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    Preparing for a Gluten-Free Vacation


    Daniel Moran

    Celiac.com 05/05/2008 - We have all had our terrible times at a restaurant. It doesn't matter if it is your local diner or a 5 Star restaurant--it is hard to have somebody make our food if the smallest crumb can make you sick, then ruin your day or week. With a little preparation on your part, you can go on a cruise or dine on food made for a king or queen.


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    Preparing for Your Travel
    The most important part of any travel is to prepare for it. If you are like our family you search for a fare that the family can afford.  You also have to go the extra step for your food. “PLEASE REMEMBER I GET VERY SICK FROM THE SMALLEST CRUMB SO I GOT TO BE SO CAREFUL OR I AM SICK FOR 5 DAYS.”  Not every one is like me but I am one of the worst cases so I have to be extra careful. Judge for yourself and decide what you can handle and how extreme you need to be.

    When you are looking for a place to sleep if you are booking your motels ahead of time it is nice to try to get a microwave and refrigerator in your room. Most chains have a few rooms with microwaves in them so ask for it. During our trip to Las Vegas I cooked a whole chicken in the microwave and then cooled it and put it in our little fridge.  When I got hungry and my wife got pizza or a burger and I just didn’t trust the place I would wait and go to my room to eat. You don’t have to go that far, but if you like a canned or other product you can pick it up from a local grocery store and then warm it up.

    Don’t forget to ask, especially if you are staying at a resort or a hotel with restaurant, whether they have a gluten-free menu.  Not every restaurant knows about the "Gluten Monster." Eventually we will get out the word and the world will cook for us.

    One time when we were traveling we found a little deli that was just across from the hotel and they prepared gluten free-food if you ordered a day ahead.   My wife ordered some gluten-free bread sticks for our dinner. We picked them up and brought them to dinner.  The restaurant didn’t have a problem with this and they said that for the next meal they would have someone pick up our food from there if we wished.

    Perform Internet searches for the area where you will be staying and look for any advertised gluten-free restaurants or health food stores. Also check to see if there is a local celiac group.  The local celiac support group will know of restaurants and stores in that and can make other important suggestions.  You can find some of this info right here at celiac.com.  The celiac groups can be reached by email and they will know of all the important information that you can use during a trip to their area. This also goes for any trips outside the USA.

    You should be prepared for your trip. You know where you’re staying and you already have got some contacts with fellow celiacs in the area and where you can eat. Let’s start by getting your paper work ready.

    1.  You need your gluten-free list of ingredients.  The safe or forbidden list if you are not sure what you can and can’t eat.
    2. You need a gluten-free restaurant card.  This is what you use when you go to a restaurant to let the cook or chef know that you are a celiac and your food needs special handling. You should make plenty of copies of them to last for your trip, and it needs to be in the language that is common for the place you are going.  If you are going into Mexico it needs to be in English and Spanish.
    3. If you are bringing spices to put on your food, I some times like to bring a small amount of a Cajon spice that I make up.  I ask for my food not to be spiced in the kitchen because in the resorts that I have worked at we would make our own salt and pepper mixtures to season the food and everybody used it--meaning everyone’s hands, including crumbs could be in it.  Bring your own gluten-fre soy sauce and other sauces like hot sauce.
    4. Make sure you have all your gluten-free information. The restaurants, delis and any thing you need plus the directions and phone numbers.  Don’t get there and find out that you have just ended up on the wrong side of the tracks.
    5. Keep all of this in a folder nice and tidy so you know where it is.
    If you have to drive I found it very easy to stop at a fast food place.  The kids like it and if you haven’t noticed most of them keep it very clean and that is very important to us. Ask for your food to be made fresh. Even at fast food restaurants mistakes can happen and if you ask for a salad right from the counter it could have bread on it.  They will prepare your food fresh if you ask and be nice and tell them you have a special diet and you will get very sick from a crumb.

    Ask for the manager at this fast food place to help you.  The manager is going to be someone who has worked at the restaurant longer than a week and will care more.  Again tell them you have a special diet request and you could get very ill if you vary a crumb.  It’s a crap shoot that the manager might prepare your food or will tell some one to make it for you.

    When you go to the fast food place you don’t have to eat salads only.  I go and ask for “Double burger with cheese and lettuce, tomatoes, onions.”  No sauces, catsup, mustard, mayo or pickles.  Ask for the packets that are for to go and you can read what the ingredients are in them.  I ask them to prepare it for me and I watch to make sure they use a clean fork that I hand them or if they put fresh gloves on. With these fast food restaurants you can see all the way to the back and I love that. Order some French fries if you know they are gluten-free and you’re on your way. Make sure if you do order French fries that they only cook French fries in that fryer and they cook nothing else in them. If you eat at any restaurant you must ask them if they are made in a dedicated fryer.

    Some fast food places have chicken breast and other food so again, you don’t just have to eat salads. If you don’t stop at a fast food place and it is not on your list of gluten-free places you should get out one of your “Chef Daniel Letters” to give to the chefs in the back.  Be prepared to wait longer.  When you arrive ask the waiter or matre’d if they have a gluten-free menu.

    If they have gluten-free menu that is great but the gluten-free menus I have seen don’t give the restaurant its due.  They just put a few items on the menu like salad and a steak and expect that to feed everyone…WRONG.  Chef Daniel wants to eat what I want not what they tell me what I can eat.  I mean if my wife can have chicken, pork, shrimp, lobster, lamb and that entire menu why can I only get three things? I AM A BIG BOY…one of my pet peeves is this limited choices offered by most gluten-free menus.

    It is so much easier to talk with the manager when you come in and explain that you have a special diet request and you will get very ill than it is to explain it to the wait staff who have 12 tables and could care less about you because the manager is yelling at them to get to the next table or that an order is up.

    If you don’t order from the gluten free menu and you see something else on it you might like you have to ask questions:

    1. Is the product marinated before it is cooked? If it is you can’t have it. Like a chicken teriyaki.
    2. Can it be thawed if it is in the freezer? They have all of the chicken or pork in a marinade but they have some in the freezer and could they microwave it to thaw it so you can have it.
    3. What type of broiler do they use if you’re asking for your food to broil and can it be cleaned before you have your food broiled?  Food stays on the broiler for a while so it must be steel brushed, or the chicken teriyaki he just cooked could be on your broiled steak.  The over the head broilers can have the grills lifted up to the flame and it will cook everything away.
    4. If the waiter or manager can’t answer your questions you should look to see if you can ask for the cook. Before you ask for the cook you should look around the dining hall and if it is extremely busy remember you are not the only one there and asking for a cook might really upset them. If it is slow the chef or cook won’t mind coming out.  If it looks too busy you should only ask the manager or keep it very simple.
    When you decide what you are eating I like to put down on the paper exactly how to cook my food (Chef Daniel P. form). Do I want it pan fried or broiled? If I have it broiled I ask them to steel brush the grill.  Your Chef Daniel slip should ask them to use a fresh tong, knives, cutting board and even a fresh cloth if they wipe your plate.    I give them as much direction I can think of so they know I am very serious about my special diet and that if prepared wrong in any way I will get very ill.

    Real World Here
     I have gone to a restaurant and did everything I said--triple checked and the salad came out with croutons on it. I am polite to the wait staff and tell them again that I can’t have any bread on my salad. Then I gave it back to the wait staff and sat and waited for a new salad and I received the salad I JUST GAVE THEM TO TAKE BACK and they simply took the croutons off the salad and brought it right back to me!

    Don’t be afraid to say “Hey you just brought me the same salad back and I can see the crumbs from the croutons.” Oh yeah that is a true story. Check your food carefully when it comes out to you.  If you see the tiniest piece of something that doesn’t look right say NO WAY.  You order a steak and you see a bit of carrot on it THAT PROBALLY MEANS HE USED TONGS THAT HE USED TO PICK UP CARROTS WITH. The carrots are not on your plate.  My wife has to deal with me when we go out to eat but I have no choice because the smallest crumb takes me out for four days. I’d rather go hungry then get sick. When that salad came out I gave them one chance and if they don’t do it right I don’t take the chance with the local “hot head” cook to get one over on me.  I POLITLY SAY “NO THANK YOU,  I DON’T WANT TO EAT HERE ANYMORE” . It’s my money, my health and sadly, during the subsequent four days that I am sick they don’t care about me, so I’d rather get some cheese or chips or something simple. In these cases I leave the restaurant and they take my food off of the bill because I don’t eat a thing.

    So always have an alternative plan if you can’t eat.  My wife and kids can eat but if I don’t feel the right vibe in the restaurant I must move on, and you should to.  It’s not hard for any restaurant to make a burger and fries for the family so let them eat and you move on to plan B.  Again each person’s tolerance is different so you have to make up your mind but it is your trip and your health.

    When you are on the road you have to choose your restaurant and always have a plan B.  I choose the fast food because I can watch them make my food. You might like to be pampered so pick a nice restaurant and try to make sure it is not during peak hours--this will help a lot.

    I hope this is Helpful

    Chef Daniel P.

    I will continue with staying at hotels and motels in my next article.


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    Guest tonya schoenfeld

    Posted

    I have had this happen to me several times where they just take the croutons off and bring me the same salad, now i make sure and tell them to bring me a new salad, i can't believe they do this!!

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    Guest susan oransky

    Posted

    I absolutely enjoyed your article and I did actually learn from it. my son is a sous chef and he has learned from me and serves his customers the safe and easy way and they comment so graciously and come back for more. You really don't have to be a brain surgeon to deal safe and please your customers.

    Thanks again

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    Guest faithwalk

    Posted

    Thank you so much for your article! I too react to micro amounts of gluten. I talk to some celiacs and for them a little gluten is no big deal, but for me it's one to two weeks of not feeling well. Actually, I have stopped eating out because it just wasn't worth it to feel bad so much of the time. You have given me a glimmer of hope that one day I too may eat out again. BTW...I heard about a product called Lectin Lock that is supposed to protect the body for small amounts of gluten exposure. I haven't tried it yet, but am hoping it will help me resume eating out without quite as much anxiety.

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    Guest Kelly Prunty

    Posted

    This article really made me think A LOT about eating at ANY restaurant --- not just when I'm on vacation. Its a good reminder on how strict I should be and not just 'trust' the cooks, restaurants, whatever. THANK YOU!!!

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    Guest linda

    Posted

    I also had the salad with the croûtons removed and returned, the restaurant had a gluten-free menu, and it happened anyway. I'm going to Las Vegas in October and have already been looking for gluten-free restaurants online.

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    Guest Wendy

    Posted

    Thanks for the info. I know a sous chef and I was telling him what I can't eat. He was surprised when I said barley and rye. He said that he often made meals with barley in it when customers asked for gluten free meals. The hospital I worked at serves patients on a gluten free diet Rice Krispes and rice milk with the barley malt flavoring and gravy made with wheat to thicken it. The hospitalist told a patient he didn't know if grapes had gluten in them, the patient's physician just told the patient to avoid gluten, that was it. I had to educate the patient. It is so frustrating! To top it off for me, I'm a vegetarian, making it that more difficult. I did have a good gluten free meal at PF Changs with no suffering after :)

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    Guest Loke

    Posted

    Thank you for putting together these articles. I am also one who cannot have any possibility of cross contamination. After 10 years diagnosed (and 10 years undiagnosed) and many brown rice and green tea diets (to clean out my system and the add one food or one supplement back at a time) I discovered that eating out is just not worth it or letting anyone prepare an unsupervised (by me) meal for that matter. I can no longer afford to get sick it takes too long to recover now and I am sick of being sick.

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    Guest kathy

    Posted

    I was just diagnosed and love to travel. This was the information I needed to see. I am hoping I will feel better for the first time in so many years--I can't count on a gluten free diet. As a newbie this is really hard.

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    Guest Don Eisenbarth

    Posted

    Folks around here would slip in some gluten to see what happens. I know of one case where this was done. The fellow spent two weeks in the hospital.

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    Daniel Moran
    Celiac.com 05/14/2008 - Staying at a Hotel or Bed and Breakfast with Breakfast Included
    With your trip you will have to stay at a hotel or resort. I am going to discuss my thoughts on how to eat and stay safe. I will be talking about breakfast because some hotels and B&B’s offer free breakfasts. Lunch and dinner are different subjects that need to be discussed in great length.
    It is very important for you to keep the Gluten Monster away during your trip.  If you are in a hurry just grab some fruit, clean it, and leave.  If you want to stay, you have to monitor how the wait staff warms the food up.  In the past I have asked to see the ingredients from various boxes so don’t be afraid to ask to see packages.  You are looking for a variety of things. After I find out if I can eat the food I again observe the staff and how they handle the food I will be eating.

    Are they careful or sloppy? Do they use the same plate in a manner that might cause cross contamination? Once I decide that I can eat the breakfast I wait until they bring fresh food out and I take food from the fresh plate. I do ask for clean plate if they use the same plate for everything. If the staff does use the same plate I ask if they can use a different or fresh plate for me.  I also sometimes give them my plate and ask them nicely if they could put some of the cooked product on my plate before they do anything else with it.
    Always explain your diet the best you can and let the staff know that you have a special diet and that they have to be very careful with your food.  Tell them you get very sick and you must be extra careful.  If the staff doesn’t speak English well you can try using a gluten-free restaurant card in the language they speak, or just keep it short and try to explain in the easiest possible way.In the hotels where they warm up sausage, eggs and pancakes I have found that I was able to eat the breakfast sausage and the eggs.  These products came to the hotel already cooked and frozen so all the staff had to do was put them into the microwave and heat them up. I just asked to look at the boxes that the food came in so that I could read their ingredients. As mentioned, I always wait for a fresh batch of food to come out, and I even go as far as to use a clean fork to serve the food out of the pan or plate before it is dumped into the chafing dish. 
    I would have already explained to the wait staff in detail of my special diet needs so they will already know that I take my health very seriously. By taking the food out of the pan I hopefully take care of the accidental cross contamination from other patrons.  If you take the food out of the pan as it sits there for all to use you are taking the chance that somebody has spilled a crumb into the pan.  Be kind to the wait staff and they will help you.
    For the other products served at the hotel like fruit be sure to wash it to make sure it is clean.  If they are using bulk cereal it is probably not a cereal that you can eat so stay away unless you read the ingredients on the box or are certain that it is gluten-free.  Remember that bulk cereals might have different ingredients than the versions that you are used to—or it could be another brand or another type. Hard boiled eggs are sometimes available—just be sure to ask for them right out of the pot or wash them very well.  Some of the eggs have vinegar in the buckets to preserve them so be careful to read it thoroughly and also ask the staff if they have poured the end of a bucket into the bucket you are looking at.
    In small kitchens like these you will find that the staff will often pour the remaining food back into the container if it can be reused. You have to determine if this is happening. Notice if the containers are very full or empty—will the staff let you open a fresh bucket or box if you ask?  If it is early they won’t have much trouble doing that for you because they are going to use it anyway, but if it is at the end of breakfast they might not want to open a new container. 
    Remember to always have a plan B and to be nice. If necessary have your Chef Daniel's restaurant paper that can be used to explain your illness.  Sometimes it is easier for people to read celiac disease so they can understand.  I always grab a piece of fruit for later in case I have trouble finding lunch and it is a good snack to have.  Once you have your breakfast it is out to lunch.
    Gluten-Free at Buffet Breakfasts
    If you are at a hotel that offers a buffet breakfast for free it is the same procedure as above.  Always try to get a fresh pan as it comes out to eliminate cross contamination from other customers.  Try to talk with someone in charge like the manager who could help you if they are not busy. Be nice and explain your illness and how sick your will get.  Don’t be afraid to ask for the ingredients.  Ask for them to cut or tear the ingredients out of the box for you if possible.  Sometimes they have written them down for me and brought it out to our table.  Make sure you ask whether they using fresh eggs or “egg products.”  Also ask if they are putting something in the eggs to keep them from turning green.  If they are using real eggs they have to keep them from turning green.  Real eggs turn green from the heat and the chefs sometimes put lemon juice or vinegar in the eggs while they cook them.
    Always ask—no matter how silly you think it is—whether they add anything to the food. Seasoning salt sometimes has wheat in it, so ask if they use something besides just salt
    and pepper. Remind them how sick you will get if you eat a little piece of gluten and never be ashamed to ask.  Always ask for your food to be unseasoned—that also eliminates the risk here.
    Whatever you want make sure that you try to get the freshest that they have and also use a clean fork to retrieve your food. Most of the tongs or spoons are going to be used from one container to the next.
    If the staff can help you they will, so ask and be patient don’t expect to be out fast.  If you are expecting to be fast then you probably will be sick.  In some cases you can ask for some fresh products from the back.  Find the person who has been helping you and if the food you want is taking a long time to empty or just isn’t getting refilled on the buffet line.  Ask if someone can go to the back and get you some food.  Hand them your clean fork and ask them nicely if they can use this to get the food on your plate.  As long as you are nice they will help you. Always try to ask someone who seems to care about the establishment where you are eating—you will know them.
     Don’t forget to ask how they cooked your food.  Just because the sausages are gluten-free doesn’t mean they cooked them that way.  They could cook them on the same grill that they cooked the pancakes on and you will have bread on your sausage!  Most places cook sausage and bacon in the oven but you need to ask how they cook everything.  Are the scrambled eggs cooked on the grill—if so can they cook you a small batch on the side?  Keep that in mind with all of the food you are going to eat.  Don’t forget to be careful and remember about cross contamination  
    A Sit-down Gluten-Free Breakfast
    For your sit down breakfast you want to make sure they cook your entire meal ala cart.

    Cook your eggs in a fresh pan. Use olive oil or real butter to cook them not the spray can of oil. Have your Chef Daniel's restaurant paper or gluten-free restaurant card that tells the cooks about you and your illness and let them know how to cook your food. Tell them in great detail how to prepare your food, Ask them to use a fresh fork to grab items if need to be.. Not to use garnish or spice on your food. Don’t be afraid to ask for a clipping of the ingredients from the box if you want to check to see if you can have the sausage or ham. Tell them about the cross contamination from cutting boards, knives, tongs and the table they work on.
    I can’t emphasize this enough—you have to judge for yourself how busy the place is.  This is the most important thing you have to remember.  As humans under stress do stupid things and the cook could fall under that.  Just think of how you would do if you were working there.  Would you, for example, have enough time to get part of a box that you threw away two hours ago when you started breakfast?  The type of restaurant matters to.  Is this a Motel or is it a very successful chain that pays well and has good benefits.  This usually means the staff is very good.These tips can help you but you do have to make sure that you inform the staff, waitress, manager and hopefully the person who is cooking your meal.  It doesn’t do any good if you tell one person and they forget because they got busy.  That is why I always try to tell the manager when I enter.  In your Chef Daniel's restaurant paper make sure you give them exactly how to cook your meal.  Don’t assume they will do it because you told them you get very sick.  As a chef myself, if I read something and it told me to use olive oil and not salad oil—I would do as it said.  If it said use oil I would grab the closest product or even margarine.  Even when busy if you read something it should stay in your head.  When you’re busy and someone tells you that table #22 has celiac and needs gluten-free food…well it could get lost if I am busy listening to 20 different orders, so bring a form or gluten-free restaurant card that they can read.


     
    Gluten-Free Travel Hints:
    You should always try to getthe manager to help you.  In any restaurant they have the most time tohelp you and they will help you because they typically care more thanthe regular workers (today’s restaurants have employees that come inone day and are gone the next.help.  It is sad but that is the way itis so at least try to get the manager. Don’t be ashamed to askfor anything. If you want a hot dog or the chips they put on the sideof the plate ask for a bag with the product inside.  Take out your safeand forbidden lists if needed and look at them to see if you can eat aproduct. 
    Always have your Chef Daniel's restaurant paper with you in your walletor purse.
    Always have a copy of your safe and forbidden lists with youin case you need it to read ingredients. Always have a gluten-free restaurant card in the language you need.
    Crosscontamination is the greatest risk for a celiac when traveling.  Crosscontamination can happen and you would never know it, such as when thechef uses a knife to cut a piece of bread, and then they use the sameknife on your vegetables, or when the chef uses a pair of tongs to flipa breaded chicken and then uses them to flip your sauté chicken.Thereare too many other ways to mention, but the main thing is that glutencould be on the tool before it is used on your meal, and it doesn’tmatter how safe the chef thought he was because you got one crumb andyou are sick for days and that ruins your vacation.

    Keep the comments coming and together we will get rid of the Gluten Monster!

    Chef Daniel P

    Daniel Moran
    Celiac.com 05/16/2008 - Knowing the Kitchen on Your Travels
    As you travel there is no way around it—you need to eat at a restaurant.  If you are like me, you probably don’t look forward towards eating out.  I have been trained by some of the finest chefs in the world and there wasn’t enough training to prepare me for eating out gluten-free.  Don’t get me wrong, if I was not celiac I could take the menus apart and know everything necessary to impress my wife and order the right food and wine.  Yes I even was involved in wine tasting in Palm Beach Florida.
    That was then and this is now.  Walking into the restaurant, sadly, the first thing I do is ask for the manager and whether or not they have a gluten free menu.  I have been told over and over about restaurants that have a gluten-free menu, and yes, this is great, but in these cases I have found that most of the time:

    The staff in the back is not trained in proper food handling techniques, and cross contamination often occurs. The wait staff (who know I just ordered gluten-free) still put bread rolls on my plate for me to eat, or even croutons on my salad (again, lack of proper training). The gluten-free menu is limited to 3 or 4 items when the full menu has over 40 items to choose from.  Why can’t I have an appetizer, soup, salad, entrée and a dessert?  It is already there in the menu so why do I have to be limited?
    Like I said, it is nice that they offer a gluten-free menu, but when I go out to eat—especially on vacation—I want to be treated special just like my wife and kids.  So when I look at the menu I look for the food I like and then I use my Chef Daniel's restaurant paper to write down exactly what I want and how I want it prepared.I have had comments that some of you think the chef is going to get mad and that you are insulting them by writing down what you want to eat…my reply—this is hogwash!
    For those of you who still believe that they will be upset let’s look at what happens from the chef’s viewpoint during the day at a restaurant.  He waits for the wait staff to bring in the order. It is usually on a ticket stating whether the food should be rare, medium or even broiled or sautéed.  On the same ticket the wait staff tells them what vegetables or whether they will have French fries or baked potato.  Hopefully you see where I am going with this.
    As you must have learned by now, if you have traveled to a restaurant, even one with a gluten-free menu, sometimes the staff doesn’t even know what gluten-free means, and if this is the case how could the chef possibly know?  Who is training them? They come to work and are told they have to make a steak gluten-free.  So they make a steak and put the garnish on it and when the customer gets it they say “wow, this is great, I am about to eat a steak from the gluten-free menu.” HOLD ON!  “Oh no, the garnish on the plate is a fancy fruit relish that is made with malt vinegar.”  CROSS CONTAIMNATION. What I have been saying from the start.  Yes this really happen to me—the liquid from the relish ran down the plate and on my steak—this was a few years ago before I started to use my restaurant/chef skills to order my food.  
     I have talked with some of my chef friends and not one of them said they would get offended, and it would be just like if someone came in to the restaurant and asked me to make a kosher meal.  I am expected to do it right because if I didn’t they would be offended and then they would never return to the restaurant.  If I pleased them, however, they would tell their friends about their positive experience. This would mean more money for the restaurant, and that makes my boss happy. Some of you will still doubt me but that is okay because when I walk into a restaurant I expect to be pampered just like everyone else does.  Be sure to always have a plan B, and be prepared to leave or not eat your meal if there are problems with it.  There are way too many restaurants in a town for me to get sick over a crumb.  Once you start talking with the manager or the waiter you will quickly learn if what they are telling you is real or just hogwash.
    Another Real Experience
    I was given a gluten-free menu at a restaurant and I asked the waiter if he knew what gluten-free meant.  He said “yes,” so I asked him whether croutons come on the salad that I had ordered. He said “sure, croutons come on all the salads and they are already made, but I can take them off”.  I am not making this up folks, this was at a well known Italian restaurant that is a chain all over the USA. I switched to plan B and didn’t eat there. My wife who loves this place did eat and I went to a party store got some snacks. It might be harsh to some but if the waiter is not properly trained how do I know whether the cook or anyone else there is properly trained?  Just because a restaurant has a gluten-free menu means nothing (unless I can verify that the staff was properly trained by speaking to them).
    Fast Food Restaurants
    If you have followed my articles you will know that I like some of the fast food restaurants.  Many of these large chains adhere to strict cooking methods.  This is good for us because they stay the same and there is less of a chance for cross contamination.  In many cases these restaurants use dedicated fryers for certain foods, for example French fries. So you can usually have French fries and not worry about the batter from the chicken nuggets.
    Cross contamination to me is the way the “Gluten Monster” attacks us—when we least expect it.  No matter how much you say or ask, if they put your food on the table that just had gluten on it you’re going to get sick. I always ask for the manager to help me. Here is an example of how I order:

    Could you please give me the double cheese burger with only lettuce, tomato and onion?  I have a special diet request and it is very important that you do not touch any bread or crumbs from any other product. Could you please put fresh gloves on or could you use a plastic fork to get my burgers out?  It is important that the cook back there doesn’t’ get my meal because he has handled other bread with those gloves. I would like catsup, mustard and mayo packages (to read the ingredients myself). I would like French fries if they are cooked in a dedicated fryer. I would like a plain salad and could you please open a fresh bag of the salad mix for me because, again, I am afraid that maybe a crumb got into the salad.  If you can’t open a fresh bag of salad I would go without the salad. I would like to look at a couple of your salad dressings to see what salad dressing I can eat if that is ok with you. Beverage usually isn’t a problem. Gluten in ice cream is a possibility. Always watch the staff the whole time they are making your food to see if any mistakes are made. Never be afraid to say you don’t want something if you fear it.
    There are also other options, for example you might be able to do the chicken or other products if you know that they are gluten-free.  Not all French fries are gluten-free.  Some that have a spice on them might have wheat on them. Be sure to know your fast food place by searching online for information on what you can and can’t eat, and never be afraid to ask.Mexican Cuisine
    Going to Mexican restaurants is one of my favorite options.  Much of the food is made with corn.  After you sit down, review the menu and decide what you want.  The chips are usually corn, but be sure to ask, and if so you can have them with some shredded cheese as an appetizer. Most of the salsas are made with only fresh vegetables.  The main items that you ask for is to make sure they use only fresh foods for you.  This is why you should ask for the manager when you walk in. The manager should be able to help you order.
     If you like hot sauce I would bring it myself.  Those specialty items are small and handy to have if you like them.  You never know what type they will have and it is nice to eat it with your Mexican meal.  If you ask for refried beans and they are gluten-free, I would ask for them to open a fresh can and have them microwave it.  Any of the food that is processed I would ask for fresh can and for them to microwave it.  If they don’t have a microwave they can heat it up in a steamer, broiler or a sauté pan.  You should always be able to eat well at a Mexican restaurant.
    How I Order Gluten-Free Mexican Food:

    I would like some corn chips and cheese melted over the top of them.  You could use the above broiler or just use the microwave to do it. I would like a small tomato, whole not sliced for my salad and for my chips. I would like a mixed green salad from a fresh unopened bag with a small cucumber that I will cut myself. I would like one half of a fresh avocado for my salad and chips. I would like two tablespoons of olive oil and some red wine vinegar for my salad (maybe even a half of a lemon too). Cook 1 cup of meat (no seasoning) add to 2 corn shells and top with fresh cheese from a bag or cut fresh.  Add fresh lettuce and tomato and microwave it until it is hot and melted, then add 4 ounces of corn on top.
    I add some hot sauce when the food comes to the table.How I Order Gluten-Free Italian Food:
    We can’t eat the pasta but some of the mixes that go on the pasta are great.  If it is strips of chicken or shrimp, there are many items that can be looked at.  With sun dried tomatoes or avocado, those could be added to your entrée or salad.  They will have mussels and good meats, you just need to read what they have and make a great meal. When you look at the menu you have to ask or determine, what is sitting on the table by the chef and can I use that for my meal. Every entrée has mizzen pla. (Products in place) meaning that the chef needs everything right next to him to make his meal.  If the entree you are looking at is seafood fettuccini with a cream sauce.  The chef will need fresh seafood, cooked noodles, sauce, vegetables and seasoning. If this was made up already for the night, the noodles and seafood would be garbage.  As a celiac you can take the seafood as long as it is not marinated in something.  That goes for most of the items if you read what is in the entrée.  Know what is fresh and what is frozen and you will be able to pick apart a menu.  Always ask and you will learn for the next time.
    Sample Orders:

    Strips of chicken breast with no skin broiled (please metal brush the grill first before you lay my food down)  cook till done, then lay sundried tomatoes on the chicken strips and top with fresh sliced mozzarella cheese and broil in top-type broiler, or microwave until melted.  If there is no way to melt please slice thin and it will be good enough. •    Fresh spinach with 1-2 lemon and red wine vinegar, two tablespoons olive oil extra virgin, one small tomato and 4 ounces of mozzarella cheese (I will cut the tomato and mozzarella cheese  myself).
    •    Mixed melody of seafood sauté with olive oil then reduce with wine. Place on the side when ¾ of the way done.  Add ¼ cut mushrooms, shallots, fresh garlic, sun dried tomatoes and sauté until down add heavy whipping cream reduce then add the seafood (add nothing if you don’t have heavy whipping cream).  Add fresh herbs chopped up or tear apart (no dried herbs).In this article I offered examples for a few types of restaurants.  I could go on and on. You need to understand how restaurants work to be able to order your food to be made gluten-free.  Please don’t limit yourself to the gluten-free menu only (if they have one).  You should not be discriminated against because you have a health concern.  That is a big word, I know, but we should be able to eat just like the next person can.  Our money is just as GREEN as another person’s.  I would rather pay a little more if I add something to an item then to be told that they can’t do it.  That is why I say that together we can tame the Gluten Monster.  When you are traveling there are a lot of restaurants to choose from.  Be prepared to wait and not be rushed, try to pick a restaurant that is not busy so the chef is not rushed by 20 other orders.  If you follow my approach you will have success eating out gluten-free in restaurants, and your dining experience will be pleasant—like it is suppose to be!
    Gluten-Free Travel Hints:

    You should always try to getthe manager to help you.  In any restaurant they have the most time tohelp you and they will help you because they typically care more thanthe regular workers (today’s restaurants have employees that come inone day and are gone the next.help.  It is sad but that is the way itis so at least try to get the manager. Don’t be ashamed to askfor anything. If you want a hot dog or the chips they put on the sideof the plate ask for a bag with the product inside.  Take out your safeand forbidden lists if needed and look at them to see if you can eat aproduct. 
    Always have your Chef Daniel's restaurant paper with you in your walletor purse.
    Always have a copy of your safe and forbidden lists with youin case you need it to read ingredients. Always have a gluten-free restaurant card in the language you need.
    Crosscontamination is the greatest risk for a celiac when traveling.  Crosscontamination can happen and you would never know it, such as when thechef uses a knife to cut a piece of bread, and then they use the sameknife on your vegetables, or when the chef uses a pair of tongs to flipa breaded chicken and then uses them to flip your sauté chicken.Thereare too many other ways to mention, but the main thing is that glutencould be on the tool before it is used on your meal, and it doesn’tmatter how safe the chef thought he was because you got one crumb andyou are sick for days and that ruins your vacation. Chef Daniel P.


    Daniel Moran
    Celiac.com 05/20/2008 - I am going to be honest—I have not traveled outside the U.S.A. except for Mexico and Canada.  When I went to Mexico it was on a cruise ship, so that meant I could eat on the ship.  I would take snacks to tide me over or get a bag of chips.  Hopefully I will one day be able to tour the world and educate everyone on how to make true gluten-free meals for all of us.  I also hope that my when the time is right I will go on such trips with my loving wife.  So I will tell you how I would approach a trip to another country and you can decide if this is worth a try.
     Planning for the Trip (All per emails and internet and phone calls)

    I would contact the area chamber of commerce or tourist office in the country that I will be going to and see if they have heard of the gluten-free diet or celiac disease. If I was staying at a hotel or resort I would ask them to look into gluten-free meals and if they have a kitchen where I could talk with the executive chef or manager of food and beverages.  I would also tell them that I am a chef from the U.S.A. I would go to celiac.com to locate the nearest celiac support group to where I will be staying.  If there is one I would find out about local spots that I might be able to visit to get gluten-free meals, and if there are any bake shops or natural food stores where I could get some supplies and snacks. I would find a book on the languages that they speak and make a chef Daniel restaurant form so I could eat in a restaurant.  I would have it in all the languages including English for the chef to make sure they understand I am very serous about my health. I would have a card that said “May I speak to the manager and I have a special diet request.” Hopeful I could say that in their language. I would have a gluten-free restaurant card in their language and present it to the chef or manager. I would have a safe and forbidden list in the language where I was visiting.  That way I could check foods from the store so I could eat snacks. I would try to stay at a place with a microwave and possibly a refrigerator.  By doing this if I ran into a language problem I could cook chicken or meats in the microwave (I have cooked whole chickens in a microwave on vacation before and put it in the refrigerator for later). I would carry cards with me to ask for directions or to ask a wait staff for something I might be able to eat.  Like maybe some cheese, beverage, snacks or any type food of the area that I might like.  If you were at a port on the ocean your card could be sauté seafood and with olive oil.  Even if I didn’t look at the menu I would know that because I am at a town on the water, they would have fresh fish coming in. If any of you watch the Travel Channel  you know that there are a lot of different types of foods.  Being a chef I would want to experience all types of different foods.  If I knew something about the local cuisine and how it is prepared before I got there, it could give me an advantage. In Hong Kong I would love to eat some of the hot foods.  Could I eat them?  Is it just the chilies or is it the sauce?  Those are some of the questions I would wonder, so I would research the area and review cookbooks to see how they prepare their foods. If I knew where I would be traveling I would try to contact a local restaurant beforehand to see if I could view their menu for the time when I would be visiting.  If I did this, I could make my Chef Daniel restaurant form up ahead of the visit. I would make sure that when I was at my vacation spot I could get Internet access.  By doing this I could look up restaurants that I see when I am walking around to see if their menus were available online.  Also I would be able to translate a chef Daniel P restaurant form for that place if we decide to go there. I would make sure that I had a phone with internet access to look up info at any time. Also with the phone I could translate a sentence with a Web site I know about.
    As you see I have put a great deal of thought into traveling, but not one of them has been tested.  I wish I could say that these ideas all worked for me and they will for you too.  My thought is that the greatest asset for us celiacs is the Chef Daniel P restaurant form you take into the restaurant.I would have every direction I could give on paper for the chef to see.  When I was cooking I cooked with chefs from around the world.  We all had the same common cause:  To make our customers happy so they will spread the word and come again.  So to me it doesn’t matter if they can read English or Spanish.  It comes down to me as the customer to tell them I have to have a gluten-free meal.  To tell them that if they don’t do as I ask, I could get very sick and it would be their fault, and no restaurant wants to hear that their food caused a person to get sick.
    If you are like me, you are going to want to taste some of the home town small restaurants.  I would know the area as mentioned before, and find out about any fresh vegetables or meats that I would like to try.  On my phone I would access the Internet and I would find information on the town I was in.  When I walked in I would ask for a manager, and if that person doesn’t speak English I would get one of my restaurant cards out to let them read what I am trying to say.  I also would try to read the card out so they could see that I am trying very hard to speak their language.  I believe that shows I am not a stuck up rich person who hires everyone to do what I want. If I mess it up, I would feel it is okay as long as I look like I am trying to commutate to them “I am very serous about my health.”  Asking them questions would be hard but I would have cards with questions on them and I would know what yes or no sound like.  If it was a small café I would ask to talk with the chef.  At least try to speak through my cards and being a chef I usually have no trouble seeing the kitchen.  It is an advantage to be a chef from a very popular resort that is known world wide and I would use that to my advantage.  Even if they never knew of me, I know my way around the kitchen and I would be able to look around to see if I could eat there. I would look to see:

    Is it dirty or clean? Does it look like they cut everything on the same cutting board? Does the cook look very sloppy?
    Even if I don’t go to the back where the kitchen is, the dinning room represents the kitchen too.  I am not expecting a clean perfect kitchen.  I am expecting the cook who might be this little old lady who has had this restaurant in her family for four generations to care about me. That is what all restaurants usually want—if they care about their customers they will survive for years and years.  It is a hospitality business in America or in Russia—and it doesn’t matter what you language you speak.   That is when you don’t have to worry so much about the Gluten Monster.I would be honored to walk into some of these smaller kitchens of the world and find out about their history and who they have cooked for.  Just thinking about it gets me all wiggly in side.  You can tell a lot about a restaurant when you walk in—if you only take the time to notice.
    So when you plan your vacation as a celiac you need to keep this in mind:  It is just like over here and it will take you some time to order and eat.  If you are in a hurry, I suggest that you take your safe and forbidden lists to the store and get some snacks.  If you have the time you need to sit and relax and take a stab at eating restaurant food from another country.
    Chef Daniel P.


    Destiny Stone
    This is the time of year when familiestake vacations and travel the world. Traveling can often be stressfuleven under normal circumstances; packing problems, flight delays,getting lost, are all possible when trying to get from point A topoint B. So imagine how stressful it can be for a celiac orgluten-sensitive person to get ready for a big trip, especially to alocation that doesn't cater to the gluten-free lifestyle.The following tips are geared towardhelping even the most sensitive celiac to have a fun filled andgluten-free vacation while minimizing the stress factor as much aspossible. This article covers the following: preparing for yourgluten-free travel adventure, gluten-free travel by plane,automobile, train or ship, gluten-free accommodations, gluten-freemeals and snacks, what to do if you accidentally ingest gluten.
    Before beginning your vacation, thereare many important things you will want to consider, like method oftravel, your destination, and gluten-free options in the city ortown in which you will be staying. To help find gluten-freeaccommodations and eatery's in your location, perform a “Google”search for 'gluten-free restaurants and accommodations' in the areayou will be traveling to.

    Planes Trains and Automobiles-Tips forGluten-Free Travel by Danna Korn Gluten-Free Transportation
    Traveling by car is the best way totravel, if you have a choice. That way you can stop at stores asneeded and load up on your gluten-free snacks. Trains are also good,because they allow and encourage you to bring your own food on the train. Planesand ships are where it starts to get a little trick, especially if you have a long trip ahead of you.
    Airlines are fairly easy to manage,because you can bring your own food aboard the flight. However,there is a limit to what and how much you are allowed to bringaboard, which can be a problem on a long flight. While many airlinesoffer vegetarian or Kosher options for those with special dietaryneeds, most airlines do not have gluten-free menu options for thoseof us with gluten-intolerance. However, Continental Airlinescurrently offers gluten-free food options. Although, if you areextremely sensitive to cross-contamination, it is still safer tobring your own food.

    More Gluten-Free Airline Travel Tips
    Continental Airlines
    However, if you are planning to travela cruise-line, most cruise-lines do not allow you to bring your ownfood aboard. So in this situation it is important to find acruise-line that will accommodate your special needs. RoyalCaribbean Cruise-lines, and Orbridge ships are two cruise-lines thatoffer gluten-free menu options, as well as catering to other dietaryneeds.
    Royal Caribbean Cruise Orbridge
    Gluten-free accommodations
    Most motels or hotels offer acontinental breakfast and that's about it. Short of eating coffee andorange juice for breakfast,there usually isn't much in the way ofmeal options for a celiac. However, many small bed and breakfast'swill accommodate you special dietary needs if you talk to them andset it up in advanced, and some even offer gluten-free options. To find a gluten-free Inn, perform a “Google” search for'gluten-free accommodations' in the area you will be traveling to.
    Staying with family or friends can bestressful if they aren't sensitive to your dietary needs. It can alsobe difficult to explain to your friends and loved ones, what it meansfor you to be gluten-free, and who really wants to spend their entirevacation educating the everyone you meet on what it means to beceliac or gluten-sensitive? That could literally take the entirevacation. If cross-contamination is an issue for you and you areconcerned about eating in a gluten based house, the following linkwill help you determine what you need to be free from gluten whileyou are staying with others. It might be a good idea to print theinformation and share it with your host, maybe even emailing them alink with the information, prior to your visit.

    What to do if you can't have agluten-free kitchen Gluten-Free Meals and Snacks
    Finger foods, gluten-freechips/crackers, veggie sticks, gluten-free sandwiches, these are allwonderful foods to keep with you on a trip. Bring as muchgluten-free, shelf-stable food with you as possible. Find out wherethe local farm market is, for fresh and local, organic produce andbuy fresh produce when you arrive at your location.
    Many people getting ready for a trip,will place an order online in advance and have it delivered to thelocation they will be visiting. The Gluten-Free Mall is veryaccommodating and can ship shelf stable food Nationally andInternationally and frozen goods can be shipped within theContinental US. Having a package of gluten-free food delivered toyour location, gives you one less thing to worry about. No extrapacking, or extra luggage, no worries about your food getting crushedor apprehended at customs or tossed out at an airport. It's assimple as placing an order online or by phone.

    Gluten-Free Mall The National Foundation for CeliacAwareness (NFCA) works very hard to train chefs and kitchen staff allacross the globe, on the dos and don't s of cooking gluten-free fortheir guests with extreme gluten sensitivities. Check out the listthey have compiled of of GREAT kitchens that have the stamp ofapproval from NFCA for a possible location near you.

    NFCA GREAT Gluten-Free Kitchens list Unfortunately, not all restaurants havethe GREAT seal of approval from NFCA and the likelihood of one beingat your chosen destination is pretty slim, and finding a dedicated gluten-free restaurants are also rare depending on where you travel. That's why it is important to knowwhat to do when you go out to eat with a group of gluten-eaters.There is a great deal of information on this subject, but here aresome links to get you started.

    How to eat a gluten-free breakfastwhile traveling Eating gluten-free when traveling What to do if you Accidentally Ingest Gluten
    There are varying opinions of what thebest thing to do is when you accidentally ingest gluten, drink gingertea, take laxatives, hot water bottle on the abdomen; there really isno right answer, as everybody is different and has differentreactions to gluten. However, here are some tips that might help ifyou accidentally ingest gluten.

    Accidental Gluten Ingestion What to do if you accidentally eat gluten
    The most important thing you can do for yourself is to have fun. Stress can affect how youdigest your food, and then it won't matter if you avoid gluten, you stillwon't feel good. 
    Happy and safe travels everyone!


  • Recent Articles

    Jefferson Adams
    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.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] 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
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
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    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
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    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics