Eating in France is no straightforward affair for people like Fecher due to the very nature of French food its people are so proud of. A country historically steeped in creamy haute cuisine, pastries and a different cheese for every day of the year, France is a dream come true for many, but a bit of a nightmare for others: food intolerance is tolerated, but only barely.
The recorded number of people in France with food intolerances is growing, but without a corresponding rise in awareness. According to a report by the French Association of Gluten Intolerance (AFDIAG), more doctors are running diagnostic tests on their patients to determine possible food allergies and intolerances, and coming up with positive results. Social security support has been in place as recently as 1996, but the French food industry still lags behind its European neighbours in accommodating the dietarily challenged.
“France loves everything that is dairy products, so when I’m out eating it means that I ask a lot of questions to the waiters because almost all dishes have some sort of milk in it, some sort of dairy product, be it cream, cheese, butter… Often, they have to change the dish slightly in order for me to eat it,” said Fecher, who has lived in France for four years.
Fecher’s dilemma represents between 20 to 40 percent of the French population, according to Valérie Laplaine, head nutritionist for the Casino Group, which just created a new range of foods called Bien pour Vous specifically targeted at customers with particular dietary needs. Laplaine explains the numbers are not very precise because a large number of people are not even aware if they are lactose-intolerant.
Diagnosed since young and having grown up with the condition, Fecher is fully in the know and is used to the inconvenience. “It’s fine when I cook for myself. I don’t substitute for dairy products, I just do without it. But when I go to people’s places for dinner and they haven’t thought it through entirely or just forgot about it, I end up eating toast and marmalade.”
An estimated 600 000 people in France suffer a more severe disease which makes Fecher’s dilemmas appear trivial. Up till the age of 19, Pauline Vary led a normal life and diet. Growing up in France, she was used to rich French dishes. One summer changed the way she enjoyed food forever: In 2009, Vary was diagnosed with coeliac disease, an autoimmune disorder of the small intestine that forced her diet to become gluten-free. Like those with lactose intolerance, only a fraction of patients in France – between 10 to 20 percent – have been properly diagnosed for coeliac disease, even though the AFDIAG estimates one out of a hundred people in Europe are prone to developing it.
“Before, I used to frequently eat pizza, go to McDonald’s, like every student,” said Vary, now 21, whose disorder developed as a side-effect of hepatitis. “Now I have to pay attention to everything I eat, which is very difficult. There is gluten everywhere, even in yogurts and sauces, so it’s really complicated to find a dish which I can eat.”
Vary’s restrictive diet means she not only has trouble finding gluten-free products, she also faces steep prices. “I spend a fortune on groceries,” she said. “I used to spend about 30 euros a week on groceries. Now I spend about 50 euros. A pack of gluten-free pasta can cost twice the price.”
These costs are mediated to some extent by subsidies. Every month, Vary sends in price labels of her gluten-free purchases to her insurance company, which then reimburses her a fraction of the price. People above 10 years old are reimbursed up to 45.73 euros each month, those below 10 years old receive up to 33.54 euros. “I think they are cognizant of the fact that gluten-free products are really expensive,” she said. “It took a very long time for me to to get used to it, but now it is better.”
But where she has succeeded in adapting, many others are failing, according to Dr. Nadine Cerf-Bensussan, a specialist in coeliac disease at Université Paris Descartes. Gluten-free diets are poorly followed in France, with only roughly 50 percent of patients adhering to proper dietary care. Even those compliant with the regime demand an alternative treatment.
Vary attributes this somewhat to the fact that there is not a lot of variety in gluten-free products in France. “In France it is always the same thing so I used to cross the border to Germany to do my groceries. There, you have more options. There are more types of biscuits, pasta… But since I am not reimbursed for those, I try to stick to French shops.”
Both lactose-intolerance and coeliac disease share similiar symptoms such as stomach cramps and diarrhea, but coeliac disease has a grimmer outcome when a gluten-free diet is not followed. “My doctor told me that if I did not change my diet, after a few years I risk contracting intestinal cancer,” said Vary.
French healthcare and social security are learning how to spot and accommodate people like Fecher and Vary, but the two feel that general awareness levels in France still have a long way to go.
“Even though people are sympathetic, they often lack in knowledge of what is actually in the food and what actually constitutes dairy products. For example, it’s not enough to ask waiters whether there are any dairy products in the dish because often they do not think of butter as a dairy product,” says Fecher. “In Sweden, there is a much greater awareness of different allergies and intolerances. In any cafe in Stockholm, you can ask to have your coffee with either soy milk or lactose-free milk, and it’s not more expensive.”
“Here, people are lost as to how to accommodate you. Typical questions I hear during dessert time are: What kind of dessert can you eat? Should we just serve you sugar?” he jokes. Though eating in France is certainly no piece of cake, both Fecher and Vary have adapted to their circumstances with optimism.
“You have to stay positive,” said Vary. “It is possible to live with such a disease and already it is not as bad as other illnesses. I much prefer to be like this than to be in a wheel-chair!”
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