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Celiac.com 05/22/2014 - In September 2013, I found out that if I want to be healthy, I have to eat a strict gluten-free diet. Not only that, but I also have to avoid corn, casein, beef, chicken, shrimp, garlic, yeast, grapes, cantaloupe, and cauliflower. When I go to a restaurant, my diet restrictions eliminate almost everything on the menu. Because of the lack of options and my fear of cross-contamination, I have not been to any restaurant since my diagnosis except for dedicated gluten-free restaurants. But eating at home every day for the rest of my life cannot be the answer. I will not let gluten rule my life and turn me into a hermit. Traveling is one of my biggest passions and if food is my only obstacle to living my passion, I will face my fear of cross-contamination, find solutions, and overcome this obstacle one bite at a time. Of course, my first gluten-free vacation won’t be a trekking trip across the Himalayas although this is still on my bucket list. No, for my first gluten-free vacation I have chosen a less challenging trip. I have decided to go on a seven-day Mediterranean cruise on board the Aida Sol. Aida assures, on their website, that allergy sufferers can find and enjoy a variety of delicious allergen-free (especially gluten-free and lactose-free) food aboard their cruise ships. Additionally, you can meet with the head chef for 30 minutes to discuss your diet options for the week, and there is always a chef available for questions. It all sounds so promising, but is it really as wonderful as Aida claims? Is the food aboard the Aida Sol really safe for someone with celiac disease? I’m ready to find out. Day 1 It is late in the afternoon and we are finally at the check-in desk. I am getting hungrier and more nervous by the minute. When I ask the receptionist how I can schedule my private session with the chef, he tells me to just go to one of the buffets and ask for one of the chefs. That should be easy, but I’m still nervous. This is the first time since my diagnosis that I will be eating at a regular restaurant. What if I get sick tonight? What would I eat for the rest of my trip? When we arrive at the Bella Donna Restaurant, one of the buffets on the Aida Sol, a welcoming chef gives me a tour of the buffet. He doesn’t take the time to sit down with me, but he shows me around; he points out the labels right above every dish which say whether the food is gluten-free, lactose-free, and/or vegetarian. What a relief! I immediately see several dishes that I believe I can eat. After a quick tour of the buffet, I take a plate and start grabbing more and more … meat. Yes, most of the gluten-free and lactose-free options are meat and my plate is packed with it except for a few veggies on the side. Ironically, I have never been a big meat eater until now. In fact, before I went gluten-free, I was a pescetarian. The only reason I decided to eat meat again was because I was eating as much as I could but kept losing weight. By the time of my diagnosis I was no more than 106 lb. I’m feeling wonderful. I’m at a regular restaurant and I’m enjoying my food like everybody else. Not only can I eat as much as I want, but I also have multiple choices … until we get to the dessert. I’m walking from one dessert to the next. None of the labels says gluten-free. I’m slightly disappointed. But let’s try the fruit bar! And what an amazing fruit bar it is! Besides apples and oranges, I see mangoes, kiwis, papayas, pineapples, purple & green passion fruits, persimmons, dragon fruits, cape gooseberries, and coconuts. I don’t think I’ll go hungry this week. What a relief! Day 2 First day at sea, I made it through the first night without getting sick! I’m incredibly happy. The sun is shining through the window. The balcony door is open. I can hear the waves. What a perfect morning! Until I get up. Wow! The motion of the sea is stronger than I expected. I was feeling great, but now I’m not. I feel sick. Seasick. No breakfast for me. Day 3 We’ve reached Tunisia, but before I explore the cities Tunis and Sidi Bou Said, I need to eat as much breakfast as I can since I’m not sure if I’ll be back in time for lunch and I’m too scared to try a Tunisian restaurant. This is my first breakfast on board. I’m walking around the buffet, trying to find something gluten and casein-free, but none of the dishes have labels. I’m feeling a little lost. I’ve already gotten used to those labels so much so that without them I immediately expect the food to be unsafe. I’m staring at the food, but I’m afraid to touch it. Where is the chef? When I ask the chef about what’s gluten-free, he doesn’t seem as well prepared as the first night. Maybe it is because of the lack of labels. When I ask him about the deli meat, he tells me that it is not prepared on board the ship, so he can’t tell me whether it is gluten-free or not. Why not? Why does the chef of a large cruise ship, which claims to be prepared for guests with celiac disease or gluten intolerance, not know whether the food he’s offering is gluten free? That’s not what Aida advertises on their website. I begin to realize that the staff, including the chefs, is not as well educated when it comes to celiac disease and gluten as I had hoped, which becomes even more obvious when the chef suggests that I could probably eat the ham. I’m standing in front of the deli counter, staring at the ham and then the meat-cutting machine. Wait a minute! That meat-cutting machine, is it used for all the deli meats? I begin to hear the word “cross-contamination” ringing in my ear; it’s slowly taking over my mind. I feel a bit of fear rising in my body. My trust in the chefs and kitchen staff begins to crumble. I will need to be more careful from now on and watch out for cross-contamination. Day 4 We are in La Valette, Malta. The weather has been a mix of rain and sunshine, but the city is so beautiful that no rain can cloud its beauty. I’m running around the city, trying to see as much of it as possible before I rush back to the ship to grab some lunch before the buffet closes. The restaurant I usually choose is already closed and I have to try the Markt Restaurant. Usually both of these buffets offer lots of gluten-free options, but not this time. Twice, I walk from dish to dish, trying to find something I can eat. It’s not that there aren’t any gluten-free options, but the number is so small that my other food intolerances make it impossible for me to find any food. I end up eating some fruits and a salad that has garlic in it which makes my stomach hurt. This is the first time I leave the restaurant hungry, and I’m hoping that it will be the last. Day 5 We spent the day in Palermo, Sicily, and are now ready for dinner. As usual, the dinner food is delicious. Every night my plate is packed with meat, vegetables, and fruits. So far, I can say that I haven’t been glutened, but I’ve been noticing other places of cross-contamination. Tonight, for example, you can get gluten-free pasta sauce but not gluten-free pasta. In fact, the gluten-free pasta sauce is right next to the wheat pasta. Not just that, but a few of the wheat noodles have already fallen into the pasta sauce. I will certainly not eat the sauce. Day 6 My breakfast is the same as it was yesterday, and the day before, and the day before that: bacon and eggs. Every single day I’ve been eating bacon and eggs for breakfast. Lots of bacon and eggs! At least half of my plate is packed with bacon while the other half is packed with eggs. I can feel people’s eyes on the back of my neck wondering why I’m eating so much bacon and eggs. Well, it’s pretty much the only thing I can eat for breakfast. I’m slowly getting tired of all the meat, and I wish I had other options, but my body feels fine. I am still watching out for cross-contaminated food. Tonight, for instance, I’m avoiding the cut fruits from the fruit bar because the kitchen staff that is cutting the fruits is also preparing the Kaiserschmarrn (a cut-up sugared pancake with raisins) in the same work area. Even though the staff members are wearing gloves, they haven’t been changing them before handling the fruits. It becomes more and more obvious that the kitchen staff is not well informed when it comes to gluten and cross-contamination. Day 7 Last destination: Barcelona. I have heard of the city’s numerous gluten-free dining options, but while I’m exploring the city, it feels like I’m only seeing bakeries filled with pastries made out of wheat. This entire cruise I didn’t eat any pasta, bread, cookies, or chocolate, and I’m craving it, oh, I’m craving it! Even though I don’t eat much of it anymore, it feels like I’m actually addicted to it. I’m not sure whether it’s the flour or the sugar, but it’s getting harder and harder to bear those cookies and cakes behind the shop windows. I’m trying to distract myself from what I’m seeing, which works until I walk into my room. When I open the door, I see a plate with a big piece of cake lying on my bed. Is this a joke? If it is, it’s not a good one. Where does this cake come from? My father is smiling at me. He tells me that he was in the restaurant for coffee and cake and heard someone request a piece of gluten-free cake from the kitchen, so he ordered one for me. I can’t believe it! They had gluten-free cake the entire week and I didn’t know! The chef never mentioned it. I decide to eat the cake as a special dessert after dinner. Day 8 Last night was a nightmare. I had cramps that kept me awake the whole night, and I had numbness in my fingers. Until today I was convinced that the numbness in my fingers was caused by gluten, but the cake was gluten-free, so was there maybe corn in it? I’m confused. In the afternoon, I decide to go see one of the kitchen chefs to ask him about the ingredients in the gluten-free cake. I want to know whether there was corn in it or not. The chef is very accommodating and immediately goes into the kitchen to check the ingredients on the box. When he comes back, he tells me that there is no corn in the cake but that there is a little bit of wheat in it. What? There’s wheat in the gluten-free cake. How can that be? How can it be gluten-free when there is a little bit of wheat in it? He tells me that it says gluten-free on the box. He believes that it must be just traces of wheat. Right! Traces of wheat! That’s enough to make me sick. So, the numbness in my fingers last night was actually caused by gluten. Departure After my talk with the chef, it’s time for our departure. It was a great vacation, but I’m ready to get back home, especially since my trust in the kitchen chefs has been damaged too much by this last incident. Overall, Aida Sol did not deliver as well as promised on their gluten-free commitment. Yes, Aida offers various delicious gluten-free dishes on board their ships so that no one needs to go hungry; however, because of the chefs’ and staff members’ insufficient knowledge of celiac disease and of the risks of cross-contamination, I can’t declare the gluten-free food options on board Aida Sol to be safe. My advice to gluten-free travelers is to remain careful even when it says gluten-free. Always ask for the ingredients, especially of those foods that are not prepared on board the ship. Despite their ignorance of cross-contamination, I value Aida for trying to be accommodating to allergy sufferers. There are not many hotels and restaurants that are as accommodating as Aida, but I would appreciate even more if Aida had better informed staff that is more aware of the risks of cross-contamination. It’s of no use to allergy sufferers if the great gluten-free food that is offered on board the ships gets contaminated because of ignorant kitchen staff. Furthermore, there should be at least one chef in each restaurant that is familiar with the ingredients of the foods that are not prepared on board the ship. I only got sick once at the end of my time on the Aida Sol, but I am not sure if it was pure luck that it happened not more than once.

Celiac.com 07/23/2013 - Lamb is a delicious, but often overlooked addition to outdoor summer cooking. These lamb kebabs come together easily, with minimal prep and cleanup. They grill up quickly, and offer a delicious alternative to more common beef or chicken kebabs. So, next time your appetite calls for meat on a stick, think lamb, and give these tasty kebabs a try. Ingredients: 1-2 pounds of lamb leg meat, cubed (⅓ to ½ pound per person) 1 onion, grated 1 onion, cut into wedges 1 red bell pepper 1 yellow bell pepper 1 orange bell pepper 1 green bell pepper ½ cup olive oil salt and pepper Directions: Toss cubed lamb meat with 1 grated onion, ½ cup olive oil, and salt and pepper. Allow to rest and marinate for up to 8 hours before cooking. Skewer with lemon slices, onion and different colors of bell pepper. Grill over medium-high heat, being careful not to overcook. Lamb should be served rare to medium-rare inside.

Celiac.com 05/06/2011 - Recent epidemiological studies show that the prevalence of Celiac disease had been underestimated, affecting not only Europeans, but also populations of the Mediterranean countries, such as Middle East (1-4) and North Africa (5-7), where its prevalence is similar to that of Western countries. A international team of researchers recently set out to estimate the global burden related to undiagnosed Celiac Disease in the Mediterranean Area, as computed by morbidity, mortality and crude health cost. The team included Luigi Greco, Laura Timpone, Carmela Arcidiaco, Abkari Abdelhak, Attard Thomas, Barada Kassem, Bilbao Josè Ramon, Boudraa Ghazalia, Cullufi Paskal, Hugot Jean Pierre, Abu-Zekry Mona, Kuloglu Zarife, Roma Eleftheria, Shamir Raanan, Ter Terzic Selma, and Zrinjka MiÅ¡ak. Prevalence of celiac disease among low risk populations varies from 0.14% to 1.17% (15-17): 1%-1.3% in Turkey (18.19), 0.6%-0.96% in Iran (20-21), 0.5% in Egypt (22), 0.6% in Tunisia and Israel (23-24), <0.5% in Jordan, Lebanon, and Kuwait (1.10,16.25). Among high risk groups (patients with positive family history, insulin dependent diabetes mellitus, thyroiditis, etc.) the prevalence of celiac disease ranges from 2.4% to 44% assessed by serological markers and biopsy (26-27). The team discovered a celiac disease prevalence of 1%, an incidence, based on new Cases/year estimated on 1% of the live births of 1 in 7 symptomatic adults, and 1 in 5 children. Their results showed standardized mortality rate of 1.8 compared to age and sex matched population. They found that the delay between symptoms and diagnosis was six years for adults, and two years for children. The team found associated conditions in 10% of the total cohort (KB 30%: Turkey 2% Iran 33% , IDDM 10% (6.7-18.5%). Sixteen percent of symptomatic patients showed celiac disease-related complications. The team found the following non GI Symptoms among symptomatic patients: short stature 25% Anemia 40% (20-80%) Osteopenia 30% (30-50%), abnormal liver function 10% (Turkey 38%, Iran 25%). In the Northern Africa Region and in the Middle East very high incidence of celiac disease has recently been reported both in the general population and in at risk-group. These high frequencies are due to the wide consumption of wheat and barley and to the high frequency of the DR3-DQ2 celiac disease predisposing haplotypes in these population (13,14). Source: http://www.medicel.unina.it/00_materiali/materiali_evento_napoli/the_burden.pdf