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20Aug

The middle Sunday in August  and, apart from the leadership row in the Labour party, not a lot to write about so, guess what? Both the Mail and theGuardian dug out the old ‘coeliac food on prescription outrage’  and ‘food intolerance – fact or fad’ stories last weekend!

To be fair, Linda Geddes in the Guardian wrote a fairly balanced piece. She quoted all the usual figures about allergy versus intolerance and some of the more recent research on non-celiac-gluten-senstivity which suggests that the problem may not necessarily be the gluten in your food but the high level of FODMAPS (fermentable oligo-, di-, mono-saccharides and polyols) in the diet. (FODMAPS are found in a wide range of carbohydrates including wheat.) And she pointed out that the only way really to decide whether or not you have a food intolerance is to cut the relevant food out of your diet for a few weeks, see if you feel better, then reintroduce it and see if you feel worse – a classic elimination and challenge diet.

None the less the underlying tone of the piece did remain the ‘fad’ one. But  in all of these discussions, it seems that few people take into account the ‘knock on effect’ ‘going gluten-or-dairy-or-indeed-anything-else free.

Ok – so you don’t feel great. You are tired, short of energy, get what your grandfather would have called indigestion but you call bloating after you eat,  you get quite a few headaches, feel a bit depressed and your bowels are not too reliable.  You just generally feel rather ropey. You have been to the doctor and he/she can find nothing wrong. You may even have gone back again and he/she can still find nothing wrong. Then you read a few magazine articles about celebs who live the good gluten-free life and look a million dollars (no doubt with the aid of a little air-brushing…) and you think – well, why not?

The first good thing is that you now have to actually think about what you re eating – you have to check ingredients lists. You actually cannot just fill your face with the first convenient sandwich/burger/pizza/cake that comes your way. Because they are obviously gluten-free you may start to eat more vegetables, salads – plan your meals. You might even get a bit hooked on cooking! And because you are now thinking about what you eat and what is in that food, you may also think about those extra drinks on a Friday night – do you really need them? If you smoke, maybe you will start thinking – again – about giving it up. And that gym, or yoga or pilates class that you have kept meaning to join – maybe now is the moment to do so… So all ways round, you start to review your life style and, following on from your new interest in what you eat, how you live your life, in health terms, improves. And the result, in most cases, is that you start to have more energy, your digestion improves and you feel better. But what gets the credit? Not your improved lifestyle but the gluten-free diet – even though ‘going gluten free’ may actually have made up a quite small part of the whole mix.

So yes, I guess you could class this as a ‘fad’ – but if so, it is rather a beneficial fad which many people might benefit from taking up!

Gluten-free-breadThe Mail’s ‘shock horror’ story by Sophie Borland centres round the venerable discussion of whether or not coeliacs and those on low protein diets should get food on prescription – a system which was set up back in the 1960s when gluten-free food was almost impossible to buy. The argument now is that high quality gluten-free food is easily available on the high street so, whatever about low protein diets, surely coeliacs should no longer be provided with free prescription food.

The counter argument is that it is all very well for coeliacs with deep pockets to go and buy lovely fresh gluten-free breads on the high street but the cost is very significantly higher than normal bread and if you are a coeliac on a low income you simply cannot afford it. Therefore, if you are not provided with free or very cheap gf bread etc you will eat normal bread and your health will deteriorate not only making your life miserable but increasing the cost of your ‘maintenance’ to the NHS.

Following on this argument, most local area NHS trusts have continued to provide prescriptions to coeliacs but only for ‘core staples’ – such as bread and flour and pasta. The Mail’s story hinges on the fact that ‘core staples’ in pizza-margaritasome areas appear to include pizzas or pizza mixes, burger mixes, cakes and biscuits although the figures that the Mail quotes are not really as horrendous as they would have one believe. Out of over 211,000 prescriptions written out in 2014 for gluten free or low protein foods less than 7,000 were for cakes and cake mixes and only just over 2,000 were for burger mixes. Admittedly, 102,000 odd were for pizza bases but then, for better or worse, I think most people would have to admit that a pizza is now a British staple food.

Of course there are instances when the system is abused – there always are. And no doubt the Mail’s report of a patient bulk ordering gluten-free flour for a gluten-free on line cake business is true. But I must admit that I do find it quite hard to stir up much indignation over the 17 prescriptions written out in 2013 for Cornish pasties, the 20 for mini sausage rolls and the 11 for Christmas cake!! I hope the coeliacs concerned enjoyed them!!

  

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