Web sites: For more information on celiac disease and gluten intolerance, check out these Web sites to learn more about gluten-free diets, get product recommendations, and find gluten-free recipes.
(The Gluten Intolerance Group)
(Celiac Sprue Association)
Books: The following new books offer up-to-date information about the gluten-free lifestyle as well as yummy recipes:
- GLEE! by Elizabeth Atkinson (check out her gluten-free blog at elizatkinson.blogspot.com)
- Gluten Free Every Day Cookbook by Robert M. Landolphi
- 1,000 Gluten-Free Recipes by Carol Fenster, PhD, (see savorypalate.com)
Gluten intolerance is so universal these days that "special" diets have become downright common. In fact, this simple little protein has become one of our greatest dietary thugs, surpassing even white sugar in its heinousness. And it's so pervasive in our modern processed-food diet, extraordinary measures are required to avoid it. All in all, in the case of following a gluten-free diet, there's nothing special about being special.
What exactly is it about gluten that's making life so troubling for so many people?
Against the Grain: Gluten Facts
Wheat, rye, barley, spelt, and triticale contain a protein called glutenin, or gluten. As much as we've come to fear and loathe gluten, it's actually a very appealing compound in terms of food aesthetics. In baked goods, leavening agents such as yeast or baking powder create gas bubbles within the dough or batter. Gluten helps hold those gas bubbles in; this allows the dough or batter to rise and stay risen when baked and creates the light structure and uniform texture that we love in breads, cakes, cookies, and muffins.
Unfortunately, being an exceptionally sturdy protein, gluten is also very difficult to digest. For some people, this difficulty leads to a variety of problems. Extreme sensitivity to gluten manifests in celiac disease, a type of autoimmune disorder in which the immune system responds to gluten by damaging the small intestine. Immediate, acute symptoms include diarrhea, abdominal pain, and cramping and bloating; more subtle or chronic symptoms include weight loss, irritability (especially in children), depression, and skin problems such as dermatitis and eczema.
Full-blown celiac disease affects an estimated 1 in every 133 people. More common is gluten intolerance, a broad term that includes a wide range of sensitivity and subtle symptoms, from weakness and fatigue to a general lack of well-being. Gluten intolerance, or what's now sometimes called non-celiac gluten sensitivity, may affect as many as 1 in 7 people.
"For many people, there's a range of sensitivity to gluten," says Marc David, author of The Slow Down Diet. This means that some of us may be fine with gluten, while others may be mildly, moderately, or extremely sensitive. "Nature is seldom black or white when it comes to health. We always function within biochemical parameters," says David.
Why is gluten so problematic?
It may simply be that we humansaren't naturally suited to eating wheat. "When wheat was first cultivated, perhaps 10,000 years ago, it was new to the evolutionary food chain for humans-in other words, we didn't naturally evolve as wheat eaters," says David. "Eating wheat is a mass nutritional experiment, and the results seem to be that it's fine for some and not for others-quite expected in the scheme of things." [Editor's note: See "Way to Go, Paleo!" on p. 52 for information on the hunter-gatherer/Stone Age diet.]
The Gluten-Free Diet
There is currently no cure for celiac disease or gluten sensitivity, but the good news is that most people respond positively to a gluten-free diet within days or weeks. Common sources of gluten that should be avoided include the following:
- Oats (Note: oats are gluten-free, but commercial forms are made in non-gluten-free facilities. Try Bob's Red Mill Rolled or Steel Cut Oats.)
- Triticale and Mir (a cross between wheat and rye)
- Veggie burgers (unless specified as gluten free)
- Wheat and all its forms (including wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein, graham flour, durum, semolina, spelt, couscous, kamut, einkorn, emmer, fu (common in Asian foods), matzo, farina, gliadin, and faro)
Plenty of foods are naturally gluten-free, such as fruits, vegetables, eggs, dairy products, nuts, seeds, beans, legumes, potatoes, corn, rice, and meats. Other foods and grains that are gluten-free include the following:
Many health food stores and some grocery stores carry the grains listed above; flours made from these grains can be substituted in recipes.
To ensure that your body is getting a range of vitamins, minerals, and plant compounds, eat a variety of fruits, vegetables, and gluten-free grains.
Important Supplements for Gluten-Free Living
The gluten-free diet, while healthful, can be lacking in certain nutrients. Gluten-free flours are lower in fiber and not enriched with iron and B vitamins. Supplements can help facilitate healing of the body, aid digestion, and compensate for possible dietary deficiencies. Below are some supplements to consider:
Multivitamin and Mineral Complex
Make sure the vitamins and all other supplements you take are gluten-free-some manufacturers add gluten as a binder. For example, all products from Country Life Vitamins, including multivitamins, are certified gluten free. If you have iron-deficiency anemia, you may need more iron than a multivitamin provides; check with your health care provider.
Essential Fatty Acids (EFAs)
Celiacs may be at particular risk for EFA deficiency, especially prior to following a gluten-free diet, due to malabsorption of fat in the damaged intestine. Fish oil provides the highest amount of omega-3s. Look for pharmaceutical-grade, molecularly distilled fish oil from a reputable manufacturer. If you can't tolerate fish oils, try chia seed oil or flaxseed oil. The usual dosage for omega-3s is 1 to 3 g daily.
There are digestive enzyme supplements designed for celiacs and those with gluten and casein sensitivity (e.g., GlutenEase from Enzymedica). Look for a product with a wide range of plant enzymes to support complete digestion of carbohydrates, proteins, and fats, with targeted support for the digestion of gluten and casein. Taking specific enzymes before risky meals (e.g., when eating at restaurants) will aid digestion and help to defend against hidden gluten and casein.
Most celiacs may be deficient in probiotics because of intestinal damage. A quality probiotic supplement designed to survive stomach acid can deliver beneficial bacteria to the intestine.
There are other supplements that may be necessary depending on one's individual health status. For example, celiacs are at risk of osteoporosis and may require additional bone-building nutrients such as calcium, magnesium, and vitamin D. Those with diabetes, thyroid disease, or other issues may require other supplements.
It is important to consult with your health care provider if you have any health concerns and before you start taking any new drugs or supplements.
Many people with gluten sensitivity are just fine staying away from products made with wheat, spelt, triticale, barley, and rye. But for those with celiac disease or severe gluten intolerance, avoiding the obvious offenders often isn't enough. Oats, for example, don't contain gluten, but because they're usually processed in plants that also process gluten-containing grains, they may be contaminated, which can be enough to trigger a reaction in more sensitive folks. Also, hidden gluten in ingredients such as soy sauce, chicken broth, malt vinegar, salad dressings, barley malt, and common seasonings and spice mixes can make gluten-free cooking a real challenge.
There's also the taste issue. If you're on a gluten-free diet or cooking for gluten-free friends, you're probably either bored to distraction with steamed vegetables and fish, fearful of anything with Asian flavorings or complex sauces, or disgusted with gummy piecrusts or muffin mixes.
But fear not. Cooking without gluten can have gourmet appeal. We have two simple, elegant gluten-free recipes that taste great and can be made without having to perform culinary back
bends. As a plus, the recipes are vegetarian. So nearly everyone at your table can enjoy a meal that tastes like special food-not a special diet.
Olive and Cashew Hummus with Artichoke Leaves
2 medium artichokes
1 cup raw cashews
1 15-oz. can chickpeas, rinsed and drained
¼ cup olive oil, plus more for drizzling
2 Tbs. lemon juice
2 cloves garlic, minced (2 tsp.)
1/8 tsp. cayenne pepper
½ cup kalamata olives
2 Tbs. finely chopped fresh basil, plus additional leaves for garnish
- Cut stems from artichokes, remove bottom leaves, and trim about 1 inch from top of artichoke.
- Place steamer rack in large pot, and add just enough water to touch bottom of rack. Place artichokes on rack, and bring water to a boil. Reduce heat, cover, and steam until leaf near center of artichoke pulls out easily, 40 to 50 minutes. (Or place artichokes in pot of boiling, salted water, and boil 30 to 40 minutes.) Artichokes can be made 24 hours in advance, and refrigerated.
- Blend cashews, chickpeas, oil, lemon juice, garlic, and cayenne in food processor until smooth to make hummus.
- Add olives to hummus, and pulse until blended, allowing some bits of olive to remain whole. Add chopped basil, and pulse 5 seconds. Add 1 Tbs. water at a time, if necessary, to thin to desired consistency. Season with salt and pepper.
- Transfer hummus to serving bowl; drizzle with oil, and garnish with whole basil leaves, if using, before serving. Dip artichoke leaves in hummus.
PER SERVING: 336 CAL; 9 G PROT; 22 G TOTAL FAT (3 G SAT FAT); 29 G CARB; 0 MG CHOL; 331MG SOD; 7 G FIBER; 2 G SUGARS
Morel Mushroom and Arugula Risotto
¾ oz. dried morel mushrooms (1 cup) or ¼ lb. fresh
1 cup baby arugula leaves
½ cup fresh basil
3 large cloves garlic, peeled
4 Tbs. olive oil, divided
1 small leek, washed and thinly sliced (white and pale green parts only)
1½ cups Arborio rice
½ cup dry white wine
5 cups vegetable broth, kept warm in saucepan
¼ cup freshly grated Parmesan cheese.
- Place dried morels, if using, in small bowl, cover with warm water, and soak 30 minutes. Agitate with hands to clean, then drain, rinse, squeeze out excess water, and pat dry. Finely chop morels, and set aside.
- Combine arugula, basil, and garlic in food processor; pulse until coarsely chopped. With food processor running, drizzle in 2 Tbs. olive oil, and pulse until finely chopped, scraping sides as needed. Set aside.
- Heat remaining 2 Tbs. olive oil in large, heavy saucepan, and sauté leek until tender, about 3 minutes. Reduce heat to medium-low. Add rice, and stir, 2 minutes to coat with oil. Add wine and morels, and stir constantly until wine is absorbed (3 to 5 minutes). Add broth, 1/2 cup at a time, stirring and simmering between each addition, until absorbed (30 to 35 minutes total); add arugula mixture about halfway through cooking. Rice mixture should be creamy and tender when broth is completely incorporated.
- Season with salt and pepper, if desired. Transfer to medium serving bowl, or divide among six plates. Sprinkle with Parmesan, and serve hot.
PER SERVING: 212 CAL; 4 G PROT; 10 G TOTAL FAT (2 G SAT FAT); 25 G CARB; 3 MG CHOL; 499 MG SOD; 2 G FIBER; 3 G SUGARS