But before we get into that, let’s briefly understand what exactly coeliac disease is.

Coeliac disease is a condition where your immune system attacks your own tissue when you eat gluten. This, according to the NHS, damages your gut (small intestine) so you are unable to take in nutrients.

It can cause a range of symptoms including diarrhoea, abdominal pain and bloating.

As well as non-gut related symptoms like fatigue which may be a sign of iron deficiency anaemia or vitamin B12 folate deficiency anaemia, unexpected weight loss, an itchy rash, difficulty becoming pregnant, tingling and numbness in your hands and feet (peripheral neuropathy), disorders that affect co-ordination, balance and speech (ataxia) and swelling of the hands, feet, arms and legs caused by a build-up of fluid, according to the NHS.

Meanwhile gluten is a dietary protein found in three types of cereal: wheat, barley and rye.

Common foods that contain these cereals are pasta, cakes, breakfast cereals, most types of bread, certain types of sauces and some ready meals. Most beers are made from barley too.

This disease affects around one in 100 to one in 300 people worldwide – however, experts say that there are many cases that go undiagnosed.

In fact, dietician and nutritionist Mario Caruana said that only 25% of people globally get diagnosed, according to the Malta Independent. 

Like any other disease, a coeliac person encounters difficulties, even in their day to day routines and especially when it comes to eating out. 

1. Eating out

Sandra was clearly frustrated at the lack of knowledge and care that some restaurants in Malta harbour towards food allergies in general.

This can be very dangerous.

“Having restaurants that don’t know the difference between gluten intolerance and coeliac disease is unacceptable. Knowing about different food allergies and how to handle food accordingly is a minimum requirement when your main function is dealing with food.”

“Waiters shouldn’t be employed just for the sake of taking orders and for delivering food to the table. Waiters and all restaurants and hotel employees must have background and knowledge of food preparation and handling.”

“Before issuing permits to new restaurants and food trucks such conditions must be observed,” Sandra strongly urged.

She further said that serving gluten-free food has become more of a trend to attract people rather than dedication to integration. Because of this, there’s a lot of false advertising that leads to cross-contamination.

Once, Sandra ordered a salad that was labelled gluten-free and after speaking to the waiter and manager three times, she came to discover that this was the same salad that was used on a pizza.

“Why does a coeliac person have to experience such hassle just to get a salad?”

Another time, she asked for gluten-free pasta and was told they did offer gluten-free pasta – but they cook it in the same boiling water as pasta that contains gluten.

She then gave another example of a restaurant advertising that they had gluten-free buns for their burgers but didn’t specify about the actual burger and chips.

This can cause severe symptoms in sufferers who simply want to enjoy a meal.

Meanwhile, when there are appropriate gluten-free options at a restaurant, they often come at an extra cost. And while persons with this disease receive governmental POYC vouchers, Sandra argues that it does little to cover the exorbitant price of gluten-free food options.

Patients who are 60-years-old and older, along with persons receiving social benefits, are granted a €50 voucher each month as opposed to the €45 received by other patients.

According to Sandra, the amount has been the same for 15 years, despite rising food costs. Therefore, she is urging for this to be looked into – “it doesn’t reflect today’s food cost reality”.

“Just to give you an idea, two gluten-free buns are around €5 when the cost of a normal ‘panina’ is just a few cents.”

Nonetheless, she admitted that the vouchers ease a bit of the burden, but she went on to explain that the system is “very limited and not helpful at all”.

2. Shopping at the supermarket

The POYC vouchers can be stringent on what they can be used on, slashing shoppers’ already limited options and preventing people who are dependent on this benefit from enjoying new brands and tasty treats.

“Why is it that I can buy pasta by brand A but not brand B? Why can’t I buy items with the slightest hint of chocolate? Would this make such a difference for the government? As long as it’s gluten0free, it should be listed in the POYC voucher list.”

Finding tasty gluten-free food is already difficult, so having a restricted list of brands just makes the situation all the more tiring and tough, Sandra expressed.

“I would much rather receive no vouchers and not have my daughter be diagnosed as coeliac,” she desperately remarked.

She went on to say that she already has to change her daughter’s whole diet and explain to her that she’s not allowed certain items because of the disease. Having to tell her that she can’t eat the gluten-free food that she likes is unnecessary and not something she is willing to do.

“But I’m lucky, there are some people who depend on these vouchers and can’t stray from that tightly controlled list.”

3. Large events, food chains and schools

Another inaccessible aspect of Maltese society when it comes to coeliac disease is the organisation of large public events, Sandra said.

She explained that at such events, it’s generally hard to find gluten-free options, if there even are any.

“When organising an event that has food, it must be ensured that the event caters for all types of allergies with no discrimination.”

Meanwhile, certain cheap and popular food chains, like McDonalds, still don’t offer gluten-free options in Malta, according to Sandra.

“In other countries, this option has been around for years.”

In Europe, Austria, Denmark, England, Finland, Hungary, Italy, Norway, the Netherlands, Portugal, Spain, Sweden, Gibraltar, Czech Republic, Andorra and Switzerland offer at least one gluten-free burger, according to My GF Guide and Vivere Senza Glutine.

Similarly, both Sandra and her daughter have endured many school organised treats and bake sales without gluten-free options.

Having a daughter who suffers from coeliac disease has caused an unnecessary strain on both of their lives. Whether that’s unreasonably priced food items, restrictions on where to go and what to buy, or constant fear of cross-contamination. 

Creating an event or restaurant that is accessible to coeliac sufferers may take a little more effort but it will also help hundreds of people around the island feel included and enjoy the beauty of food just like everyone else.

Like Sandra explained, this all boils down to a lack of education and awareness. People don’t know enough about coeliac disease to make their establishments gluten-free friendly or to even check themselves.

The fact that only 25% of coeliac cases are diagnosed speaks for itself.

Which are your favourite coeliac-friendly establishments or events in Malta ?