Editor-in-chief, University Health News

Gluten-Free Baking: The Essence of the Gluten-Free Diet

Timothy Cole — Tue, 18 Dec 2018 05:00:21 +0000

Mike and Mary are young marrieds who share more than a household. Mike has celiac disease and Mary has both gluten intolerance and lactose intolerance.

But they have more in common than just an aversion to gluten and their gluten-free diet regimen.

“We absolutely crave bread,” says Mary from her prim domicile located in a Houston suburb. “That means we have to get creative.”

Gluten-Free Diet: Flour Choice Is Key When it Comes to Baking

In sticking to a gluten-free diet, Mike and Mary rely on the host of alternative flours and flour blends to achieve the tasty—and safe—baked goods they thought they would never enjoy again following Mike’s celiac disease diagnosis.

How do they do it? With these alternative flours, Mike and Mary learned how to make their favorite foods without compromising taste and texture. In fact, you can add essential vitamins, minerals, protein, and fiber to your baked goods, fortifying your gluten-free diet in flavorful ways. From beans and grains to tubers and seeds, there’s a rich and wonderful array of delicious and nutritious flours waiting for you.

Bean flours: Varieties include chickpea (garbanzo), bean (navy, pinto, and red) and soy. Garfava flour is a blend of flours made from garbanzo, fava beans and Romano beans. High in protein, fiber and calcium, these flours work best with heavier foods, such as breads and spice cakes.
Pea flour and green pea flour: Both have benefits similar to bean flours but without the strong aftertaste. High protein content adds structure to baked goods without any distinct flavor.
Amaranth: An ancient food used by the Aztecs, the seeds of the broad-leafed amaranth plant are milled into flour or puffed into kernels for breakfast cereals. High in protein, calcium and iron, this mildly nutty-tasting flour adds structure to gluten-free baked goods and helps them brown more quickly.
Corn flour: Milled from corn kernels, this is finely ground cornmeal that comes in yellow and white varieties. One form of corn flour is masa harina (milled from hominy) used in making corn tortillas. If corn flour isn’t available, you can make your own by grinding cornmeal into a fine powder in a food processor. High in fiber with a slightly nutty taste, corn flour is a good source of fiber, riboflavin, niacin, folate, iron, and thiamin.
Cornstarch: A flavorless white powder that lightens baked goods to make them more airy. Cornstarch is highly refined and has little nutritive value. Store in a sealed container in a dry location.
Cornmeal: With a larger particle size than corn flour, cornmeal lends excellent texture to foods and has a nutty and slightly sweet taste. Cornmeal comes in yellow and white varieties and in fine, medium and coarse grinds. Select finer grinds for baking and for polenta. Use coarse meal for breading. High in fiber, iron, thiamin, niacin, B-6, magnesium, phosphorus, and potassium.
Millet: An ancient food, possibly the first cereal grain used for domestic purposes, millet imparts a light beige or yellow color to foods. Millet is easy to digest, and its flour creates light baked goods with a distinctive mildly sweet, nut-like flavor. High in protein and fiber and rich in nutrients, millet adds structure to gluten-free baked items.
Oat flour and oats: High in fiber, protein, and nutrition, pure, uncontaminated gluten-free oats add taste, texture and structure to cookies, breads, and other baked goods. If oat flour is not available, you can make it by grinding oats in a clean coffee grinder or food processor. (Quinoa flakes can be substituted for whole oats in most recipes.) Store in a tightly sealed container in a cool, dry place or freeze to extend the shelf life. (See also our post “Is Oatmeal Gluten-Free?“)
Rice flour: This is the gluten-free flour that’s used most often by those on a gluten-free diet. It’s available as brown rice (higher in fiber), sweet rice (short grain with a higher starch content), and white rice. Rice flour is easy to digest and blend. The texture varies depending on how it’s milled—fine, medium, or coarse. Fine grind is used for cookies, biscotti, and other delicate baked goods. Medium grind, the most readily available, is suitable for most other baking. Coarsely ground is best for cereal and coatings. White rice flour has a bland taste. Brown rice is slight nutty.
Sorghum flour: Some believe this flour, also called milo or jowar flour, tastes similar to wheat. Available in red and white varieties, it has a slightly sweet taste and imparts a whole-wheat appearance to baked goods. Sorghum is high in protein, imparting all-important structure to gluten-free baked goods. It’s also high in fiber, phosphorous, potassium, B vitamins, and protein.
Teff flour: Milled from one of the world’s smallest grains, teff is a key source of nutrition in Ethiopia. It’s available in dark and light varieties. High in protein, fiber, and calcium, teff imparts a mild, nutty taste to cookies, cakes, quick breads, pancakes, and waffles.

Originally published in 2016, this post is regularly updated.

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Celiac Symptoms: Not Just Stomach Ills

Timothy Cole — Mon, 28 May 2018 05:00:48 +0000

You’re worried. You’ve got a blistering skin rash, and you suddenly have difficulty walking. It’s hard to get and stay asleep and you’re psychologically depressed. You wonder, “Are these celiac symptoms? How can a little thing like gluten be causing so much havoc?”

If so, remember that help is on the way. Specialists in gut disturbances are acutely aware of these symptoms and are working to lead you to a promised land free of pain and anxiety.

First step: Get a handle on the potential spectrum of celiac symptoms or gluten-influenced disorders you may be dealing with.

Studies and Research on Celiac Symptoms

At a recent Consensus Conference on Gluten Sensitivity in Oslo, a panel of 15 experts referred to these conditions as “gluten-related disorders” and proposed classifying them based on the type of immune reaction triggered by gluten: allergic, autoimmune, or immune-mediated.

The immune system responds to gluten in different ways, depending on who you are and your genetic disposition. Different organs can be affected by different types of gluten sensitivity symptoms or gluten intolerance.

In celiac disease, the small bowel is affected. In dermatitis herpetiformis, the skin is targeted, resulting in an itchy rash. Gluten ataxia impacts the brain; it’s a neurologic condition characterized by the loss of balance and coordination.

The Oslo researchers divided the gluten-related spectrum into three main categories:

Allergic. A wheat allergy occurs when the body produces antibodies (usually IgE) in response to wheat (including gluten, the protein found in wheat). These antibodies circulate throughout the bloodstream, triggering an immune response (an allergic reaction), which occurs within minutes or up to a few hours after gluten exposure.
Autoimmune. This includes celiac disease, dermatitis herpetiformis and gluten ataxia. In celiac disease, gluten sets off an autoimmune reaction that causes the destruction of the villi in the small intestine, interfering with the absorption of nutrients from food. Dermatitis herpetiformis is known as the skin form of celiac disease, characterized by a blistering, itchy rash. Gluten ataxia is characterized by damage to the cerebellum, resulting in difficulty with balance and coordination.
Immune-mediated. This includes non-celiac gluten sensitivity. Non-celiac gluten sensitivity is a poorly understood entity thought to possibly have its own immune mechanisms affecting different parts of the body. Many people with non-celiac gluten sensitivity have celiac-like symptoms but have no corresponding damage to the gut. It is possible, but as yet unproven, that their immune reactions are related to involvement of the innate immune system, a primitive system that sets up barriers to repel invaders, rather than the adaptive immune system. The onset of symptoms is hours to days after gluten exposure. It must be stressed again that research is ongoing about non-celiac gluten sensitivity and that the condition remains ill defined at present.

Celiac Symptoms: More to the Story

Here are additional details on celiac symptoms and celiac disease:

Dermatitis herpetiformis: A skin rash that affects 15 to 25 percent of people with celiac disease, dermatitis herpetiformis (DH) is characterized by an intensely itchy, blistering rash that may occur anywhere on the body, including limbs, trunk, groin, hands, fingers, face, scalp, and along the hairline. The rash is bilateral in nature; both knees or both arms, not just one, are usually affected. Many people with DH have none of the outward digestive symptoms of celiac disease, and only about 40 percent of them have the positive blood tests for celiac disease. But they often have the same intestinal damage as those with celiac disease.
Gluten ataxia: Gluten ataxia is a neurologic condition characterized by the loss of balance and coordination. It can also affect fingers, hands, arms, legs, speech, and even eye movements. Typical symptoms include difficulty walking or walking with a wide gait, frequent falls, difficulty judging distances or position, visual disturbances and tremor. With gluten ataxia, damage takes place in the cerebellum, the balance center of the brain that controls coordination and complex movements like walking, speaking, and swallowing. Purkinje cells in the cerebellum, key in maintaining balance, are thought to be lost in gluten ataxia.
Neurological disorders: Certain neurological disorders—idiopathic epilepsy (epilepsy without a known cause), ataxia (unstable gait, clumsiness), peripheral neuropathy (tingling or numbness in the hands or feet), schizophrenia, and even recurrent headaches—can be associated with celiac disease. Some syndromes, like epilepsy with calcification in the brain, are definitely linked to celiac disease.

In addition, certain psychiatric disturbances—hallucinations, depression, anxiety, suicide ideation—occur more frequently in patients with celiac disease.

Celiac disease can also present as autistic-like behaviors.

Although autism and celiac disease are distinct and unrelated entities, some autistic-like behaviors are common in celiac disease, especially in young children. A child with undiagnosed celiac disease may, in fact, appear sad, introverted, unwilling to socialize or communicate even with his or her parents, or the child may be cranky and excessively irritable.

Neurologic, psychiatric, emotional, and autistic-like manifestations have been described in celiac patients who show minimal or no GI symptoms and no damage in the small intestine.

Fortunately, all these symptoms, including depression, anxiety, and hallucinations, are likely to regress on a gluten-free diet.

Sources & Resources

For further reading, see these University Health News posts:

Originally published in 2016 and regularly updated.

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Celiac Disease Symptoms: Get Ready For Related Conditions

Timothy Cole — Mon, 21 May 2018 05:00:11 +0000

You’re experiencing celiac disease symptoms and your doctor suspects you may have celiac disease. That’s hard enough. But you also need to be aware that celiac disease symptoms can tee you up for a host of related disorders. Autoimmune disorders lead this list.

A 1999 Italian study published in the journal Gastroenterology showed that the prevalence of other autoimmune disorders in patients with celiac disease is related to the duration of exposure to gluten. The older patients were when diagnosed with celiac disease, the greater their chances of developing other autoimmune disorders like hypothyroidism, but also—less commonly—hyperthyroidism, Addison’s disease, vitamin B12 deficiency, vitiligo (spotty loss of skin pigment), and alopecia (hair loss), among others.

Autoimmune Risks

Type 1 diabetes: Celiac disease and type 1 diabetes are both chronic, lifelong autoimmune diseases. The two conditions have a genetic link, sharing some genes and environmental factors that may cause the immune system to attack the villi in the small intestine (in celiac disease) and beta cells in the pancreas (in type 1 diabetes). Researchers believe that celiac disease and diabetes have at least seven genes in common and there may be more.
Other autoimmune diseases: Autoimmune disorders result when the body’s leukocytes (white blood cells), which normally fight infection, attack and destroy healthy body tissue. Celiac disease is associated with an increased prevalence of other autoimmune conditions, including multiple sclerosis, Hashimoto’s thyroiditis (which results in hypothyroidism), Graves disease (which leads to hyperthyroidism), Addison’s disease, and autoimmune hepatitis.

Associated Complications

Infertility: When researchers at the Celiac Disease Center at Columbia University screened 188 women with unexplained infertility, almost 6 percent had celiac disease—a rate nearly six times higher than expected, making celiac disease an important association of unexplained infertility, according to a study published in The Journal of Reproductive Medicine in 2011.Untreated celiac disease can rob a woman’s body of nutrients, but malnourishment isn’t the only mechanism behind infertility. Antibodies to tissue transglutaminase (tTG)—one of the key markers of celiac—can have an effect on the placenta’s development.
Osteoporosis: When celiac disease goes untreated, the small intestine is injured and can’t properly absorb nutrients, including calcium. Calcium is so critical for nerve and muscle functions—like heartbeat—that if it’s not absorbed from food, survival mechanisms take over and the body taps the bones for calcium. Over time, this leads to bone loss associated with osteoporosis. Gluten can also increase the systemic level of inflammation in the body. Inflammation causes proteins, called cytokines, and other inflammatory mediators to circulate in the blood and interfere with bone growth.
Chromosomal disorders: Individuals with chromosomal abnormalities, such as Down syndrome, Turner syndrome and Williams syndrome, have a predisposition toward autoimmune diseases (including celiac disease), endocrine disorders, and cancers.
Celiac disease symptoms without the celiac disease: For years, many people reported having celiac-like symptoms—abdominal pain, fatigue, foggy mind, joint pain, tingling of the extremities, even depression—but they repeatedly tested negative for celiac disease and responded positively to the gluten-free diet. Now specialists recognize that these patients may have non-celiac gluten sensitivity, a condition that is distinct from celiac disease.

How Common is Non-Celiac Gluten Sensitivity?

Studies have now demonstrated that non-celiac gluten sensitivity is a distinct medical condition that differs from celiac disease. Celiac disease is considered a subset of gluten sensitivity. Anyone with celiac disease, by definition, is gluten sensitive. However, not all gluten-sensitive people are celiacs.

Unlike celiac disease, non-celiac gluten sensitivity causes no measurable intestinal damage. Classic symptoms are gastrointestinal, such as diarrhea, bloating, or constipation. Some people report symptoms ranging from clumsiness, brain fog, and depression to ADHD or autistic-like behaviors.

Patients with non-celiac gluten sensitivity might have various reactions to gluten. In a study of 347 gluten-sensitive patients conducted by the University of Maryland, 68 percent experienced abdominal pain, 40 percent had eczema or a rash, and approximately a third reported headache, diarrhea, fatigue, or “foggy mind.” Depression, anemia, numbness in the legs, arms or fingers, and joint pain were also frequently reported.

How Is Gluten Sensitivity Diagnosed?

Currently, non-celiac gluten sensitivity is a diagnosis of exclusion; it’s diagnosed only after other conditions are ruled out. Non-celiac gluten sensitivity is not an allergic condition, is not an autoimmune reaction to gluten, does not cause any significant damage to the small intestine, and is not associated with HLA genes (as is celiac disease).

There are no genes that are currently known to be associated with non-celiac gluten sensitivity and no diagnostic markers—such as anti-gliadin antibodies, stool tests, saliva tests, or biopsy—for conclusively diagnosing the condition. (See our post “Celiac Disease: How Do You Know If You Have It?“) Non-celiac gluten sensitivity is typically determined by a positive response to the gluten-free diet. The defining element of non-celiac gluten sensitivity is feeling better when you don’t eat gluten.

For further reading, see these University Health News posts:

“What Does ‘Gluten-Free’ Mean?“
“Gluten Intolerance Symptoms: Is It Celiac Disease That’s Making You Ill?“
“Celiac Disease Diet: Your Gluten-Free Planning Guide“

Originally published in 2016, this post is regularly updated.

The post Celiac Disease Symptoms: Get Ready For Related Conditions appeared first on University Health News.

Celiac Disease: How Do You Know If You Have It?

Timothy Cole — Mon, 21 May 2018 04:00:05 +0000

When it comes to a suspected case of Celiac disease or food allergy symptoms, everyone’s reaction is usually the same: “Okay, what am I in for? How much time will this take? Is there a gluten-free food list? And what will it cost?” Notions of how to care for loved ones, professional duties, and a bit of panic start to crowd your mental processing.

But that anxiety can begin to subside if you arm yourself with information. Start that process with better knowledge about tests and screening.

For Starters…

To diagnose Celiac disease, doctors screen the blood for high levels of auto-antibodies—proteins that react against the body’s own cells or tissues.

The first step in diagnosing Celiac disease is usually a blood test to measure levels of certain auto-antibodies produced by the immune system in response to ingested gluten. As a result, it’s important to be eating a regular, gluten-containing diet when tested for Celiac disease; if you’ve been on the gluten-free diet longer than a couple of months, results may be negative even if Celiac disease is present.

Doctors screen with a panel of blood tests, since each test alone can vary in terms of specificity and sensitivity. A positive blood test indicates that a person needs a biopsy of the small intestine; it is not a Celiac diagnosis. Once diagnosed, these same blood tests can be used to help monitor improvement on the gluten-free diet.

Intestinal biopsy: The intestinal biopsy is still the gold standard for diagnosing Celiac disease. If blood tests and symptoms suggest Celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis.

During an upper endoscopy, a gastroenterologist eases a long, thin tube called an endoscope through the mouth and into the beginning of the small intestine. As the tube is making its way to the small intestine, a camera on the end sends a video image to a monitor so that the physician can visually assess any inflammation. Tissue samples from the small intestine are biopsied to check for damage to the villi, the fingerlike projections in the small intestine that absorb nutrients.

The biopsy requires the patient be on a regular (gluten-containing) diet in order to be accurate. If taken alone, it may still miss the portion of the small intestine with flattened villi. In fact, because celiac disease doesn’t cause uniform intestinal damage, experts recommend that four to six different samples be taken from the second or third part of the duodenum. A biopsy may need to be repeated over time, since normal results don’t exclude the possibility the disease will develop later in life.

Skin biopsy: A skin biopsy is the gold standard for diagnosing dermatitis herpetiformis (DH), an uncomfortable skin condition associated with Celiac disease. It’s characterized by an itchy, blistering rash, often on the elbows and knees. The skin biopsy must be performed on uninvolved skin adjacent to the affected area since the inflammatory reaction interferes with immunological testing.

Nutrient testing: Patients, especially adults, should be tested for nutritional deficiencies, because of the malabsorption associated with Celiac disease. Vitamins and minerals are acquired through the diet and affect every system in the body in a complex interaction. Thus, nutrient testing is important to determine the condition of the body.

When the digestive tract is damaged, as in Celiac disease, the body is unable to properly absorb the foods consumed. Even with a healthy diet, the body is unable to fully extract the nutrients it requires.

Genetic testing: When blood tests are unclear or when a patient is already on the gluten-free diet, a genetic test may help clarify the diagnosis—it rules out the likelihood of Celiac disease when negative. Using a small sample of blood, cheek cells or saliva, the genetic test looks for two markers associated with Celiac disease, HLA-DQ2 and HLA-DQ8.

Human leukocyte antigens (HLA) are proteins, of which DQ is a subset, that are found on the surface of almost every cell in the body and are a key component of the immune system. While everyone has slightly different HLA proteins, each of us has two sets, one inherited from each parent.

Ninety-nine percent of Celiacs have one of these two genetic markers. Thus, a negative genetic test essentially rules out Celiac disease. A positive test result, on the other hand, does not indicate the patient has or will develop celiac disease. In fact, up to 40 percent of the population has one of these markers and very few of these people will ever get Celiac disease.

Follow-Up Testing

Although the symptoms of Celiac disease vary from person to person, some basic tests should be part of every patient’s annual health checklist. Celiac specialists recommend both antibody and nutrient testing after diagnosis and certain tests yearly thereafter.

People with Celiac disease are usually monitored annually. Those who were very sick prior to diagnosis should be seen more frequently.

Children generally respond more quickly than adults to the gluten-free diet but they also need time to heal. While antibody levels typically return to normal in 12 months, it occasionally takes longer. In part, the speed of normalization of the antibodies depends on how high they were to begin with; higher levels require longer (often more than one year) to normalize. Thus, repeat testing in one to three months may only serve to raise parents’ anxiety.

After Diagnosis

After you have been officially diagnosed with Celiac disease, make sure to consult with a doctor and nutritionist who specialize in Celiac disease. If you’re not currently receiving specialized Celiac care, consider seeking out the closest Celiac research and treatment center. It’s a good idea to see a specialist for regular check-ups and follow-up blood tests to be certain you’re not inadvertently ingesting gluten.

Celiacs are typically more susceptible to other medical conditions, ranging from lactose intolerance (usually transient) to other autoimmune disorders, and an alert doctor can work closely with you to lower the risks.

As an important aside, a specialist can counsel your relatives about whether they should undergo blood tests or genetic screening for this inherited autoimmune disorder. Your family members—particularly first-degree relatives—are at risk for contracting the disease. Undetected and untreated, Celiac disease can wreak havoc on the immune system and set loved ones up for serious medical problems in the future.

For further reading:

Originally published in March 2016 and updated.

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What’s Ailing You? We’re All Ears

Timothy Cole — Wed, 02 May 2018 16:00:35 +0000

At University Health News, we believe sound health information can empower people and even relieve symptoms—if knowledge leads to reduced stress and anxiety. Knowing more just makes us feel better. When you read about, ask about, and understand what’s ailing you, you may be helping yourself more than you know.

Quick caveat: It’s true that Aunt Daisy will always have an old wives’ tale she swears by. There is no substitute, however, for regular, confidential discussions between you and your doctor.

No information on the Internet, nor an open forum, can ever replace the intimate discussions that take place behind the closed door of a doctor’s examining room. There will always be health aspects where our own privacy and the privacy of others is non-negotiable.

Health issues? Talking about them can help; so too can our new “What’s Ailing You?” health forum, which gives you a chance to air out your experiences, concerns, and worries.

Taking Inventory

All that said, I’ve been to countless gatherings where those of us who’ve reached a certain age like to bring up the subject of our latest knee crick, tennis elbow, dodgy stomach, weepy eye, pounding headache, or sleepless night. Maybe we’re looking for affirmation, a knowing “been-there” nod. We’re also looking for any nugget of information or data we can file away for later discussion with our physician.

My own latest party patter? I’m a lousy sleeper and a CPAP washout, so anytime the subject of sleep comes up, I’m all ears. Plus, I have a nightly 3 a.m. appointment with the commode I’d rather skip. Also, on a couple of occasions in my 61 years, I have encountered blood on the wrong side of my skin. The last time led to an overdue colonoscopy, which turned out fine.

Headaches, sinus infections, an expanding girth, rampant GERD, and worrisome talk about long-term use of proton pump inhibitors: I’ve got all these things coming at me. Yet I’m truly grateful I’ve dodged the big ones like heart disease and cancer.

Blood pressure is nominal, controlled by my daily Benicar, and my cholesterol is just peachy, thanks to my daily statin. My friends these days are talking about bone-on-bone impingement, hearing loss, funny skin eruptions, creeping gum disease, and always, always insufficient exercise.

Yes, we’re crunching, ellipticizing, pumping, and taking Fido on a forced march in an effort to push back the inevitable tide of decrepitude. But it never seems enough. And am I the only one who gets funny looks at the gym?

Even when I do the right thing and saddle up for a bike ride, I sometimes have to defend myself. When I’m out on my recumbent bike, I get a fist-pumping “awesome” from little kids, but an “oh-brother, not-another-one” look from serious cyclists.

I explain: A recumbent bike allows the rider to lie backward and pedal with feet elevated. It looks like it might be comfortable for a sore back, but it’s really my solution for dealing with the downward arm pressure I endure when I am riding a diamond frame. After two rotator cuff operations on my left shoulder, and a ruptured biceps tendon and subsequent repair on my right arm, constant down force on my arms is a non-starter.

You see, our choices increasingly come down to avoidance of pain. Health starts to matter.

Tell Us About It…

What’s your beef? It might be one of the minor vexations I am fortunate to own. (Believe me, it could be worse.) It might be a serious diagnosis involving your heart, your lungs, your bones, your joints. It might be a worry sparked by the experience of a loved one.

At UHN, we can’t offer treatments or a diagnosis. We can’t prescribe medications. And we can’t refer you to a physician who might be able to help (although we work with some great health institutions; see Health Publications).

Use our “Comments” section below to describe experiences that may help other readers—and that may make a difference in your own outlook.

We’re All Ears

But we can offer a sympathetic ear and we can unite you with some fellow travelers who will read what you have to say, perhaps offer a gesture of understanding and sympathy, maybe share their own tales of an uncooperative health system or some run-around that’s driving them crazy. We can give you a chance to enlighten, to explain—inevitably, to vent.

So come on: What’s ailing you? Let us know in the comments section below. We’ll read what readers have to say, approve what we think most readers will benefit from, and use anonymous comments for future blogs in our “What’s Ailing You?” space.

Disclaimer: University Health News offers health information derived from qualified sources and materials. However, UHN is no substitute for a personal relationship with your physician. We can’t recommend treatments, diagnosis conditions, or promote medications or cures. We reserve the right to edit, cut, sanitize, and otherwise alter any material submitted to us for broad dissemination.

OUR BLOGGERS’ PERSONAL TOUCH

Besides authoring informative, straightforward, easy-to-understand posts on a variety of medical issues, conditions, and treatments, our consumer health experts use a personal touch to help inform you via our series of UHN blogs.

Aging & Independence: “What’s Ailing You? We’re All Ears” by Timothy Cole
Cancer: “A Crusade Against Cancerous Moles,” by Jim Black
Bones & Joints: “Emergency! Coping with a Broken Ankle Overseas,” by Timothy Cole
Digestive: “Blood Tests, My Liver, and Me,” by Timothy Cole
Eyes, Ears, Nose, & Throat: “Antibiotics Are Over-Prescribed,” by JoAnn Milivojevic
Eyes, Ears, Nose, & Throat: “How to Get Through Allergy Season,” by Jay Roland
Heart Health: “What’s the Right Blood Pressure for You?” by Jay Roland
Nutrition: “What Is Nutrition?” by Dawn Bialy
Pain: “How to Relieve Lower Back Pain,” by Kate Brophy
Pain: “Is Your Kidney Stone Pain a Single Episode… or Chronic?” by Timothy Cole

Originally posted in 2016, this post is regularly updated.

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What Is Gluten?

Timothy Cole — Mon, 29 Jan 2018 06:00:22 +0000

If you’ve been experiencing unresolved gastrointestinal issues after you eat, you may have wondered if you’re experiencing gluten sensitivity symptoms. That leads you—and millions of people just like you—to beg the question: What is gluten?

In a nutshell, gluten is a protein that causes some people to feel bloated, cramps, and fatigue. Their gluten sensitivity may lead to a diagnosis of celiac disease (more on that in a minute).

What Is Gluten? And Where is It?

Gluten is commonly found in wheat, barley, or rye—common ingredients in popular foods. You’ll find wheat in breads, other baked goods, soups, pasta, cereals, sauces, salad dressings, or roux. You’ll find barley in malt, food coloring, soups, malt vinegar, even beer. Rye is found in rye bread such as pumpernickel, rye beer and many kinds of cereals.

If you and your doctor suspect you have a gluten sensitivity, it’s easy to figure out what to avoid. But in the food world, what is gluten-free? Fortunately for people who have gluten intolerance, there are a variety of items you likely already enjoy that are naturally gluten-free. They include fruits, vegetables, meat and poultry, fish and seafood, and dairy, plus beans, legumes, and nuts.

Finding Your Diet Groove

There are lots of tasty, creative ways to enjoy a gluten-free diet—and no shortage of gluten-free recipes for all tastes and all meals. The Celiac Disease Foundation recommends things like oat bran muffins, lox and cream cheese on a gluten-free bagel, a breakfast burrito with eggs, bell peppers, avocado and olive oil. If you’re hosting a party, you can ensure your guests’ gluten intolerance symptoms are properly respected with snack items like strawberries and gluten-free goat cheese crackers, or tomato-garlic focaccia, which relies on sorghum and chopped herbs.

Bottom line: If you’re gluten-sensitive, don’t worry about finding foods you enjoy. There are lots of choice gluten-free recipes to choose from.

If you think your condition might be more serious, your doctor may suspect you’re suffering from celiac symptoms.

The first step in diagnosing celiac disease is usually a blood test to measure levels of certain auto-antibodies produced by the immune system in response to ingested gluten. As a result, it’s important to be eating a regular, gluten-containing diet when being tested for celiac disease; if you’ve been on a gluten-free diet longer than a couple of months, results may be negative—even if celiac disease is present. After that, your doctor might recommend an elimination diet to get at the root of your difficulties.

For further reading: See “Quick-Start Guide to Celiac Disease and Gluten Sensitivity.”

Originally published 2016, this post is regularly updated.

The post What Is Gluten? appeared first on University Health News.

Celiac Disease Diet: Your Gluten-Free Planning Guide

Timothy Cole — Thu, 11 Jan 2018 07:00:12 +0000

Keeping a strict celiac disease diet—avoiding all foods that contain wheat, rye, or barley—is essential for those with celiac disease or non-celiac gluten sensitivity. People on a gluten-free diet can eat a well-balanced menu with a wide variety of foods. Unprocessed meat, fish, rice, fruits, and vegetables do not contain gluten, plus there are plenty of gluten-free breads, pasta, and cookies that use rice flour and alternative grains. The key is to focus on what you can eat, not what you cannot.

On the other hand, the gluten-free diet requires a completely new approach to eating. People on a celiac disease diet have to be extremely careful about what they buy for lunch at school or work and what they eat at cocktail parties or order from restaurants.

Cheating (eating food containing gluten) or cross-contamination (even as small as one-eighth of a teaspoon) can cause intestinal damage. A dietitian who specializes in celiac disease can help patients learn about their new diet.

Gluten-Free Basics

A strict gluten-free diet—one free of all forms of wheat, barley, and rye—is necessary to help prevent both short-term and long-term consequences of celiac disease. Miniscule amounts of gluten—a crumb on a shared stick of butter—can be enough to cause problems for those with celiac disease.

Don’t eat a food if you are unable to verify the ingredients or if the ingredient list is unavailable. Regardless of the amount eaten, if you have celiac disease, damage to the small intestine occurs every time gluten is consumed, whether symptoms are present or not.

Understanding these dietary requirements will enable the newly diagnosed to read labels of food products and determine whether a product is gluten-free—critical knowledge for anyone on a celiac disease diet.

Grains Allowed

Sticking to a celiac disease diet starts with watching for gluten content in the food you buy. Understand which foods are absent of gluten and keep them around.

Amaranth
Arrowroot
Beans
Buckwheat
Corn (maize)
Flax
Garfava
Millet
Montina
Nut flours
Potato
Quinoa
Rice
Sorghum
Soy
Tapioca
Teff

Grains Not Allowed in Any Form

Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt)
Rye
Barley
Triticale

Foods/Products That May Contain Gluten

Beers, ales, lager
Breading and coating mixes
Brown rice syrup
Communion wafers
Croutons
Dressings
Drugs and over-the-counter medications
Energy bars
Flour and cereal products
Herbal supplements
Imitation bacon
Imitation seafood
Marinades
Nutritional supplements
Oats
Pastas
Processed luncheon meats
Sauces, gravies
Self-basting poultry
Soup bases
Soy sauce or soy sauce solids
Stuffings, dressings
Supplements
Thickeners (roux)
Vitamins & minerals

Pantry Preparation

Those who eat a celiac disease diet know it’s essential to prevent gluten cross-contamination. Clean or replace the items in your kitchen where gluten contamination can occur: scratched pans, the toaster, colanders, cutting boards, your food mill. Do the homework to truly understand cross-contamination, gluten-containing ingredients, and food labeling so that your kitchen becomes a safe haven.

If your kitchen is not fully gluten-free, take steps to make sure there is no cross contact with gluten before baking. Scrub your counters and put utensils, pans, bowls, cutting boards and sponges in the dishwasher before baking gluten-free. Be aware that particles of wheat flour can linger in the air for 24 to 36 hours.

If someone in your household plans to continue to eat gluten, organize your pantry and cabinets so that no gluten-containing foods, pots, or pans are mistakenly used. Use clear plastic bins in your pantry to segregate items so there are no mix-ups when unpacking the groceries or when reaching for cereals or snacks. Color-code pots, pans, utensils, and the like with fun-colored duct tape so that it’s easy to tell which are dedicated for gluten-free use.

Take out everything in the pantry, refrigerator, and freezer and check labels. Keep a permanent marker in the kitchen and write “GF” (gluten-free) on all safe foods and condiments. Use separate jars of mustard, peanut butter, and jelly and separate sticks of butter to avoid cross-contamination from wheat crumbs. Or buy squeeze bottles for condiments, which reduces the chance of cross-contamination. Don’t buy foods from bulk bins that are prone to contamination from other grains.

Buy some prepared gluten-free foods, like frozen pizza, pasta, soup, pretzels, and other favorite snacks—whatever you enjoyed eating before going gluten-free. Having these on hand will keep you from feeling deprived and help you avoid the temptation to eat gluten. Try a few different brands to figure out which you like best. The best ways to find tasty alternatives are to get connected with others by joining a support group and to attend gluten-free fairs and expos, where you can sample different items before buying.

You’ll also want to stock some gluten-free baking mixes and a reliable all-purpose gluten-free flour blend. Find an all-purpose flour blend that can be used for almost everything, from fish sticks and tempura to birthday cake and sandwich bread. Once you’ve gained confidence, you can experiment with the growing variety of alternative gluten-free flours made from whole grains and seeds. The best ones offer rich flavor, nutrients, and fiber that will enhance your culinary repertoire.

Even if you’ve never baked from scratch, consider doing it now. Despite all the new gluten-free products available, many just don’t taste like the foods you remember. That’s where you and your oven come in. Any item you enjoyed prior to your diagnosis, you’ll be able to enjoy once again, gluten-free. Bread, cookies, cake, muffins, pizza—you’re limited only by your imagination.

Labeling Lingo

The sweeping legislation known as FALCPA, the Food Allergen Labeling and Consumer Protection Act of 2004, requires clear labeling of the top eight allergens (milk, eggs, tree nuts, peanuts, fish, shellfish, soy, and wheat, frequently referred to as “the great eight”). Thus, all food containing wheat must declare it on the label.

The term “gluten-free” took shape in the United States in 2013. Updating an earlier proposal, the Food & Drug Administration issued a rule on Aug. 5, 2013 defining the term “gluten-free” for voluntary use in the labeling of foods. The compliance date for manufacturers was Aug. 5, 2014. Food products bearing a “gluten-free” label on or after that date are to meet the rule’s requirements: gluten content has to be less than 20 ppm (parts per million).

“In general,” the FDA ruling stated, “foods may be labeled ‘gluten-free’ if they meet the definition and otherwise comply with the final rule’s requirements. More specifically, the final rule defines ‘gluten-free’ as meaning that the food either is inherently gluten free; or does not contain an ingredient that is: 1) a gluten-containing grain (e.g., spelt wheat); 2) derived from a gluten-containing grain that has not been processed to remove gluten (e.g., wheat flour); or 3) derived from a gluten-containing grain that has been processed to remove gluten (e.g., wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food. Also, any unavoidable presence of gluten in the food must be less than 20 ppm.”

Permissible synonyms for “gluten free” include “free of gluten,” “without gluten” and “no gluten.”

For further reading, see these University Health News posts:

This article was riginally published in 2016 and is regularly updated.

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Celiac Disease: For Travelers, It Demands Advance Planning

Timothy Cole — Thu, 11 Jan 2018 06:00:08 +0000

The thought of dealing celiac disease for travelers can be daunting. Anxiety about meal planning and being away from the safety of home kitchens can often deter people from hopping in the car or boarding a plane and exploring a new city. All it takes is a little extra planning and effort. The good news is that more places around the United States and internationally are accommodating travelers who have celiac disease and need a gluten-free diet.

Before you leave home, do your homework. Map out your trip in terms of allergy-friendly places to explore and safe restaurants to enjoy. Once you arrive, double-check your information, as menus can change. Locate natural food stores at your destination in advance so you know where to purchase food throughout your trip.

According to market research sponsored by AllergyFree Passport and GlutenFree Passport, almost half of allergen-free and gluten-free consumers travel frequently, either within their own country or internationally. At the same time, more than 50 percent of resorts, spas, airlines, restaurants, and other hospitality professionals report a growing number of special-diet requests from their customers worldwide.

Regardless of destination, more than 85 percent of food-sensitive consumers are primarily concerned about two things when traveling: eating out safely in restaurants and the availability of special dietary snacks and meals. Airlines, accommodations, reactions to foods and foreign languages are significant concerns for almost 50 percent of special-diet travelers.

Celiac Disease: For Travelers, It Takes Planning

How do you increase your personal comfort with traveling and reduce your worry about celiac disease, gluten-sensitivity, or food allergies? Educate yourself about your travel and eating-out options. Prepare yourself with snacks, medications and back-up plans in the event of a mistake or emergency. Communicate your special dietary requirements effectively with airlines, hotels, cruise lines, restaurants, and hospitality professionals, as needed.

Yes, there are challenges with special-diet traveling, but food concerns needn’t keep you at home. Education, preparation and communication are your keys to a safe journey, whether it’s around the corner, around the country, or around the world.

At the Airport

It’s essential to be prepared when traveling by air. Unfortunately, air travel often brings long delays. You may be stuck (and hungry) on a plane, in an airport, or at your destination. Pack nutritious bars and other healthy gluten-free snacks in a carry-on bag to eat during your flight. Bring enough for at least one meal, just in case your plane is delayed or plans change.

Make sure your snacks are allowed based on defined regulations. In the United States, the Transportation Security Administration (TSA) has strict standards on items that can be in your carry-on luggage. Visit the TSA’s website for up-to-date information. Liquids (3 ounces or less) must be packed in one resealable, quart-size plastic bag per traveler.

Be aware that certain foods, such as yogurt, salad dressing or creamy dips, might be considered liquid and might be confiscated. Don’t bring cooling packs, as they typically contain chemical liquids or gels and will not make it through security. Instead, fill your resealable baggie or travel cooler with ice after you go through security, either at a food stand or on the plane.

Gluten-Free Dining: Use the Internet to Your Advantage

Before you leave for the airport, use the Internet to investigate airport dining options in case you have an extended layover. Some airports, such as those in Boston, New York, Philadelphia, and Tucson, have food stands that carry gluten-free snacks (example: Cibo Express Gourmet Markets).

Once in the air, different types of special meals are offered based on flight duration, destination, and meal availability. Many airlines no longer offer much in the way of food service.

Some airlines may offer snack boxes, which can be purchased during the flight. These pre-packaged items may not provide gluten-free foods. Be prepared by bringing your own safe snacks. To determine what foods are served or sold on board, review the airline’s website or call customer service before you book your flight.

On the Road

Take some simple steps to ensure safe eating while staying in hotels, resorts, bed & breakfasts, and condominiums. Start by contacting customer service at your place of lodging to address any questions and inform the representative about your gluten-free concerns before booking your reservations.

If you’re staying at an all-inclusive resort with a defined meal plan, discuss food alternatives with the appropriate culinary specialists and order your gluten-free meals in advance. If possible, obtain a mutually agreed-upon meal plan in writing. Three to five days before departure, confirm your special meal plan. Upon arrival, communicate your dietary concerns to the staff and provide feedback, as appropriate.

Hotel Tips: Celiac Disease for Travelers

When booking accommodations, look for lodgings with microwaves, refrigerators or kitchenettes so you can keep breakfast items and snacks in your room. Controlling at least one meal a day makes cross-contamination less likely. An all-suite hotel or executive-stay hotel is likely to have a kitchenette. In some hotels, you can request a mini-refrigerator for free or a small additional charge. Research local grocery stores and supermarkets located near the hotel so you can pick up food or have it delivered. Consider having your favorite online store ship products to the hotel during your stay.

Stock up on safe, healthy foods (visit a natural food store or farmer’s market) for a quick breakfast or late-night snack in your room. Gluten-free cereal, milk and fruit provide for inexpensive, safe breakfasts that will save you time and money. Pack lunches to eat on the go. Always carry gluten-free snacks with you so you have a stash of safe food when sightseeing.

For road trips, buy an inexpensive cooler to keep in your rental car. Also, use your smart phone and the Internet as you’re traveling to map out local restaurant options and nearby grocery stores.

On a Cruise

More cruise lines are catering to guests with celiac disease or special dietary needs. Carnival, Celebrity, Crystal, and Princess Cruise Lines specify on their websites that gluten-free meals are available for their customers. In addition, Royal Caribbean and Disney Cruise Lines indicate that they can accommodate gluten-free guests.

Discuss meal alternatives with the chef or ship’s culinary specialist and order your gluten-free meals in advance. Determine whether designated wait staff will serve all meals to you throughout the cruise. Three to five days before your cruise, confirm your meal plan. Once you board the ship, meet with the dining room manager, designated server, wait staff, cabin crew and/or chef to clarify and communicate your needs.

International Travel

It’s important to carry a dining card in the language of the country you’re visiting that contains an explanation of how you can be safely served. Be certain your translation is correct; a less-than-accurate translation will cause confusion and may be risky.

Read ethnic cookbooks as a guide for safer eating when traveling overseas. These recipes will give you an education on what questions those with celiac disease or food allergies should ask and what foods to order in restaurants. In particular, look at marinades and sauces, a source of hidden gluten in every country.

Focus on places and activities, not dining. You don’t have to indulge in five-star luxurious dining to have a great time. Make learning experiences and fun adventures the goal of your trip. Scale back on eating expectations-think basics, like being safe and eating healthy.

Preparation and packing are more extensive and important when you travel with special dietary needs-but do not let fear of gluten contamination keep you from leaving home. Pack gluten-free snacks to stave off hunger.

For further reading: A gluten-free diet quick-start guide.

Originally published in May 2016 and updated.

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“Best Diet”: Is There Such a Thing?

Timothy Cole — Mon, 01 Jan 2018 13:00:25 +0000

The combination of that bulging muffin-top, those sore joints, and your lack of energy signals the pressing need to lose weight. Turning yourself into a calorie counter might help, but wouldn’t a respected weight-loss diet get you there more easily? So shouldn’t you adopt one of those “best diet” plans?

Diets or dietary patterns like the Mediterranean diet, the Atkins diet, or the Zone diet have been in vogue for quite a while—and each has its adherents. U.S. News & World Report—publishers of “Best” lists on a variety of health-related subjects—has a long history of helping people cut through the clutter to find diet solutions that work.

But not so fast, according to health and nutrition researchers.

Are “Best Diets” Valid?

A recent study from the University of Florida found little evidence of clinical trials supporting these “best diet” claims. When you eliminate diets that rely solely on calorie counting or that recommend vigorous exercise (which still top most diet recommendations), then the resulting diet plans have little support in the form of clinical studies.

Researchers looked only at diets without calorie counts and/or recommendations of vigorous exercise, which are guaranteed to lead to weight loss. Do popular diets based only on what we eat—low-carbohydrate, grain-free diets and others—lead to a trimmer waist?

“Not all diets showed clinically meaningful weight-loss outcomes,” said the study’s lead author, Stephen Anton, Ph.D., division chief of clinical research for UF’s department of aging and geriatric research and a member of UF’s Institute on Aging.

Researchers looked for clinical trials evaluating the effectiveness of 38 popular diets listed within U.S. News & World Report’s 2016 ranking of “Best Weight-Loss Diets.” After cutting diets listing specific calorie targets and/or exercise recommendations, they were left with 20 popular diets.

Of these, seven had been evaluated in clinical trials that met strict criteria set by researchers. And just two of those diets were evaluated by three or more trials.

“The small number of clinical trials examining the efficacy of many popular diets is concerning, as it indicates relatively little empirical evidence exists to support many current popular diets, which are heavily marketed to the public,” said the study, recently published in the journal Nutrients.

“Best Diet” Methodology

According to U.S. News “Best Diet” methodology, a panel of experts examined research regarding each diet’s potential to produce both short- and long-term weight loss and assigned ratings. But UF researchers included only interventional clinical trials with at least 15 participants per group, study periods of at least 12 weeks, inclusion of study participants with a body mass index of at least 25, and objective measures of weight with no self-reporting. They also excluded studies that did not follow the diet as prescribed.

The low-carbohydrate Atkins diet came out far ahead of the pack, with 10 clinical trials evaluating either short- or long-term weight loss. It was followed by the moderate-carbohydrate Zone diet, with three clinical trials.

Those with two clinical trials apiece were:

The Mediterranean diet, rich in fruits and vegetables, whole grains, nuts, legumes, and olive oil;
the Glycemic-Index diet, which emphasizes “good carbs” like bran cereal and vegetables;
the Ornish diet, a low-fat, vegetable-based program;
the Paleolithic (or Paleo) diet, based on foods available to early humans 2.5 million to 10,000 years ago.

The so-called DASH diet—Dietary Approaches to Stop Hypertension, which is low in saturated fats and sodium—was researched with one trial.

Nine of the 10 clinical trials evaluating the Atkins diet demonstrated clinically meaningful short-term weight loss, and six of eight long-term Atkins clinical trials demonstrated long-term weight loss. (Some individual studies examined both long- and short-term weight loss.)

Other diets that demonstrated clinically meaningful weight loss in at least one study were the Mediterranean, Paleolithic, and Zone diets.

Watch Those Polyunsaturated and Monosaturated Fats

Researchers said their review suggests that diets high in poly- and monounsaturated fats plus low-carbohydrates “are the most advantageous” for promoting long-term weight loss.

“For not having specific calorie limits and not being paired with a formal exercise program, the magnitude of the weight loss on some diets was surprising and quite extensive,” said Anton. “Not to say this would work for every person, but it does suggest a potential approach that is successful for many people.”

The study’s co-authors include Christiaan Leeuwenburgh, Ph.D., a professor and vice chair of research for UF’s department of aging and geriatric research and a member of UF’s Institute on Aging; Todd Manini, Ph.D., an associate professor and member of the Institute on Aging; Azumi Hida, Ph.D., formerly a visiting scholar at the Institute on Aging from Tokyo University; and UF research assistants Kristen Sowalsky, Ph.D., Heather Mutchie and Christy Karabetian, Ph.D.

FYI

STAY INFORMED: DIET AND NUTRITION ADVICE

Various studies over the years have shown the Mediterranean diet to offer a range of benefits, from heart health to bone health. Read more about Mediterranean-style eating in these posts:

The DASH diet plan is another that has been shown to help heart health by lowering blood pressure while also benefiting those with gout:

For more on healthy eating plans, see the following posts:

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Living with Celiac Disease: Dining Out

Timothy Cole — Thu, 31 Aug 2017 05:00:10 +0000

Your new life with celiac disease or gluten sensitivity will require a lot of changes. You have to worry about your family, your child’s school lunch and snack programs-even holiday parties. But there’s no greater challenge than figuring out the strategies and tactics you’ll need to employ when you go to a restaurant. For those with celiac disease, dining out requires advance planning.

You can rest a little easier knowing that many restaurants and restaurant chains are now catering to the unique dietary needs of those who need to avoid gluten. Look for those certified by the Gluten-Free Restaurant Awareness Program (GFRAP), operated by the Gluten Intolerance Group of North America (GIG). About 1,600 independently owned restaurants in the United States, Canada, and Germany have been GFRAP-certified as safe for gluten-free guests, making safe gluten-free restaurant dining easier than in the past.

Restaurants are listed on the GFRAP website by location and style of food. NFCA’s Gluten-Free Resource Education and Awareness Training (GREAT) Kitchens website, beyondceliac.org/kitchens, equips chefs, restaurants, and cafeterias with the knowledge and tools to safely provide customers with gluten-free meal options.

And make sure you look over individual restaurant websites to see if they post gluten-free menus. Some establishments, especially restaurant chains, list specific ingredients and allergen information on their websites. When ordering from a gluten-free menu, inform the restaurant staff about the severity of your celiac disease and the need to prepare food without any cross-contamination.

Preparing in Advance

Call the restaurant during non-peak hours to inform them of your special dietary needs. Ask to speak with a chef or manager. If a manager isn’t available, ask for the manager’s name and the best time to call back.

Use a clear, confident, assertive style of communication. Ask questions until you’re satisfied. Here are a few suggestions:

Can you accommodate a gluten-free diet? If the staff says yes, it offers a gluten-free diet, provide information about what foods you cannot eat. Make sure they are aware of this and that they understand the severity of your reaction to gluten.
Do you have a food allergy policy? If so, this is good news. Ask what company provided the training. The Gluten Intolerance Group, for example, offers restaurant training and certification through its GFRAP program.
Do you have a designated area to prepare foods for special diets? Verify cooking procedures to check for cross-contamination. Ask about separate cutting boards and utensils. If restaurant staffers don’t understand why they should keep food segregated during the preparation and cooking process, they don’t understand gluten-free cooking.
Do you have specialty gluten-free products? When a restaurant carries prepared pancake mixes, gluten-free rolls, or desserts from reputable manufacturers, it is taking gluten-free customers seriously.
May I look at ingredient labels? If the restaurant is willing to show you ingredient labels, it’s a good sign that they’ll accommodate your gluten-free diet.

At the Restaurant

The best time to dine at any restaurant is during the first hour of a service period. The staff is more alert and attentive and the kitchen is much cleaner. At off-peak hours, the kitchen is not as rushed.

The most important strategy when dining out is good communication. Be clear about your needs—as well as the possible consequences. Clear communication is the key to interacting with servers, managers, and chefs. A calm and confident approach is the most effective way to ensure that your needs are met.

If you’re part of a group, consider ordering last. Ordering last means you get the server’s full attention, you won’t feel pressured, and you won’t disrupt the table conversation. The person taking your order should write it down.

Select simple dishes with fewer ingredients; this goes for desserts, too. Avoid casseroles, sauces, gravies, soups, and marinades. A sautéed or baked item will minimize the use of common cooking equipment and shared utensils. Go through the list of ingredients, including garnishes, to make sure there is no hidden gluten.

Originally published in 2016 and regularly updated.

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