Celiac.com Disease & Gluten-Free Diet Support Since 1995 - Articles

Celiac.com 10/05/2022 - Summer may be technically over, but the warm weather continues in many parts of the country. This presents an opportunity to squeeze in some late-season outdoor grilling. It's also a great time to test out recipes for tailgating season. These teriyaki pork kebabs are easy to make and super tasty. Ingredients: 3 tablespoons gluten-free soy sauce or tamari 3 tablespoons olive oil 1 clove garlic, minced ½ teaspoon crushed red pepper flakes salt and pepper to taste 1 pound boneless pork loin, cut into 1 inch cubes 1 (14.5 ounce) can chicken broth 2 tablespoons cornstarch 2 tablespoons gluten-free soy sauce or tamari 1 tablespoon brown sugar 2 cloves garlic, minced ¼ teaspoon ground ginger 3 portobello mushrooms, cut into quarters 1 large red onion, cut into 12 wedges 12 cherry tomatoes 12 bite-size chunks fresh pineapple Directions: In a shallow dish, mix together 3 tablespoons gluten-free soy sauce, olive oil, 1 clove minced garlic, red pepper flakes, salt, and pepper. Add pork cubes, and turn to coat evenly with marinade. Cover, and refrigerate for 3 hours. In a saucepan, combine chicken broth, cornstarch, 2 tablespoons gluten-free soy sauce, brown sugar, 2 cloves minced garlic, and ginger. Bring to a boil, stirring constantly. Reduce heat, and simmer 5 minutes. Heat an outdoor grill for high heat and lightly oil grate. Thread pork cubes onto skewers, alternating with mushrooms, onion, tomatoes, and pineapple chunks. Cook on grill for 15 minutes, or until meat is cooked through. Turn skewers, and baste often with sauce during cooking.

Celiac.com 10/03/2022 - In addition to their usual season pitch to seniors, doctors are recommending that people with celiac disease get a pneumonia vaccine. People with celiac disease face a greater risk for pneumonia than non-celiacs. However, about seventy-five percent of celiac patients fail to get a pneumonia vaccine after they are diagnosed, writes a research team in the journal Alimentary Pharmacology and Therapeutics. The recommendation stems from the team's 2016 study, in which the researchers used data on English patients collected between 1997 and 2011, including 9,803 with celiac disease and a comparison group of 101,755 people without celiac. The study was conducted by F. Zingone, A. Abdul Sultan, C. J. Crooks, L. J. Tata, C. Ciacci, and J. West, who are variously affiliated with the Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK; and the Coeliac center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy. They found that, even though people with and without celiac disease had pneumonia at similar rates, people under age 65 with a celiac diagnosis, who didn’t get a pneumonia vaccine were nearly thirty-percent more likely to get pneumonia than those who were vaccinated. The problem may be related to impaired spleen function. Celiac disease can cause spleen issues for up to a third of patients, which may put them at greater risk for infections. Spleen function does tend to improve for celiacs on a gluten-free diet, which is another reason early diagnosis and quick adoption of a gluten-free diet is essential to a good prognosis. Dr. Shamez Ladhani of Public Health England in London, who was not involved in the study, told reporters for Reuters that "getting a flu vaccine can also help protect against bacterial infections like pneumonia," and also recommended that patients with spleen problems should get a flu vaccine every year and the pneumonia vaccine every five years. Read more in Alimentary Pharmacology and Therapeutics

Celiac.com 09/29/2022 - The book Gluten-Centric Culture is the result of a nation-wide study of gluten-sensitive adults living with other adults. Previous gluten-related studies primarily examine children. This is one of few that focuses entirely on adult social experiences. As we have seen in earlier chapters, cultural practices make life difficult for those avoiding gluten at any age. The chapters have detailed how cultural constraints such as exclusionary etiquette rules make it challenging to both be polite and dodge gluten at the dinner table. Other cultural constraints such as able-bodied biases are illustrated when only gluten-containing foods are offered, and when special needs are not considered. We’ve seen how “gluten” is the butt of jokes, causing our requests to be mocked and often making us doubt whether supposedly “gluten-free” foods presented to us are safe to eat. In Chapter 2 and Chapter 4, we learned how some in the medical community aren’t adequately trained to correlate physical symptoms with gluten consumption, resulting in mis-diagnoses such as brain tumors, stomach cancer, or mental illness, illustrating the I-know-best attitude. We’ve seen how women in particular are often victimized by sexist scrutiny in Chapter 5. In Chapter 6, we illuminated the Disease Process and how a newly diagnosed person goes in and out of “limbo” as “truths” form, eventually evolving into a new homeostasis using new “truths” in every aspect of life. This ultimately leads to the final phase of the disease process called “transformation.” The present chapter expands the transformation stage, where a person with gluten sensitivities or celiac disease can press the “replay button” on scenarios that didn’t work before. Here, we apply the new awareness gleaned from reading this book, incorporating the language, breaking down cultural constraints, and living with a feeling of empowerment. A Gift for You Before getting started, I’m taking applications and will choose three people who will receive free admission to one of the Cultural Constraints workshops that take place in October as a “thank you” to my readers. If you are struggling with some aspect of the food sensitive lifestyle, the workshop is designed to review a few constraints and roleplay how we might prevail. Once we have language and have cultivated an attitude of being empowered, we can command respect. Not understanding these cultural practices results in people feeling isolated from social events. Living the gluten-free lifestyle is a social disease (Bacigalupe, 2015), but it doesn’t have to be. Understanding is the first step to thriving in life. To apply, please click here to access the application form. Pressing the "Replay Button" In previous chapters, we’ve discussed language to broach a conversation. Just as we do when thrown into the limbo stage when experimenting with alternative approaches to a social conundrum (Chapter 6), let’s try pressing the replay button in some of the scenarios we’ve already heard about. In Chapter 5, we assessed that Gianna’s (#50) living situation indicates an absence of agency. She does not have the power to ask her husband to amend his jelly-slathering ways in order to protect her from cross-contamination. What if Gianna embraced concepts of respect and compassion and said to her husband: “Honey, every time I eat anything in this house, I feel the effects of gluten. I’m sick of being sick, and also it frightens me because I know that if I expose myself to gluten, I can develop some of the long-term illnesses associated with celiac disease. How can we work together to come up with a solution so that you do not contaminate me in my own house? This conversation asserts agency and respect. Commanding agency in a relationship is risky because people generally don’t want to deal with change or assertiveness from someone who, until now, hasn’t been assertive. It is terribly hard to do this, particularly in a long-term relationship. It may expose that her husband has no intention of cooperating on that, or any other need Gianna may have. It may trigger her husband to list a litany of things he isn’t happy with in the relationship, changing the focus from Gianna’s concerns to his own. Rather than being constructive, her husband may initiate a behavior that quells Gianna from further discussing her needs. Ultimately, it may force Gianna to make some difficult decisions. On the other hand, it is very empowering for Gianna to ask that her needs be met and that her health is valued. She is commanding respect and this is an empowering step toward transformation. We also identified that in this scenario, Gianna’s husband was operating from the I-know-best attitude. Perhaps if Gianna gave him some literature that pointed out the ill-effects of gluten consumption for those with celiac disease, he would change his mind about being so careless in the kitchen. Now, I know it may fall on deaf ears. Some people you live with are locked into the I-know-best, gluten-doubt, and able-body bias frames of mind no matter what you do! Many of these people simply lack the knowledge of how to be compassionate. I believe compassion is a learned skill, and providing examples to people on how to be more compassionate goes a long way. For example, asking someone to say, “I’m sorry you have to live with this and I’ll do everything I can to support you” gives reassurance and loving concern. Or saying, “We’re all in this together” as described by Brenelle (#56, Chapter 6) is kind. Brenelle felt supported and respected by her family members. They created a safe environment where she could thrive. But whether it works or not, by taking the initiative to have the conversation, Gianna asserts her needs and defies her husband’s I-know-best attitude. She is taking control of her situation and testing alternatives while in the limbo stage. Another illustration comes with Julia (#49, Chapter 4), whose father said, “if you are so restrictive, why are you so chubby?” Rather than debating with her father, her response to his comment was to only eat very few safe foods. She describes being hungry most of the time, and seething in anger with her father’s judgment. This shows dysfunction in the relationship, putting Julia in a constant state of limbo. She can’t thrive until she works this out. Let’s hit the “replay” button on Julia’s scenario. What if Julia said to her father: “I really need you to understand what it means for me to have celiac disease. It means that I cannot eat anything that contains gluten. Do you know what gluten is? It’s a protein found in barley, rye, oats, wheat, and spelt. It is also in nearly every processed food, and any little amount of it makes me sick. Remember when I went to the doctor and was diagnosed? That’s what they told me. I really need your cooperation. I might be chubbier than you think I should be because my body doesn’t work properly. I am eating anything I can find that I know is “safe” and not all of those “safe” choices are high-quality foods. I want to get well, and I want to exist in harmony with you. Would you please help me to avoid gluten?” This shifts the dynamic in the father-daughter relationship. Before, Julia was victimized by her father’s cajoling. By saying these words to her father, Julia exerts agency. It empowers her to restate her needs in the future. Even if her father doesn’t relent, she is taking ownership of her needs, and ultimately this might lead Julia to having more self-confidence. I’m not saying it will change the way her father acts, but taking this initiative begins to give Julia more control of her circumstances and privileges her to make positive changes for her own well-being. Let’s hit the replay button on Cousin Sandra from Chapter 1. Instead of divorcing the family, which fills me with a profound sadness on her behalf, what if she had said, “I want to be a family member and to participate in these dinners and all of your conversations. I want to be included. I have a disease that prevents me from eating some foods and I feel safer bringing my own to these gatherings. When I ate foods prepared in your kitchen that should have been safe for me, I found that I became ill – likely from cross-contamination. I don’t want to have to be sick to be included. Rather than showing my inclusion by eating the same foods, how about if I bring my own foods and we dwell on our love for each other, relish being together, and not worry about whether I’m eating what you are?” And what if she actually took it a step further and singled out the person that was the most vocal about her special needs and asked him or her in front of the rest of the family, “Can I count on your support?” Would this have had the intended affect and changed the minds of some of those around the table? I don’t know, but I do know it would have given Sandra a different attitude about her dietary restrictions. I am sure there were many at the table that wanted her to continue to be a family member and were sorry when she left. If she had continued to show up with her bowl, and demanded with her actions that she was accepted into the realm, I think in time, nobody would have cared. Sure, she might have had to endure some teasing, but what family doesn’t tease each other about one thing or another? (Have you noticed though that those who tease can’t take it well when you tease them back? Just an aside observation.) It takes incredible courage, but if you can stand up to your family or the one ringleader in your life that has been making you miserable by asserting their power and ignoring your needs, you will be able to stand up to anyone. Being assertive about your needs permeates all aspects of life – rather than being apologetic, it shifts you to being self-accepting and requiring that others accept you too. Sarah (#31) first mentioned in Chapter 3, lived in limbo when she was isolated on campus that first year because of the school’s thoughtless rule of disallowing her to comingle with gluten-eating cohorts. The school environment forced Sarah to confront the able-body bias, causing her initially to be a victim of the circumstance. Because of the school’s interpretation of the American Disabilities Act, she missed out on developing those ever-important freshman relationships that can last a lifetime. Rather than having gluten-free foods available in the dining hall, authorities at the school determined that the only way to keep Sarah safe was to isolate her in her own apartment where she could prepare her own meals. She was in stages of both food and social limbo (discussed in Chapter 6) as she crisscrossed the campus to find safe havens to eat, and endured the loneliness of not being able to celebrate and party with her classmates. She resolved her limbo-state herself by finding other people on campus that would honor her needs, and they became roommates and friends in subsequent years. Her initiative yielded a positive outcome from an otherwise difficult situation. Claire (#25) from Chapter 3, was humming along in life until she re-entered into the limbo stage when she partook in the gluten-containing host on Sunday during communion in the church venue. She felt she had to participate in the communion ritual, eating the gluten-containing host to please the priest and to comply with the Pope’s edict; while at the same time, she suffered the consequences of being sickened each Sunday afternoon and feared the long-term effects of consuming gluten on a weekly basis. It was a dilemma that invoked the I-know-best attitude, able-body-bias, absence of agency, and gluten-doubt beliefs. Whew! That’s a lot to deal with, not to mention the higher-power guilt factor imposed by some religions. Couple all that negativity with a stomachache, and you can imagine what her state of limbo felt like – mentally and physically! If Claire reconsiders her decision to partake in light of these “truths” that are in play, she may decide not to consume the host, or she may approach the church and request that they accommodate her physical needs. When faced with the same gluten-containing host dilemma, Cora (#36) from Chapter 3 took control of the situation when she decided that she would only take the wine because “The Lord knows what is in my heart.” This is a very personal decision, but one that has to be ultimately resolved to avoid constant gluten contamination. By understanding the dominant powerful forces that cause us to feel pressured into participation, we can claim agency as to what works or doesn’t for us. In the workplace, Ava (#7) from Chapter 3 showered, groomed, and dressed for work only to turn around and go home because she accidentally soiled herself. She endured humiliation when she had to explain this to her boss and co-workers who told her to take Imodium or visit the doctor. This illustrates the state of social limbo, which is an out-of-control situation, where you have no answers and when other aspects of life cascade as a result. Ava tried to explain to her I-know-best and gluten-doubting boss and coworkers to no avail, causing her to ultimately quit working there. Sometimes, that is the only answer to get out of limbo—to put an end to a bad situation. Hopefully, Ava can find a more flexible situation where this problem won’t interfere with getting her work done. Pressing the replay button is an important component of transformation. It provides alternative ways to deal with tricky social situations. Transformation Our identities evolve as we live under the veil of celiac disease or non-celiac gluten sensitivity. When we attend ceremonies, rituals, or engage in commensality with family or friends, we constantly have to remember, “I can’t eat that,” or, “I need to ask about the ingredients,” or “I have to prepare in advance the foods I’ll eat.” It weighs on us in every aspect of life in the beginning, but over time we adapt. We wear a new mantle of food awareness as we learn to live with the disease. Individuals transform themselves under their evolved identity (Charland, 1987). It is at this level where the formation of stories and new “truths” interact to ultimately transform the identity to answer the question: How do I adjust my gluten-free lifestyle so that I can thrive? When a person with an illness stops fighting, hiding, and denying her disease, and takes assertive and protective steps by disclosing as necessary, she has attained identity transformation. In essence, she “owns” the disease, considers it part of her reality and incorporates its demands into all aspects of life. When someone with a disease attains the state of identity transformation, she accepts it and expects those around her to respect her resolve. She has altered her belief system to accommodate her new situation. Her identity is reformed as a result of changes in mental and physical awareness. She has found a way to love her new set of circumstances. She’s gone through the Big Shift (Chapter 6) to transformation. When the transformed individual thinks of her homeostasis “before,” she can’t believe how much life has changed. She even thinks differently! What she once held as sacred “truths” are now redefined. Foods she used to consider “normal” are not foods to her anymore. Pizza, which used to represent a fun celebration now looks like something that will cause her agony and pain, but that doesn’t bother her. She knows how to make a delicious gluten-free alternative that’s a lot healthier! She genuinely likes her diet of healthy, whole foods and she feels a million times better than she did when she ate gluten. Many of her younger friends can’t keep up with her energetically. She has endless energy, sleeps soundly at night, and wakes up pain-free, ready for the new day. She’s established new rituals with her family, and she has altered her ways to accommodate her needs. Things are mostly smooth. Occasionally, something happens that throws her back into the limbo stage, but those instances happen less and less often. She accepts herself and is no longer feeling at odds with the world around her because she has changed her attitude. She lives with confidence and self-esteem. She is not afraid to ask politely for what she needs, and she quit apologizing for her situation long ago. Life isn’t a series of food-conflicts anymore because she has surmounted the obstacles. She loves her new identity and the graceful living she has finally attained. Positive Adaptations Scarlet (#14) conveys an example of coming to terms with gluten-free constraints in describing her first post-diagnosis Thanksgiving. She reports she was initially stumped as to what to serve, so she made cheeseburgers without buns. To this day, her family jokes about that first Thanksgiving. Family adaptation is further illustrated in Sadie’s (#41) story: “We make [gluten-free food] a fun thing, to find places to go such as gluten-free bakeries when we travel, or places we wouldn’t otherwise go to when at home.” She describes gluten-free chocolate doughnuts her husband found at a bakery 40 miles away, and how he would occasionally get them for her as a treat. These adaptation stories illustrate positive ways families accommodate the needs of the person with celiac disease. In time, these stories become integrated in the family’s collective lore and new traditions replace food-centered rituals. For example, when reflecting on her relationship with her husband, Caroline (#28) says: Food is a pretty central part of our lives. We both enjoy food. And we both come from families that have always nurtured with food. So, I am trying to shift that and find other ways to connect, and to show that we are nurturing each other without being so food-focused. We do a lot more outdoor activities, like hiking and biking. We used to be more indoors people up until that point. We are learning that together. When we want to be with friends, instead of going out, we have friends over, and I try to do a game night, instead of a food-focus night. Then, we can just have a couple of snacks versus a meal that most people would be unhappy with, if their favorite foods weren't involved. Caroline describes her adaptive strategies for spending quality time with her husband and friends without involving food. She tells how they now do physical activities rather than centering social gatherings on food. Similarly, Willow (#30) describes how she consciously tries to remove the emotional connection to licorice and baseball, separating the gluten-containing licorice association from her enjoyment of a baseball game. After a few months of eating gluten-free, Madeline (#57) said, “Wow, I didn’t realize how sick I was,” connecting her diet with her newfound health. After several mishaps, Lillian (#58) has taken the helm to host Thanksgiving and Christmas dinners, so she doesn’t inconvenience her family members with her needs, and so she is assured of a safe gluten-free meal. She enjoys her new role as host. Scarlet decided to grow the foods she consumes in her garden. She discovered a fulfilling hobby, while also assuring that she has safe foods. These are just a few examples of how study participants transformed the way they view themselves, changed their rituals, and how they interact with friends and family. Rewarding Transformations For some participants, the gluten-free diet required by celiac disease provides a rewarding personal transformation. Those who are able to find “redemptive meaning” through transformation tend to be happier (McAdams & McLean, 2013, p. 233). For example, Allison (#35) describes her transformative story as follows: When I was first diagnosed, I was well over 230 pounds. I gained 60 or 75 pounds in a year. I was so sick. Once I was put on the gluten-free diet, I immediately felt a change in my body. I lost weight. I was feeling great, and I had a lot of energy. I have lost well over 50 pounds and 21 inches. And I am still losing! I am pretty thankful I’ve gone from a size 20 to a size 12. I’m happy with the results. I am definitely an advocate for getting diagnosed with celiac disease because I can understand the frustrations and the feelings and emotions and the cycles that you go through. Because when you stop eating gluten, you are grieving, and it’s like you’ve lost a loved one. It’s a whole new lifestyle. In this story, Allison describes the grieving process and then the personal satisfaction from being on the gluten-free diet. Her transformation was rewarded with a healthier body and lifestyle. Similarly, Sally (#3) describes a positive physical transformation as a result of accepting the diet and constraints of the disease: You know, it’s something I had to go through to become who I am today, and in a lot of ways, I’m a much better person than I ever have been. I mean, I eat better. I may still be overweight, but I’m getting my leaky-gut syndrome taking care of and that’s going to eliminate a lot of my issues. I appreciate the things a lot more in my life now than I ever have. And I suspect that I had celiac disease for about 10 years before I was even diagnosed. But something changed about four or five years ago, and it went from small issues to major issues. Sally’s weight and physical health improved after eliminating gluten, enhancing the quality of all aspects of her life. Sally’s positive metamorphosis illustrates a common sentiment expressed by other study participants as they realize how much better life is with a healthy body. Forty-five-year-old Hazel reports she first attributed her physical ailments to aging, saying, “I decided that was part of getting old...like I felt like I was about 70 years old.” After being gluten-free for a while, she commented on how much better her body felt, and how much more she was able to do with it. She went from surrendering to “old age” to feeling “young” again. Correspondingly, Claire (#25) notes, “I am thrilled. I am eating healthier, and I also noticed I was more relaxed now that I got off the gluten.” Claire’s outlook on life changed from being anxious about everything to having a calmer demeanor. And Lucy (#26) describes her post-gluten transformation as follows, “I have increased energy, and symptoms I had my whole life—like abdominal pain, fatigue, and constipation—are gone. I slowly felt better and now have a lot more energy and a lot less illness in general.” Lucy enjoys a more physical life than she did before she stopped eating gluten and feels she has regained her health. My surgeon father-in-law, Jacob Peretsman reminds us: “When you have your health, anything in life is possible.” Creative Transformations Hazel (#22) describes how her life changed after being diagnosed with celiac disease. She reports, “I used to be a chef. And I have a really, really strong intolerance to gluten. I actually react tactile: if I touch it, my hands peel. So it changed my whole life. It changed everything about my life.” Hazel was no longer able to perform her trade of baking gluten-containing foods and had to relearn how to bake. Hazel’s example illustrates the entire arc of transformation. Her liminality or “limbo” stage occurred when she realized it was gluten causing her hands to peel. She describes how devastating it was to learn that materials she used for the skill she worked so hard to cultivate were causing her to have problems. She experienced the fear of being unable to do her job. Her life was upended, as she worked out a solution. But her homeostatic shift included learning to bake without gluten, while using her culinary skills. Her identity transformation occurred when she declared herself to be a gluten-free baker. Hazel makes gluten-free bread for her Mormon sacred communion and shares it with others in the congregation who are gluten-free. Her positive transformation was reinforced when her son said: “Mom, you make gluten-free food taste good.” Other participants talked of how they adapted. For example, Riley (#65) now makes a lovely, soft gluten-free bread from a recipe she found on the Internet and sells it at the local farmer’s market. She says: “It has been a really nice experience, especially when people who eat gluten want to try your food.” Isla (#39) reflects on a kind gesture from her brother. He had the bakery put several frosting roses into a separate bowl for her to eat, so they wouldn’t be contaminated by the cake. She felt his kindness indicated his full acceptance of her disease, and he was helping her to still be able to enjoy some “normal” aspects of a birthday party. Carrie (#4) describes how her once rebellious family now enjoys eating the same gluten-free foods she prepares for herself, especially her desserts. In fact, they say they like her gluten-free food as much as they like gluten-containing desserts. Cara (#53) was diagnosed along with her two sons. She describes how she brings similar gluten-free dishes to social engagements for her family to consume. Someone at one of the potlucks said, “How blessed your boys are that you are their mother, and how hard this would be if you didn’t have the positive attitude you have.” That comment made Cara feel like she achieved a milestone because she was recognized for her unique talents to make tasty foods for her sons and herself. She also felt accepted by the potluck attendees. These examples illustrate how participants became comfortable with their new homeostasis and identity transformation. Snags After Transformation A friend of mine, Margaret described how she changed her ways after her transformation only to hit a snag. They decided a few years before to stay in a hotel when visiting family and friends so that Margaret could prepare her meals in a safe environment without having to disrupt the flow of the household. This worked for several years. She and her husband, John were planning to visit her in-laws for Christmas. This time, John really wanted to stay in his parent’s newly remodeled home. It also meant a lot to his mother, Milly for them to stay under one roof to have quality family-time. Margaret briefly went back into the limbo stage and worried this would cause a host of problems for her because no one in the family is gluten-free. John’s family members have shown reluctant tolerance and I-know-best attitudes toward her before – particularly Milly – the territorial captain of the kitchen who really doesn’t like sharing it with anyone. After hearing my Thanksgiving story (Chapter 5), Margaret was also worried if Milly baked while she was there, that the flour dust in the air would cause her to have a reaction. Margaret was in a dilemma. She didn’t want to request that Milly didn’t bake her favorite Christmas cookies, cakes, pies, and breads. In Milly’s mind, it wouldn’t be Christmas without them. And Margaret didn’t want to impose her dietary restrictions on everyone. Because Margaret is so sensitive to gluten, part of her transformation was to decide not to eat foods anyone else prepared. The only exceptions are if she co-prepares, or if the person making food for her also has celiac disease and is strictly gluten-free. On previous visits to Milly’s house, before Margaret’s transformation, Margaret ate “gluten-free” foods that Milly prepared, only to become sickened. When Margaret asked about ingredients, Milly said, “Oh come on… you are being so dramatic.” Margaret actually wondered if Milly didn’t “accidentally” slip gluten into her food just to observe what happened. Needless to say, they don’t have a trusting, loving relationship. Margaret determined the only way to stay safe is to bring her own food, cooking utensils for meal preparation, and an emetic, just in case she inadvertently consumes gluten. “Best to get rid of it fast than let it go through the body,” she said. Rather than worrying as she would have in the past, about bread crumbs on the counter, flour dust in the air, or being contaminated from the sponge in the sink, Margaret took the initiative to call her mother-in-law to ask: “How can we work together to accommodate my special needs during our Christmas visit?” Asking the question this way suggests a cooperative attitude, and empowers Margaret to (re)broach the topic rather than sweeping it under the rug. It brings to light that Margaret has a bona fide disability that needs to be addressed. Margaret came up with a few ideas that she thought would protect her while visiting. During the conversation, Margaret explained that on way to her mother-in-law’s house from the airport, she would need to stop at a grocery store. She told Milly that she would need a designated cooking area in the kitchen that was hers, about 2” x 3” that she could put her things on and cover with a dish towel. She asked that all baking be finished 24 hours before she arrived (it takes 24 hours for the flour dust to settle). She asked Milly to have space in the refrigerator for her food (about the size of two gallons of milk) where she could put her bag of groceries – that everyone else knew to leave alone. In the kitchen when cooking occurred, Margaret explained to Milly that she would need a burner so she could use the pan and lid she would bring with her to cook a one-pan meal. Margaret worked out how to make a quick, easy one-pan dinner and practiced making them at home so she could time her meal to be done when everyone else’s dinner was ready to serve. Her plan entails making a piece of fish or chicken she cooks half way (about 10 minutes), then adding slices of baked sweet potato, a fresh vegetable such as broccoli, and a little water for steam, then put the lid on it and cook it on medium for 10 more minutes. Margaret said since her pan is covered during the cooking process, if someone is cooking gluten containing foods, she won’t worry too much about cross-contamination. She plans to bring her own seasonings (since some packaged mixtures contain gluten). Broaching that conversation with Milly shows a lot of courage on Margaret’s part – she owns her special needs. She is not imposing them on anyone, except to ask for room in the kitchen to be accommodated. She also commands respect and took the initiative to get it. She also took the burden of providing gluten-free foods from Milly – taking all of the initiative to purchase and prepare her own foods. As a hostess, Milly must be relieved, (at least you’d hope so.) While driving from the airport to Milly’s home, Milly pushed back. Milly said she had plenty of frozen meats and vegetables in the house that Margaret could eat and that they didn’t need to stop at the store. Milly explained that she has a list, it wouldn’t take long, and then she’d be sure to have everything she needed. Milly said, “I’m insulted!” Margaret said, “Please don’t be insulted. I react to the smallest amount of gluten and this is what it takes for me to be safe. I really need you to understand I’m not insulting your food, you make beautiful foods I wish I could eat, but this disease makes it challenging for me. I’m doing what I need to do in order to stay well.” Under her breath, Milly said, “No wonder John has gotten so skinny!” Reluctantly, she agreed to stop at the grocery store. Then Milly said she wanted to make her special Christmas morning braided cinnamon roll to serve hot from the oven for breakfast. Margaret didn’t want to impede on any of the established traditions, so as a concession she said she would wear a mask while the roll was baking, but asked that Milly make the dough 24 hours prior to her arrival. John and Margaret adjusted their arrival date accordingly. It is hard to demand that special needs are addressed, especially when staying in someone else’s home. Usually there is a “ruler of the kitchen.” Cooks tend to be territorial about their domain and don’t want people in their drawers and cabinets either. If you know there is someone in the home that feels this way, it’s best to have your own station somewhere off from the main part of the kitchen, so most of your food preparation can be away from where the “ruler” presides. In this situation, cooking on the same stove top is a problem. If you can bring a hot plate, that problem is resolved. It takes courage to assert yourself in this way. If you already have strife in the relationship, this can easily add fuel to the fire – but it’s better to take precautions than to starve yourself, or be “glutened.” Some people, like Margaret react to such a little amount of gluten that it’s not worth taking any chances. I admire her courage and hold her up as a role model for how to gracefully travel and stay in someone’s home. She has inspired me to adapt her practices when I visit other people’s homes, though staying in a hotel where you can pre-make your meals for the day is so much less complicated (and peaceful). It’s A Process It seems that the first year or so, people often struggle to figure out what they can and cannot eat. They are coming to terms with their personal levels of sensitivity, which often change as the body gets cleaner. Several participants noted (and I have also experienced this) that the cleaner the body is (after avoiding gluten for a period of time), the more sensitive to gluten it becomes. Much of the first year is also spent in teaching our friends and loved ones the severity of the disease. It is hard enough for the person with celiac disease who has been consuming a lifetime of gluten to come to terms with a gluten-free lifestyle. As we have seen, study respondents described lots of struggles at home in the transition to gluten-free. Since food is integral to most social situations, many described relationship problems, breakups, separation, and general turmoil. Gluten-free restrictions permeate nearly every aspect of life. How families handle these restrictions is a barometer for how well they handle conflict and disruptions, often revealing other relationship problems. And over time, these food-related alterations might take a toll on all aspects of family life (Konrad, 2010) as we have seen with several of the participants who reported major changes in their relationships. There were problems before they were diagnosed; afterward, things escalated, so that the gluten-free diet became the catalyst that prompted change. Grace (#17) conveys the heartbreak that accompanied her Big Shift (Chapter 6) and identity transformation: I miss looking forward to eating. Sometimes I view food more as an enemy. I used to love it. I think back to the days when I would get excited about knowing we would go to a certain restaurant to eat. Or, when my mom was making lasagna for a special occasion. My family celebrated around food. When you look at photo albums of my family, there are more pictures of food than there are pictures of people. Because that’s what an Italian family does. And the holidays, the special things that were baked for a specific holiday, whether it was special Easter bread at Easter time or a certain Italian cookie for Christmas, or whatever the tradition was. I miss that. And I don’t feel that anymore because I can’t eat lasagna. Christmas comes and goes, and my mom makes at least 10 different kinds of cookies, and multiple dozens of each one. She starts on Thanksgiving, and she would put them in the freezer. She would put them in shoeboxes. And she would freeze them. And then at Christmas, we would have them. It’s been four years, and I haven’t had any. And she still does it. So I’m like, don’t even show me mom. She’s another one that doesn’t get it. She’ll call me and tell me, ‘Oh, yes, this morning I tried a new recipe for this homemade muffin’… And I’m like, ‘Oh, mom, really? Do I need to hear this? Do I need to hear about your homemade muffins?’ So, now I look at food more like an enemy. I get angry at it. I miss that excitement. Grace’s story emanates remorse and a longing to enjoy her mother’s food with other family members. She also expresses anger at her mom’s lack of understanding of her dietary restrictions, and at her own inability to eat foods the way she used to. Food, which once represented practices of love, is now an adversary, and an enemy. Her homeostatic shift encompasses her grief, losing the ability to eat the foods of her heritage, as well as the acceptance that this is how it is from now on. She concludes the story with, “This is my reality.” Though she admits to mourning her past lifestyle, she conveys a high degree of acceptance and a transformed identity. These redemption stories illustrate how the sharing of our stories can result in rewarding transformations after the homeostatic shift. I also observed that people’s acceptance of life with celiac disease changed over time. The longer someone lives with it, the more they seem to adapt to the lifestyle. Those newly diagnosed seem to struggle more with all of the elements of what to eat and how to navigate the imposing cultural constraints. Those who have had it a while figured out what diet works best for their bodies, and have incorporated successful adaptive strategies for social encounters. Throughout this book, we’ve learned that when we have a life-altering diagnosis, (or really any life-altering event), dominant cultural constraints may no longer serve us. We have to redefine our own set of “truths,” work with them to tweak them out for ourselves, such as when we experiment with foods and in social settings. It is a balancing act that takes time. In the past chapters, we’ve discussed examples of how respondents shared the discomfort of shifting truths in various venues as they struggled in the limbo stage: workplaces, restaurants, and schools. Here, cultural constraints were challenged and “truths” were redefined as a result of being diagnosed with an illness. Next, people experienced the Big Shift as they accept their new circumstances and attempt to gracefully navigate life in light of it. The Big Shift occurs when we realize life will forever be altered to a new definition of homeostasis. Finally, we transform our very identity to accommodate our new “self.” It’s a process that takes years. It certainly did for me. Jean’s Transformation Story Celiac disease has transformed nearly every aspect of my life, my occupation, and my social interactions. My individual transformation, as with most people, happens over the course of several years. Before I am properly diagnosed, I find myself between jobs. Feeling miserable and wondering who would hire me with my maladies, I decide to attend a vegan “healing” cooking school for a year. It makes sense to take some time off to regain my health. Diet is something I can control, and I hope it is the answer since none of the drugs doctors prescribe work. I find a cooking school that advertises teaching “The Art of Healthful Cooking.” It is a professional, certified school run by a culinary artist in Boulder, CO. I love it the minute I walk in. The aroma from the kitchen melds a combination of cumin, cinnamon, chocolate, green tea, chili powder, and lemongrass. It is intoxicating. The teacher teaches us the “Zen” of cooking, where the body and senses reflect taste combinations to the chef. Students never use a recipe and learn to creatively employ what is on hand. In the course of becoming a vegan chef, I learn about healing foods, grains, beans, vegetables, nuts, seeds, and fruits. Other teachers at the school teach me how to make beautiful gluten-filled baked goods and how to manipulate dough to get the best crumb and texture. The most important thing I learn is “ratio” baking and the concept of “to fit.” Though the cooking school is not gluten-free, these techniques later enable me to develop recipes for my gluten-free baking cookbook. Another significant thing the teachers teach me is to focus on how the foods make you feel as it progresses through the digestive process. Does it make you feel satisfied and comfortable? Or, do you feel like your body is fighting the food? I don’t put two and two together, but it is a glimmer of what is to come. How I love that cooking-school phase of life! This experience contributes to my new identity once I learn my maladies are caused from gluten. Shortly after I finish the cooking school, I am diagnosed with celiac disease. While I am glad to have a diagnosis, I still feel untethered. One day, my husband shows me an article in a magazine announcing a contest called “Win Your Dream Job.” It promises coaching from experts, a new computer system, cash, and best of all, the opportunity to consult with renowned career mentors appropriate to the winner’s dream job field. I fill out the entry form and send it in. And wait… Wow, imagine winning! But even if I don’t win, just writing about my “dream” help me to formulate what my next step in life will be. Alternative Cook, LLC is born. I immediately start working on the first instructional DVD. I don’t know what gave me the idea that I would be as engaging as Rachael Ray, but when I watch the first few segments of the “takes,” I am embarrassed to see that I am a chatty airhead. One of the people who sees me in those early “takes” says I am condescending and bossy. (Now that hurt… and how can a person be bossy on a cooking video?) I am going for “warm, engaging, and insightful. Another describes me as “pleasant and straightforward.” That is better but I have a long way to go. Then one day, the phone rings. I am one of three contest winners! I feel validated. Like others I interviewed, my life was transformed with the diagnosis. The process of attending cooking school, creating the instructional DVDs, becoming a published gluten-free cookbook author, and then realizing that gluten sensitivities impose social constraints and earning a PhD to study that, is how I came to terms with having celiac disease. Food has defined my life and it has been either my greatest nemesis or my healing solace, depending on my choices. It has determined how I spend most of my time, altered my career, and has consumed my thoughts for the last two decades. As I look back on this path, the steps I’ve had to take to surmount physical issues amaze me. It has truly shaped my identity, occupation, and trajectory for the second half of life, and I feel like I’ve been through hell and back with pain, suffering and dealing with some of the professionals in the medical community. As wonderful Julia Child said when her cookbook was initially rejected, “At least it kept me occupied for many years.” Celiac disease has given my life a meaningful purpose while evolving into my transformed identity as “an insecure, overachieving orthorexic.” I am grateful for finally being diagnosed, and for the life path it put me on. Summary of the Transformation Process We’ve now covered the components of transformation. Re-capping the Disease Process from Chapter 6: we live in our happy state of homeostasis until we experience a life altering event such as a diagnosis with celiac disease; then we question everything we once held as true, learning it isn’t true for us anymore; we enter the “limbo” stage or liminality where we have to experiment with new strategies in order to survive physically and socially. This is an uncomfortable stage when we think we’ve got it all figured out and the rug is repeatedly pulled out from underneath us. Slowly, we come to terms with it and enter into a new state of homeostasis where our new “truths” seem to be working for us. This is the Big Shift. Finally, we transform our lives so that living with the disease isn’t the focus of everything we do. It becomes normalized and we can function smoothly once again in life. While undergoing the process of transformation, we have learned to command respect, to educate those we love, and to expect compassion. It’s a process that applies to anything that changes the way we think. Transformation doesn’t require a disease diagnosis to occur. It happened to the entire world when it was determined that the Earth wasn’t flat. Everything about how we had previously thought about the Earth changed in that moment. The collective population had to go through a process of transformation to re-think everything that had been previously thought. It happens when there is a global pandemic and we have to alter every aspect of our lifestyle, or when any life-altering event happens. This is the process we go through. Some get stuck in one component. For example, some may never get out of the limbo stage, as illustrated with the participant stories above. Others may never even get to the point of defining new “truths” because it is just so different from how they believed. For example, a religious person who thought of bread as a sacred food may never be able to eliminate it from their diet. By understanding the process, we can navigate ourselves through it, and hopefully get to the other side with a rewarding transformation. Moving Forward Having language equips us with tools to discuss these evolving “truths.” The next chapter provides a summary of the language developed herein, as well as proposing a catch phrase to efficiently communicate without long explanations. Discussion Questions: 1. Describe what life looks like for you, now that you’ve completed the stages and entered into transformation. ___ References in Chapter 7 Bacigalupe, G., & Plocha, A. (2015). Celiac is a social disease: Family challenges and strategies. Families Systems & Health, 33(1), 46-54. doi: 10.1037/fsh0000099 Charland, M. (1987). Constitutive rhetoric: The case of the people Quebecois. Quarterly Journal of Speech, 73, 133-151. doi: 10.1080/00335638709383799 Konrad, W. (2010). Food allergies take a toll on families and finances. New York Times, Late Edition (East Coast) May 15, 2010. McAdams, D. P., & McLean, K. C. (2013). Narrative identity. Current Directions in Psychological Science, 22(3), 233-238. doi: 10.1177/0963721413475622 Back to: Gluten-Centric Culture: Chapter 6 - From Shaky Ground to the Big Shift

Celiac.com 10/01/2022 - When’s the last time you truly felt calm, stress free and at ease? Don’t worry… It’s not your fault. There’s a lot of uncertainty in the world these days that naturally causes us to be more stressed. Unfortunately, that stress causes us to become deficient in magnesium. Magnesium deficiency causes us to be even more stressed. It’s an endless cycle. The Bad News: Close to 80% of Americans are deficient in magnesium and you likely are too. Supplementing with a quality magnesium can end the cycle and have you feeling less stressed and sleeping deeper than ever. But be careful though… Most magnesium supplements only have one form of magnesium and likely won’t give you the benefits you desire. In order to bring your body back in balance, you need all 7 forms of magnesium. The Good News: Our friends at Organixx have created a breakthrough Magnesium supplement with all 7 forms of magnesium… And they want to prove to you that it’s one of the best magnesium supplements on the market by giving you a bottle to try for yourself (for a limited time only). >> Click Here to get your FREE bottle of Magnesium 7 (no subscriptions or strings attached) Listen, constant stress, anxiety and poor sleep is associated with everything from weight gain, to increased risk of disease. Consider that Magnesium 7 might be the missing piece you’ve been looking for and exactly what your body needs. Try it today - free Grab your bottle of Magnesium 7 and start getting the best sleep you’ve had in years. All of Organixx supplements are gluten-free, GMO-free, and doctor formulated with organic whole food ingredients. Click here for your complimentary bottle of Magnesium 7 *FDA Disclaimer: Products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using our products. Not intended for children. *Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.

Celiac.com 09/27/2022 - Bouillon is one of those products that can often contain gluten. For example, Knorr bouillon cubes contain autolyzed yeast extract from barley, and so are not gluten-free. While the powdered versions of Knorr bouillons do not contain gluten ingredients, they are not considered gluten-free by the company. In answer to the following question: Is this gluten free? The Unilever company responded by saying that: "The Knorr Granulated Beef Bouillon is not currently certified Gluten Free. As formulations may change, we advise checking the ingredients before each purchase." -- Unilever Consumer Services MANUFACTURER on June 22, 2021. The following companies make gluten-free bouillon: Harvest Harvest chicken bouillon is gluten-free. Hella Phat Hella Phat No Chicken Bouillon is gluten-free Hormel Hormel Herb-Ox Bouillons are gluten-free, and available in chicken, beef, and vegetable. Maggi Maggi Chicken Base, Stock and Bouillon is Gluten Free Massey Massey Bouillon Stock Powder Chicken Flavor is Gluten-Free. Mom's Mom's Chicken Bouillon is gluten-free

Celiac.com 09/26/2022 - Celiac disease is on the rise, and so are the gastrointestinal and other symptoms that go with it. A number of researchers have documented connections between various psychiatric disorders and celiac disease. However, the relationship between celiac disease, and such psychiatric disorders is not well studied or documented. A team of researchers recently set out to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of celiac disease. The research team included Emma Clappison, Marios Hadjivassiliou, and Panagiotis Zis. They are variously affiliated with the Medical School of the University of Sheffield, Sheffield, and the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield. Their systematic review and meta-analysis appears in a special issue on gluten-related disorders, titled, Time to Move from Gut to Brain. The team conducted a search of online medical literature search using PubMed, pulling data on rates of celiac disease and psychiatric disorders from eligible articles. They then conducted a meta analysis of odds ratios. For their review, the team found a total of 37 articles that met their eligibility parameters. Compared with healthy controls, the team found people with celiac disease to have a significantly higher risk for autistic spectrum disorder, attention deficit hyperactivity disorder, depression, anxiety, and eating disorders. They found no significant differences for bipolar disorder or schizophrenia. The study revealed that celiac disease is associated with a higher risk of depression, anxiety, eating disorders, along with ASD and ADHD. The team is calling for more research into the specific biological reasons underpinning this connection, along with the potential benefits of a gluten free diet in improving these conditions. Read more in Nutrients 2020, 12(1), 142

Celiac.com 09/24/2022 - When an individual is diagnosed with celiac disease, every family member is affected. Suddenly, the diagnosing physician or the helpful support group informs the new celiac that first and second degree relatives must be regularly tested for celiac disease. They learn that it is necessary because celiac disease is a genetic condition and could appear at any time in other family members. Antibody vs. Genetic Testing The blood tests that celiacs are more familiar with are the antibody tests. These tests, such as the tissue transglutaminase test, or the antiendomysial antibody test, measure the immune response to gluten that occurs at a point in time (think of it as a photograph). These are important tests because they characterize the extent to which the immune system is responding to a specific antibody created in response to gluten. More celiacs and their families are learning about genetic testing, which is also a blood test. Unlike antibody testing, the HLA gene testing for celiac disease measures the presence or absence of genetic material that is found on the surface of cells. Celiac disease is associated with the presence of HLA DQ2 and HLA DQ8. Genetics of Celiac Disease When the genetic predisposition for celiac disease was detected (on Chromosome 6) researchers noted that the genes were a necessary but not sufficient condition for the disease to develop. In fact, up to one third of the U.S. population has the genes for celiac disease, but it is thought that only 1-4% will actually develop the disease at some point during their lifetimes. This means that people with DQ2 or DQ8 can develop celiac disease, but aren’t destined to develop it. This is most evident in the case of identical twins, where only one of the twins is affected by celiac disease. Despite the fact that the twins have identical genes, the unaffected twin only has a 70% chance of developing the condition. How can this happen? Researchers and medical professionals use the term “environment” to refer to lifestyle factors, diet, or medical history that affect an individual’s chances of developing a disease. It is thought that environmental factors such as the duration of breast feeding and the presence of other autoimmune disorders can impact the development of celiac disease. Environmental factors can have a protective effect or a promotional effect with regard to the development of a genetic disease. Medical Knowledge and Celiac Genetics At the International Celiac Conference in Paris last summer, numerous presentations were made by researchers looking at the role that of other genes that could modify, protect, or directly lead to the development of celiac disease. Most of them, however, failed to establish a direct connection between a gene and the disease process. Since the Paris conference, however, researchers have published work that looks at subsets of HLA DQ2 and HLA DQ8 and have determined that some combinations of these subsets lead to a greater or lesser risk of developing celiac disease (called gene dosing). In addition, it is thought that a certain genetic typing (within DQ2 and DQ8) can identify people who will develop celiac disease later in life. Gene Testing Considerations The gene test for celiac disease is a blood test that looks to measure HLA DQ2 and HLA DQ8 positivity on the surface of cells. It does not diagnose celiac disease. It places an individual into an “at-risk” group for celiac disease, which indicates the individual should be closely monitored with antibody testing in the future. Celiac centers across the United States have different approaches towards the use of genetic testing with patients and families concerned about celiac disease. Be sure to talk to your doctor about his/her perspective on genetic testing for celiac disease. Rule Out Celiac Disease Given that two-thirds of the U.S. population does not have DQ2 or DQ8, which are necessary for celiac disease to occur, the gene test can “rule out” with a very high degree of certainty that person’s potential for becoming celiac (95% of celiacs are DQ2 positive, 5% are DQ8 positive). In families where the potential celiacs are children, many parents feel that genetic testing offers them additional information—the ability to know which of their children to monitor more closely. On the Diet before Diagnosis In individuals with symptoms who have been on the gluten-free diet for a significant period of time, the gene test is often the only way to determine if symptoms could possibly be related to celiac disease. For a person who faces this situation, a negative gene test would indicate that symptoms are not likely to be celiac disease. A positive gene test, however, does not diagnose the disease but increases the likelihood that it is present. The Blame Game Genetic testing provides very useful information for clinicians and families facing celiac disease. However, family members may joke about or comment that testing will determine whose side of the family is at fault for the presence of celiac disease. Genetic testing of any kind affects everyone in the family (close and distant relatives). Interpersonal relationships and potential problems should at least be considered before testing. In considering the genetic test, families have to realistically assess what they will do with the information if and when members test positive. If the family is planning to have a gluten-free household anyway, genetic testing will not offer information that will change the health outcome of each family member. In this circumstance, the family is probably not a good candidate for genetic testing. The Cost of Genetic Testing Genetic testing can be very expensive, and this can vary by geography and the type of medical center where the testing is done. Costs include the cost of the actual test, the hospital laboratory fees, equipment/supplies, and processing. Ask your doctor’s office about the cost of the test before you have it done. In addition, you should take steps to insure that your insurance company will cover the test before the blood is drawn, unless you plan to pay for the test yourself.

Celiac.com 09/22/2022 - Looking for an easy-to-make dish that will stand out at your next outdoor grill session, and also happens to be gluten-free? These grilled polenta crackers are the perfect treat. Oh, and they happen to be vegetarian. You're welcome. Ingredients: 1 tube, 24 ounces, prepared polenta, plain or sun-dried tomato flavor, cut into 1/2-inch slices ¼ cup extra-virgin olive oil, eyeball it 3 roasted red peppers, drained well, 1 large jar, 16 ounces ½ cup kalamata black olives, pitted 2 tablespoons capers ¾ cup flat-leaf parsley, a couple of handfuls ½ white onion 1 clove garlic ½ teaspoon red pepper flakes Directions Heat grill pan to high. Slice polenta and brush lightly with oil. Grill 2 or 3 minutes on each side to score the cakes and warm them. Place peppers, olives, capers, parsley, onion, garlic and red pepper flakes in processor and pulse the power to chop salsa. Top each slice of polenta with a spoonful of salsa and serve.

Celiac.com 09/21/2022 - The dream of creating a safe, effective drug that can help people with celiac disease to tolerate small amounts, or perhaps even large amounts, of gluten. Until its recent failure, 9 Meters' larazotide was the only celiac drug in Phase 3 clinical trials. The recent discontinuation of larazotide, based on disappointing interim results, highlights the unmet need for effective alternatives to a gluten-free diet for treating celiac disease. Larazotide's failure also opens the doors for current and future Phase 1 and Phase 2 celiac therapies to be first-to-market. It also highlights the lack of a good lineup of potential new drugs. The reality is that, with the collapse of several once promising candidates, the bench for viable alternative celiac disease treatments is shallow, at best. Current Celiac Disease Pipeline Therapies Include: Latiglutenase (ImmunogenX) PRV-015 (Provention Bio, Inc. with Amgen) TAK-101 (Takeda Pharmaceuticals) ZED-1227 (ZEDIRA GmbH) KAN-101 (Anokion SA) In an effort to assess the current and future alternatives for treating celiac disease without a gluten-free diet, data marketing company Spherix recently interviewed one-hundred US gastroenterologists, and conducted eight qualitative interviews to compile a report on the issue. Spherix has issued a recent report on the form gastroenterologists engaged in a thorough review of these pipeline product descriptions (based on publicly available clinical information for each product). The report assesses celiac diagnostic and treatment trends emerging, as well as physician reactions to potential therapies in the pipeline. The 2022 report reveals a greater sense of urgency from gastroenterologists versus the 2021 report. Indeed, the number of respondents in the 2022 survey who say that their celiac patient load has increased in the past year, is up by 60% over 2021. Read more at PRNewswire.com

Celiac.com 09/19/2022 - A team of researchers recently set out to calculate rates of non-coeliac gluten sensitivity (NCGS) in a group of fibromyalgia patients, to evaluate their clinical response to a six-week gluten-free diet, any improvement in symptoms, rates of diet responders who did not meet non-coeliac gluten sensitivity diagnostic criteria, and any baseline characteristics associated with diet response and diagnostic criteria fulfillment. The research team included Miriam Almirall, Francesc Casellas, Joan Dot, Inés de Torres, Hegoi Segurola, Sara Marsal. They are variously affiliated with the Department of Pathology, Department of Endoscopy, Department of Rheumatology, and the Nutritional Support Unit ant the Hospital Universitari Vall d’Hebron, Barcelona, Spain; the Rheumatology Research Group, Vall d’Hebron Research Institute; the Digestive System Research Unit Gastroenterology; and the Department of Morphological Sciences, Autonomous University of Barcelona. The team carried out an uncontrolled prospective experimental study in a group of patients with fibromyalgia from a specialized hospital ward. The team analyzed the percentage of patients who met the Salerno Experts’ Criteria, responded to a gluten-free diet, improved their symptomatology and baseline characteristics, and met diagnostic criteria. In all, the team found a non-coeliac gluten sensitivity rate of about 6% in 142 patients. About 22% of those showed an improvement in intestinal symptoms on a gluten-free diet. In total, 74.2% of the responders did not fulfil the Salerno Experts’ Criteria. The presence of diarrhea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of gluten-free diet response. No predictive factors of non-coeliac gluten sensitivity criteria fulfilment were found due to the low number of discriminators between gluten and placebo. These results show that patients with fibromyalgia have non-coeliac gluten sensitivity at rates similar to the general population. That means a gluten-free diet won't be appropriate for all patients with fibromyalgia. However, it could be useful for patients with diarrhea or intraepithelial lymphocytosis, at least to assess any improvement in intestinal symptoms. Read more in Rheumatology

Celiac.com 09/16/2022 - What’s for dinner? Somewhere between soccer practice, business meetings, hobbies, dentist appointments and time for family and friends, that question is always in the background. People often ask me for quick dinner ideas. In the real world, not every meal––or even week of meals––can be gourmet. Hectic lifestyles warrant easy, affordable meals that are kid-friendly and satisfying for adults. Everyone’s lifestyles and dietary needs are a little different. Some of the quick meal ideas below start with seasoned or pre-made items. Many people may enjoy this technique while others would prefer to add all the seasonings themselves and start from scratch at each meal. Whatever your preference, you can add any of these ideas to your meal-making repertoire either as they are shown, or by making your own personal adjustments. Brand names given were gluten-free at the time of writing this article. However, it is always necessary to verify before enjoying. Order a Meal to Take Home When dining out at a restaurant, order an extra gluten-free dish to take home to enjoy the next evening. I frequently enjoy this option locally at P.F. Changs Thai Restaurant, Outback Steakhouse and Boston Market. Many of their dishes travel well and are equally as good on the second day. This second meal is not to be considered leftovers. Pitch the take-home box and serve it on dinner plates. Shop the Grocery Deli Pick up a gluten-free pre-made rotisserie chicken or two, a pre-washed bag of salad greens, bag of baking potatoes, shredded Mozzarella cheese and pears. Once home, add raisins, pine nuts and mandarin oranges to the salad. Sprinkle Mozzarella cheese on top. Combine the Mandarin orange juice with mayonnaise for a tasty dressing. Bake the potato in the microwave until done. Add toppings of your choice. For dessert, wash and cut the pear in half. Remove the stem and seeds. Top with Mozzarella cheese and warm the pear in the microwave until the cheese melts. Use a Store Bought Dinner Mix Thai Kitchen and other brand names offer meal mixes that need very few additional ingredients for a complete meal. You can expand the number of servings for their Pad Thai seasoned noodle mix by adding more of your favorite vegetables to the dish, 1⁄2 teaspoon of their red curry and a can of low fat coconut milk. For a refreshing dessert, a simple scoop of gluten-free lemon sorbet is very satisfying. Enhance a Premade Item Amy’s Gluten-free frozen Cheese Pizza provides the base for a quick meal. Bake the pizza for 5 minutes as directed on the package. Top with stewed tomatoes or gluten-free pizza sauce, add gluten-free pepperoni, a layer of onions, chopped bell peppers, chicken from a can or left over rotisserie chicken from a previous meal and top with a layer of Mexican Cheese Mixture and Mozzarella. Bake for an additional 15 minutes. Serve applesauce on the side. Of course leftover pizza makes great snacks and lunches. Have Fun with Finger Food Make a Tuna Spread with a can of drained gluten-free tuna or seasoned tuna from a pouch, a half-cup of gluten-free mayonnaise, and a dab of pickle relish, salt and pepper. Serve with crackers and cheese and sliced Boars Head or Hormel luncheon meats. Add a plate of cut vegetables (can be purchased precut from the store) and a tray of beautiful fruit. Gluten-free cottage cheese or a fruit yogurt are an easy dip. For an even hungrier crowd, make Chebe Bread Mix into Pigs in the Blanket with Hillshire Sausages and enjoy a fun finger food dinner with a movie. For dessert, serve apple slices with melted gluten-free chocolate. Prepare a Pasta Dish One of the fastest meals is a pasta dish. This recipe for Sarah’s Cheese Lasagna may be changed by using different types of pasta. Serve it in a stylish dish. Boil gluten-free lasagna noodles until tender then drain and rinse with warm water Slice mozzarella cheese into thick slices Open a jar of your favorite gluten-free spaghetti sauce Find a pretty baking dish that is suitable for the microwave Layer lasagna in the dish as follows: Sauce, noodles, ricotta cheese, mozzarella, sauce, noodles, ricotta cheese, and mozzarella. Top with a layer of noodles and sauce. Cover entirely with mozzarella and parmesan cheese. Microwave on high for 5-7 minutes until the cheese has melted. Vary the recipe by including walnuts and a can of spinach. Or while the noodles are boiling, you can fry a pound of ground turkey with a few diced vegetables and onions to add to the lasagna. This dish also makes great leftovers. Keep it Simple with Salad and Poached Fish Seafood Salad and Apple Rings for Dessert Open a package of pre-washed Spring Salad Mix. Add sliced almonds, sesame seeds, sunflower or pumpkin seeds to the salad Pour 2 cups of gluten-free chicken broth in a fry pan and add 2 teaspoons of berry jelly to the broth. Turn on to medium heat and stir together. If desired, add strips of green, yellow and red pepper to the broth. Add your choice of cod, monkfish or tilapia fillets and simmer (poach) until the fish turns opaque and flakes, about 7 minutes. Remove from the broth, salt and pepper the fish and serve on top of the salad greens. Be careful of any bones. Top with a gluten-free dressing like Annie’s Naturals Low Fat Raspberry Vinaigrette or make your own Ginger Dressing by combining 1 1⁄2 Tablespoon of freshly chopped ginger, 3 Tablespoons of gluten-free soy sauce, 3 Tablespoons of mirin, 1 teaspoon of sugar and 2 teaspoons of rice wine vinegar Dessert: Cut a tart apple horizontally into 1⁄2 inch rounds. Remove the core. Baste with butter and sprinkle with brown sugar and then with cinnamon (or ginger). Top with chopped nuts if desired. Placed rings on a lined cookie sheet and broil until soft, about 8 minutes. Broiling is Fast Steak Rolls with Vegetables and Wild Rice. Pistachio Peaches for Dessert. Slice 1 pound of flank steak across the grain into 16 strips. They should be less than 1⁄2 inch thick. Pound each strip to 1/8 inch thick and season with salt and pepper Place slices of bell pepper and Portobello mushrooms (or any of your favorite vegetables––well, corn probably wouldn’t work) across the short end of a strip of pounded flank steak. Roll the steak around the vegetables and secure with a toothpick. Place on a lined baking pan in a single layer. Marinate for 10 minutes using your favorite gluten-free salsa, Lea & Perrins Steak Sauce or your favorite vinegar dressing. Or prepare a marinate of 6 Tablespoons of seasoned rice vinegar, 6 Tablespoons of gluten-free soy sauce, 4 teaspoons of brown sugar and 1 Tablespoon of toasted sesame oil. Broil steaks for 5 minutes 10 inches from the broiler. A grill would also work, but be careful of the toothpicks (if you soak the toothpicks prior to using, they will not burn). Serve steaks with gluten-free barbeque sauce or Lea & Perrins Steak Sauce and pre-prepared wild rice by Fall River. Simply open the package of rice and reheat. Add as many toasted pecans and sliced grapes as you desire. Or make the rice into small patties by combining 1 cup of the cooked rice with 1⁄4 cup chopped pecans, 1 Tablespoon of cornstarch and 2 eggs. Mix all ingredients together and fry on medium heat for about 3 minutes on each side. For dessert, open a can of sliced peaches. Put in a medium size pot on the stove and add 1/3 cup of low fat cream cheese. Cook on low until the cream cheese has melted. Remove from the stove. Pour a package of Pistachio Instant Pudding (or your favorite complimentary pudding) into a clean bowl. Pour the peaches and cream mixture over the pudding. Mix well. Serve warm with a gluten-free cookie or on top of pound cake. Or serve cold by mixing in 1 cup of whipped cream.

Celiac.com 09/14/2022 - With grilling season at full steam, the search for new recipes can reach a fevered pitch. If you're looking for a dish that turns corners and take you someplace new, then these coconut-lime pork tenderloin kebabs are just the ticket. A delightful marriage of coconut milk, lime, spices and Sriracha, this recipe is easy to make, and sure to please. Ingredients: 1½ pounds pork tenderloin, cut into 1-inch cubes 1 13.5-ounce can coconut milk 2 tablespoons vegetable oil, plus more for the grill 4 cloves garlic, smashed ⅓ cup plus 1 tablespoon packed dark brown sugar ⅓ cup chopped fresh cilantro, plus more for topping 2 tablespoons gluten-free fish sauce (some contain wheat!) 2 tablespoons fresh lime juice 2 tablespoons Sriracha (Asian chile sauce) Romaine lettuce leaves, for serving Chopped roasted peanuts, scallions and cucumber, for topping Directions Toss the pork with half of the coconut milk, the vegetable oil, garlic, ⅓ cup each brown sugar and cilantro, and 1 tablespoon each fish sauce, lime juice and Sriracha in a large bowl. Cover and refrigerate 1 to 4 hours. Heat a grill to medium and lightly brush the grates with vegetable oil. Thread the pork onto eight 10-inch skewers. Grill the kebabs on a hot grill, turning occasionally and brushing with the remaining coconut milk, until marked and cooked through, about 12 minutes. Meanwhile, combine 1 tablespoon water and the remaining 1 tablespoon each brown sugar, fish sauce, lime juice and Sriracha in a small bowl. Serve the kebabs in romaine leaves and drizzle with the sauce. Top with chopped peanuts, scallions, cucumber and cilantro. If you're using wooden skewers, soak them in water for 20 minutes to prevent scorching.

Celiac.com 09/10/2022 - Starch––the single word “starch” on a US or Canadian food label is considered the common or usual name for cornstarch. Starches from other sources must be labeled accordingly such as “potato starch”, “tapioca starch” or “wheat starch”. It is very difficult to completely remove all traces of protein during the manufacture of food-grade starch. Wheat starch contains varying amounts of gluten. Some European products labeled “gluten-free” are made from Codex Alimentarius quality wheat starch. North American celiac organizations do not recommend that celiacs consume wheat starch-based products. Modified Food Starch There are specific regulations for how food starches can be modified. However, there is no requirement for the identification of the name of the plant sources of the modified food starch on US or Canadian food labels. Corn, tapioca, potato, wheat or other starches can be used by the food industry. Corn is the most common source of North American modified food starch, with potato, tapioca or rice used occasionally. To be 100% certain, it is best to contact the company to determine the source of the modified food starch. Dextrin Dextrin is partially hydrolyzed starch by heat alone or by heating in the presence of food-grade acids and buffers. A variety of starches such as corn, milo, potato, arrowroot, rice, tapioca or wheat can be used. In North America, dextrin is almost always derived from corn or tapioca; however, contact the company to confirm the source of dextrin. Maltodextrin Corn, waxy maize, potato, rice or wheat can be used in the production of maltodextrin. North American maltodextrin is usually derived from corn or potato; however, wheat is often used in European products, and occasionally in some North American products. The US Code of Federal Regulations for maltodextrin (Sec. 184.1444) state it is derived from corn, potato or rice starch. The FDA also permits the use of other starches including wheat. If wheat is used, it must be labeled “wheat maltodextrin”. Caramel Color Caramel color is manufactured by heating carbohydrates, either alone, or in the presence of food-grade acids, alkalis and/or salts, and is produced from fructose, dextrose (glucose), invert sugar, sucrose and/or starch hydrolysates and fractions thereof. Although gluten-containing ingredients [malt syrup (barley) and starch hydrolysates] can be used in the production of caramel color, they are not used according to food processors in North America. Corn is used most often, as it produces a longer shelf life and a much better product. *Note that food allergen labelling laws passed after this article was written require companies to disclose the top 8 food allergens in the ingredients, including wheat.

Celiac.com 09/09/2022 - Any seasoned celiac knows that making sure spices and seasonings are gluten-free can be tricky. We get a lot of questions about seasonings and spices and products made with them, especially about brands of gluten-free taco seasoning. Even after an earlier article, numerous readers wonder if McCormick, Old El Paso and other brands of taco seasoning are gluten-free and safe for people with celiac disease. Numerous brands of taco seasoning are made without gluten-ingredients. For anyone wanting to make their own taco seasoning at home, this recipe gets pretty close to most of those store bought taco seasonings, and is pretty well guaranteed to be gluten-free. McCormick- or Old El Paso-style Gluten-Free Taco Seasoning Ingredients: 2 tablespoons ground chili powder* 3 teaspoons ground cumin 2 teaspoons salt 2 teaspoons ground black pepper 1 teaspoon ground paprika ½ teaspoon dried oregano ½ teaspoon garlic powder ½ teaspoon onion powder ½ teaspoon dried red pepper flakes Directions: Mix ingredients in a bowl and place in a jar to use as needed. *Note: For less spicy taco mix, cut back on the chili powder.

Celiac.com 09/07/2022 - Any seasoned celiac knows that making sure spices and seasonings are gluten-free can be tricky. We get a lot of questions about spices and seasonings, especially about brands of gluten-free taco seasoning. Even after an earlier article, numerous readers have asked us if McCormick, Old El Paso and other brands of taco seasoning are gluten-free and safe for people with celiac disease. Here's the rundown. Both McCormick and Old El Paso taco seasonings are naturally gluten-free, but not labelled as such. There are no gluten ingredients and no declared allergens. Ingredients per Old El Paso web site are: Chili Pepper, Maltodextrin, Salt, Onion Powder, Spice, Corn Starch, Sea Salt (Potassium Magnesium Chloride, Salt). Like most major companies, General Mills, the maker of Old El Paso Taco Seasoning, has a policy of clearly declaring known allergens on the label. Taco Seasonings that are Gluten-Free or Contain No Gluten Ingredients: Durkee Durkee Taco Seasoning is gluten free. According to the company, Durkee is made of a “gluten-free blend of mild spices and herbs.” McCormick McCormick now makes both an Original Taco Seasoning Mix and a Gluten-Free Taco Seasoning Mix.The original contains no gluten ingredients and no declared allergens. Ingredients per the McCormick.com website: Chili Pepper, Paprika, Oregano, Onion, Salt, Potato Starch, Sugar, Garlic, Natural Flavor. Of the gluten-free version, the company says: “If any product has a gluten free claim, the product and the manufacturing line has been validated gluten free.” CAUTION: Do not use Lawry's Taco Seasoning, which is made by McCormick. Lawry's Taco Seasoning contains wheat ingredients and is UNSAFE for people with celiac disease. Old El Paso Ingredients per Old El Paso web site: Chili Pepper, Maltodextrin, Salt, Onion Powder, Spice, Corn Starch, Sea Salt (Potassium Magnesium Chloride, Salt). Like most major companies, General Mills, the maker of Old El Paso Taco Seasoning, has a policy of clearly declaring known allergens on the label. Ortega Ortega Taco Seasoning contains no gluten ingredients and no declared allergens. Ingredients as per Ortega.com: Yellow Corn Flour, Salt, Maltodextrin, Paprika, Spices, Modified Corn Starch, Sugar, Citric Acid, Yeast Extract, Natural Flavors, Silicon Dioxide. Pioneer Pioneer gluten-free taco seasoning mix is certified , one of the few mixes that is certified by the GFCO. Be sure to avoid the non-gluten-free version of this product. Spice Island Spice Island makes a large container of its premium taco seasoning mix, and the container is clearly labeled gluten free. Please always check labels as ingredients can change.