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      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
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    TRAVELING AND EATING GLUTEN-FREE AT RESTAURANTS


    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.


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    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.


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    Guest Teri Heenan

    Posted

    Your article was great. I have had celiac for over 30 years and going out can be a pain. I have had good and many many bad meals at restaurants who have said they didn't cook or put anything in my food. Well tell that to my stomach as I am heaving over a sink. It has gotten to be a chore to go out to dinner. I don't have the patience to ask all the questions you do. I eat before we go out with friends so I know I won't have any problems later. Thanks for your tips.

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    Guest dan mcmahon

    Posted

    Chef Daniel P-

    lots of things for you to reconsider:

    never order a CHEESE burger. Many cheaper possessed cheeses have gluten. Because of secrecy, many chefs would NEVER allow you to watch something special being made. No one should accept a salad with croutons put on when made in advance-they get soggy, etc

    I have a few more if interested but all in all article was helpful

    ....Dan

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    I am giving a poor rating for one reason only - you must not eat the corn tortilla chips until you know how they are prepared! Ask and you will find out that if they are made fresh at the Mexican restaurant they most likely where deep fried with the flour tortillas that they also serve. Huge cross contamination problem!!!!

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    No offense, you but are what gives annoying people in restaurants a bad name!! "I'd like 1/2 an avocado, 1 whole tomato, 2 tbs. vinegar and please use new gloves to touch my food and please open a fresh bag of salad".....you are not the prince or princess of anywhere. This is how people get their food spit in..hopefully that is gluten free though! We all have our gluten allergies here, but I would never EVER dream of being this picky at a restaurant! If you're going to be this bad, consider not ever eating out.

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    Wow! I did not like this article because you are expecting the world to bend over backwards for your disease. I have celiac disease and would never want to be "one of those people". I can make wise decisions based on what I already know to be gluten-free. There is no need to make everyone in the restaurant aware or give specific instructions. YOU, yourself need to educated on what you can and cannot have. It's not your responsibility to educate others everywhere you go.

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    As a server for many years, I do not mind helping people especially since a close friend is deathly allergic to peanuts, nuts, anything with traces of nuts, etc. But if a customer ordered with that attitude I would definitely not give them my best service and most restaurants would laugh. Here is your 3 cm in diameter tomato and 5 inch small cucumber. If you're this picky, eat at home.

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    Guest heather

    Posted

    No offense, you but are what gives annoying people in restaurants a bad name!! "I'd like 1/2 an avocado, 1 whole tomato, 2 tbs. vinegar and please use new gloves to touch my food and please open a fresh bag of salad".....you are not the prince or princess of anywhere. This is how people get their food spit in..hopefully that is gluten free though! We all have our gluten allergies here, but I would never EVER dream of being this picky at a restaurant! If you're going to be this bad, consider not ever eating out.

    Love this response!

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    No offense, you but are what gives annoying people in restaurants a bad name!! "I'd like 1/2 an avocado, 1 whole tomato, 2 tbs. vinegar and please use new gloves to touch my food and please open a fresh bag of salad".....you are not the prince or princess of anywhere. This is how people get their food spit in..hopefully that is gluten free though! We all have our gluten allergies here, but I would never EVER dream of being this picky at a restaurant! If you're going to be this bad, consider not ever eating out.

    Very true! I was a waiter in college and if someone requested all this I would tell them to go "you know what" themselves.

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    Daniel Moran
    Celiac.com 06/03/2008 - As you travel and experience the sites of the world you are going to have to stop at a restaurant or destination that has a small kitchen.  Let me tell you a little bit about myself so you can understand that I also started in a small kitchen.
    Chef Daniel P's Autobiography
    I started working at the age of 13 and began my work in a very small tourist town and was promoted up from busboy to dishwasher.  I was so fast at washing the dishes that I was promoted up within a month to cook.  I went from the buffet type restaurant to an ala cart restaurant and buffet line.  At the age of 17 I was completely in charge of the kitchen—this included all ordering, menu making, staff hiring and firing, and every task a person would do to run a successful kitchen.  I didn’t know how to cook though—at least not compared to what I learned later. Yes I could do the basic menus but I wanted more and I left to climb the ladder of a big kitchen—so I set my sites on gourmet food.  At that time I saw that Prince Charles from England was visiting Palm Beach Florida.  I saw that he visited two places while he was in Palm Beach—the Palm Beach Polo Ground and he also visited the Breakers Resort.  I applied at both places when I came to Florida and both wanted to hire me.
    Every one has to start somewhere and you as the traveler are the ones who are going to train the future cooks or chefs.  Yes you—the cook is going to learn from you as celiac patrons, so you need to do the right training.  Let’s use the example of eating on a train that cooks for their patrons as they travel across the country.  I like to think of a small boat or train as two of the most difficult places to prepare a gluten-free meal.  They both are going to be small, and both have the potential to get bumpy while the cook is preparing food.  This means there is a good chance an accident can happen and of course cross-contamination.
    These kitchens probably keep their fires contained in the stove or flat top burners.  By keeping the flame for cooking contained in a box, this means they have less chance of a fire starting and that is very important if you are on a river or going down the train tracks. The cooks are going to use sauté pans, hard top grills, ovens, steam boxes and possibly microwaves.   If you know that you are going ahead of time to these types of restaurants you should see if they can send you the menu ahead of time so that you can look it over.
    Hint: If you know your destination for any of your trip, see if you can get the menu before you arrive, as most places always have their menus prepared ahead of time. If you get the menu you can make up your Chef Daniel P Restaurant Form before you go.
    I would try to spell out your entire meal in great detail.  I also use this technique for all mom and pop restaurants.  You are not insulting a cook or chef by asking them to prepare your meal a certain way.  Every day the cook receives orders from the waitress on how to prepare a particular meal.  Just because you are giving the instructions yourself only means to the chef that you are very serious about how your food is prepared.
    What to Eat And How to Cook Your Meal
    In these type of restaurants that are small and have limited space you have to try to eliminate any mistakes that the cook might make. How…you ask?  Try some of these ideas:

    Notify them ahead a time if you can.  Let the train, boat or any restaurant know that you are coming.  Make sure you tell them the date, time and how many people will be receiving special meals. Don’t be upset if you get there and no one knows that you are coming, it is just part of the business. Have their phone number available so when you arrive in the city you can call a few hours before you arrive to eat.  Just remind them again that you are planning on eating at their restaurant and ask them when their slowest time is. If it is a train or boat ask if you can eat at the last seating time (unless they indicate that an earlier time is slower).  Feel them out to see when the best time is for you to order a specially prepared meal. During your phone call, ask who you should ask for when you do arrive for your meal. Make sure you arrive with your Chef Daniel P Restaurant Form and a pen or pencil. When you arrive ask for the manager or the person you talked to on the phone. Tell the manager in great detail about your special diet request.  Let them know you will be writing out your request that will specifically tell them how to prepare your meal. Ask if there is anything you should know about the kitchen or the chef—anything that could help you in preparing your meal and making it as safe as possible.
    You might have to ask the manager how they cook their food. Some are going to use a flat-top grill, broiler, steamer or even a microwave oven.  Once you find this out it is time to create your meal instructions and present them to the manager so he can deliver them to the cook.How the Cook Prepares Your Food:

    Sautéing: To me is one of the safest ways to have your food prepared.  No matter if the cooks are in a small or large kitchen.  This is how I might write it down for the cook to see:  “Sauté 1 whole chicken breast in olive oil, make sure the pan is very clean and does not have a crumb on it.”  When asking to sauté you can ask for them to make a quick sauce in the pan.  That is what I do, even if it is just to squeeze a lemon on your food, this can add some fresh flavor. Hard Top Grill:  I don’t recommend using this unless you are the very first ones to arrive.  During the day when they cook on the grill pieces of food stay on the grill for the whole day.  You can ask them to use the razor blade to scrape the grill.  Even using the razor blade it is not 100% and food from other meals may get on your food. Steamer: This is a good way to cook as long as your food is the only one in the steamer.  You can ask them to wrap the food and this will keep all crumbs off of your food.  Example:  “Please wrap a piece of salmon up with some saran wrap.  Place it on a holey pan so the steam can circle salmon." Microwave: This is great for potatoes or vegetables and a good way to keep food safe.  I always ask for my veggies to be micro-waved.  This is a great way to get a baked potato.  Even some fish and other entrees can be cooked in the microwave.  Example: “Could you please cook a potato and my vegetables in the microwave.  Put them in a dish then cover with saran wrap.” Fryer: You must stay away from a fryer in small kitchens (unlike fast food chains and some bigger restaurants).  They use the fryer for everything and that means that everything could be in it. When they cook your French fries, the crumbs from the chicken nuggets could get on your food. Boiling: This is another great way to cook food.  You must ask them to only cover the food product that they are cooking.  Some fishes, vegetables and other meats can be cooked this way. If they have a steamer I would ask for that first since they don’t have to wait for it to get hot. Example:  “I would like two eggs boiled or poached in just enough water to cover the entrée so it won’t take so long. You could have the cook put a small amount of water then cover the pan and steam it.” Broiler: Sometimes small kitchens that are moving are not going to have a broiler.  It is the fear of the open fire that could cause a fire in the kitchen.  If they do have one you could ask for this example:  “I would like a piece of salmon on a metal plate.  Cook it until it is done, then splash it with white wine before plating.”

     The main idea you take into small kitchens is this:  It is a lot like cooking at your home (unless you have a huge kitchen).  Those kitchens are made small but can put out large amount of meals if needed.  Those menus are made to accommodate the small amount of storage also.  You need to really know your menu and the ingredients they are using.  Unlike a large kitchen you might not have the extra supplies that a big kitchen has.  They just don’t have the room and you need to think of that.  So if it is a river boat or a train, when you look at the menu some of the items will be canned products, because canned products are so much easier to store than refrigerated items. As you look at the menu take the item you would like and ask them if they can cook it in a sauté pan or maybe in the oven.  This is a very safe way to have your food prepared.
    When I was employed at the resort and we would often have banquets for over 200 people. If the meal was New York strip steak we would put the steaks on the broiler and mark the diamond char marks in order to get the steaks cooked exactly at the same time. We would then pull the steaks off and put them on large sheet pans. Just before we needed the steak, we would put them in the ovens and cook them until they were the proper temperature. The customers never knew that the steaks were cooked in the oven and not the broiler. The char marks on the steak made everyone believe that it was broiled.
    The point is that you can have your food baked as long as you don’t get sick—for me that is the most important thing.  When I do eat out, I don’t care too much about the taste or temperature of the meal—my number one goal is that I get a gluten-free meal and that the restaurant doesn’t ruin my vacation.
    Also, you have to be very careful when you send your food back.   Just remember how busy the cooks are and whether or not they are going to remember your specially ordered meal when it comes back to them.  If they are busy in the back and the waitress says to the cook, “Cook it more,” what do you think happens—will they take as much time as they did the first time?  These are the types of questions that you have to ask yourself when you are sitting at your table and thinking about sending your meal back.
    I know that we all expect a perfect meal when we pay for it.  Sometimes it is just easier to ask them to only warm it up in the microwave. Something to think about is that the microwave is like a closed room where it is not likely that your food will get contaminated.  Most kitchens, especially smaller ones, have a microwave like the one that you use at home.  If you do need your meal cooked more, try to explain it to the manager and remind him that you will get very sick if it gets contaminated—ask the manager nicely if you can watch and see if the cook does it right.
    Another thing to remember when you are eating in these types of restaurants is that they are small and that means the kitchens are small too.  The cooks are going to be right next to each other—only arms and shoulders apart. Remember; if you don’t think they will be able to feed you properly always have a plan B, so you can still eat. Plan your meal to be as simple as possible for them to prepare and you will be able to conquer the Gluten Monster and have a wonderful train or boat experience!
    Chef Daniel P. 

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    Celiac.com 04/19/2018 - Previous genome and linkage studies indicate the existence of a new disease triggering mechanism that involves amino acid metabolism and nutrient sensing signaling pathways. In an effort to determine if amino acids might play a role in the development of celiac disease, a team of researchers recently set out to investigate if plasma amino acid levels differed among children with celiac disease compared with a control group.
     
    The research team included Åsa Torinsson Naluai, Ladan Saadat Vafa, Audur H. Gudjonsdottir, Henrik Arnell, Lars Browaldh, and Daniel Agardh. They are variously affiliated with the Institute of Biomedicine, Department of Microbiology & Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; the Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Division of Pediatrics, CLINTEC, Karolinska Institute, Stockholm, Sweden; the Department of Clinical Science and Education, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden; the Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden; the Diabetes & Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; and with the Nathan S Kline Institute in the U.S.A.
    First, the team used liquid chromatography-tandem mass spectrometry (LC/MS) to analyze amino acid levels in fasting plasma samples from 141 children with celiac disease and 129 non-celiac disease controls. They then crafted a general linear model using age and experimental effects as covariates to compare amino acid levels between children with celiac disease and non-celiac control subjects.
    Compared with the control group, seven out of twenty-three children with celiac disease showed elevated levels of the the following amino acids: tryptophan; taurine; glutamic acid; proline; ornithine; alanine; and methionine.
    The significance of the individual amino acids do not survive multiple correction, however, multivariate analyses of the amino acid profile showed significantly altered amino acid levels in children with celiac disease overall and after correction for age, sex and experimental effects.
    This study shows that amino acids can influence inflammation and may play a role in the development of celiac disease.
    Source:
    PLoS One. 2018; 13(3): e0193764. doi: & 10.1371/journal.pone.0193764

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6