One of the first restricted diets to really infiltrate the mainstream, certainly in the west, was gluten-free food. Many of those avoiding gluten do so because they have a sensitivity or an intolerance that causes bloating and some other digestive issues. Celiac disease, on the other hand, is an autoimmune issue whereby gluten damages the small intestine.

Causing great discomfort and bowel issues, celiac disease affects a small percentage of the population, between 0.5-1%. However, a far greater number, between 20-30%, of people carry the HLA-DQ gene which carries with it a predisposition to celiac disease. The issue impacts children more so than adults, afflicting females more than males too. The fact is that over 95% of sufferers are undiagnosed.

Left untreated celiac disease can increase the risk of some cancers while also increasing the risk of diabetes type 2, epilepsy and dermatitis, plus a whole array of other conditions.

Gluten, a protein that’s found in wheat as well as rye and barley, affects the cells of the small intestines, leading to malabsorption. A strict gluten-free diet needs to be followed to prevent problems since there’s no cure for celiac disease. Nutrition is the main medical intervention.

With fruits, vegetables, seafood and meats not containing any gluten, there’s a lot of choice for meat-eaters, pescatarians and those who value a plant-based diet. Beans and legumes, as well as dairy products, are also gluten-free, while wheat, ryes and barley are not. Oats contain a protein similar to gluten but in general can be tolerated, however they are often contaminated and unless stated to be gluten-free are best avoided. In Thailand, where baked goods and processed foods are not part of traditional cuisine, avoiding gluten is relatively easy in terms of avoiding bread. Unfortunately, some of the main Asian flavors are derived from foods that contain gluten.

A major issue for celiacs is that gluten is a widely used ingredient in many dishes and it’s important to check labels and look out for foods that contain this ‘hidden’ gluten. Soy sauce is made with fermented soybeans as well as wheat and therefore gluten is a significant ingredient. There are gluten-free varieties available in Thailand, otherwise  another choice is tamari sauce, although it’s important to check if a particular variety is low in wheat grains, and therefore just low gluten, or whether it’s entirely gluten-free. Liquid aminos can also be used as a substitute.

In Thailand, opting for the rice-noodle soup, minus any wontons, is a good option with ‘sen lek’, ‘sen mee’  and ‘sen yai’ varieties to choose from, (thin, medium and flat), whereas ‘bamee’ yellow noodles are made using wheat. These egg noodles are also used in ‘khao soi’ curry, although most curries are safe for celiacs as they usually contain coconut milk or simply water with herbs and spices.

Since gluten acts as a thickening agent, it’s often incorporated into sauces. For example, oyster sauce,  a staple in a lot of Thai dishes, often contains gluten, while fish sauce creates a strong flavor and is gluten-free.

Cross-contamination is a big issue in Thailand, not just for celiacs but anyone on a restricted diet. With many stir-fries on the menu in restaurants, the same woks and pans cook up a huge variety of ingredients.

Even salads can contain gluten if barley is used instead of Job’s tears which are gluten-free. Soy sauce is often added to Asian-inspired salad dressings too, while sauces for gyoza dumplings, dim sum and sushi all usually contain either soy sauce and/or malt vinegar, another no-no ingredient.

Other foods that also less-obviously often contain gluten are processed meats, including sausages which are rarely made without breadcrumbs, and also some vegetarian meat alternatives which frequently have with soy and/or wheat added.

Thai roti pancakes, waffles and crepes as well as fried sweet potatoes and bananas are off the menu for celiacs. However, most other traditional Thai desserts are made without gluten, although the sugar content is a consideration for those watching their weight and blood-sugar levels.

In Thailand, the growing popularity of healthier foods has put an emphasis on natural ingredients and cleaner dishes, with far more varieties that appeal to those who cannot tolerate gluten. At the same time, the types of cuisines being served in Bangkok has expanded and with it a growing number of shops and restaurants offer bread-based snacks and main meals. This increases the risk of cross-contamination while with choice can come confusion about what’s allowed and what’s not.

Many of the main supermarkets have gluten-free pastas as well as cereals that contain non-gluten ingredients such as corn, quinoa and amaranth. Of course rice, the most popular go-to carb in Asia, is safe for celiacs to eat too.

Bumrungrad Hospital not only tests for celiac disease but also offers sufferers invaluable support via their Nutrition Support Team.