wheat Archives - Lifelab Testing

The 14 Common Allergens

Food allergies occur when you consume allergen foods that your immune systems mistakes for harmful substances. Your body will then release chemicals such as histamines which cause inflammation and thus symptoms of allergy. It doesn’t matter the amount of food you consume with the allergen. You’ll still experience allergy symptoms within a few minutes to a few hours of consumption.

Since there are many common allergens in foods we consume daily, the way allergens are labelled on pre-packed foods has changed. The Food Information Regulation, born in December 2014, also introduced a regulation that food businesses must provide information about allergenic ingredients in any foods they sell {1}. In the UK, there is a list of 14 allergens (which we list in this article) that sellers must list if used in any of their products {2}.

There are mainly 14 common allergens in the UK. The 14 main allergens include:

Gluten and wheat

A wheat allergy occurs when one’s immune system responds to the proteins in wheat. Most children suffer from wheat allergy but tend to outgrow it once they reach ten years of age. On the other hand, gluten allergy or celiac disease occurs when one has an abnormal immune reaction to gluten present in many grains, including wheat. So, when suffering from a gluten allergy or celiac disease, you’ll also need to avoid grains like wheat, rye, barley, and oats. These are often found in flour, baking powder, batter, breadcrumbs, cakes, couscous, meat products, pasta, pastry, sauces, soups, and fried food.

What to look for in food labels

Wheat, Kamut, Einkorn, Faro, Durum wheat, Semolina, Spelt, Barley, Rye, Oat, Malt, and Couscous

Common foods with gluten

Bread, Baked goods, Baking mixes, Condiments, Chocolates, Sauces, Pasta, Crackers, Cereals

Sulphites/Sulphur Dioxide

Mostly you’ll find sulphites are mostly added to beverages and canned foods to make them last longer. However, some foods like aged cheese and grapes naturally contain sulphates. People with asthma are likely to develop this allergy.

What to look for in food labels

Sulphur, E150b Caustic sulphite caramel, E150d Sulphite ammonia caramel

 Sulphur Dioxide, Sulphite, Sulphites, Dithionite, Metabisulphite, Sulphiting agents, Potassium bisulphite, Metabisulphite, Sodium bisulphite, E220 Sulphur dioxide, E224 Potassium metabisulphite, E221 Sodium sulphite, E222 Sodium hydrogen sulphite, Sulphurous acid, E223 Sodium metabisulphite, E226 Calcium sulphite, E228 Potassium hydrogen sulphite

Common foods with sulphites or sulphur oxide

Pickled foods and vinegar, Beer, wine and cider, Dried fruit eg dried apricots, prunes, raisins etc., Maraschino cherries, Tinned coconut milk, Guacamole, Dehydrated, pre-cut or peeled potatoes, Vegetable juices, Bottled lemon juice and lime juice, Some soft drinks, Grape juice, Condiments (bottled sauces etc.), Fresh or frozen prawns, Some processed meat products

Celery

An allergy to celery includes celery leaves, stalks, seeds and the root called celeriac. Celery is present celery in celery salt, salads, meat products, soups and stock cubes.

What to look for in food labels

Celery seed, Celery leaf, Celery salt, Celeriac or Celeriac, Celery stalk

Common foods with celery

Vegetable juice, marmite, savoury snacks, sausages, curry, spice mixes, soups, bouillon, processed meat products, and prepared salads

Crustaceans

Crustaceans mostly have hard shells and walk around with jointed legs. These include Crabs, lobster, prawns and scampi. The most common one among them is shrimp paste used in Thai and Southeast Asian cooking.

What to look for in food labels

Amphipods, barnacles, crabs, mussel shrimp, mysids, hermit crabs, crayfish, isopods, lobsters, mantis shrimp, sea spiders, shrimp, and prawns

Common foods with crustaceans

Paella, Chinese products, Soups, Asian Salad, Thai Curry, Prepared sauces, Fried rice, Fish paste, Fish Soup

Egg

Egge allergies are pretty common, especially in children. It is the second most common allergy in children {1}.

What to look for in food labels

Albumin, livetin, lysozyme, mayonnaise, meringue, meringue powder, apovitellin, egg yolk, egg wash, eggnog, cholesterol-free dried egg solids, dried egg, egg substitute, egg, egg white, fat substitutes, globulin, ovalbumin, powdered eggs, silici albuminate, ovoglobulin, ovomucin, ovomucoid, ovotransferrin, ovovitelia, ovovitellin, simplesse, surimi, trailblazer, vitellin, and whole egg

Common foods with eggs

Meringue, Marshmallow, Artificial flavouring, Egg glazed pastry, Some ice cream, Baked goods, Lecithin, Natural flavourings, Nougat, Pasta, Salad dressing, Mayonnaise, Marzipan, Tartare Sauce, Hollandaise, Cakes, Some custard

Fish

Fish allergies are pretty common, affecting around 7% of the population. You’ll find that some individuals develop a fish allergy in adulthood too. Fish allergies result from finned fish like tuna, salmon, catfish, and cod. You can be allergic to finned fish and not shellfish since these two have varying proteins that result in allergens.

What to look for in food labels

Anchovies, perch, scrod, swordfish, sole, pike, pollock, bass, catfish, snapper, tilapia, trout, cod, flounder, grouper, haddock, hake, halibut, herring, Mahi Mahi, salmon, and tuna

Common foods with fish

Barbecue sauce, caesar salad and caesar dressing, soups, barbecue sauce, caponata, pizza, Worcestershire sauce, bouillabaisse, meatloaf, imitation or artificial fish or shellfish), a Sicilian eggplant relish, num pla, dips, gelatine, and relishes.

Lupin

Even though lupin is a flower, it’s also found in flour. You can use lupin flour and seeds in some bread, pastries, and pasta.

What to look for in food labels

Lupine, Lupin flour, Lupin seed, and Lupin bean

Common foods with lupin

Pies, products containing crumbs, pizzas, waffles, pastry cases, pancakes, crepes, vegetarian meat substitutes, and deep-coated vegetables such as onion rings

Milk

Milk allergy is mostly the first seen in children, and while some outgrow this allergy, others don’t. It is also possible to develop milk allergy in adulthood. Proteins like whey and casein are most responsible for an allergic reaction in those suffering from milk allergies.

What to look for in food labels

Butter, cheese, cream, milk powders, yoghurt, margarine, cream, and ice cream.

Common foods with milk

Yoghurt, Natural flavouring, Milk, Milk powder, Buttermilk, Butter, Ghee, Flavouring, Caramel flavouring, High protein flour, Chocolate, Instant Mash, Rice cheese, Soy cheese, Cream, Lactic acid starter culture, Ice Cream, Cheese, Custard, and Margarine

Mustard

Mustard seeds contain a primary allergen known as “Sin a 1.” This allergen is still present even when in cooked food. However, brown mustard has a different allergen called “Bra j 1.” Most people allergic to mustard are also allergic to rapeseed.

What to look for in food labels

Mustard seeds, Mustard powder, Mustard flour, Mustard leaves, Mustard oil, Sprouted mustard seeds

Common foods with mustard

Sausages and processed meat products, Cumberland Sauce, Ketchup, tomato sauce, Spices, flavouring or seasoning, Chutneys, Soups, Sauces, Chutney, Piccalilli, Salad dressing, Indian foods, Vegetables with vinegar, Dehydrated soups, Salad Dressings (vinaigrettes and cruditées), Barbecue Sauce, Curry Sauce, Béarnaise Sauce, Mayonnaise, Pesto, Gravies, Marinades, Chutneys pickles and other pickled products

Mollusc

Molluscs include land snails, mussels, squid, and whelks but can also be found in oyster sauce, a common ingredient in fish stews.

What to look for in food labels

Oysters, Snails, Clams and cockles, Abalone, Squid, Scallops, Mussels, Mussels, Octopus, Oysters

Common foods with mollusc

Ethnic Food, Mussel dishes, Soups, Sauces, Scallops, Calamari

Tree Nut

Most people suffering from peanut allergies often have more tree nut allergies. Tree nuts grow on trees, unlike peanuts which flourish underground. Examples include cashew nuts, almonds and hazelnuts.

What to look for in food labels

Almond, Walnuts, Cashews, Hazelnuts, Pecan Nuts, Brazil Nuts, Pistachio Nuts, Macadamia or Queensland Nuts.

Common foods with tree nut

Nut butter, chocolates, salad dressings, bbq sauce, chocolate spread, artificial flavouring, baked goods, mortadella, natural flavouring, nougat, pesto, pesto, crackers, and desserts.

Peanuts

Peanut allergies affect a vast population of people worldwide. Peanuts are also called groundnuts because they’re legumes that grow underground, which is why they’re also known as groundnuts. Often, peanuts are the most common cause of anaphylaxis.

What to look for in food labels

Extruded or expelled peanut oil, mixed nuts, nut pieces, crushed nuts, ground nuts, monkey nuts, beer nuts, nut meat, Arachis oil, kernels, peanut protein, peanut butter chips, peanut butter morsels, arachic oil, cold pressed, crushed peanuts, Arachis, Arachis hypogaea, artificial nuts, beer nuts, boiled peanuts, earth nuts, goober peas, ground nuts, hydrolyzed peanut protein, ground peanuts, mandelonas, nutmeat, peanut butter, peanut flour, peanut paste, peanut sauce, peanut syrup, and Virginia peanuts.

Common foods with peanuts

Graham cracker crust, hydrolyzed plant protein, artificial flavouring, baked goods, candy, chilli, chocolate, crumb toppings, egg rolls, enchilada sauce, ethnic foods: African, Thai, Vietnamese, Asian, Chinese, Indian, Indonesian, Mexican, fried foods, flavouring, hydrolyzed vegetable protein, natural flavouring, marzipan, mole sauce, nougat.

Sesame

You’ll find sesame seeds in baked foods or used to make certain dips. Sesame is often sprinkled on buns used to make hamburgers and in other foods like breadsticks, houmous, sesame oil and tahini.

What to look for on food label

Sesame seeds, Sesame oil, Gingelly, Gingelly oil, Benne, Benne seed

Common foods with sesame

Bread, tahini butter, soups, marinades, chutney, crackers, dressings, toasts, dips, hummus, sauces,

Soya

Soya is commonly consumed around the world. It contains lots of protein and is thus good, especially for vegans, plant-based and vegetarians.

What to look for on food labels

bean curd, edamame beans, miso pates, textured soya protein, soya flour, tofu

Common foods containing soya

Soy milk, Soy oil, Bean sprouts, Canned tuna, Surimi, Natural flavouring, Artificial flavouring, Hydrolyzed plant protein, Asian foods (e.g. Japanese, Chinese, Thai, etc.), Baked goods, Soy sauce, Tamari sauce, Teriyaki sauce, Miso, Vegetable broth, Hydrolyzed vegetable protein (HVP), Vegetable gum, Vegetable starch

Allergy symptoms

Symptoms of food allergies include:

  • Hives
  • Flushed skin or rash
  • Face, tongue, or lip swelling
  • Vomiting and diarrhoea
  • Dizziness and lightheadedness
  • Swelling of the throat and vocal cords
  • Difficulty breathing
  • Loss of consciousness
  • Tingling or itchy sensation in the mouth
  • Abdominal cramps
  • Coughing or wheezing
basic-allergy-test-front
Our Basic Allergy Test Kit.

In rare cases, food allergies can be life-threatening, leading to a severe condition known as anaphylaxis. Even though most symptoms of food allergies only result in skin reactions and digestive issues, anaphylaxis can also happen in rare cases, mostly in peanut allergy cases. Symptoms of anaphylaxis include:

constricted airways in the lungs

Low Blood pressure and shock

Swelling of the throat and larynx

Most symptoms of anaphylaxis start mild and become life-threatening within minutes of happening. When one suffers from anaphylaxis, you must use an EpiPen on them, and if they don’t have one, you need to contact emergency medical services.

Food allergy test

If you suspect you have food allergies, you may need to go to your doctor and see whether the symptoms you’re witnessing could result from underlying conditions. You’ll need to take an Allergy Test home test kit if everything is ruled out. Sometimes figuring out which food is causing you allergy symptoms can be difficult because we consume different foods simultaneously. An allergy test kit will show you which foods you’re allergic to so you can avoid them.

References

  1. https://www.anaphylaxis.org.uk/about-anaphylaxis/14-major-food-allergens/
  2. https://www.food.gov.uk/sites/default/files/media/document/top-allergy-types.pdf

7 wheat-free bread replacements for those with wheat intolerance

Having a wheat intolerance isn’t all that easy to deal with. For some, it can be quite a disappointment to hear that they need to drop the ingredient to have a symptom-free life. Some may find that the hardest part of living wheat-free is the loss of bread from the diet – a staple for many of us. Here we’ve compiled a quick list of wheat-free replacements that can be enjoyed in place of a regular loaf.

1 – Ezekiel Bread

Ezekiel bread is arguably one of the healthiest types of bread you can eat. Made from several different grains and legumes it’s packed with a wide variety of nutrients. To top it off, this loaf contains no added sugar, cutting your daily intake of the sweet stuff.

2 – Corn Tortillas

If your lunch is usually a few sandwiches, try a corn tortilla wrap instead. It’s wheat-free and can lead to a more adventurous lunch-time. You could also experiment with using tortillas as a pizza bottom replacement.

3 – Lettuce and Leafy Greens

Swap out your sandwich altogether for a plate of leafy greens on the side of your usual sandwich filling and you’ll not only have avoided an upset stomach, but you’ll also be enjoying a healthier, less calorie-dense alternative.

4 – Rye Bread

This darker, denser loaf is both wheat-free and rich in fibre. Be warned though, as it does have a more acquired taste and is NOT gluten-free.

5 – Potatoes

Filling and nutritious, potatoes area wonderful carb alternative. Packing more than 70% less calories-per-gram compared to a wholemeal loaf, this diverse and satiating vegetable is a great alternative.

6 – Sourdough Bread

This sour bread contains probiotics to feed our gut bacteria, and its longer fermentation process may mean that it’s easier for your body to breakdown the nutrients. It isn’t recommended that you have this loaf with sweet toppings though, so leave the honey or jam for another day.

7 – Oats

Try swapping your morning toast for a wholesome bowl of porridge. You can even add a few berries to sweeten it up. Or throw in a handful of nutritious nuts to add that extra crunch.

Living with a Wheat Intolerance

Going wheat-free isn’t the end of the world and learning that you have an intolerance to wheat can actually be a good thing. It means working around your wheat intolerance and trying alternatives. Most importantly, it means learning how to eat without suffering uncomfortable symptoms from your food intolerance, and ultimately, improving your relationship with food.

Wheat-free bread alternatives for those with wheat intolerance

Bread. The downfall of many a diet. However, when you live with wheat intolerance, the consequences of giving into carby temptation can be much more severe. So how can someone with a wheat intolerance enjoy a food so universally loved as bread? 

There are plenty of wheat-free alternatives to regular bread;

Rye Bread

Typically denser than wheat bread, rye bread is made using flour from the rye grain as opposed to wheat flour. Rye bread is a source of vitamins and minerals, including magnesium and potassium. One of the other benefits of rye bread over wheat bread is a substantially increased shelf life. That means more days of sweet, sweet bread satiety with none of the side effects associated with wheat intolerance. Some rye bread is mixed with wheat flour too, so be sure to check the label if purchasing pre-made.

Sourdough Bread

Made using rye grain flour, sourdough bread is another fantastic alternative. As the bread is typically made using fermented grains, it also has a host of other benefits including easier digestion, more bioavailable nutrients and the presence of probiotics. It is easy to bake and can be made at home. An intolerance test is the best way to find out whether you need to start looking at wheat-free alternatives.

Gluten-free bread

Another bread that is incredibly easy to make at home, it is considered the easiest way to avoid wheat. With the clue in the name, gluten-free bread is also suitable for those with a gluten sensitivity as well as wheat intolerance.

Corn Tortillas 

Fajitas & burritos are two of the most common uses for corn tortilla’s but, did you know they’re also used as a wheat bread substitute? They’re widely available, cheap and a significantly lower calorie alternative to regular wheat bread. All of this makes them a healthy choice when managing your wheat intolerance.

Corn tortilla for wheat intolerance

Sweet Potato

Okay. Not bread. But, still a great alternative. As an alternative to toast, they can be topped with many of the same things you would put on your morning slice. Added to this, they’re packed full of nutrients and fibre as well as being a complex carbohydrate which keeps you fuelled for longer.

To see whether a wheat intolerance is holding you back, you can take an intolerance test.

Heal your Gut

Here at Lifelab Testing, we’re dedicated to helping teach our readers how they can best improve their health. The gut has a major impact on one’s health, since it determines what nutrients your body absorbs, and which toxins, allergens, and microbes are kept out. It heavily impacts the health of your entire body. Many factors affect gut health, such as diet, food intolerances, lifestyle, hormones, sleep, and medications. These all affect how your gut digests and manages what you consume. We’ve put together a few tips to help you heal your gut.

Probiotics

Consuming probiotics is an excellent way to reintroduce healthy bacteria into your digestive tract. Remember that probiotics are the good bacteria that are essential to proper gut health.

You can consume probiotics by taking a probiotic supplement or adding fermented foods to your diet. We’d recommend starting with the latter, rather than running to the supplement aisle right away (unless your doctor recommends you do so).

Probiotic-containing foods include;

  • Fermented vegetables
  • Yoghurt
  • Kimchi
  • Kefir
  • Sauerkraut
  • Tempeh
  • Kombucha
  • Miso

Prebiotics

Prebiotics are how you can nourish those healthy bacteria, so they stick around and keep helping your gut. Think of it as feeding the good guys.

Probiotics eat prebiotics, which are natural soluble fibres, and then produce short-chain fatty acids, inhibiting the growth of pathogens and prevent disease. Ultimately, this helps maintain your intestinal and overall health.

Here’s a list of prebiotic foods you can add to your diet;

  • Bananas
  • Jerusalem Artichoke
  • Onions
  • Asparagus
  • Chicory
  • Whole Grains
  • Garlic

Ginger

Ginger has various health benefits, from blood-thinning (great for preventing blood clots) to relaxing muscles. One gut-helping example is the smooth muscle of the intestines. This is a godsend for those who suffer from gas or cramping. As if that wasn’t enough, ginger can also stimulate saliva, bile and gastric enzymes, making it an all-around supporter in your digestion.

Limit FODMAPs

FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols) are short-chain carbohydrates found in certain types of food, such as wheat and beans. Studies show a strong link between FODMAPs and digestive symptoms like stomach pain, bloating, gas, diarrhoea and constipation. Low-FODMAP diets are shown to provide exceptional benefits for many people with common digestive issues.

Here are of a few high FODMAP foods to avoid;

  • Beer
  • Fortified wines
  • Soymilk
  • Milk (from cows, goats and sheep) and other dairy products
  • Fruits
  • Beans and Lentils
  • Barley
  • Rye
  • Fructose
  • Wheat 

It might feel overwhelming to start with, but we can help you on your path to a healthier gut. Purchase an intolerance test today, to quickly find out which foods that are currently a problem and shorten your initial elimination phase.

Gluten or Wheat Intolerance?

One area of nutrition, which often leads to head scratching and confusion for many people, is that of gluten intolerance and how this relates to wheat intolerance. Common questions include; what is gluten, which foods would you find it in, what’s the difference between gluten and wheat intolerance and what does a gluten or wheat intolerance test entail?

What is Gluten?

Gluten is the name given to the protein in a number of grains such as wheat (including wheat varieties such as spelt, kamut, faro, durum, bulgar, semolina), rye, barley, and oats. The name gluten comes from the Latin word for ‘glue’. It gives the dough its elasticity, prevents crumbling and as such plays a vital role in the production of baked goods. Most commonly you would find gluten in bread products, pasta, biscuits, crackers, cereals, beer but also in sauces or processed meat products as a thickener.

Gluten Versus Wheat Intolerance

Gluten intolerance and wheat intolerance are different conditions but obviously cross over with one another, which is where the confusion often comes in. Additionally, the symptoms experienced, although highly individual, can be very similar such as bloating, cramps, diarrhoea, constipation, fatigue, sometimes headaches and a general sense of malaise.

Gluten intolerance means an intolerance to all grains containing gluten; wheat and wheat varieties, rye, barley, and oats. Whereas wheat intolerance is an intolerance just to wheat and wheat varieties, not the other gluten-containing grains. So, as you can imagine being gluten intolerant can be far more limiting than wheat intolerance.

To complicate it further there are two types of gluten intolerance: coeliac and non-coeliac [2, 3]. And the two are completely different in how they manifest and their potential overall impact on health.

Coeliac Disease

Coeliac disease is a condition where the body attacks its own cells following the ingestion of gluten. This results in small intestine becoming damaged and prevents nutrients from being absorbed. The condition affects roughly 1% of the UK population with incidence shown to have increased fivefold over the last 25 years [1].

Symptoms include;

  • Abdominal pain
  • Indigestion
  • Constipation
  • Bloating
  • Flatulence
  • Vomiting (usually only in children)

Gluten and Wheat Intolerance

Non-coeliac gluten intolerance is completely different to coeliac disease. Its far less threatening but is still a digestive issue. The difference is that it doesn’t result in a mutiny of cells, just digestive-related symptoms and discomfort. The symptoms of non-coeliac gluten intolerance and wheat intolerance are nigh identical with the only way to tell the two apart for certain being through blood sample testing.

Intolerance symptoms can include;

  • Bloating
  • Constipation
  • Diarrhoea
  • Fatigue
  • Migraines
  • Skin rashes & Eczema
  • Vomiting
  • Nausea

Testing for Wheat and gluten intolerance

Understanding the presence of either of these conditions is the first step towards making changes. It can be done through an IgG gluten or wheat intolerance test, which is a blood sample test identifying the presence of IgG antibodies created against gluten or wheat [4]. This type of testing will not show the presence or lack of coeliac disease.

Diagnosing Coeliac disease

To identify the presence of this autoimmune condition blood tests for IgA and IgA tissue transglutaminase (tTG) must be carried out. Potentially followed by a biopsy to determine how much damage has been made so far. Patients are encouraged not to begin a gluten free diet until a diagnosis has been made, this is especially important for the blood testing.  

Tailoring Your Diet

If you do find yourself having to cut out gluten or wheat after completing a gluten or wheat intolerance test do not despair! The range of products available in supermarkets is extensive and growing all the time and restaurants and cafes are also offering more and more options to those who need to avoid gluten or wheat.

Those diagnosed with coeliac disease MUST avoid glute, or else they can become very ill. But those who are simply gluten intolerant should avoid gluten containing foods to avoid symptoms. Where possible, choosing products which are naturally gluten-free or wheat-free in place of processed ‘free from’ products, is the best way forward.

On a gluten-free diet, grains such as corn, rice, millet, sorghum, amaranth, buckwheat, and quinoa are all excellent choices. For those who are wheat free, you can also add rye, barley and spelt to the party. Grains that contain gluten include wheat, rye, barley and triticale.

Wheat and Gluten Free Alternatives

Avoiding wheat is much simpler compared to avoiding gluten. The list of foods made with wheat is still quite extensive and avoiding this ingredient can prove challenging for some.  

Gluten and Wheat free alternatives include;

Avoiding wheat and gluten can be difficult if you rely on a lot of pre-packaged goods such as sauces and snack bars. The simplest solution to this is to make the majority of your meals from scratch. Not only will it help you avoid both wheat and gluten completely, it can offer various health benefits such as lower salt and sugar intake, more nutritionally dense meals and less accidentally ingested ingredients.

Final Thoughts

It’s not all bad news though. Having to avoid gluten or wheat does force you to avoid baked goods – which most of us would agree is a bonus in terms of looking after our health.

References

 [1] Catassi C, Gatti S, Fasano A. The new epidemiology of celiac disease. J Pediatr Gastroenterol Nutr. 2014 59 Suppl 1:S7-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24979197 [Accessed 27 Feb. 2020].

[2] Barbaro, M.R., Cremon, C., Stanghellini, V. and Barbara, G. (2018). Recent advances in understanding non-celiac gluten sensitivity. F1000Research, 7, p.1631. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182669/ [Accessed 27 Feb. 2020].

‌[3] Igbinedion, S.O., Ansari, J., Vasikaran, A., Gavins, F.N., Jordan, P., Boktor, M. and Alexander, J.S. (2017). Non-celiac gluten sensitivity: All wheat attack is not celiac. World Journal of Gastroenterology, [online] 23(40), pp.7201–7210. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677194/ [Accessed 27 Feb. 2020].

‌[4] Lin, S., Yang, X., Xing, Y., Wang, X. and Li, Y. (2019). The Clinical Application Value of Multiple Combination Food Intolerance Testing. Iranian journal of public health, [online] 48(6), pp.1068–1073. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31341848 [Accessed 27 Feb. 2020].