Celiac.com 03/30/2022 - I am the mother of two teenage children—both recently diagnosed with celiac disease. I manage an International Student Exchange program based in New Jersey. My hobbies include writing fiction and painting and I hold a black belt in Karate.

Do I have celiac disease? I believe so. As a matter of fact I made myself very sick trying to prove it. What can I say? I was desperate! I spent the past twenty-five years doing everything the doctors told me and I was getting sicker instead of better. All I concentrated on was eating healthy and doing anything that promised to settle my stomach. Nothing worked. Whenever I complained to a doctor they would run a few tests and tell me that I probably had irritable bowel syndrome (IBS). Their advice was to lose weight and watch what I eat—easy for them to say!

Since it wasn’t the in bed, out of work, desperately ill kind of sick at that point, I did my best to manage daily life. For the most part my family understood I had a “sensitive stomach” and learned to live with it—but I knew it was slowly getting worse and I was getting scared. Finally, I came to the point where I would just break down and pray to God, “I don’t care what it is, just give me an answer. Any answer!”

When I first explained to doctors that I seemed to always be in the bathroom with severe nausea, stomach cramps, gas, and bloating they would say: “Must be something you ate.” To which, I’d answer, “Everyday?” and they would just shrug their shoulders. It wasn’t like I was dying, losing vast amounts of weight, or exhibiting symptoms that would raise the red flag—but I was in pain and embarrassed. I don’t think the doctors realized what it took for me to come forward with my complaints. As before, I left the doctor’s office without any answers and went on with my life, managing it as best as I could.

One minute I could feel fine and the next I would be overcome with cramps. Some days I could barely manage to leave the house. It got so bad I would just not eat as I tried to “shut down” the digestive process.

Doctors kept saying IBS. Frankly, I didn’t think that was much of a diagnosis. I mean, I already knew my bowels were irritated! What causes it? What can I do about it?

I was told over and over again, “everyone gets it.” Watch what you eat, avoid junk food, alcohol, etc. Yeah right, I’d been trying that for years and it didn’t work. One day I’d eat something and be fine, the next day I’d eat the same thing and get sick. What did that tell me? I’d keep food diaries, take vitamins— even those made me nauseous— but I wasn’t feeling any better.

Finally, I resigned myself to carrying a pack of Imodium in my purse wherever I went. It was so bad that everything I ate caused pain. If I had to do any traveling I would just not eat the day before or the day of the trip. Everywhere I went I just resigned myself to not eating. Once I got home and felt safe I would be so hungry that I would stuff everything I could find into my mouth. Of course, that would make me as sick as a dog.

My biggest question was why could I eat something one day and be fine, then eat it a week later and be extremely sick? The medical community answered with “It’s IBS.” I know the real answer now. It’s because different brand names use different ingredients. One burger restaurant may add wheat, the other might not.

Though the years I developed other problems. Lethargy made me go back to the doctor for blood tests, and I was diagnosed with hypothyroid. The medication for this gave me more energy but did nothing for my IBS.

Scourge of my life. When I complained about having rough, blister-like breakouts on the back of my legs and arms I was told it was either eczema or “winter dry skin.” The recommendation was to use moisturizer and someone even told me to take vitamin E. None of this healed my skin but it did ease the breakouts a bit.

Since the IBS was an even bigger problem, I pushed these other stressful problems to the back of my mind and tried to find foods that I could eat. At that point everything made me sick. I again mentioned the problems with my stomach during one of my normal thyroid checkups, and the fact that even a plain old slice of bread made me nauseous. “How could that be?” I cried. “Bread was what you give to sick people!”

The doctor stopped and looked at me for a moment, then told me about his mother who had celiac disease. He told me I probably didn’t have it because of my weight—5 foot 6 inches and 160 pounds—because “people with celiac disease are very thin,” a belief that I later found out was incorrect. When I pressed him for more information he wrote down the name and told me to look it up on the Internet, but he still doubted that I had it.

At this point in my life I was desperate for an answer and I prayed to God everyday that he would send me a clue as to what was tormenting me. Could this be it? I logged onto my computer the first chance I got and started reading everything I could find on this disease. I started looking into how many things in our everyday life contain gluten—breads, cereals, pastas, pizzas, and cakes were the obvious sources, but I was soon to learn that gluten is also mixed into many other processed foods. I immediately started a quest to get gluten out of my diet—which was a lot harder than I ever imagined. As much as ninety percent of the soups, canned foods, and prepared foods on the market today contain gluten. It is also used in certain medicines, sauces, spices, cough drops, stamps, and even envelope glue! For a while it seemed like everything I looked at had gluten in it.

Another issue was cross-contamination. I needed to thoroughly clean those things which could be contaminated with gluten, including: toasters, cutting boards, pans, and plastic spatulas! It was incredibly depressing—yet the more research I did the easier it got.

People with celiac disease can live normal, healthy lives, and I found a lot of support on the Internet. There, people from all over the world join together to share hints, problems, and commiserate. It made the transition much easier.

I also went to my local health food store with a printout from a company that makes gluten-free foods, and they ordered some of them and now stock a wide variety of gluten-free products. I’m finding gluten-free pastas, breads, and even some cookies that are so good most people wouldn’t know that they were not made from wheat flour. There are also several good mail order bakeries that have good breads, bagels, and other products made from rice, tapioca or potato flour. I order online in quantity and freeze them.

It definitely gets easier as time goes on. Within a month on a gluten-free diet my “IBS” and stomach cramps were gone! The nausea took a bit longer to improve but each day it improved. When I returned to the doctor and shared that I believed that I had celiac disease he was doubtful. At my insistence he ordered the blood test. At that point I had been off of gluten for about six to eight weeks. The test was negative. By this time I had met other people with celiac disease through the Internet who informed me that the tests would not be accurate unless I had been eating gluten daily for at least six prior to the test. I verified this information online and found it to be correct.

My dilemma now was whether or not to go back on gluten for an accurate diagnosis. It was a hard decision. I have two daughters and I felt I needed to know since this can also be hereditary. My father suffered for years with gastrointestinal problems before dying at age 65 of colon cancer. I’m sure now that he had celiac disease.

With all of this hanging over my head I decided to go back on gluten to get a definitive answer. My first meal was a pizza! Yum! 

The next day I was fine. So I continued to eat gluten. Within two days the cramps and diarrhea were back. By two weeks I was sick everyday and having trouble getting myself to work, but I didn’t give up. My husband thought I was crazy. He kept telling me that I already knew what was making me sick—so why was I doing this to myself? But I had already made the decision to find out if I really had celiac disease—so on I ate. On really bad days I took Imodium and sometimes didn’t eat until I was at home. The nausea was constant. Some days the cramping and pain were so bad that I just couldn’t eat at all. I don’t know if this hurt my test results or not but there were times when I just couldn’t bring myself to swallow any food at all. Eating caused the pain to worsen. This continued for six weeks!

On the day of my blood test I did not eat before I went to the lab at two in the afternoon. I was afraid that if I ate anything at all I’d get sick at the lab and that would be too embarrassing. Have you ever sat in a room full of people waiting for your turn—fighting nausea and just knowing that everyone in there was watching every time you got up to use the bathroom—five times in a row?! Let alone having to sit still long enough to get the blood drawn. The blood work all came back negative. At this point I dragged in my sixteen-year-old daughter for a blood test. The doctor thought that I was crazy. She didn’t fit the profile. I asked him to do it anyway to put my mind at ease—so he did. The blood work was positive. After that my nineteen-year-old daughter tested positive as well. Both of them opted out of the endoscopes, even though this is thought to be the gold standard for diagnosis. They went gluten-free and both are feeling much better on the diet.

Two weeks later I went for my endoscopy. I asked the gastroenterologist how many biopsies he was planning to take and he told me: “Enough, don’t worry.” But I did worry. What if it’s not enough? Celiac damage can be patchy and I desperately wanted an accurate diagnosis. The doctor called two days later and said the biopsy was fine.

So I am an undiagnosed celiac. I went gluten-free the day of my endoscopy and today I am feeling better than I have in my whole life! The “IBS” is gone, my skin is clearing and I never get nauseous. Today I feel healthy and I am living a much better life. Traveling still makes me nervous but it’s getting easier as I learn to trust my body once again.

Would my tests have been positive if I had been tested before going gluten-free? I don’t know and at this point I don’t care. I know what makes me sick and I avoid it. It’s as simple as that. I only wish I had understood that before going on the gluten challenge as it would have saved me a lot of pain.

My biggest problem now is when people say things like, “Oh, I couldn’t live without pasta!” Would they say to a diabetic: “I couldn’t live without sugar”? I hope not. To these people I just say: “You could if it made you sick.” I also thank God everyday for the answer I prayed for so often: celiac disease. It’s a different way of life that takes some getting used to, but it is quite do-able. Pizza never tasted as good as being healthy feels!

©A Personal Touch Publishing, LLC. This article originally appeared in the book A Personal Touch On...™ Celiac Disease.

Celiac.com 03/25/2022 - We love summer! It awakens us to sunshine, family picnics, pool parties, longer days, beautiful nights— and easier gluten-free dining.

Many people literally move the kitchen outdoors to their grill. Meals are simpler to prepare and can center on small plates and finger foods.

At The Gluten-Free Cooking School in Phoenix, AZ, we enjoy creating easy and fun snacks to make our lives easier. Last year Whole Foods Market in Arizona welcomed us to give a gluten-free lecture series and food demonstrations in their stores.

The following recipes were created for a summer class. They were so well received; we decided to share some of them with you, our friends. Grab your sunscreen and shades, make a couple of these appetizers and let the pool party begin!

Fruit

Fruit is nutritious, fun to dress up and easy to eat. Some fruits, such as apples and pears are best prepared at the last minute unless they are in a sauce—lime or lemon juice to help prevent them from turning brown.

• Apples: Dip wedges in pure maple syrup or gluten-free Rice Syrup, then dip in a combination of finely chopped nuts and raisins.
• Bananas: Slice a peeled banana lengthwise. Spread Nutella chocolate spread on both cut sides and stuff miniature marshmallow and raisins or nuts between the two slices.
• Mellon Wrapped in Prosciutto or ham: An elegant appetizer or finger food doesn’t get much easier than this. Simply slice any papaya, muskmelon, cantaloupe or mango into thin slices (peel and remove seeds first), then wrap thin strips of Prosciutto around the center of the slice.
• Apricots: Cut a fresh apricot in half, remove the seed and fill it with a gluten-free blue cheese or cottage cheese, then sprinkle with parsley leaves.

Vegetables

Like fruits, vegetables are highly versatile and healthy. Due to their heartiness, many of the vegetable appetizers or finger foods may be prepared ahead and will not suffer from browning or wilting, unless left in the Arizona heat, of course.

Use vegetables as scoopers for any spread or as a ‘carrier’ for decorative and tasty no-cook-no-bake fillings.

Vegetable fillings do not always have to fill up the entire piece of vegetable. Use a high contrast colored filling for extra appeal.

• Endive Leaves with beets are particularly beautiful. Cut endive leaves from their base, rinse and dry. Place a layer of canned or jarred beets toward the base of each endive leaf. Add a green delicate sprout for contrast.
• Pipe Cream Cheese thinned with milk and put into the endive leaves. Add a thin slice of freshly cut apple along the side of the cream cheese. Sprinkle with finely cut chives.
• Cherry Tomatoes: Choose cherry tomatoes that still have a little green stem attached. Cut a ‘hat’ off and scoop out the insides with a small melon ball scooper. Fill the cherry tomato with a spread by scooping the spread into the cherry or piping it in with a decorative tip pastry bag.

Skewers

Purchase mozzarella balls or cut mozzarella into chunks the size of cherry tomatoes. Remove stems from the tomatoes. Make a marinade of two parts extra virgin olive oil and one part red wine vinegar with a dash of lime juice, salt and pepper. Place mozzarella and tomatoes in the marinade and refrigerate for 30 minutes. Skewer mozzarella balls and the cherry tomatoes. Arrange on plate and garnish with basil.

Make small melon balls from a firm cantaloupe and put on a skewer. For added zip, marinate melon balls in 1/3 cup Cointreau and 1/3 cup chopped fresh mint leaves prior to skewering.

No Cook No Bake Appetizer: Gluten-Free Cracker Pie

Ingredients:

• 1 cup of finely crushed 
• gluten-free crackers of your choice
• 3 Tablespoons of melted butter or olive oil
• 2 cups of sour cream or tofu
• 1⁄2 cup pimiento-stuffed green olives
• 1⁄2 cup finely chopped celery
• 1⁄2 cup finely chopped green pepper
• 1⁄2 cup finely chopped onion
• 2 Tablespoons lemon juice
• 1 teaspoon salt
• 1 teaspoon Lea & Perrins Worcestershire Sauce

Directions:

Mix cracker crumbs with melted butter and press half into the bottom of a 9 inch spring form pan. Set remaining crumbs aside.

In a medium bowl, stir together sour cream, olives, celery, green pepper, onion, lemon juice, salt, Worcestershire sauce, a teaspoon of paprika and dash of Tabasco sauce. Spread sour cream mixture over cracker crumb base; smooth top. Sprinkle remaining half of cracker crumbs evenly over the top. Press in gently. Cover with plastic wrap and refrigerate for at least 4 hours for flavors to blend. May be refrigerated for up to 2 days.

Before serving, remove sides of spring form pan. Place pie on serving platter and decorate top with alternating strips of pimiento and green pepper. Place slices of green and black olives around top edge. Surround the pie with curly lettuce. Cut into pie-shaped wedges and serve.

Serves 10 - 15 depending on the size of the cut.

Celiac.com 03/19/2022 - The world is changing. Many teenagers know more about nutrition than their parents. Adults are being taught that they can control diseases and physical conditions through proper diet. Exercise spas and diet centers are springing up everywhere. New words like ‘trans fats’ and ‘hydrogenated’ are becoming a part of our everyday vocabulary. Despite all of this, over 50% of American adults are obese, proving that we still love to consume our deep fried French fries and hot fudge sundaes!

Forget weight-loss diets. Instead, concentrate on eating healthy, every day, for the rest of your life.

Initially, it will be challenging to alter preparation methods and eating habits. But once you are committed to change, you will be amazed at how good you feel and how much your energy level has increased. It’s not easy, however, to take these steps when everyone in the family is juggling busy schedules. Kids, especially younger ones, will eat mostly what’s available at home. That’s why it is important to control the supply lines—the foods that you serve for meals and have on hand for snacks. Here are ten strategies that you should incorporate into your routine:

Have a Healthy Refrigerator

Make sure your refrigerator is stocked with more low-fat, high-fiber and low sugar foods than other types. Hide desserts behind the carrot sticks and cut-up broccoli with the low-fat onion dip, or put the dessert in the back of the bottom shelf, reserving the front of the shelves for the healthier snacks. Fill your meat bin with lean lunch meats like turkey breast and lean roast beef. Put a plate full of peanut butter-stuffed (the non-hydrogenated type of peanut butter!) celery covered with plastic wrap in the refrigerator for a quick and healthy snack. Prepare a bowl of cleaned strawberries or grapes as well.

Make Wise Use of Your Freezer

On the nights when there isn’t time to cook, have homemade, nutritious, pre-prepared dinners handy in your freezer. Buy 100% fruit juice, add some water, and then pour it into small cups or plastic glasses to make homemade slushies. When you make bread, make a double batch and freeze half of the dough for another time.

Prepare the Pantry

Replace the sugary cereals with wholesome ones. At breakfast, add sliced bananas, berries, nuts, raisins and/or dried cranberries for extra taste and nutrition. Have canned or dried beans on hand to add to soups, salads, rice, and casseroles. Replace white rice with brown rice. Replace corn or rice pasta with quinoa. If your kids love potato chips, prepare or buy baked sweet potato chips.

Make Healthy Food Appealing

Toss a few mini M&M’s into trail mix. Add sautéed almonds or mushrooms to the green beans. Stir fruits, nuts or all-fruit preserves into the low-fat yogurt then add a few baking sprinkles on top. Place a container of chocolate syrup next to the skim milk so the kids will be encouraged to get their calcium by making quick hot chocolate or chocolate milk. Make fruits fun to eat by arranging different fruits (apple slices, raisins, bananas, dried cranberries) into a face or other artistic form. Cut faces or designs out of cheese slices or use a cookie cutter to cut fun-shaped sandwiches.

Cook Healthier

Add chopped, fresh garlic to salad dressing, sautéed foods, stews, and everything else. Add shredded cabbage or spinach to meatloaf, stews and soups. Stir a few tablespoons of ground flax seed—it has no distinguishable taste—into everything, including cereals, stuffed peppers, casserole toppings, and even apple pie. Spray pans with gluten-free nonstick spray instead of using butter or oil when cooking scrambled eggs and stir-fries. Avoid deep-fried foods; choose broiling, grilling, roasting, and steaming instead. Shred hard-boiled egg whites into salads, sandwich fillings and casseroles. Add water-packed gluten-free tuna to casseroles, salads, and in wraps. There are hundreds of ways to prepare salmon—experiment with some of them. Eat ‘meatless’ at least once a week with foods like chili with beans, bean tortillas, zucchini quiche, vegetable paella, or eggplant Parmesan Parmigiana. Add fruits to your salads, including dried cranberries, raisins, pears, apples, oranges, kiwi, pineapple or melons. Add something to rice, such as sautéed chopped vegetables, cooked lentils, red or black beans, or even chopped shrimp. Serve marinated broiled tomatoes as a side dish or chop and serve as Bruschetta. Add veggies to sandwiches, such as watercress, spinach, sliced peppers, onions, cucumbers, zucchini or and radishes. Serve a baked sweet potato instead of a white potato. Serve polenta or corn bread instead of biscuits. Use more herbs and decrease salt. Forget the cupcakes; prepare baked apples for dessert. When you bake bread or muffins, sneak in some fruit or vegetables— shredded carrots, berries, apples, pears, zucchini, crushed pineapple packed in its own juice or mashed banana.

Drink Up

Have bottles of water in the refrigerator. Send them with your kids when they go to soccer practice; take them in the car anytime you leave home. Switch from coffee to unsweetened green tea. Instead of sodas, have a pitcher of iced tea in the refrigerator—did you know that there are up to 12 teaspoons of sugar in your average can of cola? Puree fresh fruits with juice for a nutritious smoothie.

Eat As a Family

Due to busy lifestyles, this is not always possible. But meals will be more balanced and more nutritious when everyone sits down together at the table instead of grabbing something from the refrigerator on the run. A new study in the Journal of Public Health Nutrition showed that what parents consumed was the biggest influence on their children’s diets. Your message will get muddled if you give your kids carrot sticks with their sandwich while you eat potato chips with yours. Set a good example for the whole family’s sake.

Shrink the Size

Cut portions of meat to three or four ounces, then serve it with a variety of beans and vegetables as side dishes to fill up your hungry crew. Eat half of a sandwich for lunch with a small tossed salad, instead of a whole sandwich. Eat half of a restaurant entrée, bringing the rest home for dinner tomorrow. Read labels—did you know that the calorie count given for one serving of pasta is usually for only one cup of cooked pasta? Use a smaller dinner dish so that no one will notice that the food portions are less.

Stay Away from the Inside Aisles

When you grocery shop, fill your cart from the aisles around the outside perimeter of the store— this is where the fresh foods are kept. Use buttermilk for baking. Originally, buttermilk was the liquid remaining after cream was churned into butter, but today it is made by adding lactic-producing bacteria and nonfat milk solids to pasteurized milk. Fresh vegetables are more nutritious than frozen—frozen vegetables are more nutritious than canned. Lean cuts of pork compare favorably with skinless chicken, so use pork tenderloin and boneless loin chops for variety. Chicken thighs are higher in fat and calories than breasts, but if you remove the skin and any excess fat, economical thighs are healthy because they provide 25 percent more iron and more than double the zinc as the same portion of breast meat.

Let the Family Participate

Picky eaters are more likely to eat a new food if they have helped in its selection and preparation. While at the store, ask your child to choose a new vegetable or fruit, from two to three choices, for a weekly “try-a-new-food” night. If you bribe your child to eat his spinach so that he can have a yummy dessert, you inadvertently reinforce the idea that sweets are better than nutritious food. Instead of rewarding your children with food, reward them with attention—hugs, kisses, and smiles—and playful activities. Three year olds can help scrub and rinse fruits and vegetables, stir ingredients in a bowl, shake liquids in a covered container, and knead and shape smaller pieces of yeast dough. Four years olds can peel oranges and hard cooked eggs, mash bananas with a fork, mix meatloaf ingredients, and use their kid-safe scissors to cut parsley or green onions. By the time they are five years old, they can help with measuring ingredients and use a whisk.

Gluten-Free Apricot Almond Bites

Sometimes, even when you are trying to eat healthy, your family craves something sweet. The recipe below is from Connie’s ‘Wheat-free Gluten-free Recipes for Special Diets’ cookbook. This recipe is dairy-free, egg-free, peanut-free, tree nut-free, soy-free, yeast-free and approved for those on a diabetic, low sodium, vegetarian and/or vegan diet.

Ingredients:

• 1 cup almond flour
• 1 1⁄2 tablespoons cornstarch
• 1⁄4 cup sugar
• 1 1⁄2 teaspoons egg replacer
• 1⁄4 teaspoon baking powder
• 1 teaspoon vanilla
• 1⁄2 teaspoon almond flavoring
• 4 tablespoons apricot nectar
• 1⁄2 cup dried apricots, minced
• 1⁄4 cup dried cranberries

Directions:

In a large bowl, stir together first 5 ingredients. With a rubber spatula, stir in the vanilla, almond flavoring and apricot nectar till blended. Stir in dried fruits. Drop by scant teaspoonfuls onto a greased baking sheet. Set sheet in the refrigerator for 1 hour to set. Preheat oven to 350F. Bake cookies for 10 minutes until tops are just barely browned (Do not over bake!). Let cookies set on cookie sheet for 2 minutes before removing to a wire rack to cool. Yield: 36 cookies.

Calories: 13. Total fat: 0.2g; Saturated fat: 0.1g; Cholesterol: 0mg; Sodium: 0mg; Carbohydrates: 2.4g; Fiber: 0.2g; Sugar: 1.1g; Protein: 0.2g

Celiac.com 03/03/2022 - When it comes to food allergy, there are basically two types:

Immediate Food Allergy (Classic, Immediate-Onset, IgE-Mediated)

This is the most understood, but least-occurring immune response to foods. It only occurs in less than 2-3% of adults and less than 5% of children. The reaction time is anywhere from seconds to up to 2 hours and typically affects the skin, airways or the digestive system. The most commonly known response is anaphylaxis, which can result in death. This type of food allergy is typically tested in a doctor’s office by means of a skin “scratch” test. Additionally, it only takes a single food to cause such a reaction and it is typically a food that is rarely eaten.

Hidden Food Allergy (Food Intolerance, Delayed-Onset, IgG-Mediated)

This is the lesser understood, but most common immune response to foods. It occurs in anywhere from 45-60% of the general population and affects children and adults equally. The reaction time occurs anywhere from a couple of hours up to 2-3 days after consumption of the food. Any system, tissue and organ in the body can be affected, and there are over 118 medical conditions/symptoms that are either caused and/or provoked by this type of allergic response to foods including, but not limited to, arthritis, weight gain, fatigue, high blood pressure, arthritis, Celiac Disease, sinus conditions, asthma and various digestive disorders.

Conventional skin “scratch” testing is incapable of detecting this type of food allergy. Even more intriguing is that both a single food and a combination of foods can cause a reaction and it is usually with foods that are regularly eaten.

Conventional therapies for treating food allergy commonly include immune suppressing drugs such as steroids and anti-histamines, but there are a number of therapies that are less harmful to the body and in many cases are just as effective, which include:

1. Food Allergen Elimination and Rotation Diet: Though many adults can self-identify their or their children’s IgE-mediated (immediate-onset) allergic foods, it is not unusual for them to be unable to identify IgG-mediated (delayed-onset) allergic foods. Due to advancements in the laboratory analysis of food allergies in recent history, a simple and convenient finger-stick test is available for identifying the culprit foods behind one’s ill-health. This test can be done in either a physician’s office or in the comfort of one’s own home. Once the offending foods have been identified, a strict avoidance of allergic foods is the key to any food allergy treatment protocol. Eliminating the allergic foods will be the single most effective thing one can do to end the suffering they experience due to food-induced illnesses, and it will also help correct malnutrition and leaky gut syndrome.
   
   The next most important thing one can do to treat their food allergy is to go on what is know as a rotation diet. A rotation diet helps prevent the development of new food allergies and encourages a more balanced, unprocessed and varied diet. It also leads to weight loss and helps eliminate food cravings that are caused by chemical mediators being released in the body by allergic reactions to foods.
2. Quercetin Bioflavanoid: Quercetin is a plant bioflavanoid that is naturally found in such things as apples, cherries, wine, tea, red and yellow onions, and chives. It has been found to help stabilize mast cells in allergic patients and is a very strong antioxidant and anti-inflammatory agent.
3. Glutamine: Glutamine is one of the most abundant amino acids in the body. It “feeds” the immune system and small intestinal mucosa and is critical for maintaining optimal levels of certain detoxifying antioxidant enzymes such as glutathione peroxidase. When the body is stressed by food allergies and conditions such as Celiac Disease, Crohn’s Diseases and ulcerative colitis, glutamine is unable to do its job of maintaining a healthy immune system and intestinal lining. Glutamine increases the release of growth hormones, restores the digestive tract and maintains a healthy immune system. It also increases the liver’s and lymph nodes’ production of glutathione, which helps the body clear itself of food allergic antibody immune complexes. Glutamine also reverses low nutrient levels in food allergic patients suffering from malabsorption.
4. MSM: Methylsulfonylmethane (MSM) is a natural component of the plants and animals we eat and is normally found in breast milk. MSM has been found to alleviate allergic responses to both foods and airborne inhalants such as pollen. It can provide relief to those who suffer from migraines and has been reported to offer long-term pain relief for those with rheumatoid arthritis. MSM aids in reversing constipation, acne, rosacea and snoring (all which have been associated with food allergy). There is a concern about contaminants in some MSM products. For instance, left over DMSO can cause an allergy in and of itself. Use only MSM products containing a distilled form, such as OptiMSM.
5. Omega 3 Fatty Oils: Omega-3 oils, which can be found in fish such as salmon, halibut, haddock, flounder, cod, trout and red snapper, help in overriding the body’s ability to over-produce inflammatory prostaglandins and leukotrienes, which make the body more prone to allergies and inflammation.
6. Vitamin A: Vitamin A is an important immune system building vitamin. It helps prevent skin conditions such as eczema and psoriasis. It aids in maintaining a healthy thymus gland and helps prevent the release of inflammatory prostaglandin during allergic reactions.
7. Vitamin C - Vitamin C has long been regarded as a natural antihistamine. It also stimulates phagocytes, which is a white blood cell that attacks food allergens and various viruses and bacteria.
8. Breast Feeding: Breastfeeding improves promotes healthy probiotic bacteria in the intestines and passes protective antibodies and nutrients from the mother to the infant, which protects against allergies and other ill-health conditions. Those who are breast-fed have been shown to have a lower incidence of otitis media, eczema, asthma, diarrhea and insulin-dependent diabetes.
9. Exercise: Exercise improves circulation, enhances digestion, stimulates the immune system, and accelerates detoxification—all which aid in reversing and preventing food allergy.
10. Elimination: Eliminating some of the initial causes a food allergy is always important for both treatment and prevention. People tend to develop delayed onset food allergies during antibiotic treatment or when taking anti-inflammatory drugs or acid blocking drugs for prolonged periods of time.

Celiac.com 02/25/2022 - Developing independence from parents or guardians, forming long-term relationships, living at college, becoming financially self-reliant, going into full time employment, traveling for pleasure and on business and starting a family—each can be affected by celiac disease as children grow into teenagers and young adults.

Dietary compliance can be a challenge at this critical stage in life. There is no evidence that children with celiac disease can go back to a gluten containing diet in their teens—or ever. Occasionally this idea gets put forward because a teenager no longer has any obvious symptoms if they eat gluten-containing food. The medical position remains clear—celiac disease is a life long condition—ingestion of gluten will cause damage to the intestines, whether or not there are any obvious symptoms.

During the teens and into the 20’s the body is going through significant growth and development, bone density is increasing, and any under-development of the bones before the late 20’s or early 30’s cannot be fully recovered afterwards. Teenage diets outside the home are likely to be based heavily on convenience foods, meaning that most of this food will likely be vitamin and mineral-deficient. School, college, socializing, sports and work can be very demanding—low energy levels due to iron-deficient anemia, (a common consequence of untreated celiac disease which creates poor absorption) will certainly not help. Maintaining a strict gluten-free diet will help their young bodies absorb more of the available nutrients like calcium, iron, vitamins and other minerals, which will help them develop properly, and aid with long-term health and energy levels. It also makes it easier for the primary care physician to correctly diagnose any other medical conditions which might otherwise be masked by the symptoms of malabsorption. Ideally annual follow up consultations with a physician and a dietitian are always recommended to help ensure that the gluten-free diet is understood and followed.

Eating At Home

Regular, balanced, sit down meals at home may become less practical as children grow into their teens and adopt more independent lifestyles. As this happens, convenience meals and snacks are bound to figure more highly in their diets. Parents of a celiacs who were diagnosed at a younger age will have had time to learn how to properly manage a gluten-free diet—including dealing with food shopping and cooking—before their children reach their teenage years. It is important to teach celiac children, including teenagers, to make their own decisions regarding the food they eat. Parents whose children are diagnosed as teenagers will face many new challenges—many food preferences will have to be changed—at a time when their teenagers are striving for independence. For many teenagers being different and having a medical condition that limits their freedom to eat and drink what they like are real problems, and denial is a common response. Parents have a key and difficult role to play—acknowledge the problems and don’t make to big of a deal out of them—but continue to stress the importance of a well managed gluten-free diet.

Eating Out

Eating out safely demands care and knowledge—even for the most experienced adult. Sometimes the appropriate choices on a menu can be very limited. Teenagers living at home might appreciate help from parents while ordering food out, or any time they have to request something special. Although there are extensive gluten-free beverage choices, beer must be avoided. All commercial beers contain gluten in varying amounts and are not suitable for the celiac diet.

School Trips

Many secondary schools offer trips involving overnight stays, and they are not likely to be familiar with celiac disease and its management. As a result, some schools may be reluctant to take a celiac child on a trip. They may not appreciate what is needed, have the facilities to prepare gluten-free meals, or want the responsibility. To help your child miss such trips you can provide the school with information on the gluten-free diet and/or prepare all of your child’s food beforehand, and have them take it with them.

College

Living away from home at college is going to involve self-catering, eating out and possibly cafeteria food in a dormitory. Having reliable access to gluten-free meals in a dorm might be a good way to begin life at college for a celiac student. Students might want to add this to the list of questions to be thought about when choosing a college. A meeting with the college dietitian is always helpful.

Employment

In the vast majority of cases, having celiac disease does not affect employment. However, several occupations—for example a baker or pastry chef—might pose a health risk because it would mean contact on a daily basis with airborne wheat flour— including skin contact—while baking or cooking with it. Special precautions may have to be taken to protect the celiac from contamination.

Starting a Family

There is good evidence that nutrition affects fertility and the success of pregnancy. Women on a well-managed gluten-free diet tend to have bigger, healthier babies. While miscarriage is not particularly common in women with celiac disease as a whole, it is more prevalent in those who are not on a gluten-free diet.

Hospitals

Food service in hospitals varies greatly, and some courses of treatment may involve dietary adjustments. If you are going into the hospital for a planned treatment, give them as much notice as possible, and ask the hospital to confirm in advance that they will be supplying you with a gluten-free diet. Also get permission to have gluten-free food brought in by a friend or family member.

A version of this article originally appeared in the Winter 2005 edition of the Celiac Disease Foundation Newsletter. The Celiac Disease Foundation is a national celiac disease support group that is based in Studio City, CA. For more information visit Celiac.org

Condensed from the Crossed Grain Magazine of Coeliac UK

Celiac.com 02/17/2022 - A true luxury in life is to have someone else prepare your meals. Gluten-free children are lucky to have parents as their personal chefs! The responsibility of having to prepare every single thing your kids eat can become overwhelming—it is very important to find a few convenient places where you can eat out!

Our family has two older celiac children and even as veterans of the gluten-free diet these challenges are present every single time we try some place new. We find that when looking for a gluten-free meal one must consider a variety of venues: Fine dining, mid-priced dining, fast food, eating out of town, social events, and overnight kids camps.

Fine Dining

When our family eats out we like fine dining options that involve a chef preparing fresh food from scratch—for us this is the easiest option. It may be uncomfortable for some people to go back into the kitchen and talk to the chef, but I find that most are very accommodating and pride themselves on being able to serve those with special diets. Take a deep breath and go talk to them—you will be glad you did—and be sure to thank them appropriately for their extra efforts.

The key to success is a friendly attitude on your part. Chefs love to go the extra mile for a friendly customer. It is always better to call ahead during off-peak hours and ask to speak to the chef rather than to just show up during a busy time. Consider early reservations, as it is easier to talk to the chef at 6pm rather than at 7:30pm, although it is always better to call ahead on the day that you plan to dine at the restaurant to ask questions.

When calling, find out when the primary chef will be in and available to meet. Once you have reached the right person, there is no need to go into a lengthy description of what it means to be gluten intolerant. It is enough to say that your child cannot eat gluten (a protein in wheat and other related grains). I usually say that if my children eat gluten they will not feel well for a few hours. I also mention that if they accidentally ingest gluten it is not life threatening. These two comments often help break the ice and set the tone for a positive, to-the-point conversation.

Focus your discussion with the chef—talk about what your kids generally like to eat. You don’t want to go through a lot of different menu items just include the ones that you think you could order. It helps to know something about how the dishes are prepared so you can knowledgeably discuss the various ingredients and preparation methods used.

Be sure to mention that gluten is hidden in many ingredients, and as you discuss the ingredients in the selected entrée you can get more specific with your questions. For example, many chefs will not know that gluten may be hidden in sour cream, but they may be happy to get the container and read the ingredient label with you, however large food-service containers do not always include an ingredient label. Often you will find that only a few minor ingredient adjustments are all that is needed to make a dish gluten-free. While fine dining is our favorite option— it is not always available or practical.

Mid-priced Dining

Chain restaurants or those owned by a large restaurant group run like finely oiled machines. They order their food in large quantities and to exact specifications. Often the food is frozen and ready to be quickly cooked and served. Hamburger patties are not always 100% beef, fillers can be used, and the boxes in which they come often contain no ingredient information. Many items are breaded and ready to fry. In general, to get a truly gluten-free meal in these restaurants poses a great challenge.

Recently though, positive inroads have been made in this area. With the help of national celiac patient support groups, some restaurants such as PF Chang’s and Outback Steakhouse now offer gluten-free menus. We visit PF Chang’s several times a month and have found them to be excellent and quite accommodating. Patronize businesses that make it easy for those on special diets and let them know how much you appreciate them! There are also commercial restaurant guides available that include safe items from many of these chains.

We recently visited Disneyland where I spoke with Chef Chris Justesen about all of the gluten-free options we had throughout the park—it was amazing. After this discussion we knew exactly where to go and what to ask for—it couldn’t have been easier. Plan to visit during off-peak days for less confusion when ordering your food—you will also have the added benefit of short lines for the rides. We made reservations at Disneyland’s Storytellers Café after learning that they stock gluten-free pizza crusts and offer a “make your own pizza bar”, the kids loved this special attention to their needs. This restaurant offered many other gluten-free options for children as well as adults.

When looking for a mid-priced meal consider small, family owned businesses where you can talk to the cook (usually the owner) about ingredients. You may find there are only a few dishes you can eat, but they will be made to order. Your options may be limited due to the size of the kitchen—perhaps there will be only one deep fryer and one griddle—but if possible these types of establishments will often do their best to accommodate your special requests. Most of the same courtesies apply here as in fine dining, such as calling ahead and not visiting during peak hours.

At some of these small restaurants customers are actually encouraged to bring in their own gluten-free pasta or pizza crusts—which is a real bonus. Cultivate some relationships—you may surprise yourself!

Fast Food

The internet offers a wealth of information on fast food restaurants, log onto the many Web sites to see what items are gluten-free. When ordering your food remember to keep it simple! For many food service workers a special request can be challenging, if your request is met with a blank stare you should generally seek out who is in charge and ask for their help. When we order a gluten-free hamburger patty we always ask for it to be moved from the grill to a box immediately and remind the cook that it cannot touch any bread along the way. I call it “meat in a box” and the message is easily conveyed even when dealing with someone with limited English capabilities.

In sandwich shops you can often watch your food being prepared. You can ask the food workers to put on clean gloves and to make your “sandwich” minus the bread in a bowl like a salad. Ask them to take the ingredients from fresh bins that have not been potentially cross contaminated by bread crumbs. We do this at Subway and have found that it is easy for them to make such adjustments even when they are busy.

Eating Out of Town

Before your trip print out a list of restaurant locations near your hotel (such as PF Chang’s) and know what you can order from fast food restaurants by checking their Web sites. Be sure to enjoy the local cuisine at a nice restaurant as well. If you are traveling to a new city and arrive there late, try to pre-plan where you can eat. Call in advance with questions about gluten-free food and ask about the hours and days of operation.

Connect with the local gluten-free support group in the city you plan to visit and find out which restaurants there best understand the gluten-free diet. This will save you plenty of time and narrow down the field.

Social Events

We recently attended a social event at a very busy restaurant where we thought the meal would be gluten free due to my advance preparation. The catch was that all of my questions were directed to a restaurant manager because nobody in the kitchen could speak English. The manager checked and re-checked on various issues and everything sounded fine. Ultimately, we had to leave early because one child became sick and when we got back to the hotel the other child joined the chorus. We will never again have the children eat at a place where we cannot speak English directly to the person in charge of the kitchen. In hind sight we should have stopped at McDonald’s on the way to the event and fed the kids. They would have enjoyed it just as much and we would not have had to worry.

Many social events have a prearranged menu. You can find out the menu in advance and talk to the chef/cook ahead of time. There have been many occasions where the chef has prepared something special for my children or has had something on hand from another event that is gluten-free. Often their meal is even better than what everyone else is eating.

If you find that after all of your advance efforts it is too difficult to find a suitable meal—plan to eat before you go to the event and understand that being with good friends and family is really the top priority of such events.

Overnight Kids Camps

Fortunately there are several summer camps for kids that the Gluten Intolerance Group oversees. Many other gluten-free and special diet camps are also catching on across the USA. My daughter attends a camp every summer where the cook is now very aware of the gluten-free diet. I am sure this is due to the education efforts that I and others have provided to the camp cook. In the past I have met with the camp cook to review the weekly menu, and together we read labels and decided which items I would provide—generally items that they don’t have time to duplicate such as pizza, baked goods, and bread.

When I drop my daughter off at camp she brings a copy of the camp menu with her that has the unsafe items marked, and notes regarding safe substitutions. The cook keeps one gluten-free shelf in the pantry, the refrigerator, and the freezer to help keep things separate. The first year I actually went to camp to go through everything, and in the following years I was able to simply call the camp cook on the phone to organize things. Be sure to discuss cross-contamination issues in the kitchen. We bring our own colander, a small fry pan, and cutting board—all with my daughter’s name on them. In camp kitchens the cookware is super-sized so it helps to offer to bring these items for individual preparation.

Be as accommodating as you can, offer to provide an entire meal pre-frozen such as a pizza or lasagna. When they see you making great efforts the camp cook is very likely to follow your lead. Remember they are cooking meals for hundreds of kids—and you need them to be your ally. Don’t worry about the fact that the money you spent on the camp was to cover all food expenses. The extra effort the staff makes on your child’s behalf more than makes up for the cost of the regular camp foods that your child won’t be eating. It was worth the effort to figure out a way for my daughter to attend camp, and the cook was eager to find a way to make it work.

Try It You’ll Like It

If you have been hesitant to eat out with your children—give it a try. You will be pleasantly surprised with the results now that you have some basic knowledge about hot to approach each situation. You will also be surprised at how much you will enjoy eating out again— and at just how accommodating most restaurants and chefs can be.

Pre-Travel Checklist
Before you leave, research your destination: Check with a support group in the area you're visiting to see if they have a list of celiac-friendly restaurants or grocery stores. Also search the St. Johns Celiac Listserv archives for frequent posts about gluten-free-friendly restaurants. You might want to go to the Internet and look up your destination city to see if they have one or more health food stores. If they do, call the store(s) and ask what gluten-free products they carry—if you have a favorite product, ask them to order it for you before your trip so they will have it in stock when you arrive.

Be aware of legal considerations when crossing borders: Some countries have laws about what foods can be imported. Make sure you know what the laws are, and don't try to bring foods with you that might be confiscated. My family and I had an – umm – interesting experience at the Mexican border when we brought gluten-free pancake mix in an unmarked, vacuum-sealed plastic bag.

Know the language (at least key words): Learn at least a few key words of the language spoken in the country you'll be visiting. Make sure you can say wheat, flour, and other key words. Bring restaurant cards written in the language(s) of the country you're visiting (see www.celiactravel.com), or use translation software to create your own. Ask for rooms with a kitchenette, or stay in a condo: Even a small kitchenette with a microwave, refrigerator, and sink will make your life a little easier.

Ship food to yourself: If you're traveling a long distance or are going to be gone for a long period of time, consider shipping some of your favorite products to your ultimate destination so they're waiting for you when you arrive.

Carry a "kitchen in a suitcase": If you're accustomed to making your breads, cookies, and other baked goods from the mixes that you order online or find in specialty stores, bring them with you, as it may be difficult to find them at your ultimate destination. Bring your specialty tools or appliances, too, like your bread slicer, if you plan on cooking while you're away.

Grab your gadgets: Manufacturers offer some ultra-convenient travel gadgets these days, even for the traveling eater. Most sporting goods stores carry a small refrigerator (there are several brands) that plugs into the cigarette lighter of your car, making it easier to bring yogurt and other perishables on long drives. And we all know how toasters can present a problem since "regular" toast seems to spray its crumbs everywhere, contaminating them for gluten-free eaters. A travel toaster available on the Internet: eliminates the worry—just take your own and you're set.

BYOF: Even gluten-free bread travels well if you slice it and pack it in a hard plastic storage container. Hard-to-find cereals, pretzels, and favorite treats—even pre-baked frozen cookies—make great snacks en route or when you arrive. Don't forget to pack food for the trip itself, as well as food for your stay at the destination.

There are grocery stores everywhere you go: When you arrive at your ultimate destination, stop in at the local grocery store and stock up on some of the basics. Dont forget to buy aluminum foil and resealable bags, which work well to store leftovers from restaurants, or any foods that you may have brought with you.

Remember your restaurant rules: Use the tips mentioned in my books or in past issues of Scott-Free for eating out at restaurants, since youll probably be eating out more than you do when you're at home. If you're traveling to certain places in Europe, you might be pleasantly surprised to find that in some countries like Sweden McDonalds offers two types of hamburger buns: gluten-free and "regular."
Getting There

When planning how and what you're going to eat on your trip, you have to first decide where you're going and how you're going to get there. How much and what you bring depends on whether you're taking planes, trains, or automobiles.

Driving: Driving allows you the most flexibility, and is easiest when you're trying to accommodate a restricted diet. If you're driving in the United States, there will most certainly be national fast-food chains all along the way. Even if you don't want to rely on greasy burgers and fries as a staple for your entire drive, you know that you have a backup—just in case. National restaurant chains (even those that are not of the fast-food, greasy-burger variety) have branches in all major cities—find out which restaurants are along your driving route (you can check www.mapquest.com or a similar Website), and check the restaurants Web sites or contact them for their lists of wheat-free/gluten-free products (this is where your three-ring binder with restaurant lists that you leave in the car comes in handy). There are also commercial gluten-free restaurant guides available, such as the one at www.celiac.com.

Most important, BYOF. You will probably bring snack foods to munch on while you drive, so just make sure you're loaded with snacks that are easy to eat in the car, travel well, and of course, meet your dietary restrictions (and don't forget the paper towels or wet wipes!).

Flying, cruising, and riding the rails: There's less flexibility in how and where you can eat when you're at the mercy of a commercial airliner, ship, or train—but you still have a number of options. Many commercial airlines offer a selection of specialty meals, including gluten-free ones. Be careful, though, and read the labels if the food has them, because sometimes our gluten-free meals have come with fluffy, doughy bagels (that obviously aren't gluten-free). If mistakes are made, don't be mad. They tried, and at least they considered having a gluten-free meal as an option. Be glad they made the attempt, and consider writing a polite, gratuitous letter to the food supplier offering information on what's gluten-free and what isn't.

These days, airlines restrict the number of carry-on bags, so you'll have to be more efficient in packing snacks and meals for the flight. Snack items that you might include in a sack lunch usually make good take-along foods for the airplane.

Cruise ships always have executive chefs. They're accustomed to accommodating restricted diets, some of which can have dangerous consequences if mistakes are made, so they take the subject very seriously. By contacting the administrative offices of the cruise line several weeks in advance, you can arrange for the chef to provide you gluten-free meals throughout your cruise.

Trains are tougher, since most of the foods found in café cars are usually along the lines of packaged sandwiches, croissants, pastries, and other oh-so-not-nutritious goodies. I highly recommend bringing food on the train, and not just because of your restricted diet, if you know what I mean.

Danna Korn’s Tips for Disneyland, Disney World, and Other Theme Parks

Disney theme parks aren’t just the happiest places on earth—they’re among the most accommodating for people with restrictive diets. When planning a trip to any theme park, call a couple of weeks in advance and ask to talk to the executive chef. Tell the chef what day you’ll be there, and specifically what your restrictions are (Disney parks are well-versed on the gluten-free diet). Indicate the type of food that you’d like to eat, and if you’ve been there before you may even be able to specify the restaurant of your choice. The chef will ensure that you have a safe, enjoyable meal.

Once You’re There For some reason, people who worry about traveling sometimes forget that other cities also have grocery stores. In fact, just about any city I’ve ever been to has a store of some sort or another. This is the most convenient thing!

When you first arrive at your destination, check out the local grocery stores and see if you can sniff out a health food store or two. They may carry products you’ve never seen before, which is always an added bonus. If you call a few weeks before you arrive, you can even request that they order some of your favorite products and have them in stock when you get there.

If you’ll have kitchen facilities available and plan to do a lot of your own cooking, you’ll find that being away from home isn’t much different from being there, especially if you pack your kitchen in a suitcase and come equipped with some of your favorite foods.

Happy Travels!

The most important thing to remember is that travel is about the experience—the company you’re with, the places you visit and the activities you enjoy— and not necessarily the food. If you can enjoy another country’s foods because they’re gluten-free, that’s terrific. And we know there are plenty of gluten-free foods available in the U.S., no matter where you are. So make those spring and summer travel plans—you’re now well-armed to have a happy, healthy gluten-free trip!

On the other hand, gluten sensitivity is characterized by antigliadin antibodies. This condition afflicts at least 12% of the general population⁴ and is found in patients with a wide variety of autoimmune diseases. In some studies of neurological diseases of unknown origin, a majority of patients show signs of gluten sensitivity⁴. These patients are mounting an immune response to the most common food in the western diet, yet many practitioners consider gluten sensitivity to be a non-specific finding, frequently counseling patients to ignore these test results. This is particularly unfortunate since a strict gluten-free diet has repeatedly proven helpful to patients who are fortunate enough to consult a practitioner who is versed in gluten sensitivity and its connection with autoimmunity.

Untreated celiac disease carries an added risk for a wide variety of additional autoimmune diseases. The most likely cause of this predisposition to additional autoimmune disease is a condition sometimes referred to as leaky gut syndrome. We know that gluten causes intestinal damage. We also know that this damage allows large undigested and partly digested proteins to leak into the bloodstream through the damaged intestinal wall. This leakage results in immune system production of antibodies to attack these foreign proteins as if they were invading microbes. The result is the production of a huge variety of selective antibodies, and each type recognizes a particular short chain of amino acids located somewhere in the proteins structure. Unfortunately, our own tissues can contain very similar or identical sequences of amino acids. Hence, by a process called molecular mimicry, we are producing antibodies that attack both the foreign food proteins that are leaked into our blood through the damaged intestinal wall, and similar amino acid sequences in our own tissues, often resulting in an autoimmune disease⁵.

The supposedly non-specific antigliadin antibodies in gluten sensitivity provide two important pieces of information: 1) That the intestinal wall has been damaged and is permitting leakage of food proteins into the bloodstream, and; 2) That the dynamic contributing to increased autoimmunity in celiac disease may well be an important contributing factor in gluten sensitivity⁵. The currently common view that celiac disease is a serious illness, while disregarding gluten sensitivity, is dangerous to gluten sensitive patients.

This bias is also a divisive element in the gluten-sensitive/celiac community. Whether a person has "biopsy proven" damage to the intestinal wall, if this person gets sick from eating gluten, or mounts an immune response to gluten, we are all in the same leaky boat (please pardon the pun). We need to work together to get a better understanding of gluten sensitivity in all its forms (including celiac disease). As a community, we need to discourage any kind of dismissal of illnesses that are partly or wholly mediated by gluten.

If we can stand together in our quest for widespread recognition of the damaging impact of gluten consumption, we can all enjoy a healthier life. Our descendants will also inherit a more gluten-savvy world.

Sources:

• Cooke W, Holmes G. Coeliac Disease. Churchill Livingstone, New York, N.Y. 1984.
• Fasano A. Celiac disease--how to handle a clinical chameleon.
  N Engl J Med. 2003 Jun 19;348(25):2568-70.
• Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
• Hadjivassiliou M, Grunewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002 May;72(5):560-3.
• Braly J, Hoggan R.. Dangerous Grains, Penguin-Putnam-Avery, New York, N.Y., 2002.

In reality, when you eat at restaurants, some chefs will "get it" and work to ensure a safe meal for you, and others wont. Going to restaurants isnt really about eating as much as it is the ambience, the company, and, well, okay—the convenience. Focus on those primary reasons for going to a restaurant, and make the food secondary, even if theres very little you can eat. If youve heard me speak or read my books, then youve followed my advice and stuffed yourself before you left the house, so youre not hungry anyway.

Defensive Dining
Its been said that the best offense is a good defense, which probably applies to restaurant excursions as well as it does to the football field. Im not encouraging you to be offensive; in fact, quite the opposite. Its not, after all, the waiters or chefs responsibility to accommodate your diet. If they do, be prepared to leave a big tip, because their job descriptions definitely do not include understanding the intricacies of this diet. Nor should you fill them in on all the minutiae surrounding the diet.

A brief education is all they should need, because you should already have narrowed down the choices on the menu that look as though they might be safe, or at least may be prepared in a way that would make them safe. Its okay to ask that your food be prepared in a special manner—people do that all the time even when they are not on a special diet.

Most important, you need to be aware of specific foods and ingredients to avoid when eating out. Some things are more likely to be okay than others, and you should make it easier on yourself by choosing items that are more likely to be wheat-free/gluten-free.

Plan Ahead
Your days of eating at Italian restaurants with ease are probably behind you (although many Italian dishes are made with polenta, which is gluten-free). Pizza joints: also not likely. Chinese: possibly. Dont set yourself up for disappointment by selecting restaurants that will fill you with frustration by the very nature of their menu selection. Instead, choose restaurants with a large selection, or choose a restaurant based on its ethnicity or culture because its likely to offer more wheat-free/gluten-free foods. Thai foods, for instance, are often gluten-free, since they use fish sauce instead of soy sauce for a lot of their marinades and seasonings (although some fish sauces can also contain wheat). Study your ethnic foods so you know the ingredients they contain and can make good choices when it comes to restaurant selections.

Knowing what to order is just as important as knowing where to go. Consider, for instance, an American-style restaurant like Dennys or Sizzler. For breakfast, youre better off contemplating the eggs (beware: many restaurant eggs are from a mix that contains gluten), hash browns (be sure to check), and bacon (check again) than you are the Waffle-Mania, even if it is only $3.95. For lunch or dinner, you can almost always find a restaurant that will offer you a burger (no bun), fries, and a salad (no croutons).

Be aware of things that are likely to be problematic. For instance, most sushi is okay, but some of the products, such as imitation crabmeat, usually contain wheat, while other sushi items can contain soy sauce, which usually also has wheat. Cajun cooking often uses beer to cook shrimp and other shellfish, and of course beer is off-limits on a gluten-free diet.
Make it easier on yourself by choosing foods that are more likely to be safe for you. What you end up with may not be your first choice, and you may find yourself longing for the days when you could order from a menu with your eyes closed. Dont whine about what you cant have, and focus on the things you can. Remember, eating out isnt about the food. Its about the atmosphere, the company, and the fact that youre not cleaning up.

Talk to the Waiter and Ask the Right Questions
Sometimes talking to the waiter is an exercise in futility. If you realize this is the case, either order what you deem to be safest, order nothing at all, or leave.

A cooperative waiter or waitress, on the other hand, is your first line of defense in keeping bad food away. Make friends. Be kind. Tip well. After youve picked what you think could be a safe menu selection or could be made into one, ask questions. Dont be shy; its not rude or uncommon for people to ask questions, even when theyre not accommodating a restrictive diet. Ask if the hamburger patty is 100 percent beef or if it has fillers; ask if the eggs are all-egg, or if they have fillers; check to make sure the fries arent coated with breading, seasonings, or anything else that would make them off-limits. Check sauces and marinades; even if you mention that you cant eat wheat or gluten, people rarely realize, for instance, that soy sauce usually contains wheat.

Once youve made your menu selection, the waiter isnt dismissed. At this point it gets a little awkward because youve probably already asked a lot of questions, but there are a few more to ask, because how the food is prepared is also important. You need to make sure that the hamburgers arent grilled on the same rack as the buns, and that the croutons arent just plucked out of your salad, but rather that they were never put in. You even need to ask about the oil the fries are cooked in, because if theyre cooked with breaded foods, you really shouldnt eat them.

At this point, even the most patient of waiters is likely to be giving you a stiff smile with that "Is there anything else youd like to know?" expression. Offer to talk to the chef, if it would make things easier. Chefs, although not often educated in the fine art of accommodating restricted diets, are usually interested in them nonetheless, and are usually quite fascinated when you talk to them about the wheat-free/gluten-free diet. Each time you talk to a chef, youre educating him or her and making it easier for the next wheat-free/gluten-free patron who comes along.
Do Your Homework
Many national chain restaurants have lists of their wheat-free/gluten-free products available by phone or on their Websites. Collect lists from your favorite restaurants and fast-food chains, and keep them in a folder for future reference. You may even want to consider putting them in a three-ring binder that you keep in the car.

Once youve done all the work to find restaurants that work for you, by all means dont worry about getting in a rut. Theres nothing wrong with "tried and true" when your only other option is "guessed and now Im sick." Dont get too complacent, though, because just like products at the grocery store, menu items at restaurants sometimes change ingredients. Check frequently, and remember that even if you think its safe, if something makes you sick, dont eat it!

BYOF (Bring Your Own Food)
It probably wouldnt be too cool for a group of eight to walk into a lovely Italian restaurant, with everyone carrying their entire meal in a brown paper bag, simply to enjoy the ambience. But if you go to a restaurant and bring a small amount of food with you—even if its the main course—its certainly not rude. Some (but not many) restaurants have regulations about preparing food, and are allowed to serve only foods that theyve prepared. Most, however, have no problem if you bring in your own pizza and ask them to heat it for you.

If you do bring your own food, make sure you its wrapped in aluminum foil to avoid contamination during the heating process. Pizza ovens, for instance, sometimes have convection fans that can blow the flour from other pizzas around the oven, contaminating yours. If you bring bread and ask them to toast it for you, theyre likely to put it in the slot of a toaster, contaminating it with "regular" crumbs and ruining your pristine bread. In that case, you might want to explain that it cant be put in a toaster, but if they have a toaster oven or broiler (that isnt blowing flour around), that would be wonderful. If youre asking them to microwave something, of course, theyll just remove the aluminum foil. The most important thing to remember if youre bringing your own food is to leave a big tip.

Sprechen Sie Gluten?
When eating at restaurants of different cultures and ethnicities, its a good idea to know the language, especially if the restaurant is staffed by people who speak a language other than your own. Learn the important words to best communicate your special needs. For instance, in Spanish the word for flour is harina, but that can refer to corn flour or wheat flour, so you need to know that the word for wheat is trigo, and corn is maize. Some restaurant cards come in a variety of languages. Additionally, some Websites offer translation capabilities.

Tipping
Im aware of the redundancy in my continuous references to tipping and the importance of being extra generous at tip-time, but I believe it bears repeating. When it comes to asking people to accommodate the gluten-free diet, it seems imperative that we express our gratitude to those who generously oblige our requests. As awareness of this diet increases over the next few years, it will be more common for restaurateurs to understand these restrictions and accommodate them. Anything we can do as a community to enhance their understanding and acceptance will benefit us all in the long run.

Have fun!
Now that youre armed with some basic restaurant realities, remember rule #1: Have fun! Dont live your life in a bubble just because you have a dietary restriction. Bon appetite!