Fermented food for the Family

 The production and consumption of fermented foods have been part of many different cultures for a long time, as a way both of preserving food, and adding nutritional and probiotic value. Ever heard of lacto-fermentation? It is one of the simplest processes used in making fermented foods like Sauerkraut, Kimchi and pickled cucumbers. This process involves submerging the vegetables in a brine which creates an anaerobic environment (no oxygen present) for a period (often several weeks depending on the temperature) until the bacteria present, are predominantly lactic acid bacteria. Studies of the bacterial cultures present in lacto-fermented Sauerkraut have found a predominance of Lactobacillus and Leuconostoc species, as well as Weissella, Enterobacteriaceae and Lactococcus1. The ‘living’ nature of these lacto-fermented foods is different to many store-bought ‘pickled’ vegetables, which are preserved in vinegar and contain few live bacteria. All of this is relevant to an evolving area of health and physiology called the gut microbiota. Associations have been found between lower bacterial diversity in the gut and many different health conditions including, inflammatory bowel disease, obesity, coeliac disease, psoriatic arthritis, type 1 and 2 diabetes, atopic eczema and blood vessel stiffness2. Diet has a strong influence on gut microbiota composition2. Probiotic supplements, many of which contain lactobacilli species, may have several beneficial effects on human health however, further research is required to clarify these benefits compared to an improved diet alone. There is still much to be learned in this area. Having a diet that includes a variety of live bacterial cultures, such as those in fermented foods, may have health benefits. Perhaps a spoonful of sauerkraut per day might help to keep the doctor away? Gastroenterologist, Dr Josh Butt has an interest in the health benefits of fermented foods. He enjoys not only the delicious flavours, but also the process of creating fermented foods. It is an activity he likes to get the whole family involved in. Below, he shares his simple sauerkraut recipe. JOSH’S EASY SAUERKRAUT UtensilsFermenting Crock or some sort of glass jar/ ceramic vessel washed with warm soapy water and rinsed wellKnifeChopping boardWeight to put in the crock or jar – could be a small saucer or similar Ingredients1 Large cabbage (can be white or purple) approx. 1kgNon-iodised salt approx. 20g Directions Wash your cabbage and remove any damaged outer leaves. Keep two clean outer leaves for later. Remove the core and then finely shred the cabbage using a sharp knife or food processor. Put the shredded cabbage into a ceramic or plastic bowl and sprinkle over the salt (we use approximately 2% salt but you may prefer slightly more or less).Allow it to rest for a few minutes before massaging the salt & cabbage leaves together with your fingers (or giving them a gentle pound) until the water from the cabbage starts being released. Put the cabbage into your clean vessel and continue to compress it down until enough water has been released to completely submerge the shredded cabbage. Lay the washed and reserved cabbage leaves over the top of the shredded cabbage to hold it all down. The cabbage may want to float up – in which case, weighing it down can be helpful. The weight should also be completely covered in the water that has come out of the cabbage to prevent it from growing unhealthy bacteria. Once you have the cabbage pressed down in your crock (or jar), place the lid on the crock (or jar) without screwing it down. Alternatively, you can use a tea towel over the open top. You don’t want to seal it as gas will form as part of the fermentation process, and if the crock or jar is sealed with the lid on, the jar may explode. Place the jar into a cool part of the house and let it sit. You can taste it at various points to see how crunchy/ tangy it is. In warmer weather it will be ready sooner, in winter it may take 3-4 weeks. At the end it should be slightly soft, yet still with texture and bite, and it should have a lovely zingy feeling on your tongue. References:
  1. Zabat MA, Sano WH, Wurster JI, Cabral DJ, Belenky P. Microbial Community Analysis of Sauerkraut Fermentation Reveals a Stable and Rapidly Established Community.Foods. 2018;7(5):77. Published 2018 May 12. doi:10.3390/foods7050077
  2. Valdes AM, Walter J, Segal E, Spector TD. Role of the gut microbiota in nutrition and health.BMJ. 2018;361:k2179. Published 2018 Jun 13. doi:10.1136/bmj.k2179
   
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Is it Coeliac Disease OR Gluten Intolerance?

Many people will tell us that they simply feel better when they don’t eat gluten.Gluten is a protein found in wheat, barley and rye and many find that when they omit gluten from their diet, that their symptoms subside. Could it be Coeliac Disease or is it Gluten (wheat) Intolerance? It can be hard to know, as both coeliac disease and gluten (wheat) intolerance present with similar symptoms like, abdominal pain, bloating, diarrhoea, constipation, fatigue, headaches, nausea, vomiting, skin conditions and joint pain. There is increasing evidence of symptoms such as anxiety and feelings of depression too. The severity of symptoms will vary from person to person for both conditions. A lot of patients with coeliac disease do not have symptoms.  Why is it important to know? If the symptoms go away when you stop eating gluten, wouldn’t you just omit gluten from your diet? Do you need an actual diagnosis? The answer is YES.It is important to have a definitive diagnosis, because both conditions are quite different in terms of the long-term implications.  Let’s start by explaining the difference between the two conditions. Coeliac Disease In coeliac disease, the presence of gluten stimulates the immune system to attack the lining of the small intestine. The resulting damage to the intestines is called villous atrophy. As coeliac disease is autoimmune in nature, the gluten doesn’t directly cause the damage, instead it triggers the immune system to cause the damage. This is particularly worrying, as it means the body is unable to properly absorb much-needed nutrients and minerals when food is digested. Whilst there is no cure for coeliac disease, following a strict gluten-free diet is recommended as it helps minimise symptoms and keep the condition at bay. This is vital, even if symptoms are very mild, as even the smallest amount can have detrimental effects on the body. These long- term risks include osteoporosis, other autoimmune conditions such as thyroid disease, type 1 diabetes and rheumatoid arthritis. Coeliac disease may also contribute to the development of anaemia (low blood count), micronutrient deficiencies (e.g. iron, folate, B12, calcium, vitamin D), malnutrition, depression, infertility, and even cancer, if left untreated. The long-term risks resolve on a strict gluten free diet. Knowing the diagnosis will mean that appropriate medical assessments can take place. Gluten (Wheat) Intolerance With gluten (wheat) intolerance, the mechanism is poorly understood, but it is thought that there is a direct reaction to wheat, gluten or even the carbohydrates (FODMAPs) in wheat during the process of digestion, causing abdominal symptoms. There is still no actual ‘test’ for gluten (wheat) intolerance, and scientists are yet to determine the root cause of the condition. Unlike people with coeliac disease, people with a gluten (wheat) intolerance may find they can tolerate a small amount of gluten in their diets, and there are no long term heath problems.   Testing for coeliac disease is a 3 step process 1. The Gluten Challenge It is important to be on a normal diet (including gluten) for 6 weeks prior to testing. The Gluten Challenge requires adults to eat a minimum of 4 slices of wheat based bread (or equivalent) each day. The amount is halved for children. 2. Screening using a blood test The coeliac serology (blood test) measures antibody levels in the blood, which are typically elevated in people with untreated coeliac disease, due to the body’s reaction to gluten. Immediate relatives of those diagnosed with coeliac disease should also be screened.A diagnosis of coeliac disease should not be made on the blood test alone. A positive blood test always needs to be followed by a small bowel biopsy to provide a definitive diagnosis. Also coeliac serology is negative in 5-10% of patients with coeliac disease. 3. A small bowel biopsy is essential to confirm diagnosis This involves a gastroscopy, which is a simple day procedure performed whilst under a light anaesthetic sedation. During this procedure, several tiny samples (biopsies) are taken from the small bowel. These biopsies are examined under a microscope to confirm the presence of villous atrophy (damage to the intestinal lining). If positive for villous atrophy, then the diagnosis for coeliac disease is positive. If the biopsy is negative for villous atrophy, you do not have coeliac disease even if the serology is positive (false positive serology occurs in 3-5% of people). There may be other reasons for your symptoms, one if which could be Gluten (wheat) Intolerance. In addition, there’s gene testing Gene testing (HLA genes) may be useful only in select cases where the diagnosis of coeliac disease is unclear. It is performed on a blood test by your doctor. The gene test on its own cannot diagnose coeliac disease. If the gene test is positive, confirmation of coeliac disease still requires serology and a small bowel biopsy. Gene testing can be helpful if you have symptoms but the coeliac serology is negative. If the gene test is negative it effectively rules out coeliac disease.  In Summary It is important to know if you have coeliac disease because it is imperative that you stick to a gluten free diet and are assessed for possible complications of this condition for the long term. If managed effectively, those with coeliac disease manage very well. If you do not have coeliac disease, your doctor may investigate further to rule out other conditions, but may confirm that it is in fact gluten (wheat) intolerance. However, before cutting anything out, it’s important sufferers check in with their GP first to make sure it’s gluten causing the reaction and not another condition entirely, such as irritable bowel syndrome. For further information on coeliac disease or other gastroenterological conditions please visit gastronorth.com.au/If you have been referred for a gastroscopy to confirm coeliac disease please call us on 9468 9700.  
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