.
Reading labels can sometimes be quite challenging. There is a product called Chinese Chili. The ingredients on the back of this product are:
“Corn flour, sugar, salt, monosodium glutamate, onion, yeast extract, dehydrated vegetables, spices, garlic, hydrogenated palm fat, tomato powder, artificial flavors, malic acid, sodium inosinate and guanylate, soya sauce powder, sodium acetate, citric acid and maltodextrin”
Such products are available in a variety or flavors and packages in the market, but many individuals with celiac disease might avoid the product as the list of ingredients is complicated. Some items listed are rare and, therefore, without proper knowledge it is difficult to judge whether the product is truly gluten-free or not. How many of the above mentioned items are known to you? Even after learning about many of the ingredients used commonly there are still some items which will be unfamiliar. Examples of such items in the above ingredient list would include “guanylate” and “malic acid”.
Guanylate is produced from dried fish or dried seaweed and is often added to instant noodle, potato chips,and other snacks, savoury rice, tinned vegetables, cured meats and packaged soup. Good to know that the item is gluten-free.
“Malic acid” sounds like malt but actually malic acid is found mostly in unripe fruits. It is used to bring sourness in food and is gluten-free.
Many products presumed to be containing gluten may actually be free from it. Knowledge about such products can improve food choices.
There is an urgent need to deal with the issue of food labelling in Pakistan. The celiac community should work towards improving awareness on this problem and lobby the government agencies to mandate detailed and accurate labelling of food products.
Learn to read labels. There is no other way out.
Do not buy or consume anything that is made from or contains any amount of wheat, barley or rye, no matter what the product package says.
If you are not sure whether a product is gluten-free or not, it is best to leave it.
Pakistani Celiac Society is dedicated to provide information on proper reading of food labels so that individuals on gluten-free diet can enjoy a safe living.
Many parents who have children with celiac disease, have a difficult time adjusting to the gluten-free lifestyle. Gluten-containing foods are common in our diet and the parents may feel overwhelmed with this change. This article will act as a guide for parents in this situation providing some tips that can be used to ensure a proper diet for their child. With lack of awareness and difficulty in obtaining gluten-free food locally, parents must be educated on how to deal with these problems.
Parents of newly diagnosed children should get themselves educated on the gluten-free diet through resources including doctors, dietitians and websites. Understanding the boundaries and limits of a gluten-free life can help parents manage their child’s life more effectively. The knowledge acquired will help them explain this to others individuals who are around the child. For school going children with celiac disease, parents remain the primary source of information and support.
As parents, the goal is to raise the child with celiac disease with an understanding and knowledge of living a healthy, gluten-free life. Involve your child in his/her condition, no matter how young the child. Read labels loudly to them, explaining the terms. Encourage them to make food choices among the best available (do not force an item on them). Help the child in menu selection when dining out and try to avoid repeating menus (despite limited availability of gluten-free foods). Do not take child to a restaurant where you know gluten-free foods will not be available. Teach your child to say no to contaminated and forbidden foods offered by friends or family. Never have your child feel let down and alone due to the dietary restrictions. Make arrangements in advance for special occasions like parties.
Pakistani Celiac Society can be an important resource for increasing awareness and educating people on celiac disease and gluten-free diet. Parents of children diagnosed with celiac disease can play an important role in this regard. Providing the child’s teachers with as much information about the condition and diet that they understand is essential. Similarly, our school teachers can also play a important role in helping the child cope with the dietary restrictions. A list of allowed and not-allowed ingredients should be provided to the teachers. Make sure they understand the child’s symptoms, so that if he/she accidently takes gluten, the error is recognized. Brochure on celiac disease in Urdu and English can be printed from the Pakistani Celiac Society’s web site and given to the teacher.
Children with celiac disease should have an adequate breakfast before going to school each day. Breakfast is the most important meal of the day. Milk and other dairy products should be part of the diet as this supplies the body with calcium. Fruits should be included in breakfast and our country has a variety of local seasonal fruits available. It may be possible to let your child buy lunch at school, but it requires planning and coordination between you and the lunch provider. As much as possible, it is advised to send home-made lunch as this would reduce the risk or eating contaminated food items. The child’s taste, preference and likings should always be taken into consideration.
Parents tend to stop the social activities of children as soon as they get diagnosed. This is not recommended as it diminishes the child’s self confidence he/she feels dejected. Parents should encourage socializing as much as possible with proper precautions to avoid any gluten ingestion. Birthday parties at school should be managed with the help of education provided to teachers and other children. For such an event, the parents should prepare gluten-free food like cakes in advance and send it to the birthday party at school. The teacher should provide support to the child on such occasions so that he/she does not feel lonely when others are celebrating and eating cakes made from regular wheat flour. Parents of the child’s friends should also be educated about the gluten-free diet. This will also help spread awareness.
Children with celiac disease will remain well and healthy as long as they stay on a strict, gluten-free dist. Many parents stop medical follow-up once the child is diagnosed. However, it is advisable for the patient to have periodic check-ups with the doctor and with a dietitian. Children’s height and weight should be monitored regularly to ensure adequate growth. Any concerns should be discussed with the doctor.
Wheat is the major staple in Pakistan. Rice is also widely available but a lot more expensive. Availability of certified gluten-free foods in Pakistan is limited. Labelling on products is in English and in most cases packaged foods are labelled accurately. Food items sold in open package or in bulk cannot be guaranteed to be gluten-free.
Urdu language is widely spoken throughout Pakistan. In many hotels and restaurants, English is also understood to a limited degree. While eating at a restaurant, check with the waiter or manager regarding the status of the food.
The following phrases can be used by individuals on a gluten-free diet traveling to Pakistan who may not be familiar with the Urdu language. This can help them communicate or at least convey their message regarding the gluten-free diet in Urdu.
The use of Google Translator may also be helpful. There is no direct translation for the words CELIAC or GLUTEN in the Urdu language.
Mujhai marz celiac (see-lee-ek) hai.
MEin aisEE koEE khorak nahi kha sakta jis mai Gandum, Jo ya rye shamil ho.
In cheezon kai khanaY saY mai beemar ho sakta hoon. Or In cheezon kai khanaY saY meri tabiyat kharab ho sakti hai.
Kia is maY gandum, rye, jo ya jaee ka aata shamil hai?
MEIN chawal, makai, sabziyan, phal, UndaY, doodh, GAI, BAKRA, MURGHI, MACHLI KA gosht aur besan sai banEE khorak kha sakta hun Jab tak yaY gandum kaY aataY, maidaY aur double roti kay choori saY paak ho.
Agar aap is khanaY kaY ajzaa kaY baaraY main nahi jantaY HAIN, to mujhaY bata dEE JEEAY.
Mujhai mashwara dE JEEAY kaY konsAY KHANAY maYraY lEEaY sahi haiN.
MujhaY doodh saY bani ashia istaYmal karnai ki ijazat nahi.
Kia aap koEE BAGHAIR gluten (gluten-free) cheezaIN baichtaY hain?
This Travel Guide has been prepared to help individuals on a gluten-free diet. All efforts have been made to keep this document as accurate as possible with phrases commonly used to explain the dietary restrictions. Pakistani Celiac Society accepts no responsibility for any misinterpretation of information in this guide.