4.1 Food Chemicals

Pages 131-158 from The Food Intolerance Handbook
Copyright (c) Sharla Race. All rights reserved.

4.1 FOOD CHEMICALS

Food chemicals are compounds found in food that either occur naturally or have been added during the manufacturing process.

As plants produce toxins to protect themselves from spoilage and from being eaten by predators, you cannot avoid the naturally occurring chemicals in food. You can avoid food additives but only if you avoid all forms of processed food. A food chemical, natural, or manmade, becomes a problem for some people when it is eaten in large amounts, is eaten on a regular basis, or the body cannot detoxify it due to illness or a deficiency in the metabolic pathways.

The complexity of each individual plant is immense and any one of its constituent chemicals can, potentially, cause problems for someone sensitive to it. Emsley and Fell estimate that there are about half a million natural chemicals in the food we eat.[Emsley J, Fell P. Was it something you ate? Food Intolerance: what causes it and how to avoid it. O.U.P. 1999.] Only a few of these have been identified and even fewer have been tested, analysed and their implications for health understood.

This section of the book looks at some of the natural chemicals, as well as some of the manmade versions which have often been produced to mimic those produced by nature. The information presented is based on the research done to date and will provide you with an overview of the main chemicals that have been identified as causing problems for some. The key factor to understanding how these chemicals can affect you is to understand that they are most likely cumulative in the body and will generally only cause you a problem if you exceed your own individual tolerance level.

Amines

See also Histamine, Phenylethylamine, Serotonin, Tyramine.

Amines are naturally occurring chemicals in certain foods which, like salicylates, are cumulative in the body. Over a period of time these can build up in your system causing reactions that mimic allergies. Amines are produced in food as a result of protein breakdown and/or fermentation which means they are often highly concentrated in processed foods.

If you noticed a substantial decrease in your symptoms when you simplified your diet you may want to consider testing to see if you have an amine problem. If you also regularly suffer from constipation then the amine problem could be more pronounced.

Naturally occurring amines are generally thought to act in the body as neurotransmitters and the term “biogenic amines” is now frequently applied to these. These “biogenic” amines include amongst their number—histamine, phenylethylamine, serotonin and tyramine. Each of these is dealt with separately as each has been found to have clearly defined symptoms in certain individuals.[i],[ii] Some people, however, seem to have a more general sensitivity to amines. Diets low in food chemicals usually include amines in this more general way.
[i] Joneja JV. Dietary Management of Food Allergies and Intolerances: A Comprehensive Guide. Second edition. J.A. Hall Publications, 1998.
[ii] Emsley J, Fell P. Was it something you ate? Food Intolerance: what causes it and how to avoid it. O.U.P. 1999.

Cooking certain foods, in particular meats, at high temperatures produces a set of amines that were not present before. One group of these is heterocyclic amines (HCAs). More than seventeen different types of HCAs have been found in meat cooked at high temperatures. Stewing, barbecuing and frying appear to produce the most HCAs. Gravies made from meat juices, therefore, also have a high amine content.

The other form of amine produced by cooking is polycyclic aromatic hydrocarbons (PAH). These are formed by the browning of carbohydrate based foods such as bread and are also found in foods such as smoked and grilled meats and coffee. A sensitivity to these amines can often be misinterpreted as an intolerance specific to one type of food. For example, if toast doesn't agree with you it is easy to think that wheat is the problem; if a grilled steak upsets you then you might think you have a problem with beef.

What everybody should know is that various studies have linked these types of amines with cancer. The rule of thumb here is do not overcook food and always eat your food as fresh as possible. Pickling, smoking and other forms of preserving all increase the number of amines.

There is no specific list of symptoms indicated for amines but migraines that don't respond to other treatments may be relieved by a diet low in amines. The key to testing for an amine intolerance is to reduce the amount of amines in your diet, and hence your body, over a period of two weeks. Stick to your simplified diet as much as possible but eliminate all the high amine foods.

Re-think your cooking style. Avoid over cooking anything and avoid meat cooked in sauces as these will have a high amine content. Never eat anything that has been burnt and avoid toasted breakfast cereals. After two weeks, eat some of your most favourite high amine foods and monitor your response. Remember that amines are cumulative in the body.

Some people may immediately get a reaction such as a headache or digestive problems and others will only get similar symptoms after their level has increased—this can take up two weeks so keep your food diary up to date.

At the end of the testing time, if you have felt no better at all then you are unlikely to have an amine problem. If there has been a little improvement you may want to consider reducing your level even further and seeing if that increases the improvement. You should, however, also note that individuals who are intolerant of one chemical in food often are intolerant of another so you may need to test some of the other food chemicals.

If you have had a substantial improvement then you are amine sensitive and need to now work on establishing the level of amines you can generally tolerate. At this stage you may find your tolerance is very low but that over time this may change.

Establishing the amine content of food is quite difficult as it can be greatly affected by the way food is stored, processed and cooked. Avoiding the foods in the list below for a week or two should be enough to give you an idea as to whether you are especially sensitive to amines or not.

Foods high in amines

All forms of processed meats including sausages, pâtés, bacon, salamis, deli counter cuts.
All forms of processed fish including fish cakes and fish fingers.
All smoked, salted and pickled meats and fish.
All offal including kidneys, liver and brains.
Game and other meat that has been “matured”.
Cheese (whilst some very mild cheeses may be okay it is easier, at this stage, to avoid them all)
Fermented bean products such as tofu, tempeh, bean curd, miso, soy sauce, tamari.
Pickled vegetables such as sauerkraut, gherkins and piccalillis.
Cocoa, dark chocolate, milk chocolate high in cocoa solids.
Meat extracts, gravies, sauces, yeast extracts.
Chocolate flavoured drinks, cola type drinks, vegetable and fruit juices.
Beer and wine.

Benzoates

Caffeine

Caffeine is one of three dietary methylxanthines, the other two being theobromine and theophylline. All three are readily absorbed from the gastrointestinal tract and distributed throughout the body, metabolised in the liver and excreted in the urine. Theobromine is weak in comparison to caffeine, and theophylline is only found in small concentrations in food so the only methylxanthine dealt with in this book is caffeine.

Caffeine naturally occurs in the leaves, seeds or fruits of at least sixty three plant species world-wide. The most familiar sources of caffeine in our diet are through drinks such as coffee, tea and cola. The amount of caffeine in any product varies depending on the plant variety used and also how it was prepared.

Caffeine is so readily available in coffee, tea and chocolate that we have come to accept it as harmless but the truth is that caffeine is a powerful drug that affects both your body and your mind. It has the strange quality of at first decreasing the heart rate and then increasing it about an hour after intake. It, also, has a powerful effect on the nervous system and can, in small doses, help improve concentration but the reverse takes place with a higher dose.

Even a relatively moderate amount, two to three cups of tea a day, leads to observable effects and caffeine abuse can result in symptoms that mimic mental illness. Children, because they have smaller bodies, are at greater risk from caffeine toxicity, and insomnia in children could be linked to the amount of cola drinks they consume.[i],[ii] How much caffeine you can tolerate will depend on a number of factors including the amount you consume, how often you consume it, and your individual metabolism.
[i] Bolton S, Feldman M, Null G, Revici E, Stumper L. A pilot study of some physiological and psychological effects of caffeine. J Orthomolecular Psych 1985;13(1).
[ii] Bolton S, Null G. Caffeine: Psychological Effects, Use and Abuse; Orthomolecular Psych 1981;10(2):202-211.

Some people seem to experience no noticeable effects whilst others have uncomfortable symptoms after just a small amount. Products containing caffeine are often used to boost energy which takes place as a result of caffeine's ability to stimulate adrenal gland activity. This constant abuse of the adrenal glands can, however, lead to a state of burn out where the adrenal glands quite simply become exhausted. Fatigue, although it can have many causes, can often be the result of diminished adrenal function. If this is the case, no amount of additional coffee or chocolate will help.

The speed at which your body is able to eliminate caffeine depends on factors such as age, state of health and your own unique biochemical make-up. The rate at which it is cleared is decreased by liver disease, pregnancy and oral contraceptives. Women taking oral contraceptives have been found to have significantly lower rates for breaking down caffeine than women not using these contraceptives and men.[Spiller GA. The methylxanthine beverages and foods: chemistry, consumption and health effects. Prog Clin Biol Res 1984;1: 854-6.]

Fluoroquinolines, drugs used to treat bacterial infections, impair caffeine and theophylline metabolism leading to a greater concentration in the body.[Marchbanks CR. Drug-drug interactions with fluoroquinolines. Pharacotherapy 1993,13(pt2):23S-28S.] Other medications, including theophylline, can also cause a problem as these can add to the stimulant effects of caffeine-containing foods and drinks.

Sadly, caffeine is habit forming and tolerance develops so that more and more is required to obtain the desired effect. Silverman et al found that even consuming smaller regular doses of caffeine can lead to addiction.[Silverman K, Evans SM, Strain EC, Griffiths RR. Withdrawal syndrome after the double-blind cessation of caffeine consumption. New Eng J Med 1992;327:1109-14.] A variety of conditions have been linked with a caffeine sensitivity. Charney et al, in a placebo controlled study of people with panic disorder or agoraphobia with panic attacks found that caffeine significantly increases anxiety, nervousness, fear, nausea, palpitations, restlessness and tremors. These effects all correlated with plasma caffeine levels.[Charney DS, Heninger GR, Jatlow PI. Increased anxiogenic effects of caffeine in panic disorders. Arch Gen psychiatry 1985;42:233-43.]

Observations made by Davis and Osorio suggest that caffeine may precipitate tics in susceptible children.[i] Greden found that caffeine in large quantities of tea and coffee could produce symptoms that mimic anxiety and panic disorders.[ii] Even caffeine induced urticaria has been noted.[iii],[iv] In one case a sixteen year old woman had experienced episodes of generalised urticaria for about eight years. They appeared to be linked with ingestion of cola drinks. The episodes had at times been severe enough to require emergency treatment. Various ingredients were tested using the skin prick test but were all negative. A double blind, placebo-controlled, oral challenge test, was performed with a regular cola drink and a decaffeinated cola-drink. The regular cola-drink provoked itching and urticaria on her body and legs within ten minutes. The caffeine-free cola-drink elicited no adverse reactions. A skin prick test confirmed that caffeine was the trigger.[v]
[i] Davis RE, Osorio I. Childhood caffeine tic syndrome. Pediatrics 1998;101(6):E4.
[ii] Greden JF. Anxiety or caffeinism - a diagnostic dilemma. Am J Psychiatry 1974;131:1089-92.
[iii] Gancedo SQ, Freire P, Rivas MF, Davila I, Losada E. Urticaria from caffeine. J Allergy Clin Immunol 1991;88:680-81.
[iv] Pola J, Subiza J, Armentia A, Zapata C, Hinjosa M, Losada E, Valdivieso R. Urticaria caused by caffeine. Ann Allergy 1988;60:207-8.
[v] Fernández-Nieto M, Sastre J, Quirce S. Urticaria caused by cola drink. Allergy. 2002 Oct;57(10):967-8.

The symptoms that have been linked to a caffeine sensitivity or to a high intake of caffeine include:

Agitation, Anxiety, Blood Sugar Problems, Depression, Disorientation, Dry mouth, Headache, Heartburn, Increased need to urinate, Insomnia, Irritability, Nausea, Palpitations, Panic Attacks, Restless legs syndrome, Rhinitis, Stomach problems, Sweating, Tinnitus, Tremors, Urticaria.

It is quite possible that regular headaches or migraines are linked with caffeine withdrawal. If you have any of the above symptoms and consume large amounts of caffeine then consider testing for caffeine sensitivity. The only way of assessing sensitivity is to eliminate all caffeine from the diet for ten days, reassess the situation and then reintroduce it if you choose too. If you consume large amounts of caffeine and are concerned about the effect of withdrawal symptoms then reduce the amount that you use over a period of ten days until you are as caffeine free as you can manage. Make a list of how much caffeine you consume and draw up a reducing strategy. Choose the best option for you. The foods you need to eliminate/reduce are all forms of:

Coffee, tea, chocolate and cocoa, cola drinks, guarana, mate and any other soft drinks that contain caffeine.

To be on the safe side also check any medications, supplements and tonics. Any prescribed forms of medication containing caffeine should be continued until you have discussed them with your doctor and been given permission to reduce or stop taking them.

You will either find that you very quickly begin to feel calmer and less stressed or will begin to experience withdrawal symptoms. Do not be alarmed if you find yourself feeling ill. All of the following have been linked with caffeine withdrawal: low attention span, depression, nervousness, problems sleeping, mood swings, and irritability. Drink lots of water and be gentle with yourself and let your body do the job of detoxification.

The positive changes you are looking for are an increase in energy but less manic, fewer sleeping problems, increased ability to concentrate, more relaxed, less irritable and nervous, and a peaceful sense of well being. If you experience any of the above then you really should question the sense of returning to using any products containing caffeine.

Replacements in the form of decaffeinated coffee and tea, caffeine free drinks and carob bars are all now readily available and make acceptable substitutes. If you do return to using caffeine products ensure you keep them to a minimum in your diet—if you don't then before you know it all the symptoms will have returned. For example, some people may get away with two cups of coffee and a bar of chocolate, or three cups of tea, or two cans of cola and some may not be able to tolerate any at all.

If you have gone through withdrawal then the safest course of action is to quite simply say NO to caffeine. This also applies to anyone that has or is suffering from anxiety or depression as the intensity of both of these states can be exacerbated by caffeine.

The amount of caffeine in various products is a matter of some dispute. For example, some studies show no caffeine in chocolate, others have shown a large amount. As caffeine has definitely been found in chocolate and cocoa it is safest to eliminate it at this time. Also please note that even decaffeinated drinks may still contain some caffeine albeit in small amounts.

One example of estimated amounts of caffeine in products comes from a UK survey:[MAFF Survey of caffeine and other methylxanthines in energy drinks and other caffeine-containing products (updated). Food Surveillance Information Sheet, (144): 26pp, March 1998 (No 103 revised).]

Non decaffeinated cola drinks 33 to 213 mg/l
Low caffeine colas                      less than 0.2 mg/l
Energy drinks 0.5 to 349 mg/l
Standard tea products                95 to 430 mg/l
Instant and ground coffee          105 to 340 mg/l
Decaffeinated instant coffee       10 to 11 mg/l
Chocolate products                    5.5 to 710 mg/kg
(highest levels in chocolate bars)

Be cautious if your caffeine intake is mainly from cola drinks and your preference is for the diet free variety as these tend to be higher in caffeine than full sugar colas.[http://www.mayoclinic.com/health/caffeine/AN01211]

Rozin et al found that a chocolate bar contains 20mg of caffeine compared to 80-100mg in a cup of coffee. This relatively low dose in comparison with other sources of caffeine, such as coffee and cola drinks, which are not craved to the same extent, suggests that caffeine is not the major reason that chocolate is craved. However, if you are extremely sensitive to caffeine it could be a problem.[Rozin P, Leveine E, Stoess C. Chocolate craving and liking. Appetite 1991;17:199-212.]

Capsaicin

The genus “capsicum” encompasses several species including chilli peppers, red peppers, and paprika. Capsaicin is the most important biologically active compound within these and it is known for providing pain relief in conditions such as arthritis and neuralgia. It can also have an adverse effect if you are sensitive to it.

The most common adverse reaction is a burning sensation in the mouth but others have also been noted. Serio et al outline a case of plasma cell gingivitis linked with exposure to capsaicin.[Serio FG, Siegal MA, Slade BE. Plasma cell gingivitis of unusual origin: A case report. J Periodontol 1991;62:390-3.] Myers et al found it led to a significant increase in gastric acid secretion as well as mucosal bleeding.[Myers BM, Smith L, Graham DY. Effect of red pepper and black pepper on the stomach. Am J Gastronterol 1987;82:211-14.] Evidence of nausea, vomiting and abdominal pain after ingestion have also been noted, and exposure in the workplace has led to cases of coughs being linked with its inhalation and to contact dermatitis.

To test for a sensitivity eliminate all of the following from your diet for at least five days:

Bell pepper, cayenne, cherry pepper, chilli, cone pepper, green pepper, hot pepper, paprika, red chilli, spur pepper, sweet pepper, tabasco.

Be very careful with any pre-prepared meals and sauces or restaurant food as some of these may contain capsaicin under the term “spices”. After the elimination period, test by eating whichever one you used to eat most often in as simple a form as possible. If you get a reaction then wait another five days before trying a different food from the list.

The reason for testing more than one is to ensure that the problems you are experiencing stem from capsaicin and not the individual food. If you experience no reaction then capsaicin is unlikely to be a problem for you.

Gluten

See also: Grains, Wheat.

Gluten is made up of a number of proteins including gliadin and naturally occurs in a number of grains.

Gluten has been linked with a number of conditions most notably dermatitis herpetiformis and coeliac disease. Atherton states that there can be no real doubt that dietary gluten is responsible for most, if not all dermatitis herpetiformis.[Atherton DJ. Diagnosis and management of skin disorders caused by food allergy. Ann Allergy 1984;53(6Pt2):623-8.] Feighery writes that coeliac disease is an inflammatory disease of the upper small intestine and results from gluten ingestion in genetically susceptible individuals. Treatment consists of permanent withdrawal of gluten from the diet resulting in complete remission.[Feighery C. Coeliac Disease. BMJ 1999;319:236-39.]

Other conditions have also been found to be linked with gluten sensitivity. These include Crohn’s disease, diabetes, irritable bowel syndrome, and rheumatoid arthritis.[ Braly J., Hoggan R. Dangerous Grains. Avery, 2002.] In one study, twenty individuals who had suffered from recurrent aphthous ulcers, some for more than eleven years, were given a gluten-free diet to follow. Five of these became ulcer free and when challenge tested with gluten the ulcers returned.[Wray D. Gluten-sensitive recurrent aphthous stomatitis. Dig Dis Sci 1981;26:737-740.]

Mental symptoms that respond to no other treatment may also benefit from a gluten-free diet. In the book Brain Allergies, Philpott and Kalita note that "After years of observing maladaptive mental reactions to foods, most orthomolecular-ecologic psychiatrists would agree that gluten is the most frequent and severe symptom reactor of all foods".[Philpott W H, Kalita D H. Brain Allergies: The Psychonutrient and Magnetic Connections. Keats 2000.]

Braly and Hoggan explore the links that have been found between gluten sensitivity and various “brain disorders” including ADHD, autism, depression, epilepsy, multiple sclerosis, schizophrenia, senility, and sleeping problems. Whilst links are being found the authors acknowledge that a great deal more research needs to be done so that links between brain disorders and diet are taken seriously.[Braly J., Hoggan R. Dangerous Grains. Avery, 2002.]

The gluten grains are barley, rye and wheat. Oats are also included and on a gluten-free diet should at least in the first instance be excluded but then tested as some gluten sensitives have found them safe. There are tests available that will establish if you have a gluten sensitivity but you can also exclude gluten from your diet to see if there is any improvement. The difficulty is that if you see an improvement you will not know if it is because of a grain sensitivity (to one or more of those excluded) or a gluten intolerance. Given this difficulty you would be advised to test the grains individually over a period of time to ensure that you are clear about what it is that is causing you problems, this will help prevent you limiting your diet unnecessarily.

If you need to eat a gluten-free diet you will need to avoid all foods that contain wheat (including spelt, triticale and kamut), rye, barley and possibly oats. Alternatives will need to be found for bread, cakes, pastries and biscuits. It is also essential that you check all processed foods, including meats, to avoid accidental ingestion.

Although oats are often excluded on a gluten-free diet there is increasing amounts of evidence that they are in fact tolerated by many individuals with a measurable gluten sensitivity; it is also now possible to buy oats that are certified as being gluten free. Janatuninen et al, in a study of adults with coeliac disease, compared the effects of a gluten-free diet including oats with a conventional gluten-free diet. They concluded that adults with coeliac disease can consume moderate amounts of oats without adverse immunological effects.[Janatuinen E K, Kemppainen T A, Pikkarainen P H, Holm K H, Kosma V-M, Uusitupa M I J, Maki M, Julkunen R J K. Lack of cellular and humoral immunological responses to oats in adults with coeliac disease. Gut 2000;46:327-31.]

Hallert et al carried out a review of published reports in 1999 and also presented details of their own experience at including oats in the gluten-free diets of adults. They found oats to be safe and well tolerated by adults with coeliac disease and dermatitis herpetiformis, though the risk of wheat contamination of commercial oat products was a cause of concern.[Hallert C, Olsson M, Storsrud S, Lenner RA, Kilander A, Stenhammar L. Oats can be included in gluten-free diet. Lakartidningen 1999;96(30-31):3339-40.]

Reunala et al carried out a study to ascertain the tolerance to oats by individuals with dermatitis herpetiformis. Eleven individuals on gluten-free diets with the condition were challenged daily with 50g oats for six months. A control group comprised of eleven people with dermatitis herpetiformis on a conventional gluten-free diet were also studied. Eight of those challenged with oats remained symptom free, two developed a transient rash, and one withdrew because of the appearance of a more persistent but mild rash. It should be noted that three of the eleven controls also developed a transient rash. Various tests were conducted to measure the impact, if any, of the oats, and the conclusions were that oats do not affect gluten sensitive small bowel mucosa and indicate that dermatitis herpetiformis is not activated by eating oats.[Reunala T, Collin P, Holm K, Pikkarainen P, Miettinen A, Vuolteenaho N, Maki M. Tolerance to oats in dermatitis herpetiformis. Gut 1998;43(4):490-3.]

Given this evidence the wisest course may be to, at first, exclude oats along with the other grains and then, once the condition has been stabilised, to test oats but only those classed as gluten-free.

Although gluten is now seen as the cause of coeliac disease this was not always the case. As Gottschall tells us, prior to 1952, coeliac disease was being treated as a carbohydrate intolerance problem by a specific carbohydrate avoidance diet. She argues that the gluten-free diet does not work for all sufferers because of the continued use of carbohydrates. It is certainly the case that straightforward avoidance of gluten does not work for everyone. [Gottschall E. Whatever happened to the cure for coeliac disease? Nutritional Therapy Today. 1997:7(1):8-11.]

It cannot be disputed that gluten-free diets help many people but the reality is that for some individuals with dermatitis herpetiformis and/or coeliac disease removal of gluten is not the answer or at least not the whole answer. A study by Faulkner-Hogg et al found that some individuals with coeliac disease who did not wholly improve on a gluten-free diet were sensitive to salicylate. On testing, salicylate was found to provoke diarrhoea, headache, nausea and flatulence.[Faulkner-Hogg KB, Selby WS, Loblay RH, Morrow AW. . Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999;34(8):784-9.]

Braly and Hoggan recognised that some coeliac patients continued to have symptoms even after following a strict gluten-free diet. Their symptoms improved or disappeared when their other food sensitivities were identified. The most common problem foods were found to be milk, soy, corn, egg, citrus fruit, and seafood.[Braly J., Hoggan R. Dangerous Grains. Avery, 2002.]

An Australian study set out to explore why some people with coeliac disease continue to have symptoms even when following a gluten-free diet. Thirty nine adults who had persistent gastrointestinal symptoms despite adhering to a gluten-free diet were evaluated. They discovered that twenty two were consuming a gluten-free diet as defined by the WHO/FAO Codex Alimentarius (Codex-GFD) in which foods containing up to 0.3% of protein from gluten-containing grains can be labelled as “gluten free”. The remaining seventeen were following a “no detectable gluten diet” as defined by Food Standards, Australia.

All thirty nine followed the “no detectable gluten diet” during the study. For five, of the twenty two who made the change in diet, symptoms disappeared and were reduced for a further ten. Food elimination diets were then tried with thirty-one of the participants leading to further improvement for twenty four of them. The three most common problems were soya, amines and salicylates. They argue that if symptoms persist after following a “no detectable gluten diet” then other food sensitivities should be explored.[Faulkner-Hogg KB, Selby WS, Loblay RH, Morrow AW. . Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999;34(8):784-9.]

The way food is labelled varies from country to country. In the UK, January 2012 saw the introduction of new rules on how food can be labelled with claims about gluten. The law covers all food, whether it is in a packet on a supermarket shelf, on a menu in a restaurant, or at a deli counter. This means that any food making claims about gluten content has to stick to strict low levels. These rules mean that food can be labelled as:

Gluten-free—these foods are suitable for people with coeliac disease (they can have no more than 20 parts of gluten per million).
Very low gluten— small amounts of these foods can be eaten by most coeliacs, but they should get advice from a dietitian or health professional about how often they can eat them. (These foods must contain no more than 100 parts of gluten per million, and must contain ingredients that have been specially processed to reduce their gluten content, so this labelling will be mostly found on specialist products).
The phrase “suitable for coeliacs”, can only be used alongside the terms “gluten-free” or “very low gluten” and can’t be used on its own.[FSA. Claims about gluten: consumer advice. Jan. 2012. http://www.food.gov.uk/multimedia/pdfs/publication/glutenconsumer.pdf]

To avoid gluten you need to very carefully check the ingredients of all foods. Some of the terms that might indicate the presence of gluten include:

Baking powder, barley, barley grass, barley malt, beer, blue cheese, bran, bread, bulgar, caramel, cereal, couscous, dextrins, durum, farina, flour, groats, gum, HPP (hydrolyzed plant protein), HVP (hydrolyzed vegetable protein), kamut, malt, matzo, miso, MSG (monosodium glutamate), mustard powder, oats, pearl barley, rice malt, rye, semolina, soy sauce, spelt, starch, stock cubes, teriyaki sauce, TPP (textured plant protein), triticale, TVP (textured vegetable protein),wheat, wheatgerm.

The addictive nature of some foods and food chemicals is not something that there is general agreement about yet it is something that undeniably exists. One of the difficulties seems to be when a food, or aspect of a food like gluten, is reduced in the diet but not fully eliminated and this constant small amount in the body seems to lead to cravings for products that contain the food or food chemical. Braly and Hoggan make specific reference to the addictive nature of gluten and the problems this causes some individuals when first attempting to eat a gluten free diet.[Braly J., Hoggan R. Dangerous Grains. Avery, 2002.]

The same authors also note that a powerful tobacco addiction can indicate a sensitivity to gluten. They write that smoking “can amount to a form of neurochemical ‘self-medication’ for those who have problems with gluten”. For individuals affected in this way, attempting to stop smoking before they have dealt with their gluten problem can lead to depression and mood disturbances.