Exploring the Gluten-Free World

When I began writing this blog entry last Friday, the mouth-watering smell of hot, fudgy brownies baking in the oven was wafting throughout the house.

Gluten-free hot, fudgy brownies.

That was followed by the equally mouth-watering smell of a lemon ricotta-almond cake.

Also gluten-free.

I was baking gluten-free goodies because I was in charge of dessert and coffee after religious services on Friday night, and one of the women in the congregation was just diagnosed with celiac disease. When she told me a few days earlier when she came to pick up her children from religious school, I saw the same look in her eyes as I imagine most of us had when we were told we had a chronic condition that was going to change our lives.

The other women on my committee and I wanted her to be able to enjoy the fellowship of her friends without looking at the dessert table and mourning what she could no longer have. Joining the gluten-free brownies and cake was fresh fruit, chocolate-dipped dried apricots, and a selection of cheeses and gluten-free rice and caraway crackers.

I’d never deliberately baked anything gluten-free in my life. It must have been OK, however, because her eyes lit up when she bit into a brownie and immediately asked me what brand mix I’d used.

Mix? Although gluten-free mixes do exist, I ground almonds and found rice flour to make those brownies, I’ll have you know! Where I live, gluten-free mixes are unheard of, except at the privately-owned grocery near my house with the very responsive owner. The specialty flours needed also can be hard to find, but I’m persistent. And I like to cook.

But why am I talking about celiac on a diabetes blog? In case you haven’t heard, according to the American Diabetes Association, the overall incidence of celiac disease worldwide is estimated to be 1 person in 250, but as high as 1 in 20 for people with Type 1 diabetes. The Juvenile Diabetes Research Foundation, on the other hand, gives figures for the United States: 1 in 100 people in the general population and 1 in 10 people who have Type 1 diabetes. In either case, yikes!

Like Type 1 diabetes, celiac disease is an autoimmune disease, meaning that your body basically attacks itself. The American Celiac Disease Alliance (ACDA) defines celiac as “a permanent intolerance to the gliadin fraction of wheat protein and related alcohol-soluble proteins (called prolamines) found in rye and barley.” According to several other sources, oats also may be culpable.

When any form of wheat, rye, barley, and, perhaps, oats is eaten, small, finger-like projections in the small intestine called villi are damaged or destroyed. “The resulting inflammation and atrophy…results in the malabsorption of critical vitamins, minerals, and calories,” says the ACDA.

People with celiac disease must completely avoid ingesting all products containing the triggers. It’s more involved than just avoiding the obvious, such as breads, pastas, and such that have gluten-containing grains in them. Some medications—both prescription and over-the-counter drugs—contain gluten. My can of baking powder advertises that it is gluten-free. Soy sauce generally contains gluten. Even Play-Doh has it. (I’m not suggesting you eat Play-Doh—not that there’s anything wrong with that; but if you need to avoid gluten, be sure to wash your hands after handling it and before putting your fingers in your mouth.)

One ad I ran across in my research touted gluten-free lipstick, which seems to indicate that the cosmetic may contain gluten.

Cross-contamination is another factor if, for example, you use the same toaster for standard bread and for gluten-free bread. Even using the same knife you used to spread peanut butter on your child’s sandwich made with standard bread to make your own peanut-butter sandwich could cause problems.

Just to be on the safe side, I went to the discount big-box store and got an inexpensive bowl, a rolling pin, and sets of measuring cups and spoons and mixing spoons to use. In an attempt on Sunday to make gluten-free matzah, I covered the food preparation area with plastic wrap before beginning and used parchment paper on the baking sheet.

You may be diagnosed with celiac if you experience symptoms that “include diarrhea, short stature, iron-deficiency anemia and lactose intolerance,” says the ACDA. Nonclassic symptoms may include abdominal pain, irritable bowel, and osteoporosis. My friend was diagnosed after complaining of ongoing stomach pain.

On the other hand, you may have no symptoms at all.

If you suspect that you have celiac disease, it’s best to be tested before eliminating gluten from your diet, several sources say. Diagnosis includes tests for antibodies and/or a small-intestine biopsy plus elimination of gluten from your diet.

Another reason to find out if you have celiac—in addition to the permanent organ damage and malnutrition part—is that people with celiac disease are at higher risk for gastrointestinal cancers.

Luckily, in the United States, food manufacturers are required to list the top eight food allergens, which includes wheat, on food labels, says the ACDA. The U.S. Food and Drug Administration has until August 2008 to “develop and finalize rules for the use of the term ‘gluten-free’ on product labels.”

My friend now knows that Rice Chex are gluten-free because it says so on the box. But she won’t touch Rice Krispies, even though I told her it didn’t appear that any of the ingredients contained gluten, because it didn’t say “gluten-free.” Good thing, because Diane Fennell, assistant editor at Diabetes Self-Management who has celiac and read through this blog entry before it was posted, told me it contains malt, which is made from barley. I imagine that my friend will have an easier time after the new food-labeling laws take effect—just as those of us with diabetes benefited from nutrition labels on foods.

Can you still eat out? Sure! Just ask your favorite sit-down or fast-food restaurant if it has a gluten-free menu. You might be pleasantly surprised.

And don’t forget those old standbys: fresh fruits, veggies, and meats, none of which contain gluten.

As for the “goodies,” my friend found out last Friday, there are some pretty “yummy” (as she told me in an e-mail) recipes out there. Just key in “gluten-free (whatever) recipe” into your search engine and go for it.

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