Coeliac Link, Autumn 2022 by Coeliac New Zealand

O F F I CI A L M AGAZINE OF COELIAC NEW ZEAL AN D

| Gluten-free living

$ 9. 5 0

AUTUMN 2022

CYCLE AOTEAROA FUNDRAISER UNDERDIAGNOSIS IN OLDER PATIENTS

MEET WINE INDUSTRY CHAMPION SOPHIE PARKERTHOMSON

READING FOOD LABELS

THRIVING – LIVING YOUR

BlifeESTwith COELIAC DISEASE

NOTE ____

This is a

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of the official CNZ magazine –

VERSION

Coeliac Link

Coeliac Dedicated Awareness GF cafes Week* 2020 JuneWellness 6-12 2022 Calendar * Gluten* New Free Recipes gluten-free * Newproducts GF products

AU TU M N

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O U R V I S I O N | That people with coeliac disease live healthy lives every day ____

Contact Coeliac New Zealand PO Box 9734 Newmarket, Auckland 1149 Email admin@coeliac.org.nz Website coeliac.org.nz

F E AT UR E S

Towards Bluff .............................. 12

Thriving not just surviving Tour Aotearoa.

ID K G IN T R O P P

Elderly onset coeliac disease �� 20

The importance of early detection and treatment. Lactose intolerance....................... 22 R

Navigating lactose intolerance on a coeliac safe gluten free diet.

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Medical Advisory Panel Professor Andrew Day MB CHB MD FRACP AGAF; Dr Kamran Rostami MP PhD Consultant Physician and Gastroenterologist; Dr Kristin Kenrick Senior Lecturer University of Otago; Professor Clare Wall, University of Auckland Faculty of Medical and Health Sciences; Dr Jonathan Bishop MB ChB MRCPCH CCT (UK) Paeds FRACP Paediatric Gastroenterologist and Hepatologist; Dr Richard H Steele MbChb FRCPA FRACP Clinical Immunologist and Immunopathologist; and New Zealand Registered Dietitian’s: Anna Richards, Sylvia North and Margaret Thorsen. Honorary Patron Dr Simon Chin MBChB Dip Obst DCH 1985 FRACP Patron Professor Bob Anderson MBChB, BMedSc, PhD FRACP

Board Brett Thorburn, Kirsty Vercoe, Corinne Cameron, Rosie Jerram, Max Smitheram, Jenny Kuttel, Gary Peacham and Ben Grant.

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Editor and advertising enquiries Dana Alexander +64 9 414 7467 dana@coeliac.org.nz ____

Art Director Sue Pepper marketing@coeliac.org.nz

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Summer issue deadlines Booking 30 September Material deadline 17 October Magazine in mailbox 14 November

Coeliac disease in children............ 24

Enjoy your favourite bickies

2022

Supporting children. Meet wine industry champion Sophie Parker-Thomson................ 26

Refusing to swallow limitations in life or career.

News ....................................................... 6 Dining Out Programme ........................... 7 From the regions ...................................... 9 Thumbs up ............................................11

Food allergen labelling.................. 32

What’s behind the label?

R EG IO N AL

D IR EC TORY

�� 41

F O O D

Coeliac New Zealand Incorporated is a registered charity. Our Charities Commission Registration Number is CC27810. Disclaimer: All reasonable attempts are made to ensure the accuracy of the content of this magazine. The contents are not independently checked for medical accuracy and are not necessarily endorsed by Coeliac New Zealand. We welcome submissions; however, please note that articles may be edited.

GF meal inspiration ........................ 30 GF bites and delights ...................... 33 Peace and Comfort Kitchen recipes ........................................................ 35 R EG UL A R S

A note from the General Manager ��4 A note from the Editor .......................5

30 coeliac.org.nz | 3

Regulars / C N Z B O A R D

DA N A’ S

MESSAGE from the GENERAL MANAGER T E N A KOTO U

MEET THE

TEAM

C N Z B O A R D (Clockwise from top) Brett Thorburn (Chair), Corinne Cameron, Jenny Kuttel, Gary Peacham, Max Smitheram Rosie Jerram, and Kirsty Vercoe (Vice-chair). ____

C N Z S TA F F Wendy Bremner (General Manager) Dana Alexander (Sales and Marketing Manager) Lisa Jury (Health Promotion Manager) Fred Tan (Membership and Accounts).

4 | Autumn 2022 Coeliac Link

– hello everyone, our magazine is packed full of fantastic articles, so it’s time to find a cozy nook, grab a cuppa and settle down to enjoy this great read from cover to cover! Our conference in November seems almost like a distant memory now, but what a fabulous memory it is! The agenda was designed to be a mix of medical and personal sessions. Transitioning to a virtual event platform was new for us all but it worked superbly and if you didn’t join us, you missed something very special. We plan to host our next conference in 2023 on a virtual event platform too. A huge thank you to the members of the medical advisory panel who made such a big contribution to the day! What is fresh in my mind at time of writing is the amazing achievement by Maximus Smitheram and Andrew Trevelyan who completed the Tour Aotearoa in March and April this year. A magnificent effort cycling over 3,000 km from one end of the country to the other. They started at Cape Reinga on March 1 and travelled through the glorious land of Aotearoa across both islands through idyllic scenery and allowing us to join them on their journey via the tracking app. They decided this would be a great opportunity to raise awareness about coeliac disease and to also raise funds. Many thanks to those of you who supported them with donations via the Givealittle event page and by taking on the cycle for coeliac challenge and getting pledges for your own challenges. There’s still time to register yourself or a team, so why not get on your bike at home, at school, at the gym, on the track, on the road wherever and whenever you like and cycle as many kms as you can. You register and then get pledges and we add up all the kms between now and coeliac

awareness week in June to see if we can match what Andrew and Max have done. Email healthpromotion@coeliac.org.nz for registration and pledge forms or more info. Thank you to everyone who completed our member survey this will really help us with our strategic planning day on May 28. We will present the next strategic plan 2023-2026 at our AGM on Saturday, June 11 during Coeliac Awareness Week. Our theme this year for Coeliac Awareness Week is Thriving: Living Your Best Coeliac Life. This is about not just living with coeliac disease but living your best life. Please put a ring around the date in your calendar now so you can join us virtually at the AGM. Why is it so important you become a member of CNZ and renew your annual subscriptions? The short answer is: When you are there for us, we can be there for you! For many people with CD and their whānau, CNZ is one of the only places that understands their condition and helps them to not feel alone in managing this lifelong condition. We advocate for people with coeliac disease and the more members we have the louder our voice is. All ages are affected, particularly children, their parents and whānau. As well as the physical challenges of coeliac disease, mental health issues caused by the lack of opportunities for inclusion in social activities, combined with the feeling of being different from others requires attention. ____

Hope you have a warm and safe winter and all the very best for the year ahead. WENDY BREMNER General Manager

LIVE YOUR LIFE WELL S RESTRICTIONS

ease from another year of living with COVID-19 it can be difficult imagining a return to life as it once was, as many of our normal routines have been upended. Oftentimes it can be reassuring to know that you are not alone in times like these. This is particularly so if you are newly diagnosed with coeliac disease or if you are feeling below par and just getting through the day sometimes feels enough.

Whether you are seeking new information and skills to adapt to the gluten free diet or are looking for places to shop and eat out safely or need medical or dietary advice to get your health and wellbeing back on track – Coeliac New Zealand (CNZ) is here to support you. Being fit and eating well is really only one part of the equation. Getting the support and finding ‘your people’ and ‘your tribe’ is important to varying degrees for each of us – so lean into CNZ and get involved in

M ESSAG E

/ Regulars

making our community stronger. In this issue of Coeliac Link, we share further stories of people’s courage and commitment to live their best life with coeliac disease. We also provide tools and advice to help you improve your overall wellness so you can stay mentally and physically healthy. A special thank you to our Coeliac Awareness Week (June 6-12) supporters – including Lee Kum Kee, Kellogg’s, Bakels, Vogels, FreshLife, Sunrice and Nature Valley. With their support and the media relations promotion from GoodePR we look forward to delivering another exciting week of activities and awareness raising. Look out for CAW updates in your monthly newsletters or follow us on: facebook.com/ coeliac.new.zealand ____

Ng mihi.

Dana

DANA ALEXANDER Editor, Coeliac Link

News / F R O M T H E O F F I C E

E VERY

much value the support you give to us by being a member of Coeliac New Zealand and by continuing to renew your subscriptions annually you enable us to continue to work on the behalf of people with coeliac disease. When you are there for us, we can be there for you! We are running a special offer this Coeliac Awareness Week, if you introduce a friend to become a member, they get the joining fee waived (usually $35 joining fee + $57 subscription) and you go in the draw for a hamper.

D I N I N G

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Coeliac New Zealand would also like to extend a warm welcome to Gary Peacham and Ben Grant who joined as a members of the Coeliac New Zealand Board in April.

INTERESTED IN BECOMING A MEMBER? ____

E . admin@coeliac.org.nz T . 09

414 7467

thank you funders!

THANKS to Community Organisation Grants Scheme (COGS), The NZ National Lotteries Community Fund, The Lion Foundation, Pub Charity, Aotearoa Gaming Trust (formerly Southern Trust) without who’s support we would not be able to deliver educational tools to increase awareness of the disease, or provide funds to improve the everyday existence for people committed to being ‘gluten free for life’.

C ROS S E D G R A I N LO G O U P DAT E CNZ began the process to update our Crossed Grain Logo (CGL) Registered Trademark in mid-2020 and the process was completed in late 2021 which means that all products that carry the Crossed Grain Logo must also make a GLUTEN FREE claim and can no longer be labelled as meeting the CODEX Alimentarius standard of <20ppm or 20 mg/kg of gluten). S A result, Ceres Organics reviewed all products carrying the CGL and based on this review have discontinued its’ use on a small number of products and are in the process of transitioning their packaging to remove any reference to both the CGL and relating claims. Ceres Organics would like to assure its customers that despite any planned changes relating to the use of this certification by Ceres Organics, all products displaying the Crossed Grain logo, including those accompanied by our less than 20 ppm disclaimer, are safe for consumption by the coeliac community and gluten intolerant and pose no apparent health risk. Ceres Organics continue to monitor supplier data/history and routinely check gluten content in these products to be compliant. To date all tests have validated there is in fact no detectable gluten, thereby meeting the requirements for a gluten-free claim accordingly to the FSANZ Code. If you

6 | Autumn 2022 Coeliac Link

have any concerns, you can contact us on info@ceres.co.nz. Some Ceres Organics products are currently still available in some outlets in the old Ceres Organic packaging that displays a CGL and refers to CODEX Alimentarius standard of <20ppm. ____

The global COVID pandemic has significantly impacted both sales and supply chain, including the supply of bulk materials and packaging, thereby

delaying Ceres Organics projected transition to new packaging on a small number of products. This means consumers may find products on shelf with outdated packaging for longer than anticipated. While they are working through options to speed up this process, Ceres Organics are seeking to balance the significant waste and cost due to product and packaging write offs if they transition sooner. Contact Ceres customers services if you have questions.

A DVO C AT I N G fo r M E M B E R S Recently we had several queries about a government funded paracetamol medicine, Pacimol that had 'nonsensitising gluten' included on the label. We managed to get clarification around the ingredients by contacting the sponsor who provided the declarations concerning the status of the pregelled starch derived from corn. We also suggested they consider renaming non-sensitising gluten to gluten free starch on their packaging so there was less confusion.

If you ever have any doubts about the safety of your medicines, your first port of call is your GP or pharmacist. If they are unable to satisfy your concerns, contact Medsafe: medsafe.govt.nz and look up the medicine on their website which gives you the data sheets and consumer medicine information. If you still are unsure about whether the list of excipients are gluten free you can contact the sponsor who will be listed on the data sheet and get them to provide you reassurance directly.

OUT

P ROG R AM M E

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SOUTHERN CROSS HOSPITAL GOES COELIAC SAFE Southern Cross North Harbour Hospital, on Auckland’s North Shore, has become the SECOND HOSPITAL in the country to go COELIAC SAFE, thanks to Coeliac New Zealand’s DINING OUT PROGRAMME of training and accreditation. OMPASS

Group NZ runs the kitchen and café, which is located on-site at the independent private hospital, and is now offering certified coeliac safe gluten free meals for patients. “We have always catered for allergens but wanted to ensure our coeliac patients can enjoy a meal without worrying if it is safe or not,” says Yvette Holloway, Compass Group’s Unit Operations Manager for Healthcare. “As a manager it is important to me that all patients have a pleasant dining experience, which includes ensuring gluten free food is produced and served safely to coeliac patients and customers. We can only achieve this if all staff are well trained and informed,” Holloway says. The Dining out Programme (DOP) approved menu features delicious gluten free versions of classic meals such as beef lasagne and cottage pie, as well as a delicious selection of wraps, sandwiches and a specially

crafted ploughman’s platter. Thirty-five staff from Southern Cross North Harbour Hospital and Compass Group NZ received training from Coeliac New Zealand (CNZ), including healthcare assistants, chefs, café assistants, kitchen assistants and dishwashers. The training included online DoP training modules with video clips and information, followed by a test to ensure the staff gained the knowledge required to manage coeliac disease in the hospital. “We had very good feedback on the training programme from our staff, who enjoyed it and found it very informative,” Holloway says. To become DOP accredited, new equipment was brought into the hospital specifically to prepare meals for coeliac patients, including a toaster, panini press, pots, pans, cutlery and utensils. A separate area was also created in the kitchen for the sole purpose of coeliac preparation and specific spaces were allocated in the fridge for storage. To ensure gluten free surfaces are

as safe as possible, the preparation surfaces are also swabbed with GlutenToxpro before any meals are prepared, to remove any risk of cross-contamination. The feedback on the gluten free meals has been fantastic so far, as found by a recent survey at Southern Cross North Harbour Hospital, with one patient saying “it was the best meal I’ve ever had in a hospital”.

THE FEEDBACK ON THE GLUTEN FREE MEALS HAS BEEN FANTASTI C S O FAR... O N E PATI E NT EVEN SAID IT WAS THE BEST MEAL THEY’VE EVER HAD I N H O S P ITAL.

CNZ is thrilled to welcome Southern Cross Healthcare as the newest partner of the DOP, and is looking forward to continuing to offer support to provide coeliac safe meals for patients, staff and visitors at its North Harbour hospital. ____

healthcare.southerncross.co.nz

coeliac.org.nz || 7 7 coeliac.org.nz

News / D I N I N G O U T P R O G R A M M E

COELIAC SAFE GF GUIDELINES

Not just a lifestyle choice or a fad! Coeliac disease affects 1 in 70 New Zealanders. For those with a diagnosis of coeliac disease the future is gluten free for life. Failure to do so can cause potentially serious consequences. Key tips for providing coeliac safe food practice Every request for a gluten free meal must follow strict protocols to ensure the ingredients are gluten free and that there is no risk of cross contamination. The food industry has more gluten free options available to their kitchen however foods labelled gluten free are required to meet strict food

H OS P I TA L I T Y I N DU S T RY

EVERY REQUEST FOR A GLUTEN FREE MEAL MUST FOLLOW STRICT PROTOCOLS TO ENSURE THE INGREDIENTS ARE G LUTE N FR EE A N D TH AT TH E R E I S N O R I S K O F C R O S S C O NTA M I N ATI O N

ISA JURY

Health Promotion Manager for CNZ and Karen Gough Regional Manager for Auditing Solutions presented together at the New Zealand Institute Environmental Health (NZIEH) 2022 Conference in April. In this presentation they have dived beneath the label of coeliac disease and discovered why gluten free for life is so important for the hospitality industry to comply. They drilled down into the practical application of the food standard, common errors, and questions to ask when carrying out an audit.

FOR THE

standards Australia New Zealand (FSANZ) and have: • No detectable gluten • No oats/products made from oats • No cereals containing gluten ’gluten that have been malted, or products of such cereals.

• Regularly self-audit (3 monthly) all ingredients for allergen content • Conduct a gluten free risk assessment of its operation in terms of risk of cross contamination in the environment (e.g., heavily floured work areas, shared equipment etc.).

The food standard considers gluten and the foods from which it is derived (wheat, rye, barley, oats and spelt) as allergens.

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For more information, support, education, resources and accreditation contact dop@coeliac.org.nz

Tips for keeping your coeliac and gluten free customers informed and safe • The presence of these gluten containing allergens must be declared in connection with the display of the food or be available to the customer upon request Declare the gluten free items on your menus and menu boards • Maintain up-to-date allergen matrix/details for all your menu items and available upon customer request

Join the DINING OUT PROGRAMME

so diners will know they can trust your food to be truly gluten free Register today! coeliac.org.nz

Helping Kiwis with coeliac disease and gluten sensitivity eat gluten free, confidently.

TEL 09 414 7467 EMAIL dop@coeliac.org.nz

TO B I O P SY OR NOT TO B I O P SY ? CCORDING

to Mahatma Gandhi, “A correct diagnosis is three-fourths the remedy”. Whilst this may be something of an overstatement, the importance of medical diagnosis is clear. It is recognised that an accurate and timely diagnosis provides an individual with the best opportunity for a positive health outcome.1 In contrast, a diagnostic error may result in the individual being denied prompt, effective treatment or even being offered inappropriate and potentially dangerous therapies. Diagnosis is of particular importance in a condition like coeliac disease, which is life-long; has profound health effects; and for which treatment has huge lifestyle implications. The positive benefits of an early and correct diagnosis are especially important for children with coeliac disease in order to optimise growth and development. In contrast, the effects of an incorrect diagnosis are keenly felt in this group, as they may experience longstanding unpleasant symptoms or receive inappropriate and ineffective treatment. The diagnosis of coeliac disease has evolved over the decades since a gluten-sensitive enteropathy was first recognised by Dutch Paediatrician, William Dicke in 1950.2 Key to this evolution has been the development of increasingly accurate blood tests to identify the immunological features of coeliac disease. The original antigliaden antibody tests which had relatively poor accuracy have been superseded by far more sophisticated

and reliable tests, including the tissue transglutaminase and endomysial antibody tests. As well as improvements in blood tests, there has been an increased awareness and understanding that coeliac disease is a complex, immunemediated disorder with effects on many bodily organs and functions, rather than being a disease which only affects the intestine. This recognition has brought into focus the question as to whether a diagnosis which rests solely on intestinal biopsy is accurate, appropriate and fit for purpose for all individuals with coeliac disease, some of whom may have few, if any, gastroenterological symptoms. Furthermore, a biopsy-based diagnosis requires the individual to undergo an endoscopy. Although endoscopy is generally extremely safe and straightforward, it is an invasive procedure which is not wholly without risk or inconvenience to the individual. This is of especial note for children who usually undergo endoscopy as a hospital inpatient under general anaesthesia. Endoscopy is also a relatively costly procedure for which there may be limitations in availability and accessibility related to health service constraints. The status of intestinal biopsy as the “Gold Standard” (best and most accurate) diagnostic test for coeliac disease has also been questioned. Although it remains an important tool in diagnosis, correct diagnosis may be hampered by poor biopsy technique; insufficient biopsies; and variations in reporting of biopsy findings.3 It is also recognised that coeliac disease may cause patchy injury to the intestine, which may result in missed diagnoses

if biopsies are not taken from the affected areas.4 Although biopsy-free diagnosis has been adopted successfully in the Auckland area, it has yet to be rolled out nationwide. This is an important next step to consider, in order to provide effective, timely and equitable care for all of our tamariki. However, any nationwide roll-out needs to be carried out with due care and attention. The Auckland study investigated the diagnostic accuracy of tests used in local laboratories but did not look more widely at tests used around the country. Although there is local expertise in use and interpretation of these tests, not all laboratories offer precisely the same type and range of tests. Discussions are on-going to explore whether a consistency of testing approach could be achieved across laboratories to permit consideration of biopsy-free diagnosis for children with coeliac disease across New Zealand. CL ____

Read the full article here (including references)

D R J O N AT H O N B I S H O P

completed undergraduate and postgraduate paediatric gastroenterology training in the UK before undertaking a six-month Fellow post in Starship Children’s Hospital in 2007. He returned to the UK to work as a consultant post in the Royal Hospital for Sick Children, Glasgow between 2008 and 2011 before the lure of the Southern hemisphere proved too strong and he returned to Starship as a Consultant Paediatric Gastroenterologist/ Hepatologist. His professional interests include coeliac disease, inflammatory bowel disease and cystic fibrosis liver disease and is a member of the Coeliac New Zealand Medical Advisory Panel.

coeliac.org.nz | 9

F ROM

TH E

R EG ION S

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T H U M B S U P G F R ECO M M E N DAT I O N S ! If you are out and about exploring Aotearoa, you may like to try out the following recommendations for gluten free cafes and restaurants that Max and Andrew visited on their cycle tour (turn the page for their story). Please take the ordinary precautions to check the gluten-free menu choices are right for you! Villa Nine in Te Aroha has a great range of GF cakes and snacks to dine in or takeaway. They also stock a wide range of organic and GF products, dietary supplements, Malcolm Harker products and lots more.facebook.com/villaninecoffee

THRIVING

Munch Café in Palmerston North is 100% coeliac safe and offers menu options for vegan, keto and dairy free. The global street food menu is sure to surprise and delight the coeliac in your family. facebook.com/munchpalmy

L i v i n g Yo u r B E S T COELIAC LIFE

An estimated 100,000 kiwis live with coeliac disease and need to live 100% gluten free. If you react to gluten talk to a health professional and get tested for coeliac disease? coeliac.org.nz

Situated in the wine village of Martinborough, Medici Café offers delicious food using the best seasonal ingredients the Wairarapa has to offer – and will make coeliac safe meal options if you ask the kitchen. Their food style is fresh and honest with a twist of innovation. Locally made ‘The Peoples Coffee’ is pretty good too! facebook.com/cafemedici1

Coeliac AWARENESS WEEK

The Interislander is New Zealand's original Cook Strait ferry, which has been connecting the North and South Island together for nearly 60 years! Along with the breath-taking views,

JUNE 6-12 2022 Do you have anyone you want to give a T H U M B S U P to? ____

Please email Fred at: admin@coeliac.org.nz

CAW SUPPORTERS.

CNZ FUNDING PARTNERS.

coeliac.org.nz

Community Organisation Grants Scheme, Pub Charity, Aotearoa Gaming Trust, Lotteries Grant Board, The Lion Foundation

Support to be coeliac safe and gluten free for life.

the gluten free food and premium lounges are a welcome respite for all coeliac travellers.

deep fryer and an understanding about preventing cross contamination. eriksfishandchips.co.nz

With a vision to see people connect and become better educated through food and nutrition so they can live life to the absolute fullest – you can see why The Kitchen is a popular destination for locals and travellers alike. They also cater for special dietary requirements. ktchn.co.nz

The Grill Restaurant Invercargill was a great place to host a member breakfast with many gluten free options. The staff were attentive and communicated our needs to the chef. facebook.com/thegrilleinvercargill

East St Eats takeaway and deli make vegetarian food that’s fresh and hearty – and served with a favourite local GF craft beer or cider. A vibrant and community-oriented space also available for event hire. facebook.com/eaststeats At the entrance to the Abel Tasman National Park, you will find the menu at Hooked on Marahau has heaps of GF choices, including baked goods and they also have a separate fat fryer. hookedonmarahau.com

Greymouth's newest gastropub Sevenpenny is located in the town square and serves coeliac safe gluten free meals. With friendly, knowledgeable staff and a great East St Eats atmosphere this was a welcome respite for Max after eating only dehydrated GF food for much of the West Coast. sevenpenny.co.nz

The Saucy Chef that adjoins the Northern Tavern, Invercargill provides a delicious and comprehensive GF à la carte menu with specialty fish, Hereford beef dishes, and the vegetarian delight. thesaucychef.co.nz We were fortunate to support our board member Max Smitheram with the Tour Aotearoa, Cycle for Coeliac challenge to cycle the length of NZ, 3,000km. The health promotion manager wrote his training programme, and our volunteers (on route) dropped off care packs to support him on his journey. ____

A special thank you to The Gluten Free Shop who provided coeliac safe care packs filled with nutritious, naturally gluten free whole foods such as dry nuts and fruit from Ceres Organics, as well as some of Max and Andrew’s favourite gluten free products including chocolate from Natural Bennetto and Pure Delish bars and much, much more. glutenfreeshop.co.nz

A Kiwi tradition Erik’s Fish and Chips Queenstown sources and provides local NZ ingredients from potatoes grown in Canterbury to fish from Dunedin, delivered daily to their location in Queenstown. They provide gluten free options using a separate

coeliac.org.nz | 11

Feature / F U N D R A I S I N G

HRIVING

TOWARDS

LUFF

A desire for a CHALLENGE and PERSONAL GROWTH was the catalyst that raised approximately $5,000 for Coeliac New Zealand.

not just surviving. That was the plan to take on Tour Aotearoa a cycle tour from Cape Reinga to Bluff on cycle trails, tracks, beaches, and roads. I was needing something to look forward to and essentially a break from surviving. I think I am something called an active relaxer. Sitting on a beach or a deck doesn’t work for me. I needed a chance to step out of work and for that matter the sense of confinement and limitation that the COVID-19 lock downs have brought. My friend Andrew surprised me with a phone call – and perhaps an answer. Was I up for Tour Aotearoa? I didn’t hesitate and I didn’t think about. I was unfit, had no bike, no gear, no time, and no experience on a mountain bike. Add to the mix lock downs and supply issues – and oh yeah, I have coeliac disease! Yes, I was keen. Back to my diagnosis I was biopsy diagnosed with coeliac disease in 2007 after a seven year long medical focus on adventure traveller type afflictions finally wore out. Think Montezuma’s revenge and about every cold and flu going. I was later found to be anaemic and that spurred bowel investigation and diagnosis. A brief period of denial was followed by substantial general health improvements. But it felt like a tap had

been turned off. Lucky, I got my health back, not so lucky that I had lost a sense of everyday freedom. I did not really want to be, you know, that person who had to think and act differently – but then coeliac disease gave me no choice. A real pleasure in life for me had been to try any food anywhere, with anyone and anytime. I was not aware how central food and drink were to my sociability. A beer and chips, that was freedom – and I was going to miss it. Motivated to make a change Things are better now than in 2007. I can find a great GF Beer, and there is the Dining Out Programme (DOP). I am into that! You can go to a restaurant and feel safe, and there are chips, at least the Attic Bar and Restaurant in Mission Bay, Auckland where staff are DOP trained and the kitchens are independently audited to be coeliac safe. There are not many DOP accredited places yet, but I hope that this cycle will help raise awareness about the challenges of living coeliac safe and gluten free for life; and CNZ are right behind me on that. I am not ready to give up eating out and trying new cuisines. Although I have the good fortune that friends and family let me choose the venue, I do sometimes fear restaurants and limit dining away from home to just a few that I have come to trust. I have a supportive partner who insists that we keep our kitchen fully gluten free – which is my freedom zone. A mess can be made, and no one gets

hurt. I am relieved that gluten is not a topic of discussion because there isn’t any. So, getting back to the cycle ride and fundraising for a cause. When it comes to social media, I am a novice. So, it’s been a challenge to profile myself and the ride – and in fact my first and second ever posts were on LinkedIn and Facebook. However, as a long-term supporter of CNZ, and having contributed on the Board for numerous years, using this opportunity to fundraise for CNZ was a no brainer. I want to continue to raise awareness about coeliac disease and help make life better and safer for everyone affected. I would also like to use this opportunity to promote the DOP and encourage others to do the same. I am committed to do this ride, and CNZ has got right behind it and Andrew did too, although not himself a coeliac. Andrew, well he’s an enthusiast who likes an adventure and a challenge and likes helping others like us too. As it has turned out, adding the fundand profile-raising element to the journey has taken what seemed to be a relatively solitary pursuit of cycling, to being social. It has been great working with my CNZ colleagues on the project and some of the responses coming through have been inspiring. I am heartened that other people will get onto their bikes along the tour and fundraise alongside us, and perhaps try cycling for the first time – or just be enthused about the adventure like my dad. I have spent time right out of my comfort zone and that has been the best thing of all. CL ____

Donations can be made to CNZ via givealittle.co.nz/event/gfforlife-bikeaotearoa-2021

Max and Andrew take on Tour Aotearoa.

12 | Autumn 2022 Coeliac Link

The fund- and profile-raising element to the journey has taken what seemed to be a relatively solitary pursuit of cycling, to being social. coeliac.org.nz | 13

Feature / M Y C O E L I A C S T O R Y

RIDING HI GH

Former competitive CYCLIST CLAIRE BARRY regains her HEALTH and rediscovers her PASSION for racing.

S A

teenager, I loved to ride. I was a track and road cyclist competing at a national level until I had to give up because I started getting continuously sick. Anaemia at 15. Glandular fever at 16. Bouts of exhaustion, terrible migraines, brain fog, loads of colds. I was finally diagnosed as coeliac in my late 20’s. I have never lost my passion for riding and I’m now competing again.

14 | Autumn 2022 Coeliac Link

A couple of years ago I bought a really nice mountain bike and took ladies’ skills classes, learning better technique and jumps and drops to make the trails more fun. I have met some awesome girls and I feel so much more confident now, riding trails I never thought I would. My partner Jeremey and I live in Christchurch, where I work as a local government administrator. Jeremy has been awesome about my coeliac disease right from the start. When he cooks, he saves all the packages for me to check before I eat. He must have done some sneaky research as

I HAD TO GIVE UP [CYCLING] BECAUSE I STA RTE D G E T TI N G C O N T I N U O U S LY SICK. ANAEMIA AT 15. G L A N D U L A R F E V E R AT 16. B O UTS OF EXHAUSTION, TERRIBLE MIGRAINES, BRAIN FOG, LOADS OF COLDS.

sometimes he surprises me with the things he knows. My mum was diagnosed as a coeliac when I was a teenager but that was never considered part of my family history by my doctors over the years. My sister was diagnosed by blood test a couple of years ago. The year I was diagnosed, with a blood test and endoscopy, I had whooping cough twice and had a whole bunch of awful general symptoms. I had tried eating healthier; Weetbix for breakfast every day, whole grain bread sandwiches for lunch. The healthy eating had me feeling nauseous each day, I constantly felt I had a cold and so much hair was falling out. I also had a strange pimple rash on my back, chest and arms that made me wonder if I was not showering correctly. So, it was a bit of a relief to find out what was causing my health issues. By then, I had calcium leeching from my bones into my blood (osteopaenia), a vitamin D and a vitamin B12 deficiency as well as the usual anaemia. It took me at least a year to start to feel better again and initially I would still eat “may contain gluten” foods but I am extremely strict now, so I can feel well and at my best. When I was first diagnosed, it wasn’t as 'cool' to be gluten free. For the first year or two, often all I could get at restaurants was just a brownie. Yes, as dinner. I feel like I’ve eaten a lifetime worth of brownie. Now I usually stick with Indian, Thai or Vietnamese food when I go out as they have the best and tastiest options and less chance of cross contamination because they don’t generally have lots of flours or breads in their kitchens. I found joining Coeliac New Zealand was invaluable. The ingredient booklet and information on reading labels opened my food world and meant I was not restricted to expensive gluten freelabelled products. So, I cook and eat normally, as I used to, just substituting things like flour and pasta with alternatives. Recently, I did a women’s downhill mountain bike race and became

It was a bit of a relief to find out what was causing my health issues. separated from the support person who had my snacks. I was tired and hungry, and by the last section, I had started to get the shakes so a kind woman behind me offered me her muesli bar. She tried a couple of times and of course I declined, knowing it would be full of gluten. Then I had a close call with a tree, and she insisted I eat

something. When I admitted I had coeliac disease, she replied she was also coeliac and offered a whole snack selection. I couldn’t believe it. I felt so much better and did my best racing in the final section. I tried to find her afterwards but missed her so, if she’s out there reading this, thank you. It was so appreciated. CL

COELIAC AWARENESS WEEK Coeliac Awareness Week runs from June 6-12, 2022 and this year’s theme is Thriving: Living Your Best Coeliac Life. THE AIM

of this year’s campaign is to raise awareness of how people with coeliac disease can really thrive and live their best life while eating safe gluten free food. The theme, Thriving: Living Your Best Coeliac Life aims to inspire those living with coeliac disease* to live well every day and build a greater understanding about the need for gluten free food to be safe and accessible for people with coeliac disease. Throughout the week we aim to raise awareness and educate New Zealanders that coeliac disease is a serious inflammatory condition but with the right support, people with coeliac disease can truly thrive. We will also be sharing how our Crossed Grain Logo allows people with coeliac disease choose safe gluten free foods and shining a

light on how the hospitality sector can cater for people with coeliac disease with the support of the CNZ Dining Out Programme. This Coeliac Awareness Week we encourage you to support our partners who are part of these important initiatives by choosing Crossed Grain Logo products and eating at Dining Out Programme certified cafés and restaurants. Coeliac Awareness Week is an important campaign in the calendar for all New Zealanders, especially those living with coeliac disease, your families, and friends. We encourage our members to get involved in local events, activities, and conversations about coeliac disease. ____

To stay updated on our latest activities connect with us on the CNZ Facebook page.

coeliac.org.nz | 15

, WITH NO ROOM FOR N D E W E R B ASTIE RALLY U S. T A N

Feature / I N D U S T R Y N E W S

GLUTEN FREE BOUNTY T T A K E S a bold move to go from a farmer’s market stallholder to a NZI Rural Women NZ Business Award winner – but this is exactly what Sue Loder the owner of ‘Well & Truly Artisan Pantry’ did. Sue had applied for the awards in July last year and won the ‘Bountiful Table’ category which put her in contention alongside six other rural businesses for the supreme award. “What I loved about the process more so than winning the award was having to stop and look at the business and reflect on it. Quite often, particularly in the recent period dominated by COVID, you are often spending time fighting fires. To take the time to be reflective has been a great reminder of where we have come from and where we are going,” Sue says. Located in Kaipaki, Well & Truly

Artisan Pantry owners Sue and husband Matt bought the small market business three years ago and converted a double garage on their six-acre section into a commercial kitchen. The focus behind this Crossed Grain Logo accredited range is to create products with wellness in mind, using whole all-natural nutritious food – just how nature intended, simply made, special and 100% gluten free. Sue prides herself on the business being totally artisan. The entire range is handcrafted, from blending of the ingredients to cooking and packaging. Each part of the process from the measuring of ingredients to the bag filling is all done by hand. Part of living a balanced life for Sue and her family is living in their rural community, “It’s funny most people we meet don’t know where Kaipaki is, but it’s

the best kept secret around. We have such a wonderful community, and we love being a part of it. It’s about getting back to basics, connecting with the people and the land around you”. CL ____

“We love how the Crossed Grain Logo provides such assurance for our coeliac customers; it aligns with one of our core values of people before profits.” wellandtruly.nz

HOW IT SHOULD BE. WE BELIEVE IN MAKING BEAUTIFUL SOY SAUCE THAT ALSO TASTES AMAZING. OUR SOY SAUCE IS NATURALLY BREWED THEN SIMPLY BOTTLED. THERe's NO ROOM FOR ADDED PRESERVATIVES, COLOURS OR FLAVOURINGS. Now that's one thing you don't have to worry about.

16 | Summer 2021 Coeliac Link

LeeKumKeeNZ

LeeKumKeeNewZealand www.LKK.com

Feature / O S T E O P O R O S I S

B O NE HEALT H Dr David Kim talks to Coeliac Link about coeliac disease, BONE HEALTH and OSTEOPOROSIS.

STEOPOROSIS

is a condition where your bones become thinner and lose strength such that you become more predisposed to broken bones (fractures), in some instances without significant trauma. Our bone density declines with ageing, particularly in the post-menopausal period in women. Roughly one in three women and one in five men over the age of fifty will suffer a broken bone due to osteoporosis in their life time. These fractures not only cause pain and suffering but also often lead to disability, temporarily or permanently, with loss of independence in many instances. What is the relevance of osteoporosis in coeliac disease? While osteoporosis often occurs ‘naturally’ with ageing, a significant proportion of osteoporosis and fragility fractures occur, at least in part, due to other factors that weaken the bones. These ‘risk factors’ are usually modifiable and treatable, and coeliac disease is one such example. Bone density can be objectively assessed with bone mineral density (DEXA) scan, and mild-moderate reduction called osteopenia, and moderate-severe reduction called osteoporosis, can be readily detected. Studies revealed that osteopenia or osteoporosis was present in at least a quarter of coeliac disease patients at the time of diagnosis. Additionally, it

18 | Autumn 2022 Coeliac Link

has been shown that those with coeliac disease have about 30% increased risk of bone fractures compared to others without coeliac disease. What are the mechanisms of poor bone health in coeliac disease? There are a number of ways in which coeliac disease reduces bone density and bone quality. Most well-understood mechanism is through malabsorption of calcium and vitamin D – both play important roles in maintaining healthy bones. Another mechanism is through malnutrition related low body weight; weight is an important factor in maintaining bone mass. Other possible links between coeliac disease and bone health include immunological and inflammatory processes directly impacting on bone health. Abnormalities in sex hormone metabolism, such as delayed puberty, hypogonadism and early menopause that are common in coeliac disease, can also negatively impact the bone. What to do to improve and maintain good bone health if you have coeliac disease? Good coeliac disease care through strict gluten free diet is the first and foremost way to improve and preserve bone health. Vitamin D and/ or calcium supplementation may be needed in some situations. DEXA scan should ideally be performed at the time of diagnosis of coeliac disease particularly if the condition may have been present for a number of years

prior to the diagnosis or there are concurrent risk factors for accelerated bone loss. These risk factors include family history of osteoporosis, low body weight (BMI under 20), inflammatory conditions such as rheumatoid arthritis and inflammatory bowel disease, other hormone conditions such as overactive thyroid or parathyroid, and having been on certain medications that are known to reduce bone density. These medicines include corticosteroids (e.g. prednisone) and hormone suppressing cancer treatments such as those used in breast and prostate cancers. There are a number of online fracture risk calculators that could also be used. While these cannot replace a DEXA scan, they provide a reasonably reliable osteoporotic fracture risk. One such tool freely available for New Zealanders is called Know Your BonesTM: knowyourbones.org.nz. Upon completing this questionnairebased analysis, a short report is generated stating whether you are at low, medium or high risk of fractures. This report can be printed or downloaded so that the information can be discussed with healthcare professional. If you are deemed to have osteopenia or osteoporosis on DEXA scan, your healthcare professional will discuss the necessity and options for bone-protection treatment. There are now several different treatment agents available, most of them funded, in New Zealand. These medications are generally safe and well-tolerated, and can significantly reduce risk of future fragility fractures, by about 50%. CL ____

Dr David D.W. Kim (MBChB & FRACP), Endocrinologist, Auckland

RESOURCES More useful information about osteoporosis can be found from following online resources: • bones.org.nz • osteoporosis.foundation

Bakels PROUDLY SUPPORT COELIAC AWARENESS WEEK JUNE 6-12 | 2022

Bakels Gluten Free Flour is a quality flour suitable as a direct replacement for standard flour in many types of baking. Visit bakels.co.nz for recipes

Feature / K A M R A N R O S T A M I

ELDERLY ONSET COELIAC

DISEASE The importance of EARLY DETECTION and TREATMENT of coeliac disease IN LATER LIFE.

OELIAC

disease is an autoimmune condition that is triggered by gluten. The gluten’s antigens induce an immune reaction against the small intestinal mucosal lining. This reaction is known as inflammation leading to several symptoms including fatigue, abdominal pain, anaemia, diarrhoea or constipation and bloating. Gluten damages are not confined to the

20 | Autumn 2022 Coeliac Link

small intestine as there are a range of extraintestinal presentations, like neurological disorders in particular, peripheral neuropathy, unexplained headache, skin and joint related symptoms reported in some patients. Ataxia and neuropathy are two essential neurologic complications of untreated coeliac diseased (CD) which can particularly be problematic in elderly patients1. Cognitive impairment, like accelerated dementia, has also been seen in older patients with CD, although its effect is controversial, the gluten free diet should be introduced, as early as possible,

because of its potentially protective effect. The other associated autoimmune diseases include type 1 diabetes mostly in younger patients and autoimmune thyroid disorders (Hashimoto thyroiditis and Graves’ disease) more frequently in older patients. Since, in elderly, autoimmune thyroid disorders are more common when they are affected with coeliac disease, screening for thyroid diseases is strongly recommended in these patients. Another important manifestation of coeliac disease is osteopenia or osteoporosis that may affect older people more often. A low bone density can be

associated with unexpected fractures and bone pain. For instance, lack of calcium and vitamin D are consequences of malnutrition and bone pain might be the only presentation of CD as this condition may present with atypical symptoms or no symptoms in some cases. Due to the complexity and atypical presentation, many patients remain undiagnosed, and the lack of treatment expose these patients to complications unfortunately. For instance, malignancy is another long-term complication that is increased in untreated elderly with coeliac disease. Atypical presentation is the main reason why some patients not being diagnosed with CD or there is a major delay between the onset of symptoms and timing of diagnosis. The current guidelines strongly recommend treating all patients with a gluten free diet disregard to their age or whether they are symptomatic or not. The main reason for this policy is the fact that untreated CD are at high risk for developing complications like above mentioned autoimmune disorders and malignancy. The estimated prevalence of coeliac disease in New Zealand is now about 1% in the general population with many cases remaining undiagnosed2. The challenges are not confined to only underdiagnosis but also the management of this condition especially in older patients. One of the challenges is changing a life-time of dietary habits. In addition, some elderly may also have limited financial or social resources,

Providing a gluten-free diet might be difficult for elderly patients residing in assisted living facilities. limited mobility that restrict their ability to walk or travel to gluten-free suppliers3. Providing a gluten-free diet might be difficult for Elderly patients residing in assisted living facilities. Acknowledging the challenges would hopefully alert the health professionals on how they can provide the best care of older people with coeliac disease. Additional issues require consideration may relate to poor nutritional intake and impaired vision limiting their ability to read the labels which are often minute in size3. Patients should be encouraged to seek out community support and family members should be engaged and participate in the patient’s dietary consultation3. Direct communication between the dietitian and the food services at the patient’s organisation, if institutionalised, are likely necessary to optimise a safe and uncontaminated gluten-free diet. In the very elderly or debilitated patients who have minor symptoms, consideration of not treating the patient with a gluten-free diet may have some rationale 3-4. However, it should be noted that patients can often have a dramatic improvement in chronic symptoms, after starting a gluten-free diet, and the opportunity for possible recovery should not be overlooked. CL ____ 1.

ONE OF THE CHALLENGES IS CHANGING A LIFETI M E O F D I E TA RY H A B I T S ... E L D E R LY M A Y ALSO HAVE LIMITED FINANCIAL OR SOCIAL RESOURCES, AND LIMITED MOBILITY

Osman D, Umar S, Muhammad H, Nikfekr E, Rostami K, Ishaq S. Neurological manifestation of coeliac disease with particular emphasis on gluten ataxia and immunological injury: a review article. Gastroenterol Hepatol Bed Bench. 2021;14(1):1-7. Ashtari S, Najafimehr H, Pourhoseingholi MA, et al. Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis. Sci Rep. 2021;11(1):2383. Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin North Am. 2009;38(3):433-446. Shiha MG, Marks LJ, Sanders DS. Diagnosing coeliac disease in the elderly: a United Kingdom cohort study. Gastroenterol Hepatol Bed Bench. 2020;13(1):37-43.

D R K A M R A N ROS TA M I

is well known for his research on coeliac disease and non-coeliac gluten sensitivity. Having received his MD degree from Carol Davila University Bucharest, Dr Rostami undertook his postgraduate training at Internal Medicine University of Groningen, the Netherlands, after completing his PhD at University of Amsterdam. He continued and accomplished specialist training through the West Midlands Deanery in UK and has been an attending Physician in the Gastroenterology Division, Department of Internal Medicine in both UK and later at Palmerston North, New Zealand. He acted as clinical lecturer at the University of Birmingham and visiting lecturer in Nutrition Therapy at University of Worcester. His ongoing research interests are on gluten related disorders and nutrition therapy in inflammatory bowel disease. He is deputy editor of Gastroenterology & Hepatolgoy from Bed to Bench Journal, a member of the editorial boards and reviewer of several scientific journals. He has organised and presented at numerous national and international Gastroenterology conferences, coordinated a number of multicentre studies and has published over 150 peer-reviewed articles. A D E L E ROS TA M I

Adele has worked as a specialist dietitian for 2 decades in NHS, UK in many specialist areas including intensive care, gastroenterology, diabetes, oncology, bariatric surgery and paediatrics. Being part of the Gastroenterology Nutrition Team at University Hospitals Birmingham NHS Foundation Trust is how Kamran and Adele met in 2003 and eventually got married. Through the years they have supported and learned from each other, not only personally, but also in their various interests of nutrition.

coeliac.org.nz | 21

Feature / N U T R I T I O N

T IS

common for people to experience lactose intolerance when they are first diagnosed with coeliac disease (CD). Lactose intolerance does not mean all dairy must be avoided. Rather it means limiting high lactose foods, such as milk, soft cheese, and non-sour yoghurt, to limit the total amount of lactose in the diet. If you are unsure then it is best to speak to your doctor about why you suspect that dairy is an issue and to also get help from a dietitian or nutritionist to

products, the lactose is not digested properly, due to the absence of lactase, and can cause uncomfortable symptoms such as bloating, gas, diarrhoea, and abdominal cramps. This is because the undigested lactose lingers in the intestines and is fermented by gut bacteria. Some dairy products are higher in lactose than others. Many people with lactose intolerance can tolerate a very small amount of low lactose dairy such as ghee, butter and hard cheese, and probiotic yoghurt (as the beneficial bacteria breaks down the lactose) providing they don’t have too much in the same day. It is important that you test your level of tolerance to lactose as you may find you are

Lactose intolerance on a GF diet Navigating LACTOSE INTOLERANCE on a coeliac safe gluten free diet.

LACTOSE TOLERANCE U S U A L LY RETURNS IN CHILDREN ONCE INTESTINAL DAMAGE FROM COELIAC DISEASE HAS HEALED 22 | Autumn 2022 Coeliac Link

ensure nutritional gaps in the diet are managed if you go dairy free. Lactose tolerance usually returns in children once intestinal damage from coeliac disease has healed. What is Lactose intolerance? Lactose is the milk sugar found in all forms of milk whether it is cow’s milk, goat’s milk, sheep’s milk and even human breast milk. It can also be found in a varying amount in dairy products made from milk such as cheese and yoghurt. Lactose intolerance occurs when there is an insufficient production of the enzyme lactase to digest lactose in the small intestine. This is often due to the damage to the villi, the absorption cells of the small intestine. The enzyme lactase would normally sit at the very tip of the healthy villi of the small intestines, however, in the presence of inflammation and intestinal damage caused by CD, lactase is often deficient. If you have lactose intolerance and you drink milk or eat dairy

able to have a very small amount of butter or hard cheese once a day with no symptoms at all but are unable to tolerate any milk or yoghurt. Keeping a daily food diary can be helpful to track symptoms. Lactose is often used as a filler in some medications and processed foods, although the amount is usually very small so is unlikely to cause too much of a problem for most people unless you have a dairy protein allergy. If you are concerned though I would recommend checking labels. Digestive Enzymes containing lactase can be helpful Taking a digestive enzyme supplement containing the enzyme lactase can help relieve symptoms of lactose intolerance as it provides the tools for lactose to be properly digested. It is recommended to take a capsule with each meal containing dairy products. These are available in most health shops as a stand-alone lactase enzyme or in a broad-spectrum digestive enzyme formula. However, though lactase

IT I S E A SY TO W O R RY TH AT YO U M A Y N O T B E G E T T I N G E N O U G H C A L C I U M ... B UT B E A S S U R E D TH AT TH E R E A R E MANY NON-DAIRY FOOD SOURCES enzymes can be used as an acute management strategy, particularly in unpredictable situations such as parties. They are unlikely to provide complete protection from symptoms if the child continues to consume a normal lactose-containing diet. If a child has lactose intolerance, this is best managed with a low lactose diet until lactose intolerance improves. Lactose tolerance usually returns in children once intestinal damage from CD has healed. You can also purchase zero lactose milk from the supermarket that has the enzyme lactase added to the milk during the production process. You may be able to tolerate this if you just have lactose intolerance and not an intolerance to the dairy milk protein. How do I get enough protein on a lactose free diet? Dairy foods are a popular source of protein so when dairy is eliminated from the diet it can be a challenge to get enough protein during the day. I always advise my clients to aim to have a good source of protein with each meal (breakfast, lunch, and dinner). Protein will also help you to feel fuller and more satisfied and help you keep your blood sugar in a healthy balance, so you are less likely to snack on refined carbohydrates. Good dairy free protein sources are: • Beef, pork, or lamb • Fish and seafood • Poultry such as chicken or turkey • Eggs • Nuts and seeds • Quinoa – a good gluten free grain alternative that is also a great source of protein as it contains all nine essential amino acids.

Can be used in baking, as a grain substitute or in a salad. • Beans such as black beans, pinto beans, kidney beans – can be added to soups, stews, salads, tacos. • Legumes such as chickpeas, lentils, peas, pea-based protein powders • Organic soy milk, tempeh, tofu, tamari What about calcium? It is easy to worry that you may not be getting enough calcium when you remove dairy from your diet but be assured that there are many non-dairy food sources that are naturally rich in calcium. Try and aim for 2-3 servings of the following calcium rich foods a day: almonds, almond butter, figs, kale, spinach, broccoli, canned sardines, canned salmon with bones, sesame seeds/tahini, chia seeds tofu, beans and lentils, dairy free milk alternatives that have been fortified with calcium such as soy, almond or coconut milk. As a general rule, it is more beneficial to choose whole foods that are naturally gluten and lactose free (e.g., fish, meat, nuts, vegetables, eggs, etc) rather than relying on refined processed foods that are low in nutrients, may have hidden sources of gluten and lactose, and can be high in refined. CL ____

Catherine Garney is a Registered Clinical Nutritionist and coeliac. These suggestions have been the most helpful for me over the years and for many of my clients as well. For more assistance see nutritionforhealthnz.com and nutritionists.org.nz to find a local practitioner.

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Feature / R E S E A R C H U P D A T E

BOUT 25%

COELIAC DISEASE IN CHILDREN

Paediatric Gastroenterologist and Coeliac New Zealand Honorary Patron Dr Simon Chin discusses DIAGNOSIS and TREATMENT of coeliac disease in CHILDREN. 24 | Autumn 2022 Coeliac Link

of total coeliac cases are diagnosed in the paediatric age group, with 23-40% diagnosed <5years of age, 48-65% between 6-12 years and 11-12% >12 years1. It is most commonly diagnosed in the European population, but increasingly is being found in North India, Middle East and North Africa2. It is very uncommon amongst Maori, Pacific Island and South East Asian people. Its childhood presentation has changed. Previously, toddlers would present with failure to thrive, abdominal distension and steatorrhoea. It is now far more common to have nonspecific symptoms, such as recurrent abdominal pain, diarrhoea, poor weight gain, lethargy, irritability and intermittent vomiting occurring in the older child. Other manifestations include recurrent mouth ulcers, enamel hypoplasia, short stature and iron deficiency. Because symptoms are nonspecific, making a diagnosis of coeliac disease requires a high index of suspicion. This is particularly so when symptoms such as recurrent abdominal pain in children are so common. However, where such symptoms become persistent, and especially if there is a family history of coeliac disease, coeliac serological testing should be requested. Coeliac disease in children can now be diagnosed without a small bowel biopsy, providing the child has coeliac serological blood tests high enough (transglutaminase IgA antibody >X10 upper limit of normal) on initial testing, and then a second separate blood sample showing a positive endomysial antibody3. This approach at Starship Children’s Hospital has led to children being diagnosed without a small biopsy in more than 60% of cases and includes asymptomatic children (usually as part of a family screen), who also have high enough antibody levels. Patients who have

Because symptoms are nonspecific, making a diagnosis... requires a high index of suspicion lower transglutaminase antibody levels still need a confirmatory small bowel biopsy to be absolutely sure of the diagnosis. Asymptomatic patients can account for about 25% of total cases diagnosed. Genetic testing looking at risk genes (HLA DQ2/8) for coeliac disease was at one stage needed to help diagnose coeliac disease without a small bowel biopsy but is now no longer needed. It is useful when a patient has gone onto a gluten-free diet without having any prior blood tests done. While virtually all coeliac disease patients carry the DQ2/8 genes, about 30% of the normal European population also carry these genes and most do not get coeliac disease. The gene test is, therefore, most useful in excluding coeliac disease, but cannot be used to confirm it. If the gene test is negative, it is highly unlikely that a patient has coeliac disease or will develop it in the future. The mainstay of treatment is a gluten-free diet, and it is vitally important that formal dietetic advice is sought. While following the diet consistently is difficult, dietetic advice helps to minimise mistakes, ensuring that the gluten-free diet is balanced and providing useful tips on the kitchen environment as well as shopping at supermarket and specialist stores. Pharmacies can also provide subsidised gluten-free products on prescription. The patient support provided by CNZ is a valuable resource for many aspects of coeliac disease, such as gluten-free recipes, travel stories, a restaurant and cafe dining guide and local support meetings. There is a common perception that a gluten-free diet is healthy, resulting in this diet becoming popular. However, it is important that children are not put onto a GF diet without a proper diagnosis of coeliac disease being made. In the current COVID-19 environment, there does not appear to be any evidence that children with

coeliac disease are at increased risk of getting COVID-19 infection4. Regular GP follow-ups is necessary to monitor children’s growth and compliance with the diet. Follow-up blood tests should be done 6-12 months after the diagnosis to check that coeliac antibodies have returned to normal, although this can take up to two years to occur. CL ____ 1.

Krauthammer A, Guz-Mark A, Zevit N, et al. Age-Dependent Trends in the Celiac Disease: A Tertiary Center Experience. J Pediatr Gastroenterol Nutr 2021;72:894-899. Lebwohl B, Rubio-Tapia A. Epidemiology, Presentation, and diagnosis of Celiac Disease. Gastroenterology 2021;160:63-75. Husby S, Koletzko S, Korponay-Szabo I, et al. European Society Pediatric Gastroenterology, Hepatology and Nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr 2020;70:141-156. Uche-Anya E, Husby S, Kaplan G, et al. An International Reporting Registry of Patients with Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC. Clin Gastroenterol Hepatol 2021;19:2435-2437.

D R S I M O N C H I N is an Otago Medical School graduate, having completed his initial paediatric training in Auckland and having extensive advanced training in Australia and USA, completing a 2 year clinical fellowship at Royal Children's Hospital in Brisbane and also a 3 year fellowship at the Children's Hospital of Philadelphia. He works in private and at Starship Children's Hospital with the Paediatric Gastroenterology, Hepatology and Nutrition Service and does outreach clinics to provincial centres. He has a special interest in coeliac disease and accepted the role of Patron in 2020 having contributed extensively to the CNZ Medical Advisory Panel over several years.

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Feature / M Y C O E L I A C S T O R Y

MASTERING WINE AND

LIFE

WINE INDUSTRY champion Sophie Parker-Thomson refuses to SWALLOW ANY LIMITATIONS in life or career. HILE

studying intensely for a prestigious international wine qualification, Sophie Parker-Thomson assumed stress was making her unwell. After nailing the notoriously difficult final exam in Adelaide, she discovered her symptoms were caused by gluten rather than anxiety. By February 2021, the Marlborough wine company owner had become the

26 | Autumn 2022 Coeliac Link

South Island’s first ever Master of Wine and the 15th person in New Zealand to attain the wine tasting qualification. She was one of only 10 people in the world to attain the qualification that year. The news she received a year earlier, however, was much less welcome. A biopsy had confirmed she was coeliac. “Initially, it was a huge shock,” Sophie says. “I felt almost embarrassed about it

because I’d always been the person who had no dietary requirements or dislikes and would happily eat anything. Obviously now I have no trouble explaining to people I’m coeliac. However, it’s made me aware there is still quite considerable misunderstanding about what it actually means.” She notes older generations are more prone to accusing her of being pedantic or of overreacting about cross-contamination of food, due to lack of awareness.

However, she is adamant the diagnosis has neither changed nor limited her career, ambitions, or lifestyle. The former lawyer turned wine producer has been immersed in hospitality and the wine industry since childhood. Raised in the wine regions of Gisborne and Central Otago, she and husband Matt Thomson craft premium wines under the 'Blank Canvas' label and also own 'Lock Stock & Barrel Consulting'. “I’m lucky that wine is obviously naturally gluten free, and I always remind myself, just as well I didn’t end up in the brewing industry. “I ordinarily spend nearly three months of the year in Italy, as we make wine in northern Italy and southern France for a major client. Immediately after my diagnosis, I was dreading having to live in Italy for three months thinking I was going to get so sick of risotto and not be able to enjoy any of the incredible pasta and pizza. But I was pleasantly surprised to see that gluten intolerance and coeliacs are arguably better catered for there than here in New Zealand. “I was also very surprised to learn that Italy has one of the highest rates of gluten intolerance and coeliacs in the world. Italian supermarkets have entire aisles with gluten free products, including croissants. Some restaurants aren’t necessarily aware of coeliac requirements, so some caution is needed when eating out, but I certainly didn’t have too much of a problem.” France proved more difficult, but she found hospitality venues in the United Kingdom generally well informed about dietary requirements. In New Zealand, Sophie says the landscape for food intolerances is changing rapidly, with some restaurants

opting to forgo all gluten on their Recently, Sophie has discovered menus. Since her diagnosis 2.5 years Kereru Brewery’s Hoppy GF Ale, ago, she has noticed significant which has cured my occasional pang improvements in general awareness for a hops-heavy craft beer. and availability of gluten free meals and She is particularly interested in products. In her research that is looking at enzymes adopted hometown, that can degrade gluten and says Marlborough’s best some breweries are trialling adding restaurants are these to beer. particularly well “Of course, there have been tuned to coeliac adjustments in my day to day life but requirements. it’s been relatively easy and now the “There is often a whole family essentially eats gluten lot of dining out and free, aside from the odd bit of non events associated gluten-free bread and croissants with the marketing which I’d be cruel to deny the rest of side of the industry the family. It’s easy to find gluten-free but typically it’s not substitutes for most ingredients a problem as long and I’ve actually enjoyed the challenge as one remembers to let organisers of making dishes gluten free – and hosts know as soon as possible. A last week I pulled off an exceptional number of wine industry people here are Beef Wellington.” CL coeliac, too, which makes it easier. She has high hopes that revolutionary research will prove a game-changer in the coming decade. “There’s ongoing research into oral enzyme therapy. I think that’s a very exciting development for coeliacs. I realise that a lot of this good work is being driven by the likes of CNZ, so I’m hugely appreciative of their hard work in the background.” Tradition dictates that, following a wine tasting or wine judging event, After my diagnosis, I was dreading having to live in Italy for three months thinking judges enjoy “an almost ritualistic I was going to get so sick of risotto. palate cleanser” beer or two.

SHE IS ADAMANT THE DIAGNOSIS HAS NEITHER CHANGED NOR LIMITED HER CAREER, AMBITIONS, OR LIFESTYLE

coeliac.org.nz | 27

Feature / W E L L B E I N G

YO GA

10.

11.

12.

13.

14.

19.

20.

Brooke Cowsill from Yoga Collective talks to Coeliac Link about the IMPORTANCE of YOGA with coeliac disease.

O G A ’ S origin can be traced back to northern India over 5000 years ago, well before science has discovered modern medicine. Health, from a yogic perspective, focuses on treating illness through physical, mental, social, vocational, moral, emotional, and spiritual dimensions. Disorders of the gastrointestinal system, such as coeliac disease, would be related to an imbalance in the solar plexus chakra, known formally as manipura chakra. On a physical level, the third chakra rules metabolism, where food is transformed into energy. The major organs of the digestive system – stomach, liver, pancreas, and gallbladder – are influenced by manipura chakra. There are multiple ways through yoga, breathing and mudra practises that can influence an imbalance in manipura.

28 | Autumn 2022 Coeliac Link

While these practises may help with the symptoms of gastrointestinal disorders, such as coeliac disease, they are to be used as complementary to medical interventions, not as a substitution or cure. Just like any other exercise regime, it is recommended to partake in yoga at least twice per week for a minimum of 20 minutes, with better outcomes coming from 3-6 sessions each week depending on experience. Be sure to ask your doctor if yoga might be right for you and, if possible, attend a class with an experienced yoga teacher who will be able to safely show you through each of the poses. Yoga Poses (Asana) Yoga poses that influence manipura chakra may have a positive impact on those with coeliac disease through developing your inner fire via mindful movements and stimulating the core. Give some of these a try and notice what response your body and mind have. Each pose should be held for several full breaths, with corpse pose (savasana) being held for 5-10 minutes.

1. Standing side bend Parsva Urdhva Hastasana 2. Warrior I Virabhadrasana I 3. Warrior 2 Virabhadrasana II 4. Revolved Warrior Viparita Virabhadrasana 5. Triangle Trikonasana 6. Extended side angle Utthita Parsvakonasana 7. Downward facing dog Adho Mukha Svanasana 8. Boat Paripurna Navasana 9. Half upward plank Ardha Purvottanasana 10. Gate Parighasana I 11. Seated twist/half lord of the fishes Ardha Matsyendrasana 12. Locust Salabhasana 13. Wind relieving Pawanmuktasana 14. Corpse Savasana 15. Breathing practises Pranayama. Gastrointestinal disorders can be accompanied with acidosis so breathing practises should aim to slightly increase blood pH. Breath retention should be avoided as it lowers blood pH as carbon dioxide builds up in the body. Give these

exercises a go in a comfortable, seated position for 1-2 minutes. 16. Diaphragmatic/belly breathing Societal standards of being told to hold our belly in and stand tall has reduced humans ability to breathe correctly. In order to “belly” breathe, known as diaphragmatic breathing, the inhale must be preceded with a soft pelvic floor (almost like you are trying to go to the bathroom) and abdomen. This allows the diaphragm to function properly and the breath to land in the belly rather than the chest. 17. Wine barrel breathing/seated torso circles Move the middle of your torso in circles imagining that you are seated inside a wine barrel and trying to rub its sides. As your torso moves forward and your back arches, inhale. As your torso moves back and your spine flexes, exhale. Try to keep shoulders above the hips and chin parallel to the floor. Remember to go in both directions. 18. Mudra A mudra is a hand

position that is often done during certain yoga poses and breathing exercises. Two mudras that you can add to your practices above are vayu and matangi. 19. Vayu Vayu mudra helps to regulate the element of air in the body aiding in stomach complaints such as bloating. Fold the index finger to the base of the thumb and gently press the thumb over the index finger with the other three fingers stretched straight. 20. Matangi Matangi mudra treats stomach problems through releasing stress and strengthening the breathing cycle. Interlace the hands in front of the stomach area and extend all middle fingers to touch while leaving the rest interlocked. ____

While there is no known cure for coeliac disease, yoga and breathing exercises may help to alleviate some unwanted side effects, as well as improving your overall physical, mental and spiritual well-being. CL

coeliac.org.nz | 29

L Y

PHOTO: NICOLE PERCY

R R

Bakels GF banana bread brunch delight

Freshlife's raspberry cheesecake

Gluten-free / M E A L I N S P I R A T I O N

Kellogg's GF Cornflakes gluten free herb corn fritters

gluten

FreshLife waffles

EAL MIDEAS FREE

Peace and Comfort Kitcken's grilled chicken kebabs

Jan Bilton's corn, bacon & cucmbers crustless quiche HERE ARE

loads of delicious gluten-free recipes – including the ones featured here – on our website. Log into the 'members only' section at coeliac.org.nz to access weekly meal plans.

PHOTO: PEACE AND COMFORT KITCHEN

GF Vogel's white loaf hearty roast beef & relish sanwich

Peace and Comfort Kitcken's lentil & tomato chilli Kellogg's GF Special K cacao protein balls

PHOTO: NICOLE PERCY

www.mollywoppy.co.nz

Health Promotion / R E A D I N G F O O D L A B E L S

B I T E S

THE

DELIG H TS

/ CNZ Picks

Nature Valley™ Protein Berries & Peanut bar is gluten free and contains 20% of your daily protein needs. It’s a great on-the-go snack. naturevalley.co.nz

LABEL?

32 | Autumn 2022 Coeliac Link

‘Contains gluten’ and ‘Contains traces of gluten’: • Sometimes sources of gluten are not written on an ingredient list, but a label will state ‘contains gluten’ or ‘contains traces of gluten’. These products should be avoided by coeliacs. • Certain foods are exempt from the full labelling requirements, including small food packets (e.g., chewing gum), alcoholic beverages, herbs, spices, tea, coffee, and mineral water, unless a nutrition claim is made about these foods (Food Standards Australia

Why have the rules changed? Original allergen labelling rules in the Australia New Zealand Food Standards Code were not consumer friendly. These stated what allergens had to be declared, but not how this should be done. Consumers who have a food allergy need to know whether a particular ingredient is in their food. New rules for allergen labelling have been introduced to provide clear and consistent allergen information – so consumers can make safe food choices. CL ____

NB: The new rules changed on February 25, 2021 and businesses have until February 25, 2024 to update the labels and a two year stockin-trade provision so food packaged and labelled before February 2024 may be sold for a further two years. For the full article visit: coeliac.org.nz

R P SY

Introducing FreshLife’s new Raw Slice Mixes range, available in three café favourite flavours; Cacao Brownie, Zesty Lemon, and Smooth Caramel. Each is packed full of healthy ingredients and is gluten free, refined sugar free, 100% plant based and less than 200 calories per prepared serve. The perfect guilt free treat! See instructions on how to make the caramel slice via youtu.be/0Exy5oN88rM

At Ceres Organics we like our food wholesome and pure. So, our RAW Mango Slices are just that! Get them delivered to your door with the convenience of the one stop Gluten Free Shop. glutenfreeshop.co.nz

Kellogg’s® Coco Pops® Gluten Free Coco Pops is the tasty breakfast treat that kids and kids at heart have loved for generations, now available in gluten free! Crunchy, gluten free grains of puffed rice with cocoa that look and taste just as good as the original Coco Pops! kelloggs.co.nz

Bakels ‘Gold Label’ gluten free chocolate brownie mix is every chocolate lovers dream, with a crunchy chewy outside and a gooey middle. Simply just add vegetable oil and water! nzbakels.co.nz

Gluten-free

Kea Cookies are delicious gluten, wheat, dairy and egg free cookies the whole family will love. Proud to be supporting Coeliac Awareness Week this year contact admin@coeliac.org.nz if you would like to sell cookies to fundraise for CNZ. keacookies.co.nz Kellogg’s® Sultana Bran® Gluten Free – a long-time family favourite, Sultana Bran is now available in a Gluten Free option. With its crisp flakes and juicy sultanas, Kellogg's® Sultana Bran is packed with high fibre goodness and fruit in every serve. kelloggs.co.nz

The Damn Good Food Company produce raw, plant based frozen dessert slice. The product caters for dairy free, cane sugar free and of course gluten free consumers. damngoodnz.com

T N

Introducing the new and improved Vogel’s Gluten-Free range. A fresh new look and an even better taste! vogels.co.nz/bread

Ingredients Corn 94%, Sugar, Barley Malt Extract, Emulsifier (471), Vitamins (Niacin, Thiamin, Riboflavin, Folic Acid), Mineral (Iron). Contains: Gluten

Ingredients Corn 94%, Sugar, Barley Malt Extract, Emulsifier (471), Vitamins (Niacin, Thiamin, Riboflavin, Folic Acid), Mineral (Iron). Allergen Advice Contains: Gluten

NEW

OLD

LABEL EXAMPLE: CORNFLAKES

What will the label say? ‘Gluten free’. By law, a product can only be labelled as 'gluten free' when it contains no detectable gluten (i.e., less than 3ppm in NZ and Australia. These products are safe to eat for people with coeliac disease, on a gluten free diet. Other countries can label their products as ‘gluten free’ with less than 20ppm, so NZ and Australia have a more stringent criteria for gluten free labelling and safety for those with coeliac disease.

'Gluten Free' food must not contain: • Detectable gluten; or • Oats or oat products; or • Cereals containing “gluten that have been malted, or products of such cereals.

New Zealand, 2003). • Foods which are unpackaged, natural, whole, or cut fresh, like fruit, vegetables, and meat in transparent packaging, ready-toeat, sold at fundraising events, made, and packaged where sold do not require labelling. • Servings may be replaced by: – ‘slice’, ‘pack’ or ‘package’; or – ‘metric cup’ or ‘metric tablespoon’ or other appropriate word or words expressing a unit or common measure’.

Nutrition Information Panel (NIP) The most comprehensive facet of the FSANZ food labelling system is the Nutrition Information Panel which provides non-explanatory nutritional information of the food product. Non-explanatory nutritional information is generally numeric and requires the consumer to self-interpret; explanatory nutritional information indicates the healthiness of the product, usually graphically, for the consumer.

The use of “Nil detected” or “not detected” in the NIP. Not detected is the more common or preferred option by the industry as it aligns to the wording used in the FSANZ Schedule 4 – nutrient and health claims https://www.legislation.gov.au/ Details/F2017C00711 The method of analysing gluten is that it is not zero, gluten is present but in very small amounts (< 3ppm). Therefore, the terms “not detected” is preferred.

Label mandatories • Name and description of the food • Name and address of the New Zealand distributor or manufacturer • Advisory or warning statements • Ingredient list • Nutrition Information Panel • Percentage labelling of key ingredients • Net weight or volume • Date marking • Lot identification • Directions for use and storage.

B Y L A W , A P R O D U C T C A N O N LY B E LABELLED AS 'GLUTEN FREE' WHEN IT C O NTA I N S N O D E TE CTA B L E G L UTE N

in New Zealand must be labelled according to the Food Standards Code, which was established by Food Standards Australia New Zealand (FSANZ) in 2002 and is implemented by the Ministry of Primary Industries (MPI).

OODS SOLD

F O O D A L L E RG E N L A B E L L I N G – W H AT ’ S B E H I N D

A N D

coeliac.org.nz | 33

W E L L B E I N G

LO O K FO R TH E CROSSED GRAIN LO G O

J OUR N AL

/ Health Promotion

Your easy choice when shopping gluten free

HOW TO THRIVE

E I N G H E A LT H Y

A MO R E PA S TA

and happy is one goal everyone would like to achieve. Keeping track of your health condition particularly when struggling with an auto immune condition and the anxiety that coeliac disease can cause, is important. Often, we don’t notice until the symptoms are visible. While we can’t control the genes, we have received we can choose to work towards optimal health and wellbeing.

When you’re standing in front of a shelf deciding on which GF products to buy, our S H O P P I N G G U I D E is an easy way to check which brands are suitable for coeliacs, or those with gluten sensitivity.

coeliac.org.nz

Support to be coeliac safe and gluten free for life.

N OT J U S T

Crossed Grain™ A C C R E D I T E D P A R T N E R S

Our Wellbeing Journal CNZ is developing a Wellbeing Journal following the feedback we received from the Conference late last year, and to support members dealing with living with coeliac disease in the COVID-19 environment. Our theme for the journal is Thriving not just surviving and will include the key foundations of wellbeing. ‘Wellbeing’ refers to a positive rather than neutral state, framing health as a positive aspiration. This definition was adapted by the 1986 Ottawa charter, which describes health as ‘a resource for everyday life, not the object of living’. From this perspective health is a means to living well. Wellbeing refers to a state of being comfortable, healthy, or happy. Even though happiness is an integral part of your personal wellness, it includes other things such as the fulfillment of long-term goals, your sense of purpose and how in control you feel in life. Many aspects of wellbeing reach beyond health and encroach into your values, meaning of life, and spirituality. The biopsychosocial model of wellbeing emphasises the modifiable components needed for an individual to have a sense of wellbeing. The following modifiable components

SURVIVE

‘WELLBEING’ REFERS TO A POSITIVE R ATH E R TH A N N E UTR A L STATE, F R A M I N G H E A LT H A S A P O S I T I V E A S P I R A T I O N will be included in the journal: • Healthy environments (physical, social, cultural) • Developmental competencies (healthy identity, emotional and behavioural regulation, and critical thinking skills) • Sense of belonging (find your coeliac community) • Healthy behaviours (sleep, nutrition, exercise) • Resilience (recognition of one's innate resilience and healthy coping skills) through self-management skills. Research has shown that journaling has a profound impact on mental health and the ability to express yourself. There are the obvious benefits, like a boost in mindfulness, memory, and communication skills. But studies have also found that writing in a journal can lead to better sleep, a stronger immune system, more self-confidence and a higher IQ. Journaling may help ease our distress when we’re struggling. In a 2006 study, nearly 100 young adults were asked to spend 15 minutes journaling or drawing about a stressful event, or writing about their plans for the day, twice for one week. The people who journaled saw the biggest reduction in symptoms like depression, and anxiety particularly if they were very distressed to begin with. This was true even though 80 percent had seldom journaled about their feelings and only 61 percent were comfortable doing so. What is journaling? Journaling involves the practice of keeping a diary or journal that

explores thoughts and feelings surrounding the events of your life. The Thriving not just surviving Wellbeing Journal will help you set, track, and achieve your exercise goals, integrate good gluten free dietary habits, fine tune your sleep routine and mindfulness, know yourself better, learn new self-management techniques to manage coeliac disease and inspire you with quotes and recipes to keep you motivated throughout 2022. CL

Purchase a limited edition WELLBEING JOURNAL for $15. See store for details: coeliac.org.nz

H O W I T H E L P YO U The Wellbeing Journal is a preventative approach to health and wellbeing, that supports you to adjust your mindset towards living a healthy life with coeliac disease. It is designed to help you stay on top of the condition by providing a toolbox of strategies to create change through self-management education, and exploring ones goals, motivations and ambitions.

coeliac.org.nz | 35

Feature / F R I E N D S O F C N Z

P E AC E

B R I NG I NG C AL M

TO FAMILY MEAL TIMES (Above) SLorem ipsum.

The KITCHEN and DINING TABLE was always an important place in the homes of Tracey Thorp and Jessi Curwell where FAMILY CONNECT, and FRIENDS GATHER. N L AT E 2 02 1

during the COVID-19 outbreak when New Zealand was in Level 4 lockdown, they garnered together a lifetime passion of cooking to launch Peace and Comfort Kitchen an e-book and meal planner business. Both women understood the difficulty of juggling meals to fit around family, lifestyle, and work. They knew that if the concept was going to work it needed to consider equally the

36 | Autumn 2022 Coeliac Link

importance of food budgeting and reducing food waste alongside how the food looked and tasted. They also wanted to ensure that everyone regardless of their dietary restrictions could gather around a table and enjoy a meal together. Having catered for friends who are both coeliac and gluten intolerant the decision to make the recipes gluten free was an easy one.

Tracey and Jessi learnt about food and how to cook from their mothers and grandmothers. This tradition of an older woman teaching a younger woman, handing down techniques and knowledge, was also the foundation of their own cooking relationship with each other and the beginning of Peace and Comfort Kitchen. Coeliac New Zealand is fortunate to have partnered with Peace and Comfort Kitchen to share their favourite family recipes in this issue of Coeliac Link. Look out for more about their zoom cooking demonstrations during Coeliac Awareness Week (June 6-12) on upcoming member newsletters! CL ____

You can purchase the Peace and Comfort Meal Planner and Recipe e-book with 100 healthy and delicious gluten and dairy free recipes, for $20 at peaceandcomfortkitchen.co.nz. Let them know if you tried and loved any of their recipes via email at hello@peaceandcomfortkitchen.co.nz or go and give them a follow on Instagram @peaceandcomfortkitchen.

CHICKEN

WITH

A N D

COM F O RT

K ITCH EN

/ Recipe

CARAMELIZED ONION CHICKEN

1kg chicken thighs Extra virgin olive oil 1 tsp ground cinnamon 1 tsp allspice Salt and pepper

1. Preheat oven to 180°C. fan bake. 2. Slice onions thinly with a mandoline or sharp knife. 3. Heat olive oil in a frying pan on medium heat and add onion slices. Stir until onion is well coated with the oil.

RICE

1 cup basmati rice Salt Handful fresh coriander Coconut yoghurt

4. Place lid on the pan and cook for about 30 minutes, stirring from time to time. Onion should be a golden

2 kg brown onions cup extra virgin olive oil ¾ cup raw honey ½ cup balsamic vinegar 2 handfuls currants (optional)

saucepan with a sprinkle of salt. Cover with water. Bring to the boil and turn down to simmer until rice is cooked. Strain off any excess water. 8. Stir in ¼ cup of caramelised onions and chopped fresh coriander to flavour the rice. 9. To serve, place rice on the plate

in colour, softened and caramelised

and top with cooked chicken and

when ready.

layer up with caramelised onion.

5. Add raw honey, balsamic vinegar CARAMELISED ONION

7. Rinse rice and place in a large

and currants. Continue cooking uncovered until the liquid has reduced and thickened. 6. Massage chicken thighs with

Finish with a sprinkle of fresh coriander and serve with plain yoghurt and a fresh garden salad. ____

Serves 4.

olive oil, cinnamon, allspice and a sprinkle of salt and pepper. Roast in oven for about 40 minutes or until juices run clear.

TIPS ____

Serve with coconut YO G H U RT

and a fresh

GARDEN

salad.

____

Having catered for friends who are both coeliac and gluten intolerant the decision to make the recipes gluten free was an easy one. coeliac.org.nz | 37

Recipes / L E E K U M K E E

Get ready to indulge, guilt free! ME IN TH I KE

•

• NO B

OX SB

GLUTEN FREE PRAWN PHO MASON JARS

REQ U

Enjoy!

INGREDIENTS

1 tbsp Lee Kum Kee Gluten Free Soy Sauce 1 tsp Lee Kum Kee Chilli Garlic Sauce 1 tsp fish sauce 60ml coconut milk 1 small nest of gluten free rice noodles (approximately 50g per person) cooked and drained 5 cooked king prawns 1 small courgette, spiralised 3 pcs broccoli florets par-cooked or frozen 2 tbsp frozen peas 1 Spring onion, thinly sliced

1. Add the first 4 ingredients to a mason jar, stir then add in the rest. Keep in the fridge. 2. At lunchtime, take the jar out of the fridge 20 minutes before you want to eat. Heat broth by tipping the broth in a

Proudly supporting Coeliac Awareness Week.

mug and heat in a microwave till boiling (approximately 2-3 minutes). Pour hot broth into

BROTH

250ml gluten free chicken broth

Introducing our new Raw Slice Mixes range, available in three café favourite flavours; Cacao Brownie, Zesty Lemon and Smooth Caramel. Packed full of healthy ingredients such as almonds and dates, each delicious mix is Gluten Free, Refined Sugar Free and 100% Plant Based, and at less than 200 calories per serve, they make the perfect guilt free treat. All you need is a couple of extra ingredients and a fridge freezer to set your slice – no baking is required.

6 – 12 June 2022

the mason jar, cover and leave for 5 mins. 3. Add garnish and enjoy

GARNISH

A few leaves of fresh coriander 1 Lime wedge

directly from the jar or tip into a bowl. Yum! ____

Serves 1

L E E K U M K E E – P R O U D TO S U P P O R T CO E L I AC AWA R E N E S S W E E K

Available from Countdown stores and selected New World stores nationwide.

For more information, visit our website www.freshlifefood.co.nz @FreshlifeFood

Recipes / M O R G A N M C K E N Z I E M O O R E

YOUT H

W O R KO U T S M O OT H I E

INGREDIENTS

1 banana ½ cup of frozen fruit (blueberries and strawberries work best) 2 tbsp of nut butter 1 tbsp dehydrated vegetable powder 1 scoop of protein powder Squeeze of maple syrup 200ml of almond milk Sprinkle of LSA mix to top (optional)

This delicious and easy pre workout smoothie will boost your energy and aid in muscle building and help you achieve your training results. It’s dairy free, gluten free and plant based and is easy to have on the go. A good afternoon pick-me-up for active children as well. 1. Put all ingredients in a blender and whizz until completely smooth. If it’s a little thick, add a drop of chilled water and blitz again. Pour into glasses and drink straight away. 2. Optional: sprinkle with LSA to top (LSA: ground linseed, sunflower and almond) ____

Serves 1.

E L BL CA T. LA O E AI R L RK AV YOU MA R AT PE SU

WHEN HUNGER STRIKES, GET YOUR ™ NATURE VALLEY PROTEIN BAR. Nature Valley Gluten-Free Protein bars contain 20% of your daily protein needs. It’s a great on the go snack for your next adventure.

For more information visit: www.naturevalley.co.nz

CNZ Ambassador MORGAN McKenzie Moore achieves BLACK BELT glory! N NOVEMBER

last year, I sat my black belt grading in Seido Karate. As any martial artist knows, you don’t just get handed a black belt – it’s a tough process that requires months of preparation. In my case, it was four months of training to prepare me for the grading which would be 3.5 hours, and finished with 40 fights. A daunting prospect to say the least! Nutrition is a huge part (perhaps the most important part) of surviving this process, and while having coeliac disease can cause some hinderance, I managed to find what work best for me. Here is an example of what I ate...

My day always started with a smoothie (see page 35) – full of fruits, nut butters, vegetable powder, protein powder, and maple syrup. This was my sure-ﬁre way to get moving in the morning. The natural sugars from the fruit were a great energy boost for my morning training sessions, which usually consisted of either cardio, HIIT or weight training. Aside from being delicious and quick to make, another thing I found useful about having a smoothie for breakfast was that it’s easy to digest. This meant I

AM ASSADOR

/ Recipes

could start exercising about 45 minutes after eating with no tummy troubles. For lunch I had big meals – usually carb based on potatoes or rice, lots of beans for protein, and plenty of vegetables. The reason behind these big lunches was because I still had to train karate in the evening, and if I missed a meal, it would be about five times harder – physically and emotionally! Dinner was a variety of meals, usually a bit smaller because I would arrive home later and sleeps also important. I find that if I eat too late, I’m kept up by my digestive system working away. While this all seems like an unachievable healthy lifestyle, I would be remiss not to mention that I did eat plenty of gluten free cake and various treats between these meals. Especially because at the time I was testing new recipes, and tasting the products is the best part! On top of that, four months without cake wouldn’t have been feasible, it’s just not who I am as a person. Besides, I was nourishing my body with good food – I have to nourish my soul (with cake) as well! Reflecting on this time, I learnt that filling myself with good fuel was the most important thing I could do to take care of myself while training. Not only can you feel the effect physically on a day when you’ve had good meals – but also mentally. A coeliac diagnosis doesn’t have to get in the way of nutrition or big physical goals. In fact, you’ve already done the hard work on figuring out what definitely does not nourish your body! CL ____

Morgan is a gluten free recipe developed and creator of How to coeliac. She has a passion for food, comedy and living her best gluten free life.

coeliac.org.nz | 41

Directory / V O L U N T E E R S

Email: admin@coeliac.org.nz to check if there is a volunteer in your area.

Western Bay of Plenty Tauranga Need a volunteer – please ask! ____

NORTH

Whakatane Fiona Hennessey

ISLAN D

North of Auckland Northland Julienne Law

____

Greymouth, Hokitika Sandra and Karl Jackson

____

Hibiscus Coast Dannielle Walker ____

Auckland Auckland Ben Grant ____

Thames/Coromandel Jan Autumn

South Waikato Taupo Jill Henson

____

Cantebury Emma Prestage

____

Hawkes Bay Napier/Hastings Teresa Allen

South Canterbury Joan Simpson and Joy McNulty

____

Hawkes Bay Kids Club Fiona Lambert, Sam Wemyss

Otago Dunedin, Mosgiel, and Port Chalmers Heather Wilson

____

Manawatu/Wanganui Pip Meads

____

Mercury Bay Judi Foster

____

Oamaru, Palmerston Rebecca Heffernan

____

Waikato Hamilton Marina Grantham-Campbell

Wellington Kids Club Nerys Foster

____

Dunedin Kids Club Dunedin Lisa Russell

____

SOUTH

I SLA ND

Nelson Margaret Watson

____

Hamilton Kids Club Leagh-Ann Wesselson

____

Wanaka Kids Club Zoe Huggett

Nelson Kids Club Jocelyn Hendry

____

Cambridge Robyn-Anne Teal

____

Marlborough Need a volunteer – please ask!

____

Eastern BOP Kids Club Lizzy Eckersley

West Coast Reefton, Westport, and Karamea Barry Chalmers

Gore/Invercargill Becky Maarschalk ____

____

A BIG THANKS to our funders – COGS, Lottery Grants Board, Pub Charity, The Lion Foundation, and Pub Charity, and the Aotearoa Gaming Trust – without whose support we would not be able to deliver educational tools to increase diagnosis, or develop resources to support the everyday existence of people living with coeliac disease.

Join the team to learn new skills and connect with people in your community

IT’S B ETTE R TO G ETH E R

FIND OUT HOW! Email: admin@coeliac.org.nz

VOLUNTEERING IS ESSENTIAL TO OUR O RG A N I SAT I O N

____

42 | Summer 2019 Coeliac Link

SOPHIE

Volunteer Coordinator

ENDORSED

A & NZ ALI TR

ELIAC AU CO S BY

Coeliac Link, Autumn 2022

Articles inside

A note from the General Manager

News

Dining Out Programme

Elderly onset coeliac disease

From the regions