Recently playing an endless production for the three million Americans with celiac disease, avoiding gluten can be the difference between life and death—and when counting those who have non-celiac gluten sensitivity, the population of Americans suffering from gluten issues triples in size. For these nine and a half million people, health is not as simple as purchasing a gluten-free cookbook and changing a few things about their diets; celiac disease and other gluten-intolerant disorders require a complete lifestyle overhaul. Gluten hides in everything from food to commonplace household items, and if it is not eliminated, it can cause gastrointestinal distress, rashes, anemia, depression, and—in the long-term—cancer, infertility and organ failure.
When Beth Hillson, food editor of gluten-free magazine Gluten Free & More, was diagnosed with celiac disease 35 years ago, all the basics on maintaining a gluten-free diet could fit on two typed pages. Fortunately, as awareness of the disease has grown, everyone from medical researchers to high-profile chains like Dunkin’ Donuts and Domino’s Pizza have cottoned on to the ever-growing need for gluten-free education—but information can still be incomplete or unreliable. To help the gluten-intolerant safely navigate their gluten-filled world, Hillson’s The Complete Guide to Living Well Gluten-Free: Everything You Need to Know to Go from Surviving to Thriving (Perseus, $17.99) provides practical, comprehensive advice for everything from why your child with celiac is allergic to Play-Doh to gluten-free dining and dating.
With pages at the end of each chapter dedicated to “Raising Your Gluten-Free IQ” by putting to rest common misconceptions about gluten and celiac disease, this guide is a go-to for embarking on a gluten-free journey to a happier, healthier life.
To whet your appetite, we are offering you a few questions that have been adapted from Hillson’s tome.
1. What is gluten?
a. It grows in wheat fields.
b. You can buy it in the dairy section of the grocery store.
c. You can’t see it or smell it. It’s colorless and odorless.
The correct answer is C. Gluten is a protein in wheat, rye, and barley. It’s undetectable without using a sophisticated test—so you can’t pick it out of your food or detect gluten by sniffing it. Instead, you need to know which foods contain gluten and which ingredients to avoid. Gluten is hidden in many foods that will surprise you, such as soy sauce, soups, barbecue sauces, brewer’s yeast, even some teas. So, for someone who must eat gluten-free, like a person with celiac disease or gluten sensitivity, it’s important to learn about places where gluten might hide.
2. Can I lose weight on a gluten-free diet?
a. Yes, gluten makes you fat so removing it from your diet will cut calories.
b. Yes, gluten-free means calorie-free
c. No, not necessarily. Calories are calories.
The correct answer is C. It depends on what you mean by gluten-free. If it means avoiding all carbs, including gluten-free carbs like rice, potatoes, corn and such, yes, you can lose weight. What’s left to eat? Veggies, fruit, protein and dairy, and these are always part of a healthy diet.
But, if you decide to replace gluten-filled pancakes, pasta, pizza with their gluten-free counterparts, you’ll be in for a surprise. You can potentially increase your calorie intake by as much as 20%, and you’ll be decreasing your fiber and nutrient intake at the same time.
3. Should everyone avoid gluten?
a. Yes, scientists believe gluten is harmful to everyone.
b. No, only those people with celiac disease, gluten sensitivity or wheat allergies must avoid gluten.
c. No, you can develop a tolerance to gluten.
The correct answer is B. People with medical conditions such as celiac disease or gluten sensitivity must remove all gluten from their diet; celiac disease cannot be cured or outgrown by eating a little bit of gluten every day. Each exposure actually puts celiac patients at greater risk for developing lymphomas and other digestive cancers, as well as other autoimmune diseases.
An additional 23-29% of the American population is estimated to have adopted a gluten-free lifestyle because of health concerns, other disorders, or the perception that eating gluten-free food is a healthier lifestyle. In fact, several bestselling authors tout the benefits of a gluten-free diet as a means to improving heart, brain and joint health as well as overall well-being. If my calculations are correct, that means around 80-90 million people are avoiding gluten.
Those who do not have a medical reason for avoiding gluten often say they feel better without it. Nevertheless, for these folks, eating some gluten occasionally does not present a health risk as it does to people with celiac disease or gluten sensitivity.
4. What do gluten-free kids want most?
a. A new body.
b. To be left alone.
c. Something to eat so they are not left out in social situations.
The correct answer is C. Kids who must avoid gluten face an ongoing stigma of feeling “different” from their peers. In fact, kids on special diets are bullied more often than their peers. It’s important for parents to help their children learn the coping skills that give them a positive attitude toward a gluten-free diet. Parents, take note if your child’s behavior changes or if he or she becomes withdrawn or depressed, doesn’t want to go to school, or doesn’t want to eat in front of peers. These are often signs they are having trouble coping with their diet in school.
Giving kids coping skills and positive support helps them adjust to this diet. One way is to make sure they have access to something they like to eat when they join friends for a house party, a sports team dinner, picnic or other school or social event. Planning ahead takes the angst out of social encounters.
Most kids say they just don’t want to sit there and have to explain why they are not eating. This can be as simple as calling the host or the restaurant, role playing to help the child figure out something safe for the situation, or providing pizza or cookies that everyone can eat.
5. Should everyone in my house eat gluten-free if one person is on the diet?
a. Yes, it’s important to be supportive of that person’s diet.
b. No, but everyone should be mindful of how they store and prepare things in the kitchen.
c. Yes, but only if that person is a child so he or she doesn’t feel left out.
The correct answer is B. It’s unnecessary to purge the house of gluten; however, you will need to separate gluten-containing ingredients and utensils to avoid cross-contamination and mistakes. Start by cleaning out the places in the kitchen where gluten tends to hide.
If the gluten-free person is a young child, then it’s important to set up cabinets and storage shelves with gluten-free food and label them so there is no confusion. Let the child help shop and unpack groceries. Let him or her apply the labels and even put away the products so he or she understands what is safe and what’s available. Babysitters and grandparents will also find this system helpful when they are watching the kids.
For meal planning, rely on foods that are already gluten-free (think meats, vegetables and fruit). Buy gluten-filled and gluten-free varieties of breads, rolls, flour tortillas and pizza crusts. Be sure to use separate prep areas, knifes, cutting boards, and serving bowls to prevent cross-contamination.
6. Does the federal gluten-free labeling standard mean that I’ll know everything I need to about products?
a. Yes, the labeling system is easy to use and always accurate.
b. No, it’s a good guide, but it still has some gray areas that require more clarification.
c. No, the labeling standard still needs a lot of work.
The correct answer is B. Thanks to the new labeling rule, we know that products labeled gluten free are safe for people who have celiac disease or gluten sensitivity. But, because the rule is voluntary, we don’t know if foods that seem gluten-free but aren’t labeled as such are still safe.
Fruits, vegetables, fresh meats, fish, and dairy are almost always safe and are healthy choices. Concentrate on shopping the outside aisles of the supermarket. Once you venture into the inner aisles where packaged foods reside, two labeling directives—one of exclusion and one of inclusion—will help you select safe gluten-free commercial products. The Food Allergen Labeling and Consumer Protection Act requires products to say, “contains wheat” if it’s present in a product. Those products should always be avoided. The FDA gluten-free rule requires any product saying “gluten-free” meet the less than twenty parts per million of gluten test. So, products that say “gluten-free” can be included in your diet.
But, beyond those products that clearly state “gluten-free,” there are many products where the labeling is unclear. For instance, do you know what it means if a product states “no gluten containing ingredients” or “processed in a factory that also processes wheat?” These products, if not labeled “gluten-free,” are not subject to the FDA rule. Essentially, any product that does not say “gluten-free” requires further research.
7. Is it safe to eat at someone’s home when you are on a gluten-free diet?
a. No, cross-contamination is a serious threat.
b. No, you should eat at home and go for the company.
c. Yes, but be sure to call your host ahead of time to discuss your dietary restrictions.
The correct answer is C. Eating food prepared in someone else’s kitchen is a bit worrisome, so try these tips to help minimize the risk.
Some folks eat at home first and then go out for the company, but a lot of socializing happens during mealtimes. Instead, call the host ahead of time, ask about the menu, and mention the diet. This gives you a chance to offer to bring a hearty dish that fits in with the theme of the evening, one you know will be safe and will fill you up. If the host seems receptive, you can review the menu and pick a couple of safe-sounding items—baked chicken without barbecue sauce or marinade (and prepared in a separate pan), roasted or baked potatoes, or salad with no croutons or dressing. These give you the bare bones which you and the host can “dress up” with safe dressing for the salad, sour cream and real bacon for the potato.
8. Can I count on a restaurant’s gluten-free menu?
a. No, don’t risk your health by taking anything at face value.
b. Yes, restaurants are required to guarantee their products the same way as food-processing companies.
c. You should always assess the restaurant’s understanding of your diet before you eat there, no matter what the menu says.
The correct answer is C. Every restaurant has a different definition of gluten-free and the protocols for making a dish safe. And, each meal is prepared individually so it also depends on which chef is cooking that day. Some restaurants have received training and have a strict protocol in place to minimize cross-contamination and to double check ingredients. Others may think that using gluten-free ingredients alone is enough to satisfy gluten-free diners. And they might be right since more people are avoiding gluten by choice than for medical reasons. In fact, these days, servers often ask diners if they are seriously gluten-free.
Eating in a restaurant when you have celiac disease is always chancy. You need to do your due diligence to determine how gluten-free savvy the restaurant is. Here are some questions to ask: are fried foods prepared in a shared fryer; is gluten-free pasta made in clean water and drained in a clean colander; do you use gluten-free soy sauce?
9. My friends love to bake for me. They say they know my diet, but I always feel a little off after I eat their gifts. What should I do?
a. Ignore it. Your friends are doing something nice for you.
b. Thank your friend for their kindness and have a talk about the possibility of cross-contamination.
c. Politely decline their gifts.
The correct answer is B. A well-meaning friend might start with a gluten-free baking mix, but the actual mixers and pans used to prepare the cake can be filled with crumbs of leftover gluten from the last cake. Or, that person may be making gluten-filled and gluten-free cakes at the same time without cleaning the beaters, spatulas, or spoons in between. The result is the possibility for cross-contamination, or the regifting of a dose of gluten. After thanking your friend for the treats, make sure they are aware of the dangers of cross-contamination via baking tools and stray gluten-filled crumbs.
10. The holidays are coming. Are all of the traditional recipes off the table for gluten-free guests?
a. No, you can make minor adjustments and still keep everything safe.
b. Yes, but you can start a new tradition.
c. It’s not that critical; you can ask your gluten-free guests to bring some alternative dishes.
The answer is A. Equal opportunity holidays are very doable. Make stuffing, gravy, pies, and rolls all gluten-free. It’s so easy to make minor adjustments and keep everything safe—replace regular bread with gluten-free bread for stuffing; thicken gravy with a cornstarch slurry, make a gluten-free pie crust and fill it with your family favorites. If there is a gluten-y food that is requested, ask that person to bring it. Make sure it’s labeled so gluten-free folks will know to steer clear. That way everyone has a safe, enjoyable holiday.