You Ask, I Answer: Gluten-Free Diets

I just learned I have celiac disease.

My doctor told me to avoid wheat [and wheat by-products.]

He mentioned to also steer clear of barley and rye.

A family member told me that's only the surface of things I should avoid, since things like soymilk and spelt should also not be eaten.

Can you give me some information?

-- Marie Brilmer
(Location withheld)

Although I am sure this new diagnosis seems initially overwhelming, I am glad you now have a way to explain a lot of the uncomfortable symptons I am sure you were experiencing.

It's a shame your doctor's advice was so vague. Your family member is right -- simply thinking of a gluten-free diet as "no wheat, barley, or rye" is only part of the puzzle.

Her soymilk concern is somewhat on target.

Some soymilks use malt flavorings -- derived from barley -- as flavoring agents. As always, you must read the ingredient label to figure out which brands fit into your celiac-friendly eating plan.

Other things to look out for:

* Soy sauce, which can contain wheat

* Bulgur, which is a wheat product

* Durum flour, also a wheat product (this is what conventional pastas are made with)

* Triticale, a mixture of wheat and rye

* Products containing hydrolyzed vegetable OR hydrolyzed plant protein (this includes canned tuna) -- usually derived from wheat protein

* Items containing wheat starch (including, but not limited to, cake frosting, gravy, pre-sliced cheese, and over the counter drugs)

I should also inform you that many cosmetics companies add wheat starch to their lipsticks as filler.

Since even a tiny amount of wheat can set off all sorts of unpleasant reactions, be sure to research brands that offer celiac-friendly makeup!

FNCE 2008: Free of Gluten, Not Flavor

Although many European and South American countries sell a mulitude of products geared to individuals with celiac disease, the United States is only recently beginning to cater to this growing market with tasty, healthy, widely available alternatives.

Many people with celiac disease have a hard time finding snack foods high in fiber and whole grains, which is why two manufacturers of gluten-free products stood out at the Food and Nutrition Conference & Expo: Mary's Gone Crackers and Crunchmasters.

Mary's Gone Crackers offers a variety of wonderfully crunchy gluten-free whole grain crackers and twig-shaped snacks.

Made from brown rice, amaranth, quinoa, sesame seeds, and millet, each 1-ounce serving offers anywhere from 3 to 5 grams of fiber and no more than 150 calories.

Some of the flavors -- particularly with the twig snacks -- can offer a relatively high 300 milligrams of sodium per serving, so be sure to check the nutrition label for information (the crackers tend to stick to 150 milligrams or less.)

Crunchmasters, meanwhile, sells multigrain and multiseed whole grain crackers that are incredibly crunchy and flavorful.

Each one-ounce serving provides 140 calories, 2 grams of fiber, and no more than 140 milligrams of sodium (the rosemary flavor manages to pack in a lot of taste in less than 100 milligrams of sodium per serving!)

No wheat? No problem.

Over in Oprah Land....

Time to see what Oprah's blog reveals about her ongoing 21-day vegan diet (remember, she's also shunning sugar, gluten, alcohol, and caffeine).

Last Friday, Oprah stopped by Tom Cruise's Telluride home, where she was met with a "ribs and chicken" (marinated in some sort of Scientology-friendly sauce, I'm sure) lunch.

Granted, this was no vegan-friendly meal, so Oprah opted for salad, corn on the cob (no butter, of course) and kale.

Which brings me to a very important point. Well-balanced vegan mealplans need to be researched and planned.

I believe a vegan lifestyle can be healthy, but it must be looked into carefully prior to taking the plunge.

If anyone reading this is considering going vegan, be my guest -- but speak with a Registered Dietitian or, at the very least, read educational materials (preferably written by RDs) on how to meet your nutrient needs with meat and dairy alternatives.

Becoming familiar with vegan alternatives and always being prepared (i.e.: carrying a source of protein like nuts or seeds in your bag in a small Ziploc bag) sets you up for success.

Otherwise -- especially when attending an event at a non-vegan's house who is not familiar with your "diet," -- you run the risk of piling up on side dishes.

Oprah's lunch offers very little protein, zinc, iron, and fat. Nibbling on corn and greens is simply not nutritious -- or filling!

The next day -- Saturday -- Oprah is in Vegas and begins her entry with the following:

"Tal [the vegan chef 'assigned' to Oprah and her team] has Fed-Exed food to Vegas, so we have egg-less omelets for breakfast and lasagna for the plane ride home."

Alright, I cry foul. Come on -- anyone can do a 21 day vegan/sugar/wheat/alcohol/caffeine cleanse if a vegan chef Fed-Exes them meals!

I would have liked to see Oprah "keep it real" and traverse the meat-laden obstacle that is Las Vegas.

In that same posting, Oprah proudly mentions abstaining from having a celebratory glass of champagne.

I still don't understand how the shunning of alcohol (or gluten or sugar, for that matter) relates to becoming a more spiritually aware being.

Besides, any dietary plan that has you obsessing over certain foods and beverages (the "I would like a drink but I am on this clease so as good as that would be I am just going to have seltzer and lime" sentiment has appeared a few times already) needs to be examined more closely.

Sure, alcohol can be a source of empty calories, so although two drinks a day is not a good idea, not allow yourself one drink two days out of the week?

The next day, a pooped Oprah mentions the vegan chef dropping off gluten and wheat-free waffles at her house just in time for breakfast. Oh goodie, how convenient!

It frustrates me to think that viewers of Oprah's show will blindly follow a similar diet, oblivious of some very necessary nutrients they may miss out on.

Additionally, this idea that wheat and gluten are evil is misleading and completely subjective; it is only a problem for someone with a gluten allergy or celiac disease.

This is a perfect example of something applicable to a small percent of the population being heralded as "general nutrition advice"

Allow me to repeat my plea. Oprah, enough with the fad dieting. You're a smart, accomplished woman with an immense fan base.

Next time you want to tackle nutrition, why not invite a panel of Registered Dietitians to share information, debunk myths, and give people practical information they can apply to their daily lives?

Argentina: No Gluten? No Problem!

I took this photo last December at popular Buenos Aires supermarket chain Disco.

In case the resolution isn't clear enough, the sign up top reads "Productos Celíacos" ("Products for Celiacs").

Like many other conventional supermarkets in the city, they delineate approximately half an aisle exclusively to gluten-free products, enabling consumers living with celiac disease to have a much easier shopping experience.

In Argentina, the province of Buenos Aires analyzes products and stamps a gluten-free seal on them if they fall below 1 parts per million of gliadin (a protein in gluten).

Following this inspection, the Argentine Celiac Association reviews laboratory results from the Ministry of Health and must give its approval before a product can officially be sold as "gluten free."

It's not just supermarkets that provide gluten information.

Persicco, a renowned gelateria with various branches in Buenos Aires, places a gluten-free icon next to the flavors that are celiac-friendly.

Although the United States offers thousands of gluten-free products to the approximately three million people diagnosed with celiac disease (as of 2007, the market was valued at $700 million!), these are mostly available exclusively online or specific health food stores.

I have not, at least in New York City, seen standard supermarkets devote as much as one shelf to gluten-free products.

Part of the problem, I think, is the lack of regulation. Although you may see "gluten free" advertised on many products, no official standards for this claim have been set.

Last January, the Food and Drug Administration attempted to tackle this problem.

"Currently, there is no Federal regulation that defines the term “gluten-free” used in the labeling of foods.

Based upon comments FDA received during its public meeting on “gluten-free” food labeling held in August 2005 and other information available to the Agency, there is no universal understanding among U.S. food manufacturers or consumers about the meaning of a food labeled as “gluten-free.”

You can view the PDF file of the full (and by full I mean "very long") gluten-free labeling proposal here.

The 90-day comment period concluded last April, but I haven't heard anything since.

I do believe, though, that the original plan was to have something sorted out no later than December of this year.

I'm interested in hearing from readers who are gluten intolerant.

Do you find it difficult to know what products to buy and stay away from due to a lack of federal standards?

(Really) South of the Border

My week in Buenos Aires revealed several interesting tidbits on how nutrition and dieting are perceived in Argentina.

I’ll begin with similarities I observed between the land of tango and the nation of apple pie.

The absence of trans fats in a given food product is heavily advertised on packaging.

Supersizing is not limited to the United States. Alfajores – a popular Argentine treat consisting of dulce de leche filling between two chocolate-coated cookies – have recently started to become available in triple-sizes! This extra cookie – and additional layer of dulce de leche – increases the caloric content by 75 percent.

Vegetarian items are becoming more mainstream at supermarkets. From soy burgers to soy milanesas (a traditional food, basically breaded beef or chicken cutlets), going meat-free in the world’s beef capital is becoming a little easier. Soymilk is unheard of for all intents and purposes, though, as are seitan and tempeh.

Fiber consumption is well below recommendations. Very few restaurants offer high-fiber vegetables as side dishes, beans and legumes are not staples, oatmeal is not a popular breakfast item, and whole grains are not consumed as often as they should be.

Now, the differences.

The gluten-free market is considerably larger in Argentina. Many supermarkets boast “gluten-free” sections or aisles, and popular gelaterias indicate which flavors are celiac-friendly.

Protein is not the star nutrient it is in the United States. Unlike in the United States, you do not see any foods advertised as "high in protein" or "x grams of protein per serving!" Protein shakes and supplements are not popular.

Nuts, seeds, and legumes are not heavily consumed. Not only are they expensive for the average Argentine, they are also not culturally significant.

Despite being one of the world’s leading blueberry exporters, Argentines do not traditionally snack on this wonderful fruit.

When it comes to fighting the common cold, zinc lozenges are not advertised (or even sold, really).

For some odd reason, Omega-9 fatty acids are heavily advertised on foods containing them. I find this strange because Omega 9 is not essential (since our bodies are able to produce it).

It is Omega 3 and 6 that we must obtain from the diet (although, as I have explained in the past, our Omega 3 to 6 ratio is scarily disproportionate).

I'll expand on some of these points over the next week. Also, look for a "Shame on You" post on Argentina's latest hotshot weight-loss doctor soon.

Simply Said: "wheat-free"/celiac disease

The past five years have produced an increase in wheat-free products such as breads, pastas, crackers, and cookies.

Although the claim "wheat-free" also accompanies other health-related ones such as "Low in saturated fat!" or "No added sugar!", you should only be concerned with avoiding wheat if you have been diagnosed with an allergy to it or a genetic disease known as celiac disease.

Celiacs can not tolerate gluten, a protein mainly found in wheat as well as barley and rye. When gluten is consumed -- even if it's as little as 1/8 of a teaspoon -- the small intestine is damaged, and symptoms vary from extremely uncomfortable bloating and diarrhea to fatigue, mouth sores, and muscle cramping.

Although approximately ten percent of celiacs don't appear to show any symptoms, they are not immune from the nutrient malabsorption that occurs as a result of damage in the small intestine.

Avoiding wheat, rye, and barley is not as easy as it sounds. Many medicines have traces of gluten, and cross-contamination can often happen in factories (which is why you will often see food labels for products that don't contain either of those three ingredients warning consumers that the respective food was made in a factory that processes wheat).

Once diagnosed (after a simple blood test), the lifestyle change can be hard, especially when dining out. A fish and vegetable stew might sound harmless, but that tomato sauce on top might have a little flour in it to thicken it. Frozen yogurts often use gluten as a stabilizing agent! Remember, even the slightest trace of gluten is enough to set off some very uncomfortable symptoms.

Luckily, celiacs have more options than ever. Although all sorts of wheat flour (all-purpose, whole wheat, durum, farina, etc.) should be avoided, experimenting with other types (ie: chickpea, tapioca, rice) is recommended.

Celiacs often end up introducing their palate to a variety of flavors -- quinoa, amaranth, and flax often become a regular addition to their diet, rather than the "funky grain" they have once a month.

Unfortunately, the only "cure" to celiac disease is avoiding foods that damage the small intestine.