Delicious Living

The Everyday Gluten-Free Guide

May 2010

Navigate smoothly through grocery aisles, meal preparation, birthday parties-not to mention your favorite recipes-with these expert tips

Online Version: http://deliciouslivingmag.com/diets/gluten-free/index.html

Elation is not a common response when told you have an incurable disease, but for many who have endured countless mysterious symptoms, and often gone misdiagnosed for years, being told they have celiac disease is a chance to reclaim health. “The day I went on a gluten-free diet was the best day of my life,” says Alice Bast, 48, of Philadelphia. “My doctor had given me a recipe to live.”

Once considered an obscure malady, celiac disease now affects one out of every 133 Americans, according to a watershed study published in the Archives of Internal Medicine in 2003. Celiac disease is a genetic autoimmune disorder, meaning the immune system treats gluten—the elastic protein in wheat, spelt, barley, and rye—as a toxin. Celiac disease is four times more common today than it was five decades ago, according to 2009 research performed at the Mayo Clinic. For every person with celiac, experts believe there may be many more who have nonceliac gluten intolerance, “a condition in which you may experience a wide range of digestive problems in response to gluten, but unlike celiac, there is no appreciable damage to the intestine,” says Joseph Murray, MD, a Mayo Clinic gastroenterologist.

Diagnosis has improved in recent years, and with a 28 percent annual growth in the gluten-free food market, those with celiac disease or gluten intolerance have many more options these days. Still, the gluten-free journey isn’t without its bumps and roadblocks. Here’s how to navigate easily through every shopping trip, and each meal—and nourish yourself while avoiding gluten.

The Secrets to Gluten-Free Grocery Shopping

At first, finding enough safe and wholesome foods that won’t break the bank at the supermarket can seem daunting. Currently, the FDA is working on gluten-free labeling standards, but until then, Alice Bast, who following her diagnosis went on to become the president of the National Foundation for Celiac Awareness, offers this advice.

Get label savvy

As gluten-free food becomes a bigger seller, grocers are increasingly providing dedicated gluten-free sections. Some store managers can supply you with a list of gluten-free packaged foods found in their aisles. iPhone apps, such as Is That Gluten Free? (midlifecrisisapps.com), also make finding gluten-free brands easy. A caveat though: Products labeled “gluten-free” can be just as devoid of nutrients as other processed goods. Choose items with few added sweeteners and that are made with whole grains such as brown rice instead of processed carbohydrates such as white-rice flour.

Gluten can sneak into a dizzying array of foods and ingredients. And “wheat-free” doesn’t necessarily mean “gluten-free”—other grains, such as spelt, rye, and barley, contain gluten. Until you become an expert on the many guises of gluten, take along a detailed list of off-limit foods and iffy ingredients. Or arm yourself with “The Essential Gluten-Free Grocery Guide” available at triumphdining.com. Take a tour of a supermarket or natural food store with a dietitian who specializes in celiac disease, Bast suggests. And once you find your go-to brands, “always double check the ingredient lists to be certain the company has not altered their manufacturing to include a gluten-containing ingredient that could ruin your weekend,” she says.

Spend wisely

Gluten-free versions of common gluten-containing products, such as bread and pasta, can cost two to three times more than their gluten-containing counterparts. One way to save is to form a buying group with other gluten-free shoppers, and purchase gluten-free pizza crusts, cereal, almonds, and rice in bulk, at a discount. Some stores offer their own brands of gluten-free items, often at a lower sticker price than national brands. With more food manufacturers offering gluten-free products, compare prices on similar items. Bast says the competition is driving down prices and improving taste.

However, there are several areas to avoid, despite their appeal: Even though bulk bins are a great place to scoop up gluten-free foods such as dried lentils and brown rice, the risk of cross-contamination—when gluten-free goods are tainted with gluten-containing ingredients or residues— outweighs the price savings, Bast says. Be cautious with salad bars and sampling, too.

Write it off

You may be able to write off some food expenses associated with celiac disease if your total medical expenses for a year exceed 7.5 percent of your adjusted gross income. Go to the tax section of the Celiac Disease Foundation’s Web site (celiac.org) to learn more and to download a tax deduction worksheet to keep track of your gluten-free food costs.

Master Gluten-Free Cooking

Being diagnosed with celiac disease or gluten intolerance can be sobering news to someone with a penchant for pasta and bread. But despite some restrictions, you can still be a foodie and whip up a deliciously balanced diet.

Discover wholesome and satisfying gluten-free grains.

Some of the most nutrient-dense, flavorful, and versatile grains happen to be gluten-free, says Carol Fenster, PhD, author of nine gluten-free cookbooks including 1,000 Gluten-Free Recipes (Wiley, 2008). Fast-cooking quinoa, for example, has a wonderful nutty flavor, plus ample protein, fiber, and magnesium. Fenster, who was diagnosed with gluten intolerance 22 years ago, uses quinoa in place of bulgur to make the popular Middle Eastern dish tabbouleh.

Millet, amaranth, buckwheat, sorghum, and brown rice can also form the basis of a wide range of meals. According to a 2009 study from the Celiac Disease Center at Columbia University in New York, celiacs who eat gluten-free grains and products made from these alternative flours have improved intakes of several nutrients including calcium, protein, and iron. These grains are now widely available in natural food stores.

Hone your gluten-free cooking skills

To build confidence in preparing alternative grains and using other gluten-free ingredients, Fenster suggests gluten-free cooking classes. If there isn’t a gluten-free cooking class nearby, seek out celiac support groups for ideas and recipe sharing. Connect with others through the Celiac Disease Foundation (celiac.org) and the Gluten Intolerance Group of North America (gluten.net).

There are scores of gluten-free cookbooks to choose from nowadays. Tackle “problem” cooking areas with titles like The Gluten-Free Almond Flour Cookbook by Elana Amsterdam (Celestial Arts, 2009) and Gluten-Free Italian by Jacqueline Mallorca (Da Capo, 2009).

Transform old favorites

Don’t ditch old cookbooks and passed-down recipes because you have to leave wheat by the wayside. Instead, learn to substitute gluten-free ingredients. For example, Fenster uses sweet rice flour in place of wheat flour to thicken cream soups and gravy. Pick up quinoa or brown rice spaghetti for pasta night. Try breading chicken or fish in gluten-free cornmeal. In meat loaf or meatballs, she suggests using gluten-free crushed crackers or instant potato flakes in place of regular bread crumbs.

Be your own baker

There are plenty of ready-made gluten-free breads and muffins out there, but to save cash you may want to learn to bake your own. Gluten is what holds wheat-based baked goods together, aids in rising, and gives springiness and structure, so no one gluten-free grain flour can replace wheat flour in a recipe. Make your own gluten-free flour mix by following the all-purpose Alison’s Gluten-Free Baking Mix; then replace wheat flour 1:1 with your mix or a store-bought option such as Pamela’s or Bob’s Red Mill.

Extra flavor boosters can help subdue any curious flavors gluten-free flour mixes may lend baked goods. For sweet baked goods try vanilla extract, almond extract, ginger, cinnamon, or citrus zest. Onion or garlic powder, dried herbs, and Parmesan cheese can be used in savory baked goods such as pizza crust. “Use xanthan gum, which mimics gluten by binding ingredients in baked goods so they don’t turn into a plate of crumbs,” Fenster says. A rule of thumb is 1 teaspoon of xanthan gum for every cup of flour in cake; 1 ½ teaspoons for every cup in muffins and quick breads, and 1/4–1/2 teaspoon for each cup in cookies.

Tap into gluten-free recipes online

Deliciousliving.com has a gluten-free recipe section with hundreds of safe entrées, sides, snacks, and desserts sans gluten. (Head to the gluten-free corner). There are also a burgeoning number of gluten-free foodies out there blogging about their kitchen adventures. Check out glutenfreegirl.com and glutenfreeday.com, as well as deliciousliving.com/blogs, where you’ll find weekly gluten-free cooking tips and product reviews by Elisa Bosley, Delicious Living’s senior food editor—whose son has gluten intolerance.

Raising Gluten-Free Kids

Birthday parties, summer camp, sleepovers, or even just lunch … the gluten-free diet presents unique challenges for children and their families. We asked Jacqueline Jacques, a California-based naturopathic doctor whose son has celiac disease, for her tips on nurturing a happy gluten-free household.

Get informed, and foster acceptance

At the time of diagnosis, Jacques encourages parents (and children) to meet with qualified professionals such as a registered dietitian or pediatrician who can ease the transition to a gluten-free diet. Check out gluten-free books and resources available at your local library. Against the Grain (Holt, 1996) by Jax Peters Lowell is a must-read for newly diagnosed families, says Jacques.

Rather than sheltering kids from the facts, children should learn as much about their condition as early as possible, Jacques says. Teach them how to read food labels, get them involved in menu planning, and emphasize that they won’t outgrow celiac. “This will go a long way in helping them accept their condition,” says Jacques. No child wants to feel “different”—especially with family. So consider making your entire home a gluten-free zone, recommends Jacques. “There was some heartache at first, but now it’s just part of our family’s lifestyle,” she says.

Educate your child’s day care or school

To diminish mishaps, at the start of each school year meet with teachers and principals to educate them about the unique dietary needs of your child. The Celiac Sprue Association (csaceliacs.org) has helpful example letters that you can print and distribute to appropriate school personnel.

Packing a lunch and snacks for your child is safer than relying on school-provided meals. Rice crackers, yogurt, gluten-free fruit bars, and almond butter and jelly smothered on gluten-free wraps are some of Jacques’ son’s faves. Your child will feel more comfortable around their peers if lunch-box contents look similar to conventional options.

Don’t let parties get them down

With their abundance of pizza, cake, cookies, or pretzels, birthday parties can leave a gluten-sensitive child feeling left out. Talk to the host ahead of time, and send your child with gluten-free goodies that can be shared or offer to provide safe fare for everyone, including gluten-free pizza, cookies, or cake. (Check out these 20 gluten-free family favorites!) The good news? “Awareness about celiac disease and food allergies is increasing within communities, so it is easier than it used to be to get parents to make adjustments,” Jacques says.

Set up your gluten-free freshman for success

A whole new set of challenges await gluten-free first-time college students, particularly if they live in a dorm. Encourage your college students to establish a friendly relationship with the campus food-service managers. Give them the tools to educate college staff that avoiding gluten is not a diet choice, but a health necessity. Your college student might consider becoming a “gluten-free ambassador” to campaign for the food needs of the gluten-free student body.

During the first days in the new location, help your student locate stores that carry gluten-free options and stock up on healthy gluten-free snacks. Many stores offer lists of gluten-free foods they have available. If possible, make sure your child’s living area has a kitchen with a microwave, stove, and fridge. This way she can fuel her body and brain with safe meals when ready-made options aren’t available.

Hitting the Road – Tips for Gluten-Free Travel

Planning a road trip? Roadside stores are notoriously full of processed baked goods and potentially cross-contaminated snacks. So break out the cooler and build a travel-friendly cache of safe, nutritious eats such as gluten-free trail mix, plain yogurt, fresh veggies, and fruit. Also try the following strategies for staying gluten-free on the go.

Find accommodations with a kitchen

At your destination, Dennis suggests renting an apartment or staying at a hotel with kitchenette so you can prepare more of your own meals. Although you might pay more up front, in the end, this can be a big money saver, says Dennis.

Tap into gluten-free communities.

Get in touch with the gluten-free community in the city you plan to visit to get the lowdown on friendly restaurants, hotels, and supermarkets. Check out glutenfreerestaurants.org, glutenfreeonthego.com, and glutenfreetravelsite.com, where you can find listings and user reviews of restaurants and hotels catering to the gluten-free crowd.

Fly the gluten-free friendly skies

Some domestic and global airlines now offer gluten-free meals and snacks when given 24 to 96 hours of advance notice. But pack some security-friendly backup options—nuts, dried fruit, or gluten-free bars—in your carry-on just in case.

Celiac Disease vs Gluten Intolerance

The ballooning list of symptoms attributed to celiac disease and gluten sensitivity includes: stomach pain, bloating, gas, diarrhea, constipation, vomiting, migraines, edema, joint pain, chronic fatigue, brain fog, sinus infections, unwanted weight loss, skin rashes, unexplained infertility, and stunted child growth. Because misdiagnosis is rampant and living undiagnosed increases the risk of illness or possible death, Joseph Murray, MD, encourages you to ask your physician about taking a simple blood test for celiac disease if you or your child suffers regularly from any of these. To be accurate, the test needs to be done before you eliminate gluten from your meal plan. A positive test for antibodies to gluten should be followed by an endoscopy to check for damage to the small intestine.

If tests come back negative, you may still have nonceliac gluten intolerance. The gold standard for teasing this out is an elimination diet. (For basic instructions, check out How to Do an Elimination Diet.) If you find a couple of weeks without gluten significantly decreases symptoms, it’s likely the culprit. EnteroLab (enterolab.com) can also look for markers of gluten sensitivity from a stool sample (cost: $99–$369).

Gluten Guises

Aside from better-known culprits such as wheat, durum, semolina, farro, kamut, spelt, rye, or barley, look for these potentially gluten-containing ingredients on labels.

Added vitamins

Added vitamins

Caramel color

Dextrin

Hydrolyzed vegetable protein

Malt

MSG

Natural or artificial flavoring/coloring

Spices

Starches

Vinegar

Warning: Gluten Zone!

These items may or may not contain gluten. Look for "gluten-free" on the label; otherwise, pass.

Condiments: Bottled Asian sauces such as teriyaki, soy, or tamari sauce; bouillon, gravy, salad dressings.

Dairy: Processed cheeses, blue cheese, ice cream, and frozen or flavored yogurts.

Grain products: Cornflakes, corn bread, grits, kamut, and seasoned rice.

Nuts: Seasoned or flavored nuts.

Oats: Gluten-free, or not?

Yes, oats are gluten-free. Researchers have concluded that oats are safe for those with celiac or gluten intolerance and can improve overall nutrition while on a gluten-free diet. So why the concern? Oat crops are often rotated with wheat crops and then processed in the same facilities, resulting in cross-contamination. So look for brands such as Bob’s Red Mill that are certified “gluten-free” by the Gluten-Free Certification Organization (gfco.org), which means that the product contains less than 10-ppm gluten. Also beware that the avenin protein in oats can trigger its own reaction, so make note of any symptoms that arise after eating oatmeal.