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Found 16 results

  1. Celiac.com 12/02/2017 - Pozole, pozole, pozole. Pozole seems to be popular lately. Pozole is a hominy-based Mexican stew closely associated with the Pacific-coast state of Guerrero. I've noticed a number of references to pozole lately. I've seen articles touting pozole in place of traditional turkey dinner for Thanksgiving, and articles about using leftover Thanksgiving turkey to make pozole. This tasty recipe calls for chicken, but you can easily substitute turkey, leftover or otherwise. When stewed in chicken broth and other tasty ingredients like tomatillos, green chiles. Ingredients: Three 15-ounce cans of hominy, drained 8 cups chicken stock 2 cups water 6 chicken thighs on the bone, with skin 1 pound tomatillos, husked and halved 1 medium onion, quartered 2 poblano chiles, cored, seeded and quartered 2 jalapeños, seeded and quartered 6 large garlic cloves, smashed 1 tablespoon oregano leaves Salt and freshly ground black pepper 1 tablespoon vegetable oil For Serving: Finely shredded cabbage Fresh Mexican cheese (queso fresco) chopped cilantro sliced radishes chopped onion diced avocado sour cream tortilla chips lime wedges Directions: In a large stock pot, bring the chicken stock and water to a boil. Add the chicken thighs, cover and simmer over very low heat until they're tender and cooked through, about 30 minutes. Skim any fat from the cooking liquid and reserve. In a blender, combine the halved tomatillos with the quartered onion, poblanos and jalapeños, smashed garlic, chopped cilantro and oregano. Blend until coarsely chopped. With the machine on, add 1 cup of the cooking liquid and purée until smooth. Season with salt and pepper. In a large deep skillet, heat the vegetable oil. Add the tomatillo purée and cook over moderate heat, stirring occasionally, until the sauce turns a deep green, about 10 minutes. Pour the green sauce into the cooking liquid in the stock pot. Add the hominy and bring to a simmer over moderate heat. Add the chicken thighs back to the stew, season with salt and pepper and cook just until heated through. Serve the pozole in deep bowls, and garnish as desired with quest fresco, cabbage, radishes, onion, avocado, sour cream, tortilla chips and lime wedges at the table.
  2. Celiac.com 11/04/2017 - If you're looking for a quick, nutritious and lean gluten-free dish, then try this recipe for surefire stir-fry. It's easy, delicious and highly versatile. You can make with chicken, pork or beef, as desired. I bet you can use tofu if you like. You can use nuts of choice, or none at all. You can use snap peas instead of green beans. Whatever you do, serve this over rice for a guaranteed dinner winner. Ingredients: 12 ounces chicken, pork, or beef, lightly salted, and cut into bite-size strips (about 1½-inches by ¼-inch) 8 tablespoons gluten-free soy sauce, split 3 tablespoons honey or brown sugar 2 teaspoons, sake or white wine, just a splash 4 garlic cloves, minced 3 fresh medium brown mushrooms, cleaned and sliced ¼ teaspoon dried crushed red pepper, as desired 1 pound green beans, trimmed, cut into bite size pieces 2 carrots, peeled, cut to matchstick-size strips 2 tablespoons cooking oil, like avocado or canola, corn, etc. 1 large red bell pepper, cut into bite-size strips 1 thumb peeled fresh ginger, sliced ½ medium onion, cut into wedges, sautéed 1 green onion, thinly sliced ½ cup lightly salted dry-roasted cashew halves, or sunflower seeds or anything like that Directions: Mix meat, 4 tablespoons soy sauce, 1½ tablespoons honey, 2 cloves of garlic, and crushed red pepper in medium bowl. Whisk remaining 4 tablespoons soy sauce and remaining 1½ tablespoons honey in small bowl; set aside. Cook green beans in large saucepan of boiling salted water until crisp-tender, about 3 minutes. Add carrots to green beans in water; cook 1 minute. Drain carrots and green beans. Heat 1 tablespoon cooking oil in wok or large non-stick skillet over high heat. Add onions, ginger, red bell pepper, mushrooms, and stir-fry 1 minute. Add green beans, carrots, and remaining 2 cloves garlic, and stir-fry 1-2 minutes, until firm, but tender. Transfer vegetable mixture to a dish. Add remaining 1 tablespoon cooking oil to wok and allow to heat. Add meat and stir-fry 3-5 minutes more, until cooked through. Add the cashews, stirring briefly, about 30 seconds. Add the soy sauce-honey mixture; stir until heated through, about 1 minute. Season to taste with salt and pepper. Transfer into the bowl with the veggies, and mix well. Sprinkle with sliced green onions and serve over rice. Serves about 4 people.
  3. One of the best things I ever ate was the green-chile stew I had at a restaurant in Taos, New Mexico the name of which I don't remember. Still the stew of local, fresh roasted green chiles, squash, corn and pork stays in my mind to this day. Anyone who has ever spent time in New Mexico can likely attest to the New Mexicans' love affair with the green chile. Anyone who's tried the fresh, green chile stew has likely thought about having more one day. They make green chile stew all over New Mexico, and they make it many different ways, but it always comes out delicious. If you can't get fresh roasted green chiles, then try to find frozen diced chiles at your local market. This recipe makes enough to serve eight people. Ingredients: 3 tablespoons olive oil 2 pounds cubed pork stew meat 1½ large yellow onion, diced 5 cloves garlic, minced 3 cups chopped, roasted green chiles 1 can diced tomatoes with juice (14.5 ounces) 2 yellow squash, cut in one-inch cubes 1 cup fresh steamed, or frozen corn kernels 1 can pinto beans, drained (16 ounces) 1½ cups tomatillo salsa 6 cups chicken broth 1 teaspoon dried oregano ½ teaspoon chili powder ½ teaspoon paprika ¼ teaspoon ground clove salt and pepper to taste Directions: Heat the olive oil in a large soup pot over medium-high heat. Season the pork with salt, pepper, paprika and chile powder, and add to pot. Cook until well-browned on all sides. Remove browned pork and set aside. Lower heat to medium, and stir in the onion, garlic and squash. Cook and stir until the onion is soft and clear. Return the pork to the pot, and stir in the green chiles, corn, diced tomatoes with juice, tomatillo salsa, and chicken broth. Add oregano and ground clove. Raise heat to medium-high, and quickly bring a boil, then reduce heat to low, cover, and simmer 30 minutes. After 30 minutes, spoon off 2 cups of the soup, making certain it contains NO pork pieces, and pour into a blender. Hold down the lid of the blender with a folded kitchen towel, and carefully start the blender, using a few quick pulses to get the soup moving before leaving it on to puree. Puree until smooth, then pour back into the cooking pot. This is a good way to thicken the stew and eliminate some of the chunkier pieces. Continue to simmer at least 30 minutes to one hour more, stirring occasionally, until the pork is very tender. Serve with rice, beans and corn tortillas.
  4. Celiac.com 02/12/2014 - This green curry is one of my favorite Thai-style meals to cook at home. It is easy to make, and delicious. It can be served over rice or gluten-free noodles, and you can include whatever vegetables you like or have on hand. You can also add any kind of meat or tofu you desire, as you are cooking the vegetables. Ingredients: 1 cup jasmine rice 1 cup torn fresh basil leaves 2 tablespoons fresh lime juice (from 1 lime) 8 ounces green beans, stem ends removed, halved crosswise ½ cup baby corn, as desired ½ cup frozen peas 2 baby eggplants, halved lengthways, cut into 2cm pieces 4 kaffir lime leaves (see note), roughly torn, plus 2 carrot, sliced in bite-sized pieces 1 medium onion, sliced 1 bell pepper, de-seeded and sliced into bite-sized pieces 2 tbs fish sauce 1 tbs lime juice 2 tsp grated palm sugar, or regular sugar 2 cups chicken broth 2 tablespoons vegetable oil 1 to 2 tablespoons Thai green curry paste, to taste 1 can (14.5 ounces) coconut milk ¼ cup cilantro (as garnish) Directions: Prepare rice. Heat oil in a wok or deep frying pan over high heat. Add eggplant and stir-fry for 3-4 minutes until golden. Set eggplant aside. Add paste to wok and stir briefly. Add green beans, carrots, onion, bell pepper, and stir-fry, tossing to ensure paste doesn't burn, for 1-2 minutes until lightly seared. Add coconut cream, chicken stock, lime leaves and corn and bring to the boil. Return eggplant to pan, then reduce heat to low and simmer for a further 5 minutes until chicken is cooked and corn is just tender. Stir in fish sauce, lime juice and sugar and heat through for 1 minute. Garnish with cilantro as desired, and serve over rice or rice noodles.
  5. Celiac.com 01/28/2014 - One of the things I love most about food and cuisine is how much there is to discover. I'm always especially pleased to 'discover' a food that seems like it has been long enjoyed by nearly everyone but me. One such 'discovery' is Portuguese Green Soup. I had a delightful version of this soup a while back, and it really stuck in my mind. This soup is perfect for a cold night. Ingredients: 1 quart cold water 1 quart chicken broth 10 small potatoes, peeled and thinly sliced 6 ounces linguica or chorizo sausage, thinly sliced 4 tablespoons olive oil, divided 1 pound kale, rinsed and julienned 1 medium onion, chopped 3 cloves garlic, minced 3-4 medium shallots minced 2½ teaspoons salt ground black pepper to taste 1 can hominy (optional) Directions: In a large stock pot over medium heat, sauté onion, shallots and garlic in 3 tablespoons olive oil for 3 minutes. Stir in potatoes and cook, stirring constantly, 3 minutes more. Pour in water and chicken broth. Boil gently for 20 minutes, until potatoes are mushy. Meanwhile, in a large skillet over medium-low heat, cook sausage until it has released most of its fat, 10 minutes. Drain. Mash potatoes, and stir the sausage, salt and pepper into the soup. Cover and simmer on medium heat for 5 minutes. About 5 to 10 minutes before serving, stir kale into soup. Add hominy as desired. Simmer, 5 minutes, until kale is tender and bright green. Stir in the remaining tablespoon of olive oil and serve at once. Serve with toasted gluten-free bread and butter.
  6. For a traditional green bean casserole, Funyuns are gluten free and can be used as a topper to replace fried onions or you can fry up your own onions with Jules Gluten Free All Purpose Flour and your favorite recipe. For a slightly healthier version, try these baked (“fried”) onions. Fried Onions Ingredients: 1 medium onion, sliced thinly 1/3 cup Jules Gluten Free™ All Purpose Flour* ¼ tsp. sea salt Nonstick cooking spray Directions: Preheat oven to 475 F. Spray a baking sheet with cooking spray and set aside. Combine the chopped onions and dry ingredients in a large bowl, tossing until totally coated with flour. Pour out onto baking sheet and separate the onion ring slices so they are not touching each other too much. Bake for 15-20 minutes, tossing one or two times while cooking to golden brown. Remove when cooked and set aside while you are making the casserole. Green Bean Casserole With a few substitutions, you can still enjoy your favorite Thanksgiving day casseroles, like green bean casserole. Progresso Cream of Mushroom Soup and Health Valley Organic Cream of Mushroom Soup are two gluten-free options. For a dairy-free option, Imagine Foods has a mushroom soup that is both gluten free and dairy free. Ingredients: 1 pound green beans, canned or fresh, rinsed, trimmed and halved 2 Tbs. unsalted butter or non-dairy substitute (e.g. Earth Balance® Buttery Sticks) 2 large portabella mushrooms, sliced ½ tsp. freshly ground black pepper ½ tsp. garlic powder ¼ tsp. ground nutmeg 1/3 cup dairy or non-dairy sour cream 2 Tbs. Jules Gluten Free All Purpose Flour* 2 cups cream of mushroom soup 1 fried onion, thinly sliced (see recipe above) *See my bio (top-right) Directions: Preheat oven to 400 F. If using fresh beans, boil in lightly salted water for 5 minutes, then rinse with cold water and drain. If using canned beans, rinse and set aside. In a large saucepan, melt the butter and toss in sliced mushrooms and pepper. Stir over medium heat for 5 minutes, then add spices and flour, stirring to coat. Cook an additional minute then add the sour cream and soup and lower the heat to medium-low. Cook while the mixture thickens, approximately 5-8 minutes more. Remove from heat and stir in half of the fried onions and all of the drained beans. Pour mixture into a large casserole and cook for 10 minutes, or until bubbly. Sprinkle the remaining onions on top and bake for an additional 5 minutes. Serve warm.
  7. (Serves one. Multiply it for each serving.) Salad is best if it’s crispy fresh. So this is for a single serving, but it fills a dinner plate to the brim! Ingredients: Tossed green salad mix. One healthy handful, chopped (You can buy this in a bag or you can mix it yourself—use iceberg, romaine, or any lettuce, mix w. carrots) Fresh spinach. One healthy handful, chopped (You can buy this is a bag also.) Grapes, ½ dozen, sliced into thirds. Mushrooms, large, sliced. Broccoli, ½ cup, lightly steamed in microwave Power 3, to soften for 2 minutes, then cubed. 1 hardboiled egg, chopped. Bacon bits, sprinkle on top. Gluten-Free trail mix, optional (make sure all small pieces.) Directions: It’s important that this salad is easy and quick to put together and that you can repeat the process many times. So I really suggest you have the ingredients already handy. This is why I suggest ready-packaged salad mixes. If you chop the lettuce, the carrots, the spinach, the mushrooms, the eggs, the grapes, and have the trail mix, you are set! You can have them in Ziplock bags or plastic containers. You’d be all set for an amazing raid all by yourself, or a family banquet, depending on the quantity or the occasion. This salad was something I discovered by standing in front of the refrigerator and the cupboard, taking all of the things I loved, and putting them together. Since I loved what I came up with so much I knew I had to tell my friends.I called it "Passionate Mixed Green Salad" for a reason. I hope you swoon over it!
  8. Celiac.com 08/24/2012 - Tired of the standard choices for gluten-free pasta? If researchers at the University of Brazil have their way, you may soon be enlivening your current gluten-free choices with pasta made from the flour of green bananas. The researchers included Renata Puppin Zandonadi, PhD, Raquel Braz Assunção Botelho, PhD, Lenora Gandolfi, PhD, Janini Selva Ginani, MSc, Flávio Martins Montenegro, MSc, and Riccardo Pratesi, PhD. According to an article in the Journal of the Academy of Nutrition and Dietetics, the team found a way to make pasta out of green banana flour. The flour is completely gluten-free, and the pasta compares favorably with pasta made from whole wheat, according to taste test results. Currently, green bananas are regarded an undesirable product, with low commercial value, and limited industrial use. In an effort to change that reality, the researchers set out to develop and analyze a gluten-free pasta made with green banana flour. When they tested their finished product, they found "no significant difference between the modified pasta and standard samples in terms of appearance, aroma, flavor, and overall quality," study researcher Renata Puppin Zandonadi, PhD, of the University of Brazil, said in a statement. For the study, researchers had 50 people without celiac disease, and 25 with celiac disease, taste whole wheat pasta made with eggs, and compare it with pasta made from green banana flour, egg whites, gums and water. Both the test group with celiac disease and the group without celiac disease reported that the banana flour pasta tasted better overall than the whole wheat pasta. If the project pans out, it could be a win-win-win, offering banana growers and pasta product makers a way to expand their markets, and offering consumers of gluten-free pasta a new and delicious alternative. What do you think about the idea of gluten-free pasta made from green bananas? Share your comments below. Source: Journal of the Academy of Nutrition and Dietetics
  9. Gorgonzola is a veined Italian blue cheese, made from unskimmed cow's and/or goat's milk. Contrary to popular belief, Gorgonzola, or blue cheese does NOT contain gluten. These days, blue cheese is no longer made with mold from stale bread as a starter, as it was once upon a time. The molds used to make commercial Gorgonzola and blue cheese are isolated for purity, and cultured in sterile conditions. They are gluten-free. That means that most people with celiac disease and gluten intolerance are free to eat most all blue cheeses. To celebrate that fact, I recently prepared a delicious beet salad with Gorgonzola, pear and arugula, which is one of my summer favorites. I just couldn't wait for summer to get started. This recipe makes a tasty, refreshing salad that will turn heads and delight tastebuds. Ingredients: 3 red beets, peeled, roasted and diced 1 firm Bosc or D'Anjou pear, diced 1 tablespoon lemon juice 4 ounces crumbled Gorgonzola or mild blue cheese ¼ cup extra-virgin olive oil 1 tablespoon honey ¼ cup balsamic vinegar ¼ teaspoon salt ¼ teaspoon freshly ground black pepper 2 teaspoons Dijon mustard 1 large shallot, peeled and chopped 4 ounces of mixed lettuce, washed 2 ounces arugula, washed 1 seedless tangerine, peeled ⅓ cup walnuts, halved, optional Directions: Heat oven to 350° F. Wash the beets, leave them wet, and wrap each one in foil. Arrange beets in roasting pan or on baking sheet; bake 90 minutes or until tender. Test by opening the foil and poking with a thin knife. Note: I often make my beets ahead of time, or make more beets than I need, then dice and refrigerate so I can make more salad later. Leave beets covered and allow to cool on a plate. Dice beets and pear pieces, and toss with lemon juice in a small bowl. In a separate bowl, combine oil, vinegar, honey, dijon mustard, shallot, salt, and pepper. Whisk these together until blended. Make sure beets and pears are at room temperature. Place roughly chopped greens and arugula in a bowl. Top with pears, beets, tangerine slices, and cheese, and drizzle with vinaigrette. Add walnuts as desired. Serve alongside your favorite burger or steak.
  10. Celiac.com 09/16/2011 - Add Green Bay Packer running back James Starks to the list of professional athletes who are reaping the benefits of going gluten-free, after experiencing health issues. Though Starks has not released an official diagnosis, his new diet may indicate celiac disease. If so, changing his diet and avoiding gluten will likely improve his immune system, energy level, and overall health. Starks told reporters recently that, before his change, he had "…been feasting off of carbs thinking it was good, but my body didn't react to it the right way. That played a big part in the healing process." Since going on a gluten-free diet, Starks says he has put more weight on his 6'2" frame, and is now up to 225 pounds, right where his coaches want him. He also says he feels stronger. Starks is one of many pro athletes who have recently gone gluten-free. Others include: Kyle Korver of the Chicago Bulls, who credits a gluten-free diet for an improved post-game recovery; US swimmer Dana Vollmer, who went gluten-free before winning her first gold medal at the 2011 World Swimming Championships, and after years of battling severe stomach aches and fatigue; and UFC fighter Dennis Hallman, who celiac disease, who has openly discussed his condition and following adjustments to his training regimen. Like everyone who has made the switch away from gluten, Starks has had to make his own personal sacrifices, avoiding favorites like fried chicken and pepperoni pizza. However, those sacrifices are paying off with a renewed energy and vitality leaving Starks hungry for another Superbowl run.
  11. The versatility of green beans to adapt to different flavors makes them an incredible side that compliments almost any meal. This is a beautiful dish that blends ease with elegance. The nuttiness of the almonds contrasts tartness of the cherries and because the beans are blanched, they cook to crisp perfection. This salad makes for an incredible bite. Cherries are high in iron and antioxidants and their flavor lends this dish to be enjoyed by even the pickiest of veggie-phobes. Ingredients: 1 ½ pounds green beans 1/3 cup minced shallots 2 tbsp chopped mint 1/3 cup dried cherries ½ cup toasted slivered almonds 1/3 cup extra virgin olive oil 3 tbsp plus 2 tsp red wine vinegar 1 ½ tsp kosher salt 1 tsp sugar Preparation: Cherry vinaigrette can be made up to one day ahead. Keep covered and chilled; bring to room temperature before re-whisking to serve. In a small bowl, whisk together olive oil, shallots, red wine vinegar, mint, salt and sugar. Stir in cherries and set aside. While a large pot of water comes to a boil, fill a large bowl with ice water and set aside. Add beans to boiling water and let cook until tender and crisp, no more than 5 minutes. Drain and transfer beans to the ice bath to cool. Drain once more. Toss cooled beans with the cherry vinaigrette and almonds. Sprinkle with black pepper and serve on a platter.
  12. Dr. Peter Green is a gastroenterologist and the director of the GI Endoscopy Unit at Columbia-Presbyterian Medical Center in New York City. He has a large celiac patient base. On September 29th, Dr. Green spoke to the Westchester Celiac Sprue Support Group and presented an excellent review of the medical care an adult Celiac patient should receive. What follows is a summary of Dr. Greens presentation, compiled by Sue Goldstein, a past president of the Westchester group. Initial Assessment Dr. Green sees a lot of patients who, either through their own frustration or because of physician advice, have started a gluten-free (gluten-free) diet without obtaining a biopsy-proven diagnosis of celiac disease (celiac disease). However, the need for a biopsy to establish a diagnosis of celiac disease must be emphasized. celiac disease is a lifelong illness with serious potential implications. In addition, sensitivity to gluten doesnt go away, and a radical lifestyle change is involved. You also need to be certain of the diagnosis because celiac patients families should be screened. The initial biopsy is also needed to serve as a baseline because one doesnt know what the future may involve. Basic blood work is also included in the initial assessment. Such things as anemia and liver function need to be looked for. But its very important to go further than that, and knowledge of the physiology of the small intestine should lead a physician to measure those nutrients that could be malabsorbed. celiac disease involves the small intestine, where iron, folic acid, calcium, fat soluble vitamins (K, A, D, and E) and zinc are absorbed. These nutrients should be measured in the initial assessment and also during the course of the illness. Physicians will see patients who present with malabsorption of just one of these nutrients. If they are aware of the consequences of all these nutrient deficiencies, it will help them consider celiac disease as a possible diagnosis. The patient should also have the celiac antibodies blood testing, but the diagnosis is still established on the biopsy pathology. In Dr. Greens experience, about 30% of celiacs have negative antibodies at diagnosis, so positive antibodies are not required to make the diagnosis. Antibodies testing often helps establish the need for a biopsy, but they also have great value in establishing a baseline so that an assessment can be made on how the patient is doing later on. All the antibodies should normalize, in time, when gluten is eliminated from the diet. What about the patient who seeks a diagnosis, but has already eliminated gluten from the diet? It is very difficult for many patients to go back on a gluten-containing diet to secure a biopsy-proven diagnosis. This can often take three to six months or longer. Columbia-Presbyterian has been talking about setting up alternative means of securing a diagnosis, such as a rectal challenge. The physician can take a biopsy of rectal tissue, and then instill gliadin extract into the rectum and do a repeat biopsy a certain number of hours afterward to demonstrate an inflammatory response similar to that in the small bowel. However, interpreting the results of the gluten challenge would require a pathologist who is very experienced, and sophisticated immunology on the cells of the rectal biopsy may be needed. Follow-up Care Soon after diagnosis and adhering to a gluten-free diet, patients will often report an increased feeling of well-being. How well they feel--and how quickly--will also depend on what the manifestations of their disease were. For example, if the patient was iron-deficient, it will take time for the iron stores to be restored. An assessment of vitamin and mineral levels should be part of the follow-up care. Specific deficiencies need to be addressed, treated, and monitored. Patients have been seen who have been ingesting too much of the fat-soluble vitamins, with resulting problems such as liver disease (from vitamin A toxicity), and hypercalcemia (from vitamin D toxicity) which can cause confusion, constipation, and kidney problems. Certain vitamins and minerals may need to be administered, but the patient should be under a physicians guidance as to how much should be taken. After a diagnosis of celiac disease, a bone mineral density test should be performed to assess the condition of the bones. Reports have shown that between 50-100% of people at initial diagnosis of celiac disease will have osteopenia or osteoporosis. Ostopenia is thinner bones, usually less than 2 standard deviations from normal. Osteoporosis involves an even greater deviation from normal.. In Dr. Greens experience, nearly 100% of the celiac patients at diagnosis will have osteoporosis. Surveys of celiac patients have shown an increased incidence of fractures prior to diagnosis and after diagnosis. If the bone mineral density is low, the patient should be referred to a bone mineral expert for assessment and specific individual treatment. For example, calcium and vitamin D needs will be addressed and monitored, and exercise and hormone replacement (in post-menopausal women) will be considered. At diagnosis, patients should get a Pneumovax, because it is very common for celiacs to have poor splenic function, which puts them at risk of developing certain bacterial infections such as pneumoccal pneumonia and meningitis. Since there is a genetic predisposition to celiac disease, another important issue in the follow-up is screening family members for celiac disease. Children and other first-degree relatives should have their antibodies status measured. About 10-15% of first-degree relatives have positive antibodies, and the bulk of the people with positive antibodies will have the disease, even though 50% of those people will be asymptomatic, even with a flat biopsy. What annual follow-up care should the celiac patient be getting? The most important thing is a good physical examination. Blood work, x-rays, CAT scans, mammograms and PSA tests, while valuable, do not replace a physical examination. The physical exam should include a breast exam for women, prostate exam for men, and a rectal exam for everyone. Blood work should include measurements of folic acid, calcium, and iron, and antibodies testing. Bone mineral density testing should be repeated annually for those with abnormal results, and every several years for those with normal results. Finally, patients with celiac disease should have at least one follow-up biopsy to confirm response--normalization of the biopsy sample. Patients who are non-responders, or whose clinical situation is somewhat confusing, may need more repeated biopsies at intervals. Non-responders What about the non-responders or people who relapse? The first thing is to check the diet with antibodies testing. People may be ingesting gluten, such as in medications, and not be aware of it. They may be getting gluten from licking stamps or envelopes. They may have misinformation from food labels or manufacturers. However, the antibodies can normalize and the biopsy still look quite flat, so once again, the antibodies have only a limited value--but they are still important to measure. It is also important to check the original biopsy to make sure of the diagnosis. Not all pathologists are experienced enough to properly diagnose celiac disease. Pathology departments, by law, have to keep the biopsies for a lengthy period of time--some keep them for 50 years. So it is important for the physician to review the biopsy sample with a pathologist who understands the spectrum of celiac disease. The pathologist needs to know, for example, how to identify latent celiac disease and different subtle aspects of the biopsy, such as increased intraepithelial lymphocytes. A problem that comes up in non-responders is other food sensitivities. Its very rare for people with celiac disease to also have sensitivities to other foods that result in the abnormal biopsy. There are, however, reports of ingestion of soy protein or egg or some kind of meats that cause the biopsy not to normalize. There are other conditions that can co-exist with celiac disease and confuse physicians. For example, pancreatic insufficiency can cause diarrhea and steatorrhea (malabsorption of fat), and bacterial overgrowth can affect absorption of nutrients. Patients may have colonic pathology. Having one disease doesnt mean you cant have another disease, and other conditions need to be investigated in the celiac disease patient who is not doing well. When there is no improvement in the biopsies, patients remain at the risk of developing or maintaining bone disease and vitamin deficiencies, and they are at a higher risk for malignancy. Patients who are refractory may need other therapies such as corticosteroids or immunosuppressent drugs such as cyclosporin. One doesnt engage in these therapies lightly (for example, steroids will thin the bones); being closely evaluated while on these drugs is important. Prognosis for the Celiac Patient The studies that have indicated increased mortality in celiac disease are from other countries where people have different smoking and dietary habits. It is hard to extrapolate these studies to our patient population. Dr. Green believes existing studies indicate that the mortality rate among adult celiacs is about two to three times that of the general population, and the increased mortality is found mainly in the first five years after diagnosis. After that, the mortality rate approaches that of the normal population. That tends to suggest that it is the continued ingestion of gluten that is responsible for the increased mortality. This is especially so in regard to malignancies, where the risk of diagnosis of malignancy such as lymphoma is usually highest in the first year after diagnosis, and then decreases in incidence downward until it equals that of the normal population after about five years. There is certainly the suggestion that adhering to a gluten-free diet reduces the risk of developing a malignancy. A Final Word--Looking For Celiac Disease Traditionally, the incidence of celiac disease in this country, based upon epidemiological work, suggests that celiac disease occurs in about 1 in 4,600 people. Certainly its much more common than that. Serology testing of blood donors by Dr. Fasano suggests the same prevalence as in European countries, about 1 in 300 people. Dr. Green, who does a lot of endoscopies, has found an incidence of celiac disease in about 1 in 280 patients who were having endoscopies for reasons other than suspicion of celiac disease. It is important, therefore, for the gastroenterologist to have a higher suspicion for the possibility of celiac disease, and for physicians to screen for celiac disease, particularly among their patients who have associated diseases such as Insulin Dependent Diabetes, Sjogrens, and Autoimmune Thyroid Disease.
  13. This recipe comes to us from Barbara Paull. Ingredients: 8-10 medium green tomatoes 2/3 cup boiling water ½ cup raisins 2/3 cup vegetable shortening 2 - 2/3 cup sugar 4 eggs 3 - 1/3 cups gluten-free flour mix (equal amounts of garbanzo, oat, potato, tapioca, rice and brown rice flours – Note that not all celiacs include oats in their diets.)* 2 teaspoons baking soda 1 ½ teaspoon salt ½ teaspoon gluten-free baking powder 1 teaspoon cinnamon 1 teaspoon cloves 2/3 cup pecans or walnuts (coarsely chopped) *Most gluten-free flours will work. Yields 2 loaves. Directions: Slice green tomatoes, cut in quarters, run through blender until creamy. Need 2 cups pulp for recipe. Soak raisins in boiling water. Set aside to cool. Cream shortening, sugar, and eggs in large mixing bowl. Add pulp, raisins and their water. Beat well. In separate bowl, combine flour, soda, salt, powder, cinnamon, cloves, and nuts. Add one cup at a time to tomato mixture. Stir well each time. Divide into 2 - 9” x 5” greased loaf pans. Bake at 350F for 1 hour. Possibly 10 minutes more (I turned oven off after 1 hour and left it in for 10 minutes more.).
  14. This recipe comes to us from Valerie Wells. This recipe serves 3 to 4. Ingredients: 3 or 4 chicken thighs, simmered in salted water until very tender (about 40 minutes) 6 soft corn tortillas 1 - 12-oz jar salsa Verde (green salsa, I used La Victoria brand) 3 or 4 ounces crumbled or shredded white cheese (white cheddar, Monterey Jack or goat cheese) Directions: Bone chicken and slightly shred meat with two forks. Stir in about 1/3 of the salsa to moisten and season the chicken. Spread a little dab of salsa on the bottom of a 2 quart casserole dish. (An oblong casserole dish with rounded ends works best.) Put a couple tortillas in the bottom of the pan over the salsa. Spread half the chicken mixture on top of that. Sprinkle with a little cheese. Add a couple more tortillas, the rest of the chicken mixture and a little more cheese. Lay on the last two tortillas, spread with remaining salsa and the rest of the cheese. Bake at 350F until heated through and a little bubbly (about 30 minutes).
  15. Makes 8-12 enchiladas Recipe for Green (Verde) Sauce: Puree in blender/food processor: 2 cups tomatillos (Mexican green tomatoes), 1 small garlic clove, 8 to 10 sprigs or fresh cilantro, and a tiny piece of Serrano raw green chili or jalpeño, ¼ cup diced white onion, and 1 teaspoon salt. Cook sauce for several minutes in a small pot with a teaspoon of oil until it changes color. Recipe for Red Enchilada Sauce: 1 cup chopped onions 2 cups canned tomatoes 1 - 8 ounce can tomato sauce 2 garlic cloves, minced Pinch of cayenne pepper 10 drops hot sauce (Tabasco) ½ tablespoon plus 1 tsp. chili powder 1 tablespoon honey ¼ teaspoon cumin Sauté the onion until translucent. Add the rest of the ingredients and simmer uncovered 30 minutes. To make the Enchiladas: Heat corn tortillas by quickly passing through hot oil and then pass them through the sauce. Fill the tortillas with shredded chicken or cheese. Fold/roll and place in baking dish. Cover with remaining sauce. Top with a layer of Monterey Jack cheese. Bake in oven on 350F, until hot and cheese browns slightly.
  16. This recipe comes to us from Beth Jacobs. Step 1: Mix 2 packages of Lipton Cup O Soup, Chicken Flavor (gluten-free when posted) together with ½ teaspoon Xanthan gum and Stir well. Step 2: Heat ½ cup water and ¾ cup milk to boiling and add soup mix. Stir well and cool. Step 3: Drain 3 cans green beans or equivalent amount of fresh or frozen beans , drain 2 cans mushrooms and sauté lightly in a pan. Add the soup mix to the beans and mushrooms. Top with crushed potato chips or toasted almonds. Cover and heat until bubbly. This will serve about 6 people.
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