Gluten-free
Judy's gluten-free breakfast "pudding"
06/Oct/12 11:08 AM Filed in: Recipes
by Kate Whimster, BCom, MIFHI, ND
I recently received this email from our lovely receptionist Judy at Kew Beach Naturopathic Clinic:
Judy’s gluten-free breakfast “pudding”
Thought of you this morning while I was eating my breakfast. Here's one for the blog. Everyone always asks me what the heck are they going to eat for breakfast if they are gluten-free. This is what I had this morning.
Ingredients:
1 cup almond milk
2 Tbsp chia seeds
A bit of sweetener (try vegetable glycerine, maple syrup, honey, agave nectar, or stevia)
2 drops vanilla
Directions:
I recently received this email from our lovely receptionist Judy at Kew Beach Naturopathic Clinic:
Judy’s gluten-free breakfast “pudding”
Thought of you this morning while I was eating my breakfast. Here's one for the blog. Everyone always asks me what the heck are they going to eat for breakfast if they are gluten-free. This is what I had this morning.
Ingredients:
1 cup almond milk
2 Tbsp chia seeds
A bit of sweetener (try vegetable glycerine, maple syrup, honey, agave nectar, or stevia)
2 drops vanilla
Directions:
- Combine ingredients and put in fridge overnight. It’s like rice pudding or tapioca!
- I actually put it in the microwave for half a minute cause I like my cereal warm in the morning.
- I added a diced apple and some gluten-free granola. You could add just about anything to it, like fruits and nuts.
Comments
Peppermint patties
14/Sep/12 04:04 PM Filed in: Recipes
by Kate Whimster, BCom, MIFHI, ND
I recently tried this recipe for Peppermint Patties from Elana’s Pantry and they were so good!
A few changes to ingredients for my taste:
I recently tried this recipe for Peppermint Patties from Elana’s Pantry and they were so good!
A few changes to ingredients for my taste:
- I used 1/8 cup vegetable glycerine and 1/8 cup agave syrup as sweetener to cut down the sugar a bit. Next time I may try more vegetable glycerine.
- I used a bit more peppermint extract/oil (nearly 1 tsp)
- I let the coconut oil sit at room temperature for a bit which made it more liquid and easier to mix.
- I froze the mixture for at least 15 minutes to get it hard enough to scoop into balls.
- I melted the chocolate and left it to cool for about 15-20 minutes - it is really important that it is as cool as possible (yet still liquid) or it will melt the patties and make a big mess!
- Make sure your patties are nice and hard before you dip them in the chocolate. I actually melted a bit more chocolate and dipped them again once the first layer was hardened as I like my chocolate and I found this made them look a bit nicer.
Gluten sensitivity talk July 18th
by Kate Whimster, BCom, MIFHI, ND
I will be giving a free talk on Gluten Sensitivity on Wednesday, July 18th, 7pm at the Deer Park Library (40 St. Clair Avenue East, Toronto). Call the library at 416-393-7657 to RSVP!
What is gluten? What is gluten sensitivity and celiac disease? Unlock the mystery of this common food sensitivity and how it can make a major impact on your health.
Topics will include:
See my Events page for more upcoming dates and topics!
I will be giving a free talk on Gluten Sensitivity on Wednesday, July 18th, 7pm at the Deer Park Library (40 St. Clair Avenue East, Toronto). Call the library at 416-393-7657 to RSVP!
What is gluten? What is gluten sensitivity and celiac disease? Unlock the mystery of this common food sensitivity and how it can make a major impact on your health.
Topics will include:
- Celiac disease vs. gluten sensitivity
- Prevalence, signs, and symptoms
- Diagnosis
See my Events page for more upcoming dates and topics!
Gluten sensitivity part 3: living gluten-free
by Kate Whimster, BCom, MIFHI, ND
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation and Gluten sensitivity part 2: diagnosis.
Many people think that living gluten-free is impossible. While it can be difficult during the initial transition and to avoid gluten 100% (because it can be hidden in foods you don’t suspect - see below), for most people living nearly completely gluten-free is totally doable!
I’ve been avoiding gluten most of the time for many years, gradually getting closer and close to 100%. In my own life, I avoid gluten 100% in my own home and I make sure to avoid obvious gluten sources the majority of the time when I eat out. Because I am not celiac, this works for me, and I find this way of life quite easy, actually, as there are many other foods to eat.
In my practice, I have found that most patients that avoid gluten soon feel better, look better, lose weight more easily, and get into the habit of eating a wider variety of foods like fruits, vegetables, and other whole foods rather than bread, pasta, etc.
The most important key to success living gluten-free is NOT to just find substitutes for the gluten you used to eat (ie: replacing bread, pasta, cookies, cake, etc with gluten-free alternatives) but rather to rebalance your diet away from grains in favour of other food groups.
Treatment
For those with celiac disease, it is very important to follow a strict 100% gluten-free diet for the rest of their lives in order to regain the health of their digestive tract and avoid further damage and associated diseases. There are some celiac disease patients who will react to even the smallest amount of gluten and must therefore use completely separate cooking tools and utensils to prepare food and who cannot even tolerate gluten in the environment (ie: in the air, in personal care products such as toothpaste and shampoo, etc).
However, if you are gluten sensitive (which is still a much more fluid and less defined diagnosis), I believe it may be possible to reduce your sensitivity such that the reaction to gluten is less severe or possibly even eliminated. I recommend strict adherence to a gluten-free diet for at least 1 year while continuing with other naturopathic treatments to see major improvement and continuing almost completely gluten-free for 3-5 years, after which patients may be able to eat gluten again (as long as they are not celiac). However, keep in mind that this depends on the severity of gluten sensitivity and symptoms and it is important to test at the beginning of treatment and do follow-up testing to compare.
In both cases, treatment beyond diet is key to healing the digestive system. This is best accomplished via:
Here are some more detailed lists of gluten grains, places you may find hidden gluten (read labels and ask questions if you are not sure!), and gluten-free grains/starches:
Gluten grains:
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation and Gluten sensitivity part 2: diagnosis.
Many people think that living gluten-free is impossible. While it can be difficult during the initial transition and to avoid gluten 100% (because it can be hidden in foods you don’t suspect - see below), for most people living nearly completely gluten-free is totally doable!
I’ve been avoiding gluten most of the time for many years, gradually getting closer and close to 100%. In my own life, I avoid gluten 100% in my own home and I make sure to avoid obvious gluten sources the majority of the time when I eat out. Because I am not celiac, this works for me, and I find this way of life quite easy, actually, as there are many other foods to eat.
In my practice, I have found that most patients that avoid gluten soon feel better, look better, lose weight more easily, and get into the habit of eating a wider variety of foods like fruits, vegetables, and other whole foods rather than bread, pasta, etc.
The most important key to success living gluten-free is NOT to just find substitutes for the gluten you used to eat (ie: replacing bread, pasta, cookies, cake, etc with gluten-free alternatives) but rather to rebalance your diet away from grains in favour of other food groups.
Treatment
For those with celiac disease, it is very important to follow a strict 100% gluten-free diet for the rest of their lives in order to regain the health of their digestive tract and avoid further damage and associated diseases. There are some celiac disease patients who will react to even the smallest amount of gluten and must therefore use completely separate cooking tools and utensils to prepare food and who cannot even tolerate gluten in the environment (ie: in the air, in personal care products such as toothpaste and shampoo, etc).
However, if you are gluten sensitive (which is still a much more fluid and less defined diagnosis), I believe it may be possible to reduce your sensitivity such that the reaction to gluten is less severe or possibly even eliminated. I recommend strict adherence to a gluten-free diet for at least 1 year while continuing with other naturopathic treatments to see major improvement and continuing almost completely gluten-free for 3-5 years, after which patients may be able to eat gluten again (as long as they are not celiac). However, keep in mind that this depends on the severity of gluten sensitivity and symptoms and it is important to test at the beginning of treatment and do follow-up testing to compare.
In both cases, treatment beyond diet is key to healing the digestive system. This is best accomplished via:
- Avoidance of other food sensitivities that may be a problem (which will differ by patient)
- Supportive nutrition to reduce inflammation in the gastrointestinal tract, rebalance gut flora, and support healing of the absorptive surface of the intestines
- Concurrent treatment of any other health concerns
- Whole body detox and improvement of elimination organ functioning
Here are some more detailed lists of gluten grains, places you may find hidden gluten (read labels and ask questions if you are not sure!), and gluten-free grains/starches:
Gluten grains:
- Barley
- Bran
- Bulgar
- Couscous
- Durum flour
- Einkorn
- Emmer
- Farina
- Faro
- Graham flour
- Kamut
- Matzo flour/meal
- Orzo
- Panko
- Rye
- Seitan
- Semolina
- Spelt
- Triticale
- Udon
- Wheat
- Ales, beers, lagers
- Bouillon cubes, soup base
- Breading/coating mix
- Brown rice syrup
- Communion wafers
- Croutons
- Candy
- Chips/potato chips
- Luncheon meats, hot dogs, salami, sausage
- French fries
- Gravy
- Marinades, sauces
- Pasta
- Rice mixes
- Seasoned tortilla chips
- Stuffing
- Self-basting poultry
- Soy sauce (soy sauce is made of wheat, tamari sauce is made of soy!0
- Thickeners
- Prescription and over-the-counter medications (check out www.glutenfreedrugs.com)
- Vitamin, mineral, and herbal supplements
- Lipstick, lip gloss, balm
- Play Dough
- Shampoo and conditioner
- Toothpaste
- Amaranth
- Arrowroot
- Buckwheat
- Corn
- Flax
- Millet
- Montina
- Oats (if gluten-free, such as Bob’s Red Mill)
- Potato
- Quinoa
- Rice
- Sago
- Sorghum
- Soy
- Tapioca
- Teff
- Flours made from nuts, beans, seeds
Healthy hiking food
by Kate Whimster, BCom, MIFHI, ND
I will soon be heading north to hike the Coastal Trail in Lake Superior Provincial Park, which means I’ve had to plan what I will carry and eat for about a week. In your typical outdoors store, you will find a wide variety of “camping” food, most of which is full of sodium, sugar, and preservatives, not to mention common allergens such as wheat, gluten, and dairy! Here I’ll share some of my food choices on my first long hike in the hopes of helping you choose healthy hiking food.
I used NutritionData.com to calculate calories as well as other nutrient info. On this site you can find info on many, many whole and packaged foods and you can also enter your own custom foods using the label info if you need.
Fruit and veggies
The greatest challenge of camping food is vegetables and fresh fruit, since I don’t have refrigeration. However, that doesn’t mean I can’t still bring some fresh stuff, I just have to eat it early on! I’ll be bringing a few bananas and some whole organic carrots (washed but unpeeled) for the first few days of the trip. Many fruits (bananas, apples, oranges, pears, etc) travel well and I find that carrots of all vegetables also can last a few days without refrigeration quite nicely as long as they still have their peels and are protected.
Dried fruit and nuts
Once the fresh foods above run out, dried fruit provides a great portable snack that is light and keeps a long time. Nuts and nut butters are also good choices. I’m bringing dried mango, peaches, and raisins, along with almonds (that I roasted myself in my oven) and almond butter.
Homemade jerky
Many years ago I got a dehydrator and one of the things I’ve used it for is to make my own homemade beef and turkey jerky, which is MUCH tastier (and healthier) than anything store-bought you can find! For this trip I’ve made a bit of both and frozen it until we leave to keep it fresh. I plan for it to last about 3-4 days.
Packaged stuff
To supplement what I have above, I’ve found a few packaged items that, while not as optimal as a fresh, whole foods diet, are workable for me.
Oatmeal:
Instant oatmeal packets are great for breakfast. Glutenfreeda’s are gluten-free and there is also Nature’s Path. You can get both these brands in plain, unsweetened varieties to which you can add your own fruit, nuts, etc.
Dehydrated meals:
In looking through all the dehydrated packaged stuff in the store, I did find a few brands that have healthier ingredients and less/no preservatives. What I chose for this trip was Mary Janes Farm Outpost Organic Instant Lentil Soup packs. They also make several other meals which look tasty!
Bars:
There are a wide variety of bars out there, so look for some that you like and that fit your needs. Generally, bars higher in protein and lower in sugar are best. I bought a few brands just for flavour variety and plan to eat 1-2 bars per day.
Protein and/or greens powder:
Both are good portable additions to your morning oatmeal to add more nutrition and help make up for a lack of fresh fruits and veggies while hiking.
Drink mixes and electrolyte replacements:
While not necessarily a product I would use on a day-to-day basis, Emergen-C can be a good option for electrolyte and vitamin replacement while hiking and to take the chlorine edge off your purified water! They may also help with immune support while travelling.
Another simple option for sodium and mineral replacement is plain old sea salt. When I travelled to India in 2007 and to Nicaragua in 2010 I brought a small container of sea salt that I added to my bottled water to replace all the salt I was losing via sweat. I truly think this simple trick helped keep me better hydrated on both those trips and therefore illness-free!
I will soon be heading north to hike the Coastal Trail in Lake Superior Provincial Park, which means I’ve had to plan what I will carry and eat for about a week. In your typical outdoors store, you will find a wide variety of “camping” food, most of which is full of sodium, sugar, and preservatives, not to mention common allergens such as wheat, gluten, and dairy! Here I’ll share some of my food choices on my first long hike in the hopes of helping you choose healthy hiking food.
I used NutritionData.com to calculate calories as well as other nutrient info. On this site you can find info on many, many whole and packaged foods and you can also enter your own custom foods using the label info if you need.
Fruit and veggies
The greatest challenge of camping food is vegetables and fresh fruit, since I don’t have refrigeration. However, that doesn’t mean I can’t still bring some fresh stuff, I just have to eat it early on! I’ll be bringing a few bananas and some whole organic carrots (washed but unpeeled) for the first few days of the trip. Many fruits (bananas, apples, oranges, pears, etc) travel well and I find that carrots of all vegetables also can last a few days without refrigeration quite nicely as long as they still have their peels and are protected.
Dried fruit and nuts
Once the fresh foods above run out, dried fruit provides a great portable snack that is light and keeps a long time. Nuts and nut butters are also good choices. I’m bringing dried mango, peaches, and raisins, along with almonds (that I roasted myself in my oven) and almond butter.
Homemade jerky
Many years ago I got a dehydrator and one of the things I’ve used it for is to make my own homemade beef and turkey jerky, which is MUCH tastier (and healthier) than anything store-bought you can find! For this trip I’ve made a bit of both and frozen it until we leave to keep it fresh. I plan for it to last about 3-4 days.
Packaged stuff
To supplement what I have above, I’ve found a few packaged items that, while not as optimal as a fresh, whole foods diet, are workable for me.
Oatmeal:
Instant oatmeal packets are great for breakfast. Glutenfreeda’s are gluten-free and there is also Nature’s Path. You can get both these brands in plain, unsweetened varieties to which you can add your own fruit, nuts, etc.
Dehydrated meals:
In looking through all the dehydrated packaged stuff in the store, I did find a few brands that have healthier ingredients and less/no preservatives. What I chose for this trip was Mary Janes Farm Outpost Organic Instant Lentil Soup packs. They also make several other meals which look tasty!
Bars:
There are a wide variety of bars out there, so look for some that you like and that fit your needs. Generally, bars higher in protein and lower in sugar are best. I bought a few brands just for flavour variety and plan to eat 1-2 bars per day.
Protein and/or greens powder:
Both are good portable additions to your morning oatmeal to add more nutrition and help make up for a lack of fresh fruits and veggies while hiking.
Drink mixes and electrolyte replacements:
While not necessarily a product I would use on a day-to-day basis, Emergen-C can be a good option for electrolyte and vitamin replacement while hiking and to take the chlorine edge off your purified water! They may also help with immune support while travelling.
Another simple option for sodium and mineral replacement is plain old sea salt. When I travelled to India in 2007 and to Nicaragua in 2010 I brought a small container of sea salt that I added to my bottled water to replace all the salt I was losing via sweat. I truly think this simple trick helped keep me better hydrated on both those trips and therefore illness-free!
Gluten sensitivity part 4: why?
by Kate Whimster, BCom, MIFHI, ND
This blog is all about “why.” As in, why (and how) do we become gluten sensitive and why does it matter?
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation, Gluten sensitivity part 2: diagnosis, and Gluten sensitivity part 3: living gluten-free.
Why are so many people gluten sensitive?
I am often asked: why so many people are gluten sensitive? It seems like just a few years ago this was a relatively rare diagnosis. Also, why might someone who has tolerated gluten his or her entire life suddenly become gluten sensitive? The short answer is that right now we cannot be sure of the exact causes. Really, gluten sensitivity, like most modern health issues, is due to many causes that come together to cause illness. Here are a few of my own thoughts on why more and more people are gluten sensitive:
Improved diagnostics:
The most obvious answer is that we are getting better and better at recognizing and diagnosing gluten sensitivity. Awareness has skyrocketed, so more people are getting tested and the tests are getting better. For more on diagnosis, see my blog Gluten sensitivity part 2: diagnosis
Higher gluten content in foods:?
I’ve heard some talk that foods we eat today contain higher gluten content than those same foods would have 10, 20, 30 years ago. Also, I’ve heard that the gluten content of grains in Europe is much lower (possibly due to greater restrictions on genetic modification) than in North America. I’ve not been able to find any real evidence to support this.
Immune system imbalance:
In people with gluten sensitivity, the immune system is no longer tolerating gluten (which is a non-harmful substance) and makes an response that causes damage to tissues. But why? This is really part of a larger problem of immune system dysfunction that may lie at the root of many chronic diseases (allergies, asthma, cancer, autoimmune disease, etc). Our immune systems simple do not develop the same way that they used to. Possible causes?
Digestive problems can be caused by poor diet, stress, toxins in the environment, poor elimination function, medications/drugs, chronic inflammation, food sensitivities, and many more factors. Specifically, intestinal permeability (also known as “leaky gut”) could explain why we begin reacting to gluten and also the reaction to gluten can cause leaky gut, so this is a vicious cycle.
A simplified explanation of “leaky gut”:
My simple answer to this question is that in the search for the root cause behind digestive issues, gluten sensitivity can be a valuable piece of the puzzle to help patients heal. In the long-term and with a view to disease prevention, gluten sensitivity can help understand other chronic illnesses. Research is still developing in this area, but thus far there is already lots of evidence to link gluten sensitivity with many other serious illnesses.
Diseases associated with gluten sensitivity:
This blog is all about “why.” As in, why (and how) do we become gluten sensitive and why does it matter?
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation, Gluten sensitivity part 2: diagnosis, and Gluten sensitivity part 3: living gluten-free.
Why are so many people gluten sensitive?
I am often asked: why so many people are gluten sensitive? It seems like just a few years ago this was a relatively rare diagnosis. Also, why might someone who has tolerated gluten his or her entire life suddenly become gluten sensitive? The short answer is that right now we cannot be sure of the exact causes. Really, gluten sensitivity, like most modern health issues, is due to many causes that come together to cause illness. Here are a few of my own thoughts on why more and more people are gluten sensitive:
Improved diagnostics:
The most obvious answer is that we are getting better and better at recognizing and diagnosing gluten sensitivity. Awareness has skyrocketed, so more people are getting tested and the tests are getting better. For more on diagnosis, see my blog Gluten sensitivity part 2: diagnosis
Higher gluten content in foods:?
I’ve heard some talk that foods we eat today contain higher gluten content than those same foods would have 10, 20, 30 years ago. Also, I’ve heard that the gluten content of grains in Europe is much lower (possibly due to greater restrictions on genetic modification) than in North America. I’ve not been able to find any real evidence to support this.
Immune system imbalance:
In people with gluten sensitivity, the immune system is no longer tolerating gluten (which is a non-harmful substance) and makes an response that causes damage to tissues. But why? This is really part of a larger problem of immune system dysfunction that may lie at the root of many chronic diseases (allergies, asthma, cancer, autoimmune disease, etc). Our immune systems simple do not develop the same way that they used to. Possible causes?
- Suppression of normal immune responses like fevers prevents the normal learning and development of the immune system. For more on this subject, see my blog Give me fever.
- Changes in management of minor illnesses (including the overuse of antibiotics) also impacts the normal development of the immune system. For more on this subject, see my blog Sick kids.
- Vaccinations at a young age supercede or alter the natural immune response to many common illnesses that we used to get during childhood. The subject of vaccines is large and is beyond the scope of this blog. However, I think is it clear that vaccines do not replicate the experience of actually having the same illness. Research in this area is constantly evolving, so there is still much debate about the long-term effects of vaccines.
- Finally, we simply do not get sick with the same things anymore! Our food and environment are highly sanitary, so we are exposed to many fewer pathogens and in North America, we are also far less likely than in the past to have parasitic infections. Again, this will effect the education of our immune systems.
Digestive problems can be caused by poor diet, stress, toxins in the environment, poor elimination function, medications/drugs, chronic inflammation, food sensitivities, and many more factors. Specifically, intestinal permeability (also known as “leaky gut”) could explain why we begin reacting to gluten and also the reaction to gluten can cause leaky gut, so this is a vicious cycle.
A simplified explanation of “leaky gut”:
- Junctions between cells lining the small intestine become permeable (due to factors listed above)
- This allows undigested food particles to enter bloodstream
- The immune system views these as “foreign” and creates immune response, causing inflammation and further damage
My simple answer to this question is that in the search for the root cause behind digestive issues, gluten sensitivity can be a valuable piece of the puzzle to help patients heal. In the long-term and with a view to disease prevention, gluten sensitivity can help understand other chronic illnesses. Research is still developing in this area, but thus far there is already lots of evidence to link gluten sensitivity with many other serious illnesses.
Diseases associated with gluten sensitivity:
- Autoimmune disorders (rheumatoid arthritis, lupus, Sjogren’s syndrome, thyroid autoimmunity, and likely many more)
- Bone disease (Osteoporosis, osteopenia, kyphoscoliosis, fractures)
- Anemia
- Infertility or repeated miscarriages
- Addison’s disease
- Down syndrome
- Intestinal cancer or lymphoma
- Lactose intolerance
- Thyroid disease
- Diabetes type I
- Low blood sugar (hypoglycemia)
- Liver disease
Gluten sensitivity, part 1: definitions, prevalence, presentation
by Kate Whimster, BCom, MIFHI, ND
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)
Signs and symptoms
Signs and symptoms of celiac disease (1):
Signs and symptoms of “silent” celiac disease (8):
Children:
References:
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
- Wheat (all forms, including durum, semolina, spelt, kamut, couscous, bulgar, etc)
- Rye
- Barley
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
- In average healthy people: 1 in 133
- In people with related symptoms: 1 in 56
- In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22
- In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39
- 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)Signs and symptoms
Signs and symptoms of celiac disease (1):
- Abdominal pain, bloating, gas, or indigestion
- Constipation
- Decreased appetite (may also be increased or unchanged)
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Signs and symptoms of “silent” celiac disease (8):
Children:
- Short stature
- Anemia
- Neurologic symptoms
- Dermatitis herpetiformis
- Anemia
- Reduced bone density (osteopenia/osteoporosis)
- Apthous stomatitis, dental enamel defects
- Infertility, recurrent miscarriage
- Irritable bowel syndrome (IBS)
- Dyspepsia
- Esophageal reflux
- Neurologic symptoms
- Autoimmune diseases
References:
- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
- http://en.wikipedia.org/wiki/Gluten_sensitivity
- Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
- Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001 Jan;96(1):126-31.
- Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999 Aug;117(2):297-303.
- Sanders DS, Hurlstone DP, McAlindon ME, Hadjivassiliou M, Cross SS, Wild G, Atkins CJ. Antibody negative coeliac disease presenting in elderly people--an easily missed diagnosis. BMJ. 2005 Apr 2;330(7494):775-6.
- Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236-9.
- Green PH, Alaedini A, Sander HW, Brannagan TH 3rd, Latov N, Chin RL. Mechanisms underlying celiac disease and its neurologic manifestations. Cell Mol Life Sci. 2005 Apr;62(7-8):791-9.
Gluten sensitivity part 2: diagnosis
by Kate Whimster, BCom, MIFHI, ND
It’s now been over a year since my first blog about gluten sensitivity, so it’s about time to follow that up with more information! If you’d like a refresher, check out Gluten sensitivity part 1: definitions, prevalence, presentation.
Definitions:
Common:
Diagnosis seems to be constantly changing and evolving, so I’ll share what my current knowledge is on the subject from my own experience being tested and what I use with my patients.
Diagnosis of Celiac Disease:
To unequivocally diagnose celiac disease, a patient must complete 3 steps:
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
3. Positive results from a gluten-free diet
Diagnosis of Gluten Sensitivity:
Gluten sensitivity is often a diagnosis of exclusion, meaning that you have to rule-out celiac disease while still demonstrating a reaction to gluten and improvement in symptoms when the patient avoids gluten.
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
What do I use in my practice?
I’ve used 3 different tests in my practice so far, but I haven’t settled on just one because they each have advantages and disadvantages.
1. CELIACSURE
This is an in-office test for tissue transglutaminase (tTG) only and can be completed with quick results in-office at a reasonable price.
The advantage is quick diagnosis using only a finger-prick while the patient is still eating gluten. The disadvantage is that tissue transglutaminase (tTG) antibodies may be negative while other antibodies (such as deamidated gliadin peptide (DGP)) are positive, so even with a negative result, further testing is indicated to really rule-out gluten sensitivity or celiac disease.
2. Gamma Dynacare Celiac Profile Panel
This is how I tested myself because it includes the combination of 4 tests that is currently considered to be the most comprehensive: total IgA, transglutaminase IgA, deamidated gliadin IgA, deamidated gliadin IgG.
The advantage is that it is most complete and highly accurate as long as the patient is eating gluten daily for 3-4 weeks before testing. None of these tests cover endomysial antibodies, but this test can be added onto the Gamma Dynacare testing at additional cost. The disadvantage is that this test is more expensive, involves a blood draw rather than finger-prick, and I have to send patients to a Gamma Dynacare lab location for the blood draw, which also involves a collection fee.
This is currently my test of choice because it minimizes the need for future testing, although the test below is also a great option.
3. Rocky Mountain Analytical Celiac Profile
I’ve recently ordered some of these test kits for in-office finger-prick blood collection that then needs to be sent away for results. This kit tests tissue transglutaminase, gliadin IgA, and gliadin IgG.
The advantage is an easier in-office finger-prick collection that covers 3 key tests at a lower price than the Gamma Dynacare testing. For most people this testing is sufficient and at a lower price without having to do a full blood draw at a lab. The disadvantage is that testing gliadin rather than deamidated gliadin is less sensitive and specific and this test does not include total IgA (which is helpful to rule-out IgA deficiency).
References:
It’s now been over a year since my first blog about gluten sensitivity, so it’s about time to follow that up with more information! If you’d like a refresher, check out Gluten sensitivity part 1: definitions, prevalence, presentation.
Definitions:
- Celiac disease is a condition in which eating gluten causes damage to the small intestine which impacts the ability to absorb nutrients from food
- Gluten sensitivity is less specific - it includes medical conditions which are caused by and made worse by exposure to gluten and covers patients who feel better while gluten-free but may not fit the definition of celiac disease
Common:
- Diarrhea
- Fatigue
- Borborygmus (fun word for rumbling or gurgling in the abdomen)
- Abdominal pain
- Weight loss
- Abdominal distention/bloating
- Flatulence
- Irritability, mood swings (especially children)
- Short stature
- Osteopenia/osteoporosis (especially premature)
- Abnormal liver function
- Nausea, vomiting
- Iron-deficiency anemia
- Neurological dysfunction
- Constipation
Diagnosis seems to be constantly changing and evolving, so I’ll share what my current knowledge is on the subject from my own experience being tested and what I use with my patients.
Diagnosis of Celiac Disease:
To unequivocally diagnose celiac disease, a patient must complete 3 steps:
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
- Serum immunoglobulin A (IgA) must be normal (rule-out IgA deficiency)
- Endomysial antibodies (IgA)
- Tissue transglutaminase (tTG) IgA antibodies
3. Positive results from a gluten-free diet
Diagnosis of Gluten Sensitivity:
Gluten sensitivity is often a diagnosis of exclusion, meaning that you have to rule-out celiac disease while still demonstrating a reaction to gluten and improvement in symptoms when the patient avoids gluten.
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
- Serum immunoglobulin A (IgA) must be normal (rule-out IgA deficiency)
- Deamidated gliadin peptide (DGP) IgA and IgG are considered more sensitive and specific than gliadin antibodies (1) especially if other tests are normal
- Endomysial antibodies (IgA) and/or tissue transglutaminase (tTG) IgA antibodies may be negative
What do I use in my practice?
I’ve used 3 different tests in my practice so far, but I haven’t settled on just one because they each have advantages and disadvantages.
1. CELIACSURE
This is an in-office test for tissue transglutaminase (tTG) only and can be completed with quick results in-office at a reasonable price.
The advantage is quick diagnosis using only a finger-prick while the patient is still eating gluten. The disadvantage is that tissue transglutaminase (tTG) antibodies may be negative while other antibodies (such as deamidated gliadin peptide (DGP)) are positive, so even with a negative result, further testing is indicated to really rule-out gluten sensitivity or celiac disease.
2. Gamma Dynacare Celiac Profile Panel
This is how I tested myself because it includes the combination of 4 tests that is currently considered to be the most comprehensive: total IgA, transglutaminase IgA, deamidated gliadin IgA, deamidated gliadin IgG.
The advantage is that it is most complete and highly accurate as long as the patient is eating gluten daily for 3-4 weeks before testing. None of these tests cover endomysial antibodies, but this test can be added onto the Gamma Dynacare testing at additional cost. The disadvantage is that this test is more expensive, involves a blood draw rather than finger-prick, and I have to send patients to a Gamma Dynacare lab location for the blood draw, which also involves a collection fee.
This is currently my test of choice because it minimizes the need for future testing, although the test below is also a great option.
3. Rocky Mountain Analytical Celiac Profile
I’ve recently ordered some of these test kits for in-office finger-prick blood collection that then needs to be sent away for results. This kit tests tissue transglutaminase, gliadin IgA, and gliadin IgG.
The advantage is an easier in-office finger-prick collection that covers 3 key tests at a lower price than the Gamma Dynacare testing. For most people this testing is sufficient and at a lower price without having to do a full blood draw at a lab. The disadvantage is that testing gliadin rather than deamidated gliadin is less sensitive and specific and this test does not include total IgA (which is helpful to rule-out IgA deficiency).
References:
Quinoatmeal cookies
06/Feb/11 05:38 PM Filed in: Recipes
by Kate Whimster, BCom, MIFHI, ND
I think I came up with these cookies from a recipe somewhere and modified it a bit from there. I’ve been making them for several years and they are always a hit!
Quinoatmeal Cookies
(makes about 36 small cookies)
Ingredients:
Directions:
1. Preheat oven to 300 degrees F.
2. Mix quinoa flakes, oats, almond meal, baking soda, and salt together in a medium bowl.
3. Mix ghee, vegetable glycerine, and egg together in a small bowl.
4. Blend wet and dry ingredients together until combined.
5. Add chocolate chips.
6. Spoon onto baking sheets lined with parchment paper and flatten a bit with a fork.
7. Bake for 10-15 minutes until golden.
8. Let cool for 5-10 minutes before removing from baking sheet.
Notes:
You can also make a chocolate version of these cookies by adding 1/4 cup cocoa. You can also add a bit more sweetener to taste.
I think I came up with these cookies from a recipe somewhere and modified it a bit from there. I’ve been making them for several years and they are always a hit!
Quinoatmeal Cookies
(makes about 36 small cookies)
Ingredients:
- 1 cup rolled oats (I use Bob’s Red Mill Wheat-free Oats)
- 1 cup quinoa flakes (from Go Go Quinoa)
- 1 cup almond meal (Bob’s Red Mill again!)
- 1/2 cup ghee, melted (I make my own ghee using organic, cultured butter, see ghee recipe here) or butter - ghee is wetter than butter, so adjust accordingly
- 1/4 cup vegetable glycerine (very sweet but does not spike blood sugar - I get mine in large bottles from Azure Standard) or agave syrup - adjust according to desired sweetness
- 1 egg
- 1/2 tsp baking soda
- 1/8 tsp salt
- 1/2 to 3/4 cup chocolate chips (I use Enjoy Life semi-sweet chocolate chips which are gluten, dairy, and nut-free)
Directions:
1. Preheat oven to 300 degrees F.
2. Mix quinoa flakes, oats, almond meal, baking soda, and salt together in a medium bowl.
3. Mix ghee, vegetable glycerine, and egg together in a small bowl.
4. Blend wet and dry ingredients together until combined.
5. Add chocolate chips.
6. Spoon onto baking sheets lined with parchment paper and flatten a bit with a fork.
7. Bake for 10-15 minutes until golden.
8. Let cool for 5-10 minutes before removing from baking sheet.
Notes:
You can also make a chocolate version of these cookies by adding 1/4 cup cocoa. You can also add a bit more sweetener to taste.
Kate's walnutty chocolate
21/Jan/11 10:56 AM Filed in: Recipes
by Kate Whimster, BCom, MIFHI, ND
Yes, another post about chocolate! This is my other major chocolate “substitute.” Back in 2003, I decided to stop eating sugar entirely for one month as an experiment. This was actually a lot easier than I expected and completely changed the way I eat since. It made me realize how often I was eating sugar to sooth uncomfortable emotions and that I didn’t need to eat cookies, cake, and other desserts to have a good time or connect with people. However, the biggest thing I missed was chocolate! Not even really sweet chocolate, just that distinct taste! So I came up with this recipe for making my own fudge-type dessert using some healthier ingredients.
Kate’s Walnutty Chocolate
(makes about 36 small pieces)
Ingredients:
Directions:
1. Melt cocoa powder, butter, and almond butter in a medium pot over low-medium heat.
2. While those are melting, chop the walnuts (and cacao beans or nibs if you are using these) using a chopper/grinder until they are a size you desire.
3. Once the cocoa mixture in the pot is melted and blended, remove from heat and add vegetable glycerine and combine.
4. Next, add the walnuts, cacao nibs, ground flax, and puffed rice and combine.
5. Press the mixture into a square pan lined with parchment paper.
6. Place in fridge or freezer to cool.
Yes, another post about chocolate! This is my other major chocolate “substitute.” Back in 2003, I decided to stop eating sugar entirely for one month as an experiment. This was actually a lot easier than I expected and completely changed the way I eat since. It made me realize how often I was eating sugar to sooth uncomfortable emotions and that I didn’t need to eat cookies, cake, and other desserts to have a good time or connect with people. However, the biggest thing I missed was chocolate! Not even really sweet chocolate, just that distinct taste! So I came up with this recipe for making my own fudge-type dessert using some healthier ingredients.
Kate’s Walnutty Chocolate
(makes about 36 small pieces)
Ingredients:
- 1/2 cup cocoa powder (I now use raw cacao powder)
- 1/2 cup butter or ghee (I make my own ghee using organic, cultured butter, see ghee recipe here) - ghee is these softer/wetter than butter, so use a bit less
- 1/2 cup almond butter (you can also use tahini or any other nut butter you like)
- 1/4-1/2 cup vegetable glycerine (very sweet but does not spike blood sugar - I get mine in large bottles from Azure Standard) or agave syrup - adjust according to desired sweetness
- 2-3 handfuls walnuts
- 1 handful cacao beans or nibs (optional)
- 1/2 cup ground flax
- 1/2-1 cup puffed rice or quinoa
Directions:
1. Melt cocoa powder, butter, and almond butter in a medium pot over low-medium heat.
2. While those are melting, chop the walnuts (and cacao beans or nibs if you are using these) using a chopper/grinder until they are a size you desire.
3. Once the cocoa mixture in the pot is melted and blended, remove from heat and add vegetable glycerine and combine.
4. Next, add the walnuts, cacao nibs, ground flax, and puffed rice and combine.
5. Press the mixture into a square pan lined with parchment paper.
6. Place in fridge or freezer to cool.
Antioxidant brownies
16/Dec/10 10:29 AM Filed in: Recipes
by Kate Whimster, BCom, MIFHI, ND
I LOVE chocolate, but I try to avoid sugar because I feel so much better without it. When I stopped eating sugar in 2003, I was faced with the dilemma of how the heck I could still feed my chocolate cravings while avoiding sugar? Necessity is the mother of invention and the result was that I have come up with a few creative recipes to make chocolatey things without sugar. I also avoid gluten and dairy, so I have had to modify my recipes for those too.
One of the most popular recipes I’ve created has been for gluten-free, dairy-free (if you use ghee instead of butter), sugar-free (if you use vegetable glycerine instead of agave syrup) brownies. I recently had the idea to make them more nutritious by using raw cacao powder (instead of traditional cocoa) which is high in antioxidants!
Antioxidant Brownies
(makes about 36 small brownies)
Ingredients:
Directions:
1. Preheat oven to 300 degrees Fahrenheit.
2. Melt the ghee/butter and combine in a medium bowl with the cacao powder until smooth.
3. Add vegetable glycerine/agave, almond meal, and egg yolks and combine.
4. Beat the egg whites in a small bowl until soft peaks form. Fold egg whites into other bowl with the chocolate mixture.
5. Gently combine until blended and pour into a square pan lined with parchment paper.
6. Bake for approximately 20 minutes, then turn 1/4 turn and bake for another 10-20 minutes or until a toothpick inserted comes out nearly clean.
7. Let cool for about 15 minutes, then continue cooling in fridge.
I LOVE chocolate, but I try to avoid sugar because I feel so much better without it. When I stopped eating sugar in 2003, I was faced with the dilemma of how the heck I could still feed my chocolate cravings while avoiding sugar? Necessity is the mother of invention and the result was that I have come up with a few creative recipes to make chocolatey things without sugar. I also avoid gluten and dairy, so I have had to modify my recipes for those too.
One of the most popular recipes I’ve created has been for gluten-free, dairy-free (if you use ghee instead of butter), sugar-free (if you use vegetable glycerine instead of agave syrup) brownies. I recently had the idea to make them more nutritious by using raw cacao powder (instead of traditional cocoa) which is high in antioxidants!
Antioxidant Brownies
(makes about 36 small brownies)
Ingredients:
- 1 cup raw cacao powder
- 1/2 to 3/4 cup ghee (I make my own ghee using organic, cultured butter, see ghee recipe here) or butter - ghee is wetter than butter, so adjust accordingly
- 1/2 to 3/4 cup vegetable glycerine (very sweet but does not spike blood sugar - I get mine in large bottles from Azure Standard) or agave syrup - adjust according to desired sweetness
- 1 cup almond meal (from Bob’s Red Mill)
- 4 eggs, separated
Directions:
1. Preheat oven to 300 degrees Fahrenheit.
2. Melt the ghee/butter and combine in a medium bowl with the cacao powder until smooth.
3. Add vegetable glycerine/agave, almond meal, and egg yolks and combine.
4. Beat the egg whites in a small bowl until soft peaks form. Fold egg whites into other bowl with the chocolate mixture.
5. Gently combine until blended and pour into a square pan lined with parchment paper.
6. Bake for approximately 20 minutes, then turn 1/4 turn and bake for another 10-20 minutes or until a toothpick inserted comes out nearly clean.
7. Let cool for about 15 minutes, then continue cooling in fridge.
