Posts Tagged ‘contamination’

When it comes to making bread and cakes, wheat has some remarkable cooking properties that nothing else

can match. Its characteristic proteins, called gluten, form very strong elastic threads. These make a

stringy dough that can be stretched and stretched as the bread rises. As a result, the bubbles of gas

given off by the yeast or baking powder are all embraced by the dough, giving an open, airy consistency

to the finished product.
Have no illusions – without wheat flour you cannot make a crispy baguette or a well-risen cottage loaf.

If you are able to eat rye, then rye flour makes a pretty good substitute, because it also contains

gluten, though not as much as wheat flour. But a gluten-free diet excludes rye too (see p. 177), and

then baking definitely becomes a challenge.
Even on a gluten-free diet, however, you can still make several perfectly edible, even delicious, types

of bread and cake. The secret, especially with bread, is to accept that the texture is going to be

different from wheat-based bread, but to add enough interesting flavours to give the finished product

its own special character. The gluten-free bread you make at home will taste vastly better than the

pale and pappy commercial substitutes – and at a fraction of the price.
Wheat-free and gluten-free bread tends not to keep as well as ordinary bread, so make a batch of small

loaves and freeze some of them. You can slice them before freezing, then extract and defrost a few

slices at a time, as needed. Bread that is not frozen should be kept in a plastic bag in the

refrigerator. Even when kept in this way, the bread gets rather dry and tough after a few days, and

will benefit from being toasted. Try spreading it with butter, margarine or solidified olive oil (see

page 182) before putting it under the grill – this revives bread far better than ordinary toasting.
Pastry-making without wheat is also a challenge (see p. 180) but cakes, biscuits and other sweet items

are much less of a
problem. As long as you accept the limitations of non-wheat flours, cakes can be made perfectly well

using gluten-free flours. With the right culinary tricks, you can even make a light fluffy sponge (see

pp. 180-81).
To thicken sauces and gravy, you can use cornflour or any other non-wheat flour.
If you have an allergy or intolerance to other foods, besides wheat, the recipes here can be adapted

accordingly. For example, commercial egg replacers (see p. 186) can be used in place of eggs, and milk

substitutes (see p. 183) can replace cow’s milk.
Wheat-free diets
This section is for people with an allergy or intolerance reaction to wheat. Those with coeliac disease

should read the section on gluten-free diets.
In devising a successful diet for yourself, you need to take account of two factors:
1 How sensitive are you? If you have a true allergy (see p. 62) to wheat, you may be very sensitive and

need to avoid even the tiniest amount of wheat. But if you are just intolerant of wheat (see pp. 74-6),

you probably won’t react to such small amounts. so you don’t need to be so careful.
2 Are you sensitive only to wheat, or do you also react to related cereals, namely rye, barley and

oats? Some people have to avoid these as well, because of cross-reactions (see p. 14).
Those who are highly sensitive to wheat and have cross-reactions to related cereals, need to follow the

same kind of diet as the most sensitive coeliacs (see Gluten-free diets). Ready-made gluten-free foods

(such as bread and biscuits) can be useful, and they should be safe for you, unless you are

ultra-sensitive.
Those who don’t have any cross-reactions to related cereals can tolerate the following:
•    rye bread and rye crackers, as long as they are 100% rye
always double-check. If you buy rye bread from a local bakery, and it is unlabelled, make sure the

staff understand that you must always have 100% rye bread. Ask them to tell you if they ever change the

recipe – and jog their memories about this from time to time.
•    beer – as long as it is brewed using barley. Most is, but watch out for German Weissbier, which

is made from wheat.
•    oatcakes, as long as they don’t contain wheat flour or bran. Check the label carefully.
Gluten-free diets
A gluten-free diet is more restrictive than a wheat-free diet, since gluten is also found in rye,

barley, triticale and spelt. All these must be carefully avoided.
At one time, this list would have included oats as well, but new research suggests that the proteins

found in oats, called avenin, are sufficiently unlike gluten to be safe for many coeliacs. If you have

coeliac disease, you must have medical approval before eating oats. Only those who are healthy and

doing well on a gluten-free diet should try oats, and they should not eat more than one small serving

(less than 50g/13/4oz) per day. It is vital that the oats are grown, harvested, transported, milled and

packaged separately from all wheat to avoid contamination. See your doctor regularly for check-ups (and

if possible a biopsy) to check that the oats are not causing problems.
Various flours are used to make gluten-free breads, including
flours derived from rice, potatoes, soya beans and buckwheat (not
a true wheat). These are sold in health-food shops, and can also
be bought by mail order. For gram flour, try Indian groceries. There
are also special gluten-free bread mixes available in both health-
food shops and pharmacies, but these almost always contain
soya, and it is best to avoid eating too much soya (see page 71).
coeliacs who are extremely sensitive to gluten, and have to
avoid all trace of it, should be very careful about ready-made food.
These are just some of the unexpected sources of gluten:
•    Thickeners and stabilisers sometimes contain traces of gluten. These additives are very widely

used in ready-made foods.
•    A number of food additives (including caramel, citric acid, dextrin, mono- and di-glycerides,

gum base, malt, malt flavouring, maltodextrin, maltose, MSG and vegetable gum) are manufactured from

wheat, barley or oats. Although the amount of gluten/avenin they contain is extremely small, it can

affect a few coeliacs.
•    Barley enzymes, used to make rice milk, some brands of soya milk, soy sauce and miso, can leave

minute traces of gluten in the finished product. Blue cheese can also contain minute traces of gluten

(see p. 174).
•    Whisky and gin – both grain-based spirits – can contain gluten. So may distilled white vinegar.

These will only affect the most sensitive coeliacs, whereas beer must be avoided by all coeliacs, since

it is made from barley.
•    Composite ingredients in ready-made food are covered by the 25% rule (see p. 174), and

frequently contain wheat.
•    Wheat flour may be used as an aid to food preparation, leaving tiny residues in the food (see

p. 174).
•    Non-wheat flour may be delivered to the factories, or transferred from one area to another,

through hoppers or vacuum tubes that have previously been used for wheat flour. Very low levels of

contamination can occur in this way, sufficient to affect those coeliacs who are extremely sensitive.

This is one problem with gluten-free foods (see below), unless they are made in dedicated gluten-free

factories.
•    Products labelled ‘gluten-free’ may not be suitable for the most sensitive coeliacs. Testing

for very small amounts of gluten is difficult, and the international standard set by the FAO/WHO (not

more than 200 parts per million) is dictated by what can be accurately measured, and therefore policed.

Many countries (e.g. Sweden and the United States) feel that the permitted level of gluten should be

lower, and have set their own standards. These higher standards can be achieved by careful control of

the production methods.
There is a great deal of useful information about gluten on the
Internet, but there is also some very misleading information on one
particular website. It is advisable to consult several different sites.
Wheat-free baking powder
Some brands of baking powder contain a little wheat flour. You can make a wheat-free version by mixing

60g (2oz) sodium bicarbonate with 125g (41/2oz) cream of tartar and 60g (2oz) of a non-wheat flour.

Sieve together very thoroughly.
Brown bread
This mixture of buckwheat and potato flour makes a light-textured loaf that also toasts well.
PREPARATION TIME: 15 minutes, plus about 1 hour rising time
COOKING TIME: about 35 minutes
MAKES: 1 large loaf
250g (9oz) buckwheat flour
250g (9oz) potato flour 1 tsp salt
1 sachet easy-blend yeast
25g (1oz) butter
1 tbsp black treacle 1 large egg, beaten
Mix the flours, salt and yeast in a large bowl and rub in the butter. Dissolve the treacle in 225ml

(8fl oz) hand-hot water. Add this and the egg to the flour, and mix to a soft dough. Transfer to a

buttered 900g (21b) loaf tin, wrap in a polythene bag and leave in a warm place for about 1 hour – or

until the mixture has risen to the top of the tin.
Bake in a preheated oven at 220°C/ 425°F/gas mark 7 for about 35 minutes until risen and firm to the

touch. Remove from the tin and tap the base – it should sound hollow. If not, return to the oven for a

further 5 minutes. Cool in the tin for 10-15 minutes.
Variations: many different kinds of flavourings can be added to this bread. Try seeds such as poppy

seeds, mustard seeds, caraway seeds and onion seeds (Indian stores usually stock these with their

spices). Sunflower seeds and sesame seeds – either plain or lightly toasted – are also good. A

combination of black olives, sun-dried tomatoes and a pinch of mixed herbs makes a Mediterranean -style

bread.
Seeded rice bread
This makes a delicious, ‘nutty’, textured loaf that is yeast-free as well as wheat-free. It toasts

quite well.
PREPARATION TIME: 30 minutes COOKING TIME: 40 minutes MAKES: 1 small loaf
150g (5′12oz) brown rice, well rinsed
100g (31,2oz) rice flour 100g (3V2oz) fine oatmeal
1 tsp wheat-free baking powder
1 tsp salt
50g (13/4oz) sunflower seeds
25g (1oz) linseed
1 large, slightly under-ripe pear. peeled, cored and coarsely grated
2 large eggs, beaten
2 tbsp vegetable oil
4 tbsp buttermilk, live natural yogurt, milk or milk substitute
Cook the rice in plenty of boiling water for 15-20 minutes until tender. Drain thoroughly and cool

slightly.
Preheat the oven to 200°C/400°F/gas mark 6.
Combine all the ingredients in a large bowl, then transfer to a well-oiled 450g (1 lb) loaf tin and

bake for about 40 minutes, until slightly risen and golden, and firm to the touch. Cool slightly, then

turn out onto a wire rack and leave until completely cold. Serve cut into thick slices.
Banana loaf
This semi-sweet bread is yeast-free as well as gluten-free. It is good for packed lunches – and it

toasts well.
PREPARATION TIME: 10 minutes COOKING TIME: about 1 hour MAKES: 1 large loaf
4 medium ripe or under-ripe bananas 300g (10′,12oz) brown rice flour, sieved 100g (3112oz) butter,

softened
2 tbsp wheat-free baking powder 2 large eggs
225ml (Bfl oz) milk or soya milk
Butter and line the base of a 900g (21b) loaf tin. Peel and cut up the bananas and place in a food

processor with the remaining ingredients. Blend thoroughly, then transfer the mixture to the prepared

tin Bake in a preheated oven at 180  350°F/gas mark 4 for about 1 hour until risen and firm to the

touch. Cool in the tin then turn out onto a wire rack and leave to cool completely.
Rich herb bread
This is useful for those who have to avolo yeast as well as wheat/gluten.
PREPARATION TIME: 20 minutes COOKING TIME: 30-40 minutes MAKES: 1 small loaf
1108 (4oz) gram or chickpea flour
1 tsp syrup or honey
2 tbsp olive oil
1 tsp salt
1 unripe pear, peeled and grated
200m1 (7fl oz) boiling water
2 eggs
V2  onion, finely chopped
fresh herbs (thyme, tarragon or marjoram)
Mix the first five ingredients, then pour on the boiling water. Separate the eggs, beat the yolks

thoroughly and add to the flour mixture when It has cooled, along with the onion and herbs. This

mixture should now be the consistency of double cream. If too thick, add a little more water.
Whisk the egg whites until they will stand in soft peaks. Carefully fold them into the flour mixture.

Pour into a well-greased loaf tin and cook at 180 - C/ 350°F/gas mark 4 for 30-40 minutes.
Seeded rice bread    Pressed prune and walnut bread
Crispy millet baps
Tasty and filling, these are popular with children. They make no pretence to be bread but are an

excellent substitute for breakfast toast or a lunchtime sandwich. They are free from yeast, milk and

eggs, as well as wheat.
PREPARATION TIME: 30 minutes COOKING TIME: about 20 minutes MAKES: about 20 small baps
225g (Boz) millet seeds
1 tsp salt
150g (5′,12oz) peanut butter (or cashew, pecan or another nut butter)
1 tsp sesame seeds, toasted until golden
oil for frying
Wash the millet and soak overnight. Wash again to remove the starch, drain and add 600ml (1 pint) water

plus the salt. Boil over a low heat for 20 minutes, or until the water is absorbed.
While still hot add the nut butter and sesame seeds. Mix together well using a potato masher to break

up the millet. Take egg-sized lumps of the mixture, roll into a ball between the palms of your hands,

then squash into a flattish shape. It is vital to do this while the mixture is still warm.
Fry the baps in oil over a low heat, for about 20 minutes, or until the outside is golden and crunchy.

(They can also be frozen, and then fried from frozen, for a quick meal.) Serve with fruit or a salad.
Savoury spiced pancakes
This variation on a traditional drop scone makes a good substitute for bread. The pancakes are

delicious served warm from the pan. When cold, they may be reheated in a moderate oven.
1008 (3112oz) gram flour
1008 (3 72oz) rice flour
1 tsp wheat-free baking powder
1 tbsp ground cumin
large pinch of salt
1 large egg
300mi (112 pt) coconut milk
vegetable oil for frying
To serve:
Skinned and chopped fresh tomato mixed with a little freshly chopped coriander, or fried mushrooms with

chopped spring onion and parsley moistened with a little crbme fraiche.
Mix the dry ingredients together in a bowl then beat in the egg and coconut milk to give a thick

batter. Set a large non-stick frying pan or griddle over medium heat. Generously oil the surface of the

pan then drop well-spaced tablespoons of the mixture into the pan.
Cook until the edges of the drop scones start to form bubbles and the base of each is golden, then

carefully turn and cook on the second side until golden. Keep warm, covered with a clean tea towel,

while you make the rest.
Serve warm, spread with butter or topped with one of the savoury mixtures.
Variations: for sweet drop scones omit the cumin and add 25g (I oz) caster sugar and either a sweet

spice such as cinnamon, or the finely grated zest of 1 lemon or orange.
Pressed prune and walnut bread
Based on a traditional Spanish recipe, this is delicious served with cheese, or as a snack on its own.
PREPARATION TIME: 10 minutes, plus overnight COOKING TIME: 45 minutes MAKES: 1 x 18cm (7in) loaf
500g (1 lb 2oz) ready-to-eat pitted prunes 100g (3%2oz) walnut or pecan halves 50g (13/4oz) brown rice

flour
1 large egg, beaten
Place all the ingredients in a bowl and mix together. Press into an oiled 18cm (7in) sandwich tin,

cover with oiled foil and cook in a preheated oven at 170°C/ 325°F/gas mark 3 for 45 minutes. Place a

heavy weight on top and leave until completely cold before unmoulding. Serve cut into thick slices

using a serrated knife.
PREPARATION TIME: 25 minutes MAKES: about 27
Walnut macaroons    Lemon surprise pudding
Millet tabbouleh
Tabbouleh is a salad from the Middle East that is traditionally made with cracked wheat. Millet makes a

very tasty wheat-free alternative. This dish can be useful for packed lunches.
PREPARATION TIME: about 40 minutes MAKES: 4-6 servings
175g (6oz) millet 7 tbsp olive oil
3 tbsp lemon juice
3 tbsp each freshly chopped mint and
flat-leaf parsley
2 spring onions, finely chopped
salt and pepper
Place the millet in a saucepan with 1 tbsp oil and cook over medium heat, stirring, for 2-3 minutes

until lightly toasted. Stir in 350ml (12fl oz) boiling water and simmer uncovered for about 20 minutes

until the water is absorbed and the millet seeds are just cooked. Transfer to a bowl, stir in the rest

of the oil and season generously. Stir in the lemon juice and fork it through the mixture. Leave to

cool, then add the herbs and spring onion and stir well.
Variations: add other finely chopped ingredients such as tomato, red pepper or dried apricots.
Wheat-free flan pastry
Make a flan as suggested below, or chill the pastry then grate it roughly over a savoury or sweet pie

filling. For a savoury pie, the grated pastry can be mixed with grated cheese.
PREPARATION TIME: 15 minutes, plus 30 minutes freezing
COOKING TIME: about 20 minutes MAKES: 1 x 20cm (8in) flan case
125g (412oz) fine cornmeal (maize flour) 50g (13/4oz) gram flour
25g (1 oz) arrowroot powder
25g (I oz) ground almonds
75g (23/4oz) butter or baking margarine 1 egg white
Mix the dry ingredients together in a bowl then rub in the butter. Mix to a soft dough with the egg

white. Press the pastry evenly into a 20cm (8in) fluted flan tin and set in the freezer for a minimum

of 30 minutes.
Preheat the oven to 200′C/400′F/gas mark 6 and cook the flan case towards the top of the oven for about

20 minutes, until lightly golden.
Variation: for sweet pastry, add 25g (I oz) caster sugar
Rich cheese biscuits
These crisp biscuits are good to serve with drinks. Store them in an airtight tin.
PREPARATION TIME: 20 minutes COOKING TIME: about 25 minutes MAKES: 20 biscuits
55g (2oz) soya flour
40g (1 V2oz) potato flour
40g (I Y2oz) rice flour
115g (4oz) butter, softened
1158 (4oz) Cheddar cheese, grated
1 large egg, separated
2 tbsp seeds such as celery or poppy
Mix the flours together in a bowl, then work in the butter, cheese and egg yolk to give a firm dough.

Roll into 20 balls. Lightly whisk the egg white and turn the balls in it until lightly coated, then dip

in the seeds to coat lightly.
Space the balls well apart on baking trays and press down firmly to flatten. Bake in a preheated oven

at 200°C/400 T/ gas mark 6 for about 25 minutes until golden. Cool slightly then transfer to a wire

rack. Leave until cold and crisp.
Whisked sponge cake
This cake’s lightness lies in the whisking. A trail of the mixture, falling from the whisks, should

remain visible for at least 30 seconds. Then it’s time to add the flour.
PREPARATION TIME: 25 minutes COOKING TIME: 25-30 minutes MAKES: 1 x 23cm (91n) cake
75g (2314oz) gram flour
50g (13/4oz) cornflour
4 large eggs
125g (4 V2oz) caster sugar
50g (13/4oz) butter, melted
To serve:
jam or lemon curd
whipped cream (optional)
caster sugar
Sift the flours together. Butter a 23cm (9in) spring-release tin and line the base with greaseproof

paper. Using a handheld electric whisk, whisk the eggs and sugar in a heatproof glass bowl over a

saucepan of simmering water for about 10 minutes until thick and mousse-like.
Fold the flour into the egg mixture in 2-3 batches until completely incorporated, then fold in the

butter.
Transfer to the prepared tin and cook in a preheated oven at 190′C/375′F/gas mark 5 for about 25

minutes until risen and golden. Cool slightly then remove from the tin and cool on a wire rack. When

cold, split and fill with jam or lemon curd, and whipped cream if wished. Dust with caster sugar.
Walnut macaroons
These biscuits are good with coffee. Store in an airtight container. If you want, only decorate half of

them with walnut halves, then sandwich together with the other halves using coffee-, chocolate- or

orange-butter cream, or whipped cream. Do this just before serving.
PREPARATION TIME: 15 minutes COOKING TIME: about 45 minutes MAKES: 24
rice paper
2 egg whites
100g (3112oz) golden icing sugar
1008 (3 Y2 oz) walnut pieces, finely
chopped
grated zest and juice of 112 small unwaxed
lemon (if waxed, wash thoroughly in
hot water)
24 walnut halves
Line a large baking tray with rice paper. Whisk the egg whites in a heatproof glass bowl until stiff.

Stir in the icing sugar, chopped walnuts, lemon zest and juice, and stir over a saucepan of simmering
water for about 10 minutes until the mixture is slightly stiffened. Drop well-spaced spoonfuls of the

mixture onto the rice paper and top each with a walnut half.
Bake in a preheated oven at I 50′C/300′F/gas mark 2 for about 45 minutes. They should be risen but

still slightly chewy. Cool on the tray, then trim away the excess rice paper.
Lemon surprise pudding
The surprise is in the two layers. You end up with a creamy lemon sauce topped with a delicate sponge.
PREPARATION TIME: 20 minutes COOKING TIME: about 45 minutes MAKES: 4-6 servings
50g (1314oz) butter
125g (4 Y2oz) caster sugar
2 large eggs, separated
25g (1 oz) cornflour, sieved
25g (1oz) fine cornmeal (maize flour), sieved
finely grated zest and juice of 2 unwaxed lemons (if waxed, wash thoroughly in hot water)
250m1 (9fl oz) milk To serve:
icing sugar
Cream the butter and sugar with 1 tbsp hot water until pale and fluffy. Beat in the egg yolks followed

by the flours. Slowly stir in the lemon zest and juice, and then the milk. The mixture may appear to

have curdled but this is normal.
Whisk the egg whites to form soft peaks, then fold into the lemon mixture. Transfer to a 1 litre (13/4

pint) ovenproof dish and set in a roasting tin. Pour hot water from a kettle around the dish and cook

in a preheated oven at 180°C/350°F/gas mark 4 for about 45 minutes, until risen and just firm to the

touch. Dust with icing sugar and serve immediately.
Apricot and apple Eve’s pudding
This wheat-free Eve’s pudding can be varied by changing the fruit. Try peaches, strawberries or

blackberries instead of the apricots.
PREPARATION TIME: 30 minutes COOKING TIME: about 1 hour MAKES: 4-6 servings
400g can of apricot halves in juice
2 medium cooking apples, peeled and thickly sliced
50g (1314oz) caster sugar
Topping:
125g (472oz) butter, softened
125g (4 Y2oz) caster sugar
2 large eggs
125g (4V2oz) ground almonds mixed with
1 tsp wheat-free baking powder
50g (1 31ioz) flaked almonds
To serve:
pouring cream or whipped cream
Pour the juice from the can of apricots into a saucepan, add the apple and sugar and cook gently for

about 5 minutes, until the apple is softened. Remove from the heat and stir in the apricots. Transfer

to a 1 Iltre (13/4 pint) ovenproof dish.
In a separate bowl, cream the butter and sugar together until pale and fluffy then beat in the eggs one

at a time. Fold in the ground almonds and baking powder. Spread the almond mixture over the fruit and

sprinkle with flaked almonds. Cook in a preheated oven at 180°C/ 350°F/gas mark 4 for about 1 hour

until risen and golden and just firm to the touch. Serve with pouring cream or whipped cream.

Allergy: Selecting the Right Food

An avoidance diet is for people who already know what food or foods affect them, and simply need to

avoid those foods. A diagnostic diet is for those whose symptoms suggest that they might be suffering

from food sensitivity of some kind, and who cannot be diagnosed by indirect methods such as skin tests,

because true food allergy is not involved. A diagnostic diet is intended primarily to show whether or

not food is causing the symptoms.
The diagnostic diets themselves fall into two basic categories. Firstly, there are diets that, by a

process of elimination, identify a particular food (or foods) as a cause of symptoms. Called

elimination diets, these are used to diagnose idiopathic food intolerance (see p. 74) and certain other

kinds of sensitivity reactions to particular foods. An elimination diet is purely diagnostic - simply a

means to establish which foods are at fault. To this end, all commonly eaten foods are avoided at the

outset, and each food is then tested individually. Once an elimination diet is complete, the

information gathered is used to establish a suitable avoidance diet. For example, if milk, wheat and

oranges caused symptoms during the testing phase of the elimination diet, those foods are all avoided

in future.
Secondly, there are specific diagnostic diets, which are a great deal simpler to carry out than

elimination diets. A specific diagnostic diet aims to reduce the intake of a particular substance that

is found in certain foods. The substances concerned -histamine or nickel, for example - are known to

cause particular symptoms in susceptible people.
A specific diagnostic diet simply cuts out all the foods that contain large amounts of the substance
under suspicion. If this diet alleviates the symptoms, and does so consistently, it is plausible that

the substance concerned is indeed the culprit. However, the diet should be stopped and then started

again, preferably several times, to check the response. Once the sensitivity is confirmed in this way,

the avoidance diet which follows is basically the same as the diet used for diagnosis.
Note that there is no agreed terminology for these different kinds of diet, and the definitions given

above will not necessarily be followed in other publications. You may even come across ‘elimination

diet’ being used to mean ‘avoidance diet’, which is particularly confusing. If you are consulting other

sources of information, check the context carefully to see what meaning is intended.
There is one odd man out in this chapter - the diet to protect against asthma, described on pp. 206-7.

It is neither an avoidance diet nor a diagnostic diet, but a health-promoting diet of the kind commonly

advocated to combat other widespread conditions, such as cancer and heart disease. In fact, it has a

remarkable number of similarities to diets that reduce the risk of these other diseases.
The anti-asthma diet is immensely healthy, whereas many avoidance diets carry a risk of malnourishment.

An allergic individual following any kind of restrictive diet - especially a child - should be

medically assessed for the possible risks. That is why it is important to talk to your doctor before

starting any dietary treatment or investigation. A referral to a dietician or nutritionist may be

necessary, and your doctor can arrange this.
When malnutrition does occur as a result of self-treatment, there are often very complex factors at

work. One potential hazard with dietary treatment is that psychological problems can easily become
entwined with obsessions about food. Eating can be a potent form of self-expression, or a way of

exerting control over oneself and others. Many doctors have seen patients who are mistakenly convinced

that food sensitivity is at the root of their health problems, or those of their children. In some

cases, no amount of objective evidence to the contrary will deflect people from such beliefs.
A few people with mistaken beliefs of this kind impose very restrictive diets on themselves - or

sometimes on the whole family. The food rules that they establish may be a way of limiting contact with

the outside world, avoiding other problems and issues by making diet the central focus, or simply

making demands on other people’s time and attention.
The current fad for identifying ‘food allergy’ using very dubious diagnostic tests (see p. 93) will

probably send many more psychologically vulnerable people down this route.
Another unhelpful trend in the dietary field is the wholesale (and usually ineffective) use of

vitamins, minerals and other supplements for a great variety of diseases, including allergy and other

forms of sensitivity. It is important to realise that none of the sensitivity diseases described in

this book has nutritional deficiency as its primary cause, so supplements are not a major part of

treatment in most cases. For the majority of people with some kind of sensitivity disease, a supplement

will make only a small difference, if any. However, it is true that, with some sensitivity problems,

certain supplements may be helpful to certain individuals. The use of Vitamin C in asthma (see p. 207)

is one example of this, and there are some other instances mentioned in Chapter 2.
Generally speaking, it is better to get the vitamins, minerals and other nutrients you need (such as
antioxidants) from food, not from tablets. Studies of adult-onset asthma have shown that only natural

Vitamin E protects against the disease: supplements have no effect.
Many vitamins and minerals, along with various plant and animal extracts, are now referred to as

nutriceuticals - in other words, substances that are classed as nutritional supplements for legal

purposes, but are being marketed as if they were medicinal drugs (pharmaceuticals). Many doctors are

concerned about this, if only because of the duplicity involved. These substances can be sold freely to

the public only because they are, in theory, nutritional supplements, yet they are actively promoted to

the public as if they were drugs.
The marketing is usually indirect, to avoid falling foul of the law, but very effective nonetheless.

Advertisements for the product avoid making any medicinal claims, since these would be unlawful, and

just speak vaguely of ‘health-giving properties’. The specific medicinal claims are made in magazine

articles (which often appear right beside the advertisement), penned by journalists who have been

supplied with a great many ‘facts’ - actually unsubstantiated claims -by the manufacturer of the

supplement. These claims are reproduced uncritically, so the journalists are simply acting as

mouthpieces for the manufacturer. There is no law preventing this.
This is a ruse that circumvents important laws intended to protect consumers from misleading

advertising. Few of these products are likely to be damaging - although there are concerns about some,

especially beta-carotene supplements (see p. 207). What matters here are the large amounts of money

being made from products that frequently have few benefits for those who take them.

What exactly is in ready-made food? People with food sensitivity, especially those with severe food

allergy or coeliac disease, need a simple answer to this question, but frequently they don’t get one.

Research among food-allergy sufferers has found that, in the course of a year, half of them

inadvertently eat the food they are trying to avoid, owing to a lack of information about ingredients.

Restaurants and canteens are responsible for many of these accidents, and most of the fatalities (see

p. 111), but packaged food also plays a part.
Unfortunately, many food ingredients that are potentially allergenic, such as milk and eggs, appear in

packaged food without this being stated on the label in everyday language. The information is usually

there somewhere, however – you just need to know what words to look for.
Decoding food labels
The problems with food labels fall into two general categories:
•    some of the ingredients are described using technical terms. These are usually specific

constituents of the original foodstuff e.g. lactalbumin, one of the proteins found in milk.
•    some manufactured ingredients can be made from different starting materials. So an item such as

‘edible starch’ could be made from either wheat or maize (corn), while ‘hydrolysed protein’ could be

made from soya, maize or yeast, sometimes with wheat added.
One day, no doubt, manufacturers will realise what a burden this type of obscure labelling imposes on

their allergic customers and will start using plain language. In the meantime, food-allergy sufferers

just have to learn all the terms that may be used for their culprit food or foods.
Labels used in health-food shops and delicatessens are another matter altogether. Here the problem is

with exotic-sounding items, such as kamut, which is actually an allergenic food (wheat).
Maize (Corn)
Items always made from maize: cornflour, cornmeal, cornstarch, dextrose, polenta
Items sometimes made from maize: baking powder, cereal starch, edible starch, food starch, glucose

syrup, hydrolysed protein, hydrolysed vegetable protein, malt, malt flavouring, modified starch,

modified food starch, starch, textured vegetable protein, vegetable gum, vegetable protein, vegetable

starch
Note that the gum on envelopes and stamps is sometimes made from maize, and that many medicines contain

cornstarch.
Eggs
Items always made from eggs: ovalbumin
Items sometimes made from eggs: lecithin (In fact this is rare in foods – lecithin is usually derived

from soya. Only in pharmaceuticals is lecithin likely to be derived from egg.)
Terms used for egg on cosmetics and toiletries: Ovum
Fish
Be very cautious when travelling. The use of fish meal as an ingredient of spicy sauces is common in

Southeast Asia, and in some parts of Africa. The strength of the spices may make the flavour of the

fish undetectable.
Milk
Items always made from milk: casein, casemate, lactalbumin, whey
Terms used for milk on cosmetics and toiletries: Lac
If you see the term ‘dairy-free’ on standard packaged foods, you can safely assume that the contents

are free from goat’s and sheep’s milk, as well as cow’s milk. But be more wary with homemade or locally

produced foods labelled ‘dairy-free’ - some
people think that ‘dairy’ refers only to cow’s milk.
Parev or pareve is a term used for kosher (Jewish) food that contains neither milk nor meat. However,

there can be contamination with traces of milk.
Lactose is a sugar produced from milk, and while it is not allergenic itself, it may contain a trace of

allergenic milk proteins. The amounts involved are tiny, and will only affect the most sensitive

individuals.
The label ‘non-milk fat’ sometimes misleads people if they just glance quickly at labels. The fact that

a product contains non-milk fat does not, of course, mean that it is entirely milk-free -remember to

look for all the synonyms of milk (see above).
Nuts
Items always made from nuts: frangipane, marzipan, praline
Standard packaged food will almost always include the nuts by name, but if you are buying other food

(e.g. from a stall selling home-made food) watch out for the above names.
Be very cautious about unrefined nut oils (see p. 110). Almond essence may be produced chemically, in

which case it is safe, but some is made from real almonds and could be allergenic.
Terms used for nuts on cosmetics and toiletries: Prunus, Juglans, Bertholletia, Corylus
Peanuts
Items always made from peanuts: arachis oil, groundnut oil satay sauce
Unrefined peanut oil should be avoided. This is not much used, and unlikely to be encountered except in

Indian and Oriental cooking. Most groundnut oil sold in Britain and Europe, or used in packaged foods,

is refined and considered safe (see p. 110).
Alternative names: arachide, beer nuts, cacahuete, earth nuts, goobernuts, groundnuts, monkey nuts
You are only likely to encounter these names on imported food, or when travelling. Always be very

careful with Indian or Southeast Asian food, where the use of peanuts is very common and often not at

all obvious. Avoid chocolate from Poland, which often contains peanuts that are not declared on the

label.
Items sometimes made from peanuts: hydrolysed vegetable protein. (The usual source is soya or wheat,

but some is derived from peanuts.)
Terms used for peanut on cosmetics and toiletries: Arachis hypogea, Arachis oil
Sesame
Items always made from sesame or containing some sesame: gomashio, halva, hummus (houmus), tahini, the

drink Aqua Libra
Alternative names: ajonjoli, berme, gingelly, teel, til, simsim
Check carefully for sesame in any food from a health-food shop or a stall selling home-made food, and

in foods from the Middle East, or Chinese packaged food (e.g. stir-fry oils). Sesame oil is always

unrefined and therefore allergenic (see p. 110). Watch out for contamination by traces of sesame in

bakeries and delicatessens where goods are sold unwrapped.
Term used for sesame on cosmetics and toiletries: Sesamum indicum
Shellfish
Items sometimes containing shellfish: curry paste, fish sauce and other sauces/pastes used in Southeast

Asian cooking
Standard packaged food should mention shellfish specifically, but you may need to read the label

carefully. Be cautious about bottles of imported sauce, and home-made or takeaway food.
Soya
Items always or usually made from soya: miso, soy sauce, textured vegetable protein, tofu, vegetable

protein
Items sometimes made from soya: hydrolysed protein, hydrolysed vegetable protein, lecithin, vegetable

gum, vegetable starch Changes in ingredients
Unfortunately, the ingredients of a product can change without any obvious warning on the label, or any

change in the packaging. You should always check the label in detail, every time - even on foods that

you have eaten before without any trouble.
Wheat
Items always made from wheat: bran, flour, graham flour, hard flour, strong flour, wholemeal flour

(there are non-wheat brans and flours, of course, but the words ‘bran’ or ‘flour’, without any

qualification, usually mean wheat)
Regional names for particular types of wheat: bulgur or bulgar wheat, Chilton, couscous, dinkel, durum,

einkorn, farro, fu, kamut, semolina, spelt, triticum, triticale (a hybrid of wheat and rye)
Items sometimes made from wheat: baking powder, cereal binder, cereal filler, cereal protein, cereal

starch, edible starch, food starch, hydrolysed protein, hydrolysed vegetable protein, modified food

starch, modified starch, starch, textured vegetable protein, vegetable protein, vegetable starch.
Assume that bread, crispbread, pastry, pasta and noodles are made from wheat, unless definitely

labelled otherwise (and read the label in detail too, because a little wheat is often added to items

such as rye bread and rye crackers).
Note that buckwheat is not wheat at all - it is not even a cereal. Nor does it commonly affect

coeliacs, as is sometimes claimed, though a few coeliacs may develop an intolerance reaction to it,

through eating it very regularly.
For more information on avoiding gluten, see p. 177.
Yeast
Items usually made from yeast: leavening
Items sometimes made from yeast: hydrolysed protein, hydrolysed vegetable protein
Labelling loopholes
Manufacturers do not have to include on the label:
•    Any ingredients used in an earlier manufacturing process e.g. yeast used to make bread for

breadcrumbs, wheat flour added to spices or mustard powder during the grinding process, or bread used

to innoculate blue cheeses with mould -this can leave minute traces of gluten in the cheese.
•    Residues left by substances used during processing, such as wheat flour used to dust processing

lines or prevent dried fruits from sticking together. Manufacturers do not need to declare these

residues on the label because the substance serves no function in the final product and is present in

amounts that are considered insignificant. The vast majority of those with coeliac disease or food

allergy will tolerate such microscopic traces, but the most sensitive individuals may not. Some

coeliacs are even affected by food additives manufactured from cereals (see p. 177).
•    The individual constituents of a composite ingredient (such as salami on a pizza), if that

composite ingredient makes up less than 25% of the finished product. This is called the 25% rule. As

from November 2005, this is all set to change, thanks to the European Parliament. The contents of a

composite ingredient like salami will be listed in full. A few composite ingredients with officially

defined contents (such as jam, or chocolate) can be listed just as ‘jam’ or ‘chocolate’ if they make up

less than 2% of the product. Likewise herb mix or spice mix, if less than 2%. But there are certain

items that must always be listed if they are anywhere in the product, and however small the amount.

They are: milk, eggs, tree nuts, peanuts, sesame, mustard, celery/celeriac, fish, crustacean shellfish

(shrimps, prawns, crab etc), soya, wheat and all other cereals that contain gluten. Sulphur dioxide and

sulphites must be listed if more than 1 Oppm. This list will be reviewed from time to time.
`May contain’ labels
Labels reading ‘May contain nut traces’ are springing up like weeds on packaged food. Similar labels

relating to sesame, milk and eggs are also starting to appear.
Allergy sufferers, suddenly unable to eat foods that they formerly enjoyed, feel very frustrated about

this development. Many suspect that these labels are often just a defensive tactic - warning off

consumers with food sensitivity when the chance of the food containing the allergen is actually very

small. The danger is that some allergy sufferers may stop taking the labels seriously. Teenagers, in

particular, are increasingly dismissive of ‘May contain’ labels, and this is a huge worry for parents.
Could the need for ‘May contain’ labels be eliminated altogether with more careful factory procedures?

The problem here is that, with nuts, perfect cleaning of production machinery is extremely difficult.

Most machines have nooks and crannies in which a nut from one production process can become lodged,

only to free itself later during the making of a non-nut product. It is quite possible that someone

could encounter a whole nut, or substantial pieces of nut, in a non-nut product. That is why no one

with nut allergy, even if it is relatively mild, should disregard ‘May contain nut traces’ labels.
Some makers of confectionery and biscuits have now set up dedicated nut-free production lines, with

stringent precautions to avoid any possibility of contamination. This allows them to market products

that are guaranteed nut-free. If you cannot purchase these locally, you may be able to order them by

mail or over the Internet (see p. 255).
Note that packaged foods that have been produced on nut-free production lines in the past can be

switched to different production lines, that necessitate a ‘May contain nut traces’ label.
In some cases, a product is manufactured in two separate places, one of which is nut-free, while the

other is not. Consequently, the same product may sometimes be sold with a ‘May contain’ label and

sometimes without. Don’t disregard these labels, however illogical they might seem.
Packaging errors
As most people with food allergy are now aware, ready-made foods sometimes go out in the wrong

packaging. Alarming cases that have occurred in recent years include hazelnut yoghurts labelled Toffee

Yoghurt, and Vegetable Bake (containing nuts) sold in packets intended for Vegetable Lasagne (no nuts).
Manufacturers are increasingly aware of the hazards and when mistakes are discovered, allergy

information websites and organisations such as the Anaphylaxis Campaign are quickly informed, so that

they can alert allergy sufferers.
Belonging to such an organisation (see p. 255), and/or checking websites regularly, is definitely

recommended for anyone with food allergy. However, you should bear in mind that no information service

can protect you completely from this hazard. The odds against it are high, but one day you might just

be the unlucky person who first discovers a packaging error by suffering an allergic reaction. To

protect yourself as far as possible:
When is a nut not a nut?
Those with nut allergies often worry about eating nutmeg and coconut. In fact, allergic reactions to

these are rare. People with nut allergy are no more likely to react to nutmeg or coconut than anyone

else.
Tiger nuts or chufa nuts are not nuts at all, but the roots of a sedge plant – they are most unlikely

to cross-react with true nuts.
Peanuts, botanically speaking, are not true nuts at all. They are legumes (pulses). There can be

cross-reactions with soya and/or lupin (proceed very carefully with this novel food ingredient) but

reactions with other pulses are rare. Cross-reactions with tree nuts such as almonds and Brazils are

quite common however (see p. 15). Many people with peanut allergy can in fact eat tree nuts, but they

should be aware that a cross-reaction could develop at some stage.
Because cross-reactions between tree nuts are so common, doctors tend to speak simply of ‘nut allergy’.

However, it is possible to be allergic to one type of tree nut, without being allergic to others.
•    always check that the food in the packet looks like the photograph on the packet
•    double-check, when you serve the food, by noting the conspicuous ingredients of the meal

(carrots, for example), and ensuring that they are indeed on the list of ingredients – any discrepancy

should make you suspicious
•    note the smell and appearance of any ready-made food, before you taste it. Do this even for

very simple things such as flavoured yoghurts
•    only have a very tiny mouthful at first, and if you have any tingling of the lips or other

symptoms, however mild, stop eating immediately (this is helpful for true food allergy only, not for

coeliac disease)
•    be especially cautious about vegetarian food if you are allergic to nuts or soya.
Latex in food
Those with latex allergy may react to very small traces of it in food. This sometimes occurs with

packaged food or restaurant food that has been prepared by workers wearing latex gloves. On one

occasion a highly allergic individual reacted to a water glass that had been handled by someone wearing

latex gloves. The amounts of latex involved are minuscule, and only affect those with severe latex

allergy. However, there is a strong case for workers handling food to wear non-latex gloves, especially

with the rise in cases of latex allergy.
There are also reports of people with latex allergy reacting (usually very mildly) to cold-seal

adhesives in food
wrappers, such as those used for ice cream. The reaction only occurs if the wrapper actually touches

the lips or mouth.

Allergens in Food
Anyone with true food allergy or coeliac disease needs to be very careful about avoiding certain foods. The information given here is aimed mainly at such people, rather than those with food intolerance (see p. 74), who can usually tolerate small amounts of their offending foods. However, some of the basic information given here is relevant to those with food intolerance as well.
There are different levels of sensitivity even among those with true food allergy. The ‘exquisitely sensitive’ can react to unbelievably minute traces of the food, and for them life is especially difficult. The same is true of some coelicacs, who can be affected by the tiniest quantity of gluten.
These people are a small minority. The level of vigilance required of such people will not be necessary for most people reading this book, so don’t get things out of proportion. While it is vital to be sensible about avoiding your problem food, it is also important not to become over-anxious.
Buying basic ingredients
Cooking for yourself is the safest way to eat for those with true food allergy and coeliac disease. There are relatively few hazards, but do beware of well-meaning assistants in health-food shops who try to sell you some exotic package of grain or flour – spelt or kamut or triticale, for example – reassuring
you that it is ‘definitely not wheat’. Be well informed about the different forms of your problem food and the names under which it is sold (see pp. 172-5).
Oils made from foods such as corn or peanut sometimes cause concern. Ordinary refined oils have been so thoroughly processed that they actually contain no allergenic proteins, so you can safely use these. Bottles of gourmet walnut oil and almond oil are a different story however, and should be avoided if you have nut allergies. Sesame oil is not purified either and can provoke serious reactions. With any oil, if you are unsure how safe it might be, go by the smell. Oils that smell or taste like the food from which they are made could well contain allergens.
Those with allergy to tuna can usually eat tinned tuna because the processing makes it safe. The allergens in fresh fruit and vegetables are generally inactivated by cooking too, so jams and tinned fruits tend to be safe – but test very cautiously. Cooking does not have much effect on other food allergens, apart from eggs. In rare cases, cooking can create allergens (see box on p. 186).
If you share your kitchen with others, and are highly sensitive, check that all cooking utensils are truly clean before use. Coeliac should watch out for breadcrumbs in the butter dish, jam or toaster. Where small children are allergic to a food, it may be best to keep the culprit out of the house entirely.
Genetic engineering and food allergy
Many people with food allergies are very concerned about the possibility that genetic engineering could introduce allergens from one plant species into another. This concern seems to be shared by government officials and those in the food industry, who are being extremely vigilant and cautious at present. As long as this attitude continues, there should be little danger to food allergy sufferers.
Finding food in funny places
If you are suffering some inexplicable reactions to non-food items, it might, just possibly, be a food reaction. Some latex gloves contain the milk protein casein, for example, added as a manufacturing aid.
Buying packaged foods
There are several different issues here:
• the need to read labels carefully for allergenic ingredients described by unfamiliar names (see p. 172)
• errors in the packaging used (see pp. 174-5)
• contamination by minute traces of a food substance due to processing machinery not being cleaned adequately. Cartons of fruit drink have occasionally been contaminated with traces of milk because the same production lines were used for packaging milk drinks. Tofu desserts made in ice-cream factories can also become contaminated with milk. These tiny traces of a food will only affect the most highly sensitive individuals, but contamination by nuts can involve large pieces and affect anyone with nut allergy (see p. 174).
• foodstuffs which are used as part of the production process
and leave a tiny residue in the finished item (see p. 174).
Be very cautious indeed about ready-made food that is unlabelled, such as that from bakeries and home-made stalls. Egg is frequently used as a glaze on baked products, nuts may lurk within, and milk or wheat can turn up in the most unlikely places.
Restaurants, cafes and takeaways
The majority of fatal and near-fatal incidents involving people with true food allergy are due to restaurants, cafeterias and canteens. Takeaways can also be a problem except in the case of the large chains such as McDonald’s, where ingredients are standardised. It is alarming that highly allergenic foods (e.g. peanut) are sometimes used – yet far from obvious – in recipes and sandwich fillings where they would simply not be expected. Anyone with peanut or shellfish allergy should be ultra-cautious about Chinese, Thai or Malaysian cooking – but those with milk allergy should find a haven here, because milk is not part of these culinary traditions.
The simplest solution is to eat very plainly when you go out –steak and salad, for example. Steer clear of casseroles and thick soups, where you can’t see what’s in it (the occasional chef throws in peanut butter to thicken the mix…). Food wrapped in pastry is best avoided for the same reason. Desserts and cakes are risky for anyone with nut, egg or milk allergy.
You must insist on accurate information about the food before you taste it. If the counter staff, the waiter or the waitress
is unsure of the ingredients, ask them to check with the chef, or with the label on pre-packaged food. Be persistent and never eat anything unless you are sure. Make eye contact with the person concerned, and learn to be a good judge of character. Your life could depend on telling the difference between the waiter who knows the facts about the food and the waiter who is being blandly reassuring for the sake of a quiet life.
It is a great mistake to pick out the pieces of offending food – kiwi fruit from a fruit salad for example – and eat the rest. There is often enough allergen left behind to cause anaphylaxis in the highly allergic individual.
Those who are extremely sensitive to the offending food must also consider the problem of contamination in the kitchen. Grills and fryers in restaurants and canteens can become contaminated with fish allergens or nut allergens (e.g. from nut cutlets) and these can be transferred to fried potatoes or other foods, provoking anaphylaxis in the highly allergic individual. One person with fish allergy died in this way. Sesame seeds can also contaminate equipment, work-surfaces or bakery counters.
Parties and buffets
Milk, egg, shellfish or nut allergies can make it especially hazardous to eat buffet or party food. Regard everything with suspicion. Cocktail snacks with nuts or peanut paste hidden inside are a particular problem.
When fish allergy isn’t fish allergy
Anisakis is a parasitic worm that infests fish and can sometimes survive the
cooking process to infect humans. The worms are easily thrown off by the human immune system, but the body is primed to make IgE antibodies should
it ever encounter Anisakis again. Another meal of parasitised fish – even if the Anisakis worms are all dead this time, and only the allergens remain
will provoke a massive IgE-mediated reaction, leading to anaphylactic shock. This problem is usually misdiagnosed as allergy to fish itself.
Other inconsistent reactions to food can be due to contaminants such as antibiotics, preservatives, other food additives or (especially in the case of shellfish) naturally occuring toxins.