Dr. Susan Michell - Nutrition Expert Dr. Susan Mitchell Nutrition Expert
home about services media clients Contact

December 8, 2011

Gluten-Free: Update on Gluten Sensitivity and Celiac Disease

One of my most popular blog and podcast topics is gluten-free. Do you have questions too? I’m thrilled to have as my podcast guest this week registered dietitian and a leading international expert on celiac disease and the gluten-free diet, Shelley Case. She’s a member of the Medical Advisory Boards of the Celiac Disease Foundation, Gluten Intolerance Group and Canadian Celiac Association.

Her best selling book is Gluten-Free Diet: A Comprehensive Resource Guide. Shelley’s website offers a bevy of free helpful information and resources.

Celiac disease is an autoimmune disorder that attacks your small intestine and persists for a lifetime.  Autoimmune basically means that your body turns on itself. Specifically your intestine is damaged by the protein you eat found in wheat, rye and barley…collectively this protein is referred to as gluten.

Any food item that contains gluten is like poison to your small intestine particularly to the little fingerlike projections called villi and makes it difficult to absorb the nutrients from food such as vitamins and minerals.

Gluten is so ubiquitous that becoming a label sleuth is a top diet strategy. The dangerous grains and their protein include barley, rye, wheat, spelt and kamut while the safe grains include rice, corn, potato, amaranth, quinoa, buckwheat, millet, chickpea flour and oats (have the oat discussion with your registered dietitian for your particular case).

Remember wheat free is NOT gluten free. Wheat free can contain barley, bulgur or other grains with gluten.

This is really important if you think you might have celiac disease. A gluten-free diet can interfere with obtaining an accurate diagnosis so never start on the diet until you’ve had the tests suggested by your doctor such as blood tests and a biopsy.

If you have celiac disease life is NOT over. Your diet, the gluten-free diet, can make you feel much better and it’s easier to follow than just a few years ago. Plus the really good news… when you live a gluten-free lifestyle, most of the complications associated with celiac disease can be prevented.

***Giveaway: Register to win a $20 variety pack of Lucy’s Cookies, which are gluten free and made without milk, eggs, peanuts or tree nuts making them worry-free snacks for anyone who suffers from any kind of food allergy.

Remember the bottom-line basics of the gluten-free diet for celiac disease and gluten sensitivity: The grain group is most affected and the specific grains we just mentioned.

  1. Dairy, fruits, vegetables and protein food groups have minimal changes especially in their most natural form
  2. Put your emphasis on whole foods versus processed foods or those modified in some way. Processed and modified foods are most likely to contain gluten.
  3. Remember there are many naturally gluten-free foods such as fruit and vegetables and many grains. Reach for whole grains such as brown rice over white rice.

Want more information on how to select fish in the grocery? Listen to this week’s podcast below.

Listen to this week’s podcast


June 2, 2010

Gluten Free Update, Part 2

Did you know that chocolate bars, imitation seafood and herbal teas may contain gluten? To really make the gluten free diet work for you, it’s important to know all the ins and outs…particularly where gluten hides in products that you might not think about.

Where does gluten hide? Here are a few examples.

  • Processed foods particularly deli meats, hot dogs
  • Malt vinegar and soy sauce
  • Imitation seafood
  • Beer
  • Dry Roasted Nuts: some companies use dust with a wheat mixture
  • Glue on postage stamps and envelopes
  • Chewing gum
  • Some lotions, creams and cosmetics such as lipstick
  • Vitamins and medications

Terms to watch out for that may contain gluten:

  • Corn starch and wheat starch
  • Dextrin
  • Modified food starch
  • Natural flavoring/artificial flavor/color/smoke flavor
  • Fillers

Now is the time to become a label sleuth. According to registered dietitian Bonnie Taub-Dix, author of the new book Read It Before You Eat It, if you need to follow a gluten-free diet always be vigilant about label reading, especially because many manufacturers change their products without notifying the public. Something you might have enjoyed previously may now be unsafe.

I’ve posted a gluten-free and celiac disease resource document with links to celiac organizations, food companies, recipes, cookbooks and more at the Nutrition & Health Center.

You might be wondering if you will ever eat a chocolate brownie again. The answer is absolutely! My colleague, dietitian Liz Weiss, writes a blog called Meal Makeover Moms’ Kitchen. She has shared a gluten-free black bean brownie recipe that her readers rave about. Yes, it’s made from black beans instead of flour.

The folks at Cabot Creamery have a number of gluten-free recipes on their site using cheese such as cheddar mashed potatoes and layered broccoli salad.

If you love cheese, register to win a $60 gift box of award-winning reduced-fat Cabot cheeses at the Nutrition & Health Center. Go to the Nutrition & Health Center at WDBO.com …you’ll see the link to register.

More Websites for Helpful Information:

Celiac Disease Foundation http://celiac.org/

Shelley Case, RD, Gluten-free Expert http://glutenfreediet.ca/

Her Book: Gluten-Free Diet: A Comprehensive Resource Guide

Gluten Intolerance Group of North America http://gluten.net/

Gluten-free Cookbooks, Recipes and Food:

Savory Palate, Inc. http://savorypalate.com/

The Gluten-Free Mall http://www.glutenfreemall.com/

stellaLucy Gluten-Free Market http://www.stellalucy.com/

Listen to this week’s podcast


May 26, 2010

Gluten Free Update, Part 1

The gluten-free diet has become a popular diet de jour. Oprah pushed its popularity a couple of years ago when she went on a cleanse that was free of several items, gluten included.

The vast majority of you who are following a gluten-free diet are doing so because you’ve been diagnosed with celiac disease and there’s a war going on between your gastrointestinal tract and your immune system. A gluten-free diet wins the war.

The bottom-line basics of the gluten-free diet:

  1. The grain group is most affected.
  2. Dairy, fruits, vegetables and protein foods have minimal changes (and typically don’t contain gluten) especially in their most natural form.
  3. Put your emphasis on whole foods versus processed foods or those modified in some way. Processed and modified foods are most likely to contain gluten.
  4. Remember there are many naturally gluten-free foods such as fruit and vegetables and many grains (see list below). Reach for whole grains such as brown rice over white rice.

This is really important if you think you might have celiac disease. A gluten-free diet can interfere with obtaining an accurate diagnosis so never start on the diet until you’ve had the blood test and biopsy.

For this week’s more in-depth podcast on gluten-free click here.

Next week I’ll post an updated list of gluten-free and celiac resources at the Nutrition & Health Center. Just go to WDBO.com and click on the Nutrition & Health Center. You’ll see the link to the resources at the top of the page.

With Celiac disease, the tiniest bread crumb containing gluten can set some people off, make them sick and harm their intestines. Gluten is so ubiquitous that at times it can make managing celiac disease difficult.

The dangerous grains include:

  1. barley
  2. rye
  3. wheat
  4. spelt
  5. kamut

Some of the safe grains include:

  1. rice
  2. corn
  3. potato
  4. amaranth
  5. quinoa
  6. buckwheat
  7. millet
  8. chickpea flour
  9. oats

Remember wheat free is NOT gluten free. Wheat free can contain barley, bulgur or other grains with gluten.

In the past, oats were included on the dangerous list of grains because of cross-contamination. Oats were usually contaminated with wheat, barley or rye during harvesting and processing. More recent studies suggest that for most people eating oats in moderate amounts, meaning about ½ cup of dried oats is safe.

Celiac disease is an autoimmune disorder that attacks your small intestine and persists for a lifetime. Autoimmune basically means that your body turns on itself. Specifically your intestine is damaged by the protein you eat found in wheat, rye and barley…collectively this protein is referred to as gluten.

Any food item which contains gluten is like poison to your small intestine particularly to the little fingerlike projections called villi and makes it difficult to absorb the nutrients from food such as vitamins and minerals.

If you have questions that need answers now and want a personalized gluten-free diet, consider making an appointment with the nutrition expert, a registered dietitian. You can search for an RD in your area at the American Dietetic Association homepage.

Listen to this week’s podcast


July 22, 2009

Gluten-Free Living Guidelines, Part 2

g-free-2This is part two on the gluten-free diet so if you missed part one you can read the blog here on our site or listen to the podcast.  Did you know that the glue on envelopes, imitation seafood and gum may contain gluten? To really make the gluten free diet work for you, it’s important to know all the ins and outs particularly where gluten hides in products that you might not think about.

Last week I said that in celiac disease, the tiniest amount of gluten can set you off and harm your intestines. As a reminder, one easy way to recall the categories of food to avoid is the word BROW like your eyebrow. BROW reminds you of the dangerous proteins including barley, rye, oats and wheat…BROW. Remember wheat free is NOT gluten free. Wheat free can contain barley, bulgur or other grains with gluten. Some other grains that contain gluten include wheat bran, graham flour, spelt and triticale (a cross of rye and wheat), malt and malt extract (so this means if you’re a beer drinker, you want a gluten-free beer).

I also mentioned the update on oats. In the past, oats have been restricted because of cross-contamination. Oats were usually contaminated with wheat, barley or rye during harvesting and processing. Studies from the past 10 years have found that for most people eating oats in moderate amounts, meaning about ½ cup of dried oats is safe.  A growing number of celiac organizations and health professionals allow oat consumption in the gluten-free diet. More good news: various food companies are offering pure, uncontaminated oat products.

Don’t forget, there are many foods you can eat on a gluten-free diet. In fact, there are more things you can eat on the gluten-free diet than items you must avoid. As a reminder, foods you can eat are:

  • Plain meat, processed meats or meats with sauces, marinades, etc, may contain gluten
  • Seafood and poultry
  • Dairy products unless they have gluten ingredients added to them
  • Fruit
  • Vegetables
  • Nuts
  • Rice              Potatoes               Corn              Beans
  • Alternative grains: millet, quinoa, amaranth, buckwheat, and teff
    • Flours from rice, potatoes and beans, along with flours from alternative grains can be used in baking so check out the recipes on sites such as:  savorypalate.com or the Celiac Sprue Association. If you like to cook, you’ll find you can make most anything gluten-free with some modifications.
    • Many stores carry a range of gluten-free cookies, pastas, bread using rice flour, arrowroot, potato and tapioca.
  • If you crave the occasional treat there are candies, ice creams, chips and other gluten-free specialty products such as carrot cake, pecan pie, brownies and scones available. Read the labels closely because when gluten is removed, other items such as more fat and unhealthy fats can be added.

Becoming a label sleuth is the smartest move you can make as gluten hides in all types of products beyond wheat, rye and barley. Gluten can hide in foods and non food items that you might not think about.

Where does gluten hide?
Processed foods particularly deli meats, hot dogs
Malt vinegar and soy sauce
Vegetable cooking spray
Tomato pastes
Spaghetti sauces
Veined cheeses such as blue cheese may contain gluten
Vitamins and medications
Imitation seafood
Instant or flavored coffees and teas
Beer
Soup, salad dressing
Gravy and sauces thickened with flour
Glue on postage stamps and envelopes
Chewing gum
Some lotions, creams and cosmetics

Terms to watch out for that may contain gluten:
Corn starch and wheat starch
Dextrin
Modified food starch
Malt or maltodextrin
HVP or hydrolyzed vegetable protein
HPP or hydrolyzed plant protein
Emulsifier and stabilizer
Natural flavoring
Fillers
Durum flour
Couscous
Semolina
Spelt

Big changes coming in the food label for those on gluten-free diets.
In 2006, the first phase of the Food Allergen Labeling and Consumer Protection Act went into effect. Food products containing any of the top eight allergens of which wheat is one, must include an allergen statement on their labels. The second part of this Act which is in final stages will define gluten-free for the purpose of food labels inclusive of language which states how much gluten is allowed in a gluten-free product. Right now the consideration is under 20 ppm. Gluten-free labeling will be voluntary but once a final federal definition is in effect, if a manufacturer wants to label a product as “gluten-free,” the food with this gluten-free label must meet the regulatory definition.

The gluten-free diet is not only workable but very livable. It will take you some time up front, but the rewards for your body will be worth it.

Listen to this week’s podcast


July 15, 2009

Gluten-Free Living Guidelines, Part 1

g-free-1Did you know that the glue on envelopes, imitation seafood and gum may contain gluten? The vast majority of you who are following a gluten-free diet are doing so because you’ve been diagnosed with celiac disease also referred to as CD or non tropical sprue. Some of you may have chosen a gluten-free lifestyle because you feel you have a gluten intolerance or someone in your family has autism and you want to see if a gluten-free diet will help. Researchers at the University of Texas Medical School in Houston are conducting a clinical study, part of a number of clinical studies, to determine if the elimination of some foods, like gluten containing foods, truly have an effect on autism.  I’m focusing on celiac disease today since for you a gluten-free diet is not a choice. It’s a diet for life. A gluten-free diet is the only treatment for celiac disease. 

I want to say right up front that if you have celiac disease life as you know it is NOT over. It’s OK to feel upset, frustrated, down, sad, mad or a myriad of other emotions tied to a diagnosis of celiac disease. But your diet, the gluten-free diet, can not only make you feel better but it’s so much easier to follow than just a few years ago. Plus, when you live a gluten-free lifestyle, most of the complications associated with celiac disease can be prevented. Yes, you will have to give up some food items that you may love but you can find new ones to replace them. Yes, there’s a learning curve for the gluten-free diet. Yes, it takes extra work and detailed shopping. Yes, you have to change what you eat for the rest of your life. But there is so much accurate information available on the Internet to help guide you and I’ll give you some websites to check out. Also, there are more gluten-free foods available in stores and online than ever before and they taste good….not like a cardboard box. You know what I’m talking about…that flat, pasty, no flavor taste that is awful. You can live a gluten-free lifestyle and live it well. 

Celiac disease is an autoimmune disorder that attacks your small intestine. Autoimmune basically means that your body turns on itself. Specifically your intestine is damaged by the protein you eat found in wheat, rye and barley. Collectively this protein is referred to as gluten. Any food item which contains gluten is like poison to your small intestine. This intestinal damage makes it difficult to absorb the nutrients from food such as vitamins and minerals. Celiac disease does run in the family and can show up in people with Type 1 diabetes, Down syndrome and thyroid disease. CD can be tough to diagnose because the symptoms are so variable, can occur at any age (even in the elderly) and often involve other organ systems besides the gastrointestinal tract.  

Symptoms can range from bloating, gas, diarrhea and weight loss to anemia, lactose intolerance, mouth ulcers, bruising, joint pain and more. Because the symptoms vary person to person, CD is often misdiagnosed and it’s not uncommon for someone to have celiac disease for 8-10 years before it’s diagnosed correctly.  A skin condition called dermatitis herpetiformis or DH, often seen with CD, is celiac disease showing up on the outside of your body, on your skin. DH is an itchy, burning rash where small blisters form and then become erosions. This rash might appear on the scalp and back of the neck, knees, elbows and upper back.  Today we have better blood tests for diagnosing CD but they’re not foolproof. The only definitive diagnosis for celiac disease is a small intestinal biopsy. The skin rash DH is also diagnosed by biopsy where a skin biopsy is taken in an area close to the blisters. A gluten-free diet can interfere with obtaining an accurate diagnosis so never start on the diet until you’ve had the blood test and biopsy. 

With Celiac disease, the tiniest amount of gluten can set you off and harm your intestines. One easy way to remember the categories of food to avoid is the word BROW like your eyebrow. BROW reminds you of the dangerous proteins including barley, rye, oats and wheat…BROW. Remember wheat free is NOT gluten free. Wheat free can contain barley, bulgur or other grains with gluten.  

In the past, oats have been restricted because of cross-contamination. Oats were usually contaminated with wheat, barley or rye during harvesting and processing. Studies from the past 10 years have found that for most people eating oats in moderate amounts, meaning about ½ cup of dried oats is safe.  A growing number of celiac organizations and health professionals allow oat consumption in the gluten-free diet. More good news: various food companies are offering pure, uncontaminated oat products. 

Where can you find the information that you need to get started now? There are many terrific websites to start with that will lead you to others. 

          Her Book: Gluten-Free Diet: A Comprehensive Resource Guide
    Gluten-free products:

If you have questions that need answers and want a personalized gluten-free diet, consider making an appointment with the nutrition expert, a registered dietitian. You can search for an RD in your area at the American Dietetic Association homepage.

Listen to this week’s podcast


Featuring Advanced Search Functions plugin by YD

Dr. Susan Mitchell's Blog