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  • Amie  Valpone
    Amie  Valpone

    Gluten-free Made Simple

    Reviewed and edited by a celiac disease expert.

    Journal of Gluten Sensitivity Autumn 2012 Issue

    Celiac.com 10/06/2017 - Gluten-free doesn't have to be complicated or confusing. It can be easy and delicious without thinking twice about the processed foods in the food stores. Simply eat Clean. What's Clean, you say? It's about eating real, wholesome, naturally gluten-free foods and steering clear of processed, packaged foods.

    My Clean eating philosophy is about fresh and simple ingredients. That's right, how about starting with some avocado, roasted turkey, fresh raspberries and balsamic vinegar that you can easily whip up in a food processor for a tasty turkey pate to use throughout the week with crudités or corn tortillas? It takes five minutes to make and you can store it in the fridge for a quick dose of protein any time of the day whether it be a meal or snack.

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    How about adding some to your morning omelet, spread it atop your afternoon sandwich with lettuce and tomato or added to your burritos for dinner? See how easy it can be? And guess what? It's naturally gluten-free and delicious. You don't have to think twice or worry about eating anything out of a box when you can visit your local farmers' market for fresh produce and your butcher for lean proteins such as turkey, chicken, bison and eggs.

    If you're a vegetarian or vegan, simply use tofu and you're all set. It's as easy as 1,2,3 and you've got a week's worth of eats to enjoy when your stomach starts rumbling. So, next time you are yearning for a processed food, think again and slice up some veggies to serve with your new pate recipe. Believe me I know first-hand about eating Clean as my whole approach to Clean eating started a few years ago when my body started reacting negatively to packaged foods. What helped me heal? Food. That's right. Real, Clean food; I have real food to thank. Because gluten-free is not about the gluten-free cookies and packaged, over-processed foods. It's about eating Clean. Eating fresh fruits and vegetables, lean proteins and healthy fats. That's exactly what I eat. I love it and I know you will to!

    Bon Appetite.

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  • About Me

    Amie  Valpone

    Amie Valpone, HHC, AADP is a Manhattan based Personal Chef, Culinary Nutritionist, Professional Recipe Developer and Food Writer specializing in easy Gluten-Free and Dairy-Free recipes. Amie is the Editor-in-Chief of the gluten-free blog, The Healthy Apple. Amie shares her passion for and approach to "Clean Eating" by focusing on natural, whole foods and ingredients that are good for you and your body. Amie works with Whole Foods Market as their Gluten-Free Manhattan Cooking Instructor and is a Gluten-Free Industry Innovator when it comes to helping clients, the community, companies and client live a healthy and happy life. Visit her site at: thehealthyapple.com.

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  • Related Articles

    Fawn Burgess, RN
    Celiac.com 12/23/2016 - Before my dog Amber's health started to fall apart, I had observed friends and family members on their gluten free journeys without ever considering this could be a solution for me. Years of periodic juice fasting, vegan and vegetarian diets, and then finally a GMO-free, semi-vegetarian lifestyle, had never led me to consider complete and total gluten free eating, until Amber.
    At nine years old she began to have a chronic yeast and skin infection and she stunk. Her stools became bloody, she was fat, her walking was slow and labored, and the vet said that if we didn't find out what was wrong with her soon she'd be dead within a year. He referred me to a woman in Eugene, OR who worked with animals and might know what I could do.
    The woman told me to immediately change her diet from dog food that contained grains, to gluten-free. She said that most retrievers and labs will carry on as if healthy for years with no issue, and then suddenly begin to fall apart when they reach senior ages. Their bodies can no longer tolerate gluten at that point, and a bundle of symptoms will appear.
    We began shopping at Animal Crackers, a store in town that sells a variety of high quality animal foods. Amber began eating gluten-free Orijen dog food, and within three months her skin lesions and yeast infection had healed. Also, all stink was gone, her stools were normal, and she was suddenly bounding around the park with puppy energy again. No doubt a dietary change had healed her.
    Soon afterward, at 47 years old, I suddenly decided to not eat anything with gluten in it. It wasn't even a plan or necessity, it was just like, one day I found myself buying gluten-free muffins and trying them. For some unexplainable reason I stuck to no gluten for a while, and by day three I noticed I was feeling happier.
    A lack of longing for traditional bread surprised me, because I love baking, and eating homemade bread. To omit my beloved goodies seemed extreme, and I was always of the opinion that organic and GMO-free wheat and gluten was sufficient unto itself, if one didn't have celiac disease.
    Yet here I was, day four and feeling fantastic. Actually, I wasn't sure what changes were occurring. I felt lighter, with an absence of discontent in my body. I experienced frequent bursts of 'anti-depression', akin to joyful energy rushes, which I never related to hyperactive sensations. Sleep became easy and relaxing. I would awaken with recharged emotional and physical well being. I began to crave junk food less, my stomach flattened, and all jitters went away. I found myself patiently standing in long lines, an unfamiliar feeling to me, and my mind cleared up, pleasurably.
    After about two weeks of observing these lovely 'feel-good' transformations, I discovered a divine intervention had occurred with bladder control. Years of frustration and concern, even discussions with a doctor about surgical intervention, had led me to believe that I was cursed with a life long issue of urinary stress incontinence. Yet, now I was noticing that a gluten-free change had all but dissolved my problem!
    Even as a 'wheat bellied' child I'd had incontinence issues, and this only exacerbated after two natural child births. Months of yoga, kegal exercises, and daily trampoline jumping helped some, but it never entirely went away. With a gluten-free dietary change, bloating and mild incontinence are now absent. This calm, non jittery, focused, new me, experimented ever so cautiously with jogging around the block, and nothing happened!
    About a month into it, I decided to eat a wheat bun with a hamburger, just to see if I would feel any different. After a couple hours, my mind went to dull and foggy mode, my body felt a little heavier and 'full', and what must have been a chronic urinary tract inflammation for years, returned again to nag at me. Minor leakage reared it's bothersome head again, but only for as long as it took to get gluten out of my system. The difference was like going from "Ah!" to "blah."
    A surprising factor in my gluten-free experience is that I've always been a healthy and happy person. I never seriously considered taking beloved gluten filled foods out of my diet, because I love those foods and never got sick eating them, OR so I thought. Aches and pains I figured were genetic curses, and part of my natural aging.
    Oh how wrong I was! After a year of gluten-free living, every organ in my body approves of this change, including bowels and nervous system. Best of all, I've experienced a seeming miraculous, non surgical intervention, with hardly any effort. And there's more to my story:
    Before gluten-free my cholesterol was high. I'd tried diet and natural supplements to no avail, and finally went on a statin medication to control it. It remained high and challenging until I changed my diet to gluten-free. With virtually no decrease in my fat intake, this life style change has brought the cholesterol level down. My latest labs shows normal levels, and once I accomplish a goal of eating more vegetables (than all these darn delicious gluten-free baked goods), and staying on a clean, low fat diet, I will explore going off cholesterol medication, once and for all.
    I continue to get caught up in all the numerous gluten-free pizza crust, pastry and bread recipes available. My salad creations are sorely neglected and I know this is my next challenge. But I won't beat myself up too much for enjoying this new exploration of 'all foods gluten free', (including beer- I recommend Omission).
    As for ever going backward, I have zero desire whatsoever, to return to a gluten filled lifestyle. I LOVE the way I feel now. When tempted by gluten-filled foods, I think of how I can now jog as long as I want to, with no leakage, for the first time in over twenty years. And I remember how surgery is out of the picture when it was once in my future, which is fantastic! I'm aware now that the source of my incontinence was a chronic, low level inflammation caused by gluten. The inflammation attacked various organs and areas all over my body, especially the bladder and urinary tract. Gluten even effected my cholesterol level in negative ways. So no way to that whole wheat bread, because I feel terrific now and I want to stay this way.

    Dr. Rodney Ford M.D.
    Celiac.com 04/08/2017 - "Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric" – Bertrand Russell.
    I would like to introduce the term "zero" when we talk about eliminating gluten. Precise language leads to precise action. Zero means none, not some.
    Yes, my recommendation is to change the gluten-language that we have been using. The meaning of the phrase 'gluten-free' has been diluted, so it almost has the connotation of 'not-much-gluten'. It suggests that 'a-little-gluten-does-not-matter' or 'you-are-free-to-give-up-gluten-if-you-want-to'.
    A much stronger expression is needed. I am changing the term 'gluten-free diet' to 'gluten-zero-diet'. This should change how people think about gluten.
    I am a paediatrician, so I see lots of sick children, and many of them are gluten-affected. Happily, they get better much more quickly, after going off gluten, than gluten-affected adults.
    I am a strong believer in putting these children on a gluten-free diet well before they end up with substantial gluten-related harm, and to spare them from years or even decades of gluten- induced symptoms. This means making an early diagnosis. It also means putting them on a gluten-zero-diet before they get the severe gut damage of celiac disease.
    The big question for the children, their parents, and me is "how gluten-free does he need to be?" and "for how long does he have to be gluten-free?" If you read my early books, I talk about eating gluten to tolerance. But I have completely changed my mind about that. My stance now is firmly zero-gluten.
    This might seem a radical position to take in the face of the FDA and other groups talking about 20 ppm as the okay level of gluten contamination. So, how can I justify my gluten-zero-diet opinion? I'll explain a little background information first.
    Do I have to go gluten-free?
    I am often asked if a gluten-free diet is the only way to manage celiac disease. Many of my families are initially resistant to the idea. This is no surprise because gluten-foods are all they know about. Actually, all they know about gluten is that they are just living like everyone else, mostly on wheat-derived foods. They have a food habit. They do not think much about what they are eating. They just eat what is cheap and convenient - that means wheat.
    But the simplistic answer to this question is "Yes! a zero-gluten diet is the answer." However, this is a complex question. So to broaden the question I have included all gluten-related disorders. I repeat, "Yes! A gluten-free diet is the central management strategy for celiac disease and gluten-related disorders."
    But what does a 'gluten-free diet' mean? How free-of-gluten do you have to be? To me, a gluten-free diet means zero-gluten for life – with no exemptions. Certainly there are many who suggest that people can eat gluten to tolerance. (I used to say this as well.) But now I strongly disagree. Any gluten has the potential to cause you harm.
    Get your gluten antibodies down
    Going on a gluten-free diet is more than just the eradication of gluten from your diet. Surprisingly, it is also about reducing the gluten antibodies that your immune system is churning out. Gluten can harm you in more ways than by a direct, or an immune effect, in your gut. Did you know that gluten can also cause you harm through the gluten antibodies that your body produces? (See the chapter on neurological harm.)
    There is growing evidence that the gluten antibodies (AGA – anti-gluten-antibody) are damaging to us, particularly to our neurological system. The research work done by Hadjivassiliou (2012) needs to be heeded.
    Think about why you get vaccinated. Vaccination is to keep you protected from bacteria and virus throughout your life. For this purpose, once you have stimulated antibody production by your immune system, whenever your body comes in contact with the identical stimulant again, your immune system begins to produce much more of this same antibody again.
    Most people get vaccinated against illnesses. For instance, most people have had their tetanus shot. This comprises a tiny amount of tetanus protein (the allergen), which stimulates your body to produce antibodies against the tetanus bacteria. This then protects you from tetanus infection for years to come. The vaccine is intended to stimulate your body to produce the anti-tetanus-antibodies, lifelong. To ensure this happens you will need to get a couple of booster shots during your lifetime.
    This also happens in gluten sensitization. So when you think about gluten, and the antibodies against gluten that your body is continually making, you can now understand that every time you eat gluten, by error or design, this will stimulate more gluten antibody production. And that is a very bad thing for you.
    It is crucial to reduce gluten antibody levels. Even a tiny amount of gluten is enough to stimulate ongoing antibody production, which is potentially harmful for your nerves and brain. The goal should be to get and keep your gluten antibodies down.
    Antibody reduction rather than just the elimination of gluten
    Hadjivassiliou, in his 1998, paper says, "These results strengthen our contention that eliminating these antibodies through strict adherence to a gluten-free diet may have important therapeutic implications for patients with gluten ataxia." Here the focus is on antibody reduction rather than just the elimination of gluten. Surely there is a strong case for investigating for gluten-sensitivity in all people with the likelihood of gluten-related disorders.
    Is 20 ppm really okay?
    Does a gluten-zero-diet literally mean no-gluten-at-all? Definitely, "Yes!"
    But the question everyone is asking is, "what does a gluten-zero-diet mean in terms of every-day practicality?"
    There is ongoing debate about how many parts per million (ppm) of gluten is acceptable in food. Pragmatically, because it is so difficult to get rid of cross-contamination in food production and processing, the number of 20 ppm is now surfacing as a 'reasonable' level of gluten to be consumed (some countries have 200 ppm, and the FDA is recommending 20 ppm). When you first hear about this number, it seems to be a negligible amount. However, there are still concerns for some people who seem to be exquisitely sensitive to gluten.
    For me, a gluten-zero-diet means 'no-gluten-at-all'. This can be achieved if you eat fresh fruits and vegetables, unprocessed meat and fish, uncontaminated rice, corn and other alternate grains, eggs, nuts and unprocessed dairy foods. This means no packet or processed foods – I have called this the no-packet-food-diet.
    Gluten-free is more than removing gluten
    It is a lot more than 'just' going gluten-free. Yes, there are many more things to do when healing someone with celiac disease/ gluten-related disorders. The longer you have had gluten-symptoms, the worse your body will be. More healing will be required. You may need additional minerals, vitamins and probiotics. There are many routine health checks to take. You should also ensure that your gut has healed (via blood test and, maybe, a repeat endoscopy).
    Advocating ZERO gluten
    Yes! I am a zero-gluten man. I advocate a gluten-zero-diet. This is based on the concern that tiny amounts of gluten in your food are enough to stimulate your immune system. Even if you are not feeling unwell from this apparently trivial exposure, your body could be getting sick. What seems trivial to you may not be trivial to your highly tuned and sensitized immune system.
    By definition, 'zero gluten' means ZERO! In other words – it is undetectable gluten (say less than 1 ppm – gluten detection is now getting down to these very low levels). Consequently, any food in which gluten can be detected (between 5–20 ppm should not be labeled gluten-free. This is because it is NOT gluten-free. It does contain (an apparently) trivial amount of gluten. These foods that contain 5–20 ppm need to be labelled 'contains gluten at levels 5–20 ppm'. We need to know exactly what is in our food. We need this information to make informed, healthy food choices.
    The main opposition to zero-gluten labeling comes from the food manufacturing and processing industries – not from the gluten-free community. Food companies say it is not practical or economic to make zero-gluten products. They claim that a 20 ppm is a realistic compromise. They say that 20 ppm is close enough.
    But this is not what the gluten-free community want: we demand "no-gluten-at-all". That is zero-gluten. The gluten-contaminated food chain needs to be entirely cleaned up. The zero-gluten market is growing. The gluten-free community does not want any gluten traces in their food.
    Gluten labeling: a two-tier approach
    In New Zealand, "Coeliac New Zealand" runs a gluten-logo program to give "consumers a quick reference point when shopping and faced with uncertainty about the genuine gluten-free status of a product." They have, very sensibly, adopted a two-tier system of certification (http://www.coeliac.org.nz/crossed_grain).
    Products carrying the 'Crossed-Grain-symbol' in addition to the words 'GLUTEN-FREE' adhere to the FSANZ standard of "No detectable gluten".
    Products carrying the Crossed-Grain-symbol without any other words (that is, not displaying the wording 'GLUTEN-FREE') adhere to the international Codex standard for 'gluten-free tested' and they have gluten levels of less than 20 ppm ( which is considered suitable as per the Codex standard for gluten content).
    This two-tier system: undetectable-gluten; and less-that-20-ppm-gluten, is simple. We know just what we are getting. How hard is this? Everyone is satisfied. So why does the FDA just want a single definition?
    If we, the gluten-free consumers, refuse to buy gluten-contaminated products, then food makers will have to change – or some may decide not to chase the gluten-free market.
    Refractory celiacs still gluten contaminated
    Another argument for zero-gluten is that not all celiac sufferers heal on an apparently gluten-free diet. Celiac disease does not heal when you are constantly exposed to gluten.
    Dewar and co-workers investigated 100 patients who had non-responsive celiac disease. They found the following: 45 (45%) of these patients were not adequately adhering to a strict gluten-free diet, of whom 24 (53%) were inadvertently ingesting gluten, and the remaining 21 (47%) admitted non-compliance. http://www.ncbi.nlm.nih.gov/pubmed/22493548.
    I suggest that you look at the "Gluten-Free Certification Organization (GFCO)" website for detailed information on testing for gluten and gluten cross-contamination. http://gfco.org
    The GFCO is a program of The "Gluten Intolerance Group" (GIG). GFCO inspects products specifically for gluten.
    They say "Unless food is grown in your own garden in an airtight bubble, it is impossible to guarantee a 100% pure product."
    Measuring gluten contamination is difficult as there are so many factors to consider. For example: the raw materials and the possibility they were cross-contaminated; the process used in production (such as the movement of raw materials and equipment) that could increase cross contamination; cleaning and packaging processes.
    Also their testing procedures need to be robust but affordable. They have to take into account: what is being tested (raw materials, equipment or finished products); the type of laboratory technology that is appropriate; the appropriate frequency for testing samples.
    Companies rely on "their Good Manufacturing Practices (GMP), Hazard Analysis Critical Control Point (HACCP) programs, and standard operating processes and procedures to determine a corrective action plan."
    Living with cross contamination
    Terri says about cross contamination at school, "We have to be so careful. So we go with home lunches, because food preparation can be an issue. Just one spoon in the wrong dish, and then back again, contaminates everything … and have you ever seen the cloud of flour that emits when you turn on a food mixer? We deal with celiac disease for my girls and for me. It is just not worth the risk of cross contamination. We prepare homemade gluten-free pasta salads, make homemade gluten-free "Lunchables" with far healthier ingredients, homemade minestrone, gluten-free sandwiches, chili, and a thousand other foods. We make gluten-free granola and trail mix for snacks. It gets easier. The best thing you can do is to find some awesome recipes and make sure whoever has celiac disease learns how to cook! My daughters are 7 and 9, and both know how to read labels and search for hidden gluten. They can prepare several easy foods and snacks, and do not feel like they are missing out. It really does get better!"
    How much easier it would be if there was no gluten in the food chain!
    Yes, cross contamination is the big on-going issue that few gluten-outsiders understand. At a recent hotel breakfast, I asked if they offered gluten-free options. She said, "yes, we have gluten-free bread". This was sitting among the ordinary gluten-breads, and shared the same toaster – covered in crumbs. The staff had no understanding of the concept of cross contamination.
    Should the whole family go gluten-free?
    Yes, there is a huge benefit for the entire household when all adopt a gluten-free lifestyle. But there is always resistance due to the cost and the "inconvenience" – and dads who do not want not give up their beer. However, if there is gluten in the house, there will be cross-contamination. Also, it is poor role modelling when the parents eat gluten (a forbidden food for the child) but their child is denied foods that (from their child's perspective) might seem like a punishment or an arbitrary rule. (Children often do not understand the reason they were put onto a gluten-free diet.) Having said that, at least having their child on a gluten-free diet is a great start, and many children seem to manage with low levels of cross-contamination. By the way, the parents can eat gluten outside the house if they are prepared to play gluten-roulette. However, for their own health they should adopt the gluten-zero policy.
    If gluten is in the house, there is cross-contamination.
    A Day in the Life: Living in a Mixed House
    If you want to know how to avoid cross contamination on a day-to day basis, I recommend that you read this article by Al Klapperich (GIG, East Central WI).
    Al says "This document draws upon my knowledge and experience I have acquired since going gluten-free in 2003. I have given you, the reader, a glimpse into how I personally carry out a gluten-free diet in a mixed house. I am not suggesting this is the only way or the best way; it's simply my way. My only intent is to help others that may be struggling with the gluten-free lifestyle. Not only do we have to be concerned about gluten ingredients that make up our food – we also have to be concerned about any gluten that may come into contact with our gluten-free food."
    Do you put gluten on your skin?
    Cosmetics, should they be gluten-free? Nancy asks: "Doctors in the USA state there is no need to avoid gluten-containing cosmetics & topical medications for those with celiac. What is your viewpoint on this?"
    This is a great question. I tell my patients to avoid any gluten on their skin. However, the answer depends upon where your focus is. If your focus is only on gut damage (that is, celiac disease), then the tiny amounts of gluten in these skin products is trivial and not enough to cause intestinal damage.
    But, if your focus is on the person and symptoms, then gluten on the skin often causes itch and irritability. For example, people complain of itchy hair if using a gluten-containing shampoo. Children using play-dough can develop a contact rash and become irritable. Swallowing gluten in lipstick causes some people a sore tummy.
    I recommend gluten-free cosmetics and topical medications.
    Gluten-free food not always healthy
    There is a not-so-subtle message promoted by many food-manufacturers, that gluten-free foods are, as of by right, healthy foods. This is definitely not true. Have you seen all those advertisements for gluten-free cookies and sweet treats? They are empty calories, full of fat and sugar, and lacking micronutrients.
    I was recently sent a message that was advertising the gluten-free benefits of a "Natural alternative healthy energy drink". This was misleading and dishonest. This drink was just a sugar (sucrose) water, with a few added vitamins. It is a terrible product. It cannot even be called a food. It would be much healthier to eat fruit and vegetables than drink this. It would be much better value to buy and eat healthy whole foods and drink water.
    Carrying the label "gluten-free" does not automatically mean that the product is either healthy or good for you. Often it is not. For example, Coca-Cola is both gluten-free and fat-free, however, few health professionals would recommend it.
    Lots of specialized gluten-free products are full of sugar and fat. They might taste great, and they are okay for a treat, but should not be eaten as a regular every-day food.
    When first confronted with the need to go on a gluten-free diet, most people feel overwhelmed. They also want to reject the whole notion of being gluten-free. They might be angry. They feel as though they are giving up a cherished food, and they certainly are. They have been used to eating gluten-foods for their whole lives. Suddenly, they have to start paying attention to what they are eating. This is very difficult. No wonder there is resistance to a gluten-free diet from so many people.
    Is gluten-free food safe to eat for everyone?
    Anna asks me by email: "Hi Dr Ford, I would like to know if people who are not gluten-free should eat gluten-free food? Can you provide any information of this topic please for me as to the pro's and con's of this? Many thanks."
    This is an interesting question, as it insinuates that gluten-free foods could be unhealthy for some people. Except for the gluten-grains of wheat rye and barley, all foods are naturally gluten-free. Gluten free foods are naturally healthy.
    It is only over the last 100 years that wheat has been added to more and more of our foods.
    There is nothing harmful about eating gluten-free foods.
    Can you live without gluten?
    Arthur wrote: "Your article about gluten causing nerve problems has touched a nerve, as you could see from the general round of applause and approval it received. Bravo! I have consulted dozens of doctors over 30 years (in USA and France) but not one had ever suggested gluten could be the culprit for my problems. Now, I wonder if more education is needed in the medical community on this problem. I've been gluten-free for nearly three months now, and all my symptoms have disappeared and I feel great."
    My question is 'Can humans get along without gluten?' and what role does gluten play in nutrition. Thanks. Best wishes, Art."
    Who needs gluten?
    Here is the dilemma. The world still needs gluten grains to feed the population. But this is creating ill health in at least 10% of the population. If so many people are getting ill from the foods that they are eating, then surely it would be better to shift to other food types to improve the health of the population.
    It turns out that gluten is not a necessary protein. The gluten grains are convenient and demanded - but they are not biologically essential. In fact, for perhaps a third of the population, gluten is biologically undesirable. (This is a controversial statement and needs a lot more research to back it up.)
    Are there risks when going gluten-free?
    It is my experience that for most families who go gluten-free, the quality of their diet actually improves. As they no longer rely on the easy-filling cheap breads, they are forced to branch out into vegetables, fruits, meats and other non-gluten grains. This greatly enhances their food variety, which, in turn, improves their health. Gluten is unnecessary for a well-rounded diet.
    Is the gluten habit easy to kick?
    Unfortunately, gluten has an addictive quality because one of its breakdown products has a morphine-like activity. As you know, foods crammed with gluten such as cakes, dumplings, steamed puddings and big hunks of bread are often referred to as "comfort foods". For some, this comfort is derived from this morphine-like sedation of gluten on the brain. Consequently, when gluten is suddenly removed from the diet, some people experience a withdrawal effect.
    This is one of the reasons a gluten-free diet is viewed as a horror story by so many people. Indeed, withdrawal effects from gluten during the first week of a gluten-free diet are not uncommon. Although this usually passes after a week or so, it can be difficult for children during the first few days. It is sensible to gradually go gluten-free over a week or so to avoid this reaction.
    To sum up, yes! You can you live a healthy life without gluten! Absolutely! Overall, your diet without gluten is a much more healthy, wholesome and packed with goodness. This will be good news to people who have embarked on their gluten-free journey.
    High-fat high-sugar. When deprived of gluten, people often feel that they deserve something to replace it. This yearning for some sort of compensation for being on a strict gluten-free diet leads to people over-indulging in these high-fat, high-sugar gluten-free specialty products. Although these foods are gluten-free, they are not disease-free. They have a high glycemic index, and you can eat too much. They are unhealthy. Weight gain, obesity and insulin resistance may catch up to you.
    Many people are also addicted to gluten. Therefore, as they go through the withdrawal phase, the pleasure of eating sweet-food can provide some compensation to them for being denied gluten. Going gluten-free is not an easy thing for most people.
    Gluten-free reluctance
    You would think that being diagnosed with celiac disease would be a big motivation factor to go onto a gluten-zero-diet. But a study in England (2011) found that over 40% of patients with celiac disease were dissatisfied with a gluten-free diet (http://www.jgld.ro/2011/1/6.pdf).
    They said that they were keen to go back onto gluten if they could get some sort of vaccine or pill to change the way their gut processes gluten. They were willing to make unknown changes to their immune system just so that they could go on eating a toxic food.
    To me this shows:
    the massive ignorance of these people about the seriously harmful nature of gluten. the low level of family and community support for these people. Going gluten-free should be easy, healthy and enjoyable. Gluten-free does need assistance initially. the lack of knowledge about the neurological and autoimmune harm caused by gluten. This is a chapter from Dr Rodney Ford's new book "Gluten: ZERO Global" which is available as an ebook at http://www.glutenZEROglobal.com

    Jennifer Nyce
    Celiac.com 06/08/2017 - After thirty three years of a self indulgent relationship with food, my life hit rock bottom and took an unexpected turn, for what momentarily seems to be the worst. As spontaneous and adventurous as I am, I decided to challenge myself and make my already horrid situation, even worse. Or, as you will come to see, surprisingly better.
    To start, when I say self indulgent, I mean I allowed myself to have whatever delicious and comforting food I wanted, whenever I wanted. This was never anywhere close to an eating disorder, but I most certainly had a seductive sweet tooth and I definitely experienced emotional eating. A bowl of ice cream always made a bad day turn good, despite my lactose intolerance issue.
    When I was forced into this drastic change in my life and my world was flipped upside-down, it challenged me emotionally, physically, and spiritually. My health was crashing. I couldn't regulate my blood sugar. I was diagnosed with a stress induced hiatal hernia. I had constant and burning indigestion. My emotions were all over the place and my faith in who I was and what I believed in was tested.
    Courage I never knew I had slowly came out of the depths of my soul and spilled over into all the areas of my life. I wanted to press on, conquer, and show how strong I am. I decided to challenge myself even further. I decided for the fun of it, to go refined sugar and gluten-free. I wanted to see if I had it in me to exhibit extreme self control under my extreme circumstances. I ultimately wanted to stretch my faith in God and the power residing within me; that which sustains me. Now to some that may sound silly or easy to eliminate a few ingredients, but to my fellow sweet tooth and carb lovers, you know the kind of uphill battle I was committed to taking on.
    My way of eliminating these things was very simple. I just stopped eating them. I didn't wean myself off of them. To me that would be a tease. I can have a crumb but not the cake? Silly, right? To make matters worse, both sugar and gluten are challenging in themselves to eliminate, as they are in EVERYTHING, but putting them together to eliminate and trying to find something to eat seemed nearly impossible.
    I had to get creative. I already knew all about eating healthy and the gluten-free diet because my six year old has been gluten-free for the past five years. I know what products to avoid. However, going gluten-free after eating gluten filled food for thirty three years was tough, and even though I knew better by raising my daughter gluten-free, I always found excuses for my own eating habits. I do believe taste buds get accustomed to unhealthy food. But I reasoned in my eye opening feat, that if taste buds can get accustomed to unhealthy food, then I guess taste buds can get accustomed to healthy food.
    I have to say that the first and fourth weeks were the most difficult. Week one, I had to keep telling myself no! No one wants to hear the word "no" all day long. Weeks two and three were pretty easy. I was into my routine of making healthy meals, trying new recipes, and baking yummy things without sugar or gluten! I have to say, the cake I made the other day was seriously the best cake I ever ate! Week four was the true test of my willpower. I had rampant cravings. For some reason it seemed like everyone kept forgetting that I was now gluten and sugar free and kept offering me bad things! Smells drove me crazy. I couldn't really be around anyone who was eating things I couldn't. Since then, I have to admit, it's been pretty smooth sailing.
    Despite the difficulty and temptations of week four, I began to notice something amazing. My hair and nails were longer than I can ever remember. For thirty three years I've been trying to grow my hair long and it was always thin and would never grow past my shoulders. Looking in the mirror at this long beautiful hair gave me some kind of warm smile inside and urgency to share my good news. I noticed other changes too. My bloating and stomach aches were gone. This was another chronic condition of mine that has been with me for so long that I actually came to accept it as "normal." Horray! I no longer feel like I'm ten pounds heavier than my scale says! Now mind you, I'm a very tiny and petite girl, and with the realization that gluten must have been stunting my hair and nails growth, I can only imagine what other things might have been stunted? You get the picture.
    Going gluten and refined sugar free was one of the best decisions I have ever made. It changed me in ways I could never have imagined and it opened my eyes to a whole new way of living and optimizing my health. Experiencing firsthand the kind of care and dedication that I give to my daughter and her health makes me feel like a whole new woman!

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/30/2017 - Dear attending physician: If you are reading this it is because your patient either expects you to refuse or you have refused to test them for celiac disease. You may believe, in keeping with prior training, that this patient does not display the signs or symptoms associated with celiac disease. However, the symptom complex of celiac disease has recently undergone dramatic changes, beginning with the understanding that celiac disease is a systemic, rather than an intestinal ailment. World renowned researchers have weighed in on this issue, with peer reviewed reports that repeatedly establish the protean manifestations of celiac disease. They defy prior algorithms for symptom assessment toward diagnosing celiac disease. In the past, undiagnosed celiac patients were often identified as asymptomatic because their symptoms were simply not diarrhea, abdominal bloating, and muscle wasting. However, the Celiac Disease Center at the University of Chicago lists more than 300 presenting symptoms of celiac disease (1). The same group also offers a list of symptoms that demonstrate the wide range of apparently unrelated symptoms that can indicate celiac disease, only the first two of which represent these classical symptoms (2).
    Recurring abdominal bloating and pain Chronic or recurrent diarrhea Constipation Nausea or emesis Liver and biliary tract disorders (increased serum transaminases, primary sclerosing cholangitis) Weight loss Pale, foul-smelling stool Iron-deficiency anemia unresponsive to iron therapy Fatigue Failure to thrive or short stature Delayed puberty Arthralgia Tingling numbness in the legs Pale sores inside the mouth Dermatitis herpetiformis Abnormal dentition (tooth discoloration, loss of enamel) Unexplained infertility or recurrent miscarriage Osteopenia or osteoporosis Peripheral neuropathy Psychiatric disorders (anxiety or depression) Please remember that any one or more of the above symptoms and/or ailments may indicate untreated celiac disease, so testing for celiac disease is an important, inexpensive step toward assisting a patient to resolve these troubling, sometimes debilitating, symptoms.
    Overweight and obesity may also indicate underlying celiac disease. Today's affluence and accompanying food surpluses permit people who are not absorbing nutrients efficiently to eat enough to more than compensate for otherwise calorically deficient diets. Thus, only a minority of celiac disease cases present with classical symptoms in most of the first world. In fact, some reports indicate that overweight patients with celiac disease are as common as those who are underweight ( 3, 4, 5). This is why researchers have long employed the iceberg metaphor to describe the mass of people with celiac disease. The vast majority these people with celiac disease remain undiagnosed (6). Until sensitive and specific serological screening tools became available, very few cases were diagnosed and celiac disease was erroneously considered rare.
    In addition to alleviating quite a lot of human suffering, early detection offers some rather large economies for the health care system, as many of the more serious ailments that often befall those with untreated celiac disease may be averted through these inexpensive serological tests and subsequent prescription of a strict gluten free diet.
    Prior to the therapeutic use of a gluten free diet, mortality was reported at 36% among 73 children with celiac disease (7). Admittedly, it is likely that these were the more serious cases and perhaps some cases of misdiagnosis. However, even as recently as 1989, adult celiac patients experienced almost double the early mortality rate seen in the general population (8), so an early diagnosis and treatment of celiac disease is not just helpful in mitigating current symptoms, it is a powerful form of preventive medicine that is coincidental to the appropriate diagnosis and treatment of celiac disease.
    Let me expand on that last comment a little further. Chronic depression (9), ADHD (10), neurological (11) and neuromuscular disorders(12) treatment-resistant iron deficiency (13, 14), impaired lung function (15, 16) a variety of lymphomas including B cell and T cell (17, 18, 19) and adenocarcinomas (20, 21) dental enamel defects (22, 23) autoimmune thyroid disease (24, 25 ) autoimmunity in general (26) type 1 diabetes (27, 28) kidney disease (29) liver disease (30, 31) skin disease (32, 33) seizure disorders (34) gait disorders (35) obesity (36) fatigue (37) anxiety (38) infertility (39) osteoporosis (40) learning disorders (41, 42) aphasia (43) and many more such sequels to untreated celiac disease (44) impose an enormous economic burden on our health system and education system. This burden weighs on most levels of government, private insurance companies, families, and individuals. Much of this unnecessary cost is ultimately passed along to taxpayers and/or are incorporated into insurance premiums. We all pay.
    And the human costs are even greater. Attention deficits and learning disabilities impose life-long inhibitions on success and are corrosive to self esteem. Depression robs us of individual, economic and social achievements, as well as denying us the day-to-day pleasures of life. Similarly, anxiety and infertility are socially isolating and heartbreaking, each in their own ways. Neurological and seizure disorders, including gait disorders, can inhibit our mobility and/or our safe function in this increasingly complex and fast-paced society. Impaired lung function can prohibit or interfere with normal, desirable activities ranging from pleasant walks, sports, and even having sex. Lymphomas and adenocarcinomas can have rapidly fatal consequences. The individual and familial consequences are often devastating. Type 1 diabetes tethers us to insulin injections and requires that we maintain a careful balance between carbohydrate intake and insulin injections. The challenges of this diet dwarfs the inconvenience of a gluten free diet, and a late celiac diagnosis may require that some people comply with both sets of dietary constraints. Skin disease can also exact an enormous social toll, and this is ignores the discomfort and embarrassment of constant itching and scratching, as well as the pain associated with the most common skin diseases connected to celiac disease. Similarly, obesity is not only socially excluding, it poses its own sets of health hazards and life shortening penalties. As osteoporosis becomes more and more common, we can see that society's increasing nutritional dependence on gluten grains may well have set the stage for this degenerative condition, often requiring painful and expensive joint replacement surgeries as our bones gradually crumble and shrink. The dramatic loss of our ability to produce intelligible speech, called aphasia, is by no means the least of this list. The horrific nightmare of being unable to speak to others and have them understand us has been the lived experience of at least one individual. His speech slowly returned after his celiac diagnosis and some time on a gluten free diet. Too many of us are not so lucky.
    Many of us see ourselves, and our symptoms, in the many posts, blog comments, listservs and websites that discuss celiac disease. Yet outdated medial training can create barriers to patients seeking testing. However, given the above, peer reviewed data and expert opinions, it is difficult to imagine any reasonable argument for refusing to test a patient who requests serological testing for celiac disease. The cost is minimal and the potential benefits to those who are diagnosed, and our society, are enormous.
    Current data suggest a prevalence of celiac disease in the general population at somewhere around 1%, based on serological testing for selective antibodies. However, newly emerging data suggest that a portion of the population that is at least six or seven times the size of the group with celiac disease mounts an innate immune response to gluten grains. The careful characterization of one pathway for activating intestinal inflammation by non-gluten components of these grains, leaves open the possibility of "gliadin-dependent signaling pathways that still remain to be characterized" (45).
    Other forms of non-celiac gluten sensitivity, as signaled by IgG class antibodies against gliadin, are seen in 10% to 12% of the general population. Whether these segments of the population with non-celiac gluten sensitivity overlap or are distinct has yet to be determined, so it remains unclear whether they form 10% of our population, or as much as 19% of our culture. Finally, based on a new book by the world renowned pediatric gastroenterologist and allergist, Dr. Rodney Ford, titled Gluten: Zero Global, there is considerable evidence to suggest that, with their many other anti-nutrient, addictive, allergenic, and blood-glucose altering features, gluten grains are a questionable macronutrient food source for humans (46).
    Thus, testing for non-celiac gluten sensitivity, may offer many of the benefits that testing for celiac disease offers. Your patient and I are asking that you heed the above data from your professional literature and the first dictum of your profession, by 'first doing no harm', and ordering testing for celiac disease and non-celiac gluten sensitivity.
    Dr. Ron Hoggan, Ed. D.
    1. http://www.cureceliacdisease.org/wp-content/uploads/2011/09/CDCFactSheets10_SymptomList.pdf
    2. http://www.cureceliacdisease.org/medical-professionals/guide/symptoms
    3. Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006 Oct;101(10):2356-9
    4. Tucker E, Rostami K, Prabhakaran S, Al Dulaimi D. Patients with coeliac disease are increasingly overweight or obese on presentation. J Gastrointestin Liver Dis. 2012 Mar;21(1):11-5
    5. Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010 Apr;44(4):267-71.
    6. Katz KD, Rashtak S, Lahr BD, Melton LJ 3rd, Krause PK, Maggi K, Talley NJ, Murray JA. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol. 2011 Jul;106(7):1333-9. doi: 10.1038/ajg.2011.21. Epub 2011 Mar 1.
    7. Hardwick C. 1989, as described in Holmes GKT. Non-malignant complications of coeliac disease. Acta Paediatr Suppl. 412: 68-75. 1996.
    8. Logan RF, Rifkind EA, Turner ID, Ferguson A. Mortality in celiac disease. Gastroenterology. 1989 Aug;97(2):265-71.
    9. Zipser RD, Farid M, Baisch D, Patel B, Patel D. Physician awareness of celiac disease: a need for further education. J Gen Intern Med. 2005 Jul;20(7):644-6.
    10. ADHD (10),Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3).
    11. neurological and neuromuscular disorders (11, 12,) Currie S, Hadjivassiliou M, Clark MJ, Sanders DS,
    12. Wilkinson ID, Griffiths PD, Hoggard N. Should we be 'nervous' about coeliac disease? Brain abnormalities in patients with coeliac disease referred for neurological opinion. J Neurol Neurosurg Psychiatry. 2012 Dec;83(12):1216-1221.
    13. Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grünewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry. 1997 Dec;63(6):770-5.
    14. Fayed SB, Aref MI, Fathy HM, Abd El Dayem SM, Emara NA, Maklof A, Shafik A.
    Prevalence of celiac disease, Helicobacter pylori and gastroesophageal reflux in patients with refractory iron deficiency anemia. J Trop Pediatr. 2008 Feb;54(1):43-53.
    15. Cekın AH, Cekın Y, Sezer C. Celiac disease prevalence in patients with iron deficiency anemia. Turk J Gastroenterol. 2012 Oct;23(5):490-5.
    16. Robertson DA, Taylor N, Sidhu H, Britten A, Smith CL, Holdstock G. Pulmonary permeability in coeliac disease and inflammatory bowel disease. Digestion. 1989;42(2):98-103.
    17. Edwards C, Williams A, Asquith P. Bronchopulmonary disease in coeliac patients. J Clin Pathol. 1985 Apr;38(4):361-7.
    18. Bautista-Quach MA, Ake celiac disease, Chen M, Wang J. Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features. J Gastrointest Oncol. 2012 Sep;3(3):209-25.
    19. Leslie LA, Lebwohl B, Neugut AI, Gregory Mears J, Bhagat G, Green PH. Incidence of lymphoproliferative disorders in patients with celiac disease. Am J Hematol. 2012 Aug;87(8):754-9.
    20. Elfström P, Granath F, Ekström Smedby K, Montgomery SM, Askling J, Ekbom A, Ludvigsson JF. Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. J Natl Cancer Inst.2011 Mar 2;103(5):436-44.
    21. Benhammane H, El M'rabet FZ, Idrissi Serhouchni K, El Yousfi M, Charif I, Toughray I, Mellas N, Riffi Amarti A, Maazaz K, Ibrahimi SA, El Mesbahi O. Small bowel adenocarcinoma complicating coeliac disease: a report of three cases and the literature review. Case Rep Oncol Med. 2012;2012:935183.
    22. Vecchio R, Marchese S, Gangemi P, Alongi G, Ferla F, Spataro C, Intagliata E. Laparoscopic treatment of mucinous adenocarcinoma of jejunum associated with celiac disease. Case report. G Chir. 2012 Apr;33(4):126-8.
    23. El-Hodhod MA, El-Agouza IA, Abdel-Al H, Kabil NS, Bayomi KA. Screening for celiac disease in children with dental enamel defects. ISRN Pediatr. 2012;2012:763783.
    24. Erriu M, Sanna S, Nucaro A, Orrù G, Garau V, Montaldo C. HLA-DQB1 Haplotypes and their Relation to Oral Signs Linked to Celiac Disease Diagnosis. Open Dent J. 2011;5:174-8.
    25. Cats EA, Bertens AS, Veldink JH, van den Berg LH, van der Pol WL. Associated autoimmune diseases in patients with multifocal motor neuropathy and their family members. J Neurol. 2012 Jun;259(6):1137-41.
    26. Bardella MT, Elli L, De Matteis S, Floriani I, Torri V, Piodi L. Autoimmune disorders in patients affected by celiac sprue and inflammatory bowel disease. Ann Med. 2009;41(2):139-43
    27. Nass FR, Kotze LM, Nisihara RM, de Messias-Reason IT, Utiyama SR. Autoantibodies in relatives of celiac disease patients: a follow-up of 6-10 years. Arq Gastroenterol. 2012 Jul-Sep;49(3):199-203.
    28. Saadah OI, Al-Agha AE, Al Nahdi HM, Bokhary RY, Bin Talib YY, Al-Mughales JA, Al Bokhari SM. Prevalence of celiac disease in children with type 1 diabetes mellitus screened by anti-tissue transglutaminase antibody from Western Saudi Arabia. Saudi Med J. 2012 May;33(5):541-6.
    29. Van den Driessche A, Eenkhoorn V, Van Gaal L, De Block C. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. Neth J Med. 2009 Dec;67(11):376-87.
    30. Welander A, Prütz KG, Fored M, Ludvigsson JF. Increased risk of end-stage renal disease in individuals with coeliac disease. Gut. 2012 Jan;61(1):64-8.
    31. Drastich P, Honsová E, Lodererová A, Jarešová M, Pekáriková A, Hoffmanová I, TuÄková L, Tlaskalová-Hogenová H, SpiÄák J, Sánchez D. Celiac disease markers in patients with liver diseases: A single center large scale screening study. World J Gastroenterol. 2012 Nov 21;18(43):6255-62.
    32. Massironi S, Rossi RE, Fraquelli M, Bardella MT, Elli L, Maggioni M, Della Valle S, Spampatti MP, Colombo M, Conte D. Transient elastography in patients with celiac disease: a noninvasive method to detect liver involvement associated with celiac disease. Scand J Gastroenterol. 2012 Jun;47(6):640-8
    33. Caproni M, Bonciolini V, D'Errico A, Antiga E, Fabbri P. Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy. Gastroenterol Res Pract. 2012;2012:952753.
    34. Criado PR, Criado RF, Aoki V, Belda W Jr, Halpern I, Landman G, Vasconcellos C. Dermatitis herpetiformis: relevance of the physical examination to diagnosis suspicion. Can Fam Physician. 2012 Aug;58(8):843-7.
    35. Maniar VP, Yadav SS, Gokhale YA. Intractable seizures and metabolic bone disease secondary to celiac disease. J Assoc Physicians India. 2010 Aug;58:512-5.
    36. Hadjivassiliou M, Grünewald R, Sharrack B, Sanders D, Lobo A, Williamson C, Woodroofe N, Wood N, Davies-Jones A. Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain. 2003 Mar;126(Pt3):685-91.
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    39. Smith DF, Gerdes LU. Meta-analysis on anxiety and depression in adult celiac disease. Acta Psychiatr Scand. 2012 Mar;125(3):189-93.
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    42. Knivsberg AM. Urine patterns, peptide levels and IgA/IgG antibodies to food proteins in children with dyslexia. Pediatr Rehabil. 1997 Jan-Mar;1(1):25-33.
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    44. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48.
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    47. Ford R. Gluten: Zero Global. YfoodX Ltd. Christchurch, New Zealand. 2012.

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