Be Free For Me Blog

Q. I have just been diagnosed with celiac disease. In addition to avoiding gluten do I need to avoid dairy products too? I hear that celiac disease and lactose intolerance can sometimes go hand-in-hand.

Celiac disease is an autoimmune disorder triggered by the consumption of gluten found in the grains wheat, rye and barley. The small intestinal villi (tiny finger-like projections) become inflamed and flattened (known as villous atrophy) due to the reaction to gluten. Malabsorption of various nutrients such as iron, folic acid, calcium and vitamin D can result. Fortunately, removing gluten from the diet will allow the villi to regenerate fairly quickly- often weeks to a few months. In some people with long-standing, undiagnosed celiac disease or in older individuals, it may take months to several years until the villi are completely healed. The most important factor is to follow a strict gluten-free diet for life.

The tips of the villi also contain enzymes such as lactase which is responsible for the digestion of lactose- a natural sugar found in milk and milk products. In some individuals with newly diagnosed celiac disease, especially those with major villous atrophy, the level of lactase is significantly reduced. This temporary lactose intolerance causes undigested lactose to pass through the intestinal tract, drawing fluid with it. It is then fermented by bacteria in the large intestine producing short-chain fatty acids and gases. Symptoms of lactose intolerance may include abdominal cramping, bloating, gas, nausea, headache and diarrhea. These symptoms can occur 15-30 minutes or as long as several hours after consuming foods with lactose.

The good news is that this temporary lactose intolerance often improves on the gluten-free diet alone. However, some people may also need to restrict or reduce lactose until the villi are completely healed and the lactase enzyme levels are restored to normal. This may take weeks to months depending on individual response. It should be noted that most individuals with lactose intolerance can digest small amounts of lactose.

Here are some options for those with lactose intolerance:

 Lactose-reduced milk contains added lactase enzymes and about 99% of the naturally occurring lactose has been converted to simple, easily digested sugars. Some brands such as Lactaid and Dairy-Ease are available in refrigerated forms and Lacteeze is in shelf-stable and refrigerated forms. Lactose-reduced milk is slightly sweeter than regular milk but it has the same nutritional value and can be used in cooking and baking as well.

 Lactase supplements can be taken just before meals or snacks that contain lactose. Lactaid makes caplets that can be swallowed or chewable tablets. Lacteeze brand has ultra-strength tablets.

 Lactase enzyme drops can be added to liquid dairy products. You need to pre-treat the milk at least 24 hours in advance to ensure the lactase breaks down the lactose. Lactaid and Lacteeze make these drops that are available in drug stores.

 Non-dairy beverages made from nuts, potatoes, rice or soy do not contain any lactose. Look for brands that are gluten-free (do not contain any barley malt flavoring) and are enriched with calcium, vitamin D and other nutrients.

 Yogurt is often tolerated by those with lactose intolerance. Although yogurt contains lactose, the lactase enzymes in the active cultures digest this lactose. Choose brands that contain “active” or “live” cultures.

 Cheese  especially aged, natural cheese such as Cheddar, Swiss, Parmesan and Mozzarella are low in lactose. In these cheeses most of the lactose is removed with the whey and the small amount remaining is broken down during the aging process, therefore, most aged cheese are well tolerated.  However, processed cheese food and processed cheese spreads often contain added modified milk solids, therefore their lactose content may be higher than plain processed cheese. Light cheese products also contain modified milk solids that replace milk fat. They tend to be high in lactose.

 Milk  taken in small amounts (1/4-1/2 cup) at a time may be tolerated. Avoid drinking large amounts at once. Consume milk with meals or snacks but avoid drinking on an empty stomach. The higher the fat content in the milk, the slower it is digested and more easily tolerated. Whole milk may be better tolerated than low-fat or non-fat milk.

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

Question: Are oats allowed on a gluten-free diet? 

Historically, oats were not allowed on a gluten-free diet for those with celiac disease. The avenin protein in oats was thought to cause the same reaction as the proteins in the gluten-containing grains wheat, rye and barley.  However, many studies over the past 15 years have revealed that moderate amounts of pure, uncontaminated oats are tolerated by the majority of individuals with celiac disease.  It should be noted that a small number of individuals with celiac disease may not tolerate pure, uncontaminated oats. The mechanism triggering this intolerance has not yet been identified. So it is important to check with your doctor and dietitian before adding pure, uncontaminated oats to your gluten-free diet.

To learn more about the safety of oats in celiac disease, read the extensive review by Health Canada.

Remember… Not all oats are gluten-free:
Many commercial oat products on the market are cross-contaminated with wheat, rye and/or barley during harvesting, transportation, storage, milling, processing and packaging. An American study by dietitian Tricia Thompson tested three brands of commercially available oats and found varying levels of gluten contamination. Similar results were reported in two other studies by Hernando and Gelinas. Cross contamination has been the major reason why most health professionals and celiac groups have not allowed oats on a gluten-free diet. Fortunately there are companies in the USA and Canada that produce pure, uncontaminated oats on dedicated fields with dedicated equipment and processed in dedicated gluten-free facilities. The major specialty gluten-free oat companies include:

• Cream Hill Estates
• Gifts of Nature     
• Gluten-Free Oats 
• Only Oats from Avena (Formerly FarmPure Foods)
• PrOatina      
• Bob’s Red Mill

In addition to the above producers, many companies are adding gluten-free oats to their products in items such as granola, snack bars, muffins and breads.  Look for the words on the package label – “gluten-free oats”, “pure, uncontaminated oats”, or “certified gluten-free oats”. Also, the Gluten-Free Certification Organization (GFCO) does certify a number of companies producing and/or including gluten-free oats in various products. The GFCO symbol will be located on the package. The Canadian Celiac Association will be launching a new certification program for pure, uncontaminated oats in early 2010. Products meeting the certification will have the trademark “PAVENA™” on the food label.

Authorities approve oats:
Many health professionals, celiac organizations, celiac research centers and other associations around the world allow consumption of moderate amounts of pure, uncontaminated oats. I have included a detailed listing of the position statements from these organizations in my book Gluten-Free Diet: A Comprehensive Resource Guide.

The Canadian Celiac Association Professional Advisory Board has developed guidelines for the introduction of pure, uncontaminated oats in the gluten-free diet for those with celiac disease.  

Oat’s nutritional value:
A nutritious whole grain, oats are a good source of protein, fiber, iron and B vitamins.  Oats contain two kinds of fiber- soluble and insoluble. The soluble fiber (ß-glucan) can help lower cholesterol and control blood glucose levels. Insoluble fiber promotes regular bowel movements and prevents constipation. As many gluten-free products are frequently made with refined flours and starches and are low in iron, B vitamins and dietary fiber, oats are a healthy addition to the diet.

Where to find Oat recipes:
Gluten-free oats are available as whole oat groats, oatmeal, oat flour and oat bran. They can be incorporated into many recipes. BeFreeForMe.com has many gluten-free oat recipes including Oatmeal M&M Cookies and Orange Oatmeal Granola Trail Mix. Cream Hill Estates also has a great recipe for Muesli Cereal.

Shelley Case, RD
Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide

Question: I love to use spices, herbs and various seasoning blends to spice up my food… but I heard they may contain gluten! Help!

Answer: A wide variety of spices and herbs are used in foods for flavoring purposes. American and Canadian food regulations differ in how they define the terms spices, herbs and seasonings. Here are some facts about the gluten-free status of these ingredients.

Spices, herbs and seeds do not contain gluten

Although anti-caking agents may sometimes be added to spices, it is often silicon dioxide, calcium silicate or sodium aluminum silica and NOT wheat flour or wheat starch. Some imitation black peppers contain other ingredients such as buckwheat hulls and ground rice in addition to black pepper. I have not found any companies using wheat as a filler in imitation pepper.

Seasonings may contain gluten

In general terms “seasonings” are a blend of flavoring agents (spices and/or herbs) which are often combined with a carrier agent such as salt, sugar, lactose, whey powder, starches or flours. The carrier agent in seasoning mixtures in gravy mixes, sauces and snack foods often contain wheat flour or wheat starch.

If a seasoning mixture/blend is sold separately as a bottled or packaged seasoning(e.g., Cajun Seasoning, Taco Seasoning Mix, etc.) the components of all the ingredients must be declared on the label. When a seasoning mixture is used in other foods it may only say “seasoning” on the label and not indicate its components. However in the USA, the FDA’s “Food Allergen Labeling and Consumer Protection Act” requires that all components of ingredients when used in other foods must be declared if they contain any of the top eight allergens (including wheat). So if wheat flour or wheat starch was used in a seasoning blend it would have to be listed as “seasoning (wheat flour or wheat starch)” or “seasoning” and at the end of the ingredient list “Contains Wheat”. Also, whenever the term “seasoning” is used in the ingredient statement of a meat or poultry product, its components must be identified as a sublist.

It should be noted that, in Canada, seasoning, spice or herb mixtures, when used as ingredients in other foods are exempt from a declaration of their components. Although it is not currently required by regulation, Health Canada strongly urges manufacturers to declare components of ingredients such as seasonings if they contain allergens or gluten sources. Fortunately many companies are voluntarily labeling the components of seasonings when used in other foods. Also, Health Canada has proposed new labeling regulations entitled “Schedule No 1220- Enhanced Labelling for Food Allergen and Gluten Sources and Added Sulphites” that would make it mandatory to declare allergen and gluten sources.

The Bottom Line

If gluten sources such as wheat flour or wheat starch are used in a seasoning mixture/blend, it must be declared on the label of products sold in the USA. Although it is not yet mandatory in Canada, most companies do declare the source of the seasoning blend if it contains an allergen or gluten source. However, if a food product in Canada lists “seasonings” on a food label it is recommended to contact the company to ask if wheat is used as the carrier agent.

The above information was adapted from Gluten-Free Diet: A Comprehensive Resource Guide, Revised and Expanded Edition by Shelley Case, RD. Case Nutrition Consulting Inc.
www.glutenfreediet.ca

Question: I love to bake! Can you give me any gluten-free baking tips and pointers for this upcoming holiday season?

Answer:

Baking with gluten-free ingredients can be both challenging… and fun! In order to make tasty and satisfying gluten-free baked products it is essential to learn how to use different types and combinations of flours, starches and other ingredients, as well as specific baking techniques in order to compensate for the lack of gluten. Here are a few general gluten-free baking tips:

General Gluten-free Baking Tips:
Store gluten-free flours and starches in plastic airtight containers with wide and tightly fitting lids; and for optimum freshness keep them in the refrigerator or freezer. Allow the cold flour or starch to return to room temperature before using.

• Mark It: Label containers with the name of the item and date purchased.

• Measure it once… and twice: Measure flours and starches carefully. Inaccurate measurements can greatly affect the quality of gluten-free recipes because each flour and starch has very unique properties.

• Keep it loose: Loosely spoon the flour or starch into the measuring cup, leveling the top with the flat side of a knife. Never pack down the flour.

• Cook with sparkle: Use shiny, light-colored metal pans (gray not black). Products bake and brown more evenly in lighter colored pans than in dark pans, which can leave edges crisp and over-browned.

• Keep it low: When using glass baking pans and non-stick metal baking pans [gray not black), reduce oven temperature by 25 degrees F.

• Longer is better: Most gluten-free breads are better when baked at lower temperatures for longer periods of time. After the first 10- 15 minutes of baking, tent the bread with foil to prevent over –browning.

• Lows and highs: Baking is also affected by temperature and altitude. Slightly reduce the amount of liquid in recipe if baking at a higher altitude or on a very humid day. For baking at very low altitudes, slightly increase the amount of liquid.

• That’s the way the (gluten-free) bread crumbles: Gluten-free bread dough tends to be softer, stickier and more batter-like. If it is too heavy and dry, the bread tends to be too crumbly.

• Dust it with sweetness: When making a gluten-free chocolate cake or brownies, grease the pan and then “flour” the pan with cocoa.

Texture Tips:

• Double it up: A combination of gluten-free flours and starches makes a better product than single flours.

• Leave it to leavening: Gluten-free baked products often require more leavening than products made with wheat due to the lack of gluten which is necessary to form an elastic dough and enables the product to rise.

• Crumbler fixers: It is important to use xanthan gum or guar gum in baked products in order to prevent crumbling. Add the gum to the dry ingredients as it does not mix with water. For every cup of gluten-free flour, use 1 teaspoon of gum for breads and ½-3/4 teaspoon for other baked goods.

• Gelatin to the rescue: Unflavored powdered gelatin also works as a binding agent and can prevent crumbling. If substituting gelatin for xanthan or guar gum, use twice as much gelatin. Soften the gelatin in half the water called for in the recipe before adding.

• (Butter)Milking it: Substituting buttermilk for the milk or water in recipes results in a lighter, more finely textured product. Carbonated beverages [not diet soft drinks) in place of water or milk can also result in a lighter-textured product (e.g., pancakes, cakes).

• Take the time: Let gluten-free dough sit at least 30 minutes at room temperature to soften. This results in a better-textured product

Flavor Tips:

•  Spice it up: To improve the flavor of gluten-free baked products use more herbs, spices and flavorings (approximately 1/3 – ½ more than normal).

• Get cocoa, nutty & fruity too: Adding chocolate chips, nuts, fruits (e.g., applesauce, bananas) dried fruits (e.g., apricots, cranberries, raisins) can also improve the flavor.

• Hey Sweetie: Honey or molasses can provide more flavor than white sugar. You need to reduce the amount of liquid in the recipe if making this substitution. If a recipe calls for 1 cup of sugar, use 3/4 cup honey or molasses.

• Toast it: Most gluten-free breads taste better toasted or warm.

Storage Tips:

• Seal it:  Baked products made with gluten-free flours have no preservatives, become stale quickly and are quite perishable. Wrap them tightly in plastic wrap and store in airtight plastic containers or self-seal plastic bags. If the product will not be eaten within one or two days, freeze to ensure minimum loss of moisture and flavor. For breads, it is best to thoroughly cool, slice and separate each slice with wax paper before bagging and freezing.

• Keep it moist: Placing baked products such as muffins in plastic bags when still warm can preserve moisture.

• Thaw Tips: Thaw frozen baked goods at room temperature instead of microwaving at full power; microwaving causes them to become rubbery and tough.

Note: Thanks to the following gluten-free culinary experts for some of the background information on gluten-free flours and starches, substitutions and many of the above baking tips:

Carol Fenster, PhD, President and Founder of Savory Palate, Inc., gluten-free publishing and consulting firm. Author of:
1000 Gluten-Free Recipes; Gluten-Free 101: Easy Basic Dishes without Wheat; 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 www.savorypalate.com

Connie Sarros, Author of gluten-free cookbooks and other resources:
Wheat-Free Gluten-Free Recipes for Special Diets; Wheat-Free Gluten-Free Cookbook for Kids and Busy Adults; Newly Diagnosed Survival Kit; Wheat-Free Gluten-Free Dessert Cookbook; Wheat-Free Gluten-Free Reduced Calorie Cookbook; All You Wanted to Know About Gluten-Free Cooking DVD
www.gfbooks.homestead.com

Donna Washburn, P.H.Ec. and Heather Butt, P.H.Ec., partners in Quality Professional Services, specializing in recipe development and bread machine baking. Authors of:
Complete Gluten-Free Cookbook; 125 Best Gluten-Free Recipes; The Best Gluten-Free Family Cookbook
www.bestbreadrecipes.com

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 more glute-free tips at: www.glutenfreediet.ca

Q. My child was just diagnosed with celiac disease and learning about the gluten-free diet is overwhelming. Where do I begin and what resources are available to help us?

A.  Learning about celiac disease and how to eliminate gluten can be very challenging for both the child and family, especially in the beginning. Start slow and take it one day at a time! “One of the most important and effective steps you can take to equip your child to live gluten-free is to empower them with good self-esteem and the skills needed to make independent gluten-free food choices in and out of the home” says dietitian Nancy Patin Falini. “Instill in your child the appeal of being unique while dispelling the myth of needing to be like everybody else.” Fortunately there are many resources and groups that can help you on this new gluten-free journey…

See a Registered Dietitian
The first essential step is to consult a registered dietitian with expertise in celiac disease. The dietitian will do a complete nutritional assessment, provide detailed information about celiac disease and the gluten-free diet, as well as develop an individualized meal plan. Practical information about label reading, shopping, recipes, substitutions, preventing cross contamination, eating away from home and traveling will also be covered in the initial and follow-up visits. To locate American dietitians specializing in celiac disease see http://www.glutenfreedietitian.com/newsletter/dietitians-specializing-in-celiac-disease/ The Canadian Celiac Association has a list of celiac chapters that have dietitian advisors. Contact the local celiac group at http://www.celiac.ca/chapters.php

Join a Celiac Support Group
A number of national celiac support groups and their local chapters offer information and have regular meetings to help individuals and family members. For links to the American and Canadian groups see www.glutenfreediet.ca/groups.php
There is a special support group for parents, families and friends of kids with celiac disease or gluten intolerance called R.O.C.K. (Raising our celiac kids). It was founded by Danna Korn after her son was diagnosed with celiac disease in 1991. For more information or to locate a R.O.C.K. group near you, contact Rock@celiackids.com

Seek out Practical Resources
The Gluten-Free Diet: A Comprehensive Resource Guide by dietitian Shelley Case is a 368 page book filled with detailed information about the gluten-free diet. It includes a listing of foods and ingredients allowed, to avoid and question; gluten-free labeling regulations; as well as meal plans, recipes, cooking hints, substitutions, nutrition information, cross contamination, eating out, over 3100 gluten-free specialty products, a directory of more than 270 companies, listing of cookbooks, books, websites and other helpful resources. See www.glutenfreediet.ca/overview.php

Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-Free Children by Danna Korn provides parents with advice and specific strategies on how to deal with the diagnosis, cope with emotional challenges, and help their child develop a positive attitude. Includes practical information on menu planning, shopping, food preparation, recipes and eating outside the home (e.g., birthdays, restaurants, camps, vacations). Available from www.amazon.com

Dietitian Nancy Patin Falini’s Gluten-Free Friends: An Activity Book for Kids is an illustrated book for children ages 4-11 years. The book features two friendly kids who explain what gluten is, describe how gluten makes them sick and which foods to avoid, and how to make healthy food choices. Easy-to-follow instructions for parents and caregivers help guide children through learning activities and explore their thoughts and feelings about gluten-free living.  Available from www.savorypalate.com

Children’s Hospital Boston has developed a 2 hour DVD entitled Raising Your Celiac Child: Guidelines for a Gluten-Free Life. It includes 12 interactive modules with practical advice on celiac disease, lifestyle management and emotional support. See www.childrenshospital.org/celiac

Three other wonderful illustrated story books for children are:
• No More Cupcakes & Tummy Aches: A Story for Parents and Their Celiac Children to Share by Jax Peters Lowell
• Eating Gluten-Free with Emily: A Story for Children with Celiac Disease by Bonne Kruszka
• How I Eat Without Wheat by Karen Fine

Sheri Sanderson has written a cookbook for kids called Incredible Edible Gluten-Free Foods for Kids. Features 150 family-tested recipes, general food preparation tips, baking substitutes, as well as an overview of celiac disease and the gluten-free diet, tips for dealing with daycare and schools, and resources.
Wheat-free Gluten-Free Cookbook for Kids and Busy Adults by Connie Sarros has 198 easy recipes along with a chapter devoted to safe kitchen craft projects for kids of all ages. See http://gfbooks.homestead.com/kids.html

The American Celiac Disease Alliance has practical guidelines and resources to help families navigate the school lunch program. See http://americanceliac.org/for-families/school-lunch-faq/

Food allergies, sensitivities and celiac disease can be tough on a kid. Childhood traditions like trading sandwiches in the lunchroom, celebrating classroom holidays with cookies and treats, and sharing birthday cake with friends are often off-limits or require diligent oversight in order to be safe. Whether managing their unique needs leaves kids feeling isolated or helps them build self-confidence has a lot to do with how they are taught to view their situation.

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 more glute-free tips at: www.glutenfreediet.ca

Q. I am eating a gluten-free diet, but also want to make sure that I am choosing the most nutritious food choices too. Can you help?

Answer: In the quest to eliminate gluten from the diet, many people forget about the importance of good nutrition! The United States Department of Agriculture (USDA) MyPyramid and Canada’s Food Guide to Healthy Eating are practical tools to help individuals make healthy food choices. These tools differ somewhat with regard to the types of foods that are in specific groups, their serving size and recommended number of servings per day for each food group. The total amount per day for each group is based on factors such as age, body size, activity level and sex. The following chart has incorporated many of the key components of these tools with adaptations for the gluten-free diet. The symbol GF denotes gluten-free.

From: Gluten-Free Diet: A Comprehensive Resource Guide 2008 by Shelley Case, RD. Case Nutrition Consulting Inc. Publisher.

Question: I just got diagnosed with celiac disease and my two children also have food allergies. Can you give me any tips on eating out safely… and easily?

Answer: Eating out can be a real challenge, especially when you are first learning about the gluten-free diet, so I recommend mastering the basics of the diet before venturing out to eat in restaurants. But once you’re ready to eat, there are a growing number of restaurants that are gluten-free (GF) friendly. Many have a GF menu or they’re willing to make adaptations and substitutions in order to meet the needs of the GF customer. Also it’s exciting to see initiatives like the Gluten Free Restaurant Awareness Program (GFRAP) from the Gluten Intolerance Group (GIG) that includes educational and training materials for restaurants and their staff. Once they meet specific criteria they are listed on the GFRAP website so that individuals can search participating restaurants in North America by restaurant name or city and type of cuisine. Check out www.glutenfreerestaurants.org

There are many other great resources to help you eat out and travel safely:

1. The Celiac Scene™ features a free database and downloadable maps of restaurants that locals with celiac disease trust in cities across the USA and Canada. Owned and updated by an individual with celiac disease. Many restaurants bear the special symbol of the Gluten-Free Restaurant Awareness Program.

2. Glutenfreeonthego.com is another free online global directory of over 6000 GF listings of restaurants, bakeries, hotels, resorts, spas, cruises and more. Recommendations are submitted by individuals with celiac disease or others following a GFD, as well as individual GF eating establishments.

3. Glutenfreepassport.com has a variety of resources on safe GF travel and dining. One is a great book called Let’s Eat Out with Celiac and Food Allergies that provides practical information on eating out in regular and ethnic restaurants. It includes 7 international cuisines with hundreds of menus items showcasing common ingredients, hidden allergens and food preparation techniques used by chefs and restaurants. In addition they have cuisine specific pocket size guides that include sample menus, menu dish descriptions, preparation techniques, quick reference guides and questions to ask to ensure safe meals. Another handy resource is the multi-lingual phrase pocket guide that has over 1200 translations from English to French, Spanish, German and Italian. The phrases include dining requests, ingredients, specific preparation requests, sample menus and over 300 health phrases in 4 languages. They have also just released new iPhone/iPod touch applications for some of their resources.

Listen to my podcast (scroll down to podcast #3) with Kim Koeller, co-author of “Let’s Eat Out: Your Passport to Living Gluten-Free and Allergy-Free.” It features an informative discussion on Kim’s newly released revised edition on eating out in regular and ethnic restaurants around the world and tips to eat out safely.

4. Triumph Dining has an Essential GF Restaurant Guide that features over 5000 restaurants across the US listed in a state by state directory and every listing is verified and updated each year by an individual with celiac disease. And the Guide has 80 GF lists from various chain restaurants. Triumph Dining also has laminated wallet sized dining cards for 10 different cuisines. One side of the card is in English and the other side in the foreign language.

5. Bob and Ruth’s Gluten-Free Dining and Travel Club is a company specializing in assisting individuals on a GFD. They offer escorted GF getaways to resorts, on cruises and tours of exotic places all over the world. All the arrangements are taken care of and you can eat safely in these various locations with fellow gluten-free travelers while enjoying a wonderful vacation. My husband and I booked a one week trip with Bob and Ruth a few years ago to the Caribbean. We stayed at the Club Med and not only was the food fantastic and safe, but we met so many nice people.

Here are a few tips for a safe and successful dining experience for those with celiac disease, as well as any intolerance or dietary restriction:

1. Call the restaurant the day before or earlier in the day and ask to speak to the chef or manager to discuss meal options. They can often substitute other ingredients or create an alternative menu or menu item.

2. If possible try to avoid peak meal times. Dining early or late will allow more time and easier access to the staff that can answer questions and usually accommodate special needs.

3. Explain your dietary restrictions briefly. The terms celiac disease is still often unfamiliar to many to those in the food service industry. So I often find it easier to explain that you have a serious food allergy and will get very sick if your order is not handled properly. Indicate that you must not have any  foods or ingredients containing gluten which means no items made with wheat flour, breading, croutons, etc. It often helps to ask to speak to the manager or chef to make sure the order gets placed properly and prepared safely.

4. No matter whether the restaurant has a special GF menu or some GF items on the menu, it is still essential to ask specific questions. You need to inquire about cooking methods, specific ingredients that are in the item and how it is served.

5. Request that your food be prepared on a clean grill or in a clean pan. If this is a problem, suggest cooking it on clean aluminum foil.

6. When they bring your meal make sure you ask again if this is the special meal and were your instructions followed.

7. Don’t forget to thank the server, chef and manager. Leave a generous tip for good service and patronize the restaurant again.

Tips adapted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case and Restaurant Dining by the Gluten Intolerance Group.

Question: I’m always on the run and often end up grabbing chips or a chocolate bar for a snack. Can you help with some quick and nutritious gluten-free snack ideas?

When eating on the run it’s not always easy to find safe and healthy gluten-free options. But if you follow the Girl Scout motto – “Be Prepared” and plan ahead, healthy snacking is possible. Make sure your kitchen, car, workplace, briefcase, gym bag or back pack is always stocked with a variety of gluten-free items. With the growing number of gluten-free products on the market today, as well as many naturally gluten-free foods, snacking on the go can be both healthy and enjoyable. Remember to choose snacks from the different food groups- fruits and vegetables; grain products; meat and alternatives; and milk and milk products. Also many snacks can be a combination of several food groups. Here are some ideas…

Fruits and Vegetables

– Fresh or canned fruit (packed in water or fruit juice)
– Dried fruits (apricots, blueberries, cranberries, figs, raisins)
– Fruit or vegetable juices
– Frozen fruit juice bars (store-bought or homemade)
– Veggies and dip (made with yogurt/herbs or low fat GF salad dressing)
– Edamame beans (microwavable single serve)

Grain Products

– GF cereal (e.g., GF Chex, Enjoy Life Perky O’s, Glutino Cereal O’s) in zip lock bags
– GF muffin (use a GF mix or make from scratch made with a combination of nutritious flours such as almond, bean, brown rice, Montina ™, mesquite, quinoa, sorghum, teff. Include banana, pumpkin, pineapple, carrot, dried fruits and/or nuts)
– Air popped or low fat microwave popcorn
– GF granola (homemade or store bought – e.g., Bakery On Main, Enjoy Life)

Meat and Alternatives

– Nuts
– Cheese string
– Hard boiled egg
– Seeds (pumpkin, sunflower)
– GF deli meat

Milk and Milk Products

– Yogurt (plain or fruit flavored)
– Low fat milk
– Chocolate milk or hot chocolate (check to make sure there is no wheat starch or barley malt flavoring)
– Yogurt drinks
– String cheese or hard cheese
– GF puddings

Food Group Combinations

– Fruit smoothie (fresh, frozen or canned fruit; yogurt, milk or dried milk powder; crushed ice; optional – honey, sugar, or sugar substitute)
– Chex Almond Apple Bars
– Hummus and GF crackers (e.g., Blue Diamond Nut Thins, Mary’s Gone Crackers, Edward and Son’s Exotic Rice Toast, Glutino Crackers, Ener-G Crackers)
– Low fat cottage cheese or yogurt with fruit
– GF trail mix (e.g., GF Chex cereal, nuts, seeds, dried fruits, GF pretzels)
– GF crackers and nut/seed butters (e.g., almond, cashew, peanut butter, sesame seed, sunflower)
– GF corn tortilla chips, grated low fat cheddar cheese and salsa
– Ants on a log (nut or seed butter on celery with raisins)
– GF snack bars (dried fruits, nuts, seeds, GF cereals) e.g.,  Bumble Bar, Enjoy Life, EnviroKidz Crispy Rice Bars, Glutino, Kind Bars, Larabar, Orgran, PurFit.
– Avocado and Bean Dip with veggies or GF crackers
– GF soups (e.g.,Amy’s Kitchen, Health Valley, Imagine, Kettle Cuisine[frozen, microwavable single serve], Orgran soup for cups, Pacific Foods, Taste Adventure)
– GoPicnic shelf stable snack boxes (contain a variety of single serve snacks)

Many of the above ideas are from Gluten-Free Diet: A Comprehensive Resource Guide- Revised and Expanded Edition, Shelley Case, RD, Case Nutrition Consulting Inc, 2008  www.glutenfreediet.ca

Note: 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.

Q: I know that I need to avoid most breads and baked goods on a gluten-free diet, but I hear that gluten can be “hidden”  in other food products! If so, can you give me some guidelines on what I should be looking for on food labels to discover these “hidden sources” of gluten? Help!

A. Gluten is the general name for the specific proteins in the grains wheat, rye and barley. As you mentioned, most breads, bagels, muffins, cereals, pasta, crackers, cakes and cookies are sources of gluten. However, there is a wide variety of not-so-obvious food and beverages that contain gluten (see chart below). Also in order to address the issue of “hidden” gluten you need to know about labeling regulations in the USA and Canada.

USA
The Food Allergen Labeling Consumer Protection Act (FALCPA) requires the eight major food allergens (including wheat) that are used as ingredients to be declared in plain English terms on the label of all prepackaged foods under the FDA’s jurisdiction. This includes all conventional foods, dietary supplements, infant formulas and medical foods. Major food allergens used as ingredients in flavorings, colorings, seasoning mixtures and incidental additives must also be listed. For example, if a snack food included seasonings containing wheat flour or wheat starch, it must be included on the label. However, distilled vinegar derived from wheat would not have to declare wheat on the label, as the distillation process removes the wheat protein and is not in the final product.  FALCPA does not require barley or rye to be declared on the food label. The good news is that rye is not frequently used as an ingredient other than in rye bread or crackers, and barley is usually declared as barley malt, barley malt extract or barley malt flavoring.

The USDA regulates meat, poultry and processed egg products (including mixed food products containing more than 3% raw meat, 2% cooked meat or poultry). Unfortunately the USDA does not have mandatory food allergen labeling, so it is possible that wheat could be in a USDA regulated product and not included on the label. The good news is that the USDA does encourage manufacturers to voluntarily declare the food allergens on the label and many companies are complying with this recommendation.

CANADA
Current Canadian labeling regulations do not require manufacturers to declare all the components of ingredients on the food label (e.g., seasonings, modified food starch, hydrolyzed vegetable protein). This can be problematic as these ingredients may be derived from gluten-containing grains.

Health Canada (HC) and the Canadian Food Inspection Agency (CFIA) have recently developed proposed regulatory amendments to the Food and Drug Regulations called “Enhanced Labelling of Food Allergen and Gluten Sources and Added Sulphites”.  Unlike the FALCPA in the US, the proposed Canadian amendments would require all gluten sources to be declared on the food label. These proposed amendments were published on July 26, 2008 and included a 90 day comment period. Health Canada is reviewing these submissions and preparing the final version of amendments. Until these regulations are published and become law, HC and CIFA strongly urge manufacturers to declare on the label the major food allergens and gluten sources, and their protein derivatives, and sulphites > 10 ppm when added as ingredients or components of ingredients. Many manufacturers are voluntarily declaring these ingredients on the food label in response to these proposed regulations. However, consumers will still need to call manufacturers about the source of the hydrolyzed protein, modified food starch and seasonings if it is not declared on the label.

WHAT ABOUT OATS?
Oats and oat products contain varying levels of gluten due to cross-contamination with wheat, barley and/or rye during growing, harvesting, transporting and processing. These oats must be avoided on a gluten-free diet. However, there are now specialty, pure and uncontaminated oats and oat products available from five North American companies (Bob’s Red Mill, Cream Hill Estates, FarmPure Foods, Gifts of Nature and Gluten-Free Oats). These pure oats are grown on dedicated fields, and harvested, transported and processed with dedicated equipment. Before adding pure oats to the gluten-free diet, it is recommended that your celiac disease be well-controlled and to check with your physician and dietitian for specific guidelines. For more information about oats see  http://www.glutenfreediet.ca/oats.php

Examples of Food & Beverages That May Contain Gluten

 Excerpts and adapted from:

Gluten-Free Diet: A Comprehensive Resource Guide- Revised and Expanded Edition, Shelley Case, RD, Case Nutrition Consulting Inc, 2008  www.glutenfreediet.ca

Note: 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. 

Question:
How can I get more fiber in my diet? I was used to eating high fiber cereals/breads/crackers etc. before being diagnosed with celiac disease. I eat a lot of fruits and vegetables but I know I am not getting 20-30 grams of fiber a day.

Answer:
Dietary fiber is the part of whole grains, fruits, vegetables, legumes (dried beans, peas and lentils), nuts and seeds that cannot be broken down by the human digestive system.  Although fiber is not readily digested, it plays an important role in the body, particularly through its effects on the digestive system.  Fiber helps to maintain regular bowel movements.  A high fiber diet can also play a role in the prevention of certain chronic diseases such as coronary artery disease, diabetes, colon cancer and diverticular disease.

Consuming adequate amounts of fiber is especially important for people with celiac disease.  Many newly diagnosed individuals may have symptoms of diarrhea due to malabsorption caused by gluten damaging the absorptive surface of the small intestine.  However, once a gluten-free diet is initiated, the intestinal tract begins to heal and the malabsorption and diarrhea eventually resolve.  Some may then have problems with constipation. It should also be noted that many individuals with celiac disease actually present with constipation prior to their diagnosis which may get worse on the gluten-free diet. 

As many gluten-free foods are made with starches and/or refined flours which are lower in fiber, it can be a challenge getting enough fiber in the diet. The Dietary Reference Intake (DRI) for fiber varies for different age groups and sex. The DRI for females and males ages 19-50 is 25 and 38 grams per day respectively. For ages 51-70 it is 21grams (females) and 30 grams (males).

Here are some tips to increase your fiber intake…

* Gradually increase fiber in the diet (start with a small amount) along with an increased fluid intake, especially water

* Choose a variety of high-fiber gluten-free foods on a regular basis

* Mix it up.  Add ground flax, mesquite flour, rice bran or rice polish to pancakes, hot cereals or baked products. Extend hamburger patties or meat loaf with ground flax, cooked brown rice or oatmeal (pure, uncontaminated gluten-free). Add cooked amaranth, quinoa or teff to puddings. Use quinoa or brown rice flakes, oatmeal (pure, uncontaminated, gluten-free) or gluten-free granola as a topping for fruit crisp

* Toss it up. Use brown rice, buckwheat, millet, quinoa, teff or wild rice in salads

* Use your bean. Add chickpeas (garbanzo beans), kidney beans and other bean varieties to salads, casseroles and soups

* Soups on. Make soups with lentils or split peas

* Pilaf Ideas. Add cooked buckwheat, oat groats or steel cut oats (pure, uncontaminated, gluten-free)quinoa, sorghum or wild rice to a rice pilaf recipe

* Use high-fiber gluten-free mixes (homemade or from gluten-free companies) containing amaranth flour, bean flours, brown rice flour, ground flax,  mesquite flour, Montina™, oat flour   (pure, uncontaminated, gluten-free), quinoa flour, sorghum flour, teff flour or a combination of some of  these flours in baked products

* Try hot cereals for breakfast such as Altiplano Gold Instant Hot Quinoa Cereal, Ancient Harvest Organic Quinoa Flakes, Bob’s Red Mill Mighty Tasty GF Hot Cereal, The Birkett Mill Pocono Cream of Buckwheat Hot Cereal, Cream Hill Estates Lara’s Rolled Oats, Holly’s Gluten-Free Oatmeal Cereal Porridge with Cranberries, Gluten-Free Oats® Old Fashioned Rolled Oats

* Flax it up. Sprinkle ground flax on yogurt or add to fruit smoothies

* Snack right. Consume high-fiber snacks such as dried fruits, nuts, seeds and popcorn. Choose high-fiber snack bars with dried fruits, nuts and/or seeds (e.g., Bumble Bar,  Larabar, Mrs. May’s Naturals, Perfect 10)

* Eat, rather than drink. Eat whole fruits and vegetables rather than drinking juice

* Choose right.  Choose breads with at least 2 grams of fiber per serving such as Ener G Seattle Brown, Kinnikinnick Brown Sandwich or Schar Multigrain. Choose higher fiber pastas such as brown rice, lentil, quinoa, soy or wild rice instead of white rice. Try high-fiber crackers such as Mary’s Gone Crackers or Crunchmaster Baked Multigrain Crackers

* NOTE ABOUT OATS: Must be pure, uncontaminated, gluten-free oats. Some available resources are from Bobs’ Red Mill, Cream Hill Estates, FarmPure Foods, Gluten-Free Oats, Gifts of Nature. For more information about the safety of oats in the gluten-free diet see: http://www.glutenfreediet.ca/oats.php

Here are a few examples comparing the fiber content of seeds and grains:

A comprehensive list of foods and their fiber content can be found in The Gluten-Free Diet  www.glutenfreediet.ca

Note: 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.