Car Breakdown – How would you cope in this situation?
Winter is coming!
In Ireland and the United Kingdom we are coming into Winter when we can have flooding, icy roads, occasional severe snow storms and collisions to contend with never mind the “everyday” car breakdowns we all experience from time to time!
Car Breakdown
In a motor car breakdown, coeliacs should first focus on standard roadside safety procedures and then manage their dietary needs using a pre-packed gluten-free emergency food kit.
Immediate Breakdown Actions
- Stay Safe: Move the vehicle away from moving traffic if possible (e.g., to a lay-by, service station, or hard shoulder) and turn on hazard lights.
- Exit Safely: If it’s safe, all passengers should exit the car on the side away from traffic and wait behind a barrier.
- Call for Help: Use a mobile phone or an emergency roadside phone (found on motorways) to contact your breakdown provider or the police.
- Stay Calm: Panic can make any situation worse. Focus on safety and then on managing your specific needs.
Managing Coeliac Needs (Food and Drink)
The main challenge for a coeliac during a breakdown will be the potential for a long wait without access to safe food. This makes carrying an emergency supply essential.
Emergency Food Kit (to be kept in the car):
- Water/Fluids: Keep a supply of bottled water to stay hydrated, which is crucial, especially if symptoms like diarrhoea or vomiting occur.
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Shelf-stable Gluten-Free Foods: Pack nutrient-dense items with a long shelf life.
- Protein bars/Energy bars: Ensure they are certified gluten-free.
- Nuts and Seeds: Vacuum-sealed nuts, dried fruits, and trail mixes (check labels for cross-contamination risks).
- Canned goods: Small, easy-open cans or shelf-stable pouches of tuna, chicken, or beans (remember a can opener).
- Gluten-free crackers/bread: Shelf-stable options of crackers or bread.
- Applesauce/Fruit pouches: Convenient for easy consumption.
- Simple Utensils: A small kit with plastic utensils and disinfectant wipes.
- Medication: Any personal medications, including any specific remedies you might use after accidental gluten exposure (e.g., activated charcoal, ginger or peppermint tea bags, probiotics, anti-inflammatories).
During the Wait:
- Avoid Fast Food/Roadside Options (if unprepared): Most standard fast-food or convenience-store options pose a high risk of cross-contamination and should be avoided. Stick to your emergency kit.
- Stay Informed: If a lengthy delay or an overnight stay in a hotel becomes necessary, use your phone to research local grocery stores or restaurants with verified gluten-free options and call ahead to confirm procedures for preventing cross-contamination.
- Rest: The stress of a breakdown and the risk of accidental exposure can be taxing. Get as much rest as possible.
Long-term Preparedness:
- Rotate Stock: Check and replace items in your emergency kit every few months to ensure freshness and prevent expiration.
- Travel Insurance: Ensure your travel insurance policy covers pre-existing medical conditions like coeliac disease, just in case of an extended issue.
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Vending Machines and Nutritional Standards
The Food Standards Agency and Public Health Agency in Northern Ireland have recently issued their renewed Nutritional Standards for Catering in Health & Social Care in Northern Irish Hospitals.
We have been corresponding with the Standards Steering Group for some time and they have confirmed that Coeliacs and other folk on special diets were not considered when the Standards were agreed.
However, the Steering Group did say that food products suitable for Coeliacs would be available in Hospital Vending machines leading me to ask what, exactly, did the Steering Group members know about Coeliac Disease?
Coeliacs know to be extremely cautious when buying food from standard vending machines and, where possible, avoid them unless they can verify the gluten-free status and be confident there is no cross-contamination risk.
The main challenges and risks are:
- Inability to read labels: It can be very difficult or impossible to read the ingredient list and allergen information on a product while it is inside the machine. You cannot check for hidden gluten sources (like malt or modified food starch) or “may contain” statements.
- Cross-contamination: Even if a snack is inherently gluten-free (like plain crisps or certain chocolates), the shared environment of the vending machine and its dispenser can pose a cross-contamination risk, such as from crumbs of other products.
- Lack of regulation within the machine: While food labelled “gluten-free” is regulated to contain less than 20 parts per million (ppm) of gluten, the vending machine environment itself is not subject to these controls, meaning an otherwise safe product could be contaminated after being put in the machine.
- General availability: Most standard vending machines primarily stock popular snacks that contain gluten, making safe options a rarity.
Safer Approaches
- Bring your own food: The safest option for a coeliac is to bring their own pre-prepared, safe snacks and meals, especially when working remotely or during shifts where other options are unavailable.
- Dedicated gluten-free vending: Some modern or healthy vending machines may be specifically stocked with clearly labelled, certified gluten-free products and potentially have protocols to reduce contamination risk, but these are not common.
- Research brands beforehand: If you are in a pinch, you can research specific brands and products online to verify their gluten-free status before purchasing, though this does not mitigate cross-contamination within the machine itself.
- Choose naturally gluten-free items (with caution): Items like whole fruits or some nuts are naturally gluten-free, but still carry the risk of cross-contamination from handling or packaging.
In short, the difficulty in verifying ingredients and the risk of cross-contamination make standard vending machines generally unsafe for people with coeliac disease.
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Have you an opinion on food from Vending machines and, if so, we would be delighted to hear it!
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Gluten Allergy v Coeliac Disease
We read recently about an elderly Coeliac lady in Hospital being fed food that was making her ill. When her family raised queries they discovered her Hospital notes said that she had a “Wheat Allergy” with no mention of Coeliac Disease!
This is another example of poor Coeliac Disease training in our Hospitals!
For the record, these are related but distinct conditions:
Coeliac Disease
This is an autoimmune disorder where eating gluten triggers your immune system to attack your own small intestine. When someone with Coeliac disease consumes gluten, it damages the villi (tiny finger-like projections lining the small intestine), which impairs nutrient absorption.
- Immune response: Autoimmune (body attacks itself)
- Severity: Can cause serious long-term damage if untreated
- Diagnosis: Blood tests for specific antibodies, confirmed by intestinal biopsy
- Prevalence: Affects about 1% of the population
- Complications: Can lead to malnutrition, osteoporosis, infertility, neurological problems, and increased cancer risk if untreated
Gluten Allergy (Wheat Allergy)
This is a traditional allergic reaction to proteins found in wheat (including but not limited to gluten). Your immune system produces IgE antibodies against wheat proteins.
- Immune response: Allergic (immediate hypersensitivity reaction)
- Symptoms: Can range from hives, swelling, difficulty breathing to anaphylaxis
- Onset: Usually rapid (minutes to hours after exposure)
- Diagnosis: Skin prick tests or blood tests for IgE antibodies
- Scope: Reaction is to wheat specifically, not necessarily all gluten-containing grains
Non-Coeliac Gluten Sensitivity
There’s also a third category worth mentioning – people who experience symptoms when eating gluten but don’t have Coeliac disease or wheat allergy. This is less well understood and has no specific diagnostic test.
The key distinction: Coeliac is autoimmune with intestinal damage, wheat allergy is an allergic reaction, and both require avoiding gluten/wheat but for different biological reasons.
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