How to Complete a Gluten Challenge while remaining Low FODMAP (with Seitan Recipe)

How to complete a gluten challenge while remaining Low FODMAP - NOTFROMAPACKETMIX

Updated on 28.01.17

For reasons that I have mentioned before, it is crucial to get tested for Coeliac disease (CD) before you begin any elimination diets that cut out the gluten containing grains – this includes the low FODMAP diet, which eliminates wheat, barley and rye for the two month elimination period due to their fructan content. Oats also contain a protein called avenin, which is very similar to gluten and can also cause issues in overly sensitive individuals. There are many reasons why it’s important to be correctly diagnosed (which includes ruling possible differential diagnoses out) but I’ll expand on the most relevant to fructose malabsorption (FM) or the low FODMAP diet.

What is the difference between Coeliac disease and non coeliac gluten sensitivity?

Coeliac disease is an autoimmune condition in which your body’s immune system reacts to the plant-protein gluten (found in wheat, barley, rye and their derivatives) in such a way that your small intestine lining becomes the target, causing damage to your small bowel and villous atrophy. Villous atrophy in turn leads to a reduced surface area for nutrient absorption, which can contribute to malnutrition, malabsorptive disorders, osteoporosis and many other secondary complications, such as an increased risk of certain cancers. To rule CD in or out, a blood test to check for tissue transglutaminase antibodies is performed and followed up with an endoscopy to confirm any damage to the small intestine.

Non coeliac gluten sensitivity (NCGS), on the other hand, is not as well understood. It is the label given to those who test negative for CD, yet are still apparently affected by gluten. One study suggests that it is not the gluten in the grains but the fructans (acting alone or in combination with the gluten) that are causing sufferers to be symptomatic. Other research hints that it might be an innate immune response, rather than the adaptive immune response of CD, which causes the reaction to gluten-full foods and leads to symptoms that are very similar to those experienced by Coeliacs. Because there is no science-based standardised test to check for NCGS, the diagnosis is one of elimination – other conditions, like CD or a wheat allergy, are ruled out but you find you still improve on a gluten free diet – and NCGS is the possibility that is left.

If you do in fact have undiagnosed CD or NCGS, the low FODMAP diet isn’t anywhere near strict enough to be considered safe for you, as after the elimination phase comes the reintroduction phase, in which you are encouraged to test out foods higher in fermentable carbohydrates – this includes offending grains, which will just make you sick again. If you have CD, you must limit your gluten exposure to basically nothing (less than 20 ppm in the USA is considered safe), so even a contaminated chopping board or deep fryer could make you sick, let alone testing out a full slice of bread. If you have already been diagnosed with CD, you can skip those foods, saving you time and gut hurt… or any of your other symptoms that are caused by gluten.

Furthermore, if you have undiagnosed CD or NCGS, once you have finished the elimination phase and begin to test out wheat, rye and barley, you’ll realise that they bring on symptoms (either IBS or other) and you won’t know whether FM or CD is behind them – and to test for CD, you need to have gluten in your system for an established autoimmune reaction to be visible. If you haven’t been eating gluten, any damage from CD, or any sign of the relevant antibodies, will begin to disappear, meaning that you may test negative, regardless of whether you have active Coeliac disease or not. This is called a false negative result.

How to complete a low FODMAP gluten challenge

If, for one reason or another, you find yourself having been on a long term gluten free diet, yet needing to test for Coeliac disease, there is unfortunately no other way to confirm the diagnosis than to complete a gluten challenge. Instructions vary slightly but, in general, it is recommended that every day, for somewhere between six to twelve weeks (ask your gastroenterologist what they would prefer), you must consume the equivalent of four slices of bread if you’re an adult, or two slices of bread if you’re a child.

Given that:

  • The average bread slice weighs approximately 30 g,
  • Bread is typically at least 10% gluten by weight.
  • This means that the average slice of bread contains approximately 3 grams of gluten.
  • Extrapolating from the number of slices necessary for the gluten challenge, the gluten requirement works out to be 12.0 g of gluten for an adult and 6.0 g of gluten for a child, daily.

After writing the previous post, it seems almost hypocritical to tell you that I had to complete a three month gluten challenge in 2014. You can read my diagnosis story here but, long story short, I tested negative to Coeliac disease (both the antibody blood test and endoscopy) back in 2006 but then tested positive for fructose malabsorption. However, after eating largely gluten free (I didn’t worry about minute levels of contamination), I found myself, at the beginning of 2014, experiencing worsening IBS symptoms and extreme fatigue/brain fog. Ev even asked if I was broken. Now, I felt pretty certain that the culprit was the spelt flour (non-sourdough) that I had been consuming, after reading that it was low FODMAP – note, only sourdough spelt is considered low FODMAP, I had just read inaccurate information. However, the question stood: was it the fructans or the gluten that was causing this relapse?

I know that many people out there would happily re-eliminate the spelt flour and move on with their lives – but I’m not one of them. If there’s a question, I’m the type of person who needs to know the answer. So, I spoke to my GP, who referred me to a gastroenterologist and I began a twelve week gluten challenge. However, I know that fructans in wheat (and to some extent, rye) make me sick – what was I to do? The answer to your low FODMAP gluten challenge question is: SEITAN.

Seitan is a vegan protein/meat replacement that is made from vital wheat gluten, which is normally 75-80% gluten – and coincidentally, registers as low FODMAP. Now, let’s do some maths… stand back.

  • An adult needs to consume 12.0 g of gluten per day, a child 6.0 g.
  • Let’s assume that the vital wheat gluten (gluten flour) was only 75% gluten, to be safe. However, if you can get a more pure version of it, do so, as the more gluten it contains, the less likely it is to contain any FODMAPs.
  • 12.0 g / 75% = 16.0 g, so an adult would need to consume 16.0 g of the vital wheat gluten, daily, to ensure we are getting at least 12.0 g of low FODMAP gluten. A child would obviously only need to consume 8.0 g.
  • The recipe below is in grams, to keep it simple: 240 g of VWG will give fifteen 16.0 g servings or thirty 8.0 g servings.

You could just pop your seitan chunks like a form of medicine and be done with it but it was fun to experiment with it in cooking and I probably ended up consuming more than the 12.0 g of gluten on the days when we did so… which might have contributed to my gut’s unhappiness and the fatigue.

Seitan with Italian Herbs and Spices

Based off Bob’s Red Mill’s basic seitan recipe.

Seitan Dough

  • 250 ml FODMAP friendly stock or water
  • 1 pinch asafoetida
  • 1 tbsp. dried oregano
  • 2 tsp. salt
  • 1 tsp. pepper
  • 1 tsp. dried rosemary
  • 1 tsp. dried sage
  • 240 g gluten flour/vital wheat gluten

Broth

  • 1.5 L of water
  • 1/4 cup soy sauce

In a large pot (I cannot emphasise this enough, seitan balloons!) bring the broth mixture to a boil.

Meanwhile, mix the gluten flour, herbs, salt and pepper together in a large bowl. Slowly add in the stock and stir/knead until it’s a sponge-like dough. It should be tacky to the touch but not wet. Tip it out onto a well floured bench (use more gluten flour) and knead it for a minute or two, until it becomes tougher and more elastic.

Cut it into sixths, then roll them out into logs and divide each one into twenty. There you go, you now have 120 pieces and four pieces equals one daily serving of gluten for an adult.

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Place the seitan dough in the boiling water and boil for one hour. Watch how it expands – I needed to swap saucepans halfway through.

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After boiling, the seitan still isn’t good to eat. At this point, I like to think of it as “raw” meat. The flavour is nice, thanks to the spices, but the texture isn’t great. Spread the seitan out on a tray to dry, then use it in stir fries, pan fry it, bake it – it all works.

Baked seitan:

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Pan fried seitan with mirepoix as a dipping sauce:

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For those who were just curious, I hope you found this piece interesting. For those who have fructose malabsorption or IBS and need to complete a gluten challenge – good luck. I didn’t find it fun, in terms of fatigue, but I hope you fare differently.

After getting back to a normal diet (still no active Coeliac disease, phew), I have learnt that I can cope with a bit of gluten every now and then, so it’s clearly not as big of an issue for me as the fructans are. Luckily, that means that I can still enjoy (proper) sourdough breads in moderation. Yum.

This post is intended for educational purposes only. Please run anything that I have written here by your doctor or dietitian (etc) to make sure it is suitable for your individual case.

In terms of FODMAPs, vital wheat gluten is generally considered low but it is not recommended for consumption during the elimination phase of the low FODMAP diet. As always, it’s best to not need to do a gluten challenge at all, by testing for gluten/wheat related conditions before an elimination diet has begun but this isn’t always possible, for a variety of reasons.

Unfortunately, you might react during a gluten challenge (that’s the point, after all); this method just minimises the chance of that reaction being due to the fructans in wheat as much as possible.

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How to Manage your Irritable Bowel Syndrome with the Low FODMAP Diet

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. I have already shared part one, so here goes part two:

Last week I talked about fructose malabsorption, its link to irritable bowel syndrome (IBS) and the similarities it shares with non-coeliac gluten sensitivity (NCGS). This week, I will expand on the “fructose friendly” dietary management strategy for fructose malabsorption – the complete low FODMAP diet – that is gaining traction as the frontline dietary method for combating IBS symptoms.

IBS is generally understood as a long-term or recurrent disorder involving the function of your gastrointestinal system, usually due to imbalances of intestinal motility, function and sensation, leading to symptoms of digestive distress. It is a common occurrence in Western countries, with up to 30% of the population being affected at some point in their lives, women generally more-so than men.

What are FODMAPs?

FODMAPs” is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and describes a group of readily fermentable carbohydrates that are not well absorbed in the small intestines of some people; if these carbohydrates are not broken down and/or transported through the intestinal wall and into your blood stream, they continue down into your colon, where the resident gut bacteria digest them, leading to a build-up of certain gases and short chain fatty acids, which can alter the water content of your large intestine. These products of fermentation are the causes for the wind, bloating, abdominal cramps/pain and altered bowel movements that you associate with your fructose malabsorption, lactose intolerance or IBS.

The list of FODMAPs includes:

  • Monosaccharides (single sugar units) – fructose (when consumed in excess of glucose) and galactose.
  • Disaccharides (double sugar units) – lactose.
  • Oligosaccharides (multiple sugar units) – fructans (FOS, inulin), galactans (galactooligosaccharides or GOS)
  • Polyols (sugar alcohols) – sorbitol, mannitol and other sweeteners ending in “-tol.” Some polyols, such as sorbitol and erythritol, have the added effect of decreasing the rate of fructose absorption in the small intestine even further when consumed in large enough amounts.

There are hydrogen/methane breath tests that can check whether you malabsorb fructose, lactose and/or sorbitol but the other FODMAPs must be properly eliminated and then tested with a reintroduction trial (outlined below) to know whether they are causing your symptoms…”

Read more at Suggestic.com

Once again, let me know what you guys think! I sincerely hope I didn’t miss anything out – I’m planning on writing more about the links between carbohydrate malabsorption and nutrient deficiencies soon, when I have some time over the holidays.

Thank you for taking the time to read it! Have a great weekend guys – and stay tuned for the easy to make chocolate peanut butter cookie ball recipe that’s very coming soon.

Natty xo.

Could Fructose Malabsorption be the Cause of your Irritable Bowel Syndrome Diagnosis?

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. Here goes part one:

“So you’ve gone gluten free. You had coeliac disease ruled out first – as you should – but you still felt that wheat was a big trigger for your irritable bowel syndrome (IBS). You feel better off wheat – less bloated, more energy – but you’re not quite 100 %. What could it be?

I’m sure that many of you have by now heard of the study behind the media storm that apparently refutes the existence of non-coeliac gluten sensitivity (NCGS). Gluten is a protein that is common to the grains wheat, barley and rye. Contrary to what many of those journalists would have you believe, the researchers did not say that people who identify with NCGS are imagining it; rather, that it might actually be a different component of wheat, other than gluten, or in combination with it, that is causing them to experience IBS-like symptoms, including digestive distress, bloating and others, such as fatigue.

What then could be the culprit behind your wheat-triggered IBS? The answer: it might be fructans (also known as fructooligosaccharides or FOS). Fructans coincidentally happen to be found in large enough amounts to cause symptoms in the gluten containing grains, which includes all varieties of wheat, barley and rye; and they, along with fructose, made my first year of university… let us just say, “interesting.”

Growing up, I always had a fussy gut. When I was going through the last two years of secondary school, it got a little worse but not bad enough for me to really take notice, other than joke about it with friends. It was not until I was in my first year of university that it really got going, dictating not only the parties I could go to but things as seemingly insignificant as which seat I would take in the lecture theatres and what I could wear (think room for bloating). Luckily, my mum had an eye on me and about half way through the year (after end of semester exams really took their toll on my IBS) she read an article about coeliac disease. Digestive distress, nausea, fatigue, brain fog… I ticked most of the boxes, however, I did not have active coeliac disease. My gastroenterologist (since retired) had a game plan though and the next thing I knew I was being sent off to have hydrogen/methane breath tests to check for both lactose and fructose malabsorption*.

I had heard of lactose intolerance before, but fructose malabsorption? Well, fructose malabsorption was my answer and explained why the gluten free diet that my GP had advised me to trial earlier had helped significantly – but not completely…”

Read more at Suggestic.com.

Let me know what you guys think and please share – as awareness of fructose malabsorption spreads, it is more likely that people will be correctly diagnosed and the variety of food choices for us will increase, both at restaurants and in supermarkets.

Read part two here.

Have a great night!

Natty xo.

Oregano, Olive Oil and Sea Salt Spelt Focaccia – FODMAP & Fructose Friendly for Some, NOT Gluten Free

Oregano, Olive Oil and Sea Salt Spelt Focaccia - FODMAPs and Fructose Friendly for Some

Who doesn’t love a focaccia?

When I first started my science degree (pre-FM diagnosis), my Mum informed me that I needed to learn to take care of myself and that part of that was to make my own lunches from now on. Say WHAT?! I had to be an adult? Initially, my dad took pity on me and made some awesome sandwiches with Mama’s (his mum) homemade bread; I think that making a “school lunch” was such a novelty for him that he even had fun. Well, it turns out that Mama’s little bread maker couldn’t keep up with the increased demand – more like the doubled fruit in the fruit loaf that she also made for Dad – and it carked it not long after. Nice work, Dad!

What was I going to do? I’d gone from Wonder White bread to fresh, thick cut deliciousness and I didn’t want to go back. I hit on focaccia bread as a good solution and went from there… for about 4 more months until my FM diagnosis meant no more wheat for me. It was a good run while it lasted.

I haven’t had focaccia since then (2006)… until now. It took a few attempts but I’ve finally perfected a spelt focaccia loaf. All is right with the world.

This focaccia has a light oregano flavour, combined with a crispiness from the olive oil and a delicate sea salt finish. Evgeny and I might have finished one in a day. Whoops.

Notes:

  1. Spelt (Triticum aestivum subsp. spelta) is an ancient form of wheat that hasn’t been tinkered with and contains gluten that is said to be more readily digestible (due to it being more water-soluble than that in modern day wheat), so is potentially better tolerated by many who react to normal wheat. More information here.
  2. Like rye, spelt flour is generally better tolerated than wheat flour among fructose malabsorbers. Also like rye, spelt does still contain fructans and is not tolerated by everyone on a low FODMAP diet. For this reason, I would recommend trialling a small piece before you go all out and scoff the loaf.
  3. Spelt is NOT gluten free. The gluten it contains is different than that in wheat. If you have coeliac disease or non-coeliac gluten sensitivity then spelt is not safe for you, regardless of the different fructans. There is some evidence that completely fermenting wheat will degrade gluten such that it is safe for gluten sensitive people, however not enough research has been done yet to say so definitively.

Oregano, Olive Oil and Sea Salt Spelt Focaccia

Makes one 12 inch/30 cm focaccia.

  • 250 g spelt flour
  • 125 ml/g filtered water
  • 50 g + 1 tbsp. olive oil – and more for oiling the pan
  • 1 tbsp. dried oregano
  • 2 tsp. activated yeast
  • 1 tsp. kosher salt
  • 1-2 tsp. sea salt

Place your mixing bowl on a set of scales and weigh in the spelt flour, water and olive oil. Add in the rest of the ingredients (except for the sea salt) and, using the dough hook, knead on a low speed for 2 minutes until everything has combined. Cover the bowl with a tea towel and let it sit for 10 minutes.

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Now, knead on a medium speed for a further 7-10 minutes before the dough is left to rise. Alton Brown has a really nifty trick – he boils water and pours it into a baking dish placed on the bottom rack of the oven. Put your mixing bowl with dough in the oven and close the door, leaving the oven OFF. The warmth and humidity will help the dough rise; this normally takes 1-2 hours, just keep an eye on it.

If you want to start this the night before, cover it with a slightly damp tea towel and leave it in the fridge overnight before continuing on the next day. If you do this, the dough should double in size overnight but if it hasn’t, just leave it in a warm spot (or use AB’s oven trick) until it has doubled from its original size.

Pre rise

Pre rise

Post rise

Post rise

Once the dough has doubled in size, knead it gently on a lightly floured bench for a couple of minutes and then dump it into a well oiled cast iron pan (or your pan of choice). Press the dough softly to gradually spread out over the base of the pan – it should end up approx. 3 cm thick and it doesn’t have to reach the very edges of the pan. Let the pan sit in a warm (neither hot nor cold) location for about an hour and let it rise some more but it won’t rise much.

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Pre-heat your oven to 230 C/450 F – this is important, bread must go into a piping hot oven to help a crust form. Meanwhile, if you like your focaccia to have the dimples in it, just press your fingers in and make evenly spread holes. I like mine to remain a little fluffier, so I don’t do this. Finally, sprinkle the sea salt over the top of the unbaked focaccia.

Bake for 30 minutes. The focaccia should be a light golden brown colour and it will smell amazing. One important thing to remember is that there will be residual cooking after you remove it from the oven, so if it looks completely done just out of the oven, it will be over done by the time it’s cooled.

Enjoy fresh as is, pair it with a hearty soup, or use it as a sandwich bread once cooled.

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Eat and Let Eat – The Pros and Cons of Eliminating Foods? Everyone has an Opinion

I’ve read a few blog posts and media website articles lately that I find concerning – both as a person dealing with a digestive issue and a normal human being. My fructose malabsorption (FM) is definitely not as extensive as many people with whom I have spoken over online forums, or as dangerous as an anaphylactic reaction but it is there and it has impacted my life, for better and worse, over the last 8 years since I was diagnosed.

  • The first article I read was a little tongue in cheek, and complained about those with “fake” gluten allergies making a joke of it, so that wait staff/chefs don’t take real allergies quite as seriously as they should, or would, if this were not the case. That’s fine, I get it. So many people are eating gluten free now, and not all for the right reasons.* It’s understandable that those who go gluten free because it’s the latest fad might slightly tick off those who have no choice in the matter – a Coeliac friend of mine ends up in the hospital on antiemetics if she is exposed to gluten and has told me that she doesn’t understand those who chose the lifestyle over a more accessible diet without a decent reason.
  • The second article was downright depressing to read from the stand point of “one of those” customers with a food intolerance. I already feel guilty enough going to eat out at restaurants, knowing I’ll have to ask extra questions and take a little longer to decide what to order, without someone with no expertise deciding if my issues are worthy of their attention. The amount of times I get looks that tell me I’m crazy for not eating an apparently random assortment of foods keeps growing and is a large reason why Ev and I have found a couple of restaurants that suit us and we’re sticking with them.
  • The article that frustrated me the most, however, was this charmer by Mia Freedman. I understand that she was trying to make light of all the recent health related diet fads but she did so in a way that belittled those of us who deal with dietary restrictions that we would more than happily give up.

What is really depressing about most of what I read is that both the articles and the comments sections demonstrated such a lack of understanding of those with both diagnosed and un- or self-diagnosed issues. I suppose I should expect no less from the second article, but an article written by (I assume) a Coeliac would, you would think, have a little more empathy for those who are also dealing with intolerances and possibly garner an audience of like-minded people. Personally, I can tolerate gluten – which means that rye and spelt have opened up as options to me, if my FM can tolerate the fructans (it can, in reasonable amounts). However, I still cannot eat wheat, due to the amount and type of fructans present – yes, FM is a complicated beast.

I would think that most people, like myself, had a long-ish road to diagnosis, after which it took another couple of months before I was really “getting” the fructose friendly diet. It took my parents and I about six months of looking, after a couple of years of an increasingly irritable bowel that one day just got worse than my tolerance level for it. Other stories I have heard have spanned about ten years or more of inexplicable symptoms before a diagnosis was reached! The more exotic your intolerance – or the more inept your doctor – the longer the road is, generally speaking. From this I would assume that we might exercise a little more tolerance of those who are just starting out and maybe don’t quite understand their particular diet just yet. Maybe they don’t have a particular diet (FODMAPs, GAPS etc) that they are following but they have realised that certain foods don’t sit well with them. Intolerances come in all shapes and sizes; if these lucky people only need to cut out a few things in order to feel well again then great, good for them. I’m jealous but I’m not going to call them out for drinking a beer when it has gluten in it, if they are only “trying to watch their gluten” and have decided that this beer fits in with their tolerance level.

I believe in proper diagnosis but this is not always possible. A variety of factors play into this situation:

  • Finances
  • Availability of testing procedures
  • The knowledge base of your health professional
  • The test might aggravate your symptoms past a level you are comfortable with

If somebody told you that they felt better after cutting out wheat or gluten, yet could not have the test due to one of the above reasons, does that make their report of their symptom improvement any less valid than a Coeliac reporting on the benefits of cutting out gluten? No, it does not. We all know our own bodies and we have the ability to judge just what we are happy dealing with and what we will change if possible. Changing symptoms through diet is one of the easiest ways to go about it. It might take a little getting used to but it is more often than not preferable to taking medications that can have unwanted side effects. What I’m trying to say is that if we don’t know the details, who are we to judge? And even if we did, we still can’t know or understand how much the individual is affected by the food; we’re not sitting with them in the toilet, or suffering through their cramps with them at work or home – for those who are lucky enough to have dodged this bullet, it’s not just the cramps or the “runs” that we have to deal with, the initial symptoms also lead to fatigue, frustration, nutritional deficiencies and more.

The second article, for all its short comings, does raise a good point that was discussed at length in the comments section – if you are intolerant of something, and you decide that you do want to eat out (which you have every right to), set yourself up for success. If you have Coeliacs, an Italian restaurant might not be the best idea. Anaphylactic to shellfish? I’d probably steer clear of a seafood restaurant. It is of course up to you to decide what level of risk you are happy with but I can understand a waiter at an Italian restaurant might be a tad miffed if you start having a go at him regarding their lack of gluten free options. They don’t have  to cater for us, though I’m certainly glad that most of them try to. But by making a choice like this and harassing a waiter, you will only give everyone with a food intolerance a bad name. If you graciously explain your situation and keep everything civil, it will all work out for you in the end – even if you have to go elsewhere – and for food intolerant people everywhere who would like to eat out. If we are easy going to deal with as a whole, hopefully the stigma surrounding us will cease to exist.

As someone with a relatively unknown intolerance (over here in the USA, anyway – FM is gaining a good knowledge base in Australia), I experience a lot of disdain from waiters when I try to explain that it’s not gluten, it’s something else in wheat that upsets my gut. Whenever I ask about wheat in a restaurant, the response is, “gluten free?” To which I always feel obliged to say, “No, I’m not a Coeliac but I can’t have another substance in wheat called ‘fructans.'” Why  do I feel as though I have to explain the intricacies of FM to everyone? It would be easier to just answer a simple, “yes” to that question but there is an underlying feeling of guilt at lying. But why? My reason for avoiding wheat is just as valid as the next. I have even heard of other fruct mals being told that nobody is allergic to onion, so they must be faking it. Believe me, I’m not going to go into a restaurant and be difficult on purpose. Why would I avoid one of the most widely used flavours (and for good reason, onion is delicious) without cause?

Because of this, I rarely eat out, except for at a couple of trusted restaurants. It’s too difficult. I don’t like to cause trouble for my gut or my fellow diners. It’s easier to have dinner parties at our home, even with our tiny kitchen added into the equation. Sometimes, however, I do take risks – and sometimes they pay off. But not always. When this happens, lack of education is normally to blame, rather than malice – the beauty of this is that the education/knowledge problem can be solved. I was at a chocolate festival in Seattle earlier this year and I was religiously checking the ingredients in what I was tasting. One seller talked about her “all natural chocolate.” Of course I asked what sugars were added to sweeten it, apparently none? Great, I’ll try some. After I’d finished my bite she went on to talk about the organic agave syrup that she used! I let her know – as gently as I could after a frustrated outburst – that agave is a sugar, as is honey or maple syrup or any other natural syrup (as well as the processed varieties. The point being, in case you don’t have FM and don’t know, agave is incredibly high in fructose, with very little glucose – a terrible sweetener for a fruct mal to use. Cue the looks of disbelief from the chocolatier.

The fact that I continually need to justify why I’m avoiding agave, wheat or pears – such a wide range of foods that it seems I’m making it up – frustrates me. I wish FM was as well known and consistent as a lactose or gluten intolerance, then the name would be enough. We are often written off as just being difficult due to the extreme range of foods high in fructose and fructans. Add into the equation the rest of the FODMAPs that many others cannot tolerate and eating out can seem virtually impossible. It’s not just wait-staff either, friends and family (I’m very lucky with mine but not everyone else is) want to know exactly why you can’t eat certain foods and what will happen. My friends will know I’m not shy when it comes to talking about bodily functions (a health degree will do that to you) but it’s easy to tell when someone is truly interested or if they’re deciding for themselves whether they think my intolerance is real – or as other people have experienced – if their reactions aren’t so severe that they can sneak an unsafe food into the meal. I’m very lucky to have only experienced genuine fructose related mishaps when others have cooked for me – and it doesn’t bother me at all, because at least they tried.

It really is a basic act of respect to accept that someone cannot eat a food, for their own reasons. Vegetarians don’t – or shouldn’t – get harassed for eating salads at a BBQ. Why should we be harassed for being picky eaters? As Mia Freedman so delightfully put it, we “bang on about it.” I’m sorry (actually, I’m not) but you just asked me why I’m not eating/can’t eat such and such. For some intolerances, there is no simple answer. While I make every attempt not to bore people, I do feel like I am doing a good thing in restaurants by giving my little FM spiel to the wait staff. FM is so unrecognised in the US that it needs all the publicity help it can get. If someone is just newly diagnosed, they might be so excited that they finally know why they’ve been so ill that they can’t help telling their friends; they might also be so frustrated and depressed with the seemingly restrictive new diet that they’ve been put on that they need to vent. Either reason is acceptable and part of friendship is listening when it’s needed. On the other hand, I can completely understand that those who are overly zealous and trying to convert people who don’t need it to their chosen diet or lifestyle may be considered annoying. If someone asks for help in loosing weight/IBS/fatigue etc, by all means suggest what has worked for you. If you see someone scoffing a slice of Pavlova, don’t start telling them how bad sugar is for them; they might have just been at the gym.

Empathy and understanding are required by all to handle situations, such as those in restaurants, which might and sometimes do blow out of proportion. The same goes for people with different types of allergies or intolerances. As I said, my FM is generally easy for me to manage. And I’m certainly glad that I’m not so sensitive that I can’t be in the room with an apple, as some with peanut allergies cannot be near an open jar of peanut butter. I will not puff up, my airways do not swell closed and I don’t need to carry an epipen with me at all times. However, while I am lucky that my reaction to fructans aren’t too bad, my reaction to excess free fructose can be extreme. The last three times I consumed apple, the cramps were so bad that I fainted twice – luckily in the computer lab at uni and at home – and almost fainted once – in the middle of NYC, luckily with a couple of very understanding friends. While abdominal cramps due to carbohydrate fermentation in my gut isn’t life threatening, if I fainted while driving or alone in the street? What then? It could definitely get dangerous.

I have never understood why we have to be competitive with our allergies. Is this a contest that we really want to win? Because it’s not really winning at all. This occurs mainly on websites, where users can hide behind their computer screens, which I suppose removes the human element to our online interactions but I like to think that I would talk to someone in the same way that I type to someone, much as I do on here. This allergy superiority needs to stop, we need to support each other and be glad when one group/condition reaches heightened awareness, as it can only mean good things for all the rest. Should the Coeliacs out there be so mad at those with a gluten intolerance, or who are “watching” their gluten? I don’t think so, because without the vocal minority, the awareness about gluten wouldn’t be as widespread as it is now; they have actually done them a favour. Those who don’t believe in intolerances and allergies have and will always exist and whether you choose a diet for medical or “other” reasons will not change that.

Next time someone orders a beer after eating gluten free finger foods, just smile and sip on your wine. It tastes better, anyway.

* In my humble opinion, the wrong reason for going gluten free is that you’re doing it because a magazine article told you to, without looking into it any further. GF diets can and do help many people but if they’re not done properly (i.e. you rely on packaged, processed GF foods) then they can do more harm than good.

Ryce Bread – Lower Fructans but NOT Gluten Free

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My quest to create fructose friendly crumpets this week was delayed after Evgeny requested that I make him some fresh bread; wheat, seeing as he can eat it. I agreed but I thought why on Earth am I making him bread I can’t eat more than one tiny mouthful of? So I decided to  attempt the next phase of my fructose friendly – at least for me – bread at the same time. Why clean the kitchen twice, right?

I used the Virtuous Bread 100% Rye Bread recipe as a starting point and knew that I wanted to substitute half of the flour for a non-rye, non-wheat flour, to achieve a lighter loaf with less fructans in it than full rye. I chose white rice flour, as I wanted this to be easy for anyone to replicate and GF flour blends can be so different that they don’t reliably perform in the same way. By choosing a single type of flour that you could buy, rather than a brand of gluten free flour, I hope I have done this.

As to adding the gluten powder (which I had found a week earlier at the supermarket, with something like this bread in mind), I had to make an educated guess that luckily worked out. I couldn’t find relevant instructions anywhere on adding gluten to gluten free flours, because who would be crazy enough to do that?! Too little gluten and bread will crumble – we’ve all had to deal with structurally inadequate gluten free bread; too much and the bread will be very dense and won’t rise. I knew I had to add more than the general rule of 1 tbsp./2 cups of flour, because half of my flour didn’t have any gluten at all. Luckily my “guesstimate” paid off, because the bread rose well and was moist, not crumbly.

For a fantastically detailed look into bread making, watch this video of Alton Brown’s Good Eats bread episode, Dr. Strangeloaf. While it is talking about wheat bread, I like the science he brings to his baking and I was able to use much of his information to make this bread. One example is the use of cooler water – this lets the yeast ferment the carbohydrates at a much slower rate, giving the gluten present a chance to develop enough to successfully “catch” the gas, which generates more fluff in the bread.

Notes:

  1. As I have mentioned before, studies show that rye flour contains more fructans than wheat but evidence suggests that the chains are longer, thus taking longer to ferment. It is generally less of an irritant than wheat to those with FM, although many still cannot tolerate it. I am lucky enough to be able to tolerate a small serving of 100% rye. I suppose I should explicitly say that this won’t be tolerated by everyone but if you want to try it, or know that you are okay with rye, then go ahead.
  2. Rye is not gluten free, so neither is this recipe – especially as I have added vital wheat gluten. If you have issues with gluten specifically, this bread is not for you.
  3. Rye flour requires more water/hydration than wheat flour, and the dough it will make tends to be stickier and requires less kneading than wheat flour. Rye is easier to over knead than wheat flour, so it requires gentler handling. However, I added wheat gluten to this recipe – while I did knead it less than I did the wheat loaf that I made Evgeny, I kneaded it more than the 100% rye loaf I had previously made.
  4. Some with FM cannot tolerate brown rice flour, so make sure you use white rice flour if you are one of those. At any rate, I used white rice flour in this bread and I don’t know if brown rice flour would replicate the results.
  5. The IBS dietitian Patsy Catsos mentions – on her website – that vital wheat gluten isn’t recommended during the elimination/testing phase but after that it could be beneficial in your baking. As long as you’re not gluten intolerant, of course.

Ryce Bread

  • 300 g white rice flour
  • 300 g whole meal rye flour – or light rye
  • 2 cups/500 ml room temperature water
  • 1 cup vital wheat gluten
  • 1/3 cup flax seeds – optional
  • 3 g dry instant yeast
  • 1 tbsp. castor sugar/dextrose
  • 3 tsp. salt
  • Extra flour to dust surfaces for kneading
  • 1 tbsp. corn starch mixed in 1/4 cup water

Combine the white rice flour, rye flour and vital wheat gluten in the bowl of your stand mixer and combine thoroughly with the dough hook for a good minute. Once done, add in the flax seeds, salt and instant yeast and mix for another minute.

Meanwhile, add the sugar to the water and stir until combined. This shouldn’t take long. Once done, add it slowly to the dry ingredients while the dough hook is still turning. You don’t want the dough to be swimming in water but it won’t look like normal wheat dough, either. It will be tacky – i.e. stick to your fingers if you haven’t floured them – but because we have added the gluten, it will have a lot more structure than 100% rye. Use the mixer to knead it for 5 or so minutes on a medium speed.

It is difficult to explain but it should look like the dough ball directly below, minus the flour dusting from me giving it a light knead (1-2 minutes, with my hands) before I left it to rise in a lightly oiled straight sided container – it makes it easier to see how much the dough has risen. Leave your dough (covered with a tea towel) to rise for 2 hours, until it has visibly doubled in size.

After initial machine kneading

Pre-rise, in an oiled container

Once the dough has doubled in size, use your knuckles to knead it out into a flat rectangle. Hearing the gas bubbles pop is normal, although the wheat dough made more sounds than the ryce dough. Fold each outer third into the middle, like a wallet, and then repeat once more.

Let it sit for 20 minutes and then knead it again with your knuckles. Pick it up and fold the edges underneath; imagine you are creating a jelly fish or the top of a hot air balloon – if you have trouble picturing this in your head, watch the video I linked above. Once done, place it on a lightly floured surface and use your hands to roll it over the bench top without picking it up. I recommend watching the video for this step, too. I also suspect that my hands are a little too small to do this step well but that could also be a lack of skill on my behalf.

Let is rise for another hour, covered with a tea towel, on a lightly floured wooden cutting board. Below is the loaf after its second rise.

After rising, and two stages of kneading

Preheat the oven to 200 C/400 F and if you are using any sort of stoneware to bake the bread on, make sure it heats up with the oven or you might end up with a crack through it later on from the rapid temperature change.

Give the dough a light coating with the corn starch/water mixture to help with browning later on. Scoring the top to a depth of about 5-10 mm is not only decorative but functional as well; it gives the inner dough an escape route as it rises during baking, allowing it to expand even more, rather than become trapped inside and thus denser. Scatter a little more flour onto the chopping board, as the corn starch solution will have moistened everything and the dough won’t slide properly for the next step.

Cornstarch glaze and slices before baking

Using the wooden chopping board, first make sure the dough can slide around easily on the scattered flour and then slide it onto a pizza stone if you have one, or an upside down, unglazed 12″ terra cotta pot base if you don’t (mine cost $6 from a hardware store) that is sitting in the oven. Allow enough headroom for the dough to rise as it bakes – I need to remove the upper shelf but it isn’t really necessary, anyway.

Bake at 200 C/400 F for 40 minutes. It should be done when it sounds hollow when tapped – some people use internal temperatures but we don’t have a thermometer, so tapping it is for us. Below is the loaf, fresh out of the oven.

Ryce Bread - half each white rice flour and whole meal rye.

Let the bread cool for at least half an hour before cutting into it – don’t worry, it will still be lovely, warm and fresh. It is so delicious! I was really happy with this bread; you get enough rye flavour without the full load of fructans and – as the slices are big – I’ve eaten one slice for each of the last three days and had no issues. I would test more to see my limits but that much of any bread in one sitting isn’t good for anyone.

Hopefully some of you can tolerate it as well, if you’re willing to test it out.

I spread some of my stewed raspberries and rhubarb on it for a delicious breakfast yesterday and had some of my basil pesto on it with sliced turkey for lunch today. What will you do with your freshly baked bread?

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