Archive for March, 2012
Gluten-Free Passover Facts and Tips
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!
Happy Passover!
Read more from Annsley, including a personal story about Passover, on her website: Gluten Freedoms LLC
About Annsley
Annsley Klehr is the owner of Gluten Freedoms, LLC, a gluten-free coaching and consulting business.
Are You a Mindful Eater?
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!
– Cheryl
Attending a Celiac Disease Patient Conference: Part 2
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 Education
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.
– Cheryl
Attending a Celiac Disease Patient Conference: Part 1
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.
The People
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.
The Food
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.
– Cheryl
Dinner with a Celiac Disease Expert
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”!
– Nancy
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