Archive for March, 2012
By Annsley Klehr
Passover is a time of remembering the past and celebrating the fact that we Jews are no longer slaves in Egypt. The lengthy dinner we have is called a Seder, which means order. We follow this order using a Hagaddah, which guides us in the order of the 15 different holiday rituals.
Then we spend the next 8 days trying to remember what it was like by removing leavened bread from our diets, because the slaves did not have enough time to wait for their bread to rise in the ovens before running for freedom. That’s why we eat matzah, an unleavened, cracker-like bread. Needless to say, unleavened bread is still made from wheat and is not gluten-free.
But don’t worry! There is now excellent gluten-free matzah on the market and well as many gluten-free products this time of year!
Facts and Tips for a Gluten-Free Passover
Fact #1: Some Jews also avoid rice, corn, peanuts, legumes, and pulses, since they could be grown in the same fields as the wheat and have a risk for cross-contamination. (This rule really depends on the person and how closely he/she follows Jewish Law).
Tip #1: Choose how strictly you want to keep a Passover diet. Passover is a time for celebration and remembrance, but you also never want to compromise your health. I choose to eat rice, corn, peanuts, and legumes on Passover.
Fact #2: There is another group of strictly Orthodox Jews who do not eat “gebrochts,” which is Yiddish for “broken.” That means that they avoid any matzah (wheat) product that has come into contact with liquid after it has been baked.
Tip #2: Since gebrochts technically refers to wheat-based products, then “non-gebrochts” means products that do not contain wheat. Look for this statement on packaged goods and you will know that they are not only wheat-free, but also produced in a wheat-free facility, due to the strict nature of Passover laws.
Fact #3: According to KosherConsumer.org, for a product to be qualified as “kosher for Passover” it must be free of “Wheat – all classes, Barley, Spelt, Rye, Oats, Legumes & rice or any derivative of theirs.” (Matzah is an exception because it is unleavened.) In addition, there is a strict sterilization process for any equipment used to manufacture “kosher for Passover” products.
Tip #3: The kosher for Passover facilities are extremely careful with grains, so I often stock up on gluten-free products for the rest of the year:
- chocolate bars
- cocoa powder
- potato starch
- baking mixes for cakes and cookies
- gluten-free/non-gebrochts matzah and matzah crackers
Note: Not all products follow the strict Orthodox traditions. Therefore, some products for Passover are made in facilities that also process wheat. Read labels carefully.
Passover is my favorite holiday. It’s a chance for friends and family to get a little “taste” of what it’s like to be gluten-free. It’s also a great time to invite friends and family to join you in celebration, or to experience another culture while sharing a stress-free and gluten-free environment. Just don’t forget your gluten-free matzah!
Read more from Annsley, including a personal story about Passover, on her website: Gluten Freedoms LLC
Annsley Klehr is the owner of Gluten Freedoms, LLC, a gluten-free coaching and consulting business.
I recently asked on Twitter “How mindful are you when eating?” Most people tweeted that they’re very mindful, noting how observant they must be to avoid gluten exposure. Yes, that is a necessary part of the gluten-free lifestyle, but reading labels and being “mindful” can be two very different things.
It may sound counter-intuitive, but mindfulness is all about silencing those little buzzers going off in your head. It’s about being present, focusing on what’s in front of you, and ignoring the constant stream of thoughts and sounds that typically distract us throughout the day.
When it comes to eating, that means making healthy choices and savoring each bite rather than wolfing down a bag of chips in front of the TV. It may sound silly, but acknowledging your food can save you from saying “Why did I eat that?” more often than not.
Ali Weinberg, a licensed psychotherapist and Wellcoach at Engin Inspired Coaching, offered this overview to help anymore be more mindful:
“There are four components to well-being that can help contribute to increasing mindfulness and thus decreasing worry and rumination in our lives:
- Mindful exercise: This does not mean one needs train for a marathon. Going for a 30-minute walk with a pet or loved one, and/or incorporating some sort of enjoyable physical movement into the day can have profound effects on the mood.
- Eating Mindfully: This means paying attention and being thankful for and aware of the food we are eating. In our rushed schedules, much of the time we are holding the steering wheel with one hand while we inhale a burger, or we are reading and watching television as the fork mechanically goes from plate to mouth. Before we know it, the food is gone and our stomachs are overstuffed and unsatisfied. By cultivating more of an awareness and appreciation for our food, we can experience the nutrients for what they are, rather than stuffing ourselves to mask and soothe our anxieties in the moment. This may mean stepping back periodically throughout a meal and checking in with fullness levels on a scale of one to ten. Oftentimes my clients will realize that they habitually finish everything on their plates only when they happen to be eating and multitasking. When they mindfully focus on how their body feels, they realize that they are satiated earlier on in their meals, and feel energized rather than stuffed after eating.
- Sleeping mindfully: Sleep is what heals us. As anxious people, we are used to struggling with insomnia at times, and it can have many negative effects on our daily functioning when we are lacking sleep. It is important to develop good sleep habits to help our bodies to repair and heal from daily life stressors. Good sleep can also help to improve one’s mood and productivity in work and life.
- Overall development of Mindfulness: John Cabot-Zinn defines mindfulness as ‘Paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.’”
If you’re ready to be more mindful, sign up for NFCA’s upcoming webinar: Maintaining a Healthy Weight While Eating Gluten-Free: The Importance of Physical Activity & Mindful Eating on April 18. As always, it’s free!
Last week, I gave you a wrap-up of the food and people I encountered at the Intestinal Immune-Based Inflammatory Diseases Symposium at Columbia University on March 2-3. While I had a fine time networking and meeting others in the gluten-free community, my main reason for attending was to hear from prominent celiac disease researchers. Needless to say, I was an attentive listener.
The sessions in the Patient Program covered everything from the basics of celiac disease to the latest research in therapeutics. Here are a few takeaways that perked my ears:
The No. 1 cause of poor response to a gluten-free diet is gluten exposure.
7-30% of patients with celiac disease reported continued symptoms on a gluten-free diet. The reasons can vary, from lactose intolerance to bacterial overgrowth to microscopic colitis. But as it turns out, most people simply aren’t following the gluten-free diet as diligently as they should, or they are ingesting gluten unknowingly. Another factor can be having the wrong diagnosis, so doctors stress the importance of confirming an individual’s celiac diagnosis. Which leads into the second point…
Reviewing biopsies is essential.
A few months ago, a study revealed that many gastroenterologists do not take a sufficient number of samples during a small intestinal biopsy. The presenter noted that several factors play a role in making a successful diagnosis: orientation, interpretation, number of biopsies and location. That means if too few biopsies are taken, or if the small intestine hasn’t been examined as thoroughly as it should be, it could affect the diagnosis that the pathologist makes.
Children are not little adults.
A proper celiac diagnosis is critical for child development. A child diagnosed with celiac disease early on will most likely grow to their full potential. A child diagnosed later in life may be permanently stunted from so many years of malabsorption. How exactly does this malabsorption affect their development? Iron deficiency can lead to poor concentration or irritability; calcium deficiency can lead to poor bone calcification and zinc deficiency can lead to growth failure and sexual immaturity.
There’s a lot to learn about the autism/gluten-free connection.
I was eager to hear Columbia’s presentation about the potential benefits of a gluten-free diet for those with autism spectrum disorders (ASD). It was the perfect build up to NFCA’s ADHD and autism webinar that took place the following day. While research thus far has been inconclusive, it appears that the gluten-free diet may help a subset of those with ASD. More research is needed to identify these subgroups and the specific proteins in gluten they’re reacting to.
Discovering risk factors is the No. 1 step to prevention.
There are a number of potential therapies currently being researched, and they each aim to accomplish one of three goals: Reduce exposure to gluten, reduce intestinal permeability or reduce immune activation. However, the question of how to prevent celiac disease remains. As healthcare turns from a model based on treating symptoms to one based on promoting wellness and prevention, we can expect this to be a focus. The answer lies in identifying more of the risk factors, because once researchers know what causes the disease, they can focus on ways to stop it.
Earlier this month, I had the opportunity to attend the Intestinal Immune-Based Inflammatory Diseases Symposium at Columbia University. It was a joint event presented by Columbia’s Celiac Disease Center and the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medical College. I was there for the Patient Program, but it also included a CME track for physicians, dietitians and other healthcare providers.
I had been to conferences before, but never one that focused specifically on celiac disease. Needless to say, I was stoked to meet people who are just as excited to talk about gluten-related disorders as we are.
First up, I’m covering the scene: The People and The Food. Watch for my next post, when I get down to the nitty-gritty: The Education.
As someone who spends more than 8 hours a day in front of a computer, it was a treat to get some face-to-face time with patients and healthcare providers. Breakfast, lunch and dinner afforded us plenty of time for chit chat, and I met a wonderful group of people.
There was Patty McG, a spunky teacher who was diagnosed with celiac disease late in life. She was so full of energy, so inquisitive at sessions and so hilarious at mealtime – a thrill to be around.
Then there were Andrea and Alexandra, a mother-daughter duo who flew in from Ohio for an appointment at Columbia’s Celiac Disease Center, then stuck around a few extra days for the patient conference. Alex is a senior in high school and was preparing for a 2-week trip to Spain. Kristin and I immediately offered some travel resources to help her stay gluten-free while abroad. They were thrilled to hear about the new Gluten-Free in College section on our website. We’re sure Allie will be a well prepared gluten-free student come move-in day.
Next, I met Jonas Ludvigsson, MD, PhD, a renowned celiac disease researcher from Sweden who is doing research at the Mayo Clinic on a Fulbright Scholarship. I’ve posted a number of his studies on our Research News feed, so it was an honor to spend some one-on-one time with him. Plus, he’s a hoot. (He also wrote a guest post for NFCA back in November.)
Finally, there was Barbara Halpern, a long-time champion of NFCA. Barbara is a practicing dietitian in not one, not two, but three states. She even does nutrition counseling via Skype, so she’s never far out of reach. She leads a local celiac support group, and she’s done wonders to promote our Primary Care CME to physicians.
What’s a celiac disease conference without delicious gluten-free food? Each day, we enjoyed a lavish spread at each meal, including a seemingly endless supply of gluten-free rolls from Free Bread Inc. These rolls were a huge hit with gluten-free and gluten eaters alike. They were warm and hard on the outside, moist and doughy on the inside. Flavors included the Jalaa!, with cheddar cheese, buttermilk, and jalapeno, and our favorite, the MOXY, with gluten-free oats and seeds, molasses and agave nectar. It wasn’t uncommon for someone to eat two or three rolls in one sitting. (Attendees came from far and wide, so they were stocking up while they could.)
To balance out all that bread, we filled our plates with dishes like salmon, roasted vegetables, chicken with a Dijon sauce, and cold gluten-free pasta salad from the buffet. I have never seen salmon filets as big or beautiful as they ones they served. They were so fresh and tasty, I barely used the sauce.
For dessert, there was gluten-free cheesecake – plain and chocolate – and fresh fruit. The cheesecakes were light and creamy, not like the dense cheesecakes I’ve had in the past. And who doesn’t like fruit?
Stay tuned for my follow-up post, including some key takeaways from the sessions.
Last weekend, Alice and I went to Natural Products Expo West in Anaheim, CA. It was a blast!
Let’s start with the magic of Disney: their chefs are a delight, and the 8:40 p.m. nightly fireworks were icing on the gluten-free cake.
Speaking of cake, gluten-free sales continue to boom. At the Expo, we learned that Mintel projects the market to reach between $8.5 and $9.9 billion by the end of 2013. Mintel, along with market research firm SPINS, stated unequivocally what we all know – that gluten-free is a long-term industry trend that is here to stay, not a short-term fad that will fade into distant memory.
As far as products go, we saw the continued abundance of gluten-free salty snacks, including several lentil-based crackers. We previewed Rudi’s new tortilla, which didn’t crack or break when rolled or folded, and we spent Thursday evening with the team from Rudi’s and Charter Baking, including their CEO Jane Miller.
We saw the emergence of stronger nutritional profiles at Expo West this year. Schar’s new Gluten-Free Multigrain Ciabatta Parbaked Rolls are delicious and satisfying. And Lucy’s has developed a brownie bite free of most major allergens. Also free of all 8 allergens was Enjoy Life’s individually-wrapped packs of trail mix, providing easy-to-grab fiber and protein from a flavorful blend of seeds.
After an endless day of sampling chips, pizza, cookies and bars, I was especially excited to eat some actual veggies. Thank you to Kettle Cuisine for their delicious array of savory soups (I love the Roasted Vegetable) and Thai Kitchen, for their curried vegetable stir-fry with fresh pea pods and peppers. Yummy.
I spent the plane ride home reading the story of Bob Moore (of Bob’s Red Mill), whose inspirational act of generosity caught our attention when he gave the company to his employees on his 81st birthday. “These folks helped me build the company up,” Bob told me. “How could I do anything else?”
[Alexander Hymowitz is a 16-year-old junior in high school and has been gluten-free since age 11. He has been volunteering for NFCA by writing articles and "Pep Talks" for Kids Central. We asked him to set the record straight on common gluten-free myths.]
5 Misconceptions about Celiac Disease and the Gluten-Free Diet
1) It’s a healthy lifestyle.
I’ve read news articles online that say going gluten-free is a healthier lifestyle, and that’s not always true. It’s not a miracle diet. You still need to make healthy food choices and keep a healthy lifestyle.
2) Going gluten-free is cheap.
Though the rise in gluten-free products has helped to reduce some prices, the price of gluten-free bread compared to white bread is quite significant. The gluten-free lifestyle is not a cheap way of living because you get less food for more money.
3) Going gluten-free is easy.
Going gluten-free requires effort, time and vigilance. Sticking to a strict gluten-free diet requires constant awareness of what one is eating and where one is eating. It requires effort to stay gluten-free and fight urges to eat gluten-filled foods. It requires vigilance to know what is gluten-free, which places are gluten-free, where it is safe to eat and where it isn’t. Going gluten-free is no simple task, and it is not something that comes easily. You have to work at it until you get it right.
4) Gluten-free can be done all by myself.
Going gluten-free and living a gluten-free lifestyle become much easier when you have someone backing you up and pushing you through it, even when the going gets tough and you have an urge to eat gluten. When I was diagnosed, so was my sister. I know that going gluten-free would have been much harder if I didn’t have someone to keep up with me and know what I was going through.
5) There is no information out there about celiac disease.
The community is growing, and the amount of information is increasing, too. There are magazines, websites, articles, doctors and much more. One should not get lost with all this information. Take gluten-free living step-by-step until it becomes part of your everyday thing.
Read more from Alexander:
[As you know, the National Foundation for Celiac Awareness staff members are big Phillies fans. So when one of our volunteers, Nadina Fraimow, told us she shared the same passion for sports, wellness and all things Phillies, we had to get her on board. Nadina will be sharing her gluten-free experiences as she follows the Phillies year-round.]
Spring into Action
A Phightin’ to Be Gluten-Free Blog
Bright House Field in Clearwater, FL, is the Phillies home away from home for Spring Training games. On Wednesday, February 29, the Phillies won 6-1 to the Florida State Seminoles in their First Exhibition game. Next, the Phillies had a busy weekend with fellow Grapefruit Leaguer, the New York Yankees.
The Phillies lost 8-5 and 7-4 to the Yankees; however, our Phightin’ Phils are just getting warmed up. Cole Hamels, Roy Halladay, Jonathan Papelbon, Hunter Pence and John Mayberry sprung into action on the field this past weekend.
For the Phillies, these practice games keep the players fit on the field and channel team chemistry into wins. Be-Lee-ve it – Cliff Lee did just that yesterday with a 7-0 win against the Toronto Blue Jays.
On the home front, my family team has sprung into action planning my 2012 wedding, so when the Phillies official season begins, we can sit back and enjoy the games. We have discovered there are a growing number of local caterers who are well-versed in gluten-free food preparation and catering. Stay tuned for more!
Below is a new restaurant dish and new product review on the following baseball-inspired scale:
Triple- Very good
Home Run- Must try
Grand Slam- Sublime
Metropolitan Bakery- Gluten-free and dairy-free granola- Home Run
Overview: Gluten-free and dairy-free granola from Metropolitan Bakery. The 12 oz. package can be purchased online or in Philly Metropolitan Bakery retail stores.
Safe Dining: Metropolitan Bakery uses certified gluten-free oats from GF Harvest, a family owned company in Wyoming committed to growing safe, uncontaminated oats.
Note: For those who are newly diagnosed with celiac disease, oats may be omitted from the diet until the condition is under control. Please consult with your doctor before adding oats back into your diet. Even when adding them back into the diet, the oats should be “pure, uncontaminated” or “certified gluten-free” oats. Read more in this Q&A.
Taste: The MVP is the gluten-free oats, which come all the way to Philly from GF Harvest in Wyoming. The supporting players are honey, canola oil, maple syrup, sunflower seeds, pumpkin seeds, sesame seeds, dried cranberries, pecans, almonds, dried cherries, dried blueberries, unsweetened coconut, dried strawberries, cinnamon, pure vanilla and ground cloves.
One spoonful of the gluten-free and dairy-free oats is an explosion of seasonal flavors to enjoy all baseball season long. I also found the gluten-free oats quite easy to digest. The Fall flare from the honey and maple syrup coats the nuts and dried berries for a softer crunch.
Result: Metropolitan Bakery’s gluten-free and dairy-free granola is a great source of energy and flavor to spring into action. (Tip: Be creative and incorporate into non-breakfast foods, such as salads and sorbet! ).
Veal Escallops with Black Bean Sauce at Yang Ming- Double
Overview: A generous portion of veal escallops with sautéed leeks, shallots and herbs completed an enjoyable meal.
The Scene: With my sister home for Spring Break, our family team ate at Yang Ming in Bryn Mawr, PA, a Philadelphia suburb on the stretch known as the Main Line. On any given Saturday night, the restaurant is packed with suburbanites and city residents who trek into the heart of Bryn Mawr for fresh Chinese cuisine.
Safe Dining: At Yang Ming, the manager and chefs in the kitchen are educated in gluten-free friendly dining.
Presentation: An abundance of veal escallops with leeks and shallots was woven throughout the dish. Also, the dish is accompanied by two side dishes of brown rice and gluten-free version of black bean sauce. The picture above conveys rice mixed into the dish for a stir fry effect and a drop of black bean sauce for dipping. (Note: Remember to inquire about safely prepared gluten-free versions of sauces on the menu in addition to gluten-free meal options. Additionally, I always order the sauces on the side, just in case they are not as tasty as the dish itself!).
Taste: The veal escallops were tender and meshed well with the soft textures of the brown rice and vegetables. While each bite was tender, the platter could have used an element of playfulness or even color to the dish with a new ingredient or gluten-free sauce mixture.
Result: The veal escallops with the gluten-free black bean sauce is a good meal and safe option if you are craving gluten-free Chinese cuisine. My sister ordered and thoroughly enjoyed the Sizzling Triple Delight, which she rated a Home Run . This dish is served on a hot platter and includes an assortment of seafood, chicken and beef with sautéed vegetables. Note: Order with gluten-free version of sauce.
Now it’s your turn to spring into action!
*Join NFCA on Friday, July 20, 2012 for Celiac Awareness Night at the Phillies. Tickets are now available.
Nadina Fraimow began volunteering with the National Foundation for Celiac Awareness (NFCA) in April 2011, and will be happy to answer messages sent to her attention at email@example.com. Nadina learned that she has non-celiac gluten sensitivity in February 2011, and is grateful for having been diagnosed promptly and correctly by a knowledgeable gastroenterologist. She enjoys running, shopping for gluten-free sweets and creating recipes that are both tasty and healthy. Nadina is a Marketing and Communications professional living and working in Philadelphia. Nadina is also a proud Penn State alumna and an avid fan of the Phillies.
Some days, you just get lucky.
Two weeks ago, I had a fabulous chance to consult with an expert, learn something new and enjoy a delicious dinner in very good company.
The saying goes, if you want to learn about something, go to the source. Not often does the source come to you.
While traveling through the area on business, Scientific/Medical Advisory Board member Dr. Daniel (Dan) Leffler of the Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, graciously took the time to swing through Philadelphia to meet with us. As a result, Dr. Richard Mandel, NFCA Board of Directors member, and I enjoyed a delightful dinner with Dan in an atmosphere where we could catch up on the latest research and exchange ideas about the state of celiac disease today.
Thanks to some sleuthing by my associate Kristin Voorhees, we landed at Devon Seafood Grille on Rittenhouse Square in Philadelphia. Let me tell you, it is the place to be!
Because Dan had to catch a plane that evening, we dined early — 4 PM. No, it wasn’t the Early Bird Special. It seems that Devon serves all day, so no worries there. The best part is that they have a separate and quite complete gluten-free menu. Actually, many of the items on their “regular” menu are gluten-free. And, the waiter was totally knowledgeable about what was gluten-free and what was not, down to the spices used in various dishes. Impressive and reassuring!
So, after diving into oysters selected from the current best across the country and enjoying the freshest of splendidly prepared seafood, we got down to the “what’s what” part of our get-together.
The big news is all about terminology.
That’s right, there are changes afoot concerning how we define and refer to celiac disease and other related disorders. Called the “Oslo definitions,” a newly released document composed by a team of 16 physicians from seven countries outlines the preferred terms, along with terms that they assert don’t best describe the condition under discussion. That’s right; some are in and some are out.
The goal here is to develop a common language which the entire scientific, academic and healthcare communities, along with the general public, can use to refer to this range of illnesses now going under a myriad of terms that can (and do) have different meanings to different people.
Note: The name “Oslo definitions” comes from the most recent International Coeliac Disease Symposium held in Oslo, Norway in June 2011 where new definitions were introduced and discussed. The review continued after this meeting resulting in the formal document that was released in February 2012. Yes, it is hot off the presses.
While not the law of the land at this point, this consensus document has the support of leading experts worldwide, including Dan Leffler who authored the paper on behalf of the impressive group based on months of studied consideration by these medical experts and researchers, all focused on the field of celiac disease.
No, I am not going to list all of the definitions here as there is quite a list of terms, most familiar to all of us, along with some that are not part of the lay person’s daily vocabulary. (Yes, that would be me.) Should you read the document, you will see gluten sensitivity and gluten intolerance joined with other descriptors such as latent celiac disease, gluten ataxia, pediatric classical and more.
The document defines celiac disease (or, as they write it in Europe, coeliac disease). Here it is: “a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals.”
It also recommends a new way to refer to the spectrum of illnesses that involve gluten. “‘Gluten-related disorders’ is the suggested umbrella term for all diseases triggered by gluten and the term gluten intolerance should not to be used.”
There is much more to this story, of course. You can get a quick summary in NFCA’s Research News.
In short, this was a very satisfying and interesting evening. We enjoyed delicious gluten-free food and learned about the latest thinking in the field of celiac disease.
Chalk one more up for “a good time was had by all”!
- International Physician Task Force Identifies Definitions for Celiac Disease and Gluten-Related Disorders
- What is Non-Celiac Gluten Sensitivity?
- Teleseminar: How Well is Your Digestive System Working? (Featuring Dr. Dan Leffler)