Celiac.com 02/08/2018 - Have you ever considered being tested for a genetic defect called MTHFR? If you have a family history of heart disease or stroke, migraines, trouble getting pregnant or have a child with Autism you might want to consider reading on to learn more. These are just a few of the list of conditions linked to MTHFR mutation. Surprisingly, 60% of our population has this mutation and most do not even know what MTHFR is.

I recently came up positive myself for MTHFR A1298C. We will talk more about the two common markers in a bit. This changes everything when it comes to choices and is important to have the knowledge when choosing foods and supplementation. It's also important to monitor your folate levels. More to come.

Interestingly, Untreated celiac disease may be associated with hyperhomocysteinemia caused by a combination of vitamin deficiencies and variants in the MTHFR gene. If you are not healing with a gluten free diet this might be a test to consider. [1]

So, what is MTHFR?
The MTHFR gene (methylenetetrahydrofolate reductase) is an enzyme that plays an important role in processing amino acids, the building blocks of proteins. Now you know why it's an acronym! Methylenetetrahydrofolate reductase is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9). This enzyme converts a molecule called 5,10-methylenetetrahydrofolate to a molecule called 5-methyltetrahydrofolate. This reaction is required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds. [2]

Although, there are over fifty known MTHFR variants, two are commonly tested C677T and A1298.

Some of the key things methylation process is responsible for are:

• Cellular Repair – DNA repair is a collection of processes by which a cell identifies and corrects damage to the DNA molecules that encode its genome (genetic material of an organism).
• Detoxification and Neurotransmitter Production – The interconversion of amino acids.
• Healthy Immune System Function – Formation and maturation of red blood cells, white blood cells and platelet production.

What's the Difference Between the Two Most Common Types?
The 677T Variant is associated with heart disease and stroke whereas the 1298C is associated with a variety of chronic illness. Either one however can cause general health problems.

Homozygous vs Heterozygous
An organism can be homozygous dominant, if it carries two copies of the same dominant allele (allele - one of two or more alternative forms of a gene that arise by mutation and are found at the same place on a chromosome.), or homozygous recessive, if it carries two copies of the same recessive allele. Heterozygous means that an organism has two different alleles of a gene.

If you are homozygous (2 abnormal copies) your enzyme efficiency drops to 10% - 20% of normal which can be problematic. A more serious combination is 677T/1298C which has both genetic anomalies.

If you are having symptoms and can't quite put your finger on it I would suggest getting tested for the MTHFR. That will help your practitioner determine what supplementation best suits your needs. Diet will also be a factor as with MTHFR the body cannot process synthetic folate which is in fortified foods such as cereal, nutritional yeast (can get unfortified), breads, rice, pastas, flour, etc., This explains why I always got a headache after I ate fortified nutritional yeast. I switched to unfortified and I don't have the headaches.

As mentioned above, there are many chronic conditions linked to MTHFR. Here are a few:

• Alzheimer's
• Autism
• Autoimmune Disorders
• Breast cancer
• Chronic Fatigue
• Down's Syndrome
• Fibromyalgia
• Heart Disease
• IBS (irritable bowel syndrome)
• Infertility in both men and women
• Mental disorders such as bipolar and schizophrenia
• Migraines
• Multiple Sclerosis (MS)
• Sensitivity to chemicals
• Stroke

The Great Detoxifier
Glutathione is the body's main antioxidant and detoxifier. What happens with MTHFR mutation is it can make you susceptible to disease by lowering your body's ability to make glutathione. Most people with MTHFR have low glutathione levels. With low glutathione levels, you are more sensitive to toxins and chemicals including heavy metals. The good news is you can supplement glutathione in the correct methyl form and change up your diet. More to come on this. With oxidative stress, we are more likely to have premature aging as well. Another reason to be aware of MTHFR and maintain a healthy high folate diet along with supporting supplementation.

Testing
If you have any of the symptoms above or have a family history with MTHFR mutations I highly recommend testing for both C677T and A1298. Testing can be done through a practitioner. You can go to 23andme and order the test or work with your health practitioner. It's inexpensive and well worth it. Also, testing your levels of glutathione and folate would be beneficial so your practitioner knows where your levels are before recommending supplementation.

Supplementation for MTHFR
If you are taking a B vitamin, make sure it's methyl-B12, methyl-folate. Taking synthetic forms (folic acid) can be more harmful than good because the body cannot do the conversion. It's essential to make sure that your method delivers the antioxidant efficiently to your cells. One of the B vitamins I recommend from Pure Genomics is their B Complex available on our marketplace.

Glutathione is also important but hard to absorb so a liposome form is recommended or get one with a precursor called NAC (N-acetyl-cysteine). Glutathione is important for detoxification as mentioned. Here are a few to consider – Liposomal Glutathione by Pure Encapsulations as a liposome form With any supplement, you can have adverse effects so make sure you work with a knowledgeable practitioner.
Diet and Lifestyle

Folic Acid vs. Folate
While folic acid and folate may be marketed interchangeably, as mentioned earlier, their metabolic effects can be quite different, especially for those with the MTHFR mutation. Folate is the bioavailable, natural form of vitamin B9 found in a variety of plant and animal foods. Folic acid, on the other hand while readily utilized by the body is synthetic. Folate is found in supplements and fortified foods such as cereals and might I add nutritional yeast. The body is more adept at using folate and regulates healthy levels by discarding excess folate in urine. With MTHFR folic acid can be problematic so make sure you purge the folic acid rich foods and supplements. For those who love the flavor of nutritional yeast and use it in vegan recipes there are a few companies who make unfortified versions you can get off amazon.

Daily lifestyle activities such as dry brushing (lymphatic circulation) Epsom salt baths, exercise, sauna's (infrared sauna is amazing) and of course a healthy diet rich in natural forms of folate such as:

• Beans and lentils
• Leafy green vegetables including raw spinach
• Asparagus
• Romaine Lettuce
• Broccoli
• Avocado
• Bright-colored fruits, such as papaya and orange

Here are just a few examples of some folate rich foods. As you can see spinach packs a powerful punch of folate as well as papaya and lentils coming in the highest. [2]

Did you know your liver needs glutathione to produce bile in addition to the detoxification process? Look at addressing health issues such as leaky gut, IBS and Inflammation as these can affect absorption and neurotransmitter levels as well as hormones with MTHFR A1298C mutations.

MTHFR mutations are tied to higher mental disorders such as anxiety, depression, bipolar and schizophrenia as well as chronic fatigue and fibromyalgia. It's important to find ways to manage the stressors in addition to healing the gut as symptoms can be heightened with MTHFR.

Protect the heart with an anti-inflammatory diet rich in omegas, fiber and plants. Omega 3 and COQ10 supplementation is helpful. A good multi is beneficial as long as you get one with B12 (methyl cobalamin) and Folate (methyl tetrahydrofolate) forms.

Drug Interactions to consider
You should not use any supplements without first talking to your health care provider. For example, folate should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Folate is necessary if taking medications for birth control, cholesterol or seizures for example as they may lower folic acid levels in the body. Dosage and timing is important to know.

Here are some medications to keep in mind:

• Antacids, H2 blockers, proton pump inhibitors
• Bile acid sequestrants
• Carbamazepine
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Sulfasalazine
• Triamterene

When taken for long periods of time, these medications, as well as other anti-inflammatory and anti-seizure medicines, can increase the body's need for folic acid.

Also consider drugs used for cancer, rheumatoid arthritis and psoriasis as those also reduce the folic acid in the body. Supplementing folic acid can help reduce symptoms of these disorders however with cancer, folic acid may interfere with methotrexates effects on treatment. Talk with your practitioner if you are taking any medications. [3]

Knowing your DNA make up is important as is knowing your numbers (blood pressure, cholesterol, etc.) so you can keep a handle on your health and do your best to control stress. Getting tested for the MTHFR mutation is worth knowing whether it comes up or not. It can make all the difference in aging and detoxing and give you a peace of mind.

Sources:

• https://draxe.com/mthfr-mutation/ 
• http://doccarnahan.blogspot.com/2013/05/mthfr-gene-mutation-whats-big-deal.html 
• https://www.jillcarnahan.com/2014/02/23/health-tips-for-anyone-with-a-mthfr-gene-mutation/ 

Celiac.com 01/31/2018 - Methylation is a biochemical reaction in the human body that requires a variety of nutrients to perform indispensable roles in neurological health, detoxification, amino acid metabolism, gene regulation and vitamin assimilation. Every person with celiac disease needs to have their methylation variants tested by their physician so they can achieve good health. How well your body can "methylate" is important to your overall health.

Methylation pathways in the body are important in cardiovascular health, neuroprotection from dementia and Alzheimer's disease, cognition skills in the young and old, along with emotional wellness and cellular function. A simple blood test- MTHFR- which is available at all major laboratories can determine if common genetic variants require additional supplementation of B vitamins.

The MTHFR (Methylene Tetrahydrofolate Reductase) converts folate (vitamin B9) and riboflavin (vitamin B2) into an active part of the energy production cycle. In addition, it can indicate if higher levels of Vitamin B12 are needed. Since it is a genetic factor, some clinics do not test it but every celiac needs to know what variants they have in order to optimize their nutritional needs. (Author's note: I wish I had done this testing when I first learned about it 20 years ago. It has made all the difference in the world in my health these past 8 years!)

The role of methylation is to help enzymes in our body work efficiently. Enzymes are like switches for chemical reactions in cells and tissues. Inadequate methylation nutrients- folate (NOT folic acid), methylcobalamin - the active form of B12 (NOT cyanocobalamin- the cheap cyanide form), and vitamin B6 as pyridoxal-5-phosphate can improve anemia, sleep, energy production and detoxification of chemicals from gasoline fumes to ammonia odors and personal care fragrances.

Research over the past twenty years has provided a wealth of knowledge about methylation. It is the responsibility of each person to know their MTHFR variants which were inherited from mom and dad. Here is a brief list of the medical conditions affected by variants in MTHFR.

• Neurological Disorders: Parkinson's, Alzheimer's, Dementia, Multiple Sclerosis, Autism
• Cardiovascular Disorders: Atherosclerosis, Pulmonary Embolisms, General Clotting Disorders
• Mental Dysfunction: Depression, Anxiety, Insomnia, ADD/ADHD, Bipolar, Addictive Behaviors, Schizophrenia
• Conception: Infertility, Recurrent Miscarriages
• Immune Function: Allergies, Chronic Viral Infection
• Diabetes: Retinopathy, Neuropathy, Nephropathy
• Increased Sensitivity: Chemicals, Drugs, Supplements
• Birth Defects: Congenital Heart Defects, Cleft Palette, Spinal Bifida, Down's Syndrome
• Cancer
• Thyroid Dysfunction
• Chronis Conditions: Pain, Fibromyalgia, Chronic Fatigue Syndrome

These MTHFR variants are NOT uncommon but unfortunately few in the medical arena are educated to address dietary concerns related to them. A book MTHFR- Methylation Diet is available on my website www.betty-wedman-stlouis.com for those who need assistance understanding their profile and designing dietary plans. The Methylation Diet is a high protein diet with lots of folate rich vegetables. Thos individuals with MTHFR variants should avoid folic acid as a dietary supplement and foods enriched with it like cereals, breads, flour, etc.

Celiac.com 01/19/2018 - Did you know that there are so many issues and questions surrounding celiac disease that even doctors who specialize in it find that the scientific data changes every six months, and this includes research data, new diagnostic and testing recommendations, and its connections to other diseases and conditions. In fact, many of us who think we have "arrived" and know it all might actually need a refresher course on the disease.

There is always something new to learn about this disease. For example, did you know that the primary proteins in wheat gluten are gluten and gliadin, and gliadin contains repeating patterns of amino acids that many humans' digestive systems cannot break down, and gluten is the only substance that contains these proteins?

People with celiac disease have one or two genetic mutations that somehow cause the immune system to attack the walls of their intestines when gliadin is present. That in turn causes finger-like structures called villi that absorb nutrients on the inside of the intestines to atrophy and the intestines can become leaky, wreaking havoc. Symptoms which vary widely among people with the disease, can include vomiting, chronic diarrhea, or constipation and diminished growth rates in children.

The vast majority of people who have celiac disease don't know it, and not everyone who has the genetic markers will develop it. What worries doctors is that the problem seems to be increasing. Studies on blood collected in the 1950's show that the rate of celiac disease appears to be increasing. Some blame changes in wheat for this increase, as some varieties now grown contain higher levels of gluten.

Did you know that the tTg-IgA - Tissue Transglutaminase Antibodies will be positive in about 98% of patients with celiac disease who are on a gluten-containing diet. That same test will come back negative in about 95% of healthy people without celiac disease. Though it is rare this means patients with celiac disease could have a negative antibody test result. "There is also a slight risk of a false positive test results, especially for people with associated autoimmune disorders like Type I diabetes, autoimmune liver disease, Hashimoto's thyroiditis, psoriatic or rheumatoid arthritis and heart failure, who do not have celiac disease. There are other antibody tests available to double-check for potential false positives or false negatives, but because of the potential for false antibody tests results, a biopsy of the small intestine is the only way to diagnose celiac disease.

If your tests were negative, but you continue to experience symptoms, please don't give up. Consult your physician and undergo further medical evaluation. Ask to be referred to the closest hospital research department that deals with celiac disease.

Did you know that there is something called "silent celiac disease," also known as asymptomatic celiac disease, where patients do not have any noticeable symptoms, but still experience villus atrophy damage to their small intestine? The number of ways that celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs contributes to poor diagnosis rates in the United States. Some estimate that 80% of celiacs remain undiagnosed.

Did you know that some people with wheat/gluten sensitivity still experience symptoms such as "brain fog", depression, ADHD - like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue, yet they do not test positive for celiac disease? Terms like NCGS (non-celiac gluten sensitivity), and NCWS (non-celiac wheat sensitivity) are used to refer to this condition, but only after the removal of gluten from the diet resolves their symptoms.

Did you know that celiac disease research funding has been neglected in the United States, and, as I have often said, where the United States goes, Canadians soon follow. A five-year review ending in 2017 shows the NIH gave less money to celiac disease than other gastro-intestinal conditions. Additionally, the National Institute for Digestive and Kidney Diseases awarded the fewest number of grants to celiac disease research over the same period from 2011 to 2015.

The review, published as commentary in the Journal of Gastroenterology (http://www.gastrojournal.org/article/S0016-5085(17)36084-5/pdf) found that NIH funding, which is the major source of research support for inflammatory gastrointestinal diseases, showed no association between the estimated prevalence or mortality rates of a disease. In general, NIH support is seen as essential for improving the understanding of health and disease. The review included celiac disease, irritable bowel syndrome (IBS), Crohn's disease, eosinophilic esophagitis (EoE), Barrett's esophagus and non-alcoholic fatty liver disease (NAFLD). In fact, both IBS and NALFD, neither of which is associated with increased mortality, still receive more funding than celiac disease. According to the report:

"Although there is no global metric for disease importance, it is difficult to justify on medical and scientific bases as a reason for such large and persistent funding differences . Although Crohn's disease has many available and emerging treatment options, celiac disease, for example, is more prevalent and has no current treatment to patients beyond the burdensome gluten-free diet."

However, we cannot complain that celiac disease is not getting the same exposure that Irritable Bowel Disease has if we do not get involved directly and help spread the news about celiac disease, which will help others get diagnosed and treated. We also need to report erroneously labeled "gluten-free" products. Sometimes we pass the buck and hope that someone else will report an error on product label, for example I have been sold something that indicates it is gluten free when it was actually just "wheat free", which is a common error among fast food companies. What do they know about malt? Unfortunately there is no EPI-PEN for the celiac, so you must learn to be your own advocate and check whatever goes into your mouth.

Celiac.com 01/11/2018 - Gluten-free, food allergies and celiac disease have reached the media in the form of jokes and ridicule. This is a serious development because the media influences viewer's day-today reactions to various social situations. In many ways, TV becomes a role model for social interactions. DeVault (1991) says that "an enormous body of science, literature and even humor tells us how a middle-class man and woman might 'do' family life" (p. 16). This is the fundamental reason why the media jabs about gluten-free and food allergies are so impactful. What we see on TV, we emulate in life. If 'doing gluten free' is something to be ridiculed, as with the examples below, then those of us with food allergies need to unite our voices to be heard in public forums to change this practice.

An example of food-allergy ridicule is found in a scene in The Smurfs 2 when the unctuous "Corndog King" presents every child at a birthday party with a corn-dog. A concerned parent asks if the corn-dogs contain peanuts, and he says, "No, I would never use peanuts." Meanwhile, a little boy is shown eating the corn-dog just as the Corndog King recalls that they are fried in peanut oil. The parents rush to the little boy urging him to spit it out. Here is the snippet:

As much as I love Frankie and Grace, the game that the siblings played in Season 3, Episode 1, called "Bud's Super Needy Girlfriend Game" is offensive. It shows them eavesdropping as Allison, Bud's girlfriend, talks about her allergies to a stranger at the art show. With each statement Allison makes, such as, "it is easier to tell you what I am not allergic to," the group takes a shot of liquor. Allison says, "and that's when I realized I have celiac disease" and the siblings laugh and take another shot. This goes on for several rounds. The siblings ridicule Allison's allergies and maladies in a very uncompassionate way, setting an example for viewers on how to respond when there is a person in the crowd who has allergies. In another episode, when Allison faints, the reaction from the siblings is, "…she always has to be the center of attention. She conjures up some kind of illness. But there's a name for it, 'Fictitious disorder.'" (For a transcript of this and similar scenes, please check out: http://thewalkingallergy.com/2017/08/grace-and-frankie-i-bet-allison-has-mcas/). These responses to Allison's physical malaise are callous and may encourage copycat behavior in real life situations.

Humans are easily influenced, starting from infancy when they imitate their parents (McCall, Parke & Kavanaugh, 1977) and continue to be guided by what they view in the media, especially on TV. Ramasubramanian (2010) conducted a study to discover how stereotypes of laziness and criminality changed as a result of reflecting on TV depictions of racial/ethnic groups by white viewers (p. 109) and concludes that the ways these scenes influence opinions and attitudes is worrisome (p. 106), perpetuating stereotypes and prejudice. A study conducted by Tan and Kinner (1982) found that interracial children who watched a TV program showing cooperative, positive behavior, yielded "pro-social" (p. 654) social interactions, when compared with a control group. The impact of what is viewed on TV and how it translates to social (or anti-social behavior) has been validated. Humans imitate what they see. Similar to how racial stereotyping is reinforced by the media, so are people with food allergies who become the butt of jokes. The media is teaching unacceptable social norms disguised as humor.

Disney's episode of Quitting Cold Koala (edited out after parents complained, but still on YouTube in a home-video snippet) shows the character named Stuart (who has a "five page list of dietary problems" according to his nanny) sitting at the breakfast table with other children. He is a cute little boy who wears glasses cocked awkwardly on his nose. He told the cook that he couldn't eat pancakes that contained gluten only to be attacked by other children throwing gluten-containing pancakes in his face! Here it is on:

How do scenes like the three examples above translate into our everyday social interactions? Does the waiter who watches a scene on a sit-com ridiculing someone with food allergies doubt the customer the next day as she orders a gluten-free meal? Does the waiter play a derivation of the "Needy Game" seen on Frankie and Grace and have a shot of liquor in the back room with his waiter-buddies for every customer that orders a special meal? Ridicule in the media completely undermines the severity of celiac disease, and other food-related illnesses.

I experienced a situation the may have been influenced by commercial programming recently while ordering at a restaurant. I special-ordered my salad, deliberately sitting on the end of the table and explaining to the waiter that I needed to ensure it was gluten and dairy free. I spoke quietly, but since there were only two others at the table, unfortunately the conversation stopped during ordering and the others heard me. The waiter rolled his eyes when I gave him my order, and moved on to the next person who said, "I'll take the salad 'regular' with all the fixings" in a kind of a sarcastic way that belittled my order. My dinner was spoiled because I was irked with my dinner companion, and because I was skeptical of the food I was served. This kind of slight happens all the time, and is likely because of the role models depicted on TV and other media that portrays that it is it socially acceptable to mock the person with special needs.

It is hard to understand why food sensitivities trigger so much negativity. If someone says they have heart disease, they are taken seriously. Other autoimmune diseases such as rheumatoid arthritis, lupus, Hashimotos, and diabetes are met with seriousness, but gluten-sensitivities seem to be a charged 'trigger' reaction, that I believe has been perpetuated by the media. People ordering in a restaurant seem to be challenged by the waiter – scrutinized whether it is an 'allergy,' 'autoimmune response' or 'fad diet.' When did waiters have the prerogative to make that kind of decision? Where did this 'right' come from? I believe the media has perpetuated these attitudes.

Nobody with special needs should endure scrutiny or ridicule. I'm frankly glad for the publicity gluten has received because it has enhanced awareness, but I am discouraged about how the media seems to think celiac disease, gluten intolerance and food allergies are a joke. Here is our call to action: When we see something offensive in the media ridiculing food allergies, we need to say something in a public forum to bring attention to this unacceptable portrayal of people with food sensitivities. Please post on social media, or on Celiac.com to create a buzz that this type of ridicule/humor is unacceptable. Perhaps by doing this, we can influence positive changes.

And on another subject… the winners from the survey.
A couple of months ago, a survey studying the impact of food sensitivities on adults living together offered a $25 gift card to Amazon to four lucky winners. Those are: Morgan, Angela, David and Tricia. (Winners have been notified and gift cards were sent via email.) Congratulations! And thank you for your participation in the study.

References

• DeVault, M. L. (1991). Feeding the family: The social organization of caring as gendered work. Chicago, IL: University of Chicago Press.
• Huesmann, L. R., & Taylor, L. D. (2006). The role of media violence in violent behavior. Annual Rev. of Public Health (27), 393-415.
• McCall, R. B., Parke, R. D., Kavanaugh, R. D., Engstrom, R., Russell, J, and Wycoff, E. (1977). Imitation of live and televised models by children one to three years of age. Monographs of the Society for Research in Child Development 42(5), 1-94.
• Tan, A. S., Kinner, D. (1982). TV role models and anticipated social interaction. Journalism Quarterly 59(4), 654-656.

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, rum and juices 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.