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Feeding Your Curiosity
My family members probably thought I was nuts when I suggested we wrap my niece in toilet paper at our Thanksgiving gathering. It was meant to be symbolic, a way to visually “wrap up the year” while still keeping celiac awareness in mind. A little tongue in cheek, yes, but good digestive health is something to appreciate, especially around the holidays.
It also will make for an interesting post on our new staff blog, Celiac Central: Bits and Bites (celiaccentral.wordpress.com). Yes, we’ve joined the ranks of non-profits opening their doors to give you a bigger glimpse of what goes on behind the scenes.
Many of our staff members have chatted with you via Facebook, Twitter and email, but Celiac Central: Bits and Bites will help you get to know the faces behind the logo. Plus, our posts just might answer a few burning questions. Which celiac-friendly chef has our eye? Do we get frustrated when it’s 7am on a Tuesday and our favorite box of gluten-free cereal has gone MIA? You’ll have to read to find out.
The staff blog is also a chance to watch program development (and your donated dollars) in action. Looking back at 2010, the National Foundation for Celiac Awareness (NFCA) had groundbreaking achievements. We launched the first Gluten-Free Showcase Pavilion at the 2010 National Restaurant Association (NRA) Show, expanded access to gluten-free food through the GREAT Business Association, hosted the 7th Annual Appetite for Awareness, and published continuing education materials for both primary care and women’s health practitioners.
But those are all end results. The journey of planning and process often get left out of the mix, so Celiac Cental: Bits and Bites is our chance to bring you along for the ride. Will we throw in a few laughs and random observations along the way? You bet.
And don’t get me wrong. Despite all that I’m proud NFCA accomplished this year, there’s still plenty to be done. At the recent Development of Therapies for Celiac Disease Conference held at Columbia University in New York, I was reminded again of how far celiac awareness has to go. We need standardized terminology, consensus on standards of care and best practice guidelines. When you consider that the fight for attention pits us against ubiquitous campaigns like breast cancer awareness and heart health (both of which are worthy causes, of course) the celiac community could use all the unity we can get.
Fortunately, the staff and I already have some exciting projects on the horizon for 2011, and many will help foster connections. We’ll be speaking at Natural Products Expo West and the Institute of Food Technologists Wellness Conference, both in March. You’ll also see more Webinars, Alternative Appetites cooking videos and resource materials on beyondceliac.org, plus a new Twitter event via @CeliacAwareness.
Our focus next year is all about empowerment, which means we need your input and help more than ever. Please take the opportunity to comment on our staff blog, and keep the discussions going on Facebook and Twitter. We’ve even introduced a new weekly post on Facebook, “Take Action Tuesday ,” which shares quick and easy ways to promote celiac disease awareness without the need for a credit card. (Thanks to everyone who participated in our first one on Nov. 30!)
So what’s my Thanksgiving “wrap” got to do with it? Consider it our first empowerment challenge. Many families are too embarrassed to talk about toilet issues, so wrapping someone in t.p. is an easy way to break the ice. Let us know how it goes by tweeting us a photo or posting a pic on Facebook. And while you’re at it, tell us about your funniest or most embarrassing gluten-free cooking moment. We promise to share some of ours on Celiac Central: Bits and Bites and, more importantly, we’ll let you know how we learned from it.
Holiday Baking with Your Celiac Child
Now that the holidays are here, it’s time to celebrate with family togetherness and, of course, lots of seasonal goodies. Rather than focus on yourceliac child’s gluten-free dietary restrictions, take advantage of this opportunity to establish a special tradition of baking gluten-free cookies or cakes. Not only will you help establish a love and skill for gluten-free cooking in your celiac child, making him more willing and able to prepare his own gluten-free foods when he’s older, but you’ll also make cherished memories with him, making him look forward to holiday festivities that everyone is included in.
As a gluten-free advocate and mother, one of my favorite ways to support the celiac community is to help parents with celiac children make the adjustment to a gluten-free diet. One of the ways to do this is by turning the holiday season into a truly celebrated time of gluten-free baking and enjoying goodies without the pain and troubles.
Baking cookies and goodies goes back a long way in my family, and I was quick to establish it as a Turbin family tradition with my own kids. When I was diagnosed withceliac disease several years ago and adopted a gluten-free diet, I began accumulating gluten-free recipes for cookies and other baked goods, adapting recipes and testing all sorts of my wild ideas so the baking tradition could carry on.
There are plenty of straightforward, delicious gluten-free recipes for everyone’s favorite cookies and deserts. I publish a wealth of gluten-free recipes on my website. [NFCA also has compiled a Gluten-Free HolidayRecipe Box for the season.]
Gluten-free doesn’t mean sugar-free, so the kids will enjoy the gluten-free alternatives as much as gluten-containing cookies. There are numerous sugar substitutes these days too. As for gluten-free flour mixes, Bob’s Red Mill, Glutino, and Pamela’s Products have received rave reviews from the celiac community.
It’s best to bake for occasions that give your child a chance to share his gluten-free baked items with others; it gives children the pleasure of not only baking gluten-free, but also giving to others. Encourage your celiac child to share hisgluten-free treats with classmates and teachers. Contact teachers at the beginning of the holidays, and let them know your child’s dietary needs and ask if there will be any class parties that you and your child could prepare gluten-free goodies for. This way, your child can bring in cookies or other baked goods for the class and focus on sharing his own treats, rather than on being excluded from others’ goodies. With the recipes that are available these days, there is no doubt that your child will impress his classmates. When going to a relative’s house for dinner, bring along a plate full of your child’s gluten-free cookies for everyone to enjoy.
Consider baking healthy and gluten-free cookies throughout the season so there’s a regular supply of treats and healthy snacks for your celiac child. He may be offered gluten-containing treats at friends’ or relatives’ houses or at school, but by including a holiday cookie in his lunchbox or letting him enjoy a gluten-free cookie with a glass of milk after school, you’ll help him to not feel left out this season.
Inviting kids over for a baking party is also another way for your child to enjoy holiday baking. His friends will enjoy the gluten-free goodies and can bring some home for their own families. The praise his friends will give over the cookies and baking experience will make your child feel just like non-celiac children. As part of my gluten-free advocacy, I host regular monthlygluten-free parties, inviting families from whatever state I am in, usually mothers and their celiac or gluten-intolerant children. You can also host a gluten-free baking party for the holidays and invite other families, allowing your celiac child to meet and bond with other celiac children. It raises awareness, which is what we all need.
At the start of this holiday season, get with your celiac child and have him pick out some gluten-free recipes and get started baking. With these tips, you’ll soon have established a memorable family tradition while delighting the friends and classmates of your celiac child, increasing support and awareness for the gluten-free lifestyle. In the end, you’ll have given your celiac child a tasty and unforgettable holiday gift.
Happy Holidays and to a Lovely New Year!
[Editor’s Note: Congratulations to Tina Turbin for a successful year! The NFCA newsletter columnist recently won second place in the .INFO Awards and her children’s book just took home another award, this time for cover art. We’re proud to have Tina as a regular contributor and gluten-free advocate!]
More about Tina and the “Danny the Dragon” children’s book series:
Tina Turbin became extremely interested and involved in the subjects of celiac disease, gluten sensitivity and gluten issues a number of years ago, after being diagnosed as celiac after many years of unresolved troubles. Since then, she has engaged in diligent research and writing about these topics, weekly radio shows, developing gluten-free recipes and reviewing companies for celiac consumer safety (http://GlutenFreeHelp.info)
Tina is an award-winning children’s book author
by Genevieve Sherrow, MS, CN
Gluten-free diets can be costly. The availability of gluten-free foods in the marketplace is on the rise; however, market prices of many of these products make them inaccessible to those on a budget. Here are 5 tips that will help you sustain the gluten-free diet on a budget.
Tip 1: Find the bulk bins in your supermarket: Foods that are sold in bulk, such as whole grains, nuts and seeds, and dried fruits, are less expensive than their packaged counterparts, so look for the bulk section when you’re in need of these foods. For example, 1 pound of bulk rice costs $0.89 at most supermarkets, whereas a 1-pound box of packaged rice is $1.69 – almost double the price of bulk.
Caution! Cross-contamination can be an issue in bulk bins. If the bins and scoops are not washed out thoroughly before adding a gluten-free item, there can be risk of cross-contamination. Individuals with celiac disease must be careful about this, and research indicates that non-celiac gluten intolerant individuals should be equally as careful. Always read bin labels. If you see evidence of cross-contamination, such as flour dust on or near the gluten-free items, report it to the grocery manager. Some stores are more conscious about this than others, exclusively assigning gluten-free and non-gluten-free items to specific bins. When in doubt, inquire with the grocery manager.
Tip 2: Cook with whole grains: There are many whole grains that are naturally gluten-free, such as rice, corn, quinoa, millet, buckwheat and teff. Grains are versatile and can be used as the base of a dish such as fried rice, polenta or kasha. They can also be used in side dishes, salads or served hot with nuts and fruit as breakfast porridge. Noted above, it is cheaper to purchase whole grains in bulk rather than packaged.
Tip 3: Eat a whole foods diet: When individuals are put on a gluten-free diet, the first question that pops into mind is “Oh my god, what am I going eat?” Do not panic. The fact is, there are countless whole foods that are naturally gluten-free, including fruits and vegetables, meat, poultry, fish, eggs, cheeses, butter, whole grains noted above, nuts and seeds, soy products, beans, coffees and teas, oils, honey, maple syrup and spices. It can be more time-consuming, but it is less expensive and more nutritious to construct meals using foods in their natural state.
Tip 4: Minimize consumption of gluten-free packaged foods: If possible, reduce the frequency with which you purchase gluten-free packaged foods. When purchased in abundance, these foods will inflate your grocery bill. They are enticing because they’re “ready-to-go,” and it is challenging to find decent prepared meals, cookies, bars, etc. that are also gluten-free. However, naturally gluten-free whole foods can make healthy, low cost snacks and meals.
Tip 5: Get curious about gluten-free baking: Packaged gluten-free baked goods and baking mixes can be quite pricey. For example, packaged gluten-free cookies may run $3-6 dollars per box, depending on the brand and where you shop. Gluten-free cake and bread mixes also run about $4-7 dollars per box. Gluten-free baking can be intimidating, even for a seasoned pastry chef, but there are a multitude of resources, online and offline, to help you navigate this new world. Many natural food stores and food co-ops now offer gluten-free baking classes, a worthwhile investment. Find recipes online and begin experimenting with gluten-free flours, such as quinoa, sorghum, rice and bean. Blue and yellow cornmeals and nut-based flours also work well in gluten-free baking. Bob’s Red Mill and Arrowhead Mills sell these products certified gluten-free.
Genevieve is a nutritionist, writer and chef based in Philadelphia. She writes for her own gluten-free food and nutrition blog at http://wholefoodreflections.blogspot.com
Development of Therapies for Celiac Disease Conference: Top 6 Highlights
By Kristin N. Voorhees, NFCA Healthcare Relations Manager
NFCA Founder and President Alice Bast and I were thrilled to join the celiac disease field’s key opinion leaders, scientists and industry experts at the Development of Therapies for Celiac Disease Conference on Nov. 18-19, 2010.
Held at the Celiac Disease Center at Columbia University Medical Center, researchers and physicians from all over the world convened to discuss the future of non-dietary therapies for celiac disease. It was particularly fascinating to hear Ii-Lun Chen, MD, of the Food and Drug Administration (FDA) discuss the FDA’s requirements for an effective drug to treat celiac disease. Her presence was unique in that rarely do physicians, drug developers and drug administration members come together to discuss potential pharmaceutical therapies.
The two-day conference was packed with information and discussions, but here are the top six highlights (in no particular order) about the present and future of celiac disease research:
1. International leaders presented those therapies currently being investigated to treat celiac disease, including enzyme and vaccine therapy . Enzyme therapy would involve breaking down the gluten in the stomach before it reaches the intestine, and would likely act as a supplement, not a replacement, to the gluten-free diet. On the other hand, vaccine therapy would instruct a person’s immune system to ignore gluten.
2. In his discussion of the mortality and morbidity of celiac disease, Alberto Rubio- Tapia, MD, of the Mayo Clinic, presented findings on the rate of mucosal healing . Rubio-Tapia et al. (2010) found that among diagnosed adults who were adherent to the gluten-free diet, it took two years for 34% of patients’ mucosa to heal and five years for 66% to experience mucosal healing. These low rates of mucosal healing might suggest that patients diagnosed with celiac disease in adulthood should undergo regular follow-up with small intestinal biopsies.
3. A considerable amount of attention was paid to refractory celiac disease , which occurs when symptoms or villous atrophy remain or return despite a patient’s adherence to the gluten-free diet. Although current treatment includes medical monitoring and medications such as steroids, immunosuppressants and enhanced nutritional support, the majority of refractory cases are treated symptomatically. Christophe Cellier, MD, PhD, from the Hôpital Européen Georges Pompidou in France, concluded that a more effective treatment is greatly needed.
4. Alessio Fasano, MD, discussed the possible role of the microbiome
5. Given the media’s recent attention on gluten-free as the latest fad diet, it was a pleasant surprise to have the conference’s organizing committee add Knut Lundin, MD, PhD of Norway to the program. Dr. Lundin acknowledged that the gluten-free diet has become a trend across the globe and discussed the reality of non-celiac gluten intolerance . In his research, Dr. Lundin found this population to be just as strict with the gluten-free diet as those diagnosed with celiac disease and concluded that the mechanisms of non-celiac gluten intolerance remain unclear and more research is still needed.
6. The conference also incorporated workshop panels where physicians, scientists, patient advocacy leaders and even patients contributed to the conversation. The panelists shared their perspectives on the need for a therapy and raised several key questions , such as:
The last question surfaced frequently, and the resounding reply heard around the room was: “The primary care provider.” This provided the opportunity for Joseph Murray, MD, to introduce the National Foundation for Celiac Awareness (NFCA) Primary Care Continuing Medical Education (CME) activity, Defining, Diagnosing & Managing Celiac Disease, to the audience. The discussion of the primary care provider’s role in the management of celiac disease also prompted the matter of diagnosis. We know that this community can help to improve the diagnostic rate. (That is exactly why NFCA created the CME activity.) It’s also well known that pharmaceutical therapies can increase diagnoses, too. Direct-to-consumer marketing brings the potential to raise awareness of symptoms and, ultimately, improve celiac disease diagnoses.
Tell us:What would you look for in a drug?
We invite you to share your thoughts on a pharmaceutical treatment for celiac disease. Do you want something to protect you against the long-term risks associated with exposure to gluten in small amounts (from things like cross-contamination)? What about to supplement the gluten-free diet so you can enjoy the occasional gluten-filled favorite? Or are you ready for a total replacement?
By Frank Jackson, MD
Awareness of celiac disease and gluten intolerance is growing. We physicians and gastroenterologists now have the message that these problems are very common and that we need to be more diligent in testing for and treating any gluten-related conditions. But what do prebiotics have to do with celiac disease and gluten intolerance, and what are they anyway?
A prebiotic is not a probiotic. A probiotic is a live bacteria in yogurt, other dairy foods or pills. Prebiotics are certain specialized plant fibers that supply nutrition to the good bacteria we all harbor in our gut, specifically the colon. The technical names for the two best researched prebiotics are oligofructose and inulin. When these healthy prebiotic fibers reach the colon, the good bacteria there grow considerably, and as a result, create many health benefits. One good health outcome is increased calcium absorption and enhanced bone density, which can be particularly important to the celiac patient or anyone concerned with bone health [Osteoporosis has been linked to celiac disease]. Another medically well documented benefit is enhanced immunity in the colon.1 So, what is the link between celiac, gluten and prebiotics?
Recently, research has discovered that Americans may get 70-80% of these good prebiotic fibers from wheat.2,3 Additionally, current research has shown that when anyone goes on a gluten-free diet, there is a deterioration in the good bacterial mix in the colon.4 This, in turn, may result in fewer health benefits that flourishing healthy gut bacteria can supply. It is possible that the reason for this result is the marked reduction in ingested prebiotics that occurs when a person goes on a gluten-free diet.
Prebiotic awareness is gaining momentum. Food manufacturers, including infant formula makers, are now putting prebiotics in their products. They’ve seen the research and have become active in bringing prebiotics to the public.
The dietary goal should be to consume generous portions of gluten-free and prebiotic-rich foods, up to 8 grams of prebiotics per day. Natural sources of prebiotics include onions, leeks, yams, bananas, avocado, asparagus, agave, Jerusalem artichoke, chicory root and jicama, to name a few. A prebiotic supplement might also be considered.
1. Gibson GR (2008) Prebiotics as gut microflora management tools. J Clin Gastroenerol42,Suppl. 2, S75-S79.
2. Van Loos J, Coussement P, De Leenheer L, et al. (1995) On the presence of inulin and oligofructose as natural ingredients in the Western diet. Crit Rev Food Sci Nutr 35, 525–552.
3. Moshfegh AJ, Friday JE, Goldman JP, et al. (1999) Presence of inulin and oligofructose in the diets of Americans. J Nutr 129, 1407S–1411S.
4. Jackson FW (2010) Letter to the Editor – Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Brit J of Nutr. Pg 1 of 1.
About Dr. Jackson
Frank Jackson, MD, is a gastroenterologist and president of Jackson GI Medical in Mechanicsburg, PA. He specializes in prebiotics.
Looking for recipes to boost your prebiotic intake?