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Celiac.com 11/19/2008 - Day Four: After a ride on a local public bus, which hugged the narrow road's teetering edge and rounded hairpin curves with an alarming sense of speed, we felt grateful for the solid earth beneath our feet in Positano. Our first order of business was to check into the Hotel Villa Rosa and find a nearby trattoria to fill our grumbling stomachs! One of the staff, Stefania, recommended Caffè Positano on the Fornillo side of the town and arranged for a courtesy taxi to deposit us at its doorstep. Without a doubt, its chief allure was the alfresco terrace facing the sea. Situated across the road from the main restaurant and kitchen, the terrace held a dozen or so umbrella-topped tables and beckoned foreigners with unforgettable views. Jill: We decided to share an enormous plate of salty prosciutto and cold sweet melon as an appetizer. Jeff ordered pesce spada griglia (grilled swordfish) and I chose petto di pollo aceto (grilled chicken with a balsamic vinaigrette, parmesan and arugula). We nibbled at each other's dishes and savored every bite of that culinary welcoming, so much so that we'd find ourselves back for more during our stay. Days later, upon seeing zuppa di verdura (minestrone soup) on the menu, Jeff asked how it was prepared. Our server confirmed it did not contain any noodles/macaroni or gluten, and Jeff was pleased to have his fill of the strictly vegetable-based soup, which we learned is how minestrone is typically prepared in the region. Experimental cook that he is, Jeff was eager already to replicate the recipe when we returned home to San Francisco. Jeff: The Villa Rosa provided an ample gluten-free breakfast. Each morning my tray included a gluten-free chocolate croissant and gluten-free toast with butter and jam, along with our usual assortment of coffee, tea and yogurt. After we finished a late breakfast, lounging at the beach was one of our favorite things to do. Like many beach areas, lunch fare leaned toward sandwiches, pizzas and the like. The few restaurants tended to be overpriced, but we found a reliable alternative in the salumeria, the Italian version of the delicatessen which means "cured meat shop." It had a variety of cheeses, meats and salads priced by the kilo. In addition to fresh pasta and pasta salads, the place usually had salads that were pasta-free and gluten-free. Also, once I discovered that French fries were readily accessible (yes, in Italy) and the minestrone was, in my experience, always gluten-free, I knew I had a reliable fallback. This reinforced my confidence and led us to make an exception of avoiding sit-down lunches near the beach. We tried La Cambusa, where the waiter called us by our city of origin: Mr. and Mrs. San Francisco. I had my staple fallback meal, and Jill snacked on a tasty ham and cheese omelet that she washed down with a glass of prosecco. Jill: While most of our experiences were positive, we had a few missteps along the way. During our first evening at a beach snack shop, Jeff ordered saltimbocca, a dish generally prepared with rolled veal, prosciutto or ham and cooked in a wine and butter sauce. However, what he ended up with was a sandwich version, pressed between thick slabs of bread, that I stuck in our fridge for my lunch the following day. Another time for dinner, we visited Donna Rosa, a family-run trattoria perched high in the hills of nearby Montepertuso, where the locals know to go to eat well and on the cheap. For an appetizer we chose scallops which, to our consternation, were lightly dusted with a bread-crumb gratin that wasn't described on the menu. These surprises could have been averted, though, if we hadn't let down our guard and relied too heavily on the menu. Ultimately, these experiences nudged us to remember to ask questions upfront and not get too comfortable. Day Nine: When we arrived in the more isolated fishing village of Praiano, a veritable country cousin to cosmopolite Positano, Jeff plopped down in the pastel-hued restaurant of the Hotel Margherita mere minutes after dropping his bags. He was famished and awaited a sumptuous plate of spaghetti posillipo, made with the hotel's gluten-free spaghetti and mushrooms. In fact, Jeff was so enamored with the heaping dish of gluten-free goodness that he borrowed my digital camera to snap a photo and in a flurry of excitement accidentally erased all of our other pictures! Well, at least we've got the memories... The Hotel Margherita proprietor Suela and her husband Andrea were also attentive to Jeff's breakfast needs. In addition to the standard buffet that had a generous gluten-free assortment of eggs, deli meat, cheeses, yogurt, coffee and tea, they purchased extras for Jeff, including a sweet, gluten-free lemon muffin and gluten-free toast. Jeff: On the Vettica side of Praiano, the Trattoria San Gennaro was a brisk fifteen-minute walk from the hotel and sat above the main piazza and church. The view from the terrace was both panoramic and quaint, with the Mediterranean offsetting glittering Positano at night and the piazza coming alive with families sitting about while their children played soccer. The place had been recommended by a kind gentleman named Nicola who works at the Villa Rosa in Positano and lives in Praiano. The restaurant served the best bowl of gluten-free minestrone yet! It was so big I have described it as a “tankard” of soup, loaded with fresh vegetables. Though, you do need to ask the kitchen to hold off on the freshly toasted bread garnish. I’ve rarely been so completely well- fed as when I ordered the fries, minestrone and local fish specialty for dinner on our first night. We lingered well into the night, sipping the local wine and taking in the smell of the sea. Day Twelve: Perched on the cliffs, Ravello is often heralded for its gardens, Villa Rufulo and Villa Cimbrone, and has played host to departing Crusaders, famous authors and numerous other visitors throughout history. The town's stone walls, quaint walkways and tight, cobblestone streets exude the charm of antiquity. Gluten-free dining proved to be equally simple here. We arrived at the Hotel Graal early afternoon and were starving after two long cramped bus rides from Praiano. We headed to the restaurant, where the maître d' guided us to a shaded table on the terrace. Soon we lunched on gluten-free mushroom penne pasta and salad and took in stunning views of the ocean and the nearby seaside village of Minori. Jill: Perusing our guidebook, we found a trattoria tucked away beyond the main piazza called Cumpa' Cosimo and decided to give it a try for dinner. Thankfully we'd made a reservation, as the medieval-inspired place that was dotted with pictures of celebrities and run by Italian nonna (grandmother) Netta Bottone filled up fast. Everything on the menu looked enticing. The roasted rabbit caught Jeff's eye, along with more minestrone soup. He couldn't seem to get enough of the stuff! Craving comfort food, I bypassed the local specialties for a four-cheese pizza and glass of beer. After trying a bit of Jeff's entrée, though, I had a serious case of rabbit envy! We were pushing our last-bite limits when Netta paraded over to our table with a complimentary dessert, something like a cross between cheesecake and tiramisù, which Jeff picked at in order to avoid the crust (Celiac.com does not recommend doing this), and I couldn't resist polishing off. When Jeff mentioned that he was a writer as we paid our tab, Netta darted back to the kitchen and returned with a plate of figs and grapes. From her garden, she said, and insisted we put them in our pockets for later. Day Fourteen: Rome may be the Eternal City, but we had all of a day and a half there to explore, with the half starting after our nine-hour transit by private car, Amtrak train and then a female Formula One taxi driver at Termini Station. Since the next day was Sunday and we had no desire to fight the faithful who would attend mass, we opted for a quick visit to St. Peter's and from there trotted over to the Trastevere district for dinner. The Trastevere, a bohemian counterpart to New York's East Village, is one of my favorite places and it won over Jill, who hadn't quite been captured by the Roman magic. Even in August when the area was thick with tourists, street vendors and buskers, it seemed like a breath of fresh air in a city that can be every bit as overbearing as New York or London. We eyeballed a few menus and sniffed out a crowded place that seemed to move food at a good clip. It was elbow-to-elbow seating at our cramped alleyway table, with throngs of tourists shuffling past, but soon we dined under a blue Roman sky at dusk. We enjoyed a flavorful gluten-free meal of fresh salads, veal marsala, mushroom risotto and handmade local sausages. Despite being stuffed already, we couldn't resist some stracciatella (chocolate chip) and nocciola (hazelnut) gelato near the Piazza Santa Maria, where a polished quartet of young classical musicians serenaded the crowd. In general, we noticed an abundance of gluten-free salads, soups, roasted meats and risottos in Rome and in all four towns we passed through along the Amalfi Coast. We found reliable delis and easy access to fresh fruit. When we asked, places that did not have gluten-free pasta showed a willingness to prepare any that you provided. So, with a quick trip to the local pharmacy for some gluten-free pasta, you could dine with confidence! Contrary to our fears before the trip, eating gluten-free while traveling in Italy proved easy to do. With a bit of planning, a call to the airline to line up a gluten-free meal, an Italian/English explanation of your dietary needs and the standard caution nearly all people with gluten intolerance bring to eating out, anyone can look forward to an enjoyable, gluten-free holiday in Italy. Co-written by Jefferson Adams
Celiac.com 12/29/2015 - I discussed the possibility of a Low Glycemic Paleo Diet as an entertaining idea as a beneficial diet for celiac in the last issue, Winter 2015. In closing, I stated I would reveal more about this topic in the coming issue. So, let's dive in and open our eyes to some facts and even some revealing possibilities that may very well help improve our health and quality of life. As a celiac myself, (2 of my three kids have celiac disease and my grandfather died from undiagnosed celiac disease) I was more than happy to follow the gluten-free diet diligently once finally diagnosed after many years of distress, bone loss, declining health not to mention non-stop bone aches, bowel inconsistency and severe lack of muscle tone. I will spare you further details but there was no doubt a major beneficial change that occurred once I eliminated all gluten from sources of wheat, rye and barley and all its "relatives" or any possible cross contamination. Eventually I was thrilled to be able to eat baked good substitutes that did not hurt my belly, cause my joints and bones to ache and were absolutely delicious and healthy, as they were gluten-free! Soon after I became an active advocate (and for many years) I was thrilled to be able to speak broadly to help raise awareness about celiac disease and the NEED for the gluten-free diet. I was also soon working closely with many gluten-free companies (as a tester, consultant and promoter) becoming blind to the fact that the boxes that were arriving to my door by the truckload were all desserts, loaded with carbohydrates and sugars. At the time I wrote and spoke often (in interviews and on radio) about Type 2 diabetes and celiac disease but never put two and two together. If lifestyle and diet change can address Type 2 permanently, what were these diet changes that were so effective? Also, even more to the point, why was Type 2 diabetes so common as a diagnosis after being diagnosed with celiac disease and going on the gluten-free diet? Research suggests an association between Type 1 diabetes and celiac disease, but there does not appear to be a link between celiac disease and type 2 diabetes. Type 2 is not an autoimmune disorder and doesn't share genes with celiac disease. According to the Celiac Sprue Association, individuals can be genetically predisposed to Type 2 diabetes, but those genes don't increase the risk of celiac disease. Let's look at the immense increased ingestion of glucose, sugars and carbohydrates and fiber while one is on the gluten-free diet by indulging in baked goods, desserts and grains! Gluten-free foods and grains are typically made with rice starch (or brown rice starch), tapioca starch, cornstarch and potato starch. All of which have virtually no fiber. Hence straight into the blood stream spiking the blood sugar bite after bite and quickly. The latest attempt is many companies and cooks trying to improve nutrients by baking with higher fiber gluten-free grains with higher nutrient value. Such as teff, millet, buckwheat etc. These are all still VERY HIGH in carbohydrates and very little fiber to slow the glycemic entrance into the blood system, still resulting in spiking the blood sugar rapidly. I must mention that most people do not just eat 2-3 bites of millet or a ¼ cup of cooked buckwheat. This would be easier on the body, but it seldom occurs. Carbohydrates are a type of nutrient in foods and some feel we need this to survive physically and some MD's are saying we need far less than we ever thought. The three basic forms are sugars, starches and fiber. Different types of carbohydrates have properties that affect how quickly your body digests them and how quickly glucose enters your bloodstream. When we eat or drink anything with carbs, the body breaks down the sugars and starches into a type of sugar called glucose. Glucose is the main source of energy for cells in the body. Fiber passes through your body undigested. The unused glucose for energy is quickly taken out of the blood stream by the insulin and "stocked" away in the cells for future energy as fat. It is the body's amazing way of survival. To elaborate a bit more, the two main hormones from the pancreas help regulate glucose in the bloodstream. Insulin moves glucose from the blood into the cells. Glucagon helps release glucose stored in your liver when the blood sugar (blood glucose) level is low. I suggest to anyone to take a look at the nutritional value on all packages and foods and get familiar with the amount of carbohydrates you are ingesting through your meals, snack and drinks. Get familiar with the carbohydrate, sugar and fiber levels in the food you buy and have in your home. Getting educated is the first step to learning and then you can make changes to suit your health and body goals. A healthy paleo or gluten-free diet is a low glycemic one at the very least. A low glycemic diet can improve all manner of current health situations. By statistics and more than abundant research, it will deter diseases quiet commonly associated with a high glycemic diet. We will expand on this topic next time. At this point I would like to refer you to some highly respected professionals and allow you to do further research and come to your own conclusions. Please look further into DrPerlmutter.com, Mercola.com, WheatBellyBlog.com, BulletProofExec.com, ChrisKresser.com, MarksDailyApple.com. As always, wishing you the best in your life and health!
Celiac.com 09/11/2008 - After a two-leg flight and multiple trains, Jeff and I finally stepped off the local Circumvesuviana train in sunny Sorrento, our first destination on the fabled Amalfi Coast. It was hot, or as the Italians say, molto caldo. We’d been traveling for nearly 24 hours straight, and as we lugged our bags along the final stretch of cobbled sidewalks toward Casa Astarita, we both felt exhausted, ravenous and more than a bit disoriented. Jill: Any nourishment from our 10-hour flight from Chicago to Rome had long since faded. However, American Airlines had made good on its promise to provide Jeff with decent gluten-free meals. The attendant had confirmed his special meal selection at the beginning of the flight, and at both dinner and breakfast he was among the first to be served (much to the envy of the other hungry passengers!). Jeff: For dinner American served me a gluten-free meal of blackened chicken on a bed of quinoa, with green beans, melon and a gluten-free German chocolate cookie. Now, airline food is never going to win any Michelin stars, but I was grateful that my meal was gluten-free, hot and reasonably palatable. As we checked into Casa Astarita, the helpful receptionist Marella suggested that we try Bar Syrenuse, a nearby ristorante with gluten-free menu options. Marella even gave us a referral card good for a 10 percent discount. After freshening up, we sauntered a couple blocks to the Piazza Tasso, the main square, where we easily found the cheerful and airy establishment. Jill: Bar Syrenuse offered a separate gluten-free menu selection. Many of the items, such as the meats and salads, were regular staples on the menu. Jeff had many options to choose from – including gluten-free pasta. I opted for a club sandwich, stuffed with local ham and cheese, and a caffe alla nocciola (hazelnut coffee). Jeff: The intense heat of the day was just beginning to break, and I wasn’t in a pasta mood at that moment, so I ordered pollo al forno (grilled chicken with balsamic vinegar, parsley and chili flakes) and an insalata verde (green salad). The food was delicious, and sitting on the terrace made for a lovely introduction to Italy. All this for two for under 25 euros. Perfecto! Day Two: Our stay at Casa Astarita included breakfast, and we’d been assured via email of gluten-free options. The staff did not disappoint and even offered to prepare an omelet if Jeff wished. He ultimately chose from the standard offerings of orange/pineapple yogurt, fresh juices, individually brewed coffee, cheese and corn flakes (which for some might best be avoided) before we began our morning walk. Jill: During our meanderings through the town and along the cliffs overlooking the spectacular Bay of Naples, we checked out a few potential lunch spots and perused their menus. We decided on a simple outdoor restaurant, Angelina Lauro, near that train station that offered shaded tables and faced a grassy piazza bearing the same name. Jeff had a vegetable and cheese omelet along with fries, which would frequently become his reliable substitute for bread. I had a scrumptious margherita pizza. It was so big that I was able to save half for lunch the next day. Jeff: After a short nap followed by another evening walk along the Marina Grande, we again headed for Bar Syrenuse – this time, with gluten-free pasta in mind! We decided to share a few dishes and ordered gluten-free penne pasta with tiny tomatoes, grilled seasonal vegetables and an insalata caprese. The pasta was nicely cooked, with a flavorful sauce. Jill commented it tasted so good she’d have never known it was gluten-free. It was then I realized just how good it felt to be in Italy, sitting outside and eating pasta, an almost forgotten favorite, as the sun went down. The manager of Bar Syrenuse is a personable gentleman named Toni. We were able to pull him aside during a pause in his busy dinner rush and ask a few questions about how the restaurant came to offer gluten-free options. Toni explained that there are so many special diets that it is important to offer many choices to attract the fullest clientele, and noted that a wide range of food options is a reflection of good service, which is good for business. Consequently, Bar Syrenuse offers numerous items that cater to a number of specialty diets. Day Three: After a torrid afternoon spent traipsing through the ruins at Pompeii, where we’d consumed just a few snacks – gelato, granita and coconut snack bars – we were ready for a proper meal. The day before, we’d spotted several quaint restaurants tucked away in the alleys near our hotel, and so we headed in that direction. We nestled in at Ristorante Sorrento, a charming establishment with a large awning and phalanx of outdoor tables adorned in crisp white tablecloths. Jeff started with minestrone soup, followed by a main course of fresh local white fish with tomatoes in a white wine sauce and a green salad. I choose lemon risotto with shrimp and an order of pane (bread). Jeff got a little extra protein that night as I quickly passed over the jumbo shrimp to his plate. Their heads, with those little black eyes staring back at me, were more than I could take! During our stroll back to the hotel, we stopped to purchase a few postcards and sip some cappuccino before settling in for a good night’s rest, before moving on to what would be the absolute gem of our trip, picture-perfect Positano. Check back for our next article featuring our gluten-free gastronomical adventures in this serene oasis by the sea!
The following report was prepared by Ann Whalen, celiac, and editor/publisher of Gluten-Free Living , which is a bimonthly newsletter for celiacs - Gluten-Free Living, PO Box 105, Hastings-on-Hudson, NY 10706. On March 10th, more than 20 members of the celiac community and celiac disease specialists (see list at end) attended a meeting of the Digestive Diseases Intra-agency Coordinating Committee, a part of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The meeting, held to update the current status of Celiac Disease, was chaired by Jay Hoofnagle, M.D., Director of the Division of Digestive Diseases and Nutrition at the NIDDK. At the meeting, presentations were made by Martin Kagnoff, M.D., Joseph Murray, M.D., Alessio Fasano, M.D., and Frank Hamilton, M.D. Dr. Kagnoff is a gastroenterologist and Professor of Medicine at the University of California, San Diego. He spoke about his research into the genetics of Celiac Disease, focusing on the pathogenesis. Dr. Kagnoff is well known for his research into the genetics of Celiac Disease, and several of his studies have been funded by the NIH. Dr. Murray, Associate Professor of Medicine and clinician at the University of Iowa Hospitals and Clinics, described his experience with Celiac Disease both in Iowa and in Ireland, noting that his interest in celiac disease is clinical. He emphasized what he called the Classic II symptoms, meaning the actual symptoms patients have today and not the Classic symptoms many doctors may be familiar with. He said the rate of diagnosis is proportional to suspicion. Dr. Murray described the celiac disease experience at the University of Iowa from 1985 to 1997, presenting statistics that indicated a steep increase in diagnosis. At our institution, Celiac Disease is an adult disease, he said, and is now seen as frequently as Crohns Disease. Anticipating the question, Why look for Celiac Disease?, Dr. Murray gave his reasons: preventing lymphoma and osteoporosis, as well as resolving fatigue and nonspecific symptoms and shortening the current significant delays in diagnosis. Dr. Fasanos presentation was called Where Have All the American Celiacs Gone? He described what has happened in the field of celiac disease in various parts of the world, including some parts of the United States, but emphasized the European experience. Dr. Fasano noted that plans are already underway in Italy to screen all seven-year-olds in 1999. Dr. Fasano explained why an epidemiology study is critically needed in this country. He pointed out the benefits of such a study for four groups: The American health care community: lower health care costs, increased awareness of celiac disease and more knowledge of its protein manifestations in the US Participating physicians: publications, more patients and increased credibility. The American people: the prevalence will be established and celiac disease will be diagnosed more quickly. Celiac Patients: free screening of first-degree relatives, federal support for dietary and drug regulations, an improved food supply, stronger local support groups and more funding for celiac research. Dr. Fasano added that such a study, whatever its findings, would end in a win-win situation for everyone. If the study shows that celiac disease is underestimated in this country, patients will benefit as physicians begin looking for the problem with the knowledge that they might well find it. If the study shows celiac disease is indeed rare in the United States, its even more exciting because we will be able to figure out why. Dr. Hamilton, chief of the Digestive Diseases Program Branch at the NIDDK, briefly described the celiac disease research, to date, that has already been funded by the NIH. He said $1.4 million has been granted for such research, adding that over the last five years, we have seen growth in the funding of Celiac Disease. He said he was pleased funding has increased, and felt a lot of work has to be done. Dr. Hamilton ended by saying, Todays meeting will serve as an impetus for a partnership between the National Institutes of Health, academe, and the lay groups to foster more research. He added that it was important for the investigators and support group representatives present at the meeting to get the word out, referring to information about Celiac Disease. These talks were followed by a round table discussion, between the members of the committee and the presenters. Later, audience comment was invited. The committee showed an interest in the current adult nature of the disease, the changing symptoms, current testing methods, and identification of the most critical research needs. Patients who spoke were anxious to let the committee know what they felt were the important concerns in the real world. At the end of the meeting, Dr. Hoofnagle said his division will prepare a short, pithy plan, then present it to Drs. Kagnoff, Murray and Fasano. He noted that the important issues are pathogenesis, delivering the message to physicians, clinical research issues and pediatric health concern. Some Quotes from the Meeting Elaine Monarch: There is a general lack of knowledge, awareness and interest in Celiac Disease among the medical profession. We celiacs can go for years with substantial symptoms but not diagnosis...The cost to the medical community is enormous. Joseph Murray, M.D.: There is more than one gene involved in Celiac Disease. Most Europeans are homogenous. Here we have a mongrelized population. What happens when you mix? How much does it change? Our mongrelized population may be at risk at a later age. Martin Kagnoff, M.D.: The issue of other genes is not at all clear. Like Joe (Dr. Murray), I see adult celiacs. Their time delay to diagnosis is not exaggerated, but what is striking is the lack of knowledge of doctors, even at the University of California. They really are not aware of this disease. Alessio Fasano, M.D.: We receive 10-15 calls a day. The vast majority are self diagnosed. They say, I know more than my gastroenterologist. Peter Green, M.D.: We need to emphasize education of gastroenterologists. At my institution (Columbia-Presbyterian Medical Center in New York City), doctors are not used to looking at the duodenum...We need to educate many levels of the medical community and tell them, If you dont recognize something, take a biopsy. Sue Goldstein: Im concerned about the people who have not yet been diagnosed and the reasons why a physician wont consider Celiac Disease. It all boils down to, its rare and you cant have it. In addition to the speakers, the following were among those who attended: Phyllis Brogden, celiac, founder and chairperson of the Greater Philadelphia Celiac Sprue Support Group. Winnie Feldman, celiac, Celiac Disease Foundation Kenneth Fine, M.D., gastroenterologist/ researcher at Baylor University Medical Center in Dallas. Al Fornace, M.D., celiac, National Cancer Institute Sue Goldstein, celiac, founder and advisor, Westchester Celiac Sprue Support Group Peter Green, M.D., clinician/researcher at Columbia-Presbyterian Medical Center in New York City. Joanne Hameister, celiac, former chairperson, Western New York Gluten-Free Support Group Ivor Hill, M.D., clinician/researcher at Bowman Gray School of Medicine, Winston-Salem, North Carolina. Beth Hillson, celiac and proprietor of the Gluten-Free Pantry. Karoly Horvath, M.D., clinician/researcher at the University of Maryland School of Medicine in Baltimore. Marge Johanamen, celiac, CSA Kentucky state coordinator Pam King, University of Maryland Bob Levy, Celiac Research Foundation Ruth Levy, spouse Jax Lowell, celiac and author of Against the Grain Elaine Monarch, celiac, founder and Executive Director of the Celiac Disease Foundation Selwyn J. Monarch, Board of Directors, CDF Diane Paley, celiac, governing board CSA/USA Michelle Pietzak, M.D., pediatric gastroenterologist at Childrens Hospital, Los Angeles Connie Tur, celiac, president Greater Louisville Celiac Sprue Support Group