Health by Gini
The Vitamin D Controversy
Tips for a Healthy New Year
Dinner at Your Doorstep
All Things GREAT
Celiac in the News
CONNECT WITH NFCA:
The Year of You
I know this is usually where I take some time to share my thoughts and experiences. But enough about me. How are you? Really, give it some thought: How areyou?
If you’re like most Americans, you probably work too hard, play too little and sometimes make less-than-wise decisions about your health. As the New Year reminds us, we could all stand to turn more attention inward.
Obesity rates have more than tripled since the ‘80s, heart disease is reaching pandemic levels and cancer takes a life every 60 seconds. In all, chronic disease accounts for 75% of healthcare spending. The worst part is, so much of it can be prevented.
As a member of the celiac community, you probably have a better grasp of where your health stands than most. You read food labels, monitor intake and probably know your family medical history by heart. You know if you’re at risk for diabetes and which family members have high blood pressure. Now the question is: What do you do about it?
Our healthcare system has long suffered the problem of being reactive instead of proactive, giving us the tendency to “wait and see” rather than take responsibility for our health beforea problem arises.
Consider this: How long did you struggle with celiac disease symptoms before you called a doctor? Did you have a history of celiac disease in your family, but didn’t rush to get tested? And since your diagnosis, how many family members have talked to a doctor about their risk for the disease?
With our demanding schedules, we all too often put health on the back burner until a problem becomes too disruptive to ignore. At that point, it may be too late.
So, I present a challenge: Make 2011 the Year of You, the year preventive health and wellness replace patchwork treatments and ‘too little too late’ recommendations.
You’ve already started it. Social networks have made it easier to share ways to promote wellness – Check out the Pinky Swear Facebook app for mammogram reminders or the MyNetDiary Smartphone app for food journaling. Healthcare providers are also getting in on the trend.
Now, I’m not advocating for self-diagnosis. If you suspect you have celiac disease and have not yet been diagnosed, it’s crucial to get tested. What I would like to see is more self-care: taking responsibility for diet, exercise and proper screenings. That also means helping others discover what they need to do to get healthy because, well, you like having them around and need them in good standing to do that.
As the year progresses, let me know how you’re doing. Submit your Personal Story about how you got diagnosed, or be one of the first to share a “Celi-Act” – what you’ve done since your diagnosis that changed your health and your life.
To keep you involved, NFCA will present a new social media challenge designed to promote celiac awareness and preventive health each month. Click the “Take Action” tab on NFCA’s Facebook page to complete our challenge for January. And of course, make sure to refer your doctor to CeliacCMECentral.com. It’s a free course for doctors, but the real one benefiting is you!
Calcium and Celiac Disease
By Gini Warner, Clinical Nutritionist
Most of our calcium absorption takes place in the proximal portion of the small intestine. This is the area that is damaged by celiac disease. Therefore, many people with celiac disease have osteoporosis due to poor absorption of calcium. Calcium in the diet is important for strong bones and teeth.
Most people think about consuming dairy products as a way to increase calcium intake, but there are actually many other sources of dietary calcium that are lower in fat than dairy products. These non-dairy sources do not contain the enzyme lactose, which is beneficial for those with celiac disease who are also lactose intolerant.
The following chart is an excellent reference for non-dairy sources of calcium:
Source: NIH Osteoporosis and Related Bone Diseases – National Resource Center and the Food and Drug Administration.
About Gini Warner, Clinical Nutritionist
Gini Warner completed her master’s degree in Health Education and Nutritional Science at New York University in 1988 and has been working with families, individuals and corporations in the fields of celiac disease, immune dysfunction, diabetes, osteoporosis, weight loss and overall wellness. She has been a practicing nutritional counselor for more than 20 years.
Gini develops nutritional programs for people with food allergies, for safe weight control, diabetes, eating for energy, disease prevention, and overall nutritional balance. She believes that the key to achieving proper nutrition and overall health is in making positive lifestyle changes.
To learn more, contact Gini:
Gluten-Free Super Bowl Recipes
By Chef Oonagh Williams
There’s no denying it. When you get diagnosed and learn that you need to go gluten-free, part of you is happy to get answers, but part of you is also saying “Help! What do I do now?”
In today’s busy world, where takeout or prepared foods are so much a part of our lives and people rarely cook complete meals from scratch, it is a mind boggling diagnosis to hear. I call it a combination of a minefield and a maze to go gluten-free.
I was lucky. As a chef, I understand food labels and have always cooked from scratch. So when my 24-year-old son found out he was gluten and lactose intolerant two years ago, I found it easy enough to make meats, soups, salads, vegetables, etc. gluten-free.
Many people, however, don’t make the switch as easily. I received an email from a man last year asking me how to prepare meats, soups and salads gluten-free. I replied that I didn’t know what he wanted, since many foods are naturally gluten-free until processing or packaging introduces gluten in some way.
Baking was another matter. The selection of gluten-free baked goods has increased over the last few years, but some still leave much to be desired. Yes, I know I am picky, but I believe gluten-free baked goods have a lot of potential. One of my students said it best after one of my gluten-free baking classes: If you grew up eating or making packet mix cookies, cakes, etc., you would probably be happy with gluten-free packet mixes. But if you grew up baking from scratch, gluten-free goods baked from scratch will make you swoon. Her words not mine.
There is a great deal of conflicting advice about what’s safe to eat and what’s not. I am frequently asked to give practical help about reading labels, using gluten-free products and making your kitchen a gluten-free zone. Even with the help of nutritionists, many people still need help dealing with gluten-free food on a daily basis.
And thus, “Cooking with Oonagh ” was born. Each month, I’ll share seasonal gluten-free recipes from my kitchen, with step-by-step instructions on how to make delicious food from scratch. Happy cooking!
BUFFALO CHICKEN SOUP
SHRIMP, MANGO AND BLACK BEAN SALAD
For a video clip of this recipe, visit WMUR’s Cooks Corner.
SAVORY CHEESE BREAD
CHOCOLATE PECAN INDULGENCE
About Chef Oonagh Williams
British-born award-winning chef Oonagh Williams has a culinary arts degree and was trained in London and Switzerland. Based in New Hampshire, Chef Oonagh began adapting meals to gluten-free versions after her son was diagnosed with gluten and lactose intolerance two years ago. Chef Oonagh gives presentations and classes on gluten-free cooking and living, consults and guides people in adapting to a gluten-free lifestyle. She appears most months on her local New Hampshire ABC station, WMUR, as the featured chef.
Vitamin D has been a hot health topic since the Institute of Medicine (IOM) released new recommendations for calcium and vitamin D intake in November 2010. The report cautioned against the use of supplements, stating that overconsumption of vitamin D could potentially cause harm.
While these recommendations work for the typical individual, those with celiac disease have different dietary needs. So, how much vitamin D is enough? The National Foundation for Celiac Awareness (NFCA) contacted Vikki Petersen, DC, CCN, of HealthNow Medical Center, and Shannon Longhurst, RD, CD, who specializes in gluten-free nutrition, to get the scoop.
Note: The views expressed in these statements are those of the featured medical professionals only and are not attributable to the National Foundation for Celiac Awareness.
1. Should people with celiac disease change their dosages and vitamin D supplement behavior?
Dr. Vikki: The most critical thing that all celiacs and non-celiac gluten sensitive individuals should do is get a current vitamin D level through a blood test. The blood tests are accurate, and getting a baseline is very important. Supplementation levels would be based on the result of their lab test, and followed up every 3 months in highly deficient individuals. If the baseline is borderline (above 30 ng/ml) then retesting in 6-9 months is probably adequate.
It is clear that those with celiac are at a high risk for vitamin D deficiency due to damage to the small intestine. For the newly diagnosed celiac or the individual who is having trouble healing their small intestine, it may be a good idea to engage in some mild sun exposure. When doing so, be very careful and use sunblock to protect against damaging rays.
Shannon: The American Dietetic Association’s Evidence Analysis on celiac disease recommends 800-1,000 international units (IU) per day of vitamin D3 (the active form of vitamin D) for individuals at risk for vitamin D deficiency. The amount of vitamin D needed for supplementation is individual, depending on how much the body is absorbing through diet and sunlight. The IOM does make the new recommendations with minimal sunlight as the standard. I typically do not recommend below 1,000 IU per day and more often find myself prescribing 2,000 IU. Vitamin D is a fat-soluble vitamin, meaning that you need to take it with food that contains fat for absorption. Take vitamin D with meals for best results.
2. The concern of too much Vitamin D has also been discussed as a result of the new recommendations. Are patients with celiac disease [who continue to take more than the recommended dosage because of their autoimmune condition] at risk for developing complications associated with excessive Vitamin D, such as tissue and kidney damage?
Dr. Vikki: Those with celiac disease are at high risk of developing many diseases due to their malabsorption of vitamin D. Excess consumption is an unlikely problem for this population. It is prudent to test one’s levels frequently, but deficiency is a greater concern than excess.
Most of the research I found on vitamin D and its relationship to kidney function pointed to the fact that those with kidney disease are unable to convert vitamin D into its active form and therefore were more likely to be deficient. In the July 2010 Journal of Clinical Endocrinology & Metabolism , a study evaluated vitamin D deficiency with arterial stiffness, a risk factor for heart disease and stroke. Vitamin D supplementation of 2,000 IU per day resulted in a decrease in central arterial stiffness. In the study, 44 participants were randomly assigned to receive either 400 IU of vitamin D per day (the recommendation of the American Academy of Pediatrics) or 2,000 IU of vitamin D per day. “Study subjects taking 400 IU of vitamin D per day did not achieve vitamin D sufficiency, while their peers who took 2,000 IU of vitamin D per day on average became vitamin D sufficient,” the article noted.
There is highly compelling data confirming that supplementation of vitamin D is not only vital for the health of most people, but the dosages needed are likely double and above what is currently being recommended.
Shannon: The news of the risks of too much vitamin D may be startling, especially for those who are deficient and are prescribed megadoses. As vitamin D is fat soluble, that also means it is stored in the body, so too much vitamin D over time can build up and cause damage to body tissues. However, I have yet to see one person in practice with vitamin D toxicity. The recommendations state that for blood levels, 20 nanograms per milliliter (ng/ml) is sufficient for bone health (below the normal limit if 30 ng/ml). In my practice, most people report better mood and more energy at 50-70 (ng/ml). Until the lab tests are standardized, I aim for clients’ blood levels to reach at least 35-40 (ng/ml).
If a person is taking large amounts of vitamin D and not absorbing it, there is likely no risk of tissue damage, as it is lost when eliminated through fat malabsorption. If the intestines have healed, however, most people should not have to take more than 4,000 IU of vitamin D per day. In the case of chronic kidney disease where the body can no longer convert dietary and sunlight-derived vitamin D to its active form, refer to your nephrologists for specific vitamin D3 recommendations.
3. What should the dosage for newly diagnosed versus long-term diagnosed patients with celiac disease look like?
Dr. Vikki: It is important to realize that this most recent IOM report analyzed vitamin D and calcium as it related to bone density, not as it affected other diseases and conditions, such as celiac disease. There is no argument that those with celiac disease are at increased risk for osteoporosis and typically are deficient in vitamin D. While I will reiterate that the best approach is to test via blood for vitamin D levels and then retest to ensure that levels are normalizing, let’s assume that for some reason that’s not possible. In that case, I would say that a newly diagnosed celiac could very safely take 800-1,000 IU of vitamin D per day. It is likely that is insufficient, unfortunately, but then we’re back to the need for testing to know for sure.
The most important message is to be tested and then retested to ensure that what you’re doing is working. Too often those with celiac disease are still absorbing so poorly that their levels are not rising, and that continues to put their health at great risk.
Shannon: If a person newly diagnosed with celiac disease has a known vitamin D
Clearly, opinions vary on vitamin D supplementation. What these experts do agree on, however, is that blood testing at diagnosis and at intervals throughout treatment are best to monitor vitamin D levels and determine whether supplementation would be beneficial.
Whether it’s a New Year’s resolution or a lifelong goal, getting fit is an important part of living a healthy gluten-free lifestyle. To help you start 2011 on the right foot, we gathered tips from some of our favorite gluten-free athletes: Pete Bronski of No Gluten, No Problem, and Erin Elberson Lyon of Gluten-Free Fitness. Here’s what they had to say…
Getting (and Staying) Motivated
Choosing Your Exercise:
When You’ve Been Glutened:
For more pointers, including how to eat right and the best ways to gain or lose weight, watch NFCA’s staff blog, Celiac Central: Bits & Bites. We’ll post additional tips from Pete and Erin on Friday, Jan. 7.
Gluten-Free Recipes from Dr. Lucy
Renegade Chef Dan Kohler is back for another round of NFCA’s Alternative Appetites cooking videos, and this time, he has company. Dr. Lucy Gibney, founder of Lucy’s Cookies, stopped by the Renegade Kitchen to share a few family-friendly gluten-free recipes: Chocolate Cake with Cream Cheese Frosting and Chicken Tenders.
A real physician, Dr. Lucy created her gluten-free, allergy-friendly cookie company after her child was diagnosed with severe food allergies. Available in Chocolate Chip, Oatmeal, Sugar and Cinnamon Thin, Lucy’s Cookies have won praise in the celiac community. (A tip: Pop them in the microwave for a few seconds to get that “just out of the oven” taste!)
The cookie company may have started small, but Lucy’s Cookies are making their way into grocery stores across the country. According to a recent blog post by Dr. Lucy, the cookies will soon be available in more than 6,000 locations nationwide.
Dr. Lucy isn’t all about cookies. At home, she’s cooked up plenty of allergen-free meals for her family, including the ones featured in the Alternative Appetites videos.
We’ve printed the recipes below so you can follow along with the video, but make sure to listen carefully for additional tips and tricks to add variety to these dishes (Hint: Orange zest can do wonders). And don’t miss Dan and Dr. Lucy’s special guest, who pays a visit in video 3.
Twitter Contest!As an added treat, Dr. Lucy is offering a free box of Lucy’s Cookies to five video viewers. During the week of Jan. 10-14, NFCA will tweet a question about the videos each day. The first person to tweet @CeliacAwareness with the correct answer will win a box of cookies. You’ll have five chances to win, so watch closely!
Dr. Lucy’s Gluten-Free Chocolate Cake
1. Preheat oven to 350 degrees.
2. Pour egg replacer, cocoa, soy milk and hot water into a medium bowl and whisk together. Set aside to let the egg replacer bloom.
3. In a separate bowl, combine gluten-free flour blend, baking powder, baking soda, salt and xanthan gum. Whisk lightly to incorporate.
4. In a third bowl, mix oil, sugar, orange juice and vanilla together. Whisk in the egg and cocoa mixture. Add the dry ingredients and stir to combine. Fold in marmalade and carrots.
5. Pour batter into two greased and floured cake pans. Bake for 35-40 minutes or until a toothpick inserted in the middle comes out clean.
6. Remove from oven and let cool for 10 minutes before removing cake from pans.
Cream Cheese Frosting
Whip shortening, vegan cream cheese and vanilla together with a mixer for about 1 minutes. Add powdered sugar gradually, mixing on low speed to combine. Once all of the powdered sugar is incorporated, whisk on high to fluff.
Spread frosting onto cooled cake.
Gluten-Free Chicken Tenders
1. Combine flour blend, spices, salt and pepper in a shallow dish. Stir with a fork to combine.
2. Dip chicken strips in soy milk, then dredge in flour blend.
3. Place floured chicken strips on a hot, greased skillet. Cook for a few minutes on each side until golden brown.
Related Content :
By Cheryl McEvoy, NFCA Online Content Manager
What’s for dinner?
It’s a question we grapple with every day, and one made more challenging when gluten-free is a necessity. Recognizing that, gluten-free meal delivery programs have entered the scene, offering safe and scrumptious meals ready to eat in a few simple steps. But while the concept of mail order meals seems restrictive, gluten-free meal delivery programs are more flexible (and delicious) than you’d think.
“We like to say the food is made by GF Meals, but cooked by you,” said Roni Piterman, who started one of the first gluten-free meal delivery programs in 2007. Roni started the business with a focus on gourmet foods, but switched to 100% gluten-free and casein-free after noting a need in the market.
“We talked to parents and support groups,” she said. “Everyone was begging us to please do [gluten-free/casein-free].”
Instead of scheduled monthly deliveries, GF Meals offers ordering a la carte. Customers can purchase a case of 20 Asian-Style Orange Chicken or 16 Mini Chocolate Bundt Cakes, for example, and enjoy them as they please. For those looking for more structure, the website offers a suggested meal plan, and customers can order sample packs to try a variety of food at a discount price. But the real emphasis is choosing what you and your family want to eat.
“We’re more like an online supermarket,” Roni explained. Meals come frozen and ready to cook, with clear instructions on how to prepare each dish. The end result is a gourmet meal—not a TV dinner.
“We want them to be able to serve it to friends who don’t eat gluten-free and have everyone compliment them on the meal,” Roni said.
Yvonne Gifford took a different angle with Livefreeda, one of the newest programs to join the bunch. Yvonne, who also founded Glutenfreeda, used a best-of-breed model when developing a no worries way to get celiac-friendly food on the table.
“I have celiac disease myself, so I know how difficult it is to find products that taste good, and they’re expensive,” Yvonne said.
Livefreeda offers a 28-day supply of food, like lasagna from Caesar’s or soup from Kettle Cuisine, plus a menu planner that suggests what to eat when and how to supplement it with fresh items like an apple or glass of milk. The packaged items are thoroughly researched by Livefreeda’s team, so customers can rest assured the food is gluten-free. The delivery also includes tips on reading labels and balancing nutrition, from gluten-free expert Shelley Case, RD.
“What we really want to do is help people learn how to live on the gluten-free diet and have a balanced diet,” Yvonne said.
The program is designed to be a “jumpstart” for people newly diagnosed with celiac disease, Yvonne explained, but more and more people are finding a use for it. College students and senior care facilities find the packaged meals convenient, while parents order a shipment and stock the fridge for nights the babysitter is around and doesn’t know what to cook.
The majority of food comes frozen, but can easily be prepared in the oven or microwave. Baked goods can be set on the counter to thaw.
All gluten-free food is expensive, the entrepreneurs would argue. Besides price, the biggest challenge facing gluten-free meal delivery is storage. Twenty to 30 ready-to-cook dishes may give dinnertime some relief, but it maxes out freezer space. For families who don’t have the luxury of an extra fridge, a month’s worth of gluten-free food might be too much of a good thing.
Despite that, customers are logging on time and again to place their orders. The meals are convenient, nutritious and safe to eat, and for many gluten-free families, that’s reason enough.
Have you tried a gluten-free meal delivery program? Tell us about it on Facebook.
NFCA Launches Brain Fog and Gluten Exposure Survey
Have you ever felt groggy, forgetful or found it hard to concentrate after being exposed to gluten? Those neurological effects are often referred to as “brain fog.” While it appears to be a common complaint in the celiac community, little is known about the link between gluten exposure and brain fog.
In discussion with The Celiac Center at Beth Israel Deaconess Medical Center (BIDMC), the National Foundation for Celiac Awareness (NFCA) has recognized that this is an important area in need of dedicated study. In an effort to provide some of the information needed to carry out these studies, NFCA is collecting information from people with celiac disease about this mysterious symptom.
Please take a moment to answer the Brain Fog and Gluten Exposure Survey. The survey takes only a couple of minutes to complete, but your responses could lead to long-term change!
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