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When you or your child has been diagnosed with an allergy or sensitivity (intolerance) to a certain nutrient or additive, this could signal the end of long-standing illness and lengthy medical and other tests. The fact that the cause of the illness has been determined starts a new phase, which includes the positive treatment of the condition. At this stage a new problem often arises, that of how to handle the lists of permitted foods and foods to avoid with which you are confronted. These lists may discourage you, and you may be left wondering how on earth you will be able to prepare a plate of edible food. However, it remains important to maintain and repair the body and immune system. To do this, a healthy and balanced diet that excludes the forbidden food items and additives is key. A calm approach is also important as continuing stress will hamper the immune system further and may worsen inflammation in the body.

The difference between a food allergy and a food intolerance

FOOD ALLERGY

A true food allergy is a reaction of the immune system that results from eating a specific food item and can be tested clinically because there are changes present in the immune system. Antibodies (also known as immunoglobulins) develop in the blood when the food item or the allergen is consumed. Antibodies are, therefore, the immune system’s response to an allergen. Large numbers of antibodies will be present in the blood when a food allergen is consumed and, in association with the physical symptoms, the diagnosis of a food allergy can be confirmed. Usually blood tests confirm a diagnosis.

FOOD INTOLERANCE

A food intolerance is a reaction that takes place following the intake of specific food or additives, but which does not cause a response in the immune system. This could mean that the blood tests which are normally done to determine an allergic condition do not show positive results, even though the person experiences symptoms very similar to an allergic reaction. Lactose intolerance is an example of an intolerance. It is caused by the deficiency of a specific digestive enzyme, called lactase, in the gastrointestinal tract.

Symptoms

The appearance of the symptoms of a food allergy or food intolerance may vary from a few seconds after contact or intake to even two days thereafter. Sometimes the intake of a small quantity of the offensive substance has little or no effect but could, over time, cause a reaction due to the so-called cumulative effect. It seems that food eaten more often or consumed as a staple food in a person’s diet is more likely to contribute to an allergic reaction or food intolerance.

Nowadays people consume many processed foods, snacks and drinks that contain preservatives and colourants. This means that larger quantities of additives are being consumed, to which some people may be sensitive.

Symptoms associated with food allergy and food sensitivity include:

•Severe headaches and migraines, as well as some epileptic attacks.

•Depression and unpredictable mood swings.

•Teary eyes, dark circles under the eyes, swollen eyelids, and blurred vision.

•Cherry-red cheeks (rouge patches).

•Ear, nose and throat symptoms, such as:

–A constantly blocked nose or a runny nose.

–Long-lasting colds that won’t clear with conservative treatment.

–Itchiness and scratchiness of the nose, ears, mouth or throat.

–Recurring middle-ear infections, which may require grommets to be placed in the ears.

–Loss of hearing.

–Asthma, bronchitis and pneumonia.

•Symptoms of the gastrointestinal tract: dyspepsia, heartburn, flatulence, stomach pains, diarrhoea and constipation.

•Muscle and joint pain, fibromyalgia, arthritis and gout.

•Food cravings.

•Cutaneous reactions: eczema, hives, acne and dermatitis herpetiformis (a chronic rash).

•Fluid retention.

•Severe menstrual symptoms and premenstrual stress (PMS).

•Anaemia.

•Bed-wetting.

•Poor concentration, attention deficit disorder (ADD), poor short-term memory or hyperactivity.

•Weight gain, weight loss or wasting away.

•Anaphylactic reaction, including nausea, diarrhoea, chest pain, heart palpitations, asthma, hives, low blood pressure, shock and even death in the absence of timeous medical attention.

Diseases that may be linked to food allergies or intolerances

DISEASES OF THE GASTROINTESTINAL TRACT

Coeliac disease

Coeliac disease is a condition in which the lining (villi) of the small intestine is damaged by gluten, a protein which is present in wheat, rye, barley and, to some extent, in oats. This damage restricts the absorption of nutrients from the gastrointestinal tract, with resulting symptoms such as a bloated abdomen, nausea, vomiting, loose stools, poor appetite and eventually malnutrition and undesirable weight loss. In my practice I have also seen patients with coeliac disease battle with weight gain, but this is often the result of medication taken to treat the symptoms of the disease. In exceptional cases, patients may also experience sensitivity to lactose (milk sugar) and sucrose. It is important to consult a dietitian when planning a diet and meal plan to combat coeliac disease.

Dermatitis herpetiformis

This is a chronic skin condition characterised by a severe, itchy skin rash. It results from poor absorption of nutrients due to atrophy of the villi in the mucosal layer of the small intestine. This condition is associated with coeliac disease. The dietary treatment is the same as for coeliac disease and often it may also be necessary to eliminate milk and milk products.

Inflammatory gastrointestinal diseases (ulcerative colitis and Crohn’s disease)

Several theories exist regarding the causes of these diseases, including genetic as well as infective and immunological factors. In some people the distinction between the two conditions is slight.

When one or more segments of the small or large intestine are inflamed, then the condition is called Crohn’s disease. The symptoms include fatigue, poor appetite, joint pains, pain in the lower-right quadrant of the body, cramps, diarrhoea and fever.

When the inflammation starts in the rectum and extends to the colon, without affecting the ascending or right side of the colon or the connection with the small intestine, the condition is called ulcerative colitis. The symptoms include discomfort in the lower bowel, cramps, chronic diarrhoea, depression, irritability and emotional instability.

Initially, the same dietary principles are applied to both conditions. As lactase-enzyme activity is reduced in people with these conditions, milk and milk sugar (lactose) are restricted in the diet. Some people do well on a milk- and gluten-restricted diet. It is very important to consult a dietitian with the planning of this diet to improve the health of the gastrointestinal tract and to provide the necessary nutrients to the body in the long term.

Increased intestinal permeability and intestinal dysbiosis

A healthy gastrointestinal tract provides an effective barrier or filter to prevent the invasion of harmful substances into the bloodstream via the intestines. This barrier may become less effective due to diseases, resulting in substances such as bacteria, allergens and large protein molecules passing into the bloodstream.

Increased intestinal permeability may contribute to an increased incidence of food allergy and food intolerance. The excessive intake of antibiotics is also thought to have an effect on the incidence of the condition.

Intestinal dysbiosis can briefly be described as the inability of the gastrointestinal tract to absorb nutrients effectively, thereby impairing the immunity of the body.

In the medical and academic world there is no consensus on dysbiosis or increased intestinal permeability. Despite differences of opinion, many people suffering from these conditions experience relief when following a balanced elimination diet, which could include the avoidance of milk, milk products, wheat, gluten-containing grains, yeast, moulds and sugar.

Note that it is important to carefully consider the avoidance of any nutrients and to ensure that an elimination diet complies with the basic nutritional needs of a person. A dietitian will be able to provide sound advice in this regard.

Lactose intolerance

Lactose is milk sugar and is present in all forms of animal milk. Hard types of cheese contain little or no lactose. Soya milk, rice milk, coconut milk and nut milk, such as almond milk, contain no lactose. A lactose intolerance may be the result of a lactase-enzyme deficiency, which is responsible for the digestion of lactose. This enzyme deficiency may be the result of damage to the membranes of the gastrointestinal tract due to long-standing use of antibiotics, diarrhoea, malnutrition, or inflammation in the gastrointestinal tract due to Crohn’s disease or ulcerative colitis.

Sucrose intolerance

Sucrose is present in many products, of which cane sugar and sugar from beet are the most familiar. A sucrose-enzyme deficiency hampers the digestion of sucrose to glucose and fructose, the forms in which sugar is absorbed and consumed by the body. Sucrose intolerance may contribute to diarrhoea and a bloated abdomen due to fermentation and gas production in the gastrointestinal tract. Note, however, that sucrose intolerance is not the same as diabetes mellitus.

Lactose intolerance and sucrose intolerance may be present in the same person, possibly because the respective enzymes are produced and excreted in the same region of the gastrointestinal tract.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is one of the diseases that keep dietitians and doctors very busy because it is a common problem in our rushed daily lives. Ongoing stress and poor eating habits weaken the immune system and may aggravate the symptoms of IBS.

The typical symptoms of irritable bowel syndrome include abdominal pain, a bloated abdomen, winds, and altered stool habits, which may include diarrhoea and constipation.

Several studies have been done regarding the causes of IBS symptoms. In summary, the following:

1.Studies suggest the possibility that some people with IBS could be suffering from a clinical condition known as non-coeliac gluten sensitivity (NCGS), resulting in a sensitivity to gluten and more specific products prepared from wheat flour such as bread, pasta and pizzas, which also contain stabilisers such as fructans to improve the texture and stability of the products. Despite the presence of gluten in rye, it seems as if pure rye products are tolerated relatively well.

2.In recent studies the influence of FODMAP (an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols) in people with irritable bowel syndrome has been documented. We will discuss FODMAP more in the next topic.

3.When comparing people without IBS to people suffering from IBS, the latter have less of the “good” bacteria, lactobacillus and bifidobacterium, in their intestinal flora. These good bacteria cling to the epithelial cells of the gastrointestinal tract and this reinforces the buffer or filter function of the intestinal wall and prevents pathogenic bacteria from clinging to the epithelial cells or passing into the bloodstream. These bacteria do not produce gas when carbohydrates are digested and will also suppress the overgrowth of the clostridium species (people who are troubled with an overgrowth of this bacteria will detect the smell of methane gas when passing wind). The tolerance for FODMAP, as well as fibre in general, will improve when supplementing a person’s existing intestinal flora with the lactobacillus and bifidobacterium species.

4.Inulin and FOS (fructo-oligosaccharides) are important foods for maintaining good bacteria. Keep this in mind if you decide to follow the FODMAP guidelines, especially when you consider eliminating water-soluble fibre (including oats, barley, cooked legumes, vegetables and fruit) from your diet.

The low FODMAP diet

As mentioned earlier, FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

Although the principles of the low FODMAP diet are commonly recommended by medical practitioners in some countries, in Australia especially, the low FODMAP diet is still a relatively new concept in South Africa. Read the following information together with the information above regarding irritable bowel syndrome. Keep an accurate record of your food intake and determine if it is necessary to eliminate all the food items below. Remember that unnecessary exclusion may lead to an unbalanced diet with a poor intake of nutrients. It is also valuable to note your state of mind every day as food is often blamed for symptoms, when in fact stress is to blame. Consult a dietitian to assist you in creating a balanced meal plan.

Food items and ingredients which are eliminated in the low FODMAP diet:

•Oligofructose, inulin and FOS (fructo-oligosaccharides). These serve as prebiotics (food) for the “good” bacteria (lactobacillus and bifidobacterium) in the gastrointestinal tract and are often added as functional ingredients (fructans) in products such as meal-replacement formulas. However, inulin and FOS may worsen the symptoms of IBS in some people. Although IBS symptoms can be relieved by avoiding inulin and FOS, keep in mind that in the long term this elimination may hamper the growth and survival of good bacteria.

•Processed and convenience foods such as breads, pizzas, pastas, instant breakfast cereals, cakes, biscuits and crackers to which fructans have been added to improve the quality and shelf life of the products. On the food label fructans will be indicated as “flour enhancer” or “stabiliser”.

•Polyols such as lactose (milk sugar), fructose (when more than 12% of the total carbohydrates are present as added fructose in cool drinks, fruit juices, flavoured waters and energy drinks) and sugar alcohols such as sorbitol, mannitol, maltitol, xylitol, polydextrose and isomalt in sugar-free products such as chewing gum and sweets.

•Vegetables such as artichokes, beetroot, Brussels sprouts, cabbage, fresh chicory, fennel, garlic, leeks, onions, peas and green beans, and fruits such as peaches, prunes and watermelon. This is a limited list. When you investigate this topic more deeply, only a few vegetables and fruits will remain “safe”.

•Grains such as wheat, rye and barley.

•Legumes such as cooked dried beans, chickpeas, lentils and soya products, as well as nuts such as pistachio nuts.

•Dried chicory in drinks such as coffee.

The determining of a food allergy or intolerance

Allergic reactions can be determined by skin-prick tests, electrodermic skin tests, blood tests and intestinal biopsies, or record-keeping of all food intake and the resulting reactions. Refer to the three examples of record-keeping.

With an elimination diet, all suspected foods are excluded from the diet with the intention of reducing or eliminating the cause of the symptoms.

The so-called food-challenge test can be done to confirm a food allergy or intolerance and usually takes place when a person is evaluated and is symptom-free after doing an elimination diet. The suspected food items are reintroduced to the diet one by one in a certain ratio and in a certain order. It is important to do this food challenge in collaboration with your doctor and dietitian, especially if you have a history of anaphylactic reactions. (Read the last remark under “Symptoms”.) All reactions should be monitored and carefully noted.

A proper medical evaluation and diagnosis regarding a food allergy or intolerance is of the utmost importance. Eliminating foods unnecessarily could result in nutrient deficiencies in the body, which may hamper the immune system of the body even more. Consult a registered dietitian who will help you to plan a balanced diet and formulate a meal plan to meet your personal nutritional requirements, taking your specific health problems into account.

Example 1: Food and symptom record

Date	Time	Food/drink consumed	Symptoms	Severity of symptoms*

* Symptoms according to scale: 1 = mild 2 = mild to moderate 3 = moderate 4 = severe

Example 2: Food and symptom record

Food, liquids and medicine takenDay and date	Negative symptomsTime of the day
Breakfast
In between
Lunch
In between
Supper
Late evening
Environmental factors such as wind, dust, pollen and so on, which aggravate symptoms

Example 3: Weekly food and symptom record

Day/date
Symptoms after a night’s sleep
Breakfast
Symptoms
In between
Symptoms
Lunch
Symptoms
In between
Symptoms
Supper
Symptoms
Late evening
Symptoms
Medication taken
Environmental factors (dust, smoke, and so on)

Healthy nutrition

A healthy, balanced diet consists of a variety of food items to provide for the body’s energy needs, to regulate ongoing processes in the body and to provide building material to repair and maintain a healthy body. It is also important to maintain a healthy body weight.

When avoiding certain food items due to a food allergy or intolerance, the elimination diet should still comply with the guidelines for optimal nutrition regarding gender, age and stage of life.

The South African Food-Based Dietary Guidelines are easy to follow and include the following:

•Eat a variety of foods every day and distribute the food evenly in your meals over the entire day.

When foods must be excluded due to a food allergy or intolerance, the diet and meal plan should be adjusted with the remaining permissible foods to comply with the needs of the body for sufficient nutrients to repair and maintain the body, as well as the need for energy production.

•Make starchy food part of most of your meals. Eat more low-glycaemic-index (low GI) starchy foods.

When, for example, excluding gluten-containing grains, the choice of starchy food is more complicated and in some instances good planning is needed to balance the glycaemic index of a meal. Other sources of fibre should be considered when grains are excluded from the diet. Grains are also an important source of B vitamins. Unrefined grains include whole-wheat products, rye, barley, oats, sorghum, unpolished or brown rice, and buckwheat.

•Eat at least five portions of fruit and vegetables every day.

Vegetables and fruit contain a variety of vitamins and minerals which can strengthen the immune system. They also provide good fibre and energy. Unpeeled vegetables and fruit, fruit juice with pulp, and purée made from whole fruit provide good fibre.

•Eat cooked dry beans, split peas, lentils and soya regularly.

Provided you are not allergic or intolerant to one or more of these foods, they can be a good source of fibre in the diet. These foods may improve the increased intake of plant protein, plant sterols and water-soluble fibre. Cooked legumes may replace starchy food in a meal plan and help to lower the GI of a meal.

•According to your food budget, lean red meat, chicken, fish, eggs, milk, yoghurt or cheese can be eaten daily.

The choice of these foods depends on your food allergy or intolerance. Protein needs are calculated according to individual circumstances. Especially in the case of growing children, a calcium supplement should be taken when excluding milk products from the diet. Also, especially in children, the absorption of iron is hampered when the protein intake is insufficient.

•Use fats sparingly and choose monounsaturated and polyunsaturated fats more often.

A fat intake of between 25% and 35% of the total daily energy intake is considered ideal, with a balance between saturated fats and fats which are high in monounsaturated and polyunsaturated fatty acids. Fatty acids help to improve immunity and strengthen the cell membranes. Fat is also an important carrier of the fat-soluble vitamins A, D, E and K.

•Get into the habit of drinking sufficient clean, safe water every day.

•Use salt and salt-containing foods sparingly.

•Use sugar and sugar-containing foods sparingly and in consultation with your doctor and dietitian.

•Be more active and keep your body weight under control.

Food supplements

The addition of mineral and vitamin supplements should only be done according to your doctor’s evaluation and a nutrient analysis by your dietitian. Injudicious mineral and vitamin supplementation is not only very expensive, but could, in the long run, damage your body or result in the unwanted accumulation of certain substances.

Explanation of less-familiar ingredients

Read the chapter “Easy bakes, bread and rusks” about the different gluten-free flour mixtures.

Barley

In South Africa barley in often used in soup, but it can also be cooked in the same way as rice. Barley flour can be used in the same ratio as wheat-containing cake flour. Barley flour gives a greyish colour to baked products and makes baked products heavier, with a dense texture. Barley contains gluten.

Buckwheat

Buckwheat flour is derived from the seeds of a plant and contains a little gluten. It has a higher protein content than most of the other flours with less gluten. Buckwheat has a distinctively robust, slightly sweet taste and a greyish colour. In South Africa it is available as a fine flour and pasta.

Guar gum

Guar gum is derived from a legume and is high in water-soluble fibre. It thickens much faster than cornflour. Guar gum may cause bowel discomfort in some people.

Millet

Millet can be used in baked products and as a breakfast porridge. The whole grains can be cooked in the same way as rice. A small portion of millet absorbs up to five times its volume in water and cooks to a large volume. Millet is a less familiar food in South Africa and contains a little gluten.

Psyllium fibre

This fibre derives from a grain which is grown in India mainly for its water-soluble fibre. In South Africa it is sold on the market as “psyllium husks” or “colon cleanse”. Psyllium fibre can be used successfully when making gluten-free bread. It helps especially to improve leavening and elasticity and it makes the baked product less crumbly. Psyllium fibre promotes the lowering of cholesterol and improves the control of both constipation and diarrhoea. It may also contribute to better blood-sugar control.

Quinoa

Quinoa (pronounced “kinwa”) is a staple food which is grown in particular in Chile, Peru, Bolivia and Colombia. Quinoa has an exceptionally high protein content in comparison to other grains. Quinoa can be cooked in the same way as rice (after rinsing it two to three times to remove the bitter taste), or used as a flour in baked products. The taste of the flour improves if it is baked in an oven on a baking tray for two hours at 100 °C. Cool the baked flour before use. Quinoa contains a little gluten.

Sago

Sago derives from the stem of the sago palm. Sago granules can be used to thicken milk puddings and sauces. Sago flour can be used for baking although baking results are better when sago flour is used in combination with other gluten-free flours. Sago contains no gluten.

Semolina and couscous

Semolina is produced from durum wheat. Couscous is produced from semolina. Semolina and couscous contain gluten.

Sorghum

Sorghum is freely available, affordable and native to Africa. It is a member of the grass family. It works best when mixed with other gluten-free flours when used for baking. Sorghum contains no gluten.

Tapioca

Tapioca is produced from the root of the cassava plant. It is used in cooking as flour and granules. Baking results improve when tapioca is used in combination with other gluten-free flours. Tapioca contains no gluten.

Xanthan gum

A microorganism known as Xanthomonas campestris is used to ferment corn sugar to produce xanthan gum. Xanthan is not suitable for people who need to avoid maize. In the food industry xanthan gum is used as a thickening agent and, in gluten-free products, it is used as a thickener, binder and to improve the elasticity of dough. Xanthan gum can be replaced by guar gum.

Adapting recipes for use

Before adapting any recipe to be suitable for someone with a food allergy or intolerance, it is necessary to determine the role and properties of a certain ingredient in a recipe before omitting or replacing it.

GLUTEN

Gluten is one of the proteins which is present in the flour of wheat, rye, barley and, to a lesser extent, in oats. Gluten in flour contributes to the elasticity, viscosity and, to some extent, to the plasticity of the dough. Dough will have a satin-like layer when the gluten has developed well, for example kneaded bread dough. Hard flour, such as bread flour, contains more gluten than cake flour. Durum flour, which is used in the making of pasta, contains more gluten and this increases the stretching ability of the product.

Dough made from rye flour has a lower viscosity and elasticity than cake flour, while the plasticity of rye flour is higher. This explains why bread that is prepared from rye flour only is inclined to be lumpy.

Gluten forms a framework in dough. Gas is captured in this framework and expands during heating.

Taking all of this into account, it is clear that omitting gluten will cause a problem regarding elasticity, viscosity and plasticity, as well as affecting the leavening (rising) properties of a product.

In some of the recipes in this book, wheat and other gluten-containing grains were replaced by maize flour, cornflour, rice flour, potato flour, soya flour, chickpea flour or sorghum flour. Due to the absence of gluten in this kind of flour, a crumbly or dense texture is obtained in the baked products. The problem can be solved to some extent by incorporating air when sifting the flour or by adding eggs, soya flour or chickpea flour, sugar, psyllium fibre, or xanthan gum or guar gum.

A better end product is often obtained when using a combination of different flours.

In the chapter “Easy bakes, breads and rusks” you will find tables which will make the mixing of different flours easier. The choice of a combination of flours will be influenced by an individual’s food allergy or intolerance.

Soya flour improves the elasticity and viscosity of a product and, in some cases, can successfully be used to replace eggs in a recipe for a baked product. Soya flour may, however, contribute to a bitter taste in baked products, which intensifies as the product gets stale.

Soya flour and chickpea flour both lower the GI value of the flour mixture.

Tapioca flour and sago flour give the best baking results when used in combination with other flours. Sauces can be thickened with tapioca flour and sago flour, but the sauce will not set in the same way as when using cornflour.

Liquids thickened with potato flour, tapioca flour or sago flour are more rubbery in texture than a liquid thickened with wheat flour.

Storing these flours in airtight containers in the refrigerator can prolong their shelf life. Compared with normal cake flour, products which are prepared from these gluten-free flours become stale more quickly. The shelf life of products which are prepared from these flours can be prolonged by packing and freezing them in user portions as soon as possible after baking. Take note that freezing will not improve a product of poor quality. At its best it will only preserve the quality of a product at the time that it has been frozen.

REPLACEMENT OF WHEAT FLOUR OR CAKE FLOUR IN A RECIPE

In the past I gave the ratio of wheat flour or cake flour to the different kinds of flour in volume (ml) and mass (g), but over time I realised that the volume (ml) may differ due to aeration when the flour is sifted or stirred before measuring. The mass (g), however, remains constant regardless of aeration.

The best ratio to replace 250 ml (120 g) cake flour lies between 100-140 g of the alternative kinds of flour, but it needs a little practise and testing to get to the exact replacement ratio.

Replace 15 ml cake flour as a thickener in soup and sauces with:

•7,5 ml potato flour, rice flour, tapioca flour, sago flour or cornflour OR

•15 ml rye flour or barley flour OR

•7,5 ml gelatine

EGGS

Eggs are responsible for incorporating air in a batter or dough. During baking the egg protein coagulates and adds to the structure of the baked product. Egg protein improves the elasticity of baked products.

Depending on the characteristics of the dish and the purpose of the egg in the dish, replace one egg with:

•As leavening agent: 10-15 ml baking powder OR 2-3 ml bicarbonate of soda PLUS 4-6 ml cream of tartar

•As binding agent: 15 ml cornflour or custard powder OR 30 ml cake flour

•As liquid: 60 ml apple juice OR 75 ml apple, pear or apricot purée OR 1 ripe medium banana, mashed

SUGAR

Sugar has a softening effect on egg protein and gluten and contributes to the soft texture of a baked product. It also delays the development of gluten.

Sugar is responsible for the incorporation of air in batter or dough and is of special importance when the creaming method is used to mix sugar and fat until light and fluffy.

Sugar promotes browning during baking. The golden colour that develops during heating is the result of a reaction between the reducing sugar and protein.

MILK

Unless indicated differently, cow’s milk was used in the recipes. Lactose-free milk is available and gives the same baking result and taste as cow’s milk. When necessary, and according to the type of dish, milk can be substituted with soya milk, rooibos tea, fruit juice or water. Rice milk and almond milk can also replace milk. Check the ingredient list on almond milk as some of the products on the market are mixed with soya milk, which makes it unsuitable for soya-free dishes. Coconut milk can replace milk, but keep in mind that it is high in saturated fats.

LEAVENING AGENTS

South African baking powder usually contains cornstarch (maize) as a starch filler. A quantity of 5ml baking powder can be substituted by 1ml bicarbonate of soda PLUS 2ml cream of tartar. Sift together at least twice with the dry ingredients or, alternatively, mix it in thoroughly with a spoon.

XANTHAN GUM AND GUAR GUM

Xanthan gum and guar gum help to bind a dough prepared from gluten-free flour, to make it more elastic and to reduce crumbling. It is better to rather use too little than too much xanthan gum or guar gum as too much gum will make the dough and end product too hard.

The formula for using the gum is approximately as follows:

•For bread and pizza dough: Use 2-3 ml xanthan gum or guar gum per 140 g gluten-free flour.

•For cakes, muffins and teabreads: Use 1,25-2,5 ml xanthan gum or guar gum per 140 g gluten-free flour. When using eggs in a recipe, the xanthan gum or guar gum may even be omitted. I sometimes use a portion no more than the tip of a knife, or 1ml per 140 g gluten-free flour.

•For biscuits and cake bars: Use 1,25-2,5 ml xanthan gum or guar gum per 140 g gluten-free flour. When using eggs in the recipe, the xanthan gum or guar gum may even be omitted. I sometimes use a portion no more than the tip of a knife, or 1 ml per 140 g gluten-free flour.

PSYLLIUM FIBRE

•Psyllium fibre works well when baking gluten-free bread. Use 20 g psyllium fibre per 450 g gluten-free flour. It may be necessary to add extra water while mixing as the psyllium fibre absorbs a lot of liquid. See the ratio of flour to liquid and psyllium fibre.

OIL, BUTTER AND MARGARINE

When oil is called for in a recipe, it can be canola oil, sunflower oil, olive oil, avocado oil or one of the nut oils. It is advantageous to choose an oil with a high monounsaturated fatty acid content.

Some people who experience intolerance to milk protein and lactose (milk sugar) may sometimes be able to tolerate butter fat, as found in pure butter. Pure butter contains no colourants, preservatives or soya (used as a stabiliser). If you are following a milk-free diet, make sure that the butter you use contains no added milk solids.

Margarine is used in some of the recipes. Contrary to butter, margarine contains colourants and most margarines contain sodium benzoate as a preservative. Trans-fatty acids – usually listed as “partially hydrolysed fat” – can be present in margarine. I use Blossom Lite, Olé and Cardin margarine because they are free of milk and are preserved with potassium sorbate (E202). Depending on choice and tolerance, margarine can be replaced by butter.

“Free of” foods

Not all recipes are “free of” all allergens. Each recipe in this book has an indication of which items it is free from. Suggestions and variations are included to make the recipe free of more ingredients.

The recipes were evaluated as being “free of” regarding:

•(W) Wheat

•(G) Gluten (including wheat, rye, barley and oats)

•(Ma) Maize

•(E) Egg

•(Mi) Milk (including cow’s milk, goat’s milk, cheese and yoghurt)

•(L) Lactose (milk sugar)

•(So) Soya

•(C+P) Colourants and preservatives

Yeast and moulds

In my previous book, yeast and moulds were indicated in the “free of” list. This space is now filled with “lactose-free”. It is, however, important to realise that it is impossible to totally avoid the intake of yeast and moulds due to the presence of their spores in the air and our immediate living space, for example from the rotting plant material and compost in our gardens.

Sources of yeast and moulds include:

•Bakers’ yeast, brewers’ yeast, compressed yeast, active dry yeast and instant yeast.

•Fermented beverages, for example beer, natural fermented wine and apple vinegar, as well as malt.

•Alcoholic beverages stored in barrels, for example wine, beer, sherry and port.

•Fungi, for example, mushrooms.

•Sprouting food, for example bean and seed sprouts.

•Mould-containing food, for example, cheese, especially Camembert, Brie and blue cheese.

•Smoked or salted food, for example, ham, biltong, bokkoms, and smoked fish such as haddock and snoek.

•When the word “leavening” appears on a food label, yeast may be present as the leavening agent, unless the manufacturer stipulates that the product is “yeast free”.

•Moulds on vegetables and fruit, as well as the mildew on grapes.

•Dried fruit.

•Nuts, especially peanuts, often contain moulds.

•Sugar stimulates the development and growth of yeast and moulds.

Colourants and preservatives

There is often good reason for the presence of colourants and preservatives in processed foods. Without preservatives, for instance, it would be difficult to deliver acceptably fresh and mould-free food to the consumer. When choosing food and the type of food preparation, it is in general easier to follow the rule of picking the “simplest and least processed”, although this is not always practical and realistic. By consciously choosing processed food and snacks less often, the intake of colourants and preservatives can be reduced drastically.

Colourants and preservatives which more often result in allergic reactions and to which I paid attention in this book, include:

•Colourants: tartrazine (E102); amaranth red (E123).

•Preservatives: sodium nitrate (E251); sodium nitrite (E250); potassium nitrate (E252); benzoic acid (E210); sodium benzoate (E211); sulphur dioxide (E220).

•Flavourants: caramel (E150); MSG – monosodium glutamate (E621).

Food labelling

Food labelling remains an endless process. The composition of products can change from time to time, therefore you need to update yourself regarding any changes on the labels of products that you use often. Also, read food labels for hidden ingredients to which you may be allergic or sensitive.

The table below will help you when reading labels for ingredients to which you are allergic or sensitive.

Food item/ additive	Present when label indicates	Foods to avoid	May be hidden in
Wheat	Wheat flour, gluten flour, hydrolysed vegetable flour, vegetable protein derived from wheat, whole wheat, wheat starch, wheat protein, edible starch, wheatgerm, wheat bran, flour, starch, thickener, wheatgerm oil, durum flour, semolinaProducts containing these ingredients should be avoided if you are allergic or intolerant to wheat	•Digestive bran•Breakfast cereals containing wheat•Cake flour, bread flour•Bread, bread rolls•Cakes, biscuits•Rusks, biscuits•Instant cake and pudding mixes•Pasta•Couscous•Soup powder•Instant pudding powder•Commercial soups and sauces	•Artificial cream•Processed cold meats such as polonies, Vienna-type sausages, tinned meat•Sausages, meat patties•Pies•Sauces•Packets of soup powder which are used in food preparation•Pâté•Processed cheese
Gluten	As for wheatBarley, rye, oatsProducts containing these ingredients should be avoided if you are allergic or intolerant to gluten	•As for wheat•Rye, rye-flour products•Barley, barley flour•Oats, oat bran	•As for wheat
Maize/corn	Maize, corn, corn oil, corn syrup, cornflour, cornstarch, vegetable oil, vegetable fat, maltodextrin, xanthan gumProducts containing these ingredients should be avoided if you are allergic or intolerant to maize/corn	•Maize-flour products, for example, mealie meal, mealie rice and samp•Sweetcorn, whole-kernel corn, popcorn, cornflour, custard powder, corn flake cereals, corn flake crumbs	•Thickened sauces•Custard•Instant puddings•Artificial sweeteners in powder form•Icing sugar•Castor sugar
Eggs	Egg, egg white, egg yolk, albumin, egg lecithin, vitelline, ovo-vitelline, livetin, globulin, ovomucoid, ovomucin, egg lysozymeProducts containing these ingredients should be avoided if you are allergic or intolerant to egg, egg yolk and egg white	•Egg dishes•Cakes, tarts, biscuits, rusks, muffins, scones•Puddings containing egg•Sauces with egg•Sweets with egg white, for example, marshmallows, nougat, meringue•Real mayonnaise	•Batter mixes•Cakes, biscuits, breads•Salads with salad dressing•Lemon curd•Mousses•Ice cream, sorbet•Pâté•Salad dressings
Milk	Milk of animal origin, milk powder, cream, butter, margarine, buttermilk, yoghurt, cheese, milk solids, whey, curds, lactoglobulin, casein, caseinate, lactate, lactic acid, whey syrup, lactoseProducts containing these ingredients should be avoided if you are allergic or intolerant to milk and milk products	•Milk•Buttermilk, sour milk, yoghurt•Evaporated milk, condensed milk•Maas, cream cheese•Hard cheeses•Milk puddings, custard•Ice cream, sorbet•White sauce•Soufflés, mousses•Butter with milk solids	•Batter mixes•Cakes, biscuits, tarts, breads•Processed meat•Soup powder•Instant breakfast cereal•Instant mashed potatoes•Coffee and tea creamers
Lactose(milk sugar)	Milk of animal origin, milk powder, cream, buttermilk, yoghurt, milk solids, whey, curds, lactoglobulin, lactate, lactic acid, whey syrup, lactoseProducts containing these ingredients should be avoided if you are allergic or intolerant to lactose (milk sugar)	•Milk unless lactose-free•Buttermilk, sour milk, yoghurt•Evaporated milk, condensed milk•Maas, cream cheese•Milk puddings, custard•Ice cream, sorbet•White sauce•Soufflés, mousses•Butter with milk solids	•Batter mixes•Cakes, biscuits, tarts, breads•Processed meats•Soup powder•Instant breakfast cereals•Instant mashed potatoes
Soya	Soya flavouring, soya flour, soya beans, soya milk, soya sauce, soya lecithin, soya sprouts, soya bean curd, tofu, soya-based margarines, dehydrated or hydrolysed vegetable proteinProducts containing these ingredients should be avoided if you are allergic or intolerant to soya	•Soya milk•Soya-milk products, for example, ice cream, sorbet, soya yoghurt, tofu•Processed meat, sausages, Vienna-type sausages•Soya mince, soya chunks, soya beans•Soya sauce•Dark chocolate	•Batter mixes•Cakes, biscuits, breads•Chinese food•Teriyaki sauce•Bacon, ham•Pâté•Processed meats, sausages, Vienna-type sausages•Vegetarian food•Milkshakes

How to understand and use the recipes in this book

1.Every chapter has its own recipe list which indicates which of the eight “free of” ingredients is omitted from each recipe.

Example 1: Protein dishes for light and main meals

Name of recipe	Free of:W = Wheat; G = Gluten; Ma = Maize; E = Egg;Mi = Milk; L = Lactose; So = Soya;C+P= Colourants and preservatives
W	G	Ma	E	Mi	L	So	C+P
Pan-grilled fish	•	•	•	•	•	•	•	•
Oven-baked white fish	•	•		•			•	•
Tuna bake	•	•			(•)	(•)	(•)	•

•If you take a look at Oven-baked white fish, you will see that this dish is free of wheat, gluten, egg, soya, colourants and preservatives.

•If you take a look at Tuna bake it has brackets (•) at milk, lactose and soya. When the milk in the recipe is replaced by soya milk, then the dish will be milk and lactose free, but not soya free.

2.The “free of” information is provided at each recipe.

Example 2: Tuna bake

Free of:	W	G	Ma	E	Mi	L	So	C+P
•	•			(•)	(•)	(•)	•

3.Substitutes will follow at the bottom of each recipe, for example:

SUGGESTIONS AND VARIATIONS•Replace the milk with soya milk, then the dish will be milk and lactose free but not soya free. Use lactose-free milk, such as Parmalat EasyGest, then the dish is lactose free but not milk free.•Crosse & Blackwell Trim Low Oil Dressing is milk and egg free. It contains maize starch as a stabiliser so it is not maize free. It contains the preservative potassium sorbate, which is considered quite “safe”.

Hints to make your meal plan more practical

•To make it easier to buy ingredients and prepare food, plan a menu for every day of the week. Plan the menu so that most of the dishes are suitable for everyone in the family. Only substitute those dishes that are not suitable for the person with the food allergy or intolerance.

•Substitute each unsuitable dish on the menu with an alternative. A person who has to restrict their diet due to a food allergy or intolerance will achieve better long-term compliance if he or she does not feel deprived.

•Make provision for the days when there is little time for food preparation by preparing food in advance when you do have time. Pack, seal and chill or freeze these dishes until they are needed. Each recipe includes “Will it keep?” information which will give you an indication of whether the dish is suitable for freezing or for how long it can be kept chilled.

•Make provision for packed meals away from home by preparing and chilling or freezing breads, muffins, soups and light meals in serving portions.

•Mark the dishes to be chilled or frozen and store them in a specific spot in the fridge or freezer. Mark each dish with a label and the following information:

–Name of dish

–Date of preparation

–Portion size or number of portions

•Although it is preferable to use fresh and unprocessed ingredients, some recipes include tinned food such as tinned tomatoes, lentils and mushrooms to assist and speed up food preparation.

•Store special flour in an airtight container in a cool place or in the fridge.

•View the dietary prescription and meal plan, with all its restrictions, in a positive manner as part of a balanced treatment and lifestyle.

Special occasions

VISITING AND EATING OUT

•Follow the guidelines under the heading “Hints to make your meal plan more practical”.

•When eating out or when you are invited for a meal, it is a good idea to visit or call the restaurant before the time, or to call the host to determine if you should take a substitute along for certain dishes which will be served.

CHILDREN’S PARTIES

If you follow these guidelines, children’s parties can still be fun:

•Choose an interesting theme, cheerful décor and a colourful table arrangement, including cheerful containers for snacks.

•Consider the child’s food allergy or intolerance and plan the snacks with this in mind. Add more snacks where needed, to accommodate the needs of the other children as well. Explain to the child which snacks are acceptable for him or her.

•When your child is invited to a party, it is advisable to contact the host beforehand to ask whether you should bring something along. By doing this, you will make sure that your child will enjoy the party without suffering any ill effects afterwards.

LUNCH BOXES AND PADKOS

•Sometimes homemade food is the only safe choice for people with a food allergy or intolerance because the selection of take-away foods and snacks is sometimes limited and even dubious.

•The variety of recipes in this book gives options for breakfast, light and main meals, muffins, breads and snacks.

Food allergies and intolerance – the social dilemma

Outsiders do not always respond positively towards people with a food allergy or intolerance. I know of people who have consumed forbidden foods just to avoid negative comments, only to suffer from ill symptoms for hours or even days afterwards.

When your allergy or sensitivity has been diagnosed by experts and responsible people, such as a medical doctor or a dietitian or by medical tests, and positive treatment is recommended, it remains both your choice and responsibility to stick to the treatment and to take a firm stand when others react as if it is “nothing to worry about”. Everyone has choices in life and these should be respected by others.

Nutritional analysis

The nutritional analysis of the recipes has been done with a computerised programme according to information regarding nutritional values found in the following sources: South African Food Composition Database (SAFOODS), including information from the South African Medical Research Council (MRC) regarding the “Food Composition Tables” (1991); updated information regarding vegetables and fruit (1998); and updated information regarding beef, milk and eggs (1999/2000).

Abbreviations

°C	degrees Celsius (metric unit of temperature)
CHO	carbohydrate
cm	centimetres (metric unit of length)
g	gram (metric unit of mass)
kg	kilogram (metric unit of weight)
kJ	kilojoule (metric unit of energy)
med	medium
mg	milligram (metric unit of weight)
ml	millilitre (metric unit of volume)
mm	millimetre (metric unit of length)
MUFA	monounsaturated fatty acids
PUFA	polyunsaturated fatty acids
SF	saturated fats

“Free of” abbreviations
W	Wheat
G	Gluten
Ma	Maize
E	Egg
Mi	Milk
L	Lactose
So	Soya
C+P	Colourants and preservatives