Be Free For Me Blog

Question: Since getting diagnosed with celiac disease, I feel like I’ve been buying and eating “anything and everything” as long as it is gluten-free! Now that it’s the New Year, I need some tips for getting back on track and take some control over my diet, especially since I have gained unwanted extra pounds. Do you have ideas for healthy gluten-free eating?

The gluten-free market is booming which is good news for those with celiac disease.  A growing number of gluten-free products ranging from breads, cereals, pasta, crackers, cakes, cookies, snack bars, soups, sauces, ready-to-eat entrees, mixes and other items are available in grocery and health food stores, wholesale outlets and even online. But people often gain too much weight because they only focus on the gluten-free status of items and do not pay attention to nutrition and meal planning. Just like gluten-containing products, not all “gluten-free” items are necessarily healthy options. Here are some of suggestions and resources for starting out the New Year on the right gluten-free track!

Plan Ahead: Planning your menu a week (or even a few days) ahead will help you select the right things to eat, and help control unnecessary or “binge type” eating.

Keep Nutrition on the Front Burner: The USDA MyPyramid and Canada’s Food Guide are practical tools to help you make healthy food choices. I have adapted these guides for the gluten-free diet to get you started. Check out this article for more information.

Watch Your Portions: Make sure that you read the back of all packaging labels so you know what “one portion” size is. Don’t be fooled! One portion could indeed be a ½ of a bagel. Being aware of portion control is a good step to manage your calorie intake.  Here’s a great portion control tool from WebMD. Although not all the items are gluten-free, it visually compares food items to commonly recognized items such as a deck of cards, light bulb, baseball or computer mouse.

Eat Breakfast: Skipping breakfast leads to overeating later in the day – often at dinner and in the evening when you are usually less active which is double trouble!  For gluten-free breakfast ideas see http://www.befreeforme.com/blog/?p=2487

Fill up on Fruits & Veggies: Fruits and vegetables contain a variety of vitamins, minerals, antioxidants and fiber. Many are low in calories so you can fill up at meals and snacks with these healthy foods. Check out this link for tips on using fruits and vegetables to help manage your weight.

Go for Whole Grains: There are a variety of nutritious gluten-free whole grains such as amaranth, buckwheat, millet, Montina™ (Indian ricegrass), millet, oats (pure, uncontaminated), quinoa, sorghum, rice (black, brown, red) and teff.  These healthy grains contain many nutrients, especially fiber- which is often lacking in the gluten-free diet because many gluten-free products are made from refined starches and flours. For more information about whole grains and how to add them to your gluten-free diet check out http://www.glutenfreediet.ca/img/WholeGrains.pdf

Snack Sensibly: Snacking can be part of a healthy gluten-free diet but you need to choose wisely. Need some nutritious options?  Check out http://www.glutenfreediet.ca/img/snacking.pdf

Short on Time? Nowadays we all seem to be running from here to there. We’re always on the go-go-go! Don’t beat yourself up trying to make all your own gluten-free foods from scratch for every meal.  There are companies who offer a variety of gluten-free mixes and ready-to-eat items that are delicious and nutritious. Check out my book Gluten-Free Diet: A Comprehensive Resource Guide that includes over 3100 gluten-free products from more than 270 companies at www.glutenfreediet.ca

Successful and healthy gluten-free eating takes a little time and planning. But with informed choices, current resources and the motivation to make a new start in the New Year, everyone on a gluten-free diet is able to get back, and stay, on the healthy gluten-free eating track!

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: Before my household became gluten and dairy free I baked all sorts of traditional holiday favorites. I would love to bake again –but need help on where to start? Shelley, can you help?

There’s nothing as special as homemade baked goods during the holiday season. But those concerned with a gluten or allergen free diet often struggle with “relearning” how to bake and adapt to these special dietary needs. By understanding a few basics in gluten-free and allergen-free baking, using a gluten-free flour mix and using your imagination when it comes to creating desserts, you will find that piping-hot cookies, cakes and other goodies can once again be enjoyed… even when on a restricted diet.

Here are the answers to a few of the most common questions I am asked about gluten-free baking.

Do you know any good gluten-free flour blends? It seems so overwhelming, and confusing!

Making your own flour blend for gluten-free baking does not have to be complicated or expensive. Carol Fenster, the President and Founder of Savory Palate, Inc., author of several best-selling gluten and allergen-free cookbooks, and an internationally recognized expert on gluten-free cooking developed an extremely versatile blend of flours that can be used as the basis for many gluten-free baked goods. Keep the following blend in a tightly sealed container in your pantry so you’re always ready to bake whenever the need arises. Here’s Carol’s recipe:

Carol’s Sorghum Blend
1 ½ cups sorghum flour
1 ½ cups potato starch or cornstarch
1 cup tapioca flour
Whisk ingredients together until well blended. Store, tightly covered, in a dark, dry place for up to 3 months. You may refrigerate or freeze the blend, but bring it to room temperature before using. You may double or triple the recipe.

For more of Carol’s gluten-free flour blend recipes using different flours check out this link.

Are there any tricks to convert my favorite recipe to be gluten and dairy free?

To answer this question I turned to Jean Duane, gluten-free, dairy-free (GFCF) expert and author of “The Complete Idiot’s Guide® to Gluten-Free Cooking”. Jean shares with us her secrets learned from years of GFCF baking trials and errors. What follows are general guidelines to convert a traditional wheat-flour recipe packed with dairy into a gluten-free and/or dairy-free version.

How to Convert a Traditional Recipe to Gluten and/or Dairy Free:
1. Start with a combination of flours in these ratios: 50% grain flour (brown rice or sorghum), 25% starch (cornstarch, tapioca or potato starch) and 25% protein flour (navy, fava, garbanzo, soy, gafava flour) or different grain flour. One cup of wheat flour translates into 1/2 cup of grain flour, 1/4 cup of bean flour and 1/4 cup of starch.
2. Add 25-50% more leavening (baking powder, baking soda or yeast) than the original recipe.
3. Add 1/2 to 1 tsp. acid (vinegar, citric acid, ascorbic acid dough enhancer, cream of tartar or citrus juice) to the original recipe.
4. Add 1/2 tsp. of either xanthan gum to the dry ingredients or guar gum to the wet ingredients for every cup of flour, or 1/4 tsp. of each. For smaller baked items, gums can be omitted.
5. Substitute butter with oil, cow’s milk with nut or rice milk (ideally with the same fat content).
6. Let the batter sit for a few minutes to absorb liquids before baking.

After you get the hang of it, it really is easy to covert your favorite recipes to a gluten-free and dairy-free version. For an example, check out Jean’s blog to see how easy it is to covert a simple brownie recipe.

Why do gluten-free recipes often contain xanthan gum or guar gum? What are they? Why are they needed in gluten-free recipes?

Gluten plays a big roll in the composition of flour. Specifically, gluten helps make dough more pliable, stretchy and “doughy”… all the attributes that is associated with gluten-containing flours.
While creating recipes with gluten-free flour blends, adding in a small amount of xanthan gum or guar gum will give the flour blend the elasticity that gluten would normally add. These gums, in essence, make the dough sticky!

Shelley, do you have any other ideas of baking without gluten?

There are plenty of delicious recipes that don’t use any flours at all. Recently, there have been many “flourless” cake recipes popping up in even the fanciest of restaurants. Other gluten-free and flourless recipes include Crème Brulee, meringues, custards, puddings, flans and desserts that include fruit as the main feature.

Experiment while baking and before you know it you’ll become a master patisserie baking up delicious and mouth-watering holiday favorites in your very own kitchen!

Note: A special thanks to Carol Fenster and Jean Duane for their contributions to this feature blog…

Carol Fenster, PhD, and President and Founder of Savory Palate, Inc., a gluten-free publishing and consulting firm. As well as being an internationally recognized expert on gluten-free cooking, she is  also the author of nine gluten-free and food-sensitivity cookbooks including 1000 Gluten-Free Recipes; Wheat-Free Recipes and Menus: Delicious, Healthful Eating for People with Food Sensitivities; Cooking Free: 220 Flavorful Recipes for People with Food Allergies and Multiple Food Sensitivities.

Jean Duane, Alternative Cook, LLC produces instructional DVDs (Chocolate, Mexican, Italian and Kids’ Meals), video streams (alternativecook.com) and Bake Deliciously! Gluten and Dairy Free Cookbook. She shows how to cook without gluten, dairy and other food-allergens. She has produced several spots for Comcast’s Video on Demand, made television appearances on PBS and has been a featured speaker at the 2009 and 2010 International Association for Culinary Professionals’ Conferences. She has developed recipes for Betty Crocker and for Beautiful Sweets bakery and is featured in the Better Homes and Gardens 2010 Christmas Cookies publication. A regular speaker and magazine writer, she won Kiplinger’s “Dream in You” contest in 2006.

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: Since going gluten-free I’ve discovered quinoa and I love it! Can you tell me more about quinoa, as well as different ways to enjoy it?

Answer: Quinoa (pronounced “keen-wah”) has been consumed for thousands of years in South America and was a staple of the Incas, who called it “the mother grain.” It is not actually a grain but the seed of a broad-leafed plant from the Chenopodiaceae family which is a close relative of the weed, lamb’s quarters. There are hundreds of varieties of quinoa, ranging in color from white to red and purple to black. Many varieties are now grown in North America. The plant stalks grow three to six feet high, containing clusters of seeds near the top of the stalk. The seed looks like a cross between sesame seed and millet. Quinoa seeds are naturally covered with saponin, an extremely bitter resin-like substance which protects it from birds and insects. To be edible the saponin must be removed. Some companies specially process the quinoa to remove this bitter coating, making it pan-ready and fast cooking. Quinoa is sold in several forms. Listed below are some of these forms, and ways to enjoy them!

Quinoa Seed:

• Can be used as a side dish instead of potatoes or rice or in salads, pilafs, stuffings, casseroles and puddings, as well as a thickener for soups, chili and stews.

• Rinse the quinoa in cold water and drain. In a heavy-bottomed saucepan with a tight-fitting lid, bring 1 cup of quinoa and 2 cups of liquid to a boil and simmer for about 15 minutes, or until all the liquid is absorbed. Turn off the heat and let stand, covered, for 5 minutes. Makes about 3 cups.

• Can also be cooked in the microwave using a round 2-quart microwave-safe casserole or bowl. Combine 1 cup quinoa and 2 cups water, cover loosely with plastic wrap and microwave on high for about 10-12 minutes, or until most of the water is absorbed. Remove from microwave, stir once and let stand, covered, for 5 minutes before serving.

Quinoa Flakes:

• Can be eaten as an instant hot breakfast cereal. Add 1/3 cup of flakes to 1 cup of boiling water and boil for 1½ -2 minutes, stirring frequently. Remove from heat and allow to cool. Add chopped nuts and dried fruits and sprinkle with brown sugar. Can also be cooked in the microwave. Combine flakes and water in a medium-to-Iarge microwave-safe bowl and microwave on high for 2 -2 1/2 minutes. Stir before serving.

• Quinoa flakes are available in plain and various flavors (contains flaked quinoa, dried fruits, nuts or seeds, sugar and spices).
• Substitute quinoa flakes for up to 1/3 of the gluten-free flour in a cookie, muffin or bread recipe.
• Can also be added to pancakes and waffles.

Quinoa Flour:

•  A tan-colored flour with a slightly nutty, strong flavor so best combined with other gluten-free flours.
• Can be used in a variety of baked items, especially in highly spiced or flavored products.

Quinoa Pasta:

• Quinoa is combined with corn or rice and is available in a variety of shapes.
• Cooks in 5-9 minutes.

Nutritional Information on Quinoa:

• Quinoa contains more high-quality protein than any other grain or cereal. The quality of this protein compares very closely to that of dried skimmed milk. Quinoa is high in iron, magnesium, phosphorus and zinc. It is also a source of calcium, B vitamins and dietary fiber.

References: Northern Quinoa Corporation, Quinoa Corporation

Question: My Aunt just got diagnosed with Dermatitis Herpetiformis. She said this is a type of celiac disease that affects the skin. Shelley, can you tell me more about this?

Dermatitis Herpetiformis (DH) is another form of celiac disease. This chronic skin condition is characterized by an intense burning, itchy and blistering rash. The rash is symmetrically distributed and commonly found on the elbows, knees and the buttocks, but can also occur on the back of the neck, upper back, scalp and hairline. Initially, groups of small blisters are formed that soon erupt into small erosions. Most people with DH will also have varying degrees of small intestinal villous atrophy although many will have no bowel complaints. A small percentage may present with bloating, abdominal pain and diarrhea, especially if the bowel involvement is severe, and some individuals may show evidence of malabsorption and malnutrition.

Prevalence
Approximately 10% of individuals with celiac disease have DH with a male to female ratio of 2: 1. The age of onset is typically between 25-45 but can also occur in children and older adults.

Diagnosis
Individuals with DH are frequently misdiagnosed with other skin conditions such as eczema, contact dermatitis, allergies, hives, herpes or psoriasis and treated with a variety of topical creams. The only way to correctly diagnose DH is a skin biopsy from unaffected skin adjacent to blisters or erosions. A small intestinal biopsy is not essential if the skin biopsy is positive for DH.

Treatment
Treatment for DH is a strict gluten-free diet for life. For some individuals, Dapsone, a drug from the “sulphone family,” may be prescribed to reduce the itching. Response to the medication can be dramatic (usually 48-72 hours). However, Dapsone has no effect on the ongoing immune response or intestinal atrophy. Following a strict gluten-free diet will result in:
•    Improvement in the skin lesions.
•    Major reduction in drug dosage for those people initially started on Dapsone. After a time, it is often possible to discontinue the drug to control the skin rash. Flare-ups due to inadvertent or intentional gluten consumption may require temporary use of Dapsone.
•    The gut function will return to normal.
For more information and photos about DH see the National Digestive Diseases Information Clearinghouse (NDDIC) website.

NOTE: Once a diagnosis of celiac disease or dermatitis herpetiformis is confirmed, it is essential to consult with a registered dietitian with expertise in celiac disease and the gluten-free diet for nutritional assessment, diet education, meal planning and assistance with social and emotional adaptation to the new gluten-free lifestyle. Also, joining a celiac support organization for further information and ongoing support is highly recommended.

Question: I am on a gluten-free diet and need help with meal planning. Do you have any suggestions on making meal time a bit more exciting by adding more variety? P.S. – Healthy & nutritious ideas are a plus too!

Successful gluten-free meal planning requires a positive attitude, a little creativity and learning how to make substitutions for some ingredients and food items in favorite recipes and menu items. Fortunately, many foods that are naturally gluten-free are also good for you, including plain meats, fish, poultry, eggs, milk, cheese, yogurt, legumes (dried beans, lentils and peas), nuts, seeds, fruits, vegetables, and grain alternatives such as amaranth, buckwheat, corn, flax, millet, quinoa, rice, sorghum and teff. In addition, there are numerous gluten-free specialty products (e.g., pasta, breads and baked goods, cereals, sauces, soups) that can be substituted for traditional gluten-containing items.

In the beginning, plan simple meals and snacks with plain foods so you don’t become overwhelmed with the new gluten-free lifestyle. But, once you have mastered the basics gradually incorporate new items and try more complex dishes with multiple ingredients. Have fun! To save time and energy, prepare gluten-free recipe and menu items that everyone can eat rather than having to “cook twice.” Other family members can supplement their meal plan with gluten-containing bread or dessert items if desired.

The trick is to keep an optimistic attitude, be creative, and embrace trying new (and exciting!) foods!

Here are some specific ideas on how to add variety and incorporate more nutritious options into the gluten-free diet:

Reprinted and adapted with permission from: Rate Your Plate, Living Without magazine, Fall 2003, pg. 26. Chart prepared by Shelley Case, RD

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: After years of being anemic, I just found out I have celiac disease. Do you have any advice on maximizing iron absorption?

Anemia is a concern for many folks that have been diagnosed with celiac disease. Anemia is a condition that results from a deficiency in the size or number of red blood cells or the amount of hemoglobin in these cells. There are many causes of anemia, however, the most common is due to iron, folate or vitamin B12 deficiency. In celiac disease damage to the intestinal villi in the area where iron and folate are absorbed frequently results in a deficiency of these nutrients. As the disease progresses, villous atrophy in the lower part of the small intestine (terminal ileum), resulting in vitamin B12 malabsorption, can also occur in some individuals. Other reasons for inadequate absorption of B12 may be due to small intestinal bacterial overgrowth, low stomach acid levels (caused by the long-term use of gastric acid blocking agents for the treatment of reflux or ulcers) or pernicious anemia (an autoimmune disease that produces antibodies that destroy specific cells in the stomach which contain the Intrinsic Factor (IF) that is necessary for the absorption of B12 from foods).

How Can You Treat Anemia?

Once a diagnosis of celiac disease is confirmed and the gluten-free diet is initiated, the villi begin to heal which allows for the absorption of nutrients. Response to the gluten-free diet varies from one individual to another and may take on average from 2-18 months until the nutritional deficiencies are corrected and symptoms resolve. In addition to a strict gluten-free diet, it is important to include foods high in iron, folate and vitamin B12. Nutrition supplements may be required if the deficiency is severe. In the case of pernicious anemia, life-long vitamin B12 supplementation (shots, intranasal or oral supplements) are necessary. Discuss with your physician and dietitian about supplementation.

There are two types of iron in foods, heme iron and non-heme iron:

Heme Iron:
•    Is more readily absorbed by the body (approximately 23% of heme iron consumed is absorbed).
•    Absorption is not changed by other foods in the diet.
•    Is found only in red meat, fish and poultry.

Non-Heme Iron:
•    Is not absorbed as well as heme iron (only 3-8% of non-heme iron consumed is absorbed).
•    Absorption can be increased or decreased by other foods in the diet.
•    Is found in fruits, vegetables, grains and eggs.

How Can You Maximize Iron Absorption?

1.    Choose foods with a higher iron content

2.    Eat a source of heme iron with non-heme iron at the same meal: An example is stir-fried beef, chicken, pork or fish with vegetables (e.g., broccoli) and rice and toasted almonds or sesame seeds; or Chili with meat and beans.

3.    Vitamin C increases absorption of non-heme iron so combine vitamin C-rich foods with non-heme iron foods at the same meal: An example of this includes Poached egg and glass of orange juice; Casserole with rice, beans, canned tomatoes or tomato sauce; or a Spinach salad with strawberries or orange segments.

4.    Avoid coffee or tea with meals rich in iron as these beverages contain tannins which interfere with iron absorption. It is better to drink these beverages between meals.

5.    If taking iron supplements, consume supplement with vitamin C-rich foods.

How Much Iron Do You Need?

For more than 50 years, nutrition experts have produced a set of nutrient and energy standards known as the Recommended Dietary Allowances (RDA’s). A new set of standards has been developed called the Dietary Reference Intakes (DRl’s) which reflect collaborative efforts of American and Canadian scientists, through a review process overseen by the National Academy of Science’s Food and Nutrition Board, Institute of Medicine, National Academies.
The newly established levels for vitamins, minerals, protein, fats, cholesterol, carbohydrate, fiber, and energy levels can be found at this Board’s website (please note that iron levels are listed on page 2).

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: On hot summer days, many people like to enjoy a cool, refreshing alcoholic beverage. Are there any alcoholic beverages that are gluten-free?

Answer: There has been a lot of misinformation about the gluten-free status of alcohol. The good news is that many alcoholic beverages are gluten-free. So lift up your glass and let’s toast to this good news! Here is the scoop…

Distilled Alcoholic Beverages:

Rye whiskey, scotch whiskey, gin, vodka and bourbon are distilled from a mash of fermented grains. Even though these alcoholic beverages can be derived from a gluten-containing grain, the distillation process removes the gluten from the purified final product, so they are gluten-free. Rum (distilled from sugar cane) and brandy (distilled from wine) are also gluten-free.

However, be aware that some pre-made Bloody Mary and Caesar beverage mixes may contain barley malt flavoring or hydrolyzed wheat protein and are not gluten-free so check the label on these items.

Liqueurs (also known as cordials):

These are made from an infusion of a distilled alcoholic beverage with added sugar and flavoring agents such as nuts, fruits, seeds, flowers or cream. Liqueurs are gluten-free.

Wine (including vermouth, port and sherry):

Wines are made from fermented grapes or other fruits. There are also fortified wines such as vermouth; port and sherry which include an added brandy or another distilled alcohol. All these wines are gluten-free.

Wine Coolers:

Historically most wine coolers were gluten-free as they were made from wine, fruit juice, a carbonated beverage and sugar. However in 1991 the US Congress increased the excise tax on wine so many producers substituted malt (from barley) for the wine. Any malt-based coolers are not gluten-free.

Ciders:

Alcoholic and non-alcoholic ciders are made from apple juice. Sparkling cider is made with apple cider and a carbonated beverage. Most ciders are gluten-free but some brands may use barley in its production and are not gluten-free. The best bet is to check with the manufacturer to determine if they are gluten-free.

Beer, Ale and Lager:

The basic ingredients in beer, ale and lager include malted barley, hops (a type of flower), yeast and water. As this mixture is only fermented and not distilled, it contains varying levels of gluten and must be avoided. However, a variety of gluten-free specialty  beers are now on the market made from various gluten-free grains such as buckwheat, sorghum, millet and rice.

Note: Always remember that although certain alcoholic beverages can be included in a gluten-free diet, it must be consumed responsibly and in moderation!

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: I prepare most of my own gluten-free meals but think I am still somehow ingesting gluten. Could it be cross-contamination while preparing and cooking meals at home? I think I’m careful, but could you give me some pointers on how to avoid potential cross-contamination in my own kitchen?

Answer: In addition to always checking the ingredients in any food you eat, you must also be aware of the possibility of cross-contamination (a process by which a gluten-free product comes into contact with something that is not gluten-free).

Many people, as careful as they are, unwillingly still ingest gluten by cross-contamination, even in their own homes. Here are some pointers and guidelines to help you prevent this avoidable ingestion of gluten:

• Label It: Store all gluten-free products in separate labeled containers. Some families buy bright stickers and put them on everything that is and/or should remain gluten-free. In addition, you may want to keep all gluten-free foods in a separate place in the cupboard and refrigerator. Another tip is to store gluten-free products on the upper shelves of the pantry or cupboards ABOVE the gluten-containing products to prevent flour dust and crumbs from falling onto the packages and containers of gluten-free items.

• No Sharing Allowed: Buy separate containers of items like peanut butter or jam and label “gluten-free” to prevent them from becoming cross-contaminated by other family members preparing gluten-containing products (e.g. toast, sandwiches).

• Give it a Squeeze:  Buy squeeze bottles of condiments such as ketchup, mustard, relish and mayonnaise. This prevents any crumbs from getting in the containers.

• No Double Dipping: Avoid other’s crumbs! Have a separate butter or margarine container designated for gluten-free users only.

• Even a Little Gluten and You’re Toast: Have your own toaster. If not, use a toaster oven, where the rack can be removed and washed if others have used it. Another option is to buy special toaster bags for gluten-free bread that can be placed in a regular toaster. These bags can be washed and re-used. Available from www.celinalfoods.com, www.elpeto.com, or www.glutenfree.com.

• Space it Out: Always make sure that the counter space you are using to prepare gluten-free foods is freshly washed to ensure it is free from crumbs or flour dust.

• Scrub, Scrub, Scrub: Make sure pots, utensils, etc., that are also used for other foods are thoroughly scrubbed before using with gluten-free foods.

• Pasta Concerns: Do not boil gluten-free pasta in the same water that previously had gluten-containing pasta. Also use a separate colander to drain gluten-free pasta, as it is difficult to remove traces of pasta from the colander.

•You-Tensils: Have your own set of utensils and other items for gluten-free baking and cooking (e.g., wooden spoons, cutting boards, sifter.)

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Question: Can you share a few quick facts about celiac disease and the gluten-free diet? I would love to pass this info along to family members & friends who want to learn more about my daughter’s diagnosis.

Answer: May is Celiac Awareness Month so it’s a great time to share many facts about the disease and its treatment – the gluten-free diet.

* Celiac disease (CD) is an inherited autoimmune disease that affects 1:100 people. The disease can develop at any age including the elderly. It is twice as common as Crohn’s, ulcerative colitis and cystic fibrosis combined. 

* Consumption of gluten, found in the grains wheat, rye and barley, damages the tiny finger-like projections called “villi” that line the small intestinal tract. As a result, nutrients from foods, especially iron, calcium, vitamin D and folate, cannot be absorbed through the villi and into the bloodstream. A variety of nutritional deficiencies can occur over time. Gluten not only affects the gastrointestinal system but many other organ systems in the body.  This can lead to a wide range of symptoms that vary from one person to another. Some individuals may only present with a few symptoms or have none at all, while others can have numerous symptoms.

* Symptoms can include nausea, bloating, gas, abdominal pain, diarrhea or constipation (or both), lactose intolerance, weight loss (note-CD can also occur in obese individuals), mouth ulcers, extreme fatigue, irritability, bone and joint pain, easy bruising of the skin, swelling of the ankles and hands, menstrual irregularities, elevated liver enzymes, migraine headaches, depression and ataxia (balance and coordination difficulties). Children may also have delayed growth, dental enamel defects and concentration and learning difficulties.

* Another presentation of CD is a skin condition called dermatitis herpetiformis (DH). It is characterized by an intense burning, itchy rash that is symmetrically distributed. Areas affected can include the elbows, knees, back of the neck and scalp, upper back and buttocks. Initially, groups of small blisters are formed that soon erupt into small erosions. Most people with DH will also have varying degree of small intestinal villous atrophy, although many will have no bowel complaints. For more information about DH check out this link.

* CD can also occur more frequently in other conditions such as type 1 diabetes, autoimmune thyroid disease, autoimmune liver disease, Down syndrome, Turner syndrome and selective IgA deficiency.

* Untreated CD can result in nutritional deficiencies; osteoporosis; reproductive complications such as infertility (in both men and women) and miscarriage; development of other autoimmune disorders and an increased risk of gastrointestinal cancers.

* Delay in diagnosis is common. Studies in the US and Canada have found that it can take over 10 years before an accurate diagnosis is made. Many individuals are frequently misdiagnosed with other conditions such as irritable bowel syndrome, ulcers, allergies, chronic fatigue syndrome and fibromyalgia prior to getting the correct diagnosis.

* There are specific blood screening tests that can be used to screen for CD, however the only definitive test for diagnosis is a small intestinal biopsy. Diagnosis for DH is a skin biopsy from unaffected skin adjacent to the blisters or erosions. In DH, an intestinal biopsy is not essential if the skin biopsy is positive.

* First degree relatives (parents, siblings and children) of individuals with CD have a higher risk of developing the disease so they should be screened for CD. For more information check out this link.

* A gluten-free diet should never be started before the blood tests and biopsy are done as this can interfere with making an accurate diagnosis.

* The only treatment for CD is a strict gluten-free diet for life. All forms of wheat, rye and barley must strictly be avoided, including spelt, kamut, einkorn, emmer, faro, durum, couscous, semolina, bulgur and triticale. Barley malt, barley malt extract, barley malt flavor, brewer’s yeast, malt vinegar, as well as barley-based ale, beer and lager must also be avoided. Here is a more detailed list of foods allowed, to avoid and to question.

* Gluten is found in a wide variety of foods such as breads and other baked products, cereals, pastas, soups, sauces such as soy sauce which is often made from wheat and soy, seasonings, salad dressings, snack foods, prepared meats (e.g., deli meats, hot dogs, hamburger patties, imitation seafood), beer, flavored coffees and teas, some candies (e.g., licorice), chocolates and chocolate bars, as well as some nutrition supplements and medications.

* The protein in oats was originally thought to trigger the same toxic reaction as wheat and other gluten-containing grains. Research in Europe and the US over the past 15 years has revealed that consumption of moderate amounts of oats is safe for the majority of children and adults with celiac disease. Most of these studies used pure, uncontaminated oats, but it should be noted that a small number of individuals with celiac disease may not tolerate pure oats. The mechanism causing this intolerance has yet to be established. Before adding pure, uncontaminated oats to your diet, talk to your doctor and dietitian. Most authorities recommend that individuals with CD be well established on the gluten-free diet, the celiac antibodies have returned to normal and symptoms resolved. For more information about the safety of oats check out this link.

* A wide variety of foods that are naturally gluten-free include plain meat, poultry, fish, eggs, legumes, nuts, seeds, milk, yogurt, cheese, fruits, vegetables, as well as many gluten-free flours, cereals and starches that can be substituted for wheat, barley and rye. Distilled alcoholic beverages, wine and gluten-free beer made from buckwheat, millet, rice or sorghum are also allowed.

* Amaranth, buckwheat, corn, flax, Indian ricegrass (Montina), legume flours (bean, chickpea/garbanzo bean, pea, lentil), mesquite, millet, nut flours, potato flour, potato starch, quinoa, rice, sago, sorghum, soy, tapioca and teff are gluten-free options.

* A growing number of gluten-free specialty products from companies in the USA, Canada and Europe are available in health food and grocery stores, as well as mail order companies. Examples include ready-to-eat baked products (e.g., breads, buns, bagels, muffins, cakes, cookies, pies, pizza crusts), baking mixes and specialty flours, hot and cold cereals, crackers, snack foods, entrees, pastas (corn, legumes, quinoa and rice), bread crumbs, coating mixes, gravy mixes, soups, sauces, communion wafers, ice cream cones, snack bars and gluten-free beers.

* Many gluten-free products are made with refined flours and starches such as white rice flour, tapioca starch, potato starch and/or cornstarch which are lower in iron, B vitamins and fiber. Choose more nutritious ingredients such as amaranth, brown rice flour, buckwheat, flax, Montina™, nut flours, quinoa, legume flours (e.g., garbanzo/chick pea, Garfava™, yellow or green pea, bean {black, cranberry, soy} and teff when preparing or purchasing gluten-free foods. In addition look for gluten-free products that are enriched with vitamins and minerals.

* It is recommended to consult with a registered dietitian with expertise in CD and the gluten-free diet. The dietitian will do a nutritional assessment, provide nutrition education and practical information to help you successfully manage the gluten-free diet.

* Join a celiac group for additional support and encouragement is also important. Here are links to celiac organizations in the US and Canada.

* There are many excellent books, cookbooks, websites and other resources for those following a gluten-free diet. Check out Gluten-Free Diet: A Comprehensive Resource Guide-Revised and Expanded Edition 2010. It is filled with detailed information about the diet, foods and ingredients allowed and to avoid, meal plans, recipes, cooking hints, substitutions, label regulations, nutritional information and practical strategies for healthy gluten-free living, over 3100 gluten-free specialty foods, a directory of more than 270 American, Canadian and international companies, resources, websites and more!

Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca

Q: I’m usually running late in the morning so I often skip breakfast. Can you give me some healthy and quick breakfast tips?

A: I’m sure you have heard that breakfast is the most important meal of the day. It literally means break the fast. In order to jump start your day both mentally and physically you need to fuel your body with food. Healthy breakfast foods provide key nutrients such as protein, iron, B vitamins, carbohydrates and fiber. Many traditional breakfast items are made with gluten-containing grains, especially wheat and barley. But not to worry- there are plenty of great gluten-free breakfast options in the chart below.

The chart includes examples of products from various companies. There are many more products available, especially baked items from gluten-free specialty bakeries across North America. The Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD, features over 3100 gluten-free products listed by company name, product name and package size and a directory of more than 270 American, Canadian and international companies. The book has a chapter on gluten-free specialty bakeries in North America. It also contains detailed information about the gluten-free diet including safe foods/ingredients and those to avoid; meal plans; recipes; cooking hints; substitutions; nutrition information and practical strategies for healthy gluten-free living and resources. See www.glutenfreediet.ca

The above information was excerpted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD. See www.glutenfreediet.ca