Sausage is a delicious food that has been around since ancient times. The word sausage comes from the Latin word for, preserved with salt - salsus. As you'd expect then, making sausage without gluten isn't something new.
In fact, we know that the first sausages made around 7000 years ago were gluten-free sausages, or in those days perhaps they were just - sausages! This remained the case for generations and is still so in many countries across the world. Though, the practise of adding cereal grains and cheaper fillers into post war British sausage remains more common than you think.
Making gluten free sausages
Primarily, making gluten-free sausage requires that all ingredients are free from gluten, one of the 14 major allergens, this includes sausage skins or casing.
Seems simple enough, though many UK butcher shops and independent producers may offer sausage, or sausage meat products labeled gluten free. Cheap sausages, in particular are most likely to have been made with ingredients containing gluten. If unsure, it's most important for anyone who has a wheat or gluten allergy to contact the manufacturer concerning allergen content of any product.
Currently, any of the 14 major allergens must be declared (in bold) in the ingredients list. As cereals containing gluten are one of these allergens, they must be declared in bold if present in any of the ingredients. You may also see disclaimers applied where there is some risk of cross-contamination with other foods, processes, preparation surfaces, equipment and/or even inadequate hygiene standards.
Ultimately, the cross-grain symbol and AOECS gluten free certified products are the only sure fire way of ensuring gluten free standards are maintained. You may see various logos and symbols indicating that a product is gluten free, though the cross grain symbol can only be displayed on products that have been verified to a UK and European Gluten Free Standard. Sadly, even big brand sausages that have been certified as gluten free may still contain other allergens, sugar, artificial preservatives or other inflammatory ingredients. This means even sausage made without even a trace of gluten may not be healthy sausages.
Related Document: Food Standards Agency - Advice on food allergen labelling
What Is Gluten?
Gluten is a actually made up of a variety of different proteins, but mostly gliadin and glutenin. When joined together, a glue-like, sticky, malleable substance is formed. Gluten is present in Wheat, (wheatberries, durum, emmer, semolina, spelt, farina, farro, graham, KAMUT® khorasan wheat and einkorn), rye, barley and triticale – a hybrid of rye and wheat created in laboratories in the 19th century, though not yet released in the UK. The effects of gluten and coeliac disease were first described by a wise Greek doctor known as Aretaeus of Cappadocia. He wrote about - The Coeliac Affection or "Koiliakos" from the Greek word "koelia", meaning abdominal.
Gluten was identified in 1953 as the cause of celiac disease, an autoimmune disease where eating gluten triggers an immune response that attacks the small intestines. In celiac disease, gliadin penetrates the intestinal lining, damages the small intestine, and triggers an immune response that causes inflammation. A gluten-free diet must be adopted for life by those with celiac disease in order to prevent further damage. An estimated half a million people in the UK are undiagnosed with this condition, which affects around 1-2% of the population.
When celiac disease is not diagnosed or treated, it can lead to long-term health conditions such as iron deficiency anaemia, osteoporosis, infertility, type 1 diabetes, multiple sclerosis, and more. The most common GI symptoms are diarrhoea and abdominal pain, followed by neurological symptoms since the gut and the brain are connected. The list of neurological symptoms can is long: seizures, dementia, migraines, neuropathy, depression.
Wheat allergy is another gluten-related condition. Gluten-containing foods cause symptoms such as bloating, diarrhoea, and cramping that are similar to celiac disease. There is an estimated 0.2 to 1% incidence of wheat allergy in the UK, in which the body reacts to wheat proteins with antibodies. In the same way as celiac patients, people who have a wheat allergy must avoid gluten entirely.
Non-celiac gluten sensitivities are the third type of gluten reaction, which is perhaps more common, but it is also vaguer. In other words, you don't have celiac disease or a wheat allergy but may still suffer adverse physiological changes from eating gluten that manifest in intestinal and extraintestinal symptoms.
Gluten withdrawal and double-blind placebo challenges are the only current ways to confirm this diagnosis. Therefore, if you don't eat gluten, you'll feel better. But soon after, the symptoms will flare-up. It's hard to differentiate between [non-celiac gluten sensitivity] and other functional gastrointestinal disorders because the symptoms are similar. It's hard to figure out what causes non-celiac gluten sensitivity due to there being contradictory data on the causes, however it is considered to affect around 6% of the population.
There's a fourth gluten sensitivity connected to the carbohydrate form of wheat - FODMAP. A FODMAP is an acronym for fermentable oligo-, di-, monosaccharides and polyols, which are indigestible short-chain carbohydrates found in wheat. As opposed to reacting to gliadin and glutenin, a person reacts to fructans instead of the proteins in wheat. They're small molecules with one to ten sugars in them that are slowly absorbed in the small intestine. If they're in the small intestine for a long time, they're likely to become undigested, which exposes them to bacteria and fermentation. IBS symptoms like diarrhoea, gas, bloating, and abdominal pain may appear as fermentation increases. FODMAPs are found in many foods, so symptoms may not fully improve until other high FODMAP foods are removed from the diet, but it explains why some people notice improvements in symptoms after cutting gluten out of their diet.
The best method to diagnose this is by doing a food elimination trial. This means you eliminate all foods containing FODMAPs for at least two weeks. You should then reintroduce them one by one over several days and monitor your symptoms and how they react. For example, if you remove lactose from your diet for three months, then introduce milk products back into your diet, you should be able to tell whether you had developed lactase deficiency (lactose intolerance) or if you were affected by FODMAPs.
Diagnosis can be confirmed by a blood test for IgG anti-gliadin antibody, a stool sample for tests for certain types of gut flora, or a biopsy of tissue taken from the stomach lining.
DRAFT COPY - To be updated and expanded. Please feel free to comment