Celiac.com 05/21/2022 - “My daughter has celiac disease. I do the best I can to provide her with gluten-free food, but I don’t know everything that has gluten in it. I give her these pills from the health food store, because they say they block gluten. I want to make sure she is healthy. Am I giving her enough of these pills?”

What Is The Antidote To Questionable Information?

We all know the saying, “if something sounds too good to be true, it probably is.” When this question was asked by a participant at one of our education presentations, we informed her that while research was underway, at this time no pill could block gluten. We said that if and when such a discovery was made, it would be scientifically validated and widely available. We offered her assistance with her questions about the gluten-free diet.

Many people who live with more commonly known medical conditions like cancer, heart disease, and diabetes have numerous ways to verify the accuracy of the health information they acquire, including a simple call to their doctor’s office.

So what happens when the patient knows more than the doctor? Many celiacs face this scenario, and are not always certain how to verify information they hear about celiac disease in a support group meeting, in a newsletter or even in the doctor’s office. How can celiacs learn if the medical or dietary information they’ve acquired is “too good to be true?”

A healthy dose of skepticism is the antidote to the information about celiac disease that seems too good to be true.

Awareness Is a Double-Edged

Sword Awareness of celiac disease has led to a greater appreciation of the needs of people on a gluten-free diet, as well as the importance of correctly diagnosing the condition in a timely manner. This is a very positive development, as it will encourage physicians to become more knowledgeable and diagnose more people.

However, the heightened interest in celiac disease has also lead to the increased dissemination of inaccurate information which could dissuade symptomatic people from receiving the highest standard of medical care for diagnosing celiac disease and the most up-to-date information on the gluten-free diet.

Of course, we’d all prefer a world with a greater level of awareness about celiac disease. But it can be helpful to understand how this would bring about more opportunities for misinformation as well.

Vital Signs: Evaluating Information about Celiac Disease

We already understand how important it is to be skeptical about much information in our daily lives, and it is important to apply this skepticism to celiac disease as well. There are many questions you can ask about the information you’ve learned in order to authenticate its source and verify its content.

Consider the Source: Speaker

Who is delivering the information? What interests do they represent (who pays their salary)? Are they presenting information that is representative of their expertise? Do they share information about their conflicts of interest (an individual who works for a testing company that is speaking about testing for celiac disease, for example)? Is the person honest about what they know and don’t know? Does the individual presentation that has been scientifically valuated (evaluated and published in a peer-reviewed medical journal) or do they present information that is based on clinical experience and individual judgment? Are they telling you which are which?

Consider the Source: Published Article/Website

Where does the article appear—is it a support group newsletter, your local newspaper or the New England Journal of Medicine? Is it an editorial, which expresses an opinion or an article which presents factual information from a third party’s point of view? What type of review process did the article go through before it was published?

Is the medical journal article a research study, a case report, or an editorial? A research study goes through the highest level of scrutiny. Was the study well designed— prospective, controlled for bias, and an adequate number of patients?

Is the website a .com, representing a commercial interest, a .edu, representing a university, or a .org, representing a non-profit? Is the site sponsored by a commercial interest? Do they present information in a way that is consistent with the guidelines on evaluating an article or speaker? Is the information presented an interpretation of the original source material, or the original material itself?

Consider the Source: Media

Television and radio stories on any type of medical topic are usually to report some type of breakthrough or discovery. Interviews with patients will often depict extremes, either the most desperate situation or a “miracle” recovery. Accuracy, while important, is seldom achieved in a 30 second television story or a 60 second radio spot.

Consider Content and Context

Is there an established, credible resource you can use to verify the content of the information you’ve received? Is the resource unrelated to the source of your information?

Was the information presented in a way that you felt less than capable, afraid or anxious? Was the information presented in the context of selling a product or a service, or to encourage you to take a particular course of action?

Consider Uncertainty

When a patient is evaluated or diagnosed with a medical condition, it is often difficult to realize that treatment decisions have to be made without perfect information. The level of uncertainty during this process can vary.

For instance, a knowledgeable physician knows that there is a high degree of certainty when a patient has a negative tTG test that it is accurate and the patient requires no further evaluation for celiac disease. However, the same physician understands that a positive tTG test result does not bring that same high degree of certainty—that there is less than a 50% chance of the patient actually having celiac disease. However, this probability is high enough to suspect celiac disease and perform an endoscopy.

For a person diagnosed with celiac disease, evaluating the gluten content of foods can be an uncertain process. While there are numerous resources available, and a new food labeling law that will take effect in a year, there is still uncertainty. Food lists change after they are printed, what happens in a restaurant kitchen may not be related to the in-depth instruction that a patron provided about his/her meal, and celiac legends about foods that are safe or unsafe abound on list servs and in support groups.

Check, Check, Double Check

Verifying the quality of the information you receive about celiac disease is not unlike verifying the gluten-free status of your meals; double checking ingredients, or information is always important.

Most of the time, you’ll find that the people, companies and organizations that serve the celiac community are doing so with the highest level of professionalism and personal integrity. But it’s always good to make sure. A little bit of gluten, like a little bit of bad information, can be detrimental to your health.

Celiac.com 05/13/2022 - It all began when Dr. Malawer called. “Good news,” he said! “We found out what’s causing your symptoms. The tests confirmed you have celiac disease” (Gastroenterologists, he explained, rarely find definitive causes for their patients’ intestinal complaints; hence his excitement). “What this means is that you’ll have to be on a strict gluten-free diet for the rest of your life—no wheat, no rye, no barley, no oats. And no cheating—you have to stick with the diet 100 percent! But let me warn you that once get the gluten out of your system and start absorbing your food you may gain weight. I had one patient who gained 50 pounds in three months!”

Dr. Malawer was elated. I was depressed. Give up bread—for the rest of my life? It seemed a sentence too cruel for someone whose favorite food, second only to fruit, was the staff of life! Tearing into a long loaf of French bread fresh from Marvelous Market and slathering it with butter was one of my favorite pastimes. I could eat the whole thing in one sitting. And what about the six-grain loaves and the Jewish ryes (with seeds, please) from Breads Unlimited where I shopped every Saturday morning? And oh my God, bagels! Big fat garlic bagels, onion bagels, cinnamon bagels, poppy seed bagels right out of the oven from Whatsa Bagel, and the flatbread bagels smothered with onions and poppy seed called bialys—never again? This was seriously depressing.

Dr. Malawer had suspected celiac disease (also known as gluten intolerance) and ordered a biopsy of my small intestine and blood tests when, in taking my family history, he learned that I had a third cousin with the disease and that when I was very young I had heard my parents mention the possibility of celiac disease when discussing the cause of my many food allergies with my pediatrician.

My symptoms had begun at least ten years prior to my diagnosis. I had frequent bouts of abdominal distress, gas, and diarrhea, which I could not associate with anything in my diet. I frequently talked with my internist about this, and for about a year I kept a daily journal on the state of my abdomen and what I had done or eaten, but no pattern emerged. Over that time period several sigmoidoscopies were performed and they repeatedly tested me for parasites and giardia—all test results were negative. The only thing we could figure out was lactose intolerance. When I went on a lactose-free diet or used lactose pills my distress lessened, but the diarrhea continued. My doctor finally told me that if I had another bout of diarrhea he would refer me to a gastroenterologist. That is how I became a patient of Dr. Malawer’s.

While trying to absorb the news about my diagnosis of celiac disease and its implications, I asked Dr. Malawer if there were any organizations that could help me with the dietary and life style changes that I’d need to make. His receptionist directed me to the Washington Area Celiac Sprue Support Group (WACSSG), which meets bimonthly and puts out a highly informative newsletter about all aspects of the disease that includes gluten-free recipes and listings of gluten-free products available in local supermarkets or by mail. To my surprise, WACSSG’s membership of adults, children, and families of celiacs was more than 100 when I joined about 12 years ago, at a time when the disease was thought to be relatively rare. Membership has been increasing with heightened awareness of the true prevalence of the disease in the United States—about 1 in 133 Americans and 1 in 22 family members of diagnosed celiacs, according to a recent epidemiologic study.

The first meeting of WACSSG I attended featured a speaker from the FDA (Food and Drug Administration) on hidden glutens found in the “fillers” of prescription and over the counter drugs. Fillers are the non-therapeutic ingredients used as binders. She urged us to contact the manufacturer of each drug we were taking to find out what substances they used as fillers. Certain fillers were not acceptable, and we needed to find out whether they came from corn, potatoes, or wheat, and of course avoid taking drugs with wheat starch fillers. What a tedious process! Not only was it almost impossible to read the fine print containing the ingredients and the manufacturer’s phone number (if listed) on a bottle of antihistamines or my prescription drugs, but when I called the manufacturers I was cycled through numerous “experts” on the abstruse matter of fillers before I got my answer. Fortunately, in most cases, the fillers were made of corn or potato starch and I was able to continue using the drug. In some cases, however, the type of starch used as filler varied from batch to batch, as the manufacturers competed on the open market for the lowest priced ingredients. If the manufacturer could not guarantee that wheat starch was never used, I could not take the drug.

Aside from the obvious things I could no longer buy for myself, such as bread and wheat pasta, I had to learn, first and foremost, to read the ingredient labels on every food item I intended to eat. I was surprised to learn how many canned, bottled, and packaged food items contain wheat or oats, or barley. Wheat, in particular, seems to be ubiquitous. In a long list of ingredients, it is not atypical to find the words “wheat starch” toward the end, even in such products as soups and chicken broth, catsup, and soy sauce. Hidden glutens, I was to learn, lurked everywhere!

Once I got over the shock of the diagnosis (an autoimmune disorder, which can manifest itself at any age) and stopped focusing on all those things I could no longer eat, I became aware of excellent gluten-free packaged products, cookbooks, and recipes for breads and baked goods which I could easily prepare. Among my first purchases was a “Zo” (Zojirushi) bread machine, which is particularly effective with gluten-free flours, such as white and brown rice flour, potato flour, tapioca flour, and cornstarch, to which xanthan or guar gum can be added to provide the elasticity which is lost when gluten-containing flours such as wheat cannot be used.

A perennial challenge for celiacs, however, is eating in restaurants or dining with friends in their homes. I’m still shocked at the number of waiters who don’t realize that noodles, at least in this country, are typically made from wheat flour. What they lack in knowledge, however, they are usually quite willing to ask about in the kitchen. If they cannot find out whether or not a particular soup or meat dish I’m contemplating contains any gluten, I choose something else. On the other hand, some restaurants, such as Bonefish Grill (I just recently discovered), can provide a diner with a gluten-free menu; and some stores, such as Trader Joe’s, have a list of all the gluten-free products that they carry.

When I eat out with friends or acquaintances, I tell them that the only kind of restaurant I really have to avoid is a pizza joint. My solution to eating in other people’s homes is to bring a dish I can eat to share with others. I tell the cook to prepare whatever they want for the guests and not to worry about me. Usually there are some things I can eat and some I can’t. To my surprise and pleasure, after I became gluten-free I was able to tolerate dairy products—including milk, yogurt, and most cheeses—quite well.

Whenever people start eating something I can’t eat in my presence, they usually apologize when it dawns on them that I can’t have it. I am now able to say, “It’s OK. I remember exactly what that tastes like and I’m getting vicarious enjoyment watching you eat it.” Sometimes I’ll take a plate of frosting from a chocolate cake, or scrape out the innards of a cheesecake that is coated with graham cracker crumbs (once I’ve verified that the innards contain no gluten). But then there’s the fresh bread…that’s when I have to look away!

A celiac always needs to be thinking about emergency foods, particularly sources of carbohydrates or high energy foods for travel, in case one cannot count on gluten-free products being available, such as at airports, train stations, or in foreign countries. I travel with Balance Bars (not advertised as gluten-free, but they are in fact), raw almonds, raisins, and hard-boiled eggs, or corn chips. I keep a couple of Balance Bars in my car at all times, in case I’m on the road and become hungry. One Balance Bar can usually forestall the need for a meal until I arrive home or at my destination.

Celiac.com 05/06/2022 - To the newly diagnosed celiac patient, beginning a gluten free diet is often overwhelming, confusing, and sometimes, depressing. Initially it may be a relief to finally have a diagnosis. All seems easy and uncomplicated when sitting in the comfort of the doctor’s office. A visit to the store and the purchase of a few things that may be safe to eat is the time when most of us come face-to-face with the fact that life as we knew it is over.

If you are lucky and do some homework, you find that gluten is hidden in almost everything. Gluten is the protein in wheat, rye, barley and oats. Or is it? Conflicting information regarding gluten abounds. Some authorities believe oats are safe for the celiac patient, and gluten is frequently being listed as including only wheat, rye, and barley.

Too many people—especially the newly diagnosed—receive conflicting information. They aren’t even sure what gluten is, and then they have to contend with the added misinformation about oats. It is a difficult situation—that sometimes gets even worse. For instance, we are continually amazed by the number of people that think that a “little” gluten is okay. Unfortunately, too many doctors and dieticians tell their patients that as long as their symptoms are gone they can safely have gluten occasionally. This is just plain wrong. It goes far beyond the oats debate in the literature, and it is of concern to those of us who have maintained a gluten free diet with zero symptoms and clean blood tests for many years.

But what about eating oats? According to Hogberg, et al., oats “can be accepted and tolerated by the majority of children with CD” (1) . This conclusion is based upon their finding that those subjects who consumed oats showed intestinal and serological recovery after one year of the diet. The indicators used to measure this recovery were blood tests and biopsies. The same group also reports that while 20% of the test subjects dropped out of the study, all subjects who stayed with the study showed no adverse effects from including oats in their diets. But what about the 20% who dropped out? How carefully were the symptoms of any of the subjects in this study monitored? Because these subjects were newly diagnosed, there was no basis for comparison with their previous experience and/or symptoms on a gluten-free diet.

In counterpoint to the Hogberg group’s findings, a very different story is told by the research conducted by Peraaho et al. They looked at the impact of oats on the quality of life along with gastrointestinal signs and symptoms. They compared these findings to similar examinations of a control group of celiac patients who were eating a gluten-free diet that did not include oats (2) . While the quality of life did not differ between these groups, those eating oats experienced significantly more frequent diarrhea. They also experienced more severe constipation, and a small but significant increase in intraepithelial lymphocytes was revealed in their biopsies. The Peraaho group did report, in congruence with the Hogberg et al. findings, that the villous architecture did not differ between groups, and antibody levels did not increase among those eating oats.

Both studies are very revealing. They show us that symptoms can sometimes be more revealing than test results, and that the serological and endoscobic evidence, without counting intraepithelial lymphocytes (IELs) can only provide a crude measurement of disease. While the Marsh system for evaluating biopsies for celiac disease requires counting IELs, and is widely accepted, too many pathologists and gastroenterologists continue to rely on the villous morphology alone when they rule out celiac disease.

Peraaho et al. identified two important weaknesses in research that suggests oats are safe for celiac patients. First, the intestinal biopsy will miss a number of cases of celiac disease if IELs are not counted, so oats advocates should include IEL counts. Second, many celiacs are exquisitely sensitive to gluten, and their reactions are far more accurate than many supposedly objective tests (please bear in mind that some/many of us can be symptom-free while the disease progresses and gluten causes internal injuries). Thus, the level of our well-being is in our own hands and is a function of the extent to which we comply with the gluten-free diet.

Further, many of us are simply not able to tolerate oats. We suggest the following approach: First, ensure that your diet is absolutely gluten free, including hidden gluten and cross-contamination. Then, if the idea of adding a grain to your diet is important to you, try oats that have not been contaminated through growing, harvesting, or processing. If you remain symptom free when eating oats, enjoy. Be aware, however, that a significant portion of celiac patients clearly react to oats, and the elevation of IELs, along with the increased bowel symptoms should suggest erring on the side of caution and avoiding oats if any signs or symptoms appear.

Co-authored by and Ginny Nehring.

References:

1. 1. Hogberg L, Laurin P, FalthMagnusson K, Grant C, Grodzinsky E, Jansson G, Ascher H, Browaldh L, Hammersjo JA, Lindberg E, Myrdal U, Stenhammar L. Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut. 2004 May;53(5):649-54.
2. 2. Peraaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Maki M, Laippala P, Collin P. Effect of an oats-containing gluten-free diet on symptoms and quality of life in coeliac disease. A randomized study. Scand J Gastroenterol. 2004 Jan;39(1):27-31. Co-author Dangerous Grains ISBN: 1- 58333-129-8

Celiac.com 04/29/2022 - This past Thanksgiving I continued a family tradition that started nearly 30 years ago. I baked a pancake that goes by many different names but we call it a Puffed Apple Pancake.

This pancake is not your usual pancake! It is baked in the oven until golden brown, puffing up with large mountains that create perfect little valleys for holding special toppings, and it is utterly delicious. We usually fill those valleys with chopped apples that have been sautéed in butter and tossed with a little cinnamon and sugar. For many years, we were content to Puffed Apple Pancakes: A Family Tradition at Our House By Carol Fenster, Ph.D. simply dust powdered sugar on the top, but my daughter-in-law recently introduced us to the joy of adding a dollop of freshly whipped cream. How divine!

I started baking this special, puffed pancake for my son when he was a toddler. It became one of our special treats as he was growing up, something I baked for him on holidays or when I wanted to make an “out of the ordinary” breakfast. Sometimes we topped it with fresh strawberries or blueberries instead of apples, but we always come back to our favorite—cinnamon-scented apples that fill our house with an enticing aroma.

This past Thanksgiving, I baked several of these pancakes so that my whole family could enjoy this treat. We were especially interested to see what my two-year-old grandson thought. Supremely unaware of the importance of this ritual (you see, I bake this pancake every time my son comes for a visit), my grandson gave it a two-year-old’s version of a “thumbs up”— he asked for seconds!

I bet there are foods that your family enjoys at special occasions—or for no special reason—simply because they hold fond memories and make everyone happy. These special foods—like my Puffed Pancake— are our way of bonding together, showing our family we love them, and instituting feelings of security and certainty in our lives. Ask your family what dishes they view as special or ones that they want you to continue serving because it makes them happy. You might be surprised!

Carol Fenster’s Puffed Apple Pancakes

This treat tastes best made with real butter. Any type of apples will work, but I prefer the flavor and texture of Gala, Granny Smith, or Fuji. Leave the skins on the apples for a more colorful dish, plus more fiber and nutrients.

Ingredients:

Pancake:

• 3 large eggs
• 1⁄4 cup gluten-free flour blend 
• 1⁄4 teaspoon salt 
• 1/3 cup milk 
• 1 tablespoon soft butter or 
• margarine, melted
• Margarine or shortening for 
• greasing pans

Filling:

• 2 large apples, thinly sliced 
• 1 tablespoon butter or margarine
• 1 tablespoon sugar
• 1⁄4 teaspoon cinnamon

Toppings:

• Powdered sugar
• Whipped cream 

Directions:

Pancakes
1. Preheat oven to 450F. Generously grease 9 or 10-inch cast-iron (or oven-proof ) skillet (or, use two small oven-proof dishes approximately 4 inches in diameter). 
2. In blender, beat eggs until thick and fluffy. Gradually add flour, salt, and milk until well blended. Beat in melted butter or margarine. 
3. Pour into greased pans. Bake 10-15 minutes until puffed and nicely browned. After removing from oven, immediately fill valleys of pancake with sautéed apples. Cut into 4 pieces. Dust with powdered sugar and add a dollop of whipped cream. Serve immediately. Makes four small servings or two large ones. 

Filling
1. While the pancake is baking, sauté the apples in butter or margarine until soft. Toss with sugar and cinnamon.

Additional Tips
1. Choose a pan or skillet with sides that slope out at the top, rather than straight up and down. This allows the pancake to rise more quickly and therefore, higher and more beautiful.
2. Cast-iron skillets are great for this recipe; either one large 9 or 10-inch pan or two 4-inch pans will work. But you can also use stainless steel or any skillet or pan that is oven-proof. 
3. Be sure to generously grease the pan to make sure your beautiful pancake slides easily onto a plate.
4. Be prepared to eat the pancake right away since it quickly falls as it starts to cool.

Celiac.com 04/21/2022 - If you work, there is little time in the morning to dawdle in the kitchen to prepare a homemade bag lunch. If you have celiac children, the problem is compounded because many children are picky eaters. But with a little pre-planning and unlimited ingenuity, there are always viable alternatives.

First, if you have children, ‘set the stage’ at the onset of the school year by taking these steps (as they apply to your situation):

1. Speak to the dietician or the person in charge of the kitchen at the school. Have a copy of the gluten-free diet requirements with you. Bring a note from your doctor stating that your child cannot eat foods that may contain or be contaminated with gluten.
2. If your child has been diagnosed with celiac disease, and if the school is receiving funding through the National School Lunch Program, it must provide a gluten-free lunch to your child Read the USDA’s Guidelines for the National School Lunch Program and print anything you think may help. Write down the site’s address and provide it to your school district’s food services coordinator and school’s cafeteria manager.
3. Ask for permission for your child to warm his/her lunch in the school microwave.
4. Ask if you may bring items to keep in the school cafeteria freezer, marked expressly for your child—items such as condiments, bread, pizza slices, cupcakes, ice cream cups, etc.
5. Teach your child about the diet restrictions—children can comprehend much more than you think!
6. Ingrain in your child the importance of never trading foods with friends.

So What’s For Lunch???

Lunch variation is limited only by your initiative and imagination.

For The Microwave

If you or your child has a microwave available to you at lunchtime, make your own ‘lunchables’ from dinner leftovers. There are divided, plastic, lidded containers that are ideal for this purpose. To prevent spoilage, freeze your ‘lunchable’ container so you take a frozen package with you in the morning; by noon, it will be thawed and ready to heat. Other foods conducive to being warmed in a microwave include pizza, lasagna, eggplant parmigiana, crustless quiche, and twice-baked potatoes. If you are making mashed potatoes for dinner, bake the potatoes (instead of boiling them); remove most of the inside to make the mashed potatoes, leaving the skins intact. Then make your own potato skins topped with cheddar cheese, sliced green onions and crumbled bacon. Potato skins make a ‘fun’ lunch for both kids and adults. Other ‘fun’ microwavable lunches are ‘Hot Pockets’ made from Chebe bread or a hot dog topped with American cheese and wrapped in a corn tortilla (wrap in waxed paper to heat in the microwave). Gluten-free tamales, Quesadillas and Chinese stir-fry add variety to your lunch and warm easily in the microwave.

Pack in a Thermos

A thermos isn’t just for soup anymore. Perhaps you’ve been brave enough to spoon chili or stew into a thermos. Now think outside the box…be daring! Pack a gluten-free bun and spoon sloppy Joe mix into the insulated container. Or fill the thermos with boiling water and add corn on the cob, or 1 or 2 hot dogs. A thermos is great for taco meat (spoon on top of a salad at lunch time), pork and beans or hot dog slices and beans, or sausage in barbecue sauce. Rice dishes and gluten-free pasta entrees hold well in a thermos, everything from Spanish rice and beans, to pasta marinara, to fettuccini alfredo, to macaroni and cheese.

Cold Lunches

To keep foods from spoiling, add an ice pack to the lunchbox. The variety of cold lunches is endless. For entrees, take baked or fried chicken or chicken wings, cold poached salmon spread with mayonnaise, shrimp with gluten-free cocktail sauce, cold sliced steak, sushi, or a tomato stuffed with tuna fish. If you prefer sandwiches made on gluten-free bread, break the routine of deli lunchmeats with meatloaf, egg salad, or Rueben sandwiches. If you don’t want the bread—no problem—wrap lunchmeat around a piece of string cheese; if you are daring, add a piece or two of marinated asparagus before wrapping. Make toothpick kabobs of cubes of lunchmeat, cheese, pickles and olives.

Salads make a perfect cold lunch, whether it is a gluten-free pasta salad, shrimp or crab salad, chicken Caesar salad, or chicken pineapple salad. There is traditional potato salad made with mayonnaise and a hint of mustard, or Greek potato salad made with green pepper, onion, olive oil and cider vinegar. A chef salad is an excellent way to use up leftovers in the refrigerator. And let’s not forget healthy bean salad. Cottage cheese with fruit is always refreshing. If you want something small to have with your sandwich, try cole slaw or marinated vegetables. If the salad is your main dish, treat yourself to an antipasto of marinated cubes of pepperoni, cheese, olives, tomato wedges, artichoke hearts and pepperoncini.

Variety is the key—switch foods and alter combinations to make lunch an event of anticipation. One day add deviled or hard-boiled eggs; the next day add salsa and gluten-free tortilla chips. Include veggies as often as possible, whether it is carrot sticks with a dip or celery stuffed with peanut butter. If time is a factor, add ‘no-fuss’ items like applesauce, gelatin cups or flavored yogurt; or pack a few gluten-free crackers to have with cheese slices or to spread with hummus. For a treat, take a ‘sandwich’ made from gluten-free sweet bread slices spread with cream cheese.

Sandwich ‘Wraps’

If you can’t find a pre-made loaf of gluten-free bread to your liking and you haven’t had time to bake your own bread, don’t despair. There are other viable sandwich ‘containers’. Purchase gluten-free corn tortillas made from either yellow or white corn. Gluten-free corn tacos are a crisp, fun holder for a multitude of fillings. Pancakes and crepes make wonderful ‘wraps,’ and lettuce leaves are the ideal holders for lunchmeat and cheese. If you feel like living life on the edge, use Belgium lettuce leaves; they are shaped like boats and make a neat ‘container’ for tuna and chicken salads. Or avoid the ‘wrap’ altogether and take gluten-free muffins instead. Gluten-free crackers are also an alternative and they are now available in so many different flavors and textures.

Miscellaneous Lunch Foods

When you are looking for that something ‘extra’ to include in your lunch, add beef or turkey jerky. If your place of employment or your child’s school has boiling water available, drop a packet of gluten-free instant soup into your lunch bag (don’t forget to pack a spoon and a bowl or mug). Then there are the old standbys: Chips, nuts, popcorn, rice cakes and marshmallows. If you have time to create treats, one week make a trail mix using a variety of gluten-free cereals, dried fruits, chocolate chips and/or nuts. The next week, stir up a gluten-free ‘Chex’ mix or make a homemade granola.

Desserts

Sure, you could pack fruit cups or a piece of fresh fruit, or gluten-free cookies or cupcakes, but dessert can be more ingenious than that. Cut up fruit and toss it with pineapple juice (to prevent browning), then take some caramel topping or cream cheese mixed with gluten-free nondairy whipped topping for dipping. Bake meringue cookies in the shape of bread sticks, then take a container of pudding for dipping. Mandarin Orange Salad or Waldorf Salad makes a refreshing dessert. Or take stacked apple slices (dipped in pineapple juice) filled with layers of peanut butter and honey. But if it is time to leave for work and you haven’t had time to prepare a dessert, fruit rolls, gluten-free protein bars or a good, old-fashioned candy bar will do the trick

Connie Sarros’ Homemade Granolas

Version 1 Ingredients:

• 1/3 cup butter
• 3 cups gluten-free corn or rice 
• flakes cereal 
• 1 cup chocolate chips
• 1⁄2 cup sliced almonds
• 1⁄2 cup shredded coconut
• 14 ounce can sweetened 
• condensed milk

Version 1 Directions:
Preheat oven to 350F. Melt butter in a 9 x 13 inch pan in the oven. Sprinkle cereal over melted butter and bake five minutes. Remove pan from oven; sprinkle chocolate chips, then  almonds, then coconut over the cereal. Pour condensed milk evenly over the top. Bake for 20 minutes. Cool, then cut into squares.

Version 2 Ingredients:

• 3 cups gluten-free corn puff 
• cereal
• 1 cup peanuts
• 1 cup banana chips, dried
• 1 cup golden raisins
• 1⁄2 cup dried cranberries
• 3 tablespoons margarine
• 1 tablespoon brown sugar
• 1⁄4 cup gluten-free pancake syrup
• 1 teaspoon cinnamon 
• 1⁄4 teaspoon salt
• 1 cup shredded coconut

Version 2 Directions:
Preheat oven to 300F. In a large bowl, combine cereal, peanuts, banana chips, raisins, and cranberries. In a small saucepan, heat margarine, brown sugar, pancake syrup, cinnamon and salt until melted; pour over cereal mixture, tossing till evenly coated. Spread on a baking sheet. Bake 25 minutes, stirring occasionally.  Stir in coconut and bake until golden, about 15 minutes. Remove from oven and cool.

Celiac.com 04/05/2022 - You have just been diagnosed with celiac disease. Wonderful! Now all your gastro problems, aches and pains and fatigue and food allergies will go away. All you need to do is maintain a gluten-free diet—NOT!

Many—if not most—of us who are gluten intolerant have quickly found our various health problems, sadly, do not go away simply by eliminating gluten from our lives. In fact, our health problems may increase over time. Many futilely and desperately search in vain for “hidden” gluten which they are sure must be present in something they missed causing them problems.

If you are among the lucky ones whose health fully recovers after starting a gluten-free diet, great! The fact is, your gastrointestinal tract and immune system may have been under attack for years. Malabsorption is likely to have caused years of vitamin, mineral, and amino acid deficiencies resulting in damage to your body systems. You may have acquired various other autoimmune conditions along the way. If you are diagnosed over age 40, your body systems may be slowing down and not able to fully recover. The mix of beneficial bacteria and microorganisms which inhabit your gut may have become altered, depleted, or in complete disarray. Your stomach may no longer be producing a sufficient quantity of stomach acid, affecting your ability to digest food and absorb essential vitamins and minerals. Intestinal permeability and perhaps a thymus gland impaired by mineral and vitamin deficiencies may have resulted in the acquisition of multiple food allergies and intolerances. Vitamin B12 deficiency could have caused permanent neurological damage. Bones may have weakened. There may be weak, brittle and malformed finger and toe nails, skin rashes, bruising, and inflammation. Fatigue and muscle pains may be present. The list goes on. So what can one do?

Low Stomach Acid

After a diagnosis of celiac disease or gluten intolerance , you should first immediately assess if you have a low stomach acid condition. Low stomach acid or hypochlorhydria will continue to cause malabsorption problems and vitamin, mineral and amino acid deficiencies. Hypochlorhydria can lead to multiple food allergies. Low stomach acid also allows potentially harmful bacteria and microorganisms to colonize the stomach where they should not be at all. The stomach cells which produce stomach acid also produce a substance called “intrinsic factor” which is necessary to allow the intestine to absorb vitamin B12. If you have low stomach acid, intrinsic factor may be low and you may not be able to absorb vitamin B12 sufficiently. In this case, sublingual or “under-the-tongue” vitamin B12 tablets can be taken to improve absorption. In some cases, vitamin B12 injections are necessary to prevent pernicious anemia.

During digestion, stomach acid levels normally increase. The higher acid level results in a secretion of hormones which, in turn, signal the pancreas to release digestive enzymes and acid-neutralizing bicarbonate ions into the small intestine to complete the digestion of contents leaving the stomach.

Maintaining a normal stomach acid level is, thus, crucial for digestion in both the stomach and intestine. Low stomach acid is also present in the vast majority of heartburn sufferers, and improper digestion due to low acid is the cause of most heartburn. Taking acid suppressors for heartburn is exactly the wrong thing to do if you have low stomach acid. Taking an acid supplement to normalize digestion can actually prevent heartburn in most cases. An excellent reference on stomach acid is the paperback book Why Stomach Acid Is Good for You by Jonathan V. Wright, M.D. and Lane Lenard, Ph.D.

Low stomach acid can be treated by taking digestive enzymes and an acid supplement, such as betaine HCl, with every meal, likely for the rest of one’s life. There are many digestive enzyme formulations available, and the choice depends on your individual metabolism. I prefer the pricey but high-quality fungal derived enzymes from Enzymedica, and take one Carbo capsule with every meal. The Carbo formulation has a modest level of protease enzymes. High levels of protease can cause a burning sensation in the bowels in some people, including myself, which normally goes away after a few weeks of use. Since I am mostly vegetarian, my need for protease to digest meat and proteins is reduced. Betaine HCl is available in tablet form, or as 10-grain capsules containing powdered betaine HCl, which works faster. You need to adjust the number of betaine HCl capsules to suit your low acid condition, and this usually means taking more than just one or two capsules with each meal. The number is adjusted by increasing it until you experience a warm sensation in your stomach, and then backing off by one capsule. I take three 10-grain capsules with breakfast and lunch, and six with dinner. I buy quantities of 250 capsule bottles of Solaray High Potency HCl from a discount health food company over the internet at a very reasonable price. Enzymedica products can also be purchased at discount over the internet.

Treating hypochlorhydria greatly reduced or eliminated my allergic responses to numerous foods.

A quick and simple test for low stomach acid makes use of fresh baking soda. You should not be taking antacids or acid suppressors to perform this test. Stomach acid and baking soda react to form carbon dioxide gas. First thing in the morning, before eating or drinking, add one quarter teaspoon of baking soda to an eight ounce glass of water. Mix, drink, and start timing for up to five minutes. You should normally belch within two to three minutes if your stomach acid level is adequate. Rapid and repeated belching may mean excessive stomach acid is present. Late or no belching indicates low stomach acid. Acid levels can be confirmed by measuring stomach pH using a small radio capsule (Heidelberg capsule) that is swallowed, a test which some gastroenterologists or naturopathic doctors can perform.

Probiotics

Probiotics provide beneficial microbes to help replace and restore order to the bacteria and micro flora which reside in the gastrointestinal tract. Celiac disease, hypochlorhydria, immune system disorders, and accompanying gastrointestinal distress can wreck havoc on the balance and mixture of the beneficial and necessary micro flora of the gut. Low stomach acid permits entry of undesirable and pathogenic bacteria. Malabsorption results in an excess of undigested nutrients in the gut, feeding and promoting an overabundance of undesirable bacteria species. Taking a probiotic supplement helps to re-colonize the gastrointestinal tract with beneficial bacteria which, in turn, displace the undesired bacteria.

Probiotics come in the form of foods, such as yogurt and kefir containing live cultures of beneficial bacteria, or in capsule, tablet, liquid or powdered form. Choosing a probiotic may not be easy. Research on probiotics is a very young field, and which species of bacteria provide the greatest benefit remains uncertain. You may need to try a number of different probiotic products to find one that best suits your needs. A probiotic containing a mixture of a number of different bacteria species might be more likely to provide the bacteria combination that works for you. Ideally, a dose of probiotic should provide billions, 10, 20, or even 30 billion or more bacteria, to effectively colonize the bowel. Probiotic capsules which provide such a high dosage are expensive. A good yogurt or kefir is a much more cost effective probiotic providing many billions of bacteria per serving. Yogurt and kefir are both fermented milk products, but kefir contains yeast in addition to bacteria. Sensitivity to yeast is a common problem among celiacs, and, hence, kefir may not be suitable for everyone. Soy yogurt and kefir are also available if you are sensitive to dairy products. Some health food stores can provide yogurt and kefir made with goats milk if cow’s milk is a particular problem. Labels on some probiotic products warn that flu-like symptoms may result during the first few weeks of use and recommend a lower dose until the symptoms disappear.

Personally, I consume a plain yogurt, without gelatin or corn syrup, preferring Nancy’s Yogurt. I had a six month bout of diarrhea after a prolonged summer cold. I had been taking a probiotic capsule, and decided to switch to yogurt to provide a larger and cheaper dose of bacteria. The website for Nancy’s Yogurt, which contains six live bacteria cultures, was the only one which provided a bacteria count from an independent laboratory. Nancy’s Yogurt seemed to be instrumental in finally clearing up the diarrhea problem for me. I consume a heaping tablespoon of yogurt on each of two rice cakes every morning and two heaping tablespoons on my salad at dinner. Depending on the age of the yogurt, this provides up to over 30 billion bacteria per two tablespoon serving. I have also tried Stonyfield Farms Yogurt, which also contains six bacteria cultures, but the product is “runny” compared to Nancy’s firm texture. I have not yet tried Mountain High Yogurt, containing five bacteria cultures, which may be another good alternative. I suggest you contact yogurt makers about their bacteria content if you try other brands. However, such information is not always reliable.

Nails

Your nails are a barometer to your health and provide a good visual aide in recognizing vitamin and mineral deficiencies and other problems. White spots and poor nail growth can indicate a zinc deficiency. Thin, brittle, spoon or concave shaped nails, and ridges running lengthwise indicate possible iron deficiency. A deficiency in vitamin A can cause slow growing brittle nails lacking pink a glow underneath. Vitamin C, folic acid, or protein deficiency can cause hangnails. A deficiency of B vitamins causes fragility, with horizontal or vertical ridges. A deficiency of vitamin B12 leads to excessive dryness, very rounded and curved nail ends, and darkened nails. Splitting, thin, chipping, or peeling nails may mean low stomach acid or low sulphur amino acid. White bands across the nails can indicate a protein deficiency. Probiotics can help fend off nail fungal infections by displacing yeasts and fungi in the gut. A host of medical problems such as thyroid, kidney, and diabetes conditions can be indicated by various malformations and discolorations of the nails. For more on these medical conditions try reading Nail Abnormalities: Clues to Systemic Disease by Robert S. Fawcett, M.D., M.S., Sean Linford, M.D., Daniel L. Stulberg, M.D.

I developed a problem with nails deteriorating on the edges of the large toe nails and on one edge of the thumb and index finger of the right hand. In addition, for years I had a chronic periodic swelling and inflammation of the toes around the toe nails. When I began taking betaine HCl for hypochlorhydria, the nail deterioration seemed to stop, but there was little or no nail growth to repair the damage. Searching the internet for solutions, I came across websites which suggested that supplementing with MSM (methylsulfonylmethane) frequently resulted in increased nail growth as well as improved hair condition. MSM is a sulfur compound, and numerous health benefits have been claimed for it for which I cannot vouch. Sulfur is a component of keratin, and keratin is a protein important for the maintenance and growth of nails, hair and skin. MSM has a bitter taste, but it does not leave an aftertaste. The powder can be mixed with fruit juice, if desired. I began taking one half teaspoon of powdered MSM in a glass of water once daily, and soon noticed an apparent increase in nail growth after a few weeks. Encouraged, I began to take one half teaspoon MSM twice daily, in the morning and evening. I also began taking 500 mg L-methionine, an essential sulfur amino acid, twice daily. This increased nail growth even more, and, quite unexpectedly, within two weeks the chronic periodic swelling and inflammation of the toes completely ceased and has never returned to this day (I also noticed my hair seemed softer and had more luster, but, hey, us males aren’t supposed to care about such things). I started taking MSM in January 2003.

I’ve had a few relapses resulting in some temporary nail deterioration, especially during the six month bout of diarrhea. Consuming yogurt seemed to help clear up the nail problem as well as the diarrhea. I also now have further increased my take of MSM powder to a heaping teaspoon in water twice daily with no side effects noticed. After nearly two years my nails are almost completely normal and healthy. Only the slow growing large toe nails still show any obvious signs of the prior condition, and they are nearly fully grown back and healthy. I buy MSM powder in 35 oz (1000 g) containers at discount over the internet.

Vitamins, Minerals and Amino Acids

Our intestines have been damaged. We may have low stomach acid. We may be vegetarian. Our metabolisms differ. Our lifestyles differ. All of these factors affect how nutrients are absorbed and how much of each nutrient we require. Does that multi-vitamin/multi-mineral supplement supplying the recommended daily allowance (RDA) of vitamins and minerals really meet your needs? Remember, these are the amounts needed to maintain a healthy normal individual. You need to look at your own condition to determine the amount of vitamins and minerals you need. This is no easy task. I am still trying to deal with it myself. Wouldn’t it be nice if there were some little meter we could poke ourselves with, much like the glucose meter used by diabetics, that could tell us which vitamins and minerals and amino acids were low and what and how much we needed to take?

After first being diagnosed with celiac disease, you are probably deficient in numerous nutrients. Once on a gluten-free diet, many of these deficiencies will return to normal levels. Some may not. In addition, some nutrients, such as vitamin B12, may not be sufficiently absorbed via the intestine, and must be take sublingually or by injection. Paradoxically, some of the very nutrients needed to repair the intestine so that it can absorb them are not being absorbed because of the damage to the intestine. Deficiencies may require higher than RDA amounts, at first, which must be reduced, later, to avoid overdosing. Without some form of testing and monitoring to determine our need for and levels of nutrients, there is no good way to manage our nutrient needs. I have already suggested that your nails can provide a clue to some deficiencies. Are there tests which can help us decide what we need?

Yes, there are tests which can provide you with serum levels of many nutrients. But these tests can add up and become very costly if tests are done for many nutrients and if follow up tests are performed. Some clinical labs offer package deals which might not be a bad idea for an initial assessment of your health condition. For example, many Web sites offer various nutrient blood tests. I do not think your insurance company is going to be willing to pay for a multitude of tests and follow up tests. A few well-chosen tests may fit within your budget. If you have the means, having the test information is better than not having it. Also, if you can find and afford a good doctor or clinical nutritionist or naturopath to work with you, so much the better. If doctors and tests are not within your means, self-education and trial and error is an alternative approach.

Besides books and libraries, the internet has a wealth of helpful websites on nutrition and nutrients. One of the best websites is the Linus Pauling Institute’s Micronutrient Information Center which provides an excellent source of information on vitamins, minerals and some other nutrients. This website also offer good information on vitamins and minerals: 
https://www.springboard4health.com/notebook/

Amino acids, the building blocks of protein, are also important. 22 amino acids are used in human metabolism. Some amino acids can be synthesized by the body, but there are 8 essential amino acids which can only be obtained from diet. The following website provides a good overview of the amino acids:
https://www.springboard4health.com/notebook/cat_proteins.html

Additionally, you need to know how much of these nutrients your diet may be providing. The USDA National Nutrient Database for Standard Reference provides a comprehensive list of nutrients from a huge database of foods and food products. Just remember that the amount of a nutrient given for a food does not represent how much of that nutrient your body will actually absorb. In some cases, the food may have a very high nutrient content, but only a very small percentage will actually be absorbed because the nutrient is not in a readily absorbable form. 

By noting your symptoms and health condition and comparing them to symptoms caused by nutrient deficiencies, you may be able to determine or guess which nutrients you may be lacking. As similar symptoms can be caused by deficiencies of any number of other nutrients, the task is not easy. You may be able to correct the deficiency by including in your diet foods rich in the particular nutrient. You may need to take the nutrient as a supplement to insure sufficient absorption. You also must determine the dose of supplementation you require. In order to be able to assess whether the supplementation is improving your symptoms and health, you must add only one supplement at a time and make no major changes to your diet, and it may take days or weeks or months to note if the symptoms improve. This process can easily become tedious, time-consuming, expensive, and frustrating. If you have narrowed down possible nutrient deficiencies, you may opt to get tested for those particular nutrients.

Vegetarians also have special needs, as there are some nutrients better provided by animal products in the diet. The American Dietetic Association has a comprehensive paper on Vegetarian Diets which discusses these nutritional needs.

Vegetarians must make sure their diets are sufficient in protein (essential amino acids), iron, zinc, calcium, vitamin D, riboflavin, vitamin B12, vitamin A, n-3 fatty acids, and iodine. Higher RDA levels and supplementation of some of these nutrients may be necessary to maintain proper levels. Malabsorption caused by celiac disease compounds the likelihood of deficiencies.

Here is an example of tracking down a deficiency problem. A symptom I have been dealing with is fatigue. I take a multivitamin/mineral supplement, sublingual vitamin B12, plenty of vitamin C, plus additional supplements. At first, I suspected adrenal fatigue and achieved some limited relief from fatigue by drinking salted water several times daily to replace lost sodium caused by an insufficient level of the hormone, aldosterone, produced by the adrenals which regulate sodium retention in the kidneys. But lately, salted water is not having much affect, possibly because my aldosterone level is improving. In addition to fatigue and lack of energy, I was experiencing episodes of daytime drowsiness while driving to work. In a self-experiment supplementing with tin in the form of stannous chloride, I actually seemed to have completely cured myself of daytime drowsiness. However, fatigue still remains a problem. 

Evaluating my supplements and considering which nutrient deficiencies are likely to cause fatigue, I noted that my multivitamin/mineral supplement provides only 10 mg iron. The RDA of iron for adult males is 8 mg and for pre-menopausal adult females is 18 mg. However, vegetarians face a lower bioavailability of iron from their diets. In meat, iron is available in a “heme” form that is more readily absorbed than the inorganic form of iron found in plants. Red meat and spinach both have a high iron content. 20% of the heme iron available in a lean steak is absorbed, but only 2% of the iron in cooked spinach is actually absorbed. The iron RDA for vegetarians is 14 mg for men and 33 mg for pre-menopausal women. Physical activity can also deplete iron stores. Sports activities, exercise, and heavy labor can raise the daily requirement for iron. Any bleeding causes iron depletion. A loss of one ml of blood results in a loss of 0.5 mg iron. Low stomach acid results in poor iron absorption, and intestinal damage from celiac disease often causes iron deficiency. Other dietary factors also affect how much iron is absorbed. Vitamin C consumed in the same meal as non-heme iron improves the absorption of the non-heme iron by up to 50%. Heme iron also increases the absorption of non-heme iron. Tea, coffee and certain types of fiber (eg. phytate) can inhibit the absorption of iron.

Taking a look at myself, I am mostly vegetarian. I have low stomach acid. My intestines may still be impaired from celiac disease, and reactions to food intolerances or allergies could also impair absorption. I sometimes experience loss of blood from rectal bleeding through an anal fissure as a result of bowel distress. I do a long series of stretching exercises every morning, and my work involves moderate physical activity. Suddenly, a supplement providing only 10 mg of iron daily seems totally inadequate for my needs. Iron deficiency could definitely explain my fatigue. Recently, I have begun daily supplementation of iron in the form of 28 mg iron from ferrous gluconate in addition to the 10 mg of iron I already take. It is too soon to tell if iron supplementation is improving my fatigue, but I do seem to be a little less fatigued. Hopefully, I will see continued improvement.

Food Allergies and Intolerances

Multiple food allergies often accompany celiac disease. In addition, temporary intolerances to dairy products and sugars may result from celiac disease. Enzymes which digest lactose and various other forms of sugar are produced in the lining of the small intestine. Production of these enzymes is impaired by damage to the intestine from celiac disease. Sugars and lactose are thus not properly absorbed. Low stomach acid, if present, also results in incomplete digestion of proteins, fats and carbohydrates. Damage to the intestine results in the intestine being less capable of absorbing nutrients. An accumulation of undigested sugars, and other nutrients promotes an overabundance of intestinal bacteria and other micro flora which feed on the ready supply of unabsorbed nutrients. The secretions and toxins generated by these micro flora can cause gas, discomfort, and other symptoms of intolerance and bowel distress. Intestinal damage also increases intestinal permeability or “leaky gut”. Undigested and normally harmless food proteins can “leak” into the blood stream and into other body systems where they may be identified as intruders, initiating allergic and immune responses.

I have come to believe that the thymus gland may also be involved in the acquisition of food allergies. The thymus is located behind the breastbone and is responsible for the generation of T cells, critical to the function of the immune system. Until quite recently, it was thought the thymus stopped producing T cells after puberty when the thymus begins to shrink. However, it is now known the thymus continues to produce T cells in adults and throughout life. Certain regulatory T cells help the immune system decide whether foreign proteins should be tolerated or attacked. If these regulatory T cells are not in sufficient supply, allergic reactions to harmless proteins may result. The thymus is particularly sensitive to malnutrition. Hence, malabsorption from celiac disease or low stomach acid may adversely affect the thymus and its ability to produce regulatory T cells, thus leading to or contributing to multiple food allergies.

Maintaining a gluten-free diet allows the gut to heal. In most cases, the intestine will again produce the enzymes to digest lactose and other sugars, and these intolerances may go away. Intestinal permeability will decrease, and food allergies and sensitivities may lessen. The thymus may also recover from malnutrition, if not too severely damaged. If you have low stomach acid, food allergies will continue to be a problem unless you take acid supplementation (eg. betaine HCl) and digestive enzymes with every meal. Some food allergies or sensitivities may not completely go away.

To help speed healing, it is probably best to avoid foods which are causing problems. If you have a reaction shortly after consuming the food, typically less than 30 minutes, it may be easy to determine the offending food. Some foods may cause a delayed reaction. It may be hours or even days or weeks before antibody production reaches a level high enough to cause a noticeable reaction. This makes identification of the offending food difficult. Elimination diets can be used to identify which foods are safe and which are not. Stick with eating a few basic foods that you know you can tolerate well, and then add suspected foods to your diet one at a time, allowing sufficient time—days or longer if necessary—to observe a possible reaction. Elimination diets are tedious. Some tests are available which can help to identify possible food sensitivities. These tests include the skin prick test, the RAST (Radioallergosorbent test), the ELISA (Enzyme-Linked Immunosorbent Assay) test, and the newest test, the ImmunoCAP® Specific IgE test (a fluoroenzymeimmunoassay (FEIA) ).

The skin prick test is performed in a doctor’s office, a prick for each allergen being tested, and can be expensive. RAST testing uses a blood sample to test for the amount of specific IgE antibodies present. ELISA testing also uses a blood sample, but tests for specific IgG antibodies instead of IgE antibodies (associated with true allergies.) IgG reactions can typically occur hours or days after encountering a food or antigen. The ELISA test can be useful in identifying foods which cause delayed reactions. ELISA tests which can test for 190 or so food sensitivities in one blood draw are available for a relatively modest cost. However, the reliability of ELISA tests depends on the laboratory performing the test, and results between different laboratories vary greatly. RAST test results also vary from lab to lab. RAST tests are being replaced by ImmunoCAP® tests. The ImmunoCAP® Specific IgE test is much more accurate and reliable than the RAST test, and test results are consistent from lab to lab. Costs for ImmunoCAP® or RAST tests can add up as the cost increases for each different allergen being tested for.

When I first put myself on a gluten-free diet after years of chronic diarrhea and learning about celiac disease, within a few days I had the first solid bowel movement I could remember in years. But the elation was short-lived. For months afterward, my bowel movement kept changing form from solid to liquid, and the chronic diarrhea kept reappearing. Then, finally, my first breakthrough came. The growing season for melons ended. When melons were no longer a part of my diet, the chronic diarrhea finally disappeared. I had made my first discovery that other foods besides gluten were causing me problems. I began to pay close attention to any reaction or bowel distress that occurred after eating any foods. Soon I was finding foods I had been freely consuming daily and all my life were creating reactions. Fruits were especially troublesome. In response to apples, pears, bananas, oranges, tangerines, hot chocolate, popcorn and more, I was sniffling, experiencing throat irritation, a general malaise, fatigue, and bowel distress within 20 minutes after ingestion. I started to eliminate these foods from my diet. Since, childhood, I have had a chronic throat-clearing problem, and, now, decades later, I finally learned the throat-clearing was due to a sensitivity to corn. I eliminated all corn and products containing corn from my diet, and the throat-clearing finally stopped. Every time I eliminated one food, however, I soon found myself sensitive to a new food. Finally it got to the point where I was reacting to almost everything I ate, even to potatoes and rice cakes. You can imagine the desperation I felt standing in the supermarket produce aisle, one day, hopelessly searching for something I could safely eat.

Meanwhile, on the internet I noted that some people were reporting that taking digestive enzymes had allowed them to consume foods they had not been able to eat for years without getting ill. Enzymes were theorized to breakdown proteins into pieces too small to cause reactions. That sounded reasonable to me. So I went to a health food store and bought some digestive enzymes, Enzymedica Digest, to be specific. Taking one capsule with each meal, the effect was immediate. I quickly found myself able to consume at least some foods again without reaction. All seemed to be going well for about a month, until I again started reacting to an increasing number of foods. Now what was I supposed to do?

Back to the internet! This time I learned about hypochlorhydria, low stomach acid. Back at the health food store, I bought betaine HCl. Taking betaine HCl and digestive enzymes with every meal once again caused the food sensitivities to go away—and this time stay away. I still keep melons, citrus fruit, and corn, as well as gluten, out of my diet. I rotate other fruits so I do not consume them on consecutive days. I find that new foods I have never eaten before can cause me problems. Montina (Indian rice grass flour) and sorghum flour cause me to have a sore throat reaction. I tried to add avocados to my diet, which I have never eaten before.

After eating a couple of avocados a week for a few weeks, I broke out in hives for the first time in my life, an experience I do not want to repeat. I guess the tolerance mechanism of my immune system is now so screwed up, my immune system will no longer tolerate the introduction of any new foods into my diet. As long as I stick with old dependable foods, betaine HCl, and digestive enzymes, I seem to be on the road to recovery.

Health Basics

While all or some of the above mentioned suggestions may help you fully recover from celiac disease, it is still important to remember the basics of keeping healthy—and that is to eat a healthy diet, keep the weight off, keep active, and exercise regularly. Celiac disease has been associated with diabetes, so it is even all the more important to keep those sugary junk foods and simple carbohydrates under control and out of your diet. In addition to improving mobility and muscle tone, exercise can just plain make you feel better and help keep your bowel movement regular. For years I have been doing daily morning yoga-like stretching exercises, becoming evermore flexible and able to obtain extreme positions as well as great balance control. I began the stretching exercises when I developed pains and cramping in my legs and it became uncomfortable just to bend my legs at the knee. My ankles would also easily buckle while walking up stairs. That was many years ago, and the leg pains and other aches are long gone. I am much more flexible now than I was as a teenager in high school. I find that the exercise almost always helps to induce a bowel movement.

Conclusion

It took me years to diagnose myself as being gluten intolerant and five more years to discover the steps toward recovery I have presented here. I am still not completely well, but, little by little I am improving. If I had not taken these steps, I would hate to think of the condition I would be in now. If I had had this knowledge years ago and acted on it—think of all the suffering and discomfort I could have avoided. It is my hope that you will use and find this information helpful to speed your recovery so your suffering will not be prolonged needlessly. Feeling ill is no way to live a life.