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  • Jefferson Adams
    Are Current Screening Methods Missing Too Many Celiac Cases?
    Image Caption: Image: CC--US Army Africa
    Celiac.com 07/03/2018 - The vast majority of celiac disease remain undiagnosed, and clinical testing is usually done on a case by case basis. Factor in vague or atypical symptoms, and you have a recipe for delayed diagnosis and unnecessary suffering. What determines who gets tested, and are current screening methods working?
    A team of researchers recently set out to assess the factors that determine diagnostic testing, along with the frequency of clinical testing in patients with undiagnosed celiac disease. The research team included I. A. Hujoel, C. T. Van Dyke, T. Brantner, J. Larson, K. S. King, A. Sharma J. A. Murray, and A. Rubio‐Tapia. They are variously affiliated with the Division of Biomedical Statistics and Informatics, the Division of Internal Medicine, at the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota.
    For their case‐control study the team identified 408 cases of undiagnosed celiac disease from a group of 47,557 adults with no prior diagnosis of celiac disease. Their team identified undiagnosed cases through sequential serology, and selected unaffected age‐ and gender‐matched controls. They made a comprehensive review of medical records for indications for and evidence of clinical testing.

    Over time, people with undiagnosed celiac disease were more likely than control subjects to present with symptoms or conditions that invite testing. This study makes a strong case that current clinical methods are ineffective in detecting undiagnosed celiac disease. Accordingly, the researchers urge the development and adoption of more effective methods for detecting celiac disease.
    Source:
    Alimentary Pharmacology & Therapeutics.

    Jefferson Adams
    Undiagnosed Celiac Disease More Common in Women and Girls
    Image Caption: Image: CC--Discos Konfort
    Celiac.com 07/02/2018 - We know from earlier studies that diagnosed celiac disease is more common in women than in men, but there isn’t much good data on sex-based differences in undiagnosed celiac disease. To address this discrepancy, Claire L. Jansson-Knodell, MD, and her colleagues at the Mayo Clinic, in Rochester, Minnesota, conducted a meta-analysis of studies that performed both a screening and confirmatory test that included either a second serological study or a small intestine biopsy, and that that provided clear and complete data regarding sex. 
    According to data they presented at Digestive Disease Week 2018 in Washington, D.C., women are significantly more likely than men to have undiagnosed celiac disease, and the numbers are even higher for younger girls.
    In all, the researchers found 88 studies that met their inclusion criteria. These studies included data on nearly 300,000 patients. When they got done crunching the numbers, the research team demonstrated for the first time that women also had a higher rate of undetected celiac disease than men. When the team analyzed data from one subgroup focused on children, they found that rates of undiagnosed celiac disease were even higher in girls compared with boys.

    Timely diagnosis of celiac disease is important for preventing unnecessary suffering, and potential damage and disease associated with untreated celiac disease. In one recent case, a doctors found that a woman's psychotic delusions were caused by undiagnosed celiac disease and an adverse reaction to continued gluten exposure. Her condition improved quickly once she began a gluten-free diet. 
    The research team says that their findings could change approaches to clinical screening, diagnosis and management of celiac disease. They also suggest that physicians might do well to increase their suspicion levels for celiac disease when evaluation women and girls.
    Source:
    Helio.com

    Jefferson Adams
    School’s Gluten-Free and Halal Meal Policies Drawing Fire 
    Image Caption: Image: CC--meesh
    Celiac.com 06/30/2018 - It seems there’s a bit of a gluten-free and halal food controversy going on across the pond. For those who don’t know, ‘Halal’ is the Muslim equivalent of what Jewish folks call ‘Kosher.’ Basically, it means food prepared to certain standards and blessed for consumption.
    The Aureus School in Didcot, Oxfordshire, England is being decried by angry parents as “like a dictatorship” after the school banned packed lunches and began serving pupils gluten-free options, including halal meat, water and salad. The ruckus began when the school recently banned students from bringing lunches and snacks from home, and began a program to make sure that “all students have access to a daily nutritious home-cooked family meal.”
    This is fine in principal, say angry parents, but in practice has become “draconian.” One father, who asked not to be named, said that he and his wife were “thinking of taking [their daughter] out of the school, adding that the situation was “getting silly and more like a dictatorship. Their views are quite extreme.”
    The dad said that "It's about choice. It's supposed to be an inclusive school but they are only catering for one particular religion.” He added that he had tried unsuccessfully to get the policies changed since September.
    So, whereas in days past, lunch might mean whatever mom saw fit to pack, these days at Aureus School lunch means the choice of a hot halal meat meal, hot gluten-free vegetarian meal, a jacket potato, a salad, a pasta pot or a baguette. The school insists that only water be drunk on site because “hydrated brains learn better”.
    The school states that their Halal kitchen policy is simply a move to “celebrate the diversity of our country’s culture,” in addition to providing nutritious food for the children.
    What do you think? A gluten-free and Halal lunch bridge too far, or a good meal for the kids?

    Roy Jamron
    The REAL Best Ever Gluten-Free Bread - Designing the Perfect 4 Inch Tall Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread
    Image Caption: Image: Roy Jamron
    Celiac.com 06/29/2018 - Warning!  If you crave the taste of "real" bread, this gluten free bread may be addictive. 
    No rice flour here.  This totally satisfying, wholesome, nutritious, hearty gluten free bread exudes the robust taste and firm, springy texture of rye bread.  It really, really tastes like REAL bread, no exaggeration.  The bread is absolutely delicious toasted or untoasted, keeps fresh for over 2 weeks in the refrigerator, and does not tear, sink in the center, dry out or crumble.  This incredible 4 inch tall loaf can even be sliced nearly paper thin and still hold together.  It is vegan, free of soy, corn, wheat, gluten, nuts, dairy, or eggs.  Add caraway seeds and you'll want to break out the mustard, pickles, and coleslaw.  It makes the perfect deli bread.  Want pizza?  Toasted slices of this bread make great pizza crusts for quick and easy gluten free mini pizzas.  Even those not on a gluten free diet will find this bread utterly irresistible.
    A Quest Begins
    This outstanding GF bread is the result of a years long quest for the perfect GF bread recipe.  It began with the classic GF bread recipe of rice flour, tapioca starch, corn or potato starch, powdered dry milk, eggs, oil, sugar, salt, xanthan gum, yeast and water.  It later evolved to include bean flours.  These early GF bread recipes, mostly starch and "empty" calories, simply tasted horrible and left a bitter aftertaste.
    Rice flour, bean flours and corn starch were quickly eliminated.  After scientific studies concluded oats were gluten free and safe (except for possible wheat contamination), oat flour became a central ingredient.  Starches were limited to no more than one third of the flour mix.  Mashed banana, apple sauce, pumpkin puree, and yogurt were added to increase bread height and volume.  Oat flour was blended with flour from other seeds and grains, including sorghum, millet, amaranth, quinoa, and buckwheat.  A blend of oat and sorghum flour, tapioca and potato starch, mashed banana and low fat vanilla yogurt became standard GF bread recipe ingredients.
    Einkorn
    Einkorn an ancient form of wheat, was separately investigated.  At that time, einkorn was considered potentially safe for celiacs.  Samples of einkorn were obtained from Prime Grains [1] in Saskatchewan, Canada.  Einkorn flour was found to have most of same height, volume, and sinking in the center problems as with any other gluten free flour blend in creating a GF bread.  Einkorn bread, however, does not require the addition of starches.  An oat/einkorn bread recipe similar to an oat/sorghum recipe minus the starches was created, but it became necessary to end the einkorn investigation when new research on einkorn came out showing that einkorn does contain gluten epitopes potentially harmful to celiacs.  However, gluten content in einkorn is very low.  The investigation produced no ill effects from consuming einkorn.  Those with gluten sensitivity rather than celiac disease may well tolerate einkorn with no problems.
    Flaxseed
    Along with the Prime Grains einkorn samples sent from Saskatchewan, samples of golden and brown flaxseed were also sent. Using a coffee grinder to grind the flaxseed, the ground flaxseed was steeped in near-boiling water and used as egg replacer in GF bread recipes.  The steeping releases mucilage from the outer coating of flaxseed to create a thick, slimy emulsion.  Flaxseed mucilage seems to have a synergy with beta glucan in oats, a soluble fiber, forming a hydrocolloid combination that increases bread volume.  When the Prime Grains flaxseed ran out, flaxseed was locally purchased.  It was immediately noticed locally purchased flaxseed produced a much thinner emulsion than did the Prime Grains flaxseed.  The local flaxseed had a much lower mucilage content.  GF bread made with the local flaxseed had less volume and height and more sinking in the center than the Prime Grains flaxseed.  Were it not for the flaxseed samples sent with the einkorn, the great variation in mucilage content in different varieties of flaxseed grown in different localities would have been missed.  Little information is available on the mucilage content of flaxseed grown in North America.  One study was found [2,3,4].
    Prime Grains flaxseed is currently distributed through Farmer Direct Co-op [5] in Regina, Saskatchewan.  High mucilage Farmer Direct Co-op flaxseed has been available from Whole Foods in the bulk foods section.  Amazon's recent Whole Foods purchase may change that as bulk bin labels no longer state "Farmer Direct", only that it originates from Canada.  However, the issue of high mucilage versus low mucilage flaxseed may be moot.  The reason is buckwheat.  Buckwheat, like flaxseed, also releases mucilage.  It turns out buckwheat mucilage also increases bread height and volume, and, when used together with flaxseed, high mucilage flaxseed has no more effect on bread height and volume than lower mucilage flaxseed.  More on buckwheat later.
    Deep Loaf Pans
    GF breads containing eggs and mostly starch can achieve high height and volume without collapsing using an ordinary loaf pan.  But to achieve a full 4 inch loaf height using flaxseed as egg replacer and a low starch content requires a loaf pan with high sides.  The deepest loaf pans available are 4 inch deep pullman loaf pans.  Ideally a pan deeper than 4 inches is desired because GF breads tend to rise above the loaf pan and then fall during baking.  Additionally, during baking, the loaf shrinks and pulls away from the pan side walls, more at the top than the bottom, resulting in a loaf narrowing toward the top rather than straight sides.  Ideally the the sides of the loaf pan should taper so the bottom is narrower than the top.  This cancels out the narrowing of the loaf at the top creating a finished loaf with straight sides.  A small batch of 4-1/2 inch depth by 4-1/4 inch width by 8-1/2 inch and 13 inch length tapered heavy duty 16 gauge solid aluminum loaf pans were custom made by a USA baking pan manufacturer for this author to sell online.  These long-life, heavy duty pans were ideal, but, unfortunately, high cost and price made for underwhelming online sales.  The website was shut down years ago.  However, a cheaper 13 inch long by 4 inch width by 4 inch depth aluminum-coated, folded thin steel pullman loaf pan should be adequate for the recipe which later follows.  The cover is not needed.  The following pans are suggested:  USA Pan 13x4x4 Large Pullman Loaf Pan & Cover 1160PM-1 [6] or Chicago Metallic 44615 Pullman pan,single 13x4x4 [7].
    Xanthan Gum and Konjac Glucomannan
    In the early development of oat and einkorn bread recipes, xanthan gum caused some problems.  The use of xanthan gum alone often produced strange odd loaf shapes with concave sides.  In one case an extra added teaspoon of xanthan gum caused the loaf to balloon well above the 4-1/2 inch deep loaf pan.  When done, the sides of the loaf were sucked inwards and a cross section of loaf had the appearance of a giant mushroom.  Konjac glucomannan powder [8] was then investigated.  Konjac glucomannan is a natural, odorless soluble fiber that is found in the konjac plant and is the most viscous hydrocolloid available.  Konjac used by itself produces a very firm loaf and restricts the bread height and volume.  Xanthan gum produces a softer, more elastic bread.  Konjac used together with xanthan gum have a synergy which allows the firmness of bread to be adjusted depending on their ratio and amounts.  Konjac also "tames" xanthan gum so that the loaf has straight sides instead of turning into a mushroom.  For a long time, 1-1/2 teaspoons each of konjac powder and xanthan gum, a one to one ratio, was used in the standard GF bread recipe.  But this ratio and amount always resulted in at least some sinking in the center of the loaf.  Recalling that additional xanthan gum creates a "mushroom" effect which results in a rounded top, the ratio was changed to 3 teaspoons of xanthan gum and 1 teaspoon konjac powder.  This worked, resulting in a loaf with a slightly rounded or flat top, no longer sinking in the center.  Psyllium husk was never tried as it generally decreases bread volume and height, not the desired effect [9].
    Attempts That Did Not Work
    For years a standard GF bread recipe consisting of oat flour, sorghum flour, tapioca starch, potato starch, flaxseed, banana, low fat vanilla yogurt, molasses, sugar, canola margarine, cinnamon, ginger, salt, yeast, xanthan gum, konjac powder, apple cider vinegar, and water became standard daily fare.  This recipe provided an acceptable GF bread, but was by no means perfect.  It tended to crumble, required delicate handling, sank in the center, and had less volume and height than desired. It was not vegan or dairy free, and its taste could stand improvement.  Deciding it was time for a change, numerous attempts to fix these short-comings were made.  The attempts that failed included using citrus pectin, sugar beet fiber, gum arabic, and aquafaba (liquid from cooked chickpeas).  High methoxyl citrus pectin did succeed in increasing height and volume and reducing crumbling, but its strong, bitter taste made it totally unacceptable.
    Choosing the Best GF Starches - Arrowroot and Potato Starch: Yes - Tapioca: No
    After the previous failures, investigations focused on how choice of starch affects GF bread volume. One especially interesting published research paper looked at GF breads made using a single starch in place of flour [10].  The study compared breads made with wheat, potato, tapioca, corn, and rice starch.  Only wheat and potato starch produced any real bread structure.  Corn starch had some bread structure.  Tapioca and rice starch produced structures too far gone to be fully analyzed in the study.  Tapioca starch produced a shapeless blob.  Rice starch produced a crust circling a large empty center.  The study revealed that potato starch would be the best GF starch for achieving greater volume and preventing sinking in the center.  Unfortunately, the study did not look at arrowroot starch which later was found to be superior to tapioca starch.
    The standard oat/sorghum GF bread recipe used equal amounts of potato and tapioca starch.  Two baking tests with these starches were performed using the standard GF bread recipe.  One test used 3 parts potato to 1 part tapioca starch and the other test used 1 part potato to 3 parts tapioca starch.  The test favoring potato starch produced a higher volume and height bread with reduced center sinking, as expected.  The test favoring tapioca starch resulted in a drop in volume and height with increased center sinking.  Potato starch has a bland, supposedly neutral taste.  In the test favoring potato starch the "bland" taste dominated the entire taste of the bread covering up the taste of all other ingredients including molasses, spices, and banana, oats and sorghum, a totally unacceptable result.  In the test favoring tapioca starch, a slight off taste was noted, but, worse, when toasted, the tapioca caused increased burning of the crust  resulting in a bitter crust taste.  It was concluded one should not make excessive use of potato starch and that tapioca starch may not be the best choice for a starch.  This led to arrowroot starch as the next subject for investigation.
    Arrowroot and tapioca starches appear to be very similar.  They definitely are not.  Two baking tests were performed with arrowroot and potato starch.  One test used 3 parts arrowroot to 1 part potato starch and the other test used equal parts of arrowroot and potato starch.  In the test favoring arrowroot starch, the bread did not sink in the center or lose as much volume as when tapioca starch was favored.  When toasted, the crust did not burn as with tapioca starch or produce any bitterness.  Arrowroot starch also had no off taste as with tapioca starch.  In the test with equal parts arrowroot and potato starch, there was a slight improvement in volume and less center sinking than with tapioca and potato starch at equal parts.  The conclusion was that arrowroot starch is a superior choice over tapioca starch.  Arrowroot may cost more than tapioca starch, but arrowroot starch now replaces tapioca starch as the preferred choice for a perfect GF bread recipe.  Arrowroot starch can be found online in bulk at reasonable prices.
    Buckwheat - The Key to Volume, Height, Amazing Taste and a Bread That Does Not Sink or Crumble
    Still seeking the key to increasing bread volume and height, the world wide web was scoured for ideas.  Intrigued by the impressive volume and height of GF breads made with buckwheat and rice flours by Strange Grains Gluten Free Bakery [11] in Perth, Australia, the question was asked, "Could buckwheat be the key?"  Buckwheat had previously been rejected from consideration in the course of earlier oat bread recipe development due to a strong, unpleasant bitter taste.  It turns out however, toasted buckwheat groats (kasha) were unknowingly used in that earlier trial years ago, a very bad and unfortunate choice.  The world wide web provides many learning opportunities, one being that buckwheat flour does not have to taste awful.
    Buckwheat flour can be ground from three different forms of buckwheat, each having a completely different taste.  The three forms are: 1) whole unhulled buckwheat; 2) raw dehulled buckwheat or buckwheat groats; 3) toasted buckwheat groats or kasha.  The familiar earthy slightly bitter taste comes from the buckwheat hulls.  In fact, some whole buckwheat flour contains added ground hulls for a stronger earthy flavor.  The hulls create a greyish colored flour.  Buckwheat groats are dehulled buckwheat seeds.  Dehulling removes the source of the familiar earthy flavor.  Flour from raw buckwheat groats has a creamy white color and a very mild sourdough rye flavor acceptable to just about everybody except for those who really miss having that earthy buckwheat hull flavor.  Kasha or toasted buckwheat groats, on the other hand, has an extremely strong taste and odor that is popular in some cultures, but absolutely repulsive to most people.  Kasha has a taste slightly suggestive of rye on the plus side but an odor strongly reminiscent of rotting food waste on the minus side.  Kasha can easily be made by stirring raw buckwheat groats in a pan on medium heat for about 5 minutes until evenly brown and "fragrant".  If the "fragrance" drives you out of your house into a freezing snowstorm, then you probably won't like kasha.  Actually, after about a week of storage in a plastic bag in the refrigerator, the odor of rotting waste in bread made with kasha flour dissipates leaving the desirable sourdough rye flavor.
    Buckwheat flour can easily be made by grinding groats or whole buckwheat in a coffee grinder.  Raw buckwheat groat flour is not readily available, especially gluten free certified flour, so a coffee grinder is needed.  Gluten free whole buckwheat and raw buckwheat groats are readily available.  Bob's Red Mill whole buckwheat flour is NOT certified gluten free (its groats are) but Anthony's Goods has certified gluten free whole buckwheat flour.  Whole Foods has raw buckwheat groats in the bulk section at a very reasonable price.  Bulk raw buckwheat groats are available online at reasonable prices. 
    To test if buckwheat was the key to a perfect GF bread, a blend of one cup each of buckwheat, oat, and sorghum flours together with 2/3 cup each of potato and arrowroot starches went into the bread dough for the baking test.  The buckwheat flour made the dough much more workable and elastic.  Into to oven it went.  The result?  Success!  Buckwheat indeed proved to be the missing key.  The bread volume and height increased, reaching just over 4 inches tall.  The use of 3 teaspoons xanthan gum and 1 teaspoon konjac powder contributed to a loaf with a slightly rounded top and absolutely no sinking in the center.  The bread did not crumble.  The rye-like taste was amazing.  Why did buckwheat work?  Buckwheat, like flaxseed, contains mucilage, and that slimy fiber likely gives buckwheat flour its high viscosity and unique baking properties [12].
    Making GF Bread Dairy Free
    The final challenge was making the GF bread recipe vegan and dairy free.  Low fat vanilla yogurt had been used to increase bread volume and protein.  A substitute was needed.  The latest trend in protein supplements is yellow pea isolate [13,14].  Yellow pea's protein amino acid profile compares favorably to that of dairy whey although it is not a totally complete protein.  One study determined yellow pea protein added to GF bread had the highest level of sensory perception consumer acceptance compared to other proteins added to GF bread [15].  Yellow pea protein has also been used as the basis for a dairy free milk made by Ripple Foods [16].  Yellow pea protein is available from a number sources including Anthony's Goods, Bob's Red Mill, and Bulk Food Supplements.  For the new GF bread vegan recipe, 2/3 cup of low fat vanilla yogurt was replaced with 1/4 cup yellow pea protein isolate powder plus 5 oz water.  Yellow pea is a legume.  If you have allergies to soy or peanuts (also legumes) use with caution, though yellow pea is considered to be much less likely to be an allergen.  The yellow pea protein powder can be omitted with little effect on the overall GF bread recipe.  Just replace it with another heaping tablespoon each of buckwheat, oat and, sorghum flours to maintain bread volume.
    Another vegan consideration is choice of oil.  Canola oil, olive oil, coconut oil or a vegan buttery flavored spread like Smart Choice Original or Earth Balance Soy Free can be used.  Smart Choice Original and Earth Balance Soy Free use yellow pea protein in place of dairy whey and sunflower lecithin in place of soy lecithin.
    Molasses or Maple Syrup?
    Molasses is used in the standard GF bread recipe to achieve a satisfying robust rye flavor.  For an alternative subtle, delicate, sweet maple taste, grade A very dark and strong flavor maple syrup can be used in place of the molasses and granulated sugar.  Pure maple syrup is a very pricey ingredient.  The subtle change in taste using maple syrup may not really be worth the syrup's high cost, but the option is included in the recipe below, nonetheless.  Maple syrup is sold in four grades:  grade A golden color and delicate taste; grade A amber color and rich flavor; grade A dark color and robust flavor; and grade A very dark and strong flavor.  Only use grade A very dark and strong flavor maple syrup for baking.  The maple flavor of lighter shades of maple syrup is too weak to be tasted when used in most baked goods.  The money spent using lighter shades of pricey maple syrup will only be wasted.  Grade A very dark and strong flavor maple syrup is mostly used for cooking and not available in most grocery stores.  It is readily available online and direct from maple syrup farms.  Shipping from the east coast to the west coast may cost more than the maple syrup itself.  Try to find an online deal with free shipping.
    RECIPES
    Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread
    This recipe produces a 56 ounce (1.588 kg) gluten free bread loaf yielding 28 slices 7/16 inch (11.11 mm) thick.  Preparation time is about 2 hours 15 minutes.  Baking time is 1 hour 40 minutes.
    Kitchen Essentials:
    Coffee grinder (preferably burr-type) Electric mixer (preferably a stand mixer) Mixing bowl Pullman loaf pan, 13 inch x 4 inch x 4 inch (33.02 cm x 10.16 cm x 10.16 cm) Lidded 2 quart/liter (or larger) plastic food container Quart/liter glass or plastic measuring cups (2) 5 ounce (150 ml) glass measuring cup Potato/banana masher, ricer or food processor Hard rubber bowl scraper, specifically Rubbermaid FG1901000000 Scraper 9-1/2 inch 1 inch pastry brush A good set of stainless steel measuring cups and spoons 10 inch x 14 inch (25.4 cm x 35.56 cm) plastic food storage bags with twist ties Cooling rack Dry Ingredients:
    1 cup (240 ml) oat flour 1 cup (240 ml) sorghum flour 1 cup (240 ml) buckwheat flour milled from raw dehulled buckwheat groats 2/3 cup (160 ml) potato starch 2/3 cup (160 ml) arrowroot starch ~3/4 cup (180 ml) (approx.) milled flaxseed freshly ground from 1/2 cup (120 ml) whole flaxseed 1/4 cup (60 ml) yellow pea protein isolate powder (* can be replaced with 1 heaping tablespoon (20 ml) each of oat, sorghum and buckwheat flour) 2 tablespoons (30 ml) granulated sugar (* omit granulated sugar if using maple syrup in place of molasses) 2 tablespoons (30 ml) caraway seed (* optional for deli rye flavor) 1-1/2 (7.5 ml) teaspoons salt 1-1/2 (7.5 ml) teaspoons ground cinnamon 1-1/2 (7.5 ml) teaspoons ground ginger 1 teaspoon (5 ml) baking soda 3 teaspoons (15 ml) xanthan gum 1 teaspoon (5 ml) konjac glucomannan powder 4 teaspoons (20 ml) fast acting yeast Wet Ingredients:
    2 cups (480 ml) cold water to mix with milled flaxseed Additional water to mix with mashed banana and molasses (or maple syrup) to achieve 2 cups total mixture ~1 cup (240 ml) (approx.) mashed ripe banana (2 medium to large bananas) 4-1/2 tablespoons (67.5 ml) molasses, unsulphured, mild (or full flavor) to one's taste  (* Alternately, omit molasses and use 3/4 cup (180 ml) maple syrup, grade A very dark and strong flavor) 2 + 1 tablespoons (30 + 15 ml) canola, olive or melted coconut oil or melted vegan buttery flavored spread Additional oil or vegan spread to grease loaf pan 1 teaspoon (5 ml) apple cider vinegar (as an antimicrobial, anti-mold agent) Directions:
    1. Grind enough raw dehulled buckwheat groats in a coffee grinder to make 1+ cups (260 ml) buckwheat flour.
    2. Grind 1/2 cup (120 ml) whole flaxseed in a coffee grinder.
    3. Place 2 cups (480 ml) COLD water in a quart/liter measuring cup and stir in the ground flaxseed with a fork.
    4. Heat water and flaxseed mixture in a microwave oven until near boiling.  Let steep for 10 to 20 minutes.
    5. Combine all dry ingredients EXCEPT flaxseed into a lidded 2 quart/liter (or larger) plastic food container.
    6. Thoroughly shake and blend dry ingredients together in the food container holding lid down securely.
    7. Mash, rice, or puree 2 medium to large bananas into a separate quart/liter measuring cup.
    8. Using 5 ounce (150 ml) glass measuring cup, warm 4-1/2 tablespoons (67.5 ml) molasses in microwave oven to thin and add to mashed bananas, or, in place of molasses, add 3/4 cup (180 ml) maple syrup to mashed bananas 
    9. Add enough water to the bananas and molasses (or maple syrup) and stir together so that the liquid mixture measures 2 cups (480 ml).
    10. Warm up the banana molasses (or maple syrup) mixture in a microwave oven for 2-3 minutes.
    11. Melt 2 tablespoons (30 ml) of coconut oil or vegan spread in a microwave oven in a small bowl, if these oils used.
    12. Stir banana molasses (or maple syrup) mixture and steeped flaxseed into a mixing bowl.
    13. Add 2 tablespoons (30 ml) oil plus 1 teaspoon (5 ml) apple cider vinegar to the mixing bowl.
    14. Grease a 13 inch x 4 inch x 4 inch pullman loaf pan.  Use a pastry brush for applying liquid oil.
    15. Using an electric mixer with a dough hook, blend liquids for 1-2 minutes at a high medium speed.
    16. Stop mixer and add dry ingredients to the bowl. Start mixing at low speed for 15 seconds, then increase to a low medium speed and mix for 16 minutes to a smooth, thick, moist (not wet), elastic dough consistency.
    17. Preheat oven to 300-325° F (150-160° C).
    18. Using a hard rubber bowl scraper, transfer dough from mixing bowl to the greased pullman loaf pan.
    19. Plunge the hard rubber bowl scraper up and down in the dough to level and even out the dough.
    20. Melt remaining 1 tablespoon (15 ml) coconut oil or vegan spread in the microwave in a small bowl, if oils used.
    21. Use a pastry brush to spread 1 tablespoon (15 ml) oil on top of the dough.  Smooth and round the top of the dough with the pastry brush.
    22. Allow the dough to rise to just above the top of the pullman loaf pan.
    23. Place the pullman loaf pan (uncovered) in the preheated oven and bake for 1 hour 40 minutes maintaining an oven temperature slightly above 300° F (150° C) to avoid burning the crust.
    24. When done, remove loaf pan from oven and allow the loaf to cool in pan for only about 10 minutes to avoid the crust becoming soggy from trapped pan moisture.
    25. Remove loaf from pan, tapping pan bottom corner edges on counter to loosen loaf.  Transfer loaf to cooling rack.
    26. Allow bread to cool to room temperature before slicing the loaf into 2 halves with a sharp, smooth edged (not serrated) slicing knife.
    27. Store each loaf half in 10 inch x 14 inch plastic food storage bags with twist ties and place in the refrigerator.
    28. If you can wait, keep it in the refrigerator overnight before consuming.  The bread taste and texture actually improve overnight as it firms up in the fridge.  When firm, the bread can easily be sliced nearly paper thin without falling apart.  The bread will keep fresh in the fridge for well over 2 weeks and seems to improve in taste as it ages.  
     
    Quick and Easy Gluten Free Mini Pizzas
    Making mini pizzas using bread slices for crusts is nothing new.  But finding a GF bread suitable for a pizza crust is somewhat elusive.  Just finding a GF bread with tall enough slices is a challenge.  The Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread presented above works great!  Its full size slices, taste, and texture make for a wonderful mini crust upon which to build an easy, tempting GF mini pizza. 
    The recipe is simple.  Key to this recipe is the use of a cooling rack on top of a metal baking sheet.  The cooling rack raises the pizza crust above the surface of the baking sheet allowing hot oven air to circulate under the crust.  This keeps the crust dry and crispy, preventing the crust from getting soggy due to moisture trapped between the crust and baking sheet. 
    Directions for one 2-slice pizza serving:
    Prepare or slice any toppings you desire. Preheat the oven to 450° F (232° C). Toast 2 slices of Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread to a golden brown. Place toast on top of a cooling rack sitting on top of a metal baking sheet. Spread a generous tablespoon of your favorite pizza sauce, canned or homemade, on each slice. Spread a layer of shredded mozzarella cheese on top of the sauce, about 1/3 cup (80 ml) per slice. Spread any other cheeses, such as diced or shredded sharp cheddar, on top of the mozzarella. Add your toppings and a touch more mozzarella. Slide the mini pizzas, cooling rack, and baking sheet together into the hot oven. Bake for 9 minutes until cheese melts and bubbles. Slide the baking sheet and rack out from the oven and transfer pizzas to a plate using a metal spatula. Serve. About Gluten Free Toasters
    Toasting gluten free bread in a typical kitchen 2 or 4-slice toaster cannot be completed in one toasting cycle.  To achieve a golden brown toast requires 2 or even 3 toaster cycles.  Typical toasters provide toasting times of no more than 2-1/2 minutes maximum per cycle.  A few more expensive toasters can toast up to 3 minutes.  It is common for GF breads to require a single cycle toasting time of more than 5 minutes to toast golden brown.  It takes 5 minutes 15 seconds starting in a cold 1000 watt kitchen toaster to toast slices of Oat-Sorghum-Buckwheat-Banana-Flaxseed GF Bread to a golden brown in a single cycle.  
    A toaster-oven can provide a longer single cycle toasting time, but may require 10 minutes or longer to toast GF bread golden brown.  A toaster-oven is less efficient for toasting bread than a 2 or 4-slice toaster because it must heat up a much larger volume than a 2 or 4-slice toaster which has heating elements up against the bread.
    A few manufacturers have provided toasters with a "Gluten Free" button to extend the maximum single cycle toasting time.  These include Crux 2 and 4-Slice Toasters [17] available exclusively at Macy's, Bella Pro Series and Ultimate Elite 2 and 4 Slice Toasters [18,19], and the Williams Sonoma Open Kitchen 2-Slice Stainless Steel Toaster [20].  There are several problems with these toasters.  First, the maximum toasting times on the "Gluten Free" setting are still not long enough.  Maximum toasting times provided by Bella for its Ultimate Elite Toaster are 3 minutes 50 seconds for the "Gluten Free" setting and 4 minutes 20 seconds for the "Gluten Free" + "Frozen" setting.  Second, a gluten-free toaster for celiacs, by necessity, must be used exclusively for GF breads to avoid wheat contamination.  A gluten free toaster does not need a "Gluten Free" button.  A gluten free toaster simply requires a 6 minute maximum toasting time to adequately toast gluten free breads.  One should not have to remember to push a "Gluten Free" button every time they toast bread.  Is it so hard for manufacturers to offer a toaster with a 6 minute timer? 
    For those with some basic electronic technical skills, there is a relatively easy solution to having a toaster with a sufficiently long 6 minute maximum toasting time for GF bread.  The electronic toaster controller board in a toaster can be modified to extend the maximum toasting time by simply replacing a resistor and/or a capacitor on the board.  First one needs to find a toaster in which the controller board can easily be accessed.  It turns out the Nesco T1000 toaster [21] is well-suited to the task.  As toasters go, almost all are made in China and tend to have a high percentage of manufacturing defects per customer product reviews.  The Nesco T1000 is a nice looking, sturdy toaster with nice features.  With the right screwdriver to remove the "tamper proof" screws, the controller board is easy to get to and easy to modify.  The only flaw in the Nesco T1000 is that the toasting time is shorter in a hot Nesco T1000 toaster than the toasting time in a cold Nesco T1000 toaster at the same browning setting, resulting in inconsistent browning.  If toasting always begins in a cold toaster, browning is always consistent, and the browning setting need never be touched to achieve the same results every time.
    Below, instructions on modifying the Nesco T1000 are provided.  A modified Nesco T1000 toaster has been perfectly toasting GF bread daily for over 4 years without a single problem.  These notes are of a technical nature.  Modifying the Nesco T1000 toaster will void the warranty.  Any modifications you perform are done so at your own risk.  If you are not familiar with electronic components or a soldering iron, do not attempt the modification.  Find a friend or someone with the technical skills if you wish to have a modified Nesco T1000 toaster.  

    Nesco T1000 Toaster Tech Notes - How to Increase the Toasting Cycle Time
    Summary:
    The browning control circuit of the Nesco T1000 toaster is designed around the AO201D toaster controller chip, an 8-pin DIP integrated circuit.  Toaster cycle timing is achieved by adjusting the frequency of a timer oscillator on board the AO201D via an external RC circuit.  The frequency is inversely proportional to RC.  Increasing R (resistance) and/or C (capacitance) decreases frequency and increases the toasting cycle time.  R in the Nesco toaster is a summation of a 250k potentiometer (variable resistor) in parallel with a 390k resistor (R6) in series with a 68k thermistor (NTC) in parallel with a 180k resistor (R5).  C is a .033µf capacitor (C3).  The Defrost button increases the toasting cycle time by switching in an additional .0047µf capacitor (C4) in parallel with C3.  The thermistor decreases the resistance as the toaster ambient temperature rises and is supposed to help stabilize the oscillator frequency which is affected by heat.  Ideally, temperature compensation provided by the thermistor and the AO201D should keep the oscillator frequency stable and browning shade the same from batch to batch as the toaster ambient temperature rises.  Unfortunately, in the Nesco toaster, the oscillator frequency becomes unstable and increases as the toaster heats up, significantly reducing the toaster cycle time when the toaster is hot compared to the cycle time of a cold toaster.  Hence, to maintain the same browning shade of a cold toaster, the browning control must be turned up higher when toasting in a hot toaster.  The modifications below will increase the original factory maximum toasting cycle time of about 2.5 minutes to about 5.5 minutes when the toaster is cold.  The Defrost button adds up to 30 seconds or so additional time.  (Note: There is no datasheet available online for the AO201D chip.  A datasheet in chinese is available for a similar MCU CMS12530 chip [22] with some diagrams and tables labelled in english.  The Pericom PT8A2514A toaster controller chip [23] is also of interest with an english datasheet and a timer that can be adjusted from 30 sec to 10 min.)
    Tools Required:
    TA23 triangle head screwdriver (Silverhill Tools ATKTR4 Triangle Head 5 Size Screwdriver Set) #1 Phillips head screwdriver Mini needle nose pliers Mini wire cutter 25 watt taper point soldering iron Desolder bulb, wick, or tool 60/40 Tin/Lead rosin core solder Parts Required:
    .02µf 25v to 100v ceramic or polyester film capacitor 68k 1/4-watt resistor (blue-gray-orange) Disassembly:
    Lay some newspaper or a towel on the work surface. Have a container handy to keep the small screws and parts from getting lost. Remove the crumb tray (which makes 2 tabs on the plastic base that slip under the shell lip more visible). Lay the toaster upside down on the work surface. Using the TA23 screwdriver, remove the tiny black screw from the bottom of the chrome pop-up lever knob. Insert a tool slightly larger than the TA23 screwdriver into the screw hole (the TA27 driver if you have it) and push  the black plastic insert out of the chrome portion of the pop-up lever knob to free the knob from the metal lever. Slip the knob off the metal pop-up lever. Remove the 4 triangle head screws which attach the black plastic base to the metal shell. Separate and lift the metal shell off the plastic base noting the 2 tabs that were under the crumb tray and the 4 metal tabs at the ends of the toaster slots that insert into small slots on top of the inner metal cage. Disconnect the 4-wire cable small white nylon connector connected to the browning control circuit board attached to the toaster shell. Completely separate the base and inner cage from the outer metal shell and set aside the base. Using the #1 Phillips screwdriver, remove the 2 broad head screws securing the insulation board to the browning control circuit board attached to the outer metal shell. Remove the 4 Phillips screws securing the browning control circuit board. Turn the browning control to an extreme so that you can easily realign it on reassembly. Lift up and slip the browning control circuit board from out behind the browning control knob and push buttons (the knob and buttons remain in place and do not have to be removed). Modifications:
    Desolder and remove the 390k resistor (orange-white-yellow) labelled R6 (no replacement needed). Desolder and remove the 180k resistor (brown-gray-yellow) labelled R5.  Replace R5 with a 68k 1/4-watt resistor (blue-gray-orange). Locate capacitor C3 (.033µf) which is numbered 2A333J. Turn the circuit board over and on the back side solder a .02µf 25v to 100v ceramic or polyester film capacitor across the two C3 capacitor connections keeping the .02µf capacitor flat against the circuit board and trimming off excess leads. Reassembly:
    Before reassembling, take a look at the pop-up lever spring mechanism and make sure the small metal plate beneath the lever properly aligns with the electromagnet arms when lowered.  If skewed, twist the the metal plate until it is properly aligned (the plate in my toaster was skewed at the factory which caused a glitch preventing the pop-up lever from latching when first testing the toaster out of the box). Reverse the steps used in disassembly. Be sure to reconnect the 4-wire connecter, use the 2 broad head screws for the insulator board, and carefully align and insert the 4 outer metal shell tabs into the inner metal cage slots. Make sure you properly align the small notch in the black plastic insert with metal pop-up lever notch before pressing it back into the chrome portion of the pop-up knob. Do not over-tighten the triangle head screws, especially the tiny black screw in the pop-up knob (tighten just enough to bottom-out the screw heads). Testing:
    Make sure all functions still work (you don't need bread in the toaster to test). Get a watch and time the toasting cycles at "1" and "6" settings both in hot and cold conditions (give the toaster plenty of time to cool to the touch for cold testing). At "1" you should get about 32 sec hot and 1 min 23 sec cold. At "6" you should get about 4 min 25 sec hot and 5 min 35 sec cold. Pressing the "Defrost" button will add additional time. SOURCES
    Prime Grains Inc. http://www.primegrains.com/about-us.htm Variation of Mucilage Content in the Flaxseed Coat;  Diederichsen A, Raney JP, Duguid SD; Saskatchewan Flax Grower Oct 2003 Vol 5 No 1 https://saskflax.com/quadrant/media/Pdfs/Newsletters/flaxfall03.pdf Variation of mucilage in flax seed and its relationship with other seed characters; Diederichsen A, Raney JP, Duguid SD; Crop Science Feb 2005 Vol 46 No 1, p 365-371 https://dl.sciencesocieties.org/publications/cs/abstracts/46/1/365 Selection for increased seed mucilage content in yellow mustard; J Philip Raney and Gerhard FW Rakow; (Describes method used for determining mucilage content in seed); The Regional Institute, Online Publications http://www.regional.org.au/au/gcirc/4/79.htm Farmer Direct Co-op http://www.farmerdirect.coop/ USA Pan 13x4x4 Large Pullman Loaf Pan & Cover 1160PM-1 https://www.usapan.com/13-x-4-x-4-large-pullman-loaf-pan-and-cover-1160pm Chicago Metallic 44615 Pullman pan,single 13x4x4 https://www.bundybakingsolutions.com/product/44615/ Konjac Glucomannan Powder http://www.konjacfoods.com/product/1.htm The Gluten-Free-Bread Baking-with-Psyllium-Husks-Powder Test by Annalise Roberts http://mygluten-freetable.com/2014/04/the-gluten-free-bread-baking-with-psyllium-husks-powder-test/ Fundamental Study on the Impact of Gluten-Free Starches on the Quality of Gluten-Free Model Breads; Horstmann SW, Belz MC, Heitmann M, Zannini E, Arendt EK; Foods. 2016 Apr 21;5(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5302342/pdf/foods-05-00030.pdf Strange Grains Gluten Free Bakery https://www.strangegrainsbakery.com.au/gluten-free-bread-perth Technological Properties of Pea and Buckwheat Flours and Their Blends; Ilze Beitane, Gita Krumina-Zemture, Martins Sabovics; Latvia University of Agriculture Research for Rural Development 2015, Annual 21st International Scientific Conference Proceedings Vol 1, p 137-42 http://llufb.llu.lv/conference/Research-for-Rural-Development/2015/LatviaResearchRuralDevel21st_volume1-137-142.pdf Northern Pulse Grower Association Pea Flour Brochure http://www.northernpulse.com/uploads\resources\661\pulse-flour-brochure.pdf USA Dry Pea & Lentil Council Brochures https://www.usapulses.org/brochures Non-gluten proteins as structure forming agents in gluten free bread; Ziobro R, Juszczak L, Witczak M, Korus J; J Food Sci Technol. 2016 Jan;53(1):571-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711467/pdf/13197_2015_Article_2043.pdf Ripple Foods Pea Milk https://www.ripplefoods.com/ Crux Toasters http://www.cruxkitchen.com/crux_toaster_2slice.php Bella Pro-Series Toasters https://bellahousewares.com/products-bella/?taxonomy=productscategories&term=pro-series Bella Ultimate-Elite Toasters https://bellahousewares.com/products-bella/ultimate-elite-collection-2-slice-digital-toaster/ Williams Sonoma Open Kitchen Toaster https://www.williams-sonoma.com/products/willaims-sonoma-open-kitchen-2-slice-stainless-steel-toaster/ Nesco T1000 2-Slice Toaster http://www.nesco.com/products/Small-Appliances/Toasters/TWO-SLICE-TOASTER-THUNDER-GREY/ MCU CMS12530 toaster controller chip (in chinese) http://mcu.com.cn/uploads/file/2015/20150819163253_26043.pdf Pericom PT8A2514A toaster controller chip https://www.diodes.com/assets/Datasheets/PT8A2514A.pdf

    Jefferson Adams
    Cornell University Takes Campus Dining Gluten-Free
    Image Caption: Image: CC--Ray Swi-hymn
    Celiac.com 06/28/2017 - Announcements from colleges revamping their dining halls to offer gluten-free and allergen-free foods to students, faculty and guests with food allergies or sensitivities are coming at a rapid clip. 
    The latest gluten-free feather in the cap goes to Cornell University, which has restructured its campus dining halls and food services to include 100-percent gluten-, tree nut- and peanut-free kitchens, including offering a new 100-percent plant-based burger at two campus locations.
    Cornell received its gluten-free facility certification from Kitchens with Confidence after cleaning or replacing equipment and meeting the rest of the qualifications for gluten-free certification. Still, even before the certification was official, Cornell had been quietly serving gluten-free dishes for the last two years.  During that time, Risley offered a stir-fry station that served only rice noodles, and also served rich brownies and fluffy biscuits made with gluten-free flour. 
    Risley’s plant-forward, made-from-scratch menu items also include house-made soups and salad dressings, and the introduction of a 100-percent plant-based Impossible Burger at two Cornell Dining eateries on campus. These initiatives are part of Cornell’s commitment to the Menus of Change principles of healthy, sustainable eating, including a focus on whole, minimally processed food and transparency in menu items. 
    As an additional part of that commitment, Cornell Dining will soon implement high-quality ingredient standards in several clean ingredient categories. The department's Clean Ingredients team has already changed more than 50 ingredients currently purchased, and is actively changing recipes at both the AYCTE locations and the retail eateries.
    Cornell Dining now oversees concession operations at Cornell Athletics facilities, while Cornell Catering manages events at Moakley House, offering snacks, meals and beverages at Big Red games, the winter season at Bartels Hall, and adding more concession sites for Cornell's spring sports season. 
    Meanwhile, Cornell Concessions will manage events at Moakley House, the clubhouse at Cornell University's Robert Trent Jones Golf Course. Students, faculty and visitors at Cornell can look for these gluten-free and other menu changes at all campus food locations and events.
    Look for stories like this to become commonplace as more colleges and universities provide accommodations for students, faculty and visitors with food allergies and sensitivities.

    Jefferson Adams
    What Can We Learn About Celiac Disease Mortality from Southern Derbyshire, UK?
    Image Caption: Death Valley. Image: CC--Peretz Partensky
    Celiac.com 06/27/2018 - Data shows that since celiac blood screening came into use, people with celiac disease are living longer, and dying of things not-related to celiac disease.
    With screening tests for celiac disease becoming more common, researchers suspected that milder cases of celiac disease coming to diagnosis might bring a reduced risk of mortality for celiac patients. However, there was no consensus for that opinion, so researchers Geoffrey K T Holmes and Andrew Muirhead of the Royal Derby Hospital, and the Department of Public Health for the Derby City Council, Derby, UK., recently set out to re-examine the issue in a larger number of patients for a further 8 years.
    For their study, the researchers prospectively followed celiac disease patients from Southern Derbyshire, UK, from 1978 to 2014, and included those diagnosed by biopsy and serology. For each patient, the researchers determined cause of death, and calculated standardized mortality ratios for all deaths, cardiovascular disease, malignancy, accidents and suicides, respiratory and digestive disease. 
    To avoid ascertainment bias, they focused analysis on the post-diagnosis period that included follow-up time beginning 2 years from the date of celiac disease diagnosis. They stratified patients by date of diagnosis to reflect increasing use of serological methods. Total all-cause mortality increase was 57%, while overall mortality declined during the celiac blood test era.
    Mortality from cardiovascular disease, specifically, decreased significantly over time, which means that fewer people with celiac disease were dying from heart attacks. Death from respiratory disease significantly increased in the post-diagnosis period, which indicates that people are living long enough to have lung problems.  The standardized mortality ratio for non-Hodgkin’s lymphoma was 6.32, for pneumonia 2.58, for oesophageal cancer 2.80 and for liver disease 3.10. 
    Overall, celiac blood tests have lowered the risk of mortality in celiac disease. The number of celiac patients dying after diagnosis decreased by three times over the past three decades. Basically, people with celiac disease are living longer, and dying of things unrelated to celiac disease, which is good news.
    The researchers see this data as an opportunity to improve celiac disease survival rates further by promoting pneumonia vaccination programs, and more swift, aggressive treatments for celiac patients with liver disease.
    Source:
    BMJ Open Gastroenterology

    Jefferson Adams
    The In Vitro Effects of Enzymatic Digested Gliadin on the Functionality of the Autophagy Process
    Image Caption: Image: CC--Pedro Ribeiro Simões
    Celiac.com 06/26/2018 - Gliadin is an alcohol-soluble wheat protein that is toxic for people with celiac disease. Gliadin toxicity is not lowered by digestion with gastro-pancreatic enzymes. It’s been documented that an innate immunity to gliadin plays a key role in the development of celiac disease. This is mainly due to an immune response that induces epithelial stress and reprograms intraepithelial lymphocytes into natural killer (NK)-like cells, leading to enterocyte apoptosis and an increase in epithelium permeability.
    A team of researchers recently set out to elaborate on the role played by innate immunity to gliadin in the development of celiac disease by assessing the in vitro effects of enzymatic digested gliadin on the functionality of the process of autophagy, or natural cell destruction.
    The research team included Federico Manai, Alberto Azzalin, Fabio Gabriele, Carolina Martinelli, Martina Morandi, Marco Biggiogera, Mauro Bozzola, and Sergio Comincini. They are variously affiliated with the Department of Biology and Biotechnology, and with the Pediatrics and Adolescentology Unit in the Department of Internal Medicine and Therapeutics at University of Pavia, Fondazione IRCCS, Pavia, Italy.
    They reported recently that the administration of enzymatically digested gliadin (PT-gliadin) in in Caco-2 cells significantly reduced the expression of the autophagy-related marker LC3-II. Moreover, analysis by electron and fluorescent microscope suggests a compromised functionality of the autophagosome apparatus. 
    The team established the rescue of the dysregulated autophagy process, along with a reduction of PT-gliadin toxicity, by using a starvation induction protocol, and by 3-methyladenine administration. Rapamycin, a well-known autophagy inducer, did not trigger significant improvement in the clearance of extra- and intra-cellular fluorescent PT-gliadin amounts. 
    These results show the potential role of the autophagy process in the degradation and reduction of extra-cellular gliadin peptides, and provides new molecular targets for counteracting adverse gliadin reactions in celiac patients.
    Source:
    Int J Mol Sci. 2018 Feb; 19(2): 635. doi:  10.3390/ijms19020635

    Jefferson Adams
    Three Ways Health Practitioners Can Help Spot Celiac Disease and Improve Gluten-Free Living
    Image Caption: Image: CC--Conor Lawless
    Celiac.com 06/25/2018 - The latest studies show that celiac disease now affects 1.2% of the population. That’s millions, even tens of millions of people with celiac disease worldwide. The vast majority of these people remain undiagnosed. Many of these people have no clear symptoms. Moreover, even when they do have symptoms, very often those symptoms are atypical, vague, and hard to pin on celiac disease.
    Here are three ways that you can help your healthcare professionals spot celiac disease, and help to keep celiacs gluten-free: 
    1) Your regular doctor can help spot celiac disease, even if the symptoms are vague and atypical.
    Does your doctor know that anemia is one of the most common features of celiac disease? How about neuropathy, another common feature in celiac disease? Do they know that most people diagnosed with celiac disease these days have either no symptoms, or present atypical symptoms that can make diagnosis that much harder? Do they know that a simple blood test or two can provide strong evidence for celiac disease?
    People who are newly diagnosed with celiac disease are often deficient in calcium, fiber, folate, iron, magnesium, niacin, riboflavin, vitamin B12, vitamin D, and zinc. Deficiencies in copper and vitamin B6 are less common, but still possible. Also, celiac disease is a strong suspect in many patients with unexplained nutritional anemia. Being aware of these vague, confusing symptoms of celiac disease can help people get bette advice, and hopefully speed up a diagnosis.
    2) Your dentist can help spot celiac disease
    Does your dentist realize that dental enamel defects could point to celiac disease? Studies show that dental enamel defects can be a strong indicator of adult celiac disease, even in the absence of physical symptoms. By pointing out dental enamel defects that indicate celiac disease, dentists can play an important role in diagnosing celiac disease.
    3) Your pharmacist can help keep you gluten-free
    Does your pharmacist know which medicines and drugs are gluten-free, and which might contain traces of gluten? Pharmacists can be powerful advocates for patients with celiac disease. They can check ingredients on prescription medications, educate patients to help them make safer choices, and even speak with drug manufacturers on patients’ behalf.
    Pharmacists can also help with information on the ingredients used to manufacture various vitamins and supplements that might contain wheat.
    Understanding the many vague, confusing symptoms of celiac disease, and the ways in which various types of health professionals can help, is a powerful tool for helping to diagnose celiac disease, and for managing it in the future. If you are suffering from one or more of these symptoms, and suspect celiac disease, be sure to gather as much information as you can, and to check in with your health professionals as quickly as possible.

    Jefferson Adams
    Green Chili Enchiladas with Chicken and Roasted Cauliflower (Gluten-Free)
    Image Caption: Image: CC--Dennis M
    Celiac.com 06/23/2018 - If you’re looking for a great gluten-free Mexican-style favorite that is sure to be a big hit at dinner or at your next potluck, try these green chili enchiladas with roasted cauliflower. The recipe calls for chicken, but they are just as delicious when made vegetarian using just the roasted cauliflower. Either way, these enchiladas will disappear fast. Roasted cauliflower gives these green chili chicken enchiladas a deep, smokey flavor that diners are sure to love.
    Ingredients:
    2 cans gluten-free green chili enchilada sauce (I use Hatch brand) 1 small head cauliflower, roasted and chopped 6 ounces chicken meat, browned ½ cup cotija cheese, crumbled ½ cup queso fresco, diced 1 medium onion, diced ⅓ cup green onions, minced ¼ cup radishes, sliced 1 tablespoon cooking oil 1 cup chopped cabbage, for serving ½ cup sliced cherry or grape tomatoes, for serving ¼ cup cilantro, chopped 1 dozen fresh corn tortillas  ⅔ cup oil, for softening tortillas 1 large avocado, cut into small chunks Note: For a tasty vegetarian version, just omit the chicken, double the roasted cauliflower, and prepare according to directions.
    Directions:
    Heat 1 tablespoon oil in a cast iron or ovenproof pan until hot.
    Add chicken and brown lightly on both sides. 
    Remove chicken to paper towels to cool.
     
    Cut cauliflower into small pieces and place in the oiled pan.
    Roast in oven at 350F until browned on both sides.
    Remove from the oven when tender. 
    Allow roasted cauliflower to cool.
    Chop cauliflower, or break into small pieces and set aside.
    Chop cooled chicken and set aside.
    Heat 1 inch of cooking oil in a small frying pan.
    When oil is hot, use a spatula to submerge a tortilla in the oil and leave only long enough to soften, about 10 seconds or so. 
    Remove soft tortilla to a paper towel and repeat with remaining tortillas.
    Pour enough enchilada sauce to coat the bottom of a large casserole pan.
    Dunk a tortilla into the sauce and cover both sides. Add more sauce as needed.
    Fill each tortilla with bits of chicken, cauliflower, onion, and queso fresco, and roll into shape.
    When pan is full of rolled enchiladas, top with remaining sauce.
    Cook at 350F until sauce bubbles.
    Remove and top with fresh cotija cheese and scallions.
    Serve with rice, beans, and cabbage, and garnish with avocado, cilantro, and sliced grape tomatoes.

     

    Roxanne Bracknell
    The Top 10 Food Cities for Gluten-Free Diets
    Image Caption: Image Above: CC--Mark Gunn
    Celiac.com 06/22/2018 - The rise of food allergies means that many people are avoiding gluten in recent times. In fact, the number of Americans who have stopped eating gluten has tripled in eight years between 2009 and 2017.
    Whatever your rationale for avoiding gluten, whether its celiac disease, a sensitivity to the protein, or any other reason, it can be really hard to find suitable places to eat out. When you’re on holiday in a new and unknown environment, this can be near impossible. As awareness of celiac disease grows around the world, however, more and more cities are opening their doors to gluten-free lifestyles, none more so than the 10 locations on the list below.
    Perhaps unsurprisingly, the U.S is a hotbed of gluten-free options, with five cities making the top 10. Chicago, in particular, is a real haven of gluten-free fare, with 240 celiac-safe eateries throughout this huge city. The super hip city of Portland also ranks highly on this list, with the capital of counterculture rich in gluten-free cuisine, with San Francisco and Denver also included. Outside of the states, several prominent European capitals also rank very highly on the list, including Prague, the picturesque and historic capital of the Czech Republic, which boasts the best-reviewed restaurants on this list.
    The Irish capital of Dublin, meanwhile, has the most gluten-free establishments, with a huge 330 to choose from, while Amsterdam and Barcelona also feature prominently thanks to their variety of top-notch gluten-free fodder.
    Finally, a special mention must go to Auckland, the sole representative of Australasia in this list, with the largest city in New Zealand rounding out the top 10 thanks to its 180 coeliacsafe eateries.
    The full top ten gluten-free cities are shown in the graphic below (Image Below:  https://www.travelsupermarket.com/en-gb/holidays/gluten-free-cities/):

     

    Jefferson Adams
    Would You Buy a Gluten-Free House? 
    Image Caption: Image: CC--Reza Etemad
    Celiac.com 06/21/2018 - Would you buy a house advertised as ‘gluten-free’? Yes, there really is such a house for sale. 
    It seems a Phoenix realtor Mike D’Elena is hoping that his trendy claim will catch the eye of a buyer hungry to avoid gluten, or, at least one with a sense of humor. D’Elena said he crafted the ads as a way to “be funny and to draw attention.” The idea, D’Elena said, is to “make it memorable.” 
    Though D’Elena’s marketing seeks to capitalizes on the gluten-free trend, he knows Celiac disease is a serious health issue for some people. “[W]e’re not here to offend anybody….this is just something we're just trying to do to draw attention and do what's best for our clients," he said. 
    Still, the signs seem to be working. D'elena had fielded six offers within a few days of listing the west Phoenix home.
    "Buying can sometimes be the most stressful thing you do in your entire life so why not have some fun with it," he said. 
    What do you think? Clever? Funny?
    Read more at Arizonafamily.com.

    Celiac.com Sponsor: Banner
    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
    Premium ingredients, bakeshop delicious recipes, and happy customers were our inspiration from the beginning— and are still the cornerstones of Bakery On Main today. We are a fiercely ethical company that believes in integrity and feels that happiness and wholesome, great tasting food should be harmonious. We strive for that in everything we bake in our dedicated gluten-free facility that is GFCO Certified and SQF Level 3 Certified. We use only natural, NON-GMO Project Verified ingredients and all of our products are certified Kosher Parve, dairy and casein free, and we have recently introduced certified Organic items as well! 
    Our passion is to bake the very best products while bringing happiness to our customers, each other, and all those we meet!
    We are available during normal business hours at: 1-888-533-8118 EST.
    To learn more about us at: visit our site.

    Jefferson Adams
    Celiac.com 06/20/2018 - Currently, the only way to manage celiac disease is to eliminate gluten from the diet. That could be set to change as clinical trials begin in Australia for a new vaccine that aims to switch off the immune response to gluten. 
    The trials are set to begin at Australia’s University of the Sunshine Coast Clinical Trials Centre. The vaccine is designed to allow people with celiac disease to consume gluten with no adverse effects. A successful vaccine could be the beginning of the end for the gluten-free diet as the only currently viable treatment for celiac disease. That could be a massive breakthrough for people with celiac disease.
    USC’s Clinical Trials Centre Director Lucas Litewka said trial participants would receive an injection of the vaccine twice a week for seven weeks. The trials will be conducted alongside gastroenterologist Dr. James Daveson, who called the vaccine “a very exciting potential new therapy that has been undergoing clinical trials for several years now.”
    Dr. Daveson said the investigational vaccine might potentially restore gluten tolerance to people with celiac disease.The trial is open to adults between the ages of 18 and 70 who have clinically diagnosed celiac disease, and have followed a strict gluten-free diet for at least 12 months. Anyone interested in participating can go to www.joinourtrials.com.
    Read more at the website for Australia’s University of the Sunshine Coast Clinical Trials Centre.

    Source:
    FoodProcessing.com.au

    Jefferson Adams
    Could Drinking Baking Soda Fight Celiac and Other Autoimmune Diseases?
    Image Caption: Image: CC--Michael
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
    Those scientists recently gathered some of the first evidence to show that cheap, over-the-counter antacids can prompt the spleen to promote an anti-inflammatory environment that could be helpful in combating inflammatory disease.
    A type of cell called mesothelial cells line our body cavities, like the digestive tract. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.
    The team’s data shows that when rats or healthy people drink a solution of baking soda, the stomach makes more acid, which causes mesothelial cells on the outside of the spleen to tell the spleen to go easy on the immune response.  "It's most likely a hamburger not a bacterial infection," is basically the message, says Dr. Paul O'Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study's corresponding author.
    That message, which is transmitted with help from a chemical messenger called acetylcholine, seems to encourage the gut to shift against inflammation, say the scientists.
    In patients who drank water with baking soda for two weeks, immune cells called macrophages, shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. "The shift from inflammatory to an anti-inflammatory profile is happening everywhere," O'Connor says. "We saw it in the kidneys, we saw it in the spleen, now we see it in the peripheral blood."
    O'Connor hopes drinking baking soda can one day produce similar results for people with autoimmune disease. "You are not really turning anything off or on, you are just pushing it toward one side by giving an anti-inflammatory stimulus," he says, in this case, away from harmful inflammation. "It's potentially a really safe way to treat inflammatory disease."
    The research was funded by the National Institutes of Health.
    Read more at: Sciencedaily.com

    Jefferson Adams
    Research Indicates 1.4% of Humans Have Celiac Disease
    Image Caption: Image: CC--Kevin Gill
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

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