Gluten Free Travel: Lake Como (Menaggio and Bellagio) and Milan, Italy

Menaggio, Lake Como

On the outside Italy may appear to be the most glutenous capital of the world, famous for its pizza, pasta, breads, biscotti, tiramisu... the list is pretty extensive. However, I am happy to report that eating out, eating in and being a coeliac wasn't a issue, at least in Lake Como and Milan that's for sure. We were fortunate enough to have our own villa, which made planning for meals a bit easier and on days out I made my own gluten free pesto pasta, just in case. We stayed in Menaggio, on Lake Como, which was beautiful. This was my first time in Italy and I've fallen in love with the sights, smells, language, culture, people and of course the food - definitely a place I want to go back to and explore new regions of this beautiful Country.  

The Italian Celiac Association

The Italians are very clued up about coeliac (celiac) disease, they test all children by the age of 6 and just over 1% of children in Italy are coeliacs. There are 20,000 new diagnoses every year and they see an annual increase of 20%. As a result of this increased awareness and understanding about coeliac disease, as soon as a person shows any signs or symptoms, the average time taken between being tested and receiving a diagnosis in Italy is 2-3 weeks, when in the UK and in the US the average diagnosis time is 10 years! This is why it's incredibly important to raise awareness of coeliac disease and the symptoms; I was told I had IBS when it was coeliac disease, I can even trace some of my symptoms back almost 10 years too. Italian's who have been diagnosed receive a monthly payment from the government for gluten free food, as well as additional vacation time to shop for and prepare gluten free meals. Wow! Maybe I'll be moving to Italy..... 

Gellato

Ice cream or 'gellato' is divine in Italy. It's mostly organic, reasonably priced (in Menaggio and Bellagio), they have a fantastic range of flavours and are very refreshing in the heat of July!   

The majority of staff in the places were we ate spoke very good English, however some of the restaurants were limited by language barriers, which is were my phone came in handy with this genius app: Gluten free restaurant cards. You can either download the iPhone app or print them off. It explains what you can and can't eat in most languages. 

Menaggio

Menaggio

Menaggio is a stunning place to stay - this picture was taken from our villa. Close to where we stayed was a  family-run restaurant called Pizzeria CO.RI (Via Per la Grona 57, Menaggio). The food was very tasty (I had steak and chips with grilled veggies) and the staff were lovely, for dessert I had sorbet with liquor - very nice! We watched an impressive thunderstorm whilst our food settled and the view across the lake was spectacular. Red Bay restaurant is also a nice place to chill, they also have mini-golf next door. I didn't try the food here but they do make a lovely long island ice tea!

Eating In - Menaggio

The supermarket Pellicano had a great selection of gluten free foods, ranging from pasta to breads, desserts to pizza bases and all food products were clearly labelled if they were "senza glutine" (gluten free). Their cherries were moreish too!

Bellagio

Bellagio is stunning. It's only a ferry ride away from Menaggio and I cannot recommend a trip there highly enough. We visited Villa Melzi whilst we were there and both the gardens and views are beautiful (see picture). In Bellagio we stumbled across a great restaurant called Far Out! where I had gluten free four cheese pasta with saffron, which was very tasty! The other place which apparently does very good gluten free options (although I haven't tried it) is Hotel du Lac which is right on the waterfront near the ferry. One thing I will say for Far Out! is always ask the staff whether they have any gluten free pasta in, they're more than happy to oblige but they did need to check in with the kitchen when I asked. 

       

Milan

We only had one day in Milan, which felt too short in some ways, but we made the most of it anyway. We got the ferry from Menaggio to Varenna and then got a train to Milan (took 40 minutes). A word of caution - make sure you buy your tickets in advance from a news agent and get them validated in this machine (see pic on right). We visited the Santa Maria del Grazie which was stunning, although I'm sad we missed The Last Supper - you need to book at least 6 weeks in advance to see this! We also visited the incredible church Duomo and La Scala - definitely a must see in Milan.

After wandering around for a while we decided to go for a bite to eat and I'd heard fantastic reviews about a place called Bebop. As soon as we entered the lady said 'gluten free'?. 

She must have known we'd travelled specifically to find the place, which we had. They also cater for people who are dairy free, vegans and even my rather fussy parents (Mum doesn't like tomatoes and Dad doesn't like cheese) which is impressive given that it was mostly a pizza restaurant! It was safe to say I was spoilt for choice by their menu, the staff were very friendly and accommodating and on the whole made the experience very special for me. They even did gluten free breadsticks! Main course was a tomato, mozzarella, palma ham and gorgonzola pizza (yum!) and dessert was spicy melon ice cream with handmade biscuits. You can get tram 9 to Bebop (please double check this is up to date).

Bebop, Viale Col di Lana, 4

20136, Milan

On the whole I was impressed by how accommodating Italy was for coeliacs and how friendly people were when you ask for a gluten free meal. Admittedly I've only been to a small proportion of Italy, but it has given me the confidence and inspiration to explore it further in future. Lake Como is an incredibly beautiful part of the world and it's definitely somewhere I'd love to visit again some day...

I do hope this post is helpful for coeliacs visiting Lake Como (Lago di Como) and Milan. If you have any questions just get in touch! 

Getting Diagnosed and Living with Coeliac Disease.

What is Coeliac disease?

Coeliac disease is an autoimmune disease, not an allergy or food intolerance, that damages the lining of the small intestine and affects the bodies immune system. This autoimmune reaction is triggered by gluten, which is a protein found in wheat (including spelt), rye, barley and oats (although not all coeliacs are affected by oats). In the bowel there are small finger-like projections called 'villi', which help us to absorb all the goodness and nutrients from food that our body needs. In a coeliac these villi become completely smooth and flattened by gluten, which is what causes the coeliac to become very ill.  The treatment for coeliac disease is a strict gluten free diet for life. Gluten is found in everyday foods such as breads, pastas, flours, cereals, cakes, biscuits, sausages (check labels), gravy, stock cubes, soy sauce, beer etc.

Symptoms can include: bloating, abdominal pain, nausea, constipation, diarrhoea, wind, tiredness, anaemia, headaches, mouth ulcers, recurrent miscarriages, weight loss (but not in all cases), skin problems, depression, joint or bone pain and nerve problems (CoeliacUK)  

Click here for a full list of symptoms

Family History:  Coeliac disease often runs in families, but does not run in predictable patterns. If you have a close relative with the condition, such as a parent or sibling, your chance of developing it is higher. This risk is approximately 10% for those with a family history, compared with 1% for someone without a close relative with the condition. If you have an identical twin with coeliac disease, there is an 85% chance you will also develop the condition. Click here for a list of coeliac disease symptoms for children.

Getting the Diagnosis - Blood Tests and Endoscopy

If you suspect you might have coeliac disease then speak to your doctor immediately - it took me years before I found a doctor who would listen to me and who knew about the disease. If your doctor suspects that you might have coeliac disease it is vitally important to keep gluten in your diet in the run up to any blood tests (they usually perform a tissue transglutaminase blood test or 'tTG' test to look for Anti-transglutaminase antibodies) or indeed before the endoscopy itself - this is to avoid any false-negative results and to make sure a proper diagnosis is possible - some doctors recommend eating gluten for up to 6 weeks before any tests take place. Yes, you will feel uncomfortable and whilst it is tempting to cut out the gluten once your blood tests come back positive or 'elevated', you must keep eating gluten to make sure you will get absolute confirmation or diagnosis of coeliac disease from the results of your endoscopy. So power through and don't stop eating gluten until a medical professional tells you to stop - usually the gastroenterologist or dietician... 

After Diagnosis 

 

When you've (finally) been diagnosed you'll probably have a lot questions about the gluten free diet, what you can and can't eat and about coeliac disease itself. It's well worth doing your research and being prepared with some questions when you first see the dietician. It can be a life-changing experience going gluten free, I was diagnosed in December 2009 - I felt alive for the first time in years, my health improved dramatically, I wasn't so tired anymore, I lost just under 2 stone in the run-up to being diagnosed and I finally knew what it felt like to be 'normal' and not suffer terrible stomach pains (amongst other things!) everyday, which is something coeliacs unfortunately get used to, when undiagnosed. It is very important to seek advice and support about going gluten free and the gluten free diet from your dietician and doctor. It is quite common to feel disconnected and sometimes bewildered about where to start and what's normal. Your body will go through quite a transformation after going gluten free and this can be quite disconcerting if you're not sure what to expect. However, for UK patients there are several valuable resources you can use:

• Coeliac UK
• Coeliac UK Facebook Page
• Juvela
• Glutafin
• Food Allergy and Intolerance Blog
• A Gluten Free Cooking Blog
• The Gluten Free Blogger
  

Facts and Figures (Statistics taken from a survey of over 1600 Coeliac UK Members, May 2009 – May 2010)

• The average diagnosis time for coeliac disease in the UK is 13 years!
• It is thought that 1 in 100 people in the UK have coeliac disease, but a lot of people are not actually diagnosed. 
• Under-diagnosis is a big problem. Research suggests around 500,000 people have not yet been diagnosed.
• 60% of people with coeliac disease have been previously misdiagnosed with IBS.
• According to a CoeliacUK survey: 23% of patients with coeliac disease had visited doctors for 11 years or more and a further 11% of patients having symptoms, visited their doctor for over 20 years before finally being diagnosed. Nearly a third (32%) of respondents said that they thought GP knowledge about coeliac disease was poor or very poor.

Gluten Free Food on Prescription

The next thing you'll notice after discovering what you can and can't eat, is the potential expense of living and eating gluten free. But thankfully supermarkets are beginning to recognise coeliac disease and are creating clearer labels and gluten-free sections. Here are a few manufacturers and resources to help you get started:

• Juvela - Gluten Free food manufacturer and prescription supplier
• Glutafin - Gluten Free food manufacturer and prescription supplier
• Livwell - Gluten Free food manufacturer and prescription supplier
• Gluten-Free Food and Drink Directory 2014
• List of Prescribable Gluten-Free Products Available
• Find out how many units you are entitled to per month
• Pre-Payment Certificate (To save on prescription costs)

But don't despair, you can eat relatively cheaply on a gluten-free diet if you know what to look for - your dietician will help you out with recipes and tips and tricks too. To help with the costs of living gluten free, you are entitled to gluten free food on prescription. Please note, this is only available for people who are medically diagnosed with coeliac disease and dermatitis herpetiformis. Click on the Pre-Payment Certificate link above for more information and to sign up. It costs about £10 per month and you can set up a repeat prescription with your doctor and local pharmacy.

Awareness of Coeliac Disease

Thankfully diagnosis of coeliac disease is on the increase, however many coeliacs (including myself) have been told they have IBS without a thorough examination or further investigation into the symptoms. One of my main concerns, with regards to a lack of awareness of coeliac disease, is some doctors willingness to attribute all adominal symptoms and complaints to IBS and not further investigating why a patient has an irritable bowel. There are numerous reasons why a patient might suffer with abdominal complaints (and other symptoms), but I believe it is vitally important that doctors listen to their patients more and look beyond the 'IBS' label. When I think about how long I've had symptoms of coeliac disease, I can trace some of them back almost 10 years before diagnosis! It was only by chance that I saw a different doctor that progress was made and I had a blood test followed by an endoscopy some weeks later, which subsequently confirmed coeliac disease. My main piece of advise is to persevere - you will find a doctor that will listen to you one day.  

Gluten Free Travel

Gluten Free Travel

No matter where you are in the world the same principles apply whether you're eating in or eating out: pre-holiday preparation and research is key to not suffering and starving when you go abroad. I stumbled across a great site which has free coeliac travel cards. They explain what coeliac disease is and what you can and can't eat in 51 different languages, so if you get a little lost in translation on holiday then hopefully these cards will come in handy. I tried them out when I went to Italy this year and they were very useful, as my Italian is quite limited! 

I've recently stumbled across this website Glutenfreeroads.com and I can't recommend it highly enough - it's a great resource for coeliacs who normally struggle to eat out, especially when travelling! It provides listings on a map of where you can eat out, where you can stay that caters for coeliacs and where to shop in most locations around the world :) Check it out fellow coeliacs! Oh and they also have some hints and tips on travelling gluten-free too. 

In-Flight Food

"I am serious...and don't call me Shirley!"

Another hurdle for many coeliacs, particularly on short flights is in-flight food, on long-haul flights you can request a gluten free meal in advance, just contact your airline or select when booking flights. This year I went to Italy in July, we flew to Amsterdam and changed to fly to Milan. Our flight was at 6am, I woke up at 3am had some breakfast, got to the airport about 4am and was unable to find anything suitable in the airport to eat before and during the flight, which meant when I finally arrived in Milan I was extremely hungry and finding something to eat straight away was difficult. By the time we arrived at the villa on Lake Como at 6pm (via Switzerland - long story!) I hadn't eaten a proper meal since 3am! I was feeling faint, dehydrated, tired and almost delusional from the heat and travel. 

Airlines need and should cater for people with dietary requirements, as there are a growing number of people with food intolerances and allergies who are regular and frequent flyers and are paying the exact same price as everyone else on the plane who do get to eat. It's unfair, discriminatory and wrong. A word of advice, always travel prepared with plenty of gluten free snack bars and munchies in your hand luggage, as taking a ready made pasta meal in a Tupperware box on board is not likely to get through security or a sensible recommendation.

Happy Coeliac!

Airlines, restaurants, shops, venues etc are extremely foolish not to cater for coeliacs and people with other dietary requirements as "between 1999 and 2004, the market for organic and 'free from’ retail products grew by 115% to reach £3 billion, a rate five times faster than that of the eating out market". It is estimated that people who have special dietary requirements spend approximately £5 billion on eating out per year and with increasing awareness of dietary issues, companies willing to accommodate for specific dietary needs will be at a distinct advantage. Mintel report, January 2005 (Impact of Diets on Eating Out). 

Travel Recommendations

My list of gluten free restaurants I have explored on my travels are expanding and this is one of the main reasons for starting this blog, alongside wanting to help other coeliacs who struggle for places to eat in the UK and abroad. So far I've posted guides on eating out when in:

Amsterdam

London

Manchester 

I've nearly finished my Lake Como and Milan gluten free guide, will let you all know when it's done. Next year I'm exploring Edinburgh as a coeliac, I went before being diagnosed so this time will be quite different - no traditional shortbread for me!

Eating Out: Gluten Free

Eating out can be a real nightmare for coeliacs. After being diagnosed it took me a long time to gain the confidence to eat out and trust that I wasn't going to be 'glutened'. The first takeaway I tried was curry, as most are gluten free (please make sure to check with the staff for cross-contamination) and it was wonderful to feel relatively normal after such a massive transformation in my diet and lifestyle. I knew the diet would test me from time to time and I'd miss quite a lot of my favourite foods, or so I thought. I actually found it easy to substitute most of what I liked with a gluten free version and consequently sticking to a strict gluten free diet was made easier.

Another issue with eating out is a lack of awareness and training among restaurant staff and owners. Too often have I asked waiters and kitchen staff what might be suitable on the menu and to be greeted with blank, expressionless faces enquiring 'what's gluten'? I bet most just think I'm on some fad diet or I'm a fussy eater, but I can assure you I would like nothing more than to stuff my face with anything on the menu and not pay the price of terrible stomach cramps and diarrhoea for several days! 

Lunchtime can also be problematic. Whether it's a working lunch or you’re out and about - preparation is key to not starving or risk being glutened. Wherever possible I bring my own lunches to work, which not only saves me a fortune, but also ensures there is no risk of cross contamination and I can enjoy a healthy and well-balanced diet.

The best thing to do is do your research. Whether you're meeting a friend in town or on a works night out - make sure you can eat something on the menu and that the staff are aware of your dietary requirements. The most important thing to check for when eating out is cross contamination, this also applies when eating at home.