Chapter 6

Gluten-Free . . . Nutritiously

In This Chapter

Recognising what food has to offer

Keeping the right balance

Understanding the glycaemic index and load

Getting the right nutrients

Controlling your weight on a gluten-free diet

Maintaining healthy eating as you get older

W hether you’re a salad-dodger or suffering from orthorexia (an extreme desire to eat only health foods), eating gluten-free nutritiously is simple but not plain. You don’t have to balance any food blocks (and turn them upside down every few years), weigh portions, keep a food log or count kilojoules.

We have more than just a passing interest in nutrition and that interest extends far beyond whether something is gluten-free or not. We love food (and who doesn’t?) and believe that eating well shouldn’t just be about getting the right nutrients, but enjoying what you eat. When you need to remove gluten from your diet it’s crucial to make sure you get the balance right and still love your food as before.

In this chapter, we hope to share with you our fervour for food as more than just something that satisfies your hunger pangs. We explain why gluten-free doesn’t always mean guilt-free and why paying attention to the glycaemic load is important to staying healthy. And with a few gentle nudges, we hope to help steer you — oh-so-gently — down the path of eating gluten-free nutritiously, for life.

If the subject of nutrition seems intimidating or far too complex, don’t worry. We boil it down to the raw ingredients and make this a lesson in nutrition that’s easy to digest.

Appreciating Your Food

You make some pretty drastic changes to your diet when you first go gluten-free, becoming far more aware of what’s going into your mouth — faithfully reading labels and scrutinising the ingredients, acutely aware of where gluten could be lurking, and avoiding it like vampires avoiding garlic. While those changes are taking place and your focus is right on food, looking at other aspects of your diet as well as the gluten-free side of things makes sense.

People tend to think that gluten-free means healthy. After all, gluten-free foods are available at ‘health food’ shops and sometimes they cost far more than ‘regular’ foods. More importantly, they don’t have the evil villain gluten in them, so they have to be nutritious, right? No, not necessarily. But a gluten-free diet can be absolutely healthy — and, in a way, you get a head start on healthy eating because you’re more likely to be eating fresh foods than people on an average Aussie diet. Foods that are free from absolutely delicious and nutritious additive stuff like polyoxyethylene sorbitan tristearates, dioctyl sodium sulphosuccinates and the pick of the bunch, calcium disodium ethylenediaminetetraacetates. (Say that one quickly three times before you take a bite and you probably won’t feel quite as hungry.)

The type of food you eat has powerful effects on preventing disease and on maintaining proper organ function, energy levels and moods, and can even affect your longevity and how you age. What you eat has a direct bearing on the way you look and feel — and live. That, of course, applies to everyone, but it has special significance for people with coeliac disease.

It’s a Matter of Balance

We promise we won’t mention the food pyramid — it seems to have lumbered back into the Egyptian desert to chat with the Sphinx and good Queen Nefertiti. But realising that just because something is gluten-free doesn’t mean that it’s healthy, or that you have to eat it, is important. Despite being on a gluten-free diet, you still need to follow the general healthy eating rules that are important to all Australians (coeliac or not).

Include a wide range of nutritious foods and liquids in your diet, such as:

• Lean meat, fish and poultry (or gluten-free vegetarian alternatives).
• Loads of vegetables, legumes and fruit, keeping in mind the following:
  • Vegetables don’t have to be restricted to broccoli, brussels sprouts and the other green stuff your mum tried to brainwash you into eating. ‘Lots of vegetables’ includes crunchy salads and yummy things like avocado, olives, grilled capsicum or eggplant and tinned tomatoes. (Okay, we know avocadoes are actually fruit, but have you ever seen one in a fruit salad?)
  • You should aim for at least seven serves of fruit and vegetables each day. Eating five serves of veggies and two pieces or serves of fruit is recommended.
  • Legumes include a wide variety of beans, chickpeas and lentils. And yes, baked beans are right in there, for breakfast, lunch or dinner. You will need more legumes and nuts than before (they are a great source of vitamin B, fibre and protein.
• Plenty of water.
• Milks, yoghurt and cheeses (or alternatives). Aim for at least three servings a day. Many dairy alternatives (like rice or soy milk) are now calcium-fortified.
• Plenty of good-quality cereals.

  When we talk about cereals we’re not just thinking about the stuff you cover with milk and demolish at breakfast, but any food made from grains. Okay, so that includes the stuff you cover with milk, including muesli and bran flakes, but also things like rice, pasta, bread and anything you make from flour.

Some other important tips:

• Fat is an essential part of your diet, but limit the saturated fats and moderate total fats (you find details about this on the package or container). The mono- and polyunsaturated fats are the good ones.

  Avoid too much salt (everyone needs some salt, but you probably get enough in your bread to meet your daily needs). Even if you don’t salt your food, you could be getting far too much in your diet. The sodium that’s found naturally in foods like shellfish and some cheeses isn’t usually a problem. But processed foods are often loaded with sodium in the form of flavour enhancers, thickeners and preservatives. Even soft drinks often have sodium to help them maintain carbonation.

• Keep your intake of sugar and foods containing added sugars low (again, you can find information about sugars on packaging). Compare similar products and choose the ones with less sugar.

As you may have heard, ‘Variety is the spice of life’. But it’s more than spice. It’s the essence of a balanced gluten-free diet. Do some homework to locate as many varieties of gluten-free products as you can and incorporate these into your regular diet. Build up a list of yummy meals or recipes, too, and keep the list handy so you can quickly check when you’re right out of inspiration.

Good Carbs, Bad Carbs: Tuning In to the Glycaemic Index and Glycaemic Load

Information about diets, especially when it contains weird and confusing words like ‘glycaemic’, sounds complicated, tedious, boring or all of the above. But please don’t go away, because what’s coming next is really important to your health and wellbeing. It also helps to explain why some people on a gluten-free diet feel hungry a lot of the time, or why they experience a ‘low’ during the day and feel awful until they eat something.

To start, here’s an interesting question: True or false — a potato is worse for you than a chocolate bar. If you’re talking about how each food affects your blood-sugar levels, it’s true. Now are you interested? Read on.

Getting into the glycaemic index

All carbs aren’t created equal; in fact, they behave quite differently in individual bodies. When you eat carbohydrates, the digestive process breaks them down into the sugar glucose, which is what gives your body the energy it needs to function. Because glucose is a sugar, it raises your blood-sugar levels when it enters your bloodstream.

The glycaemic index (GI) is a ranking of carbohydrate foods according to their effect on blood glucose levels. (Carbohydrate foods include fruit, starchy vegetables, rice, breads and cereals, legumes, dairy products and, of course, sugar itself.) Figure 6-1 shows the different rates at which high and low-GI carbohydrates affect the release of glucose into your blood. Table 6-1 shows how glycaemic index numbers are ranked according to their effect on blood glucose. Foods containing fat and protein don’t really affect your blood-sugar level that much (if anything, they help to stabilise it), so the glycaemic index really only concerns foods that contain carbohydrates.

Table 6-1 The Effects of High-, Moderate- and Low-GI Carbs on Blood-Sugar Levels

High-GI carbohydrates break down very quickly during digestion and produce a fast and high blood-sugar response. Low-GI carbohydrates break down slowly, releasing glucose gradually into the bloodstream.

Eating a lot of high-GI foods can be harmful to your health, especially if you’re overweight or don’t get regular exercise. Try to choose mainly low-GI carbs that slowly trickle glucose into your bloodstream (see Table 6-2 for suggestions). That way your energy levels are more balanced and you feel satisfied for longer between meals.

The benefits of eating low-GI carbohydrates each day include the following:

• You feel fuller for longer.
• Your body burns more fat and less muscle.
• You lose weight.
• If you have diabetes or insulin resistance (pre-diabetes) your blood glucose is easier to control. You may reduce your risk of heart disease.

Wow! That all sounds pretty good. But, you’re thinking, how hard is it going to be to maintain a low-GI diet? Now you’re going to tell me to take even more foods out of my diet. Give me a break!

It can be tricky to be both gluten-free and have low GI. But it’s do-able. The problem is that many of the gluten-free alternatives have a higher GI than their gluten-containing counterparts. (Remember that anything above 70 is considered high GI — refer to Table 6-1.)

Here is the GI of common gluten-free staples and snack foods:

• Most gluten-free breads: 70 to 80
• Most gluten-free cereals: 80 to 90
• Most gluten-free pasta: 70 to 90
• Most varieties of rice: 80 to 100
• Most varieties of potato: 70 to 100
• Rice cakes: 82
• Corn thins: 87
• Rice crackers: 92
• Plain popcorn: 72

At face value, that all looks pretty negative. How can you possibly choose low-GI foods on a gluten-free diet? But don’t panic yet. A number of gluten-free foods are also low GI (and good for you):

• Most fruits
• Legumes such as lentils, kidney beans, baked beans and chickpeas
• Most dairy products
• Some types of rice, noodles and grains, such as basmati rice, rice noodles, gluten-free soba noodles, buckwheat and quinoa
• Some starchy vegetables, such as orange sweet potato, corn and taro

Table 6-2 Comparing the GI of Some Gluten-Free Foods

The glycaemic effect of foods depends on a number of things, including the type of starch that’s in it, whether that starch is cooked, how much fat is present and the acidity level. For example, adding vinegar or lemon juice (acidic) to a food actually lowers the glycaemic index. And fat or dietary fibre can help inhibit the absorption of the carbohydrates, which also lowers the glycaemic index. That, by the way, is why a chocolate bar — which has fat in it — can have a lower glycaemic index than a potato (but this doesn’t mean the chocolate bar is a better choice). Processing affects the glycaemic index of a food, too. The more highly processed a grain such as rice, corn or wheat is, the higher its glycaemic index and the more quickly your blood sugar rises.

Why blood-sugar levels are important

Your blood-sugar levels can have profound effects on your health in many ways: Disease cause and prevention, weight loss and weight gain, moods, energy levels and even how quickly you age.

The underlying principle is simple: What goes up must come down. When you eat high-glycaemic-load foods — such as bread, pasta, pizza, biscuits and cakes — your blood sugar spikes. And chasing that spike in blood sugar is your friend insulin, a hormone produced by the pancreas. Insulin’s job is to get nutrients from the blood and make them available to various tissues in the body.

Glucose is the fuel that your body uses. Insulin is in charge of getting the glucose into the cells where they can use it for energy. Think of insulin as the delivery guy — bringing glucose to the cells, opening the door and tossing the glucose inside.

When insulin shuttles the glucose from the bloodstream into the cells, insulin lowers your blood-sugar level (the sugar isn’t in the blood anymore; it’s in the cells).

When your blood-sugar level is high, your body makes a load of insulin to try to bring that level down. The problem is that insulin is sometimes a little too good at its job.

People with diabetes used to think they had to avoid sugar — as in table sugar. But simple sugar (like table sugar) doesn’t make your blood glucose level rise any faster than complex carbohydrates do. That’s why using the glycaemic index is a more valuable tool in controlling blood-sugar levels (and losing weight) than cutting down on sugar.

The effects of high insulin

When you eat a lot of high-glycaemic-load foods (see the following section), your blood sugar spikes and the pancreas has to work really hard to pump out a load of insulin to bring the blood-sugar level down. And it works — blood sugar drops fast. You crash. You get fatigued, sometimes a little dizzy — and hungry.

When high-glycaemic-load foods cause your blood-sugar levels to spike and then drop quickly, your hormones are strapped in the front seat on this roller-coaster ride, wreaking havoc on your energy levels and even moods.

Insulin also increases the amount of cortisol in the body. Cortisol is a stress hormone that can accelerate ageing and cause other health problems.

People who eat high-glycaemic-load foods for years can develop a condition called insulin resistance. Insulin resistance is when the body has so much insulin all the time that it doesn’t respond like it should anymore. Usually, just a little bit of insulin can bring blood sugar down, but in someone who’s insulin resistant, this doesn’t happen. So in an effort to lower blood-sugar levels, the body keeps producing insulin and has elevated levels of it all the time. This can put stress on the pancreas and lead to the development of type 2 diabetes.

Looking at the glycaemic load (GL)

Using the glycaemic index alone can be a tad misleading. Watermelon, for example, has a high glycaemic index, but because watermelon’s mostly water, you’d have to eat a lot of it to raise your blood sugar much. The glycaemic load (GL) measurement is actually a little more valuable. Glycaemic load looks at how many grams of available carbs a food provides. The available carbohydrates are the ones that provide energy, like starch and sugar but not fibre. The glycaemic load of a meal takes into account both the amount and the quality of the carbohydrates present. And both of these are important in determining how much your blood glucose level rises and falls.

Looking for the GI Symbol

To make shopping easier, the Glycemic Index Foundation (in consultation with the University of Sydney) has come up with a cool logo (the GI Symbol) that tells you what the GI is for that product. When you see the logo on a food item you know that the GI has been measured and the food must contain appropriate levels of carbohydrates, total fat, saturated fat, salt and energy and, where appropriate, be a good source of fibre. Use of the symbol isn’t compulsory — it’s entirely up to the manufacturer — but it’s appearing on more and more products. Remember, the GI Symbol tells you only about the glycaemic load, not about gluten. So you still have to read the nutrition panel to see if it’s gluten-free.

Most people don’t have the time — or the inclination — to be constantly calculating the GI, product by product, as they hurtle round the supermarket. They’re already busy enough looking for the gluten-free logo or those magic GLUTEN-FREE words, or straining to read the minuscule details in nutrition panels, not to mention putting back all the junk items little Ollie is sneaking into the trolley. So how can you do low GI and gluten-free at the same time?

Don’t get carried away with enthusiasm when you see the GI Symbol on a product and scoop it up into your trolley. Remember, choosing low-GI food is all about good health, not about whether a product is gluten-free. Look for gluten-free products first, and then check the GI, either from the GI Symbol — if one is shown — or by learning to recognise the gluten-free foods that are also low or moderate GI.

Try these simple and practical tricks:

• Try to spread the amount of carbohydrate you eat evenly throughout the day.
• Watch the size of your carbohydrate portions (too much of even a low-GI food will send your blood-sugar levels skyrocketing).
• Include a low-GI carbohydrate food at each meal if possible.
• When you choose to eat high-GI foods, include some low-GI carbs in the meal to bring down the load of the meal.
• Look for low-GI, gluten-free bread.
• Mix mashed cannellini beans or orange sweet potato into your mashed potatoes so you need less potato to be satisfied.
• Add some quinoa flakes to your rice porridge.
• Use corn on the cob or canned corn rather than potato with meals.
• Look for roasted chickpeas — they’re great for snacking and now come in spicy flavours as well as plain.

If you want to find out more about the GI value of other foods, you can try the University of Sydney website at www.glycemicindex.com where you can key in a particular food and find its GI. Make sure you get the right website; some crazy ones are out there that are highly inaccurate. You can find other helpful information on www.gisymbol.com. Other countries may measure GI differently to Australia.

Avoiding Nutritional Pitfalls on the Gluten-Free Diet

People often ask whether nutritional deficiencies arise as a result of being gluten-free. Recent research by Australian dietitian Dr Sue Shepherd has found that the food consumed by most people on a gluten-free diet isn’t nutritionally adequate. Some of the deficits occur because people tend to eat less bread than those not on a gluten-free diet. Bread made from wheat is fortified with thiamin by law, but this doesn’t apply to gluten-free bread. Wheat bread (but not gluten-free bread) is also fortified with folate and iodine.

Dr Shepherd’s research found that, after one year on a gluten-free diet, women had inadequate levels of thiamin, folate, magnesium, calcium, vitamin A and iron. Men were found to be lacking in thiamin, folate, magnesium, calcium and zinc. Fibre levels were also not adequate.

With a well-balanced diet, making up for the deficits common among people eating gluten-free isn’t hard:

• Fibre: The recommended intake of fibre for adults is 25 grams per day for women and 30 grams per day for men. See the following section for reasons fibre is important and ideas on how to increase fibre in your diet.
• Thiamin (vitamin B1): This is important for the functioning of your heart, muscles and nervous system. It’s found in whole grains, pork, offal, eggs and legumes.
• Folate: This is essential for the manufacture of new cells, including blood cells. It’s found in leafy green vegetables like spinach, kale, Asian greens, broccoli as well as citrus fruits and legumes.
• Magnesium: This helps the body produce energy and is important for healthy teeth and bones as well as heart, muscle and kidney function. You can get magnesium from leafy green vegetables, whole grains and nuts.
• Calcium: This is important not only for healthy bones and teeth, but also for muscle and heart functioning as well as the regulation of hormones. Dairy food is the best source of calcium but you can also get it from leafy green vegetables, nuts, and canned fish such as sardines and salmon that contain bones.
• Vitamin A: This is essential for good vision in low light as well as healthy skin, teeth and bones. It is found in eggs, meat, fortified milk, cheese cream and offal. The body can also make vitamin A from the carotenoids found in red, orange and yellow vegetables and fruit, like carrots, pumpkin, sweet potato, rock melon and apricots, as well as leafy green vegetables.
• Iron: This is important in transporting oxygen around the body in red blood cells. Good sources of iron include meat, liver, egg yolk, legumes, whole grains and dried fruit.
• Zinc: This is important for immune functioning, reproduction, blood clotting and hormone regulation. Good sources of zinc include oysters and shellfish, red meat and chicken, fish and cheese. Other sources include legumes, whole grains, seeds and leafy green vegetables.

A gluten-free diet that’s mostly gluten-free ‘replacement’ foods like breads, pizzas, pastas, biscuits and cakes, with vegetables limited to potatoes and the tomatoes in the pasta sauce, won’t provide the minerals and fibre your body needs for healthy functioning.

If you’re concerned that you may not be getting all the nutrients you need, make an appointment to see an Accredited Practising Dietitian (APD) with experience in coeliac disease. An APD can provide you with information on eating a balanced gluten-free diet that’s tailored to your particular needs and preferences. To find an APD in your area, contact the Dietitians Association of Australia (DAA) at www.daa.asn.au.

Getting the fibre you need on a gluten-free diet

Fibre is important for many reasons. The grains you can’t eat anymore were important sources of fibre, so it’s essential to find substitutes. These three types of fibre act in different ways:

• Soluble fibre: Removes cholesterol from the body, helps with satiety (keeping you satisfied) and helps stabilise your blood glucose levels. Soluble fibres include fruits, vegetables, legumes, bran, rice, soy grits and psyllium.
• Insoluble fibre: Provides bulk and speeds the movement of material through the bowel — important for preventing constipation and lowering your risk of bowel cancer. Foods in this category include fruit and vegetable skins, flaxseed, rice bran, nuts, seeds and brown rice.
• Resistant starch: Even though this is not traditionally seen as fibre it acts in a similar way, passing through the large bowel undigested. It may help to protect against colon cancer, stabilise blood glucose levels, lower cholesterol and keep you feeling fuller for longer. These starches include legumes, unripe banana, grains and seeds, cooked and cooled potato and cooked and cooled rice.

Fruits have almost twice as much fibre as whole grains and non-starchy vegetables have about eight times more fibre. To maximise your fill of fibre, be sure to eat the peel, when it’s edible.

Some people suffer from flatulence, cramps and even diarrhoea when they try to increase their fibre intake. If you need more fibre, introduce it gradually — be kind to your guts and you’ll avoid a nasty payback!

Try these tips if you need to increase your fibre intake:

• Try brown rice instead of white.
• Add rice bran, psyllium husks, linseed, quinoa flakes or LSA to your breakfast cereal.
• Choose a gluten-free bread with more fibre (gluten-free high fibre or multigrain breads).
• If you bake your own bread, add psyllium, rice bran or seeds.
• Eat whole, unpeeled fruit and vegetables.
• Try dried fruits and nuts as a snack.
• Include more legumes (kidney beans, lentils, baked beans, soybeans, chickpeas) on a daily basis.
• Add rice bran to the mix when baking.

To keep your internal plumbing in beautiful working order, drink plenty of water throughout the day and make sure you get regular exercise. Both are essential factors in keeping your system running smoothly.

Packing a punch with protein

Protein is another important element in diet. Experts estimate that about half the dry weight of the human body is made up of protein — the brain cells, muscle, skin, hair and nails are largely protein based. The protein you eat helps you to make new protein in the body. It’s also converted into hormones or used as a source of energy.

Although your body likes carbohydrates as the best source of fuel, about 10 per cent of your energy comes from protein. Contrary to popular opinion, people who exercise a great deal don’t need additional protein.

Foods containing protein are mainly the animal-derived foods like chicken, beef, lamb, pork, fish, dairy products and eggs. Other sources include legumes, seeds and nuts. Getting enough protein isn’t usually an issue for people in the Western world. However, if you constantly feel hungry on a gluten-free diet, eating more protein helps you feel more satisfied. Eating more low-GI foods will also help (have another look at ‘Good Carbs, Bad Carbs: Tuning In to the Glycaemic Index and Glycaemic Load’, earlier in this chapter).

Try to include a source of protein at each meal to help you feel fuller for longer. If you’re constantly hungry, introducing more of the low-GI choices should keep you satisfied and less likely to raid the biscuit jar between meals.

Winning the Weight Wars

A gluten-free diet isn’t a magic bullet but it can certainly help with weight issues in several ways. Sometimes people have been unwell for a long period before diagnosis and they’re so underweight a sneeze can blow them clean across the room. Others have been unwell but have still packed on the weight regardless and constantly struggle to lose it. We cover both ends of the spectrum in this section.

Losing weight on the gluten-free diet

If you’re fighting the battle of the bulge, you’re obviously not alone. In today’s world of globesity, whether you’re part of the Boomer Generation or Generation Y doesn’t matter: The majority of the population, in the developed world at least, regardless of age, is Generation XL.

The good news is that the gluten-free diet may help with both losing weight and maintaining a healthy weight. Unfortunately, gorging on gluten-free double-choc biscuits isn’t part of this weight-loss plan; the key to weight control is that you adhere to a high-protein, low-glycaemic-load, nutrient-dense diet (refer to the section ‘Good Carbs, Bad Carbs: Tuning In to the Glycaemic Index and Glycaemic Load’, earlier in this chapter).

When you’re counting carbs, you can easily see why you get more food for your carb count when you eat fruits and veggies than when you eat gluten. The average carbohydrate content of fruits is about 13 per cent. For non-starchy vegetables, it’s about 4 per cent and it’s zero for lean meats, fish and seafood. The carbohydrate content of many cereal grains, though, averages a whopping 72 per cent.

Your blood-sugar levels affect hunger and cravings. Gluten-free foods like bread, crackers, biscuits and crisps are enemy number one. Those foods cause a rapid rise in blood glucose, which sends signals to your body to produce insulin.

Insulin does its job and brings down your blood-sugar level, but it brings it so low that you get hungry and in fact crave more of the same kind of food that made it go up in the first place. Insulin also tells your body to store fat.

High insulin levels also inhibit the release of serotonin, a neurotransmitter in the brain that tells the body to stop eating.

Making too much insulin causes you to store fat and stimulates the liver to make more cholesterol, increasing blood cholesterol levels. Excess insulin also inhibits the breakdown of fat that’s already stored in your body, so even if you’re working out like a fiend, losing those extra kilos is that much harder to achieve.

Gaining weight when you need to

Two groups of people need to increase weight on a gluten-free diet:

• Some people who have suffered malabsorption as a result of coeliac disease or gluten intolerance are underweight and actually need to pack on the kilos. When these people go gluten-free, their gut usually heals quickly and they begin to absorb nutrients more effectively. Their weight usually normalises quickly as a result of being gluten-free.
• Sometimes when people go gluten-free, they cut out things like bread and butter or toast. If you’re already underweight, you may need to eat extra carbohydrate foods for a time until you’ve reached a healthier weight. Once you’ve reached the recommended weight for your height and build you can get yourself on to a more balanced diet (see your GP or dietitian for information on your recommended weight).

Don’t feel you have to go without on a gluten-free diet. You may just need to do the rounds of a couple of different supermarkets to stock up on all the gluten-free alternatives you need.

Keeping on Top of Nutrition as You Get Older

As you get older you may find you have less of an appetite and preparing nutritious meals takes more of an effort. Sometimes it’s tempting to ‘make do’ with a piece of toast and a cup of tea, particularly if you no longer have a family to feed. But eating well is really important if you want to have strong defences against disease and enjoy life to the full. Although your total intake may be lower, you still need those all-important vitamins and minerals, in some cases, more than ever.

Keep in mind the following as you get older:

• Your iron intake is important to prevent anaemia. Make sure you include natural sources of iron — for example, red meat, offal, oily fish such as salmon, eggs and legumes such as lentils and beans. Foods that are iron-fortified, including some gluten-free breakfast cereals, are useful too. Eating foods containing vitamin C will help you absorb iron. Drinking tea and coffee at meals can impair your ability to absorb iron so limit most of your tea and coffee drinking to between meals if you can.
• You need 25 per cent more protein than younger adults to maintain strong, healthy muscle mass, bone health and improve blood pressure. Lean meat, chicken, eggs, fish, low-fat dairy foods, legumes, nuts and seeds are good sources of protein.
• Getting enough calcium and vitamin D remains important to prevent osteoporosis and keep building your bone density. Even a small increase in bone density makes your bones less likely to fracture if you fall over. About 50 per cent of older coeliacs are at risk of osteoporosis and this increases to 75 per cent for those who don’t stick to their gluten-free diet. The best sources of calcium are low-fat dairy foods including milk, yoghurt and cheese. If you don’t drink milk, choose a milk alternative that is calcium enriched. As you age, your capacity to produce vitamin D declines. Try to get unprotected exposure to sunshine on your face, arms and hands for 10 to 12 minutes, several times a week in summer months and one or two hours each week in winter. During the summer months, this should be done before 10 am or after 3 pm when the UV level is lower.
• Fibre is important to prevent constipation and diverticular disease. Drink plenty of fluids and include fruit, vegetables, legumes and if you can, nuts and seeds. (Refer to the section ‘Getting the fibre you need on a gluten-free diet’, earlier in this chapter, for more.)
• Ensuring you drink enough water is important because your sensation of thirst declines with increasing age so you may not recognise when you’re thirsty. That means it’s easy to become dehydrated in hot weather and this can lead to confusion and drowsiness. Try to have lots of liquid during the day, especially in summer.
• Regular exercise keeps your muscles strong, improves balance and helps prevent falls, helping you stay independent for longer.

If you’re finding it hard to cook nutritious meals for yourself, you can have meals delivered to your home, through Meals on Wheels or home delivery companies. Almost all of these offer gluten-free alternatives. See www.mealsonwheels.org.au for more information.

If you need to go to hospital, if possible, contact the hospital dietitian before you go in. Take some bread and crackers to ensure you have something to eat on the first day. Hospitals do provide gluten-free meals, but keep in mind that the kitchen staff putting the food on to your tray may not understand about gluten and may pop additional items on your tray, so be vigilant, or ask a family member or friend to monitor what you eat to avoid mistakes. Many hospitals now have a refrigerator where patients can store extra food — this is a boon for coeliacs.

Aged care facilities are required to provide for residents’ special needs, but the provision of gluten-free meals varies widely. Don’t be afraid to ask if you’re not happy. Busy kitchen staff may remember to remove the gluten components of a meal, but they often don’t think to replace them with something you can eat. When your options in life have narrowed down, food becomes an increasing source of comfort and pleasure and you are just as entitled to appetising meals as any other resident! Coeliac Australia and your state office have resources available to help educate caterers and carers about the provision of a gluten-free diet — see www.coeliac.org.au for more information.

Reviewing the Principles of Good Nutrition

We cover a lot of ground in this chapter — the glycaemic index, glycaemic load, getting the balance right and eating a varied diet. It all boils down to this simple approach for a healthier gluten-free lifestyle:

• Keep it gluten-free always. That comes first and foremost.
• Enjoy a wide range of nutritious foods.
• Eat smaller portions, but regularly (snacks are very important).
• Choose low-GI, high-fibre carbohydrate foods.
• Include plenty of whole, fresh fruit, vegetables and legumes.
• Include protein at each meal (including protein rich snacks) — especially lean meat and low fat dairy.

Good food is food that goes bad quickly. That means fresh produce and other foods without many preservatives. Always think about the quality and ‘nutrient density’ of the food you’re eating — if a food contains a lot of kilojoules, fats and sugars but not many nutrients, it’s probably not worth eating.