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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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    GLUTEN-FREE VACATIONS


    Yvonne (Vonnie) Mostat


    • Journal of Gluten Sensitivity Winter 2014 Issue


    Celiac.com 12/20/2016 - I know of many people with celiac disease who dread traveling. They even cringe at eating out in restaurants. One person actually said it on the Web: "I have celiac disease, and I was sick of being poisoned in restaurants, even after asking for gluten-free food." It can also be disastrous to spend even one week in a foreign country where there is a language barrier. Part of the problem? Point your finger at yourself. Many of us do not prepare ahead and travel with our diet in mind.


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    According to Wm. K. Warren, Medical Research Center for Celiac Disease in San Diego, celiac disease is twice as common as Crohn's disease, ulcerative colitis and cystic fibrosis. The website GlutenFreeTravelSite.com has named Pennsylvania as the most celiac-friendly destination in the world. Wow!

    Eating out can be difficult for several reasons. We do not yet have a global definition for gluten-free. It does not exist in the restaurant world. Most restaurants buy in bulk, such as a 12" x 6" can of tomato sauce, a gallon of sweet and sour sauce, and huge bags of fries, which more and more are being tossed in pure flour prior to frying. I have heard that McDonald's is now offering items that do not have gluten in the ingredients to allow for the possibility of inadvertent cross contamination. Their famous fries are made gluten-free in a separate fryer. Hamburger patties and many breakfast items are also gluten-free. Early breakfast at McDonald's before you "hit the road" with a packed car in which your children are belted in.

    This sounds like a travel brochure for New Zealand, but Celiac.com states that traveling in New Zealand is a pure pleasure for the celiac. Gluten awareness is widespread, there are gluten-free food options virtually everywhere you go, and product labeling for allergens and gluten is typical. Those of you planning a Disneyland holiday this year will be pleased to note that Disney is earning major kudos from people with celiac disease, gluten intolerance and other food allergies. They claim that for more than a decade Disney has worked to provide information and options to guests with food allergies.

    I read a negative blog about gluten-free dining in Maui, and have one to add myself. I would suggest calling ahead; I would suggest not dining at the peak busy periods. Our waiter did not know what celiac disease was, and I did not have my information sheet with me in those years. (I have grown up since then!) The waiter was told twice about gluten; it was described to him. When the meal arrived at our table 3/4 hour later, my husband asked him again if there was any flour used in the making of the dish, and had he checked with the chef? Slight hesitation, hopped on one foot indicating he was busy I assume. He said the meal was "okay". I was up all night ill in someone else's home. We called the next day to do some late sleuth work, only to find out that the waiter had not checked with the cook and just ‘assumed' the meal was safe to eat.

    I now travel with a small file containing our "SAFE TO EAT" and "UNSAFE FOODS", or as my husband calls them, "SAFE" and "SORRY". I have laminated my own list. I carry a home-made typed sheet about celiac disease, not going into our reactions in a big way, but telling people that ingesting gluten, that means rolled oats too, can make me very ill. Celiac disease is a most difficult disease to diagnose, and equally difficult to explain "quickly" to a host or hostess, or restaurant waiter.

    Statistics are not standing still. Coeliac disease (celiac = Western)< (Coeliac = Great Britain, in the United Kingdom is the leading charity (Coeliac UK), and affects 1% of the children in the United Kingdom. All major grocery stores have a large gluten-free section. The last time I visited my family I made a pig of myself eating cream buns and pie, all with the International Logo, and though food is more expensive in the UK, the gluten-free food was not as expensive as it is here. We made gluten-free restaurant cards with the explanation regarding the disease on the back.

    This year, when we traveled to the Grand Sirenis Mayan (all inclusive) in Mexico I did not have to keep saying, "NO FARINA". (To the person filling the heated trays, I was "nuts".) After so many years of traveling to all inclusive hotels in Mexico, this year the light bulb went on. My husband wrote out an information sheet about celiac disease and our "Safe and Sorry" list and went on the World Wide Wonderful Web and had it translated into Spanish. We were able to advise the assistant manager right away upon registration. No-one at the registration desk had heard of celiac disease, so that was my education class for them. But I received exceptional service. Every restaurant we booked for supper had the information sheets faxed to them by the registration desk ahead of time and we just had to mention our name, they went down their list to check it off, and they saw the Spanish note attached. During the entire two weeks I was not sick from ingesting gluten and I did not have one dermatitis herpetiformis lesion. I thought I had one but it turned out to be a bug bite!

    HINT: Some hotels that provide a free breakfast buffet means you will probably have access to a toaster. Several companies now manufacture heavy-duty reusable toaster bags that let you toast gluten-free bread in the hotel toaster without fear of cross contamination. Toaster bag brand names include the following:
    ...Toast it Reusable Toaster Bags ... Toastabags ... Kitchen Craft Non-Stick Reusable Toaster Bags. Bring sealed bags of gluten-free cereal, and add milk and fruit from the restaurant. Bring your own rice cakes or granola bars, and ask the restaurant for cheese, fruit or for individual servings of cream cheese. You can consider faxing a note to the restaurant staff in advance to help explain the gluten-free diet. Many restaurants are more than willing to adapt their menu items to suit your needs, but these things have to be done ahead and require a bit of thought. Celiac disease is virtually unheard of in some parts of eastern Asia, so a written description in the local language will be very important.

    "WEB: Travel and holidays Coeliac UK" state they have information leaflets for more than 35 countries, with translations that can be used in many others. These detailed, useful phrases will help you while out and about as well as with local cuisine, applicable allergen labeling and contact details for local coeliac societies. In the UK local organizations can sometimes provide lists of hotels/restaurants and shops that supply gluten-free foods, as well as their gluten-free food list.

    Some celiac association chapters actually provide a "Pocket Dictionary" that they claim is the most reliable resource available for information on what's safe for people living with celiac disease. The books are updated regularly. Check at a chapter near you and see if they provide these celiac dictionaries; I am certainly going to check ours out!

    They advertise Spain as being the celiac's paradise. Most of the products are labeled with gluten-free symbols, and their labeling system for gluten-free is quite different from any other labeling, for example "sugar free".

    Brazilians are not used to the term celiac. Almost all have heard about gluten because it is law there. All the processed foods and drinks are labeled with either "contains gluten" or "does not contain gluten". That would be wonderful, rather than reading all the ingredients, almost putting the item in your grocery buggy until you read at the very bottom of the box the wording, "may contain traces of gluten". How can they measure a trace, and which box has a bigger trace than another? Even food made in a machine that uses gluten has to be avoided if you want to stay healthy.

    I would have thought that Italy would be a difficult place to find gluten-free foods. It is the land of pasta after all. But on the website (gluten-free holidays, trips and vacations) some of the happiest holidays by writers have been spent in Italy. Switzerland is famous for it's delicious cakes and breads, but traditional Swiss food is very celiac-friendly and their core national foods are often naturally gluten-free. Don't forget your note cards, and translate them into German and Swiss-German Traveling and living gluten-free in Australia, they say there is nothing else like it for a coeliac traveler. "This country is a haven for coeliac's and their traveling buddies alike. (glutenfreeholidays, tripsandvacations)

    AIRLINES: Not only have they changed their luggage weight allowance they have also changed their short flight meal rules. Under six hours flying time, they do not provide specialty meals, like gluten-free, diabetic, vegetarian or kosher. This was a big surprise to us when flying to Mexico, and a surprise to our travel agent also. Check with the airlines regarding their dietary restrictions. This may not be the case with ALL airlines, but for sardine can flying with your knees on your chest, they think the celiac does not need to eat for six hours.

    If they do not provide special diets you are well within your rights to purchase or take a gluten-free meal onto the plane. It anyone queries what is in the bag, you can explain you are a celiac who becomes hungry in less than six hours. Since they have vetoed peanuts as a nutritious snack on airlines and substituted with pretzels that means the non-celiac partner gets double treats and you go hungry. Make sure you have emergency snacks to fall back on in case of delays or cancellations. If you are planning a cottage or camping holiday the same rules apply. I hope you have a card in your wallet indicating you are a celiac, and if you have dermatitis herpetiformis that should be listed too.

    The Web site: "http://www.celiaccentral.org/holiday/cookbook/" has a holiday cookbook you can download. It is their free first ever e-cookbook featuring the top 10 gluten-free recipes from some of their recipe contests.

    If you are traveling by car, of course, you will travel with a cooler and ice packs to prevent food spoilage. When we go to visit family in England we purchase one of the reasonable styrofoam coolers at the first grocery store we see, along with some ice packs. Sainsbury's offers a deluxe shopping experience; if they do not have the celiac food you want there then you do not need it. Great Britain also has Costco Stores that carry gluten-free food.

    I found that the Web Site:" CeliacTravel.com" offered a wealth of information. You can click away all day, reading the posts and blogs, laughing and agreeing with the suffering celiac who became sick at her own wedding. It was good to know that all packaged foods in the EU (The European Common Market) countries are covered by the same food labeling legislation as in the UK. Manufacturers must list all deliberate ingredients in the ingredients list, regardless of the amount used. Manufacturers must name the particular grain, for example, wheat, rye, barley or oats or some will use the word gluten as well. Specific information for each country is given where possible in the individual travel sheets you can obtain at this site.

    I know that for many celiac people a holiday is synonymous with relaxing with a glass of wine, a whiskey and tonic, or a bottle of beer, but after reading on Celiac.com it has given me confidence to tell you to be very careful. Sick on holidays and don't know why? Been drinking? I know you want to blame it on something else; you are like me and the malt in colas. Oh how I loved that drink, but my gut did not, and I was a fool deceiving myself that it was something else causing my bloated crampy stomach. I cannot take malt in any form, nor can I ingest MSG; it could be cross-contamination, but the angst and pain I experience are not worth the risk. Anytime you drink away from home, like on holidays, you are at risk for exposure because non-celiacs simply do not understand how we're affected. Every single one of us have been poisoned by cross-contamination, most of us multiple times.

    Reactions can be triggered by poor manufacturing practices that don't include segregation of malicious gluten bits. Some products are different because of the way they were aged (ex: wooden barrels). A lot of people state, "I understand the science behind alcohol being gluten-free but I still have a reaction to any that are distilled from grains." At first I thought my reactions may have been psychosomatic. Maybe It's just because I am questioning the validity of truly being gluten-free. Not too long ago I had a very serious reaction and did research on the drink I had. Indeed it was a wheat/barley vodka. I believe for most people it may be fine, however, I have always been super sensitive and am continually reminded that I must be careful."

    Then we come to the beer lovers, whose hot day holiday experience includes a cold beer in hand. Unfortunately a lot of beer drinkers settle for beers brewed with buckwheat or sorghum that are combined with lower concentrations of barley malts, as are the most common brewing practices. The demands of beer-lovers with celiac disease are finally gaining the attention of craft brewers throughout the world. Most of these brewers have been researching the chemical and physical features of celiac disease, and have formulated their products with 100% gluten-free ingredients and processes that ensure purity of product. They point out that some filtering processes used by brewing companies render gluten undetectable in "low-gluten" beer; however, unless a beer is totally gluten-free, there is no assurance that it is safe for celiacs.

    The most common substitutions for gluten-rich grains are : buckwheat and sorghum, rice, maize, corn, and sunflower, amaranth, flax, millet, quinoa, teff, wild rice, soybean, ragi, and rape. Sorghum and buckwheat are the most common ones used in Western gluten-free beer. This Web site lists the approved gluten-free beers and the ones that have been recalled as well. There is also a "Contact Information for Gluten-Free Beer listing of Web Sites." It is rather lengthy and you will need to photocopy the information and take it with you while traveling on holiday. This site was updated on January 23, 2010, so it is already three years old, and I am sure there are lots of other gluten-free beers around. Don't risk your health by grabbing the first beer on the table at a social outing or restaurant and keeping your fingers crossed; it will not work!

    I'm sorry if I am ruining your holiday, but drinking does not necessarily equate to a good holiday and is one drink worth destroying the villi in your gut leaving yourself open to a multitude of connective tissue disorders? You only get one body in this life. Take care of it!


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    Guest Michelle

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    I thought (December of 2016) McDonald's french fries were coated with wheat? Other than that, great article.

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    I thought (December of 2016) McDonald's french fries were coated with wheat? Other than that, great article.

    "Coated with wheat" is not correct, but, they do contain a tiny amount of hydrolyzed wheat starch, but evidently test well below 20ppm. It is your choice if you want to include them in your diet...some celiacs do including myself.

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    The more you dine out in unsafe environments, the more damage you are doing to your gut. I think articles like this can be very misleading to someone that may be new to a diagnosis. Every little bit of cross contamination adds up and will not allow for the gut to ever heal. I have never had a safe experience dinning out. I have had several very bad experiences at Disneyland, I was even served a wheat flour quesadilla labeled as gluten free! I didn't even get an apology for this incidence or others that happened at the park. For myself and my gluten free family we make sure we have a kitchen when we travel & take lots of food any flight. The worst thing that can happen is being miserable and ill while on a vacation. Maybe all 4 of us are just far more sensitive then this author.

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    The more you dine out in unsafe environments, the more damage you are doing to your gut. I think articles like this can be very misleading to someone that may be new to a diagnosis. Every little bit of cross contamination adds up and will not allow for the gut to ever heal. I have never had a safe experience dinning out. I have had several very bad experiences at Disneyland, I was even served a wheat flour quesadilla labeled as gluten free! I didn't even get an apology for this incidence or others that happened at the park. For myself and my gluten free family we make sure we have a kitchen when we travel & take lots of food any flight. The worst thing that can happen is being miserable and ill while on a vacation. Maybe all 4 of us are just far more sensitive then this author.

    Plenty of celiacs do take vacations, as well as eat out, without major issues. I am not sure why you think your situation should apply to all celiacs.

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    Guest Jeanne E. Schneider

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    I just came back from Israel - - - EVERY place I'd go to (they knew what gluten free meant), BUT EVERY meal that I'd request gluten free - was (no exaggeration ) , each place brought out Chicken and rice!!!! After 10 days of eating chicken and rice I thought I'd NOT eat chicken at home for a month... (I was really getting 'sick' of the same old, same old...)

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    I am gluten intolerant and have been gluten free for approximately 7 years. I travel extensively, both domestically and internationally and have learned to pack my own food. If you go on vacation, expect to eat very basic foods, such as rice, salads, etc. Never vacation in foreign countries and expect to chose meals from a gluten free menu, if so, you are making a very big mistake. Your article states you were somewhat surprised that Italy offers a variety of gluten free food. If you do some research, you will find that most of the E.U. is very familiar with gluten free diets and offer many choices. You can find a variety of gluten free products in grocery stores in the E.U.

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

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

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


    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.

    Daniel Cojanu
    Celiac.com 05/10/2016 - As we all know, traveling with celiac disease can be somewhat challenging. Trying to avoid situations of contamination can be quite difficult, yet we accept this challenge so we can go about a normal routine which in my situation, includes traveling. My wife and I who travel quite often do enjoy a good cruise due to the relaxing atmosphere and great care we receive for my dietary issues. Our experiences on Princess Cruises has been very positive and clearly, they take dietary issues quite seriously.
    Unfortunately, not so much with Oceania Cruises. First of all, this experience is based solely on my recent trip. I suspect some other folks with celiac may have had a positive experience. That's great. This article is based solely on how I was treated by this cruise line in August of 2015.
    Oceania insists that any request for special diets be submitted by the travel agent. Not sure what happens if you book online.
    Once on board, the person in charge of special diet requests met us at dinner and explained we would get a menu in our mailbox every evening. We are to circle our choices and bring it to the desk by 8:30am. We made the mistake of going on a tour and not having it in until noon and guess what? Yup, you order off the menu.
    After this discussion, I was directed to dinner choices that could be prepared gluten-free. I was surprised to see my dinner entrée loaded with croutons. O.K., first day shakedown, let's see what happens. Strike 1.
    As we all know, buffets can be dangerous but I attempted to try and see if they had any gluten-free foods available. I selected a breakfast item that was clearly battered and asked the server if this was gluten-free. He looked somewhat quizzical and said "yes". Strike 2. I then asked for gluten-free toast. It took a full 15 minutes for them to toast 2 pieces of bread. Strike 3. Later in the cruise, we stopped for lunch at the poolside café where I ordered a sandwich with gluten-free bread. "We don't have gluten-free bread on board" was our waiters' response. After I indicated that was surprising since I have it at dinner nightly, he finally went off and secured my lunch. Strike 4 ?
    I could go on and on but I will spare you the rest. Oceania is a high end cruise company with prices to match. Princess on the other hand was exemplary. Once your request is in, you receive an email with a list of gluten-free menu items that will be available. If you want gluten-free beer, this is also offered albeit at a price. Every evening, the maître d comes by so you can order for the next evening. Clearly, they take people with dietary issues seriously.
    Why the disparity? I believe it's what I encounter as many restaurants. Since gluten-free dining has become the latest fad diet, I honestly believe that many establishments (and cruise lines) don't feel the need to take proper care. My suspicion is that they just look at gluten-free requests like "oh good, another one of them" and don't take it seriously. I guess my final advice before selecting a cruise would be to see what the initial reaction is to your request. If they respond like Princess, and I suspect other cruise lines, I would at least look carefully at booking a nice vacation. Would I go back to Oceania? I would not. I have put my concerns into writing to them and two months later, no response. My travel agent also followed up about this situation, again, no response.
    Traveling with celiac is difficult enough, and I hope that certain companies will begin to take us more seriously.

    Rosie Tobin
    Celiac.com 08/04/2016 - Holidaying or backpacking in South America might seem daunting for travellers with celiac disease, but eating gluten-free is actually very manageable, providing you're organised and do plenty of research. Unfortunately there seems to be a lack of reliable information on the web about eating gluten-free in South America, which is what inspired this article. So, we will go through each country, highlighting 'safe' foods, those that are naturally gluten-free, and addressing any problems you may encounter.
    The Good News!
    In general, the South American diet contains less gluten than the typical western diet, with white rice and potatoes being the staple carbohydrates for most countries. So there will probably always be options on the menu that are naturally gluten-free. And if in doubt, you can always stick to simple dishes like grilled meat or fish, and fresh salads.
    The Bad News…
    Celiac disease and the gluten-free diet are much less common in South America, so although products in supermarkets may be labelled 'gluten-free' most people probably don't fully understand what this means. The language barrier can cause problems when enquiring about gluten-containing ingredients and cross-contamination. So it's advisable to learn or print out some useful phrases to help you explain your dietary requirements.
    Eating Gluten-Free in Brazil
    Labelling Laws: All packaged foods must be labelled either 'contén glúten' or 'não contén glúten'. You can use these phrases in restaurants too, although the serving staff may not really understand what this means.
    Advice: English is widely spoken, especially in the major cities, so communicating your dietary requirements shouldn't be too difficult.
    Naturally Gluten-Free Brazilian Foods:
    Tapioca/cassava flour – often used in place of wheat flour to thicken sauces. Tapioca pancakes are a popular breakfast food, and cassava fries are a popular snack, both of which are naturally gluten-free, but always check about cross-contamination. 'Pão de queijo' – These cheese balls are traditionally made using tapioca flour so are naturally gluten-free, but always check because in some hotels they'll contain wheat flour as well. BBQ meat – Brazil is famous for it's barbequed meats, which are not usually coated in flour. Top Dish: 'Moqueca' – This fish stew is cooked in a sauce of coconut milk, palm oil, parselt, garlic, tomato puree and peppers. These are the staple ingredients of many meals in the north of Brazil, which is a particularly good area for celiac travellers to visit. Eating Gluten-Free in Peru
    Labelling Laws: There are no laws in Peru which require products to be labelled 'gluten-free', and most people will not have come across celiac disease.
    Advice: Lima is probably the best city to eat gluten-free, as it has some of the best restaurants in the world and very experienced, knowledgeable chefs. So use words like 'trigo' and 'cebada' to explain that you can't eat wheat and barley, and you should be understood. The main problem in Peru is fusion cuisines, like 'chifa', which are heavily influenced by Asian cooking and nearly always contain soy sauce. Wheat flour is often used to coat foods before frying in Peru, and is often used to thicken sauces, so ensure you know the basic Spanish phrases to explain your needs.
    Naturally Gluten-Free Peruvian Foods:
    Quinoa – This is the staple grain in Peru, and you'll find soups and stews containing it everywhere. 'Tamales' – Corn flour is used to make this breakfast food or snack, which is steamed in a corn husk and filled with meat or cheese. 'Ceviche' – This popular dish has a very basic recipe of raw fish, citrus juices and seasoning, so it's always gluten-free. Top Dish: 'Rocoto Relleno' – This is a vegetarian dish of stuffed hot peppers. Eating Gluten-Free in Argentina
    Labelling Laws: Argentina has a law that requires packaged foods to be labelled 'sin TACC', if they are suitable for those on a gluten-free diet.
    Advice: Many traditional dishes are naturally gluten-free, so you should find suitable meals on most restaurant menus. However the language barrier can be a problem in more rural areas. Buenos Aires is one of the best cities in South America for celiacs, as it has a few gluten-free restaurants and even a bakery.
    Naturally Gluten-Free Argentinean Foods:
    Steak – Argentinean steaks are famous around the world, as are usually served with the dressing on the side, with salad or vegetables. Sometimes it's also served with fried potatoes or chips which you'll need to ensure are suitable. 'Fainá' – This flatbread is a popular snack, made from chickpea flour. It's naturally gluten-free, but always check that wheat flour hasn't been added as well. 'Asado' – Barbequed meats are also popular in Argentina, and should be naturally gluten-free. Top Dish: 'Humitas' - This snack is made from seasoned corn flour, boiled in a leaf or husk, very similar to Peruvian 'tamales'. Eating Gluten-Free in Chile
    Labelling Laws: Supermarkets may stock foods labelled as gluten-free, but these are mostly imported from nearby countries, such as Argentina.
    Advice: Even snacks like crisps, chocolate and yoghurts may not be suitable for celiacs in Chile, so try to learn the Spanish words you'll need to make reading packaging easier. Similarly in restaurants, English may not be widely spoken and the concept of 'gluten-free' won't be fully understood.
    Naturally Gluten-Free Chilean Foods:
    'Milcaos' – This street food snack is naturally gluten-free, as it only contains mashed potato and raw, grated potato fried in oil. The only risk is cross-contamination from the oil. 'Pastel de Choclo' – This popular dish is a stew/pie of ground beef or chicken with olives and raisins. The crust is made from pureed corn, so it's naturally gluten-free. 'Paila Marina' – Seafood stews and soups like this are very popular and usually gluten-free, although bread is often served as an accompaniment. Top Dish: 'Caldillo de Congrio' – It's not for everyone, but this boiled eel stew is a Chilean favourite. Eating Gluten-Free in Bolivia
    Labelling Laws: There are no labelling laws in Bolivia, and you may struggle to find suitable snacks in supermarkets.
    Advice: Bolivia is a tough country for celiac travellers, as English is not widely spoken and the term 'gluten-free' won't be understood by most people. You will need to learn Spanish phrases to help you get by.
    Naturally Gluten-Free Bolivian Foods:
    'Sonso' – This is a street food snack of yucca (similar to potato) and cheese, cooked over a BBQ. 'Pique Macho' – Bolivian's like sharing dishes, and this is a particular favourite, containing beef, hot dogs and boiled eggs, served with chips. You'll need to check that the chips haven't been cross-contaminated during frying. Quinoa – Similarly to Peru, quinoa is a staple grain in Bolivia, and you will find it in many soups. Top Dish: 'Palta Rellena' – This starter is typically Bolivian, an avocado stuffed with chicken and shrimp. It's very simple and naturally gluten-free. Eating Gluten-Free in Ecuador
    Labelling Laws: Similarly to Bolivia, you probably won't see 'gluten-free' labels in supermarkets.
    Advice: Wheat doesn't feature heavily in traditional Ecuadorian cuisine, as yucca, plantain and rice and the preferred carbohydrates. But bread is served with nearly every meal, and in international restaurants wheat flour will probably be used, so opt for traditional-looking restaurants.
    Naturally Gluten-Free Ecuadorian Foods:
    Plantain – This banana-type fruit is very popular is Ecuadorian cooking and can be served in many ways. 'Chifle' is a particularly popular plantain dish, dried and salted to taste. 'Pan de Yuca' – These cheese balls are very similar to the Brazilian equivalent, and are naturally gluten-free, made from tapioca flour. BBQ meat – Although barbequed meat is usually safe for celiacs, be aware that in Ecuador it is common to marinate the meat in beer before cooking. Top Dish: 'Encebollado' – The national dish of the country is a fish soup with boiled yucca and red onions.

    Yvonne Vissing Ph.D.
    Celiac.com 01/05/2018 - Cuba is abundant with music, color, and people. The countryside is a lush, rich green where fields of sugar cane stretch as far as the eye can see. Streets of Havana are filled with hot pink, lemon yellow, candy-apple red, bright blue and green classic cars. Rural streets have horse drawn carts overflowing with harvested sugar cane and the men (almost always men) with machetes from cutting the crops. It is a country of contradictions, where pillars of ancient affluence intersect with rubble as people yack on cell-phones while throwing their fishing lines off the Malecon.
    As a multiple-time tourist there, I'm overwhelmed with how friendly people are and how safe I feel, even though my ability to speak Spanish is, well, not-so-good. Given that wifi and internet connections are few and far between, my translation app doesn't work so I'm on my own when it comes to ordering food and figuring out if it's gluten-free or not. Between my Spanish being awful and the fact that menus may not be in English, much less contain a list of ingredients, asking the wait-staff if there are gluten-free menu options is a no-brainer. The communication and interpretation challenges meant that it made no sense for me to ask that question.
    So how does one go about being gluten-free in Cuba? Actually, it's not so hard once you keep in mind certain facts. One is to understand the traditional daily diet of most Cubans. Food staples include rice, beans, pork, beef, and sometimes chicken. These are all safe for people with Celiac disease. You're likely to find these foods at every meal in every home or restaurant. Cubans do not tend to use a lot of spices because they don't have them; processed foods are generally unavailable which makes food rather bland but on the other side, pretty safe because the chances of being exposed to gluten-filled flavor enhancers aren't around. Breads may be served but they, like the delicious-looking fried dough sold on the street in baskets or papers by local vendors, can be easily avoided. Pasta dishes are found in many restaurants, and the pasta is always wheat so forget asking if they have corn, rice of quinoa pasta. Eggs are pretty easy to find; cheese somewhat, but peanut-butter is not.
    For many people going gluten-free, vegetables are a life-saver. However, in Cuba this option is something we need to have a serious conversation about. Vegetables are hard to come by. Now, there is a big organic farm program in Cuba. Organopónicos, or organoponics, is a system of urban agriculture using organic gardens that originated in Cuba and is widely used there. The idea is for them to produce organic, highly nutritious vegetables in an efficient way that maximizes the use of natural resources, composting, and recycling. The farm I visited outside of Havana distributes 90% of all the produce to local residents; only 10% goes to hotels and commercial vendors. The organoponics movement is trying to lure Cubans away from their primary reliance on rice, beans and meats into eating more produce. There is a heavy health emphasis related to nutrition there – there are hospitals and health care providers, but they aren't plentiful and tend not to be the first line of health care. Food is a primary vehicle leading to better health. Sweets, salty foods and fats are not nearly as common there, due to the lack of imports of such items in this still largely socialistic country. Foods are simpler, and seem to be more “real”, if you get my drift. Since Cuba is an island, fresh fish is a good choice for meals. If you order a salad, expect them to be small and consisting primarily of lettuce (not iceberg!), thinly sliced cucumbers, and maybe a bit of grated cabbage. Don't go looking for tomatoes, broccoli, carrots, potatoes, Brussel sprouts, squashes or kale. Chances are low that you'll find them. It's more likely that when you find vegetables, they are present more as garnish.
    Fruits, on the other hand, can be easily purchased at corner open-air markets where farmers bring bananas, plantains, pineapple, mangos, papaya, and coconuts. They are beautiful and fresh, and can be served on plates as main foods, garnishes and certainly as juices.
    Food isn't why one goes to Cuba. Mojitos and rum may be (thank God they are gluten free!), cigars are a draw, and a tiny cup of their coffee will keep you rolling all day. People who have to go gluten-free have often gotten used to watching what they eat and having limited options, so in this regard traveling to Cuba is no different. In some ways it's a bit easier because of the lack of processed foods and fancy, hidden ingredients that make their way into both gourmet and convenience foods in the United States. Cuba is more of a what-you-see-is-what-you-get culinary world. Gourmet cuisine hasn't arrived there yet. Neither have fast food items that U.S. people have come to take for granted. It's not uncommon to overhear people at the airport planning what they're going to eat when they get back to the states.

    My advice for anyone going gluten free in Cuba is to pack some nuts, dried fruit, protein bars, and easy-to-keep-and-transport favorite gluten-free food options. Expect when you go out for breakfast to have fruit and eggs. Dinner will likely be a meat/chicken/fish that is simply prepared so it should not usually be a gluten issue. Rice and beans are usually cooked without much seasoning, so you're probably safe eating them. Definitely avoid anything that is deep fried, because chances are high that a bread was cooked in the oil. Plantains that are fried are probably safe because they are cooked in butter or oil in a skillet. Fresh fruits are abundant, just sometimes a bit complicated for tourists to manage when purchased on the street if they don't have knives or ways to cut and serve them in a non-messy fashion. Don't expect to see many veggies, and when you do, relish them. And of course the mantra for most tourists traveling there is – don't drink the water! There's plenty of bottled water, juices and beer around, so you should not get sick from either gluten or water if you're nominally careful. Remember why you're in Cuba – not for fine dining, but to see the culture, listen to music, and have fun.

  • Recent Articles

    Connie Sarros
    Celiac.com 04/21/2018 - Dear Friends and Readers,
    I have been writing articles for Scott Adams since the 2002 Summer Issue of the Scott-Free Press. The Scott-Free Press evolved into the Journal of Gluten Sensitivity. I felt honored when Scott asked me ten years ago to contribute to his quarterly journal and it's been a privilege to write articles for his publication ever since.
    Due to personal health reasons and restrictions, I find that I need to retire. My husband and I can no longer travel the country speaking at conferences and to support groups (which we dearly loved to do) nor can I commit to writing more books, articles, or menus. Consequently, I will no longer be contributing articles to the Journal of Gluten Sensitivity. 
    My following books will still be available at Amazon.com:
    Gluten-free Cooking for Dummies Student's Vegetarian Cookbook for Dummies Wheat-free Gluten-free Dessert Cookbook Wheat-free Gluten-free Reduced Calorie Cookbook Wheat-free Gluten-free Cookbook for Kids and Busy Adults (revised version) My first book was published in 1996. My journey since then has been incredible. I have met so many in the celiac community and I feel blessed to be able to call you friends. Many of you have told me that I helped to change your life – let me assure you that your kind words, your phone calls, your thoughtful notes, and your feedback throughout the years have had a vital impact on my life, too. Thank you for all of your support through these years.

    Jefferson Adams
    Celiac.com 04/20/2018 - A digital media company and a label data company are teaming up to help major manufacturers target, reach and convert their desired shoppers based on dietary needs, such as gluten-free diet. The deal could bring synergy in emerging markets such as the gluten-free and allergen-free markets, which represent major growth sectors in the global food industry. 
    Under the deal, personalized digital media company Catalina will be joining forces with Label Insight. Catalina uses consumer purchases data to target shoppers on a personal base, while Label Insight works with major companies like Kellogg, Betty Crocker, and Pepsi to provide insight on food label data to government, retailers, manufacturers and app developers.
    "Brands with very specific product benefits, gluten-free for example, require precise targeting to efficiently reach and convert their desired shoppers,” says Todd Morris, President of Catalina's Go-to-Market organization, adding that “Catalina offers the only purchase-based targeting solution with this capability.” 
    Label Insight’s clients include food and beverage giants such as Unilever, Ben & Jerry's, Lipton and Hellman’s. Label Insight technology has helped the Food and Drug Administration (FDA) build the sector’s very first scientifically accurate database of food ingredients, health attributes and claims.
    Morris says the joint partnership will allow Catalina to “enhance our dataset and further increase our ability to target shoppers who are currently buying - or have shown intent to buy - in these emerging categories,” including gluten-free, allergen-free, and other free-from foods.
    The deal will likely make for easier, more precise targeting of goods to consumers, and thus provide benefits for manufacturers and retailers looking to better serve their retail food customers, especially in specialty areas like gluten-free and allergen-free foods.
    Source:
    fdfworld.com

    Jefferson Adams
    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

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    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