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    The Gluten-free Market in USA, Europe and Poland


    Leszek Jaszczak


    • Journal of Gluten Sensitivity Autumn 2012 Issue


    Image Caption: Image: CC--Dennis Jarvis

    Celiac.com 10/12/2017 - Despite the economic downturn, the cost of healthy products has not diminished. Sales have continued to grow in this sector thanks to the many information campaigns aimed at raising consumer awareness of the health benefits of consuming gluten free products. Manufacturers have responded to the growing demand by expanding the variety of products they offer. Many consumers, including those that cannot eat gluten, do not want to give up eating products specially designed for them although they cost even more than traditional food. The demand for products that address food intolerance continues to grow.


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    In Poland, the number of people who are on special diets because of their health problems and food allergies is still growing. More and more people suffer from intolerance to different nutrients. This creates market conditions that encourage developing products that are safe for this group of consumers. Demand, among one sub-set of this market - gluten-free products, is growing among many consumers. Even manufacturers of standard food products have entered this market segment because they see a large and growing potential. The gluten-free food market is growing steadily. The causes, in addition to the increasing number of diagnosed patients, is an increasing awareness among doctors and patients.

    Celiac disease affects not just children. Currently 60% of diagnosed cases are adults, of which 15-20% are over 60 years of age. Coeliac disease is diagnosed in Europe in 1:200 and in 1:250 people in the U.S. Approximately 70% of those diagnosed are women. Celiac disease is a non-allergic food hypersensitivity, which is caused by a genetic intolerance to gluten, a protein found in cereals such as wheat, rye, and barley. It is estimated that celiac disease affects around 1 percent of the population and this number is likely to grow in the future. In some European countries, patients with celiac disease form more than 2 percent of population.

    Yet, the most developed market for gluten-free foods is in the United States. The number of newly introduced gluten-free packaged foods and beverages in the U.S. increased by 80% from 2005 to 2010. This trend is expected to continue through the years 2011-2014. Market analysis suggests that gluten-free food sales will grow at least until 2014. Companies producing food should therefore take advantage of the growing trend of food consumption in this category.

    Traditional gluten-free products such as bread, biscuits, crackers, cereals and pasta products are still in the development stage. In their group, in recent years, producers have continued to introduce new choices. However, we have also seen many innovations among the products in categories such as snacks, dairy products, sauces, spices, desserts and confectionery. Some of these products may already be free from gluten. However, to attract consumers they are now being labeled as gluten-free products.

    In the United States between 2008-2010 about 300 products in the category of gluten-free snacks were introduced. The U.S. achieved the highest number and value of sales in 2010. In Poland, only some of the really sick people are the diagnosed cases. Associations of people with celiac disease, such as the Polish Association of people with celiac disease and gluten-free diet is trying to raise public awareness of more aspects of the disease. This is another factor that will lead to increased demand for gluten-free foods. Such activities are already producing effects in the West, where preventive information campaigns have been widely carried out. The current emergence, in the Polish market, of western gluten-free food manufacturers and their products, demonstrates both the development of this branch of the food industry and growing awareness among people in other parts of Europe and the USA.

    For now, Polish brands dominate in our home market. This is due to lower prices compared to imported products. The quality of Polish products is also competitive. The current political situation allows distribution within the country and also for export. Competitive prices offered by Polish companies may be attractive for residents of other countries.

    Entering into foreign markets, managers should also take into account local eating habits and preferences. For foreign companies it is harder to attract customers, not only because of the price difference, but also because of the taste and form of food. Eating habits are also a strong factor, which influences customers' purchasing choices. So this factor must be included in designing process and entering new markets.

    Invariably, the problem of much higher priced gluten-free products arises. Gluten-free products are generally much more expensive than wheat-based products. This is due to less demand for them and the continuing refinement of this kind of food, which, so far, offers an inferior taste. A survey conducted by the Gluten-Intolerance Group of North America, estimates that people buying gluten free products spend about 30% of their monthly expenditures on food. This is still a big barrier to overcome for gluten-free food producers. The difference stems from the fact that the materials are non-standard and not as widely available as conventional ingredients. The development of new production technologies also generates additional costs. Furthermore, innovative products will be subjected to laboratory tests. Still, domestic products are cheaper by significant margins compared to products from abroad.

    Gluten-free food is specially marked by the manufacturers. The characteristic feature is the sign of the crossed head of grain, which indicates that product contains less than 20 ppm of gluten, which corresponds to 20 mg per 1 kg. Use of clear and legible labels will encourage customers to choose these products. The symbol tells the customer what to expect from the product. He can quickly and easily identify what he needs.

    Many leading companies monitor development of this branch of the food industry. They emphasize packaging and eye-catching labels. They also consider opening separate production lines to produce only this kind of products. Even companies not currently engaged in production of gluten-free food are starting to invest in development of these technologies.

    Much depends on the purpose of a producer who has to remember that gluten free food is a specialized product. If its purpose is mass production, entry into the gluten-free market may not produce the desired financial results. On the other hand, the advantage, in this case, is the extended offering of products at more competitive prices, which makes the products more attractive in the eyes of customers. At the same time, retailers will appreciate manufacturers that offer a wider choice of products. Financial planning should take into account the above factors and consider investing in new technologies.

    Access to the widest choice of gluten-free products is the best at Internet stores or health food stores. Supermarkets are not able to provide as wide a choice as the online stores. Potential clients are not just city dwellers who have easy access to health food stores. A package ordered from an online store reaches into every area of the country, and they are open at all hours and on all days. These store types are worth keeping in mind as they pose increasing competition. However, from a price perspective, they cannot compete with supermarkets.

    The demand for gluten-free foods is growing from year to year, among other reasons, because it also fits with the current trend of preventive health care. The gluten-free food market is characterized by outstanding performance over many years. Even during the recession in 2009, it grew by 11% in global sales (calculated on the basis of USD 2009 exchange rate), compared to the more sedate level of 3% for products in the category of health and wellness. In 2004-2009, gluten-free products reached a 15% annual growth rate (data Euromonitor). In 2009, global sales reached $ 2.3 billion for gluten-free products which represents 27% of food sales from food intolerance groups. Half of those sales were generated by bread, traditionally the most important category. According to Euromonitor analysis, a wide media campaign about celiac disease symptoms such as fatigue, weight gain, skin rashes and lack of concentration, also increased its sales in this category, turning gluten into the "enemy" of good health. As of today, many of the gluten-free product buyers are people who have not been diagnosed with the disease, and who consider themselves to be people sensitive to gluten. They believe that eating gluten-free products improves their health. According to Euromonitor analyses, retail markets around the world, are not only responding to this trend, but also actively helping to increase growth in sales by offering a number of gluten-free products. Researches predict that the market for gluten-free foods will continue to grow over the next five years, although at a slower pace. Forecasts predict that the U.S. market of gluten-free foods and beverages in 2015 will reach sales of $ 5.5 billion.

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    Sonja Luther
    Celiac.com 05/22/2014 - In September 2013, I found out that if I want to be healthy, I have to eat a strict gluten-free diet. Not only that, but I also have to avoid corn, casein, beef, chicken, shrimp, garlic, yeast, grapes, cantaloupe, and cauliflower. When I go to a restaurant, my diet restrictions eliminate almost everything on the menu. Because of the lack of options and my fear of cross-contamination, I have not been to any restaurant since my diagnosis except for dedicated gluten-free restaurants. But eating at home every day for the rest of my life cannot be the answer. I will not let gluten rule my life and turn me into a hermit. Traveling is one of my biggest passions and if food is my only obstacle to living my passion, I will face my fear of cross-contamination, find solutions, and overcome this obstacle one bite at a time.
    Of course, my first gluten-free vacation won’t be a trekking trip across the Himalayas although this is still on my bucket list. No, for my first gluten-free vacation I have chosen a less challenging trip. I have decided to go on a seven-day Mediterranean cruise on board the Aida Sol. Aida assures, on their website, that allergy sufferers can find and enjoy a variety of delicious allergen-free (especially gluten-free and lactose-free) food aboard their cruise ships. Additionally, you can meet with the head chef for 30 minutes to discuss your diet options for the week, and there is always a chef available for questions. It all sounds so promising, but is it really as wonderful as Aida claims? Is the food aboard the Aida Sol really safe for someone with celiac disease? I’m ready to find out.
    Day 1
    It is late in the afternoon and we are finally at the check-in desk. I am getting hungrier and more nervous by the minute. When I ask the receptionist how I can schedule my private session with the chef, he tells me to just go to one of the buffets and ask for one of the chefs. That should be easy, but I’m still nervous. This is the first time since my diagnosis that I will be eating at a regular restaurant. What if I get sick tonight? What would I eat for the rest of my trip?
    When we arrive at the Bella Donna Restaurant, one of the buffets on the Aida Sol, a welcoming chef gives me a tour of the buffet. He doesn’t take the time to sit down with me, but he shows me around; he points out the labels right above every dish which say whether the food is gluten-free, lactose-free, and/or vegetarian. What a relief! I immediately see several dishes that I believe I can eat. After a quick tour of the buffet, I take a plate and start grabbing more and more … meat. Yes, most of the gluten-free and lactose-free options are meat and my plate is packed with it except for a few veggies on the side. Ironically, I have never been a big meat eater until now. In fact, before I went gluten-free, I was a pescetarian. The only reason I decided to eat meat again was because I was eating as much as I could but kept losing weight. By the time of my diagnosis I was no more than 106 lb.
    I’m feeling wonderful. I’m at a regular restaurant and I’m enjoying my food like everybody else. Not only can I eat as much as I want, but I also have multiple choices … until we get to the dessert. I’m walking from one dessert to the next. None of the labels says gluten-free. I’m slightly disappointed. But let’s try the fruit bar! And what an amazing fruit bar it is! Besides apples and oranges, I see mangoes, kiwis, papayas, pineapples, purple & green passion fruits, persimmons, dragon fruits, cape gooseberries, and coconuts. I don’t think I’ll go hungry this week. What a relief!
    Day 2
    First day at sea, I made it through the first night without getting sick! I’m incredibly happy. The sun is shining through the window. The balcony door is open. I can hear the waves. What a perfect morning! Until I get up. Wow! The motion of the sea is stronger than I expected. I was feeling great, but now I’m not. I feel sick. Seasick. No breakfast for me.
    Day 3
    We’ve reached Tunisia, but before I explore the cities Tunis and Sidi Bou Said, I need to eat as much breakfast as I can since I’m not sure if I’ll be back in time for lunch and I’m too scared to try a Tunisian restaurant. This is my first breakfast on board. I’m walking around the buffet, trying to find something gluten and casein-free, but none of the dishes have labels. I’m feeling a little lost. I’ve already gotten used to those labels so much so that without them I immediately expect the food to be unsafe. I’m staring at the food, but I’m afraid to touch it. Where is the chef?
    When I ask the chef about what’s gluten-free, he doesn’t seem as well prepared as the first night. Maybe it is because of the lack of labels. When I ask him about the deli meat, he tells me that it is not prepared on board the ship, so he can’t tell me whether it is gluten-free or not. Why not? Why does the chef of a large cruise ship, which claims to be prepared for guests with celiac disease or gluten intolerance, not know whether the food he’s offering is gluten free? That’s not what Aida advertises on their website. I begin to realize that the staff, including the chefs, is not as well educated when it comes to celiac disease and gluten as I had hoped, which becomes even more obvious when the chef suggests that I could probably eat the ham. I’m standing in front of the deli counter, staring at the ham and then the meat-cutting machine. Wait a minute! That meat-cutting machine, is it used for all the deli meats? I begin to hear the word “cross-contamination” ringing in my ear; it’s slowly taking over my mind. I feel a bit of fear rising in my body. My trust in the chefs and kitchen staff begins to crumble. I will need to be more careful from now on and watch out for cross-contamination.
    Day 4
    We are in La Valette, Malta. The weather has been a mix of rain and sunshine, but the city is so beautiful that no rain can cloud its beauty. I’m running around the city, trying to see as much of it as possible before I rush back to the ship to grab some lunch before the buffet closes. The restaurant I usually choose is already closed and I have to try the Markt Restaurant. Usually both of these buffets offer lots of gluten-free options, but not this time. Twice, I walk from dish to dish, trying to find something I can eat. It’s not that there aren’t any gluten-free options, but the number is so small that my other food intolerances make it impossible for me to find any food. I end up eating some fruits and a salad that has garlic in it which makes my stomach hurt. This is the first time I leave the restaurant hungry, and I’m hoping that it will be the last.
    Day 5
    We spent the day in Palermo, Sicily, and are now ready for dinner. As usual, the dinner food is delicious. Every night my plate is packed with meat, vegetables, and fruits. So far, I can say that I haven’t been glutened, but I’ve been noticing other places of cross-contamination. Tonight, for example, you can get gluten-free pasta sauce but not gluten-free pasta. In fact, the gluten-free pasta sauce is right next to the wheat pasta. Not just that, but a few of the wheat noodles have already fallen into the pasta sauce. I will certainly not eat the sauce.
    Day 6
    My breakfast is the same as it was yesterday, and the day before, and the day before that: bacon and eggs. Every single day I’ve been eating bacon and eggs for breakfast. Lots of bacon and eggs! At least half of my plate is packed with bacon while the other half is packed with eggs. I can feel people’s eyes on the back of my neck wondering why I’m eating so much bacon and eggs. Well, it’s pretty much the only thing I can eat for breakfast.
    I’m slowly getting tired of all the meat, and I wish I had other options, but my body feels fine. I am still watching out for cross-contaminated food. Tonight, for instance, I’m avoiding the cut fruits from the fruit bar because the kitchen staff that is cutting the fruits is also preparing the Kaiserschmarrn (a cut-up sugared pancake with raisins) in the same work area. Even though the staff members are wearing gloves, they haven’t been changing them before handling the fruits. It becomes more and more obvious that the kitchen staff is not well informed when it comes to gluten and cross-contamination.
    Day 7
    Last destination: Barcelona. I have heard of the city’s numerous gluten-free dining options, but while I’m exploring the city, it feels like I’m only seeing bakeries filled with pastries made out of wheat. This entire cruise I didn’t eat any pasta, bread, cookies, or chocolate, and I’m craving it, oh, I’m craving it! Even though I don’t eat much of it anymore, it feels like I’m actually addicted to it. I’m not sure whether it’s the flour or the sugar, but it’s getting harder and harder to bear those cookies and cakes behind the shop windows. I’m trying to distract myself from what I’m seeing, which works until I walk into my room. When I open the door, I see a plate with a big piece of cake lying on my bed. Is this a joke? If it is, it’s not a good one. Where does this cake come from? My father is smiling at me. He tells me that he was in the restaurant for coffee and cake and heard someone request a piece of gluten-free cake from the kitchen, so he ordered one for me. I can’t believe it! They had gluten-free cake the entire week and I didn’t know! The chef never mentioned it. I decide to eat the cake as a special dessert after dinner.
    Day 8
    Last night was a nightmare. I had cramps that kept me awake the whole night, and I had numbness in my fingers. Until today I was convinced that the numbness in my fingers was caused by gluten, but the cake was gluten-free, so was there maybe corn in it? I’m confused.
    In the afternoon, I decide to go see one of the kitchen chefs to ask him about the ingredients in the gluten-free cake. I want to know whether there was corn in it or not. The chef is very accommodating and immediately goes into the kitchen to check the ingredients on the box. When he comes back, he tells me that there is no corn in the cake but that there is a little bit of wheat in it. What? There’s wheat in the gluten-free cake. How can that be? How can it be gluten-free when there is a little bit of wheat in it? He tells me that it says gluten-free on the box. He believes that it must be just traces of wheat. Right! Traces of wheat! That’s enough to make me sick. So, the numbness in my fingers last night was actually caused by gluten.
    Departure
    After my talk with the chef, it’s time for our departure. It was a great vacation, but I’m ready to get back home, especially since my trust in the kitchen chefs has been damaged too much by this last incident. Overall, Aida Sol did not deliver as well as promised on their gluten-free commitment. Yes, Aida offers various delicious gluten-free dishes on board their ships so that no one needs to go hungry; however, because of the chefs’ and staff members’ insufficient knowledge of celiac disease and of the risks of cross-contamination, I can’t declare the gluten-free food options on board Aida Sol to be safe. My advice to gluten-free travelers is to remain careful even when it says gluten-free. Always ask for the ingredients, especially of those foods that are not prepared on board the ship.
    Despite their ignorance of cross-contamination, I value Aida for trying to be accommodating to allergy sufferers. There are not many hotels and restaurants that are as accommodating as Aida, but I would appreciate even more if Aida had better informed staff that is more aware of the risks of cross-contamination. It’s of no use to allergy sufferers if the great gluten-free food that is offered on board the ships gets contaminated because of ignorant kitchen staff. Furthermore, there should be at least one chef in each restaurant that is familiar with the ingredients of the foods that are not prepared on board the ship. I only got sick once at the end of my time on  the Aida Sol, but I am not sure if it was pure luck that it happened not more than once.

    Yvonne Vissing Ph.D.
    Celiac.com 02/02/2016 - Thanksgiving dinner is one of the culinary highlights of the year. Family and friends join together to share a blessed moment when they give thanks for each other and for homes, jobs, and the opportunity to live comfortable lives. We may give thanks for peace, decent weather, surviving illness, or just making it through another day.
    This is all done around the celebration of a food feast. Food is of central importance to social bonding and sharing a sense of community. As we all eat from the same platters and serve from the same bowls, there is a one-ness, a unity between us. But for folks who have celiac or who can't eat gluten, there is a sense of exclusion when relegated to a "separate but equal" dining system.
    People who have no problem eating anything and everything often fail to consider how hard it is for people who need to be super-careful about what they consume. When they have gone to great expense to buy festive foods, and after they've expended significant time planning the perfect plates, it is understandable that they get frustrated when others won't eat what they've prepared. What they may not remember is that there is a big difference between "won't" and "can't". Will-not implies a preference—and in food-terms it means wrinkling up your nose over something that doesn't strike your fancy. Can-not implies the hard truth that if one eats something, they could get sick. Won't is a choice—can't occurs when there is no choice. So when people do not eat a festive food, is it because they can't or won't? The usual default is to assume won't. But for people who are gluten-free, the answer is can't.
    Going gluten-free at Thanksgiving can be tough because it's so keenly associated with memories. Some of them are sensory, like remembering the smells of fresh-baked pumpkin pie or roasted turkey wafting out of the oven. Others are emotional, such as laughing with grandma while kneading bread that they family will soon lunge to smother with melting butter, or chopping up onions, celery, and chestnuts for dressing with Aunt Molly. For folks who once weren't gluten-free, certain foods evoke desire. We all have emotional trigger-foods. What's yours? One year we were invited to a colleague's Thanksgiving dinner and the hostess asked everyone, "What is the one food that if you don't have it for Thanksgiving, you would feel sad about?" It was a thoughtful question. After we all confessed she then told us that was the item we were to bring.
    When you're going to a pot-luck type of Thanksgiving dinner where everyone is bringing something, it's dietary roulette for someone with celiac. It's gambling at its finest. What are the chances that you can eat a dish? Does the cook appear conscientious and trustworthy or make you ask "am I feeling lucky?" enough to try that dish? Eating in collective settings lowers the risk of getting glutened when everyone knows you've got dietary issues and they're openly attentive to them. The risk is greater when you're with people you don't know well, or those who aren't as careful as they seem. Culinary posers prevail during the holidays. Some stop at the deli and put the food into their own bowls and cover them with aluminum foil to make it appear they made it themselves (I know—I have in fact done this). We have no idea what's really in the food because we didn't make it ourselves. Others lie about the dish's ingredients. They may innocently fib because they don't know what's safe and what's not for someone who has to go gluten-free—or they could tell only partial truth, like I did long ago about whether I put cream in a pumpkin soup when someone was lactose intolerant. Back then, I wrongly assumed that if they didn't know, they couldn't tell, so they wouldn't put up a fuss and then I wouldn't get embarrassed. I didn't know then what I know now. Even well-intended people may screw up when it comes to telling the truth, the whole truth, and nothing but the truth about what's in food or how it was prepared.
    Preparing a gluten-free Thanksgiving dinner that is absolutely safe and delicious for everyone to eat is easy. Here's a menu and recipes that will help you to create a meal that everyone is thankful for! It focuses on foods of the season, especially apples and the family of squashes. It is inclusive and delicious, and will give everyone one less thing to worry about as we instead focus on gratitude.
    A Gluten-Free Thanksgiving Dinner Menu
    Appetizer
    When folks are milling around before a meal, it's nice to put out appetizers that they can nibble on. Usually these are very sharable, so making sure they are safe for someone with celiac is essential. So don't put out anything that could lead to cross-contamination. Here is our favorite tried-and-true appy:
    Artichoke Dip
    This is so easy and delicious as not to be believed!
    Ingredients:
    2 -3 cans of artichokes, cut into small pieces
    1 red pepper, diced
    Swiss, Cheddar, Parmesan, Muenster, and other cheeses of your liking
    Salt, pepper, onion flakes
    gluten-free crackers
    Directions:
    Spray a low casserole dish. In a bowl, mix in the cut artichokes, pepper, and pieces of cheeses. Add in the spices; only a little salt and more pepper, as the cheeses are usually salty and the artichokes could have been processed with some. Probably there will be salt on the crackers, so you don't want to kill this dish with it. Pour in the mixture into the casserole and heat until bubbly. Serve with only gluten free crackers or veggie sticks. . Part of the fun is dipping in a bowl together, so make sure if people double-dip that everyone is safe!
    Option: some people like to add spinach or cream cheese to their dip. It's not my way, but the popularity of spinach-artichoke dips conveys that it may be right for you!
    Soup
    Soup is warm, comforting, and sets the stage for what's to come. Here are two recipes from which you can choose that are sure to whet the whistle of people for dishes to come!
    Apple Kale Soup
    Apples are abundant in autumn, and I created this dish in desperation to use foods that I had in the fridge on a day when the chill started to go through my bones. As a child I didn't understand kale, but now know it's a flexible, healthy and friendly vegetable.
    Ingredients:
    2-3 apples, peeled and sliced and diced 2/3 bag of fresh kale, or a hearty bunch cut into small pieces 1 purple onion, diced 1/3 pound of bacon (maple bacon is an especially good choice) 16 oz chicken broth (have another can handy if you want it) Salt, pepper Olive oil Plain nonfat yogurt Directions:
    Saute the onion and bacon in a little olive oil until they are brown and crispy. Add in a little broth, then the kale, which will shrink up immediately. Then add the apples in, along with the rest of the broth. Season with salt and pepper and let it simmer awhile on medium-low heat. I think a creamy looking soup is elegant, so I recommend spooning out the mixture into a food processor to make it smooth. Then return to the pan, adding more broth if you want. When that is done, add in the secret ingredient—plain yogurt. It will give it a creamy consistency and a little zing. You have to play with the amount of broth, yogurt and mixture to create a soup the consistency you like. It is an unusual soup that is tasty and sure to garner compliments.
    Gluten-Free Pumpkin Squash Soup
    In contrast to the previous soup recipe with is savory, this is a sweet soup recipe.
    Ingredients:
    2 cans pumpkin 1 small diced onion 1 medium butternut squash, cubed 3 cups chicken broth 1 teaspoon butter 2 tablespoons gluten-free flour or cornstarch 2 Tablespoon brown sugar 1 cup + half-and-half Salt, pepper, ginger, cinnamon to taste Directions:
    Saute the onions and squash in butter. Mash the squash when it is soft. Add to the chicken broth and simmer. Stir in the canned pumpkin. Mix gluten-free flour/cornstarch, butter, sugar, and spices. Fold in cream last. Heat but do not boil. You can garnish with a few slivered almonds if you want.
    Salad
    While my mama had many culinary talents, the salads she made weren't her specialty, to say the least. Her "green" salad consisted of iceberg lettuce with tomatoes thrown on top, or we might enjoy a Waldorf salad that had red-delicious apples cut up, some celery and pecans that she mixed with Miracle Whip. It took me years to understand that salads could be the best part of a meal. Here are substitutions for what mama didn't know about!
    Diversity Salad
    Salads are most enjoyable with they contain a mixture of ingredients. You are the artist in the kitchen and get to decide what ingredients in what proportions. Here are our suggestions of items to consider: Baby spinach, romaine lettuce, and spring greens are the base of the salad, but don't rely on this to be the biggest ingredient. Using plenty of other vegetables will make every bite an experience, each mouthful different than the bite before. Add liberal amounts of carrots, tomatoes, onions, cucumber, and peppers, cut in various shapes and types. We love radishes, celery, sprouts, broccoli, cauliflower, and fresh mushrooms, but not everyone agrees. Avocado, beets and asparagus are other vegetables that may be questionable; while we like them, not everyone does. We are sensitive to the palate of our guests and modify the salad ingredients to please them. Leafy vegetables like kale, arugula, cabbage, chicory, watercress can make a salad interesting. Likewise, using fresh basil, cilantro, parsley and other herbs create tastes that give each salad a different flavor. Do you like roasted red peppers? Artichoke hearts? Banana pepper slices tossed into a salad can be delightful if you like that kind of spiciness. Olive varieties are endless. We recommend putting out different types of dressings so people have choice. For examples of easy and delicious dressings, there is a list for you to consider in our book Going Gluten Free.
    Waldorf Salad
    This salad can be anything but boring!
    The base:
    Toasted walnuts or pecans – toasting gives them a nice crunch that adds to the texture of the dish. Apples—I like flavorful crispy kinds, unpeeled so the color shines out. Red? Green? Combination? You choose! You also get to choose how to slice them. Hunks, thin slivers, slices—you're in charge. I rather like them slivered—they seem more delicate for an elegant meal. Directions:
    Celery—Cut it in slender shreds.
    Seedless Grapes or Dried Cranberries—Historically, grapes were the ingredient selected in the original Waldorf Astoria recipe. You can certainly keep tradition and use them. I like grapes to eat but not as fond of them in salads, so I prefer dried cranberries. I live in New England and using them at this time of year seems right. The dried berries add another texture and bright color to the dish.
    Optional: Some folks like to add thin sliced red or green peppers or even a few scallions.
    Dressing
    This is the make-or-break part of this salad. Mayonnaise is traditional, but today has been sidelined by the use plain yogurt or sour cream. Many people use a combination. I veer away from mayo in preference is a thinner, lighter dressing. Others add a tablespoon of fresh lemon juice mixed with a little honey. If you're into mustard, you may want to add a teaspoon, but no more or you will kill the dressing. It will need a little salt and pepper. Have handy some fresh mint leaves or parsley for garnish. Don't forget to serve it on some leafy lettuce. The lettuce bottom helps make the rest of the salad work even better!
    Main Dishes
    Turkey is by far the main dish at most Thanksgiving dinners. Every year, recipes seem to get more complex, like Turduckins or deep fried turkeys. Here is our recipe—it's simple, delicious, and healthy.
    Roasted Turkey
    Ingredients:
    Turkey Salt, pepper, paprika Butter Can of turkey/chicken broth Directions:
    Choose your turkey to your liking—some people like 20 pound birds with legs attached, others prefer a turkey breast and forgo the dark meat. Whatever you pick, you must decide whether to live the skin on or off. I always pull it off. It's an emotionally wrenching thing to do, but it's much healthier and makes for a tastier and prettier dish (in my opinion). I put the bird in a roasting pan that has some broth on the bottom. This keeps the bird moist as it cooks and it catches the natural juices and becomes the base for awesome gravy later on.
    Then I butter the bird a bit to enhance flavor and to help the spices stick. Heavily salt, pepper and add paprika to the exterior of the bird. There are many different types of paprika and some are quite spicy, so judge accordingly. Paprika makes the bird brown beautifully. Put a lid or aluminum foil over the bird and bake at 425F degrees for an hour or several more, depending on the size of the bird. This will enable the bird to cook through (nothing worse than raw poultry!) and not over-brown on top. After it appears that the bird is done on the inside, then remove the foil/lid and let it brown on top. You can baste it with some of the broth to keep it moist. When the bird is golden brown, you can take it out and eat it steaming hot. Add some corn starch, salt and pepper to the broth, whisk over medium heat, and make gravy to go on mashed potatoes if you like. This is a simple recipe that is sure to please!
    I was a vegetarian for two decades and know how awesome non-meat holiday dishes can be. Tofurky never quite worked for me. Here is one of our favorite dishes - but it's not safe for vegans because it contains both eggs and cheese. Sorry about that! We can't be all things to all people—but at least we are honestly transparent.
    Holiday Cheesy-Nut Delight
    Ingredients:
    30 oz. cottage cheese 1 purple onion, diced 5 eggs 1 cup grated cheddar cheese 1 cup chopped walnuts 3-4 cups gluten-free corn flakes or rice krispies Butter Directions:
    Salt, pepper, A-1 sauce, optional dried minced onions or dried parsley
    Saute the onion in butter until transparent and lovely. In a bowl, add cottage cheese, eggs, cheddar, walnuts, a tablespoon of A-1 sauce, and spices to your liking. Then stir in the cooked onions. Finally, add in the cereal. The mixture should be moist but not runny. Poor it into a greased pan—you can make them into a loaf, muffins, or cook in a casserole pan. The size of the pan you use determine how long you will cook this dish. It should take around a half-hour for most size pans. The dish will be firm and browned, but don't overcook it or it will be dry. It cuts nicely when cool. If you want to make it look even fancier, you can drizzle a bechemal sauce over it with parsley garnish. This is a family favorite, and we hope you will enjoy it too.
    Chop 1 onion sauted in butter, add to mixture of eggs, cottage cheese, cheddar cheese, walnuts, salt, pepper, a T of A-1 and mix in 4 cups of gluten-free Corn Flakes. Baked in a greased pan at 350F degrees for an hour. Let sit 10 minutes uncovered before cutting.
    Stuffing
    What's Thanksgiving dinner without stuffing? Here's our version—tweak to your heart's content!
    Gluten-Free Thanksgiving Stuffing
    Ingredients:
    Leftover gluten free bread, any type, torn into small pieces Olive Oil Celery and Onion, cut into small pieces Chicken/turkey broth Salt, Pepper, Sage, Rosemary, Thyme, Parsley Butter Optional: Nuts (your choice), dried fruit (apricots, apples), sausage, or vegetables Directions:
    I gave up cooking the stuffing in the turkey ages ago. It turns out much better if you bake it in pan of its own. Saute until soft onion and celery in butter. Spray a cooking dish. In a bowl, mix the bread pieces, pour in the celery/onion mixture, add spices, and enough chicken broth to make it very moist. Add in whatever other ingredients you want. Personally, the simpler the better. Sometimes too much is overkill. Bake at 350 until it is firm with a light crust on top – then enjoy!
    Vegetables
    Let's face it—the sky's the limit when it comes to making amazing gluten-free vegetable dishes. I learned that color was important for a festive meal, so ours is white (potatoes), yellow (corn), orange (pumpkin), and red (cranberries or tomatoes in the salads). Instead doing green beans, broccoli, or asparagus—all that are awesome—we've given you a less familiar Brussel sprout recipe.
    Mashed Potatoes
    What could be easier? Scrape clean potatoes, cut them into hunks and toss them into boiling water until soft. Then mash. Add butter, milk, salt and pepper. Make more than you think you're going to need—they are going to disappear.
    Baked Corn
    Take 2 cans of gluten-free creamed corn, a can of whole kernel corn, drained, and mix them together in a bowl with 2-3 eggs, 1/3 cup corn starch, dried minced onion, salt and pepper and a smidge of butter. Pour into a greased casserole and bake until it is bubbly.
    Bacony-Delicious Brussel Sprouts
    Ingredients:
    Bacon Brussel sprouts Olive oil Salt/pepper Balsamic vinegar Parmesan cheese Directions:
    Cut the bacon into little pieces and fry them in olive oil. When brown, toss in the sprouts—slice the bigger ones. They will brown beautifully—you may want to put a lid on them for a few minutes to make sure they cook through and become soft. Then add salt, pepper, a tablespoon of balsamic vinegar and sprinkle with parm cheese. These are bound to be a hit!
    Bread
    I'll be honest with you—as a child I learned to bake some of the most fantastic yeast wheat bread imaginable. gluten-free bread has, by far, been the hardest thing for me to recreate with satisfaction. My solution? Don't try to do it in a way that recreates child memories. Find a new way. You may be pleased with the result.
    Pumpkin Muffins
    This is my own concoction. As you may recall from our cooking model described in our book, Going Gluten Free, I don't measure ingredients. I work with them in a zen method until they seem to be right. So I'll give you my recipe, with the recommendation that you tweak it as your intuition dictates!
    Ingredients:
    1 can pumpkin 1 1/2 c. gluten-free flour 1 c sugar ½ c. canola oil 2-3 eggs 1 tsp baking powder and 1 tsp baking soda Cinnamon Chocolate chips Directions:
    Mix all of the ingredients together in a bowl, then pour into greased muffin tins. Make sure the tins are gluten-free safe. We have a special pan that nothing else goes in, and recommend you do the same. It's better to spray the muffin cups instead of using papers—the muffins actually come out much prettier. They rise high and are beautiful and tasty. These are our autumn delights!
    Fritters
    Ingredients:
    3 c. gluten-free flour ½ c. canola oil + oil for cooking 1-2 eggs 1 tsp baking powder Salt Optional ingredients: sliced scallions, cheese, herbs, or whatever pleases you! Directions:
    Mix the ingredients together in a bowl while the oil heats in a skillet. Drop a large spoonful of the batter into the oil, and flip when it browns. When both sides are golden, remove and add more fritter batter into the pan. Serve hot with butter. They satisfy the need for bread without having to feel dissatisfied with trying to make a loaf and expect it to be like traditional wheat bread. Maybe one day the recipes and products will be there for that, but not today. This is a satisfactory substitute, to be sure!
    Dessert
    Every meal needs to end with a food that ritually signifies the meal is over. By this time, bellies are usually full and dessert needs to be symbolic more than substantive. It should look pretty and taste sweet. Here is the quintessential Thanksgiving dessert.
    Pumpkin Pie
    This is the traditional dessert and so easy to make.
    Gluten-Free Pie Crust:
    1 can pumpkin 2/3 c. sugar 3 eggs 1 can evaporated milk Cinnamon, nutmeg Butter A tsp of corn starch Directions:
    The nice thing about making a gluten-free pumpkin pie for Thanksgiving dinner is that all the ingredients in the pie are naturally gluten-free, except for the pie crust. So follow the directions on the can for pie, or use the directions here. Mix all the ingredients in a bowl and then put into a gluten-free crust (your choice of frozen or homemade) and bake until it is firm and beautiful. Don't burn it! It will firm up as it sits for a few minutes. Top with ice cream or whip cream, and maybe a garnish of chocolate or glazed nuts. Serve with coffee or tea, and enjoy the closing conversation.
    This meal should leave everyone feeling satiated and satisfied. What most people are grateful for at Thanksgiving is to just sit together with loved ones and share good conversation, laughter, and connection. What they eat isn't nearly as important as eating together. But with a menu like this, everyone can eat together and feel treated to a gourmet meal fit for a king. And it's fun to show nonbelievers how scrumptious Going Gluten Free can be!

    Susan Costen Owens
    Celiac.com 07/29/2016 - Celiac is an autoimmune condition, and along with other autoimmune diseases, scientists are beginning to have a larger context for understanding what could be contributing to its immune dysregulation. In the last decades we've seen diseases becoming prevalent now that look very different from the diseases of our ancestors. The American Autoimmune and Related Diseases Association lists 159 autoimmune diseases on their website (1), but most of these diseases are very new.
    In recent years, scientists began to identify and explore a new complex that was identified within our cells and belongs to our immunological line of defense. This new player is part of innate immunity, which is also called cell-mediated immunity. This is our body's rapid responder, and its approach to immunity is more like hand to hand combat. Its role is surveillance, and it uses generalized markers to identify something as an enemy and something the immune system needs to defeat. It looks for evidence of infection from bacteria, fungi, viruses and parasites but it also analyzes cellular debris. It is looking for any sort of danger signal that conveys the message that life is not normal as it ought to be (2). This analysis can even include looking for changes in pH (3).
    The innate branch of the immune system is dependent on cells that are called phagocytes, and these cells like to engulf small pieces of things they encounter, in a process called phagocytosis. Often these cells will be breaking down those pieces it engulfs and then will returning the nutrition it contained back into the extracellular space. After fragments from outside are internalized, cells needed a way to decide if what was engulfed should lead to a stepped up immune response. That's why it is not surprising that scientists recently discovered a whole network of molecules internal to these cells that form a complex called an inflammasome. There are various types of inflammasome that cover different biological niches (4).
    What this means is that, in response to what is deemed an enemy, a phagocytic cell will gather together a distinctive list of parts to assemble into an inflammasome, and then that inflammasome will produce specific cytokines called IL-1 beta and IL-18. These chemical messengers can then go and recruit more help.
    In contrast, antibody mediated immunity is more like having an air defense. The antibodies made by this part of our immune system function more like missiles that are sent out to find a designated target.
    Vaccines are designed for the antibody side of the immune response. Future recognition of a previous invader involves selecting a piece of protein, called a peptide, that is large enough to recognize. This side of our immune response forms a memory of that peptide so that in the future, our cells will use that memory to recognize that we have seen that germ before. If the germ is recognized from a previous infection, then the immune system can respond very quickly and with more hands on deck. The piece of the intruder's identity that will be remembered is determined by our HLA type, and that is determined by a section of DNA on our sixth chromosome. The vulnerability to celiac disease is defined by the genes that are behind the formation of HLA-DQ2 and/or HLA-DQ8.
    Scientists have known for many years that these two branches of immunity compete with each other and need to stay in balance. The chemical immune messengers called cytokines will shift our immune response between a dominance of cell mediated or antibody-mediated immunity. Until very recently, all the attention in celiac was on the antibody mediated branch whose major decision-makers are T cells, but even T cells can form inflammasomes (5).
    Scientists are now studying the innate immune response to gluten. Our innate immunity relies on a specialized call type called a phagocyte. Cells of this type of include monocytes, macrophages, neutrophils, granuloctyes, mast cells, dendritic cells, osteoclasts and even migroglial cells in the brain. Phagocytic cells will incorporate debris that comes close to them into a vesicle, and that is a sort of bubble with liquid and other contents inside. This vesicle is taken into the cell through a process called endocytosis. After that, this type of cell will quickly process the contents of that vesicle probably much faster than other cell types. This competence is likely why this type of cell is given the job of surveillance for invaders. It is also is useful as a tool for recycling things from the outside that they take in. Scientists prefer to call this set of cells the professional phagocytic cells. Other cell types can be enlisted for the job of phagocytosis but they don't have that role as their main purpose. That is why this different set is called the non-professional phagocytic cells and they may also form inflammasomes but may need more stimulation. (6).
    Scientists in the last decade have done experiments to learn how inflammasomes work. These intracellular immune complexes are assembled often in response to exposures to a type of molecule called a lipopolysaccharide that can be detected after engulfing the cell membranes of invading organisms. There are many other triggers, all recognized by their ability to tell us when something inside us is not as it should be. ATP, our body's energy molecule, when it is identified as coming in from the outside, can be a trigger for the inflammasome. Engulfing this sort of molecule suggests to our phagocytes that cell death events may have occurred in the environment of that cell (7). Some of our cells have been found to extrude nucleotides in self-defense, because leftovers from that kind of event may tell the inflammasome machinery that the cell is encountering a dangerous situation (8).
    This system recognizes that certain pathogens create holes in cell walls, so when a phagocyte encounters evidence of damaged membranes with holes in them, that alone can trigger a cell danger response that enlists inflammasomes. That means two popularly used medicines that kill fungus by inserting holes in their cells, Nystatin and Amphotericin B, have by themselves been found to create this danger signal even when there is no infectious agent. Doctors and lay people need to know that many signs that are usually associated with an infection, including fever, can occur when there is nothing infectious involved (9). Another inflammasome trigger is excess alcohol which can be very damaging when it triggers inflammasomes in the nervous system. (10) Another concern is environmental contaminates like asbestos and silica which have been studied the most when they are inhaled. (11)
    Crystals of uric acid associated with gout or other cell debris can also trigger the inflammasome, as can crystals of oxalate, which may be important to celiac disease since scientists have found higher levels of oxalate in celiac sprue. These crystals must reach a critical concentration to generate this cell danger mechanism in phagocytic cells (12). In the past, nobody really was aware that oxalate could have a major effect on the immune system outside of what it does in the kidneys.
    Scientists for so many years thought the kidney alone contained cells that oxalate could influence. That's why other cell types were not studied. At least now, we realize this narrow focus had been based on some premature conclusions. We should have known to look more broadly because there was so much evidence from Primary Hyperoxaluria, a genetic disorder where a defective liver produces oxalate that travels to the whole body, creating a condition called oxalosis. That's how we know that oxalate goes all over the body. For the longest time, nobody was measuring oxalate outside of kidney disease, even though there were a few exceptions, like in people after bariatric surgery, and in celiac sprue and in cystic fibrosis, and eventually, in autism (13).
    Because there already was a literature about oxalate in celiac sprue, when our project began, we started informing the public about these links on our website, www.lowoxalate.info. More recently we have written a series of articles about oxalate in this journal, discussing the science, and also practical issues about how to reduce oxalate while on a gluten free diet. That was working with knowledge we had then, but now we know that this issue of inflammasomes has been a part of the story we didn't know, but it holds great promise of possibly addressing why there could be complications in celiac sprue that do not resolve by merely going gluten free.
    Another trigger for the inflammasome is homocysteine (14). The pathway to recycle homocysteine back to methionine is called remethylation, and this process requires both methylcobalamin and the folic acid cycle. Others on internet groups have brought attention to polymorphisms in one of the relevant enzymes, called MTHFR. This system is also tied to the process of making sulfate, taurine and glutathione, because homocysteine can be routed that direction when the body is trying to resolve oxidative stress. Many of these steps require B6, and heme is also needed to direct homocysteine towards transsulfuration. The issue of excess homocysteine may prove to be more important to our non-professional phagocytic cells that are found lining our blood vessels, because these same vessels can also take up oxalate, creating a condition of vascular swelling called livedo reticularis (15). Issues with both homocysteine and oxalate have been associated with atherosclerosis (16).
    Did your child's pediatrician recommend giving your child Tylenol before his immunizations to make him more comfortable about his body's reaction to his shots? Scientists have now found that Tylenol not only depletes our body's ability to deal with the oxidative stress from immunization, but it also turns on the inflammasome (17). The inflammasome will skew immune defense away from Th2 adaptive immunity, and that is unfortunate, in this case, because the process of developing a Th2 response was the whole point of giving a child a vaccine. Our vaccines are designed to contain adjuvants that skew the immune response in the Th2 direction (18) but some adjuvants may not be working as expected (19).
    Researchers sometimes look for the evidence that someone has developed antibodies before they will call an immunization a success. That test will ordinarily not be ordered by a pediatrician, but instead, a child will simply later be given, by default, a booster shot. Is there any chance the recommendation of Tylenol or other inflammasome activators could have impaired the antibody response in some children? Certainly, the new research on inflammasomes might suggest that in children who fail to make antibodies after a vaccine, a look at what is happening with innate immunity could be in order before assuming that these systems are working normally. Are doctors testing antibody titres or doing other immune testing in children with celiac sprue? This may be more important if such a child has developed another autoimmune condition.
    Has gluten had other ways of affecting the immune response? We have known that gluten and proteins from milk, soy, and even spinach will form opioid peptides as they are broken down. Like other opiates, these active peptides can be addictive and would be able to skew an immune response (20).Opioids can also paradoxically activate inflammasomes in the spinal column which then may provoke, amplify, and prolong pain. (21) Other work showed us that activation at the same opioid receptors that drugs use can limit our absorption of the amino acid cysteine. This amino acid is needed by our bodies in order to provide glutathione, the primary cellular antioxidant that protects us from oxidative stress, and this is especially important to save us from neurodgeneration (22).
    Why is that important? The formation of glutathione can calm down a mitochondrion that is upset enough for it to be generating reactive oxygen species (ROS). Unfortunately, scientists recently learned that the ROS produced by a mitochondrion under such stress will also trigger the inflammasome. Having adequate glutathione is especially important when our bodies are coping with the demands of immune activity, as during illness or after immunization. Unfortunately, oxalate at those times may compete with glutathione for entry into the mitochondrion at the mitochondrial dicarboxylate carrier (23).
    Until very recently, we did not know that partially digested pieces formed from gliadin could trigger the formation of the inflammasome. This occurred more in peripheral blood mononuclear cells (PBMCs) from people with celiac sprue compared to healthy donors (24). The people who did this research may not have known that people with celiac tend to be higher in oxalate than other people, and they also may not have known that oxalate by itself has been found to trigger the formation of the inflammasome. People with celiac may need to be careful about avoiding both triggers for inflammasome formation.
    In a different context, another group of scientists discovered that PBMC's exposed to titanium salts made from oxalate caused immunotoxicity when other salts of titanium did not produce that toxic effect. That experiment tells us that oxalate does enter the type of cell that was also found to respond in celiac disease to these digests of gliadin by formation of the inflammasome (25).
    The well-studied vulnerability of individuals with celiac to antibody mediated effects of gliadin came from the adaptive arm of our immunity. The HLA type is definitely known to be relevant there, but it would not be relevant to an issue of cell-mediated immunity. That is why it is a puzzle that the authors of this study did not control for oxalate by matching the control and celiac subjects for the oxalate content of their cells.
    The differences they saw in response to the gliadin digest may have required higher levels of oxalate in those cells. Do we know? If that could be the case, then it becomes possible that the response they recorded in celiac cells might also happen in those who are higher in oxalate for other reasons, but who lack the HLA risk genes that are definitional of celiac. We simply cannot tell if the risk of inflammasome activation in their experiment involved having the oxalate content of these cells also working in some kind of synergism with gluten. It is important to note that here we are talking about oxalate that this type of cell may have accumulated earlier in its life or during its time in the blood. Here we are not talking about oxalate that someone may have just eaten.
    It is possible that an inflammasome-mediated function could explain why there are so many people who don't have celiac disease discovering that removing gluten from the diet makes them feel better. The academic community and others are still having a hard time believing this story (26), and cannot understand the recent popularity of gluten free foods in the general population.
    A different reason for thinking about a possible synergism between a gluten free and a reduced oxalate diet came from a recent poll done by the Oxalate Project at www.lowoxalate.info. Those results revealed that the majority of those who reported positive effects in their autoimmune disease by reducing oxalate had been extremely high in oxalate before they reduced oxalate. Curiously, 58% of those responding to the poll said they were also gluten free, but only 16% had celiac sprue. Those who were both gluten free and low oxalate reported a 10% higher positive effect from reducing oxalate than those who were not also gluten free. That could be important.
    Many scientists still think a standard American diet will keep oxalate below 200 mgs a day, but 84% of the individuals answering that poll said that they started out with levels of oxalate over 300 mgs a day. Recent changes in eating habits for high oxalate foods may have been the result of powerful advertising that has been telling people that high oxalate foods are the healthiest foods available. Anonymous poll data has no way to be verified, and that fact keeps us from assuming that we can derive information from this poll about oxalate's role (if any) in contributing to their autoimmune condition. Even so, the poll told us that out of all respondents, 73% reported a positive effect in their autoimmune condition by reducing oxalate, but those with celiac sprue (some who had other autoimmune conditions) did much better. 88% of them reported a positive effect on their autoimmune condition. That was actually a higher percentage than what was recorded for any of the other autoimmune conditions. Does that mean that it might be important for autoinflammatory processes to be careful about both gluten and oxalate? (27) We may learn the answer to that question as more people with these issues try both dietary changes together.
    Some scientists now are generating data that they feel supports the idea that excessive activity of inflammasomes could be related to the etiology of autoimmune disease (28). The changes that the inflammasome makes to our bodies can be harsh, and in fact, some scientists studied sepsis in animals and found that just by blocking inflammasome activity by various inhibitors, they could save those animals from a certain death. The irony is that the animals were still infected, but survived anyway. That means that what had been killing them was their immunological response to infection instead of the infection itself. This type of research is still very new, but it may change some of our assumptions (29).
    What interventions have scientists found that will suppress inflammasome activity? The good news is that a lot of their research has involved supplements that anyone can buy in a health food store, and some people were already using them for different reasons. One of those items is resveratrol. When it was first studied, it seemed to have been made out of red wine, mostly, but our project has discovered that commercially, the usual product is made from an herb called Japanese knotwood, which is known to be high in oxalate (30). The Oxalate Project has not yet tested the oxalate content of commercially available brands of resveratrol to see how much oxalate ends up in a capsule, but that testing is on its agenda.
    The supplement quercitin is also an inflammasome inhibitor (31). CoQ10 is another supplement that has become widely available in drug stores and health food stores because it is needed to correct a mitochondrial problem created by statin drugs. Fortunately, CoQ10 also inhibits the inflammasome, mainly by keeping the mitochondrion happier and better protected from the need to generate reactive oxygen species (32). A popular source of sulfur called MSM (methylsulfonylmethane) also was found to inhibit inflammasomes (33). So has its close cousin DMSO, a solvent that was once used as a delivery system for secretin, when it was proposed as a treatment for autism (34, 35).
    Another exciting inhibitor is 3-hydroxybutyrate, which is one of the two ketones (along with acetoacetate) that our bodies make in ketosis (36). Ketosis occurs when the body is not getting enough energy from carbohydrate, and it switches into a mode of burning fat, and that produces these ketones. Some people will try to induce this switch in metabolism on purpose, like those dealing with seizures who find the seizures are controlled with a ketogenic diet. If the change that this ketogenic diet accomplished was due to down regulation of inflammasome activity, that might bring new hope or strategies to mind for individuals where this diet treatment by itself failed. Such individuals may have had a different environmental component that was still activating inflammasomes in spite of their use of the use of the ketogenic diet. This mechanism may point to yet another reason that obesity, which may have come from excess consumption of carbohydrate, has been linked with inflammasome activation (37).
    We can hope that more investigation of other activators and other inhibitors for those with seizures might yield better success. Also, the association with ketosis may explain a previously overlooked benefit experienced by people who were exercising the discipline of fasting…the age-old tradition that comes from many cultures. These traditions are more striking when realizing that obesity can activate inflammasomes and inflammasomes are thought to be behind the roots of metabolic syndrome and diabetes (38, 39).
    Pharma does have some drugs already in its cabinet which scientists have found will inhibit inflammasomes. There are probably more such drugs in the pipeline and we may soon hear advertisements for this new class of drugs. Our Oxalate project has already begun to hear of some doctors and hospitals using the over the counter inhibitors resveratrol or coQ10 to successfully protect patients who were at risk for developing sepsis.
    More research obviously needs to be done in this area and this new frontier has become very attractive to scientists. One of the first big questions they may need to ask is whether our health care protocols in Western medicine have led to over-stimulating this arm of immunity by emphasizing killing strategies with antimicrobial therapies or other drugs that may leave crystals or other debris behind. Why might that have been a problem?
    Phagocytes are upset about cellular debris and disrupted membranes. Some scientists have been finding that our bodies may stay healthier by tolerating some infections rather than experiencing the excessive immune activity that comes from activating inflammasomes. It will take a long time for some of these scientific ideas to trickle down and begin persuading doctors to make changes in their prescribing habits for antibiotics and other antimicrobials. Some doctors and other practitioners are already finding that inflammasome inhibitors could be an appropriate adjunct therapy during antibiotics. Of course, since this is such a new scientific area to study, it may take years before proper clinical studies can be done to address all these issues.
    In the meantime, it seems wise for anyone prone to autoimmune disease to avoid triggers for inflammasomes that are easy to avoid. This would include things like being overweight, eating foods that encourage uric acid formation (and the risks known for gout). It could include situations that encourage the body to make oxalate and that could include deficiencies of B6 or thiamine, or excess use of Vitamin C. It could come from excess dietary oxalate. We also need to consider the use of drugs or supplements that are known to form crystals in blood, or Tylenol, or antifungals that punch holes in cell membranes. We need to be vigilant about our status for homocysteine. We need to be careful about our level of consumption of alcoholand our exposureto other environmental contaminants. In time, we will learn of many other triggers.
    If there is a suspicion that inflammasomes are related to a disease process that we find in our bodies, then we should at least think about using one of the over the counter and safe and well-studied inflammasome suppressors. As the research continues, we can hope that scientists studying in this area will show us more ways to dial down the frequency and the unpleasant symptoms and other consequences of autoimmune disease and autoinflammation.
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    Leszek Jaszczak
    Celiac.com 12/27/2016 - For many years, nutritionists, doctors and the media declared a low-fat diet as an effective method of losing weight, lowering the level of so-called "bad cholesterol", and preventing health problems. We have since seen that it is not only fat intake but also the type of fat we eat is of paramount importance. So-called "bad fats" increase the level of LDL cholesterol and increase the risk of certain diseases, in contrast to the good fats that protect the heart and promote general health. Good fats, such as the ubiquitously advertised omega -3 are essential to physical and emotional wellness.
    Dietary health is becoming increasingly important to the consumer whose awareness is growing and will continue to grow. It is therefore important that in the face of these facts the wise producer will not only follow the trends set by the consumer but will try to get ahead of these shifts so he will be prepared when the new client asks for products suggested by these new insights.
    Walking through the store, it is easy to see health-oriented products displayed on the shelves, as well as customers looking for these products. When it comes to fats, the client is offered non-fat ice cream, low fat candies, cookies and cakes.
    While the number of low-fat products is growing, paradoxically increasing levels of obesity are also on the rise in our society. Thus, it becomes clear that low fat products and diets are not effective in the fight against obesity.
    Contrary to what has been widely proclaimed, fat is not always a negative factor in maintaining good health and a slim figure. Saturated fats and trans fats are unhealthy for humans. However, initially, all groups fats were considered the cause of the adverse consequences listed in the beginning paragraph. As it turned out, there are fats such as monounsaturated fat, polyunsaturated fat and omega-3 fatty acids that have the opposite effect. In fact, healthy fats play a huge role, affecting not only the appearance of the silhouette but also, human well-being and mental agility throughout life. For example, they are necessary for the proper development of a child's brain.
    This article is not a waiver for eating fat but suggests minimizing the consumption of those fats that negatively affect humans.
    To better understand these concepts about fats we should explain the way fats are grouped. In addition to the simplest categories of fat according to whether they come from animals or plants, they can be divided by the presence of bonds between carbon atoms in the chain and so on:
    unsaturated fatty acids containing a hydrocarbon chain having a double bond , are present in large quantities in plants. At room temperature they are usually liquids. monounsaturated fats - one unsaturated bond polyunsaturated fats - many unsaturated bonds saturated fats contain fatty acids having a hydrocarbon chain with only single bonds Trans fats are characterized by a specific molecular shape. They are found in natural animal fats, milk, and other dairy products. In larger quantities of solids they are present in vegetable fats such as margarine. Trans fats are normally fat particles that have been deformed by a process called hydrogenation . During this process, liquid vegetable oils are heated and combined with hydrogen gas . Partial hydrogenation of vegetable oils makes them more stable and less prone to loss of freshness, which is very good for food manufacturers, but not necessarily for the health of consumers.
    Monounsaturated and polyunsaturated fats are known to be "good" fats, and are thought to have a positive effect on heart health, cholesterol levels and general health.
    Saturated fats and trans fats are presented as "bad" fats because they increase the risk of disease and increase cholesterol levels.
    With so many different sources of fat in the diet, and increasing consumer awareness of these fats, customers will strive to reduce consumption of those ingredients that have a negative impact on their health. Thus, they will limit the intake of trans fats and saturated fats by the avoidance of products containing them.
    What is the impact of these facts on the behavior of the confectionery industry?
    Firms engaged in the production of confectionery fats have, for several years, been developing technologies and offering products with reduced trans and saturated fat content. Manufacturers are trying to limit the hydrogenation of oils and fats and produce other methods for processing fats and taking advantage of properties of existing fats. Many of those technologies are still being developed.
    In accordance with Article 30 REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL (EU) No 1169/2011 of 25 October 2011 on the provision of information to consumers about food, which will take effect from 13 December 2014, the mandatory nutrition declaration shall include the following elements:
    a) energy value and the amounts of fat, saturates, carbohydrates, sugars, protein and salt. Therefore, please note that in future, European producers will have to adapt their labels to comply with the new laws. Consumers will have easier access to information on the composition of fatty products in foods, which can have a significant impact on their choices at the time of purchase.
    If you look for information on healthy eating in the basic knowledge base of general consumer... on the internet, you can find tips such as:
    Limit your intake of saturated fat to less than 10 % of calories Limit trans fats to 1% of calories The main source of trans fats in the diet is baked goods and snacks such as cookies, crackers , cakes , muffins, pizza dough , some types of bread and hamburger buns This shows how important the selection and appropriate control of fats is for confectionery production. Moreover, the producer is required to maintain a constant and reproducible quality of raw materials that can affect the final product, avoiding any unexpected ingredients. Growing consumer awareness can be seen today when shoppers pay much more attention to the labels and what is written on them. Increasingly, this is a decisive factor in their choice of whether to buy a particular product.
    On the other hand, the desired taste of food imparted by those elements that are not always the healthiest for people offers another perspective on confectionery food. We should keep in mind that when eating so-called sweets, we do not do it to be healthier and more beautiful. The most common motive is pleasure. If we were to look at food only from a chemical point of view, just the chemical names and function of substances that emit the aroma of coffee would stagger the average person. But what would coffee be like without its aroma? A truly conscientious consumer knows these facts.
    Again, it all comes down to common sense and moderation. Those who are able to be moderate are those who do not have to fear. But you cannot disregard the information flowing from the world of science. If we are able to produce safer food for people, we should go in this direction.

  • Recent Articles

    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 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    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.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    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

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.