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'gluten free' posts

Gluten intolerance or low FODMAPs?

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unknowingly ingesting small amounts of gluten.  The results of this study described a condition termed, “Non-celiac gluten intolerance”.    It was after reading this landmark study that many physicians, including myself, began to validate parents’ concerns about gluten being the culprit behind their children’s gastrointestinal (GI) problems.

But then in 2013, just as word of non-celiac gluten intolerance was gaining popularity amongst physicians like me, the exact same group of researchers from Australia published a follow-up study on a similar set of about 3 dozen patients.  The findings of this 2nd study showed that instead...

Does your child have a food allergy or food sensitivity?

“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:

Nutrition spotlight on quinoa

This week the Registered Dietitians and Diet Technicians offered up a unique spin on quinoa for National Nutrition Month. Many of you reported you have had it as a side dish at dinner or in a salad for lunch. However on Wednesday, we served quinoa for breakfast! Spiced up with cinnamon, cloves, ginger, and cardamom, the sky is the limit for extra add-ins to further boost the nutrition of your morning meal.

Additional Flavor Ideas to Mix and Match:
  • Chopped nuts (walnuts, pecans, hazelnuts, almonds, etc)
  • Diced apple or pear
  • Banana slices
  • Mixed berries
  • Dried fruit (raisins, dried cranberries, prunes)
  • Almond or peanut butter
  • A tablespoon of flax seed or chia for healthy essential fatty acids
  • Honey, maple syrup, or agave nectar for sweetness
  • Scrambled egg for protein
Technically considered a seed (not a grain), quinoa is gluten-free and a complete source of protein. A serving provides a good source of dietary fiber, iron, magnesium, phosphorus, and zinc. Quinoa is also packed with B-Vitamins including folate, thiamin, riboflavin, and B6. Try substituting quinoa for pasta or rice at meals to change things up and increase the nutrition ..

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

What is celiac sprue or celiac disease?

An estimated 1.6 million Americans are currently following a gluten free diet, though many have never been diagnosed with celiac sprue (also known as celiac disease).  Patients commonly ask me about celiac sprue and gluten free diets, so I will try to answer some of these questions. The first question I get is what is celiac sprue or celiac disease.

What is celiac sprue?

In celiac sprue, the ingestion of gluten causes inflammatory damage to the lining of the small intestine.   Gluten is a protein, very common in our diet, found in wheat, rye, barley, and oats. (Ed. note - see this chart from the NIDDK that shows other ingredients and items that may contain gluten.)  In people with celiac sprue, the usually large absorptive surface of the small intestine is flattened from damage, significantly limiting its ability to absorb nutrients. 

Though celiac sprue is estimated to affect approximately 1.8 million Americans, many are unaware they have the disease. 

What are the symptoms of celiac sprue?

Celiac sprue causes a variety of symptoms.  They can range in intensity from very mild to debilitating.  Some of the most common signs and symptoms are:.

Gluten-Free in a Gluten-Filled World

For this French/Italian girl that grew up on bagels and loaves of bread, it wasn’t easy to read the lab results telling me gluten was the source of all my problems (digestive anyway). Despite a degree in nutrition, I’m here to break the news that it’s far from easy, not just for me, but the unfortunate waiter, the distressed party hostess, or the sibling that doesn’t quite understand why you are no help in devouring the Oreos.

This post is for anyone with a new diagnosis, those just coming to terms with an old diagnosis, and those that think that gluten intolerance might be a possibility. It’s also for the friends and family of those affected by celiac disease or gluten intolerance, and for those that just want to learn more about it.

What’s the deal with wheat, gluten, and these allergies?

Gluten is a protein found in wheat, rye and barley. You can be allergic to wheat, which is different than being gluten-intolerant (a broader category of things to avoid), which is different from having celiac disease. Here’s a little about each.

Celiac Disease

  • What it is: Not an allergy, but an autoimmune disorder that ....

Whipped Winter Squash

One ingredient, one wholesomely good—and delicious—food. And it’s a snap to prepare. Best purchased at harvest time, squash can be stored for months in a cool, dry place. Serves 4.

Try this with: Pork Dijon with Chutney and Sauteed Swiss Chard

Ingredients

  • 2 pounds seasonal squash such as Hubbard or Butternut, skin peeled away and remaining squash cut into chunks

Directions

  1. In medium saucepan boil one inch of water.
  2. Place squash in steamer basket above water, cover, and simmer 15-20 minutes until tender.
  3. Drain and puree or mash.

Per serving: 102 calories, 2gm protein, 27 gm carbohydrate, 0 gm fat, 0 gm sat fat, 0 gm mono fat, 0 mg cholesterol, 5 gm fiber, 9 mg sodium

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