Celiac.com 12/31/2022 - The Celiac Sprue Research Foundation recently held the first meeting of its Scientific Advisory Board. Marking the first anniversary of the Foundation, all nine members of the Scientific Advisory Board attended the meeting on April 16 and 17, 2003, including four scientists who traveled from Europe. The presentations and discussion included current clinical research, current and new diagnosis protocols, possible avenues for the development of therapeutic drugs, and the design of clinical trials.

Attendees from Europe were Frits Koning, Ph.D., Associate Professor at the Leiden University Medical Center, the Netherlands; Markku Mäki, M.D., Ph.D., Chair and Professor of Pediatrics at the University of Tampere and Tampere University Hospital, Finland; Detlef Schuppan, M.D., Ph.D., Professor of Medicine and the Clinical Vice Director of the Department of Medicine at the University of Erlangen-Nürnberg, Germany, and Ludvig M. Sollid, M.D., Ph.D., Professor of Immunology at the University of Oslo, Norway. Scientific Advisory Board members from the United States attending were Mark M. Davis, Ph.D., Howard Hughes Medical Investigator and the Burt and Marion Avery Professor of Microbiology and Immunology, at the Stanford University School of Medicine; John H. Griffin, Ph.D., Chief Scientific Officer of Pharmix Inc.; Martin F. Kagnoff, M.D., Professor of Medicine and Director of the Laboratory of Mucosal Immunology at the University of California, San Diego; Peter Licari, Ph.D., Vice President, Process Science of Kosan Biosciences, Inc.; and Gary M. Gray, M.D., Professor of Medicine, Emeritus, at the Stanford University School of Medicine and Foundation Scientific Director. Drs. Gray and Sollid are co-chairs of the Scientific Advisory Board.

Also attending were Chaitan Khosla, Ph.D., Professor of Chemistry, Chemical Engineering and Biochemistry (by courtesy) at Stanford University and Foundation President, Christopher T. Walsh, Ph.D., Hamilton Kuhn Professor at Harvard Medical School and a Director of the Foundation, Foundation Research Associates Qing Li, Ph.D., and Thomas Marti, Ph.D., and Clinical Associate Gail Pyle, M.D.

A major thrust of the meeting was the review of current research in celiac sprue diagnosis and potential avenues of treatment. Dr. Khosla opened the meeting with an overview of the Foundation and its mission. He noted in particular the goals of catalyzing the development of a therapeutic alternative to the strict gluten-free diet for the treatment of celiac sprue, and of development of improved, non-invasive, non-gluten challenge diagnostic tests for the disease. While the time frame for development of therapeutics may be ten years or more, and that for much improved diagnostics five years or more, he proposed that the research activities of the Foundation may help clinically validate at least one therapeutic and one diagnostic approach within the next two to four years.

Dietary gluten, found in wheat, rye and barley, reacts with cells in the lining of the gut of persons with celiac sprue leading to a marked flattening of the intestinal villi. This vastly reduces the surface area of the small intestine where most nutrients are absorbed. The result is a markedly reduced ability to absorb nutrients and leads to systemic complications such as loss of bone mass over time. More immediate symptoms include bloating, diarrhea and abdominal pain. Dietary gluten is highly resistant to digestion. In non-celiacs this is of no consequences, but in celiacs the gluten triggers a chain of event leading to the flattening of the intestinal villi.

Collaborative research by Drs. Gray, Sollid and Khosla has shown that immunotoxic fragments of gluten are highly resistant to breakdown by the human digestive process. They have also shown that a prolyl endopeptidase (PEP) enzyme can accelerate the break down of gluten in conjunction with normal digestive processes. The Foundation plans to initiate a proof of concept trial later in the year. This trial involves the treatment of common wheat gluten with PEP in order to break gluten protein into smaller, readily digestible pieces. The PEP is produced from a microorganism by recombinant biotechnology techniques, and the gluten will be treated outside the body. The deactivated gluten would be given to Celiac Sprue volunteers in remission in a double blind crossover clinical study. This trial, if successful could lead to a PEP based therapeutic for treatment of the disease.

Scientific Advisory Board members reported to the meeting on developments in their areas of research and expertise. Among other matters discussed, Dr. Maki presented unpublished results from his group on the incidence of celiac sprue among the Finnish population. His group studied an extended Finnish family of about 30,000 individuals that traces its genealogy back to a Celiac ancestor living about 1550. Remarkably, Dr. Maki’s researchers obtained tax, military, church and other written records of this individual and many other family members and were able to identify many of those who had Celiac Sprue. Between one in 100 and one in 200 persons in Western Europe are celiacs. Other populations may have a higher or lower incidence of the disease. There is evidence that the prevalence of celiac sprue is much higher among persons of North African descent where the introduction of wheat in the diet is a relatively recent event. In this population perhaps up the 5% of the population are celiacs.

Dr. Koning reported on an approach to identify and hybridize safer foods. This approach, if pursued, would involve the analysis of the many thousands of known strains of wheat. The goal would be to search for non-toxic wheat variants, a major effort that would be expected to take several years.

Foundation researchers gave reports on PEP production and gluten detoxification methods, and Scientific Advisory Board members reviewed the Foundation’s proposed trial protocol. Other promising therapeutic strategies, including tissue transglutaminase inhibitors and HLA-DQ8 inhibitors, were discussed. Regulatory and commercialization requirements were also reviewed.

Finally, in a review of the meeting and Foundation’s activities to date, board members offered suggestions for fund raising and enhancing the Foundation’s effectiveness. The Foundation believes the meeting was of enormous value to its work and the fulfillment of its goals.

Celiac.com 12/24/2022 - My doctor is a nice guy. He is also very bright and has an impressive memory for many things. He couldn’t have gotten through medical school—he couldn’t even have gotten acceptance into medical school without being pretty capable. But he can’t know as much about me as I do. Neither has he observed my children for as long or with as much concern as I have. If we are ever to achieve balanced relationships with physicians, we must all acknowledge our own, and each others’ expertise. The history of the discovery of the gluten-free diet is really a story that should improve doctor-patient collaboration if the facts ever become widely known.

World War II Grain Shortages or Concerned Mom?

Not long ago I listened to a speaker, once again, crediting World War II grain shortages in The Netherlands for Dr. Dicke’s discovery of the gluten-free diet as the treatment of choice for patients with celiac disease. This is a myth that has been perpetuated for far too long. This faulty tale sullies the memory of a great scientist, Dr. Willem Karel Dicke, and robs a concerned mother of the credit she richly deserves. The facts are available in Dr. Dicke’s Ph. D. thesis.

Dr. Chris Mulder has generously provided an English translation of Dr. Dicke’s thesis. In his thesis, Dr. Dicke clearly states that the insight came from a 1932 meeting with two colleagues and a discussion of their observations of a child with celiac disease. This was long before World War II even began, and the grain shortages actually occurred late in the war. Further, in the follow-up commentary at the end of the translation, Dr. Mulder reveals that the idea, which led to these 1932 insights, originated with a concerned mother’s observations of her own child, and her comments to Dicke’s colleagues. The myth about World War II grain shortages simply does not jibe with the facts. It seems far more likely that a concerned mom, not a busy pediatrician, would notice what a child ate and how that affected his bowel movements. To my ears, this latter explanation has the ring of truth. 

The question of who deserves the credit for this pivotal insight may not appear very important. However, our increasingly specialized society pressures us to place more and more trust in the specialist, whether lawyer, doctor, or auto mechanic. When we are placing our own and our children’s health and safety in the hands of another person, we may reasonably expect these specialists get their facts straight on simple historical issues that can easily be investigated.

Investigating a Mother's Hypothesis

Dr. Dicke’s important role, as a physician and a man of science, was to investigate this concerned mother’s hypothesis. His memory is enhanced by the recognition he freely rendered to the originators of the idea. We not only violate his memory, we insult his stature as a scientific investigator, when we perpetuate the false claim that the chance occurrence of WW II grain shortages led to the discovery of the treatment value of a gluten-free diet.

More importantly, this question speaks to the importance of trusting ourselves, our own observations, and our own assessments—our own gut, if you will, in our quest for health. Dr. Dicke’s work was extremely important and it constituted a huge contribution to Humanity. His research has already saved countless lives and will continue to do so. But we need to remember that the original insight that identified the trigger for celiac disease came from an observant mother. In remembering this, many of us will feel empowered to collaborate with our physicians, rather than blindly accepting yet another useless prescription. And that is the pivotal importance of publicly recognizing where the idea of a gluten-free diet originated. We need to recognize that the physician’s expertise is only one important element in the diagnostic and treatment process. We may often defer to doctors’ superior knowledge of medical issues. However, our own expertise, as the occupants of our bodies, or as parents, must also contribute to this process and our subsequent healing. We need to trust our own observations and judgement. Dismissal or denigration of our unique expertise bespeaks a competitive spirit; not a collaborative one. Such a competitive attitude may weaken the diagnostic process and hinder our recovery.

12/17/2022 - Quinoa (pronounced “keen-wa”) is not a grain but is a broad leaf plant of the Chenopodiaceae family, which is a close relative to the weed, lamb’s quarters. Spinach and beets are also in the same family as quinoa. Quinoa has been consumed for thousands of years in South America and several varieties are now grown in Colorado and the Canadian prairies. The seed looks like a cross between sesame seed and millet. Quinoa seeds are covered with saponin, an extremely bitter resin-like substance, which protects it from birds and insects. To be edible the saponin must be removed. Some companies have developed a special process to remove this coating, making it pan-ready and fast cooking. This eliminates the need to wash and rinse the seed. However, some domestically grown quinoa may need to be rinsed at least 3 or 4 times or until the water runs clear to remove the saponin.

Quinoa is very nutritious! It contains more high-quality protein than other grains and cereals. The quality of this protein compares very closely to that of dried skimmed milk. Quinoa is high in iron, magnesium, phosphorus, potassium and zinc. It is also a source of thiamin, riboflavin, niacin, calcium and dietary fiber. Quinoa is available in several forms:

Quinoa Seed

• Can be used in salads (see recipe below), casseroles, desserts, as well as a thickener for soups, chili and stews
• Cooks very quickly (10-15 minutes)

Quinoa Flakes

• Great as a hot breakfast cereal. Add cinnamon, chopped nuts and dried fruits.

Quinoa Flour

• Can be used in baked products (e.g., breads, cakes and cookies) and pancakes.
• Strong flavor so best combined with other GF flours.

Quinoa Pasta

• Quinoa is combined with corn or rice and is available in a variety of shapes.
• Cooks in 5-9 minutes.

Quinoa Salad Recipe

Recipe courtesy of: Northern Quinoa Corporation.

The delicate flavor of quinoa is similar to couscous. Quinoa can be used as a pasta substitute in cold pasta salads.

Lemon Garlic Dressing:

• 4 garlic cloves, minced
• 1⁄4 cup red wine vinegar
• 1⁄4 cup canola oil
• 1⁄4 cup water
• 1 lemon, juiced
• Salt and pepper to taste

Salad:

• 4 cups NorQuin quinoa, cooked and chilled
• 1 cup grated carrots
• 1⁄2 cup sliced green onions
• 1⁄2 cup chopped celery
• 1⁄4 cup sunflower seeds
• 1⁄4 cup slivered almonds
• 3 Tbsp. sesame seeds
• 1⁄2 cup sliced mushrooms

Combine dressing ingredients and let stand for at least 10 minutes. Prepare salad ingredients and combine. Toss salad with dressing. Can be served immediately or chilled for several hours.

Celiac.com 12/10/2022 - Increased awareness and celiac disease-specific diagnostic tests have aided the diagnosis of celiac disease. For instance, blood antibody testing has become a useful tool for screening suspected cases of celiac disease. These blood tests can be very sensitive in the detection of patients with severe intestinal damage, but invariably are negative in patients with mild lesions(1). Furthermore, some pathologists are not experienced in recognizing and detecting cases in which mild intestinal damage or even partial villous atrophy is present in biopsy samples. Yet, for these tests to be accurate a patient must be on a gluten-containing diet and doctors often put patients on an oral gluten challenge only after the patient has been on a gluten-free diet and/or their blood antibody tests prove negative.

The oral gluten challenge requires a patient to ingest gluten at the direction of a specialist such as a gastroenterologist for testing purposes such as preparation for an endoscopic exam with biopsies of the small intestine, still considered the gold standard of diagnosis. The demands of the oral gluten challenge are time-consuming, can exacerbate or provoke symptoms, and intentionally put celiac patients at risk for further intestinal damage.

As a patient, I was gluten-challenged because I had already instituted a gluten-free diet (despite negative blood antibody tests), three weeks before my appointment with the gastroenterologist. I suffered intense and severe symptoms that were provoked by the gluten challenges—not to mention the psychological impact posed by the challenges. At the direction of my gastroenterologist, I was instructed to "make complete damage" in a span of several days upon the first of three, short gluten challenges. At one point, I was ingesting gluten up to seven times in one day. After the close of the third gluten challenge, I felt chronically cold; it was difficult to walk without extreme fatigue and weakness; and I found it difficult to eat or drink due to intense, unrelenting stomach spasms. I had already lost ten percent of my weight before the gluten challenges but lost an additional seven percent after the gluten challenges. Furthermore, I began experiencing heart symptoms and suffered constant and severe joint pain in my extremities. The gluten challenges devastated my already compromised health and made my recovery more difficult and fraught with further complications.

It has become clear that there is a need for methods of testing which do not expose patients to the health risks of an oral gluten challenge. Also, tests that offer more sensitive diagnostic value are needed for prompt and early diagnosis. Several research studies have evaluated the diagnostic potential of various methods without the requirement of an oral gluten challenge. Some of these studies examine the possibility of challenging intestinal biopsies with gluten outside the body in culture media (in vitro). Other studies have tested the immune response elicited by sites outside the small intestine.

In vitro gluten challenge

Today, anti-endomysial antibodies (EmAs) and anti-tissue transglutaminase antibodies (tTGs) are being used in the detection of celiac disease because of their sensitivity (detection of true CD-positive patients) and specificity (omission of non-celiac patients)(2). However, the blood antibody screening tests have not proven sensitive enough in the presence of mild intestinal damage or whereby only an increased intestinal lymphocyte (a type of white blood cell) count is present as a sign of the immune activation(1,3). Therefore, the production of EmA in cultured intestinal biopsies challenged with gliadin has been evaluated for its usefulness in celiac disease diagnosis. Carroccio et al found that EmA positivity of cultured biopsies challenged with gliadin for 48 hours correlated with the degree of intestinal damage, the shorter the treatment with a gluten-free diet (i.e., newly diagnosed celiac patients), and higher counts of inflammatory cells (i.e., white blood cells including lymphocytes) in the intestinal biopsies(2). A higher proportion of celiac patients with more severe intestinal lesions (95%) were EmA positive in their gliadin-challenged cultured biopsies as compared to celiac patients with mild intestinal damage (75%) who were EmA positive. However, this test still had higher sensitivity to detect 58% more celiac patients with mild intestinal damage than the blood EmA tests which were positive in only 17% of them. Furthermore, in newly diagnosed celiac patients, 90% of patients were EmA positive in their cultured biopsies before the addition of gliadin and 96% with the addition of gliadin. Finally, those patients who were EmA positive with the biopsy culture challenge with gliadin had significant higher numbers of inflammatory cells than those who were negative.

Sixty-two percent of celiac patients on a gluten-free diet (GFD-treated) for 12 months, were EmA positive in biopsies challenged in culture with gliadin for 24 hours(4). EmA was not observed in any of their pre-challenge biopsies. However, EmA was detected in all of the cultured intestinal biopsy samples, challenged with gliadin after 72 hours. In addition, none of the control (non-celiac) patients had EmA detectable in their biopsies challenged in culture with or without gliadin.

Local Challenge of Nasal Tissue and Oral Lining

Other exciting prospects in the diagnosis of celiac disease are on the horizon which offer easy access to testing. For instance, other sites outside the intestine such as the nasal tissue and the oral lining are being studied for whether they can elicit a gliadin-specific immune response. In a study of GFD-treated celiac patients, gluten provoked a significant but only mild gliadin-specific inflammatory response in the nasal tissue scrapings (not biopsies) of the celiac patients via activation of lymphocyte cells but not in control patients(5). Another study involved the injection of gliadin into the oral lining of ten GFD-treated celiac patients who were negative for EmA(6). After a 24-hour gliadin challenge, oral biopsies were taken and the number of lymphocytes was significantly increased in celiac patients but not in the controls. Further evaluation of these methods, including studies of untreated patients, is needed to confirm their usefulness in the diagnosis of celiac disease.

Rectal Gluten Challenge

The rectum is an easily accessible site for which a gluten challenge can be performed and rectal biopsies taken7. The test does not require any patient preparation or the more invasive procedure of an endoscopic exam with biopsies. Also, no pre-challenge biopsies are required for comparison.

The diagnostic power of the rectal gluten challenge is demonstrated by its ability to recognize gluten sensitive patients whose blood antibody tests are negative at presentation or whose biopsies are inconclusive(7). The four-hour rectal gluten challenge provided both 100 percent specificity and sensitivity in the diagnosis of gluten-sensitive patients in comparison with blood EmA which had only a 70% sensitivity and 98% specificity. In a group of 45 untreated patients, the rectal gluten challenge showed a significant increase in the numbers of lymphocytes responding to gluten whereas the non-celiac group of patients demonstrated a negative response in their lymphocyte populations. Furthermore, celiac patients on a GFD for two or more years still had more rectal lymphocytes than non-celiacs(8). Post rectal gluten challenge results of biopsy samples disclosed a significantly increased inflammatory infiltration of lymphocyte cells in celiacs but not in control patients.

Inherently, the traditional oral gluten challenge is designed to cause intestinal damage to a celiac patient and may exacerbate or provoke symptoms, which may not be acceptable to the patient. The true cost of a diagnosis of celiac disease is the overt and acute as well as silent and chronic damage to the celiac patient caused by the undertaking of an oral gluten challenge. However, the future use of alternative diagnostic tests in practice offers the patient choices outside the risks and complications of oral gluten challenges. Since rectal gluten challenges, as well as the oral or nasal gluten challenges, must be taken internally, more studies must be done to evaluate the safety of using these potential methods of diagnosis. Some of these studies sought to find a more sensitive way to detect early events in the staging of celiac disease. Others also sought to find if the immune system could identify gliadin outside the gastrointestinal tract to make testing more accessible and easier on the patient. Both the sensitivity and specificity of methods such as EmA detection in cultured biopsies challenged with gliadin may one day change the way celiac disease is currently diagnosed, in the presence of more severe intestinal damage or villous atrophy. Instead, these alternative methods to oral gluten challenge have the potential to facilitate early diagnosis of celiac patients with inconclusive biopsies, those with only mild intestinal damage and negative blood antibody tests as well as high-risk patients such as relatives of celiac patients, and patients with associated autoimmune diseases.

References:

1. Tursi A, et al. 2003. The symptomatic and histologic response to a gluten-free diet in patients with borderline enteropathy. J Clin Gastroenterol 36: 13-17.
2. Carroccio A, et al, 2002. Production of anti-endomysial antibodies in cultured duodenal mucosa: Usefulness in coeliac disease diagnosis, Scand J Gastroenterol 37: 32-38.
3. Tursi A, et al. 2003. Prevalence of antitissue tranglutaminase antibodies in different degrees of intestinal damage in celiac disease. J Clin Gastroenterol 36: 219-21.
4. Picarelli A, et al, 2001. Forty-eight hours of biopsy culture improve the sensitivity of the in vitro gliadin challenge in the diagnosis of celiac disease, Clin Chem 47: 1841- 1843.
5. Torre P, et al, 2002. Immune response of the coeliac nasal mucosa to locally-instilled gliadin, Clin Exp Immunol 127: 513-518.
6. Lahteenoja H, et al, 2000b. Local challenge on oral mucosa with an alpha-gliadin related synthetic peptide in patients with celiac disease, Amer Jour Gastroenterol 95: 2880-87.
7. Ensari A, et al, 2001. Diagnosing coeliac disease by rectal gluten challenge: a prospective study based on immunopathology, computerized image analysis and logistic regression analysis, Clin Sci 101: 199-207.
8. Troncone R, et al, 1996. In siblings of celiac children, rectal gluten challenge reveals gluten sensitization

Celiac.com 12/03/2022 - Studies estimate that the number of celiacs who follow a strict gluten-free diet ranges between 30-40%. We receive a number of calls from people with celiac disease who don’t quite follow the gluten-free diet. Others have a hard time understanding why they need to follow the diet when they were asymptomatic to begin with. Then we hear from worried parents, scared that they may have given something to their toddler with celiac disease that caused familiar gluten-reaction symptoms.

While some gluten ingestion in people with celiac disease is intentional, others ingest gluten accidentally or cause another to do so. When an individual calls the University of Chicago Celiac Disease Program, we try to assess the reason behind the gluten ingestion, and often find that it is the result of a lack of access to a knowledgeable dietitian at the time of diagnosis (Often, this is found when a caller articulates that they were unaware of problems like cross-contamination, the gluten-content of medications or they needed to ask more questions when eating out at a restaurant). Fortunately, this is a relatively easy problem to remedy. We offer referrals and dietary resources, and will send our care package to those who require it.

Others callers choose not to follow the diet, or to allow themselves “rewards” on special occasions or when they feel stressed. We often hear from people who prepare gluten-containing meals for the rest of their family which they cannot resist, or they eat the meal because they are not willing to prepare themselves a gluten-free meal. Some who travel on business do not wish to call attention to their dietary needs in front of their boss or colleagues. Sometimes, all that is required is guidance regarding how to place an order in a restaurant, how to prepare ahead of time for a business breakfast, or meal preparation tips.

All of the people who call our program regarding their gluten ingestion, regardless of their circumstance, are motivated by fear. Parents often talk about their fear of poisoning their child. Some adults eat very little due to fear of gluten contamination. While it seems of the utmost importance to establish the medical need for a strict gluten-free diet, psychologists and others would probably agree that human beings are seldom motivated to adopt life-long behaviors out of fear.

It seems fair to take a brief look at what we know, and what we don’t know about the need to follow a 100% gluten-free diet, in order to replace fear with knowledge.

First, it is important to examine how a research study would be designed to measure the effect of minimal gluten ingestion (i.e., the purposeful or unintentional consumption of gluten) in a group of individuals with celiac disease.

In order to test this question, we would need a group of people with celiac disease to knowingly or unknowingly ingest gluten. People with celiac disease who already ingest gluten would not be eligible because they would bias the result. So a randomly selected group of celiacs would be needed to participate in the study. These individuals would need to eat gluten in small amounts and be followed for five, ten or more years. Then, any results would need to be confirmed in other randomly selected groups of celiacs to rule out any effect of disease status, age, gender, geography, dietitian instruction, etc.

Here’s the catch—even if it were theoretically possible to obtain a group of people to knowingly participate in studies, the studies would never be approved based on ethical grounds. Hospitals that conduct studies and the physicians who run them are governed by a code of ethics that does not permit a patient to receive a procedure or be exposed to any type of intervention that is known to be harmful to them.

So, the question is, how do we determine, in a less direct way, the effect of gluten ingestion in people with celiac disease?

Professor Giovanni Corrao and colleagues attempted to address this question through a prospective cohort study which enrolled 1,072 patients between 1962 and 1994. The study was designed to measure important factors that influenced mortality in people with celiac disease and their immediate relatives.

The study, published in the Lancet in 2001, found that mortality in people with celiac disease was most significantly affected by diagnostic delay, pattern of presentation, and adherence to the gluten free diet. A delay in diagnosis of more than one year and a severe presentation of celiac disease at diagnosis doubled the observed deaths during the study. Non-adherence to the gluten-free diet, defined as eating gluten once a month or more, increased the relative risk of death six-fold. These factors were highly statistically significant.

There are limitations to this study, however, including the fact that people diagnosed in the 1960’s were more likely to present with a severe case of celiac disease, including intestinal lymphoma. Researchers also found that people with mild or symptomless celiac disease had a slightly increased risk of death; it’s also likely that these people were diagnosed later on in the study when more screenings were available, decreasing the length of the delay in diagnosis.

Alessandro Ventura and colleagues conducted an important study on the presence of autoimmune disorders in people with celiac disease. Published in 1999 in the journal Gastroenterology, these researchers recruited 909 patients with celiac disease, as well as 1,268 healthy controls and 163 patients with Crohn’s disease. The results were dramatic, and highly statistically significant.

Ventura found that the risk for developing other autoimmune disorders increased relative to the age of the person with celiac disease at diagnosis. For instance, a child that is 2 years of age has a 5% chance of developing another autoimmune disorder, but a person over 20 years of age at diagnosis has a 34% chance.

Ventura and his colleagues equated the age of a celiac at diagnosis with the number of years that individual had been exposed to gluten, and postulated that the increasing risk was related to gluten exposure. Other researchers have reported results for and against Ventura’s claim, but a consensus has yet to be reached.

Osteoporosis and osteopenia studies have almost consistently supported the benefit of a strict gluten-free diet in rebuilding bone mass, even in post-meopausal women and patients with incomplete mucosal recovery. Researchers note, however, that the diagnosis should be made early and the diet followed strictly.

These studies indicate that in people who have not yet been diagnosed with celiac disease, gluten is very harmful. However, Marco Maki and colleagues have noted that the strict definition of celiac disease, that the intestinal mucosa flattens when gluten is consumed, is not necessarily true. We know that the damage that is created in the intestine can be patchy and variable, depending on the individual. According to the celiac prevalence study conducted by Alessio Fasano and colleagues, most Americans (diagnosed in the study) have Marsh 2 lesions, which indicate less damage in the intestine.

What is a celiac to do?

Scientists and researchers in the U.S. and throughout the world do agree on one thing: There are no clinical data to sufficiently establish a safe threshold for gluten ingestion in people with celiac disease.

This includes the well-known Codex Alimentarius Standard for gluten-free foods, which allows 200 parts per million as an acceptable threshold value in gluten-free foods. An independent observer group to the Codex commission (The Prolamine Working Group) has been working to establish a reference gliadin for use in uniform testing programs by food manufacturers, and advocates for a single testing standard. These researchers, including Martin Stern, Paul Ciclitira, Conleth Feighery and Ricardo Troncone, have openly questioned the Codex standard of 200 ppm in gluten-free foods and have reiterated that there is little clinical data to back up the Codex standard that a small amount of gluten in the diet of celiacs is safe.

Like the researchers who have conducted studies involving celiac patients, physicians who treat people with celiac disease also have an ethical standard, to “first do no harm.” At this time, that means that physicians and dietitians must educate patients to follow a 100% gluten-free diet.

If you’re accidentally ingesting gluten, or have accidentally offered your child a gluten containing food, chances are you have not caused a problem that will lead to life-long complications. However, if you are consistently ingesting gluten or having repeated accidents, it is more likely that persistent damage may exist in your intestine leading to potential problems down the road.

In either case, find out more about the gluten-free diet by contacting one of your national or local celiac organizations and get back on track. We’re here to help.

Celiac.com 11/26/2022 - Longing for soft, warm and delicious gluten-free breads? Then consider a bread machine, one of the most popular kitchen appliances—perfect for our home made gluten-free breads. When you think of it as a small oven, free of drafts and temperature changes it is easy to understand how it can turn out beautifully risen breads with great texture and remarkable taste.

There are many benefits to using a bread machine, including:

• Frees up regular oven for other uses
• Keeps kitchen cooler 
• Saves money on electricity
• Move it around the kitchen, put it in your camper or take it to your dorm
• Avoids cross contamination
• Lends itself to creativity in the kitchen 
• Safer for younger family members to use
• Less expensive than purchasing a second oven
• Perfect for those who have had difficulties with yeast breads rising in the oven

Success Starts with Purchasing the Right Bread Machine for your needs

Before you make your purchase, answer these questions:

What is your budget?

Bread machines run from $29.99 through $249.99. The good news is all price ranges offer the required features for successful gluten-free breads.

How much space do you have?

Sizes vary considerably. Measure the space where you will be using the bread machine. Some machines have shorter cords than others so notice the distance to electrical outlets. Remember you must have enough clearance space to be able to open the bread machine lid.

Do you want a bread machine that is fully programmable or one that may require you to manually change the settings during the baking process?

The more programmable the machine, the more money it will cost. The most programmable machine is the Zojirushi BBCC-V20. It retails for about $249.00, so it is best to try to find it on sale.

Bread machines with less programmability, such as Oster, Toastmaster, Welbilt, ($50 - $60 price range) also bake great bread. You will need to manually change the programming from the one hour Dough Cycle to the one hour Bake Cycle, unless you use the No-Knead No-Rise Method.

Bread Machine Features:

• The most important features are the two cycle indicators: Dough Cycle and Bake Cycle. You will need both.
• Are indicators easy for you to locate and read? Do not purchase a machine if the cycle indicators are hidden under the lid or are too small to read.
• Look for a large window. You will want to know if the bread is mixing well, or if it has risen to its full height, all without lifting the lid.
• Purchase a bread machine that will handle 11⁄2 to 2 pound loaves for the sake of versatility.
• Open the box and look at the bread pan inside the bread machine. Does it pop out or twist? Is the pan easy for you to operate?
• Open the box and look at the bread pan inside the bread machine. Does it pop out or twist? Is the pan easy for you to operate?

Some of the most common questions I receive about purchasing a bread machine:

• Does gluten-free bread have to rise more than once? No. One rise is sufficient. That is why we recommend the Dough Cycle and the Bake Cycle rather than the full cycles.
• Does gluten-free bread have to knead? This is a matter of semantics. It does not have to ‘knead’ since there is no gluten. However, it does have to be fully mixed. Our experience, after baking over 500 loaves of bread, all in bread machines, is that using the Dough Cycle provides sufficient mixing time.
• What are your favorite bread machines? This is tough since models keep changing. I have used over 8 different styles of bread machines, and every one of them has their good and their “Gee, I wish this was different” features. This is no different from the other tools we use in the kitchen, our sewing machines or even tools in our tool box. My three favorite machines are the Zojirushi BBCC-V20, the Welbilt ABYK and an old round bread machine that I purchased at a garage sale. Prices I paid were $169.99, $39.99 and $5.00, respectively.
• How long a bake time should I look for in a bread machine? I recommend a 60 – 90 minute bake time option. This is not available in every machine style. If the model you like only has a 60 minute bake cycle, see if you can restart the Bake Cycle after the 60 minutes are over, just in case the bread is not done.
• Do breads usually take longer than 60 minutes to bake in the bread machine? Just like your full oven, it depends on the bread recipe. Fruits, vegetables or heavy flours may take longer to bake.
• Is the Add-in ‘Beep’ feature necessary? My technique is to add all wet ingredients in the beginning, this includes the fruits and vegetables, since they contain water which will affect the water to flour ratio. Dry ingredients, such as nuts, seeds and cheese can be added at the beep. You will develop your own style.

Making a decision on which machine to purchase and learning how to operate your bread machine may take about one to two hours of your time, but it is well worth the effort—as the reward will be great gluten-free bread!

Celiac.com 11/19/2022 - Gluten-free bread making the first few times is an incredibly frustrating experience that begs the question—is it really worth it? After my many trials I must say—yes it is definitely worth it! We are now able to make excellent bread that we can all enjoy. Being able to make bread allows my kids to take a sandwich to school, the fact that the bread is good (and looks good) is equally important to them. Since they cannot eat the hot lunch at school due to its “gluten in every bite” nature, it is important to have the option of sending a sandwich the children like (and will eat). Other kids taste the bread and like it, and say hey this gluten-free diet is pretty good! The benefits to these exchanges are priceless.

It took awhile to get to this point but one day I was lucky enough to meet Lee Tobin. He gave me a recipe (originally developed by Barbara Emch) and I had success! I then began to shape this recipe to accommodate the various alternative flours stocked in my pantry. The recipe is fool-proof and it tastes great—especially with teff, amaranth, or buckwheat flour. In this class you will learn how to make a perfect loaf of bread. I will review alternative flours and why I use them. You will learn the tricks for successful gluten-free bread making, and how to change the template recipe for your own specific needs.

Why Use Alternative Flours?

My experience has been that these flours simply make superior gluten-free bread. Additionally, many celiacs struggle with weight gain after diagnosis and find their diet may lack important nutrients. As you adjust to the gluten-free diet it is a good time to understand how your body uses the food you eat.

Simple carbohydrates are quickly digested and are broken down into simple sugar glucose. When the cells in your body need fuel they use this glucose. Extra glucose is converted into glycogen. If your body already has enough glycogen stored up, the glucose is turned into fat. The typical American diet is overloaded with simple carbohydrates and the celiac diet is no exception.

Complex carbohydrates not only take longer to digest but they provide slow consistent energy. You feel full longer and your body doesn’t feel the wide fluctuations of blood sugar swings. Beans, whole grains, nut butters, oatmeal, soy, sweet potatoes, and vegetables are complex carbohydrates. They provide needed vitamins, minerals, fiber, and consistent energy. Many celiacs lack B vitamins, calcium, iron, and other nutrients—why not get them from your baked goods and reap the benefits of complex carbohydrates?

We try to incorporate the alternative flours in most of our baking. When making sweet breads, cookies, bread, pizza crust, biscuits, and bread sticks I try to substitute about 1⁄2 of the flour called for in a recipe with a healthier alternative flour. Our favorites are teff, amaranth, brown rice, and buckwheat. Quinoa and millet flours can be substituted in the same fashion. Be sure you buy from manufacturers who provide pure, gluten-free flour— from the field all the way to the package.

In our family we treat corn, carrots, potatoes, and white rice as if they were sweets (i.e. sugar = excess weight gain). They are all simple carbohydrates as are most of the products made from them (chips, cereal, snacks).

Here is a quick overview of the various healthy gluten-free flours and their attributes:

• Amaranth contains more calcium, folic acid, Vitamin A, C, and E than most grains. The flavor is similar to that of graham crackers without the sweetness.
• Bean Flour is a light flour made from garbanzo and broad beans.
• Brown Rice Flour is milled from unpolished brown rice, and has a higher nutrient value than white rice flour. Much higher than white rice in protein, fiber, zinc, folic acid, B vitamins, calcium and vitamin E (15 times the vitamin E as white rice).
• Buckwheat is the seed of a plant related to rhubarb. It is high in fiber, iron, and B vitamins, and is great in many baked goods including pancakes and waffles.
• Millet is a small round grain that is a major food source in Asia, North Africa, and India, and is a rich source of B vitamins.
• Nut Flours are high in protein and, used in small portions, enhance the taste of many baked goods. Finely ground nuts added to a recipe increases the protein content and allows for a better rise. It is a great substitute for non-fat dry milk powder in gluten-free recipes.
• Quinoa (keen-wah), a staple food of the Incas, is a complete protein containing all 8 amino acids as well as a fair amount of calcium and iron. It is high in some B vitamins and folic acid.
• Soy Flour has a nutty flavor, and is high in protein and fat.
• Teff is always manufactured as a whole-grain flour, since it is difficult to sift or separate. It is a good source of protein, calcium, iron, fiber, and B vitamins.

The changeable elements in the recipe are:

• Eggs: If you cannot tolerate eggs use Egg Replacer from Ener-G Foods (see also: flax seed egg replacer in section below) and be sure to use the almond flour instead of the non-fat, dry milk powder. The almond flour adds a great deal of flavor which could be helpful when you can’t use eggs. If you read the nutritional label for almond flour it might scare you as the grams of fat are high, remember this is good fat and there is fiber—both of which slow down sugar absorption in your body, which in turn helps control weight gain. The dry milk powder is high in sugar.
• Oil: Vegetable oil is typically soybean oil and some people are sensitive to canola oil so safflower oil is a good alternative.
• Sugar: Try turbinado sugar, a raw sugar that has been steam-cleaned. It has a delicate molasses flavor.
• Flour: Four cups of flour are in the recipe. The proportions of flours used can be changed around until you find what is right for you.
• Dry Milk Powder: As seen above in the eggs section I now prefer to use almond flour instead of dry milk powder. The bread turns out much more flavorful and has a wonderful texture.
• Flax Seed: This seed has many health benefits such as high-quality protein, fiber, B and C vitamins, iron, and zinc, anti-cancer properties, omega-3 fatty acids, and many other benefits. To use as an egg substitute grind 2 tablespoons flaxseed and add 6 tablespoons boiling water, let set for 15 minutes then whisk with a fork—this mixture will replace 2 eggs in a recipe. A clean coffee grinder works well to grind the small flaxseed.
• Cookware: It’s a good idea to have the proper cookware in your kitchen. You must have a heavy-duty stand mixer like the Kitchenaid mixer, as it will properly aerate the batter, producing a lighter bread with a fine crumb and more height. You should also have a good quality loaf pan.
• Temperature: In addition to knowing your oven temperature (buy a cheap oven thermometer), realize that when the temperature of your home is warm, bread will rise quicker.
• Humidity: Gluten-free flour absorbs moisture from the air so be sure to keep it sealed in its packaging and tightly cover any mixing bowls rather than allowing them to sit uncovered for any period of time. The moisture the flour absorbs from the air will affect your recipe.

Amaranth Bread Recipe

Makes one loaf. Feel free to substitute the amaranth flour with teff, buckwheat, or quinoa flour.

Ingredients:

• 3 large eggs (egg-free option see note 
• below)
• 1⁄4 cup vegetable oil
• 1 teaspoon lemon juice
• 1½ cups amaranth flour 
• 1½ cups tapioca starch flour
• 1 cup fine brown rice flour
• 2/3 cup instant non-fat dry milk powder 
• (dairy-free: substitute with finely ground 
• nuts or almond flour)
• 2 teaspoons xanthan gum
• 1 teaspoon salt
• 2 tablespoons ground flax seed 
• (optional)
• 1½ tablespoons active dry yeast
• 4 tablespoons sugar
• 1 1⁄4 cups warm water (105F-115F.)

Directions:

Bring all refrigerated ingredients to room temperature. Grease a 5 x 9-inch loaf pan. In the bowl of a stand mixer, combine eggs, oil, and lemon juice. In a separate medium bowl, combine flours, dry milk powder, xanthan gum, salt, flax seed, yeast and sugar. Pour 1⁄2 of the warm water into stand mixer and blend with egg mixture. Slowly add dry ingredients a little at a time until completely incorporated. Add remaining water, reserving some water if necessary. See note on humidity below. Mix batter on high speed for 31⁄2 minutes, then pour into prepared pan. Batter will be thicker than a cake batter and nothing like the consistency of regular bread dough.

Cover bread with foil and place in a cold oven. Set a pan of hot water on a lower shelf underneath the bread. Leave for 10 minutes with oven door closed. (This will cause the bread to rise quickly). Remove bread from oven (do not uncover) and place in a warm place in the kitchen. Preheat oven to 400F. Bread will continue to rise as oven preheats.

Uncover bread and bake for 10 minutes to brown the top. Cover bread with foil and continue to bake bread for 35-40 minutes. Turn bread out onto a cooling rack. When completely cooled, wrap tightly to maintain freshness for as long as possible.

Tips:

If humidity is high, reduce the amount of water in the recipe to avoid over-rising. Many gluten-free bakers experience the frustrating situation in which a beautiful loaf of bread deflates once removed from the oven. You will need to experiment a little to get just the right amount of water in your bread depending on the humidity in the air. If in question, use less water than the recipe calls for.

You may use rapid rise yeast instead of regular yeast. If doing so, eliminate the cold oven rise method with a pan of hot water and follow yeast package directions instead for rise time.

Hamburger Buns:

Pour batter into English muffin rings, follow directions above. Bake for just 15 minutes. Once completely cooled these buns freeze well. Serve buns warmed, otherwise they will be crumbly.

Egg Substitution: Grind 3 tablespoons flaxseed and add 1⁄2 cup + 1 tablespoon boiling water, let set for 15 minutes then whisk with a fork.

Have you ever taken a bite of unsweetened chocolate?  If you have, I’m sure your taste buds revolted!  Sugar is what makes most of our desserts palatable and desirable.  But sugar adds empty calories to the diet and little else nutritionally speaking.  So how are you going to bake foods to satisfy your sweet tooth if you refrain from using refined sugar?  There are always viable alternatives.

Sucrose (a fancy word for sugar) usually encompasses the following:

• Brown Sugar:  Much less refined than white sugar, is derived from molasses (sorghum cane) and contains very small amounts of minerals.
• Raw Sugar:  May come in crystalline form that is very similar to brown sugar.
• Turbinado Sugar:  Is partially refined sugar crystals that have been washed in steam.
• White Sugar:  Derived from cane or beets, and no matter what form it takes, offers nothing but empty calories.

First consider the less desirable sugar replacements:

• Maltose:  Not a good option because it comes from the breakdown of starch in the process of malting grains, usually barley, so it is not always gluten-free.
• Corn syrup:  A blend of fructose and dextrose; its effect on blood glucose is similar to that of sucrose. 
• Dextrose:  Usually made from plant starches, in the U.S. it is mostly made from corn, but can also be obtained by the inversion of cane sugar or sucrose.
• Honey:  Derived from flowers where bees have collected nectar, is a more concentrated form of carbohydrate than table sugar, and is converted to glucose in the body.  It is only slightly better for you that refined sugar.  If you are using honey to replace sugar, for 1 cup sugar, substitute ¾ cup honey; reduce liquid in recipe by 2 Tablespoons, and add ¼ teaspoon baking soda.
• If you still opt to use refined sugar, in most recipes you may reduce the amount of sugar called for without any noticeable effects on the finished product. 

There are several “sugars” on the market that do not have the negative effects of refined sugar:

• Date Sugar:  Derived from dates, it is not as sweet as sucrose but has far more nutritional value.  For 1 cup sugar, use 2/3 cup date sugar and add a little water to form thick syrup.
• Fresh or Dried Fruits:  Offer a natural sweetness and can be used in baking to reduce the amount of refined sugar used.
• Fruit Juice Concentrates:  While high in sugary taste, have nutritional value not found in sucrose.
• Fructose:  Sweeter than any other sugar in equal amounts, comes from fruits and honey.  Because of its concentration much less of this sweetener is needed in recipes.
• Invert Sugar:  A mixture of equal parts of glucose and fructose resulting from the hydrolysis of sucrose. It is found naturally in fruits and honey and produced artificially for use in the food industry.  It is sweeter than sucrose, so the amount used may be lessened, and it helps baked goods stay fresh longer.
• Molasses:  A thick syrup produced in refining raw sugar and ranging from light to dark brown in color.
• Maple Syrup/Sugar:  Both made from the sap of maple trees.  For 1cup sugar, use ¾ cup maple syrup or maple sugar.   
• Stevia Sugar:  Fairly new on the market this extract from the stevia leaf is combined with a pre-biotic nutritional supplement and is ten times sweeter than sugar.  It has a glycemic index of zero, and is nutritionally beneficial.  For 1cup sugar, use 2 Tablespoons stevia.
• Unsweetened Coconut:  When toasted the natural oils in coconut are exuded adding sweetness to a baked product.
• Unsweetened Applesauce:  When added to a cake or bread batter it adds sweetness, flavor, moistness and nutrition.

Experiment until you find a sugar substitute that you enjoy, and one that works well with your recipes.

Pineapple Sticks

Ingredients:
2 cups gluten-free flour mixture
3 Tablespoons stevia
½ teaspoon salt
¾ teaspoon cinnamon
½ teaspoon gluten-free baking powder
¾ cup MF/gluten-free margarine
¾ teaspoon vanilla
¾ teaspoon lemon juice
6 Tablespoons water
1/3 cup all-fruit pineapple jam

Corn-free diets:  Omit cornstarch from gluten-free flour mixture.  Use CF vanilla.  Use baking soda in place of the baking powder.  Use butter in place of the margarine.  Omit nonstick spray; use olive oil to brush baking sheet.
Rice-free diets:  Omit rice flour from gluten-free flour mixture
Soy-free diets:  Use butter in place of margarine.  Omit nonstick spray; use oil to brush baking sheet.

Directions:
Over a bowl, sift together flour mixture, fructose, salt, cinnamon and baking powder.  Cut in margarine until mixture resembles coarse crumbs.  Sprinkle vanilla, lemon juice and 2 Tablespoons water over flour mixture; toss with a fork.  Continue adding water, 1 tablespoon at a time, and tossing until mixture is evenly moistened.  Form into a ball, cover, and refrigerate for 1 hour.  Divide dough into 4 even pieces.  Roll 1 piece into a 12 X 4 inch rectangle; spread with half of the jam.  Roll the second piece into a 12 X 4 inch triangle; gently lift dough and place over jam.  Repeat with remaining 2 pieces of dough and remaining jam.  Trim edges.  Cut each rectangle into 12 one-inch strips.  Twist each strip, pinching ends to seal.  Place on a baking sheet that has been lightly sprayed with gluten-free nonstick spray.  Bake at 375F degrees for 20 minutes or until lightly browned.  Yield:  24 cookies.
Note:  For variety, use apricot or black raspberry jam in place of the pineapple jam.

Calories (per cookie): 83; Total fat: 4.4g; Saturated fat: 1g; Cholesterol: 0mg; Sodium: 121.4mg; Carbohydrates: 10.1g; Fiber: 0.3g; Sugar: 2.8g; Protein: 3g

This article originally appeared in the Summer 2003 edition of Celiac.com's Open Original Shared Link.

Celiac.com 07/05/2010 - When “our product isn’t gluten-free” doesn’t necessarily mean “our product isn’t gluten-free”

You’ve found a food you’d really like to eat. You’ve read the label, and it looks as though the product might be gluten-free.  You’re drooling!  You can dig in, right? Wrong. It’s a good idea to call the manufacturer to confirm that there aren’t hidden sources of gluten.

Years ago, when we would call manufacturers and ask them if their products were gluten-free, they would either suspect us of making a crank call and hang up, leave us on “hell-hold” for 35 minutes while they “checked” (a euphemism for when they put you on hold and hope you hang up), or respond with a confident, “Oh no, honey, there’s no sugar whatsoever!”

Before you bother calling the manufacturer, read the label.  If there is an obviously unsafe ingredient, don’t waste your time or theirs.  Tune in to the person on the other end of the phone.  Do they sound like they understand what you’re talking about? Are they giving you conflicting information?  Can you trust what they say?

Fortunately, most product labels have a toll-free phone number listed on the packaging.  I highly recommend carrying your cell phone in the grocery store with you, so that you can call quickly while you’re still there—before you buy a product.  These days, most customer service representatives actually know what we’re talking about most of the time, and can offer a knowledgeable answer that instills confidence that the answer is accurate, albeit sometimes not all that helpful.  When you call a company to find out if its product is wheat or gluten-free, you’ll get one of four responses:

No, our product is not gluten-free: Do not interpret this as meaning, “No, our product is not gluten-free.”  I realize that’s what they said, but it may not be what they mean.  Probe deeper by asking, for example, “Can you tell me what in your product has gluten in it?  I read the label and didn’t see anything questionable.” One time when I asked this, the woman told me it was “whey” that contained gluten.  Penalty flag!  Whey doesn’t contain gluten!  This is when you need to realize that you’re talking to someone who doesn’t understand the concept, and you should ask to be transferred to a quality control supervisor.

Sometimes this response is accurate, and either an ingredient wasn’t clearly called out on the label (unfortunately, this still occurs from time to time), or you were calling about a questionable ingredient only to find out it’s a good thing you called.

We can’t verify its status:  Translation: “It’s wheat-free/gluten-free, but we’re covering our rear ends because we don’t want someone to sue us.”  Sadly, in our litigious society, it may actually be a founded fear that they have.

Of course, this response—”we can’t verify its status”—could actually mean what it says—that they can’t verify the status.  Usually they’ll tell you this is because they get their additives from other sources, and even though they claim to be gluten-free, Company A doesn’t want to be responsible in case Company B used gluten.  The risk factor in either case is probably low.

Every now and then, this response is given because they have an “If we tell you what’s in our product, we’d have to shoot you” mentality.  Assure them that you’re not trying to steal their oh-so-treasured secret-sauce recipe, but that you have a serious medical condition that requires you to know if there are certain ingredients in the food you eat.  Sometimes you just can’t get an answer, in which case you fall back to the golden rule: When in doubt, leave it out!

Yes, it is gluten-free:  This doesn’t necessarily mean, “Yes, it is gluten-free.”  You have to judge for yourself whether or not they truly understand the concept.  Sometimes they’ll follow it up with, “There are no sources of wheat, rye, or barley, and there are no questionable additives. Therefore it’s safe for someone with celiac disease, gluten intolerance, or wheat allergies.”  Ah, you just want to kiss these people.  Other times, when pressed, they get squirmy. If you say, for instance, “Oh, okay, then I can assume the modified food starch is derived from a non-gluten source?” and they give you an audible “blank stare,” you might want to dig a little deeper before trusting their answer.

Huh? Thankfully, this isn’t a common response anymore, but it does happen. Politely try to explain what types of ingredients might be in the product you’re calling about, and if it doesn’t “click,” ask to speak to a quality control supervisor or nutritional expert.

Of course it’s helpful and sometimes necessary to be specific in some cases, saying, “I’m calling to see if this product is gluten-free, which means it doesn’t contain wheat, rye, or barley.”  Not only is this clarification helpful for them, but you may have educated one more person about gluten.

Many times, one of the added benefits of calling, even if the product you were calling about turns out not to be okay, is they’ll offer to send you a list of their wheat-free/gluten-free products (sometimes they even toss in a few coupons).  Always take them up on it, and save the lists for future reference.

It’s important to learn from your answers.  If there was an ingredient on the label that you had never heard of, and you talked with a knowledgeable customer service representative who told you that product was gluten-free, take note.  That means the ingredient is gluten-free, too.  Add it to your own copy of the safe and forbidden list, and remember for future label-reading experiences.

Excuse me for a moment while I put on my Miss Manners hat, but it’s important to be polite, professional, and appreciative when you call manufacturers.  Not only will you get much better service, but we need them!  We need them to comprehend the gravity of our questions and to understand how important it is to be 100 percent sure that the answers they give us are accurate.  We need them to realize that they can’t guess at their answers, and that we very much appreciate that they understand what we’re asking.

Calling manufacturers can be a pain, for sure, but it’s an important part of living and loving the gluten-free lifestyle.  Not only is it a good habit for you since ingredients change frequently, but it sends companies the message that if their labeling was clarified, we wouldn’t bother them so often!  It also tells them that millions of people avoid wheat or gluten, and maybe they’ll think twice before using an ingredient that has a wheat source when they have the option to use one that is wheat and gluten-free.

This article was partially excerpted from Danna’s book Wheat-Free, Worry-Free: The Art of Happy, Healthy, Gluten-Free Living.

Gluten-free bread making the first few times is an incredibly frustrating experience that begs the question...is it really worth it? After my many trials I must say yes it is definitely worth it! We are now able to make an excellent bread that we can all enjoy. Being able to make bread allows my kids to take a sandwich to school, the fact that the bread is good (and looks good) is equally important to them. Since they cannot eat the hot lunch at school due to its "gluten in every bite" nature, it is important to have the option of sending a sandwich the children like (and will eat). Other kids taste the bread, they like it, and say hey this gluten-free diet is pretty good! The benefits to these exchanges are priceless.

It took awhile to get to this point but one day I was lucky enough to meet Lee Tobin. He gave me a recipe (originally developed by Barbara Emch) and I had success! I then began to shape this recipe to accommodate the various alternative flours stocked in my pantry. The recipe is fool-proof and it tastes great...especially with teff, amaranth, or buckwheat flour.

In this class you will learn how to make a perfect loaf of bread. I will review alternative flours and why I use them. You will learn the tricks for successful gluten-free bread making. And you will learn how to change the template recipe for your own specific needs.

In an effort to provide you with a brief recipe for future use—all of the comments I would typically make during a cooking class will be found in the text that precedes the recipe.

Why Use Alternative Flours?
My experience has been that these flours simply make a superior gluten-free bread. Additionally, many celiacs struggle with weight gain after diagnosis and find their diet may lack important nutrients. As you adjust to the gluten-free diet it is a good time to understand how your body uses the food you eat.

Simple carbohydrates are quickly digested and are broken down into simple sugar glucose. When the cells in your body need fuel they use this glucose. Extra glucose is converted into glycogen. If your body already has enough glycogen stored up, the glucose is turned into fat. The typical American diet is overloaded with simple carbs and the celiac diet is no exception.

Complex carbohydrates not only take longer to digest but they provide slow consistent energy. You feel full longer and your body doesnt feel the wide fluctuations of blood sugar swings. Beans, whole grains, nut butters, oatmeal, soy, sweet potatoes, and vegetables are complex carbs. They provide needed vitamins, minerals, fiber, and consistent energy. Many celiacs lack B vitamins, calcium, iron, and other nutrients—why not get them from your baked goods and reap the benefits of complex carbs?

We try to incorporate the alternative flours in most of our baking. When making sweet breads, cookies, bread, pizza crust, biscuits, and bread sticks I try to substitute about ½ of the flour called for in a recipe with a healthy alternative flour. Our favorites are teff, amaranth, brown rice, and buckwheat. Quinoa and millet flours can be substituted in the same fashion. Be sure you buy from manufacturers who provide pure, gluten-free flour—from the field all the way to the package.

In our family we treat corn, carrots, potatoes, and white rice as if they were sweets (i.e. sugar = excess weight gain). They are all simple carbs as are most of the products made from them (chips, cereal, snacks).

Here is a quick overview of the various healthy gluten-free flours and their attributes:

Amaranth is a whole grain dating back to the time of the Aztecs. It is high in protein (15-18%), and contains more calcium, folic acid, Vitamin A, C, and E than most grains. The flavor is similar to that of graham crackers without the sweetness.

Bean Flour is a light flour made from garbanzo and broad beans. When using this flour in your favorite recipes, replace the white sugar with brown or maple sugar (or combine with sorghum) to cut the bitter taste of the beans.

Brown Rice Flour is milled from unpolished brown rice, and has a higher nutrient value than white rice flour. Since this flour contains bran, it has a shorter shelf life and should be refrigerated. As with white rice flour, it is best to combine brown rice flour with several other flours to avoid the grainy texture. Much higher than white rice in protein, fiber, zinc, folic acid, B vitamins, calcium and vitamin E (15 times the E in white rice).

Buckwheat is the seed of a plant related to rhubarb. It is high in fiber, iron, and B vitamins. Great in many baked goods, pancakes & waffles too.

Millet is a small round grain that is a major food source in Asia, North Africa, and India. A rich source of B vitamins.

Nut Flours are high in protein and, used in small portions, enhance the taste of many baked goods. Finely ground nuts added to a recipe increases the protein content and allows for a better rise. It is a great substitute for non-fat dry milk powder in gluten-free recipes. We like it so much we always make the substitution. Keep refrigerated.

Quinoa (keen-wah), a staple food of the Incas, is a complete protein containing all 8 amino acids as well as a fair amount of calcium and iron. High in some B vitamins and folic acid.

Soy Flour has a nutty flavor, and is high in protein and fat. Best when used in small quantities in combination with other flours. Soy flour has a short shelf life.

Teff is an ancient grain from Ethiopia, now grown in Idaho. It is always manufactured as a whole grain flour, since it is difficult to sift or separate. A good source of protein, calcium, iron, fiber, and B vitamins.

Cross-contamination at the factory can cause diet compliance issues for the gluten intolerant. Call or write the manufacturers of your preferred flours to inquire about factory and field practices.

Many people may wonder why I use just one recipe for bread. It is really a template that can be changed to suit your own tastes, preferences, or dietary needs.

Changeable elements in the recipe:

Eggs
One of the most challenging substitutions, if you cannot tolerate eggs use Egg Replacer from Ener-G Foods (or try ground flax seeds as an egg replacement see recipe in flax seed section below) and be sure to use the almond flour instead of the non-fat, dry milk powder. The almond flour adds a great deal of flavor which could be helpful when you cant use eggs. If you read the nutritional label for almond flour it might scare you as the grams of fat are high, remember this is good fat and there is fiber-- both of which slow down sugar absorption in your body, which in turn helps control weight gain. The dry milk powder is high in sugar.

Oil
Vegetable oil is typically soybean oil and some people are sensitive to canola oil so safflower oil is a good alternative.

Sugar
I want to experiment with different forms of sugar to find a healthier alternative to the white refined sugar I use presently. Try turbinado sugar, a raw sugar that has been steam-cleaned. It has a delicate molasses flavor.

Flour
Four cups of flour are in the recipe. The proportions of flours used can be changed around until you find what is right for you. We use it in the way shown in the recipe but my goal is to experiment further and reduce the amount of tapioca flour and increase the healthier flours.

Dry milk powder
As seen above in the eggs section I now prefer to use almond flour instead of dry milk powder. The bread is much more flavorful and has a wonderful texture.

Flax seed
This seed has many health benefits such as high-quality protein, fiber, B and C vitamins, iron, and zinc, anti-cancer properties, omega-3 fatty acids, and many other benefits. To use as an egg substitute grind 2 tablespoons flaxseed and add 6 tablespoons boiling water, let set for 15 minutes then whisk with a fork-- this mixture will replace 2 eggs in a recipe. A clean coffee grinder works well to grind the small flaxseed.

Cookware
Its a good idea to have the proper cookware in your kitchen before attempting to make gluten-free bread. You must have a heavy-duty stand mixer like the Kitchenaid mixer. A heavy-duty mixer properly aerates the batter producing a lighter bread with a fine crumb and more height. You should also have a good quality loaf pan. It helps to know if your oven is running at the correct temperature (an inexpensive oven thermometer will tell you what adjustments you will need to make).

Bread machines can be tricky with gluten-free bread, you can call the Celiac Hotline at Red Star Yeast for the most current bread machine recommendations 1.800.423.5422.

Temperature
In addition to knowing your oven temperature, realize that when the temperature of your home is warm, bread will rise quicker. The recipe includes some tricks to help your bread rise faster when your home is cool (as is generally the case in Seattle).

Humidity
Gluten-free flour absorbs moisture from the air so be sure to keep it sealed in its packaging and tightly cover any mixing bowls rather than allowing them to sit uncovered for any period of time. The moisture the flour absorbs from the air will affect your recipe.

Amaranth Bread:

Amaranth Bread makes one loaf. Feel free to substitute the amaranth flour with teff, buckwheat, or quinoa flour.

Ingredients

3 large eggs (egg-free option see note below)*
¼ cup vegetable oil
1 teaspoon lemon juice
1½ cups amaranth flour
1½ cups tapioca starch flour
1 cup fine brown rice flour
2/3 cup instant non-fat dry milk powder (dairy-free: substitute with finely ground nuts or almond flour)
2 teaspoons xanthan gum
1 teaspoon salt
2 tablespoons ground flax seed (optional)
1½ tablespoons active dry yeast
4 tablespoons sugar
1¼ cups warm water (105F-115F.)

Bring all refrigerated ingredients to room temperature. Grease a 5 x 9-inch loaf pan.

In the bowl of a stand mixer, combine eggs, oil, and lemon juice. In a separate medium bowl, combine flours, dry milk powder, xanthan gum, salt, flax seed, yeast and sugar. Pour ½ of the warm water into stand mixer and blend with egg mixture. Slowly add dry ingredients a little at a time until completely incorporated. Add remaining water, reserving some water if necessary. See note on humidity below. Mix batter on high speed for 3½ minutes, then pour into prepared pan. Batter will be thicker than a cake batter and nothing like the consistency of regular bread dough.

Cover bread with foil and place in a cold oven. Set a pan of hot water on a lower shelf underneath the bread. Leave for 10 minutes with oven door closed. (This will cause the bread to rise quickly.) Remove bread from oven (do not uncover) and place in a warm place in the kitchen. Preheat oven to 400F. Bread will continue to rise as oven preheats.

Uncover bread and bake for 10 minutes to brown the top. Cover bread with foil and continue to bake bread for 35-40 minutes. Turn bread out onto a cooling rack. When completely cooled, wrap tightly to maintain freshness for as long as possible.

Tips:

• If humidity is high, reduce the amount of water in the recipe to avoid over rising. Many gluten-free bakers experience the frustrating situation in which a beautiful loaf of bread deflates once removed from the oven. You will need to experiment a little to get just the right amount of water in your bread depending on the humidity in the air. If in question, use less water than the recipe calls for.
• You may use rapid rise yeast instead of regular yeast. If doing so, eliminate the cold oven rise method with a pan of hot water, follow yeast package directions instead for rise time.

Hamburger Buns
Pour batter into English muffin rings, follow directions above. Bake for just 15 minutes.
Once completely cooled these buns freeze well. Serve buns warmed, otherwise they will be crumbly.

*Egg Substitution: grind 3 tablespoons flaxseed and add ½ cup + 1 tablespoon boiling water, let set for 15 minutes then whisk with a fork.

Recipes from:
Cooking Gluten-Free! A Food Lovers Collection of Chef and Family Recipes Without Gluten or Wheat
Karen Robertson (Celiac Publishing, 2002)