Gluten-Free Vegetarian Diets

It can be challenging enough on gluten-free diet, but what if you eat a vegetarian or vegan diet?  It’s well established that there are health benefits to reducing the amount of meat in the diets of most Americans, and the lifestyle has appeal for some people based on ethical and/or environmental reasons.  Fortunately, with extra planning, a well-rounded and delicious gluten-free vegetarian diet is possible.

The good news is that many vegetarian staples, like beans, lentils, tofu, dairy, nuts, seeds and eggs are already naturally gluten-free.  And some of the best sources of vegetarian and vegan protein are gluten-free pseudo-grains, such as quinoa, buckwheat and amaranth. Also, grains, such as millet, teff and sorghum are very nutritious.  In addition to protein and fiber, they all have other vital nutrients, like B vitamins, iron, calcium, magnesium, etc.

It’s vital for everyone with Celiac disease to get enough iron, calcium, Vitamin D, fiber and B vitamins (including B12), because these are often lacking due to damage from the disease process and eating patterns often seen in gluten-free diets.  Pair that with a vegetarian diet, which can be lacking in protein, iron, calcium, B12, omega fats, and Vitamin D, and it’s easy to miss out on necessary nutrients.

So what’s a vegetarian to do?

• Focus on typical vegetarian staples that are gluten-free, like beans, tofu, nuts and seeds, and, of course fruits and veggies and.  If your diet includes dairy, eggs, fish, etc. these are very nutrient rich as well.
• Watch out for the miso!  Surprisingly, sometimes it contains barley.
• Eat a good source of protein with each meal.
• Try quinoa, buckwheat, amaranth etc.
• Get your vitamin D, iron and B vitamin levels checked.
• Consider a vegan or vegetarian omega 3 supplement from algae if you don’t eat fish.
• When possible, include fortified gluten-free foods, like cereals, breads, etc.
• Work with a Registered Dietitian to make sure you’re eating a balanced diet.

News

1 in 133

On May 4th, the world’s largest Gluten-free cake was made in Washington, DC for a good cause.  Gluten-free labeling laws were due out in August, 2008.  Thanks to a lot of great press for the event, hopefully there will soon be progress on this front, and FDA officials said they’re paying attention.  Only time (and continued attention) will tell!

While you’re at it, do stop by the 1 in 133 website and sign the petition and/or donate to the cause.

Gluten-Free Watch Dog

Gluten Free Watchdog will be fully operational Monday May 16. Preview the site www.glutenfreewatchdog.org. This site will test selected products without gluten ingredients listed and provide a detailed report of the gluten content of the selected products.

DC Area Events

Next Meeting Date: Saturday, May 14, 2011, 2:00–4:00 pm

Meeting Topic: TBD
Speaker: Anne Roland Lee, MSEd, RD, LD, Director of Nutritional Services, Schar USA

Vendors: One Dish Cuisine

Location: DC Public Library: Tenley-Friendship Branch
4450 Wisconsin Ave. NW, Washington, DC 20016
202-727-1488
www.dclibrary.org/tenley

CNMC Program

Join the Celiac Disease Program at Children’s National Medical Center on Tuesday May 17th for a FREE educational session called “Solving the Puzzle: The Many Faces of Celiac Disease.” The session will provide information about celiac disease as well as how it relates to orthopedics, allergy, neurology, endocrinology and psychology. The educational forum includes complimentary gluten-free breakfast and lunch.

Great people always know other great people…

We are moving locally, and although I will continue to see clients in Alexandria, I’m also looking for a spot to see clients near Fairfax/Burke.  Anyone thoughts of wonderful offices/people near by to connect with would be greatly appreciated!

Usually I write on one topic in particular, but there has been so much buzzing about the gluten-free/Celiac world that I wanted to share the highlights!

• 1 in 133 is a new project designed to highlight the lack of action on the part of the FDA in putting out a ruling on the definition of “gluten-free”, as promised by August 2008, and obviously long overdue.  If you’re local, consider coming out for the fun on May 4th (added incentive–world’s largest GF cake!).  Also, whether you’re near or far, sign the petition and/or consider donating to the cause.

• Dr. Fasano from the Center for Celiac Research and other researchers showed in the British Medical Journal that gluten intolerance is a true disease AND that it is biologically distinct from Celiac.   He estimated that 6% of the population is gluten intolerant. The Wall Street Journal did an excellent article on gluten intolerance as well.

• New research came out showing that Celiac is 5-10 times more common in people with Multiple Sclerosis (MS) and a whopping 32% of 1st degree relatives of people with MS had positive blood work for Celiac.  Cross testing is important!

• A little of my gluten-free journey was featured in a Washingtonian blog article on Celiac disease and a gluten-free diet.  I am hopeful that if there is a good response, they will focus on Celiac issues more often.
• LOTS of fantastic new gluten-free books have hit the shelves!  My favorites include
  • Simply Sugar and Gluten-Free by Amy Green
  • Simply…Gluten-free Desserts by Carol Kicinski
  • Good Morning Breakfasts without Gluten, Sugar, Eggs or Dairy (vegan)  e-book by Ricki Heller
  • Gluten-Free Cupcakes by Elana Amsterdam (out April 26th)
  • Shelley Case and Carol Fenster have a free, online bean (pulse) cookbook with a variety of gluten free bean and lentil recipes through Pulse Canada
• The Celiac Disease Video Project will be released in next month or 2 months.  It will be videos on medical diagnosis, follow up, all about a gluten-free diet and label reading, with a short segment on gluten sensitivity. I’m very excited to share this valuable resource, and am very appreciative of the Celiac Sprue Association for their support!
• If you love the latest news on Celiac, gluten intolerance, good nutrition and other health issues, I’ve joined the wild world of Twitter.  Follow me  @cherylharrisrd

To subscribe or unsubscribe, please see www.harriswholehealth.com

• “USDA Organic” label on fruits and vegetables:  Crops must meet the USDA standard, that is they must have been grown without most synthetic and petroleum-derived fertilizers or pesticides, antibiotics, irradiation, or genetic engineering.

• “USDA Organic” label on meat: The animals must be fed only with organically grown feed without animal byproducts, and should not be given hormones and antibiotics. Animals must have access to the outdoors — although when the label is applied to poultry (chickens, turkeys, etc.) the animals don’t necessarily need to actually spend time outdoors.

• “Organic” label on fish:  This means absolutely nothing.

• “Cage-Free” label on eggs: Implies hens not kept in cages, but the claim doesn’t mean the hens had enough room to move around freely or that they had access to the outdoors.  This claim is not regulated.

• “No Antibiotics Administered” or “Raised without Antibiotics” labels: These claims imply that the animals did not receive any antibiotics; however, this claim is NOT verified by any outside agency.

• “No Hormones Administered” label: It is illegal to administer hormones to poultry or hogs, so this claim means only that the producer has followed the law.  When applied to meat, the label implies that no hormones are used, but the claim is NOT verified by any independent agency.

Two great resources on labeling:

http://www.earthwatch2.org/sustainability/decoding%20labels.htm

Consumer Reports

http://www.greenerchoices.org/pcategories.cfm?pcat=food

So, where does all of this leave us?  Some great options for you and your family include:

• Purchase products with meaningful labels, such as USDA organic produce and grass-fed meats
• Buy more of your food from fatmer’s markets, local farms, and Community Supported Agriculture (CSA) programs.

Thanks to Fran Callahan of the Kaplan Center for helping compile links.

Passover: A Great Gluten-free Selection!

Passover isn’t here until April, but many of the products are already starting to appear in grocery stores.  Not all Passover foods are gluten-free, but many are, and there’s a much wider selection than usual at the grocery store.  This can be a good time to stock up on GF cakes and mixes, cookies, macaroons, “bread” crumbs and supplies like potato starch.  As an added bonus for people with multiple restrictions, most Kosher for Passover products contain no corn or soy products, either.

In a nutshell, the basic rule of foods for Passover is no leavened foods, which eliminates normal breads, cakes etc.  Matzo, (an unleavened bread usually made from wheat) is eaten, and some products contain products Matzo and matzo meal, (also potentially listed as cake meal or farfel).  However, many products don’t contain gluten.  Or, if you find products labeled “non-gebrok or gebroktz or grebrochts” (or another spelling variation) they’re non-grain containing and therefore have no gluten-containing ingredients. Often Kosher for Passover products and cakes are made of potato flour or nut meals rather than wheat or glutinous grains.

• As always in the gluten-free world, read labels carefully.  Kosher and Kosher for Passover are two different things entirely.  Kosher for Passover foods will be labeled “May be used for Passover” or have a symbol that says OUP.  I have often seen “regular” Kosher foods in the Passover section at grocery stores, so please do check the labels for gluten containing ingredients.

• Keep in mind that some of the foods are imported from other countries, and imports are often not labeled according to the 2004 FALCPA U.S. labeling laws.  So a label will still say matzo, but may not say wheat explicitly or have the disclaimer stating that it contains wheat.

• Most Kosher for Passover products will have to adhere to strict standards for cross contamination from a religious perspective, but again, buyer beware and no guarantees.  “Made in a factory” claims are still not regulated.

• From a gluten-free perspective, possibly the best part of Passover is AFTER Passover, when all of the great gluten-free goodies are on sale!  Passover ends April 26th, so mark your calendars, because the word has gotten out in gluten-free circles and the mad rush is on.

Here’s a link to the gluten-free products from Manishewitz:

http://www.manischewitz.com/health_corner/index.php

Back when you really couldn’t get gluten-free prepared foods in the regular grocery store, this was a much bigger deal.  But it’s still nicer to have an expanded selection, and nicest of all is AFTER Passover, when all of the products are on sale!

For people who DO celebrate the actual holiday of Passover, not just the gluten-free food, here are some great recipes and information:

http://www.elanaspantry.com/passover-round-up/

http://www.recipezaar.com/cookbook.php?bookid=112835

http://iamglutenfree.blogspot.com/

http://glutenfreebay.blogspot.com/2007/03/gluten-free-passover-recipe-roundup.html

http://glutenfreebay.blogspot.com/2010/03/gluten-free-products-for-passover-2010_26.html

http://kosherfood.about.com/od/glutenfreepassover/GlutenFree_Passover.htm

http://recipecircus.com/recipes/Writermom77/ and click on holidays.  There are quite a few Jewish holiday recipes, and they are all gluten and dairy free

You can make matza, but it’s not technically Kosher for Passover–unless, of course, you happen to have a Rabbi on hand to bless it and all that jazz.  You can also buy gluten-free oat matzoh made from certified gluten-free oats.  The only downside is that it is insanely expensive! (new note–Yehuda matza is now in the stores, and they do have a GF line–only $6 a box.  Wow!)  Shmura Oat Matzah is distributed by a mom in MD Lakewood Shmura Matzo http://glutenfreematzoh.com/

Shabtai Gourmet products are made in a dedicated gluten-free facility, they’re and Kosher for Passover AND often they have free shipping deals.  And, most importantly, they’re insanely tasty. http://www.shabtai-gourmet.com/

Kids with Food Allergies put out a booklet last year on Passover with food restrictions. http://tinyurl.com/3ser4k

Events:

DC Celiacs (free):

Current Research on Gluten Sensitivity

Classes

Events

The Wild and Wacky World of Gluten Sensitivity

For a TV segment with me on Gluten Sensitivity on Let’s Talk Live DC, click here.

Unless you’re living in a bubble, you’ve heard about plenty people who do not have Celiac disease, and yet report all sorts of positive health improvements a gluten-free diet.  While for some it is obviously a just a fad, we’ll discuss what the research is on non-Celiac gluten sensitivity, and groups of people that seem to be most affected.  The main conditions linked to both Celiac disease and non-Celiac gluten sensitivity are IBS, neurological issues, autoimmune conditions, such as autoimmune thyroid disease or Type 1 diabetes, and schizophrenia.  I absolutely believe that all  people should get tested for Celiac disease before going gluten-free, simply because the diet is a lifelong commitment, and ideally, that’s a really long time.  And I’ve definitely found that people with a firm diagnosis are usually more compliant with the diet.

I can’t count the number of times people with gut issues report that a gluten-free diet helps their symptoms, despite testing negative for Celiac disease.  Research is starting to back them up.  It’s well-established that Celiac disease is 4-5 times more common in people with IBS than the general population.  And yet there are also a group of people without Celiac disease that respond favorably to a gluten-free diet.  It is most commonly seen in people with the HLA geneotype DQ2, which most people with CD have.   So is this a pre-Celiac condition? A similar condition? We’re really not sure. The American College of Gastroenterology published a 2009 article on the “No Man’s Land of Gluten Sensitivity”[i] and states that “even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD (Functional Bowel Disorders).  Even more striking is the estimate that for every person with CD, there are at least six or seven people who are gluten sensitive.”[ii] Also, a study in Australia in January 2011 looked at people with IBS WITHOUT celiac disease and gave them either gluten or a placebo.  There were statistically significant changes in overall symptoms, abdominal pain, bloating, and fatigue in just 6 weeks[iii].  Although this is a small study, it was the first of its kind.

Neuropathy is a general term for conditions involving nerve cells.  It includes everything from ataxia, or lack of muscle coordination, peripheral neuropathy, or numbness and/or tingling in hands and feet, to headaches and more.  Neuropathy is very common in people with Celiac disease even when they are on a gluten-free diet, possibly as high as 22%[iv] .  However, compared to healthy people, a much higher percentage of people who have neuropathies WITHOUT Celiac test positive for AGA antibodies (an old screening test used for Celiac).  Our typical celiac tests look at tissue transglutaminase 2, while it seems like people with neuropathies most often have tissue transglutaminase 6. Almost all of these people have one of the HLA typings linked to Celiac (DQ2 or DQ8).  When gluten is removed, these markers disappear.  Only a few research studies have been done on removing gluten in the diet, but there are indications of improvements. And yet this is certainly an interesting area of research which we will hopefully learn much more about in future years!  Although this study is very dense, it gives a nice overview of the connection between gluten and neuropathy[v]

There has been an established link between schizophrenia and Celiac since the ‘60s, and it’s profound.  As one study puts it, “a drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies. However, this occurs only in a subset of schizophrenic patients.”[vi] Although there is still debate, non-celiacs with schizophrenia have higher rates of AGA antibodies, and the rate of response to a gluten free diet seems higher than the rate of people with CD.  Considering how debilitating the disease is, that’s astounding!

Type 1 diabetes and autoimmune thyroid disease[vii]are both linked to Celiac disease, and yet animal models show a more generalized sensitivity to gluten.  Though the word gluten was not used, a study of Type 1 diabetics without CD showed less immune dysfunction on a wheat-free diet[viii].  While this is less concrete, it will be fascinating to see what research has to show over the next few years.

At this point, there are no widely accepted, definitive, research-based tests for gluten sensitivity, although I mentioned several suggestive tests.  This is why “diagnosis” for many people it is simply a matter of trial and error. I would not recommend Enterolab testing because they have published no research in the decade or more they have been in practice.  There is a new lab out called Cyrex (beginning in January 2011 which is promoted by Dr. Tom O’Brien, who has been a leading celiac researcher for years).[ix] As of yet, their test are not validated in scientific research, but this is a very promising test to watch.

As a final note, the strength of the link between gluten and these conditions is variable, and yet, so many people stand to potentially benefit.  This is also does not mean that everyone should go gluten-free.  And this is no longer a “fringe” view. Links to all of the referenced studies are below, and all are from peer reviewed major journals from the last few years (and these are just some of the studies out there).  It is quite a controversial topic, and we all have a lot to learn.  Personally, I am delighted that the medical community is now recognizing that gluten intolerance is true a medical condition, and look forward to seeing our knowledge continue to evolve.

Links are at the bottom of the newsletter

Events:

DC Celiacs:

Holiday Tips

Recipes

Resources

Book review

Holiday Tips:

Let’s face it. We’re smack in the middle of eating (and shopping) season. Here are some of my favorite ways to enjoy the spirit of the season and favorite holiday foods, while staying reasonably healthy, too.

Get Prepared: It’s not fun to sit in a room full of people eating delicious (off-limits) foods while you sit quietly drinking your water and nibbling a carrot stick.  It’s also a recipe for a rebound binge at home. Have a 2 pack of gluten-free cookies, Clementines, or your favorite chocolate stashed away work, or bring an apple crisp, chocolate covered strawberries, meringues or “secret chocolate cake” along with you to a party.  Check out this list of naturally gluten-free and seriously delicious options.  Make sure your children have treats at school so they don’t feel left out, either.

Savor: Bottom line, you’re going to eat some treats this holiday season, so you might as well truly enjoy them.   Be choice-ful and target things you enjoy most (i.e. no filling up on chips or every day foods unless those are the only options) When you eat, really eat!  Take time to fill your senses and really enjoy.  When we are really tasting our food (rather than inhaling something while talking and multitasking) food tastes much better, we’re more satisfied and full quicker.

Balance: if you are going to a holiday party in the evening, make an extra effort to eat well on other days. Add in more vegetables, fruits, beans, gluten-free whole grains, etc. and move more, too! A piece of chocolate cake one day won’t make or break a diet, but treats every day will add up.

Move the goodies out of sight: One of the biggest challenges of the season is a see-food diet, otherwise known as “if I see it, I eat it”. Studies show that when people keep food out of sight, they eat less.  Avoid the constant temptation. Instead, put fruits on the counter or in your refrigerator where they are easy to grab. Seasonal fruits in the winter months include Clementines, oranges, pineapples, grapefruits, grapes, pomegranates, persimmons, mangos, and more.

Fill your table with fruit and veggie dishes: Have your holiday meals feature seasonal vegetables, such as sweet potatoes, collards or other greens. Make roasted chestnuts as a snack. Have a fruit inspired dessert, like baked apples, poached pears, sautéed bananas, etc.

Soups: as long as they’re not cream based, most soups are a healthy snack or part of a filling meal. Chicken and turkey soup with brown or wild rice, butternut squash soup, lentil soups and other beans soups are a great way to stay warm and enjoy seasonal flavors.

Get moving! Exercise is a great way to improve mood, reduce stress levels, and burn calories, too. Head out at lunchtime for a short walk, start a new family tradition and do something active at family events, dance at party functions, or make a habit of hitting the gym. You don’t have to wait until January for healthy resolutions.

More recipes from around the web:

Gluten Free Girl and the Chef is doing a daily cookie posting

Simply Sugar and Gluten Free

25 days of Christmas from Gluten Free Easily

Gluten Free Merry Christmas from the Whole Gang

Gluten and Dairy free Holiday tips from Gluten Free Goddess

Christmas Cookie Roundup (from my cookie exchange)

Christmas cookie roundup from Ginger Lemon Girl

Resources:

• Celiac and Thyroid Disease: Two of a Kind Please see a recent article I co-wrote with Dr. Gary Kaplan. It was published in Today’s Dietitian in November 2010 and was featured as the American College of Gasteroenterology’s Top Story.

• Celiac Disease, gluten intolerance, child feeding and more: listen to me on Celiac Radio!  This August 2010 interview covers a wide range of topics for people on a gluten-free diet.

Book Review: Real Life with Celiac Disease, by Melinda Dennis, MS, RD, LDN and Daniel A Leffler, MD, MS

Looking for a great holiday stocking stuffer?  This is an absolutely fantastic book.  Each chapter is written by a Celiac/gluten free expert, ranging from the authors to Dr. Fasano to Dr. Green and many more.  The topics are ones that I hear so frequently from my clients, like the impact of cheating, gluten challenges, a gluten-free and vegetarian diet, Celiac and anxiety, gluten intolerance, and much, much more.   I’m an avid reader on Celiac both for my clients and for myself, and yet I was surprised to find some statistics in the book I haven’t seen before.

I’ve asked for a second copy for the holidays.  And, let me say I’ve never reviewed a non-cookbook on my website before, because I can’t remember being as enthusiastic about any other book on Celiac Disease.

Harris Whole Health offers individual sessions, family sessions and group classes to help people eat healthier and feel better!  Cheryl works with people to feel and look their best with a range of specialties, including Celiac Disease, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating.  Let’s get you on your way to achieving your goals. For an appointment with Cheryl Harris, Registered Dietitian and Nutritionist, please click here, email or call 571-271-8742.