Questions and Answers
Q: My question relates to cooking. I'm just beginning to learn how to convert to totally gluten-free. We are Italian and have always used a great deal of pasta in our diet. However, I'm having some problems in learning how to prepare corn macaroni and rice spaghetti and lasagna. For me, the corn products made a good mush and the spaghetti sticks together in one cake-like unit. [or, as my husband described it--bird's nest spaghetti tonight]. I called the company to get more help with the directions, but again it turned into bird's next spaghetti.
A: You are likely to do best working with another celiac cook in your town for some good help with technique and process ideas. However, I can share some basics that I use which may also be helpful. Most corn and rice pasta products will be cooked and ready for eating after 8 to 9 minutes of cooking time. Begin with a large cooking pot, add two quarts of water and then add two to three tablespoons of corn or olive oil, two scant tablespoons of white granulated sugar, and one half teaspoon of salt. There is no need to mix or combine these ingredients--that will happen in the heating. Place the uncovered pot over High heat; when the water begins to cook and gets to a rolling boil, then add the pasta product. [Do not wash the pasta product, do not rinse the pasta product, and do not soak the pasta product as you indicate you have been doing]. Just dump the dry pasta into the rolling hot water right from the sack. Immediately begin to stir lightly with a wooden fork or wooden spoon. Pull and push the pasta product to one side, stir under and get all of the pieces that may be sticking to the bottom of the pot moving and rolling in the pot.
When the water begins to roll a second time [with the pasta having been added], reduce the heat to Medium]. Continue stirring at least 20 to 30 seconds of every minute the pasta is on the stove or you may then risk having the pasta to bind or stick together. When the heat is on Medium, set a time for seven minutes and at the end of that time period , test a piece for doneness. If it seems about ready, reset the timer for another minute or two and then do one more quick taste test and next drain immediately. Drain through a sieve or just use a lid to hold the pasta in the pot.
Before removing the pasta from
the pot, add a scant tablespoon of corn or olive oil and mix lightly. You
may wish to add the cheeses and added seasonings you prefer at this time.
Two grated cheeses and a sprinkle of Parmesan work well for macaroni and
cheese. For spaghetti, you may wish to add the sauce in the serving dish
or at the table. For spaghetti and meat balls, it may work best to add the
meat balls and seasonings before removing from the pot. No pre-wash or
soaking, a high rolling boil for the water, near-continuous stirring, and exact
timing are key points in the preparation of gluten-free pasta. As you have
pointed out in your note, technique and method are important factors in the
preparation of gluten-free products. 
Q: I'm the only celiac patient we know in the area and it has taken be a long time to figure out a diet that works. This morning, my doctor's nurse called to ask me if I would help a newly-diagnosed patient from 42 miles away to get started on the gluten-free diet. Can you help with an outline of basics to follow?
A: Congratulations! You will do well and will have made a friend for life. My suggestions are as follows: try the following 5 considerations in working out the basics for a gluten-free prescription diet for/with a new patient.
1. Choose foods from the suggested dictates of a basic gluten-free prescription diet program; teach that it is critical to follow the exact details of the gluten-free diet as prescribed. [no cheating, no tasting, not ever just a little bit, learn to take better care of your "machine" than you do your car].
2. Add "prescription food and ingredient items" from specific needs that were represented [questions that resulted] and all that evolved from the diagnostic evaluation with the physician and follow-up consultations.
3. Add food and ingredient content items that fit into the categories of other intolerances, food sensitivities, and selected hypersensitivities which are typically in addition to the key problem of gluten intolerance [gluten-sensitive enteropathy]. Such intolerances might include lactose intolerance related to lactase; trehalose intolerance which relates to molds; seafood sensitivities which may relate to such food items as shrimp, scallops, and lobster.
4. Choose to be more that "gluten-free." Add specific food [ingredient] items which are beyond the dictates of the gluten-free diet; these food or ingredient items have no known gluten or prolamin content, but cause problems and/or a similar reaction pattern to that of gluten intolerance.
5. Choose a diet that is unique for you, that is your prescription. Do not make the mistake of following or "taking" someone else's "medicine." Each patient's pattern of reactions, their condition, their illness--is different is unique to them, their patterns are different and need to be treated with their prescription of foods for the formulation of their particular version of the gluten-free diet. A food or ingredient that works for one patient may mean intolerance [or other problems] for the next well-meaning celiac.
Your illness has the same name, but has differing levels and different aspects that may require a different selection and combination of ingredients and food items. Treat your own needs, your own version of the illness in your diet--not the needs of someone else. When you meet the celiac patient who pays no heed nor attention to items 2, 3 and 4 above, uses wheat starch, oat meal and any shortening available, congratulate him or her, but go home and renew your dedication to stick to the basics of the gluten-free diet that fits you. Never make the mistake to think that the grass is greener on the other side of the "gluten-free diet fence"--stay in your own pasture!
It is often helpful for the new patient to work out 20 foods that fit their version of the prescription diet. In addition, it may be helpful to work out menu items for meals--especially for breakfast. And, to share where these foods are readily available. Help them to get started with one or two of the commercial food companies who support gluten-free diet selections. Do not omit how these foods should be prepared--with which shortenings, with which seasonings, flavorings and additions. Plan a few snack items, drinks, and desserts. Help with suggestions of two or three food selections available at most restaurants. Talk more about the thousands of foods available rather than what is not available to the gluten-free diet market. As you teach food selection for the gluten-free diet, also teach attitude. How the new patient learns to see the diet and how they see themselves in relation to the diet are often paramount factors in how they are likely to handle the illness.
It is typically difficult to teach [and likely more difficult to accept] that each commercial food company may be operating with their own version or definition of what is gluten-free. At this time, we do not have a common definition for the meaning of gluten-free and we have no general acceptance of ingredients to be included or excluded from the gluten-free diet. The findings of several studies indicate that many foods are contaminated with wheat or other gluten-containing cereals, and more importantly stresses the need for manufacturers to improve quality control in their plants, and to accurately label those foods to which gluten-containing ingredients are added. At this time, there is no reward system for companies that are doing a good job and there is no penalty system for units that are not following the dictates of gluten-free.
The celiac patient needs to
choose a prescription diet with no gluten [prolamin]; this becomes paramount
with the knowledge that even small amounts of gluten can increase the risk for
osteoporosis, malignancies, the development of other autoimmune conditions and
related complications. A critical concern is that continued ingestion of
gluten may predispose patients with celiac disease to neoplasia, including small
intestine lymphoma and carcinoma of the oropharyns and esophagus. That
these conditions are markedly reduced in patients who follow the definitions of
the gluten-free prescription diet provides strong support for adherence to a
strict gluten-free diet for life.
Q: I have 7 versions of the gluten-free diet: one from my physician's office, a different one from each of our two hospital dietitians, yours, listings from two other celiac organizations and one from ADA. How did we get to this point--with nobody knowing for sure how to get to the North Pole?
A: I like thinking through this dilemma with parts of an answer from the late Dr. Constance Kies, a Ph.D. nutrition and food researcher at the University of Nebraska-Lincoln. She would often state that we likely only have about 3 percent of the research information on foods and their ingredients in the knowledge base at this time. This leaves the other 97 percent out there and yet to be discovered. This leaves us with making decisions for the dietary needs of a celiac patient based on a 3 percent base of knowledge. There is so much to be learned and so much that we just don't know. Yet we must live and eat at this time for our livelihood and existence.
We move ahead with the use of both a factual research base of knowledge from controlled studies available and with an action research base of knowledge--the latter being experiential with patients and with observations of patients that indicate a particular point of information appears to be true for an individual or group of individuals. We then note these concepts and observations from both areas of research and offer them for the review and consideration of all patients. The task of the patient is to learn the needs for his own illness and with the help of a physician, dietitian, pharmacist--develop a prescription gluten-free diet for his particular version of the illness.
Of paramount importance in working out a definition of the gluten-free diet is the concept that "one size doesn't fit everybody." Each patient has a different and differing set of needs. In actuality, each patient has a different illness. With a different illness, each patient has the need for his or her own individualized version of the gluten-free prescription diet. Dietitians and celiac organizations help in developing a basic and general overview of the gluten-free diet, the basic philosophy for the diet, the overall umbrella needs for the diet, but the final actual prescription diet for each celiac patient needs to be set up specifically for that particular patient.
In making diet selections for the gluten-free diet, we typically urge celiac patients to err on the side of conservatism--to make mistakes on the side of being too strict. In addition, we teach "when in doubt, leave it out" as a basic guideline for food [ingredient] selection. With celiac disease, anything can happen and usually does--especially when there is non-adherence to a personalized prescription for the treatment of celiac disease.
With a developing knowledge
base, with a limited knowledge base, with many and varying differences and
complications in a complex illness, we then all have a goal of sharing what we
have learned and observed for a general overview for the gluten-free diet.
There are no pat and easy answers for defining the diet. There is no
instant cure. While diet remains the present known treatment, we are not
in an exact science and we are likely light years away from any so-called right
answers. We all hope and trust that we are on the way, and we all know
that we haven't arrived.
Q: Can drinking diet soda and using artificially-sweetened foods or drinks relate to diarrhea or other celiac symptoms?
A: Selected sweeteners may be based on grain protein content, so it the right amounts, these sweeteners could trigger problems. A sweetening agent such as sorbitol is reported in the literature to cause diarrhea in selected individuals. Second, some few celiacs may have [or can develop] a sensitivity to either the base ingredient for the sweetener, sorbitol or one of its components. Sensitivity for sorbitol and any of the several sorbates, for example, would preclude the use of a number of foods common in the market as well as the use of several toothpastes.
For
most celiacs, a simple diet elimination program may be helpful in learning if a
particular ingredient such as a sweetener is a trigger for overt and noticed
symptoms. Eliminate the suspected substance from the diet for three weeks
[or up to a month]. If the diarrhea subsides completely, the excluded food
is reintroduced as a challenge, and if diarrhea recurs, there then is a distinct
possibility the diarrhea is secondary to the suspected agent. In most
studies, the suspected substance is repeated a minimum of two times before
concluding it is a diarrhea-causing agent. As a conservative dietary
guideline, celiacs should move toward avoiding foods containing artificial
sweeteners whenever that choice can be made available to them. Use regular
soft drinks sweetened with granulated sugar and with no additives; use less of
them if that is a need for your weight management program.
Q: I've gone back to my regular vitamins; when there were no problems, I went off the gluten-free diet and have not had any symptoms.
A: Some of us as celiacs resent the dietary restrictions of the prescription gluten-free diet and may then make the choice to cheat on non-allowed medications and foods or go off the diet altogether. To their surprise, some of these patients may not observe any change in overt symptoms or in any aspect of their overall well-being. As a consequence, they extend their food intake to anything in the marketplace. But sooner or later, if the diagnosis of celiac disease was correct, symptoms of malabsorption will recur. Unfortunately, for the patient who has followed a gluten-containing diet for a period of time, there may now be both overt and covert symptoms. Those might include additional problems in and with the celiac condition; perhaps the addition of new symptoms or another autoimmune condition, and there could be added infection-related problems or selected cancers that have already been manifested or that will develop. The critical concern is that continued ingestion of gluten may predispose patients with celiac disease to neoplasia, including small intestine lymphoma and carcinoma of the oropharynx and esophagus. The patterns of additional symptoms, new and old problems, and the renewed intensity of the celiac condition appear to vary with each patient.
The message from research is very clear, however. The
patient diagnosed with the celiac condition should find and discover the most
appropriate prescription diet selections that meet the needs of their particular
version of the illness. Once a celiac, always a celiac; once on the
gluten-free diet in response to diagnosis of gluten intolerance, choose to
remain on the diet. The present known treatment provides strong support
for the practice of advising all patients with celiac disease [non-tropical
sprue] to adhere to a strict prescription gluten-free diet.
Q: When do basic symptoms of celiac disease reoccur? I have been gluten-free for about six years and now I seem to be starting all over with the illness.
A: For some individuals, the basic gastro-intestinal symptoms, weight loss or nutritional deficiencies may reoccur after an initial good response to the prescription gluten-free diet. This kind of situation should always be evaluated in conjunction with a physician review and may turn out to be a long-term study involving detailed evaluation along with some good detective work. The answer may be evasive and is often not an easy one, so the patient needs to join in the evaluation process and not be quick to self-diagnose nor lose faith in what may be a detailed medical process. A few of the possibilities for a recurrence are included in the following listing. However, this is only an elementary beginning listing. A detailed response would need to be worked out with a physician who knows both the condition and the patient involved.
1. Inadequate Prescription Diet. An inadequate exclusion of gluten is a common cause of failure to respond or for a recurrence of symptoms for many patients. The inclusion of gluten in the diet may be accidental or intentional. Gluten-restriction must be exacting and strict and long-term. There is no such thing for an auto-immune condition such as non-tropical sprue that a little bit [a minute amount of gluten] may not hurt or influence the condition. Accidental inclusion of gluten in the diet may easily occur. Offending glutens are in a variety of unexpected foods. Going back to a basic 15 to 20 [known to be acceptable] foods with an exacting review of all dietary in-take may be productive when basic sprue symptoms reoccur.
2. Lactose Intolerance. Lactose may be a factor in diarrhea symptoms that are slow to respond to the gluten-free diet. Poor absorption of dietary lactose can contribute to intestinal symptoms. Or, it could be a diarrhea that returns with a mild degree of intestinal injury. In addition, some people lose lactase enzyme as they get older, thus milk may cause diarrhea [but not malabsorption of fat or protein] even when the sprue is under good control.
3. Vitamin Deficiencies. Vitamin deficiencies are common in active celiac disease. These deficiencies generally correct as the mucosal lining of the small intestine returns to normal and is seen as "healed." Although for some patients, this process may take a longer time. Deficiency of B-vitamins, folic acid, and vitamin B-12 may result in diarrhea or even in a degree of malabsorption. Most vitamin deficiencies and absorption levels can be readily evaluated by a physician and easily treated. Thus, the celiac patient may need to be proactive and ask to have these evaluations with an annual physical or when problems are suspected.
4. Concurrent Illnesses. The association of a concomitant illness in addition to celiac disease may occur. Any of several autoimmune conditions may also be present and need their own pattern of treatment. For example, diabetes and celiac sprue may occur together. Diabetes can also result in diarrhea, weight loss, and malabsorption. Irritable bowel syndrome is a condition in which muscle activity of the bowel is not normal. It can result in diarrhea [but not malabsorption], constipation, and abdominal discomfort. It can mimic the possibility that sprue has reactivated. Also, there are a variety of gastrointestinal infections that can give the appearance that sprue symptoms have recurred.
5. Wrong Diagnosis. The erroneous diagnosis of celiac sprue would be a possible explanation for initial long-term failure of a gluten-free diet to alleviate a patient's malabsorption. While celiac disease is the most common cause for flat mucosa, there are other conditions that may also produce this appearance. Some biopsy features suggesting celiac sprue may be seen in several viral or bacterial infections, high acid secretion, radiation treatment, lymphoma, and several other uncommon diseases. Thus, the suggestion of the physician generally includes follow-up with a second biopsy and that there be improvement in villi observation following a strict observance of the gluten-free diet. [overall improvement on the diet and overall improvement in the appearance of the villi].
6. Long-Term Nutritional Deficiencies. If nutritional deficiencies have been present over a prolonged period of time with or without treatment, it may be that full growth potential, full healing, normal bone strength may not be possible. With other related and non-related conditions and infections, there may also be less potential for a full recovery with a full regeneration of villi.
7. Complications. Selected associated complications may also need to be considered when a sprue patient is no longer responding to the diet. Collagenous sprue is a rare condition that is characterized by a layer of collagen or fibrous tissue beneath the intestinal absorptive cells. Refractory sprue simply refers to active mucosal disease that no longer responds to the gluten-free diet. Ulcerative jejunitis is a term for active bowel inflammation and ulceration that can complicate celiac disease. These conditions are quite uncommon, are difficult to treat, but sometimes do respond to steroid treatment patterns. The potential of lymphoma and carcinoma, while always mentioned and always are on the list of possibilities, are likely to be a low risk problem.
Summary
Statement. It is reassuring to know that most celiac patients do very
well on the prescribed diet. The diet is a good one. The diet makes
celiac disease manageable. While patients are expected to move to
self-management, there is often the need to admonish against self-diagnosis and
the associated need to emphasize the development of a partnership with a
monitoring physician in which there is good communication. A simple chat
can often lead to a simple solution when problems appear to
arise.
Q: We had trial samples of the new vanilla coke at a friend's house last weekend. It tasted so good. But I'm not doing too well even after three days of diarrhea. What do you know about this product?
A: A check with Consumer Services at a company office in Atlanta, Georgia may not have provided a final answer to your question. It is possible that you may have had a reaction to a sweetener being used and it is possible that you could be reacting to the vanilla mix [or one of its ingredients] that is added to achieve the vanilla-flavored coke. Until a listing of ingredients can be further analyzed, it may be best for you to stick with regular Coke and not try any of the other artificially- or naturally-flavored coke products.
At this time, we do not have adequate
information to provide an answer to your question. As a rule of thumb, you
will likely always to best NOT to consume a product for which you do not have
good information. And, for good measure, you may wish to always have a
complete knowledge of and about artificial flavorings. When in doubt,
leave it out remains a safer route to prescription needs for your
diet.
Q: With some hair loss, considerable weight loss, almost full-time nausea, my physician is questioning whether I may be taking too much vitamin A. He is helping me to reformulate my dietary intake and is against my taking the food supplements and the extra vitamin A that I have been on for the past year. What can you tell me about vitamin A?
A: Vitamin A was the first vitamin discovered [hence the name "A"]. Yet after 60 years of study, the exact way this vitamin works in the body remains unknown.
Vitamin A exists in three forms within the body. Each of these forms apparently has different functions. Vitamin A is considered essential for at least three different functions--vision, growth, and reproduction.
Vision. The role of Vitamin A in vision is the only one that has been defined. Vitamin A combines with a special protein in the section of the eye that is responsible for vision in dim light. Without vitamin A, the ability to see in the dim light of evening, or at night, is lost [and or diminished]. The result of this condition is referred to as "night blindness." It is a common symptom in celiacs who may have mal-absorbed vitamin A previous to diagnosis and getting onto an adequate diet regimen.
Growth. Vitamin A functions in two areas of growth: development of bones and maintaining healthy skin tissue. Bones may fail to grow to the proper length with a vitamin A deficiency. Vitamin A is needed as well for healthy skin tissue. Skin cells are constantly being replaced. Therefore, the need for vitamin A in maintaining healthy skin is constant. Without adequate vitamin A, hardened, dry cells replace normal healthy ones.
Reproduction. The need for vitamin A in normal reproduction in animals was defined early in the investigations of the role of vitamin A. Without vitamin A, male animals become impotent, and females do not maintain a normal pregnancy.
Other functions. Vitamin A is needed for the proper functioning of certain enzymes and is needed for proper perception of taste. In vitamin A deficiency, there is a lack of appetite due to changes in taste buds on the tongue.
Deficiency. Symptoms of vitamin A deficiency include night blindness; changes in the eye that can lead to blindness if not corrected; dry, rough skin; diarrhea; loss of the sense of smell and taste; and, a greater susceptibility to respiratory infections.
Food sources. With the exception of a very low amount in spinach, preformed vitamin A is found in foods of animal origin. A series of compounds called carotenes are present in vegetables. These compounds are converted within the body to vitamin A. Rich sources of vitamin A are to be found in fish, liver oils, and in liver.
Requirements. Vitamin A is a fat-soluble vitamin that is stored in the body. The daily recommended dietary allowance has been at 5,000 international units [IU] for an adult male; 4,000 IU for an adult female; for the female this is increased to 5,000 IU during pregnancy and to 6,000 IU for nursing and lactating mothers.
Potential Danger. For individual reasons, many people take a vitamin A supplement. Because vitamin A is stored within the body, it is possible to take too much. however, there is a wide individual difference in sensitivity to high levels of vitamin A. Some people show symptoms after taking 50,000 IU per day over a long period of time; others show symptoms only at levels of 150,000 to 200,000 IU per day.
Symptoms. Symptoms of too much vitamin A vary and may be unique to each individual, but can include headache, drowsiness, nausea, diarrhea, weight loss, and loss of hair. Taking an excess of vitamin A [any amount above the recommended dietary allowance] may best be done under the guidance and monitoring of a physician knowledgeable in nutrition.
Perspective.
Before taking on extra vitamin A through vitamins or specific supplementation,
it may always be best to have documentation of need supported by blood tests and
the interpretation of a physician that the need exists and should be treated
with extra vitamin A both in the diet and through appropriate
supplementation. Most physicians will do this via consultation and
prescription. Thus, the diagnosed celiac would then be following the
prescription gluten-free diet and the added prescription definition for added
supplementation of vitamin A.
Q: What is gellan gum and is it okay for me as a celiac to use products that contain gellan gum?
A: Our reference indicates that gellan gum received FDA approval in September of 1990 for use as a stabilizer and thickener in frostings, icings, glazes, and non-standardized jams and jellies. Gellan gum is derived from a carbohydrate and is produced by a microorganism similar to that used for xanthan gum. When used in products, is produces a clear gel an is heat stable. Icings and glazes prepared with gellan gum produce a non-sticky, smooth, and shiny surface. Gellan can replace low-methoxyl pectin used in non-standardized jams and jellies and allows fruit flavor release, processing stability, and clarity.
Two
questions might remain for you: Are you carbohydrate sensitive? Are
you mold sensitive or have you been diagnosed with trehalose intolerance?
If you are either carbohydrate or mold sensitive, then gellan would likely be a
non-allowed ingredient for inclusion in your prescription gluten-free diet.
Q: What can you tell me about folic acid? Is it in everything?
A: To look at an answer related to your question, we need to consider what the FDA lists as standardized and non-standardized foods, [the so-called standards of identity]. We can get a part of the answer from a March 5 listing in the Federal Register in 1998.
Under a final rule published in the Federal Register, the Food and Drug Administration amended federal standards of identity to require the inclusion of folic acid in most enriched bread, flour, corn meal, pasta, and rice products to reduce the risk of neural tube birth defects. In addition, the Canadian government has proposed that the level of folic acid enrichment in that country be raised to the new level required in the United States and that folic acid become one of the mandatory nutrients for flour enrichment and for enriched pasta.
The addition of folic acid to non-standardized foods is now optional under both U.S. and Canadian regulations.
Foods required to be fortified with folic acid as of January 01, 1998, [those under the standard] under the new U.S. regulations include: enriched bread, rolls, and buns, 0.43 mg per lb; enriched flour, including enriched self-rising and enriched bromeated flour, 0.7 mg/lb; enriched macaroni products, including enriched non-fat milk macaroni products and enriched noodle products, 0.9 to 1.2 mg/lb; enriched corn grits, 0.7 to 1.0 mg/lb; enriched corn meal, 0.7 to 1.0 mg/lb; enriched farina, 0.7 to 0.87 mg/lb; and enriched rice, 0.7 to 1.4 mg/lb.
[For the celiac, it is important to note the rice products marked enriched have been enriched with folic acid at the rate of 0.7 to 1.4 mg per lb. It becomes important with selected rice products to learn what was used to add the enrichment for rice products being consumed as a part of the prescription gluten-free diet].
Breakfast cereals may contain folic acid at levels up to 0.4 mg per serving. Many ready-to-eat cereals now voluntarily carry up to 2.5 percent of the recommended daily consumption level of folic acid. Dietary supplements and infant foods will be the only other products to which folic acid may be added.
These fortification levels are
designed to help women consume the medically recommended 0.4 mg [400 micrograms]
of folic acid while keeping daily intake of the vitamin below 1 mg. Higher
intakes may mask symptoms of pernicious anemia, a form of vitamin B-12
deficiency that primarily affects older persons, according to the physician
consulted.
Q: I'm questioning if I might be deficient in folic acid. Are there general symptoms that I need to consider? What vitamins should I take?
A: To check out a potential folic acid deficiency or any potential need for treatment or changes in diet, discuss this concern with your physician. It is likely that an appropriate blood test and evaluation will help to give an answer to your question. Additional evaluations and follow-up may be warranted. Then, carefully follow those conclusions an directions.
If you have celiac disease, you are likely to be susceptible to folic acid deficiency because of your particular version of this malabsorption syndrome. You may not be able to absorb sufficient amounts of folic acid even if it is plentiful in your diet. However, when celiacs follow the basics of the gluten-free diet, their susceptibility to folic acid deficiency is greatly reduced. [And may never occur]. Thus, an evaluation of your particular version of the gluten-free diet may also be in order. Food intake and food combinations may be important to and for such an evaluation. A food diary and a diary of accompanying symptoms may need to be a part of the evaluation. Be sure you are on a strict GF diet plan.
The main symptoms of folic acid deficiency anemia are usually close to those of other anemias. They may include paleness, fatigue, shortness of breath, and palpitations [or heart fluttering] particularly if you exert yourself.
Some of the other overt symptoms of anemia may include: sore mouth and tongue, yellow skin color, tingling in hands and feet, lack of balance when walking, memory loss, confusion, and depression.
Most textbooks list folic acid as a collective term for pteroylglutamic acids and their oligoglutamic acid conjugates. Folic acid is thought to be a part of one or more of the amino acid sequences of gliadins; and, is a part of the vitamin B complex series necessary for the normal production of red blood cells. It is present, with or without glutamic moieties, in peptide linkages, and in liver, yeast, and green leafy vegetables. It may be a part of the pattern of therapy used in treating pernicious anemia, macrocytic anemia, celiac syndrome, and sprue. Dosage levels and patterns of therapy need to be developed for each patient and require careful monitoring.
The results of treatment with folic acid appear to depend on the chronicity of the intestinal lesion for that particular patient. Treatment can be curative for those persons who have had celiac disease for only a few months, but intestinal structure and function may not return to normal until after one or two years of therapy.
The addition of B
vitamins and/or other nutritionals may not be the whole answer for a problem
that involves malabsorption or lowered absorption of folic acid. Patients
are well advised not to respond to 4-color posters found in health food stores
that represent and easy road to cures for an anemia. Seek out medical
advice and direction for evaluation and follow-up. Work with your medical
team to develop a plan of action. Follow up carefully with monitoring and
perhaps a re-evaluation if that should be deemed necessary.
Q: I'm a well celiac doing well on the diet with one overwhelming exception. I'm always 40 to 50 lbs overweight. Before I began to include low-fat products I was only 20-some lbs over the limit. Now I'm out of the ballpark. What has gone wrong?
A: The food industry created low fat and nonfat foods in response to a federal goal of producing more than 5,000 reduced-fat processed food products by 1998. Many of us consumed these products with the intent of eating healthier and cutting intake.
The trouble is that we ate large quantities of these foods, some of which had more calories that full-fat foods. Some people were eating less fat but were taking many more calories. Excess consumption of calories is a significant factor in obesity. Weight loss efforts for good health involve consuming both less fat and fewer calories--and especially less calories.
Some of the low-fat and nonfat foods can be useful additions to the diet effort to lose weight. Not all reduced-fat food products are alike, however. Fat-free and reduced-fat milk, for example, can be a daily part of a healthy diet because milk is an important source of calcium. [if milk is allowed in your diet]. In real life, however, people sometimes assume that they can use or eat more of a reduced-fat food simply because it is "lower in fat content." This is particularly evident in consumption of reduced-fat chips, dips, cookies, baked goods, yogurts, candies, and ice creams.
Pay attention to calories and your calorie-intake; pay attention to serving sizes and portions and how much that you actually consume in one day or at one meal. Do not concentrate only on the grams of fat being consumed. Read the food label for content of both fat and calories. Know that carbohydrates will add up--and fast!
Set aside the serving size or portion you are going to eat when sancking or eating a meal. Close up the sack or container and put that food away. This means taking a reasonably-sized portion out of the bag of chips, placing the scoops of ice cream in a dessert plate--not eating out of the container.
Note also that fat replacers used in low and nonfat foods are not a panacea for weight control. It is not certain that nay of these foods provide any health benefit.
For the overweight celiac, it may be a better choice to eat regular foods and just eat less. And to make a good judgment about how much ahs been eaten and make sure that there is enough exercise to burn off those calories [plus a few more if that is what is needed]. If there is no time to do the exercise needed, then there is not enough time to eat it, may be a rule of thumb to adopt.
Since the research is not yet in, all fat replacers [and selected artificial sweeteners] are on the highly questionable list--especially for those persons with autoimmune problems. Thus, many of the low and nonfat foods could also be questionable or on the not allowed listing for the prescription diet of the celiac patient.
Note the following research report: Eat less, Live longer.
The secret to living a longer life may be to spend much, much less of it eating. Researchers at the National Institutes of Health studied 120 rhesus monkeys [with whom we share 90 percent of our genes] for 15 years, and found that animals that were fed 30 percent less than the control group, who were fed a regular low-fat diet, lived about 30 percent longer and suffered fewer age-related diseases.
Calorie restriction has been
shown to increase longevity in rats, guppies, spiders, dogs, water fleas, and
yeast. If humans consumed a similarly restricted diet, could we live to be
150? Would it work? "I'd be shocked if it doesn't work in
humans," Massachusetts Institute of Technology biologist Leonard Guarente
told The Wall Street Journal. But is it practical? The U.S.
Department of Agriculture recommends that the average sedentary woman eat 1,600
calories a day and the average sedentary man eat 2,200 calories. On a
restricted-calories diet, a woman would eat only 1,120 calories a day and a man
1,150. An average meal at McDonald's contains 1,450 calories.
Q:
A concern to many celiacs is the indication of an increased risk of
lymphoma--a form of cancer. Can you
comment, please?
A: The research to date indicates there is some increased risk, but not as much as was once thought to be the case. It is important that a physician monitor patients since there are screening methods (not 100% accurate) to access the possibility of a concurrent malignancy. From numerous research reviews, we learn that the greatest protection factor which celiacs can apply is strict adherence to the gluten-free diet.
Q:
Is there a relationship between celiac disease and arthritis?
A:
No, not the arthritis of adult years.
Both conditions, however, are considered autoimmune diseases.
In the critical phase of celiac disease, some joint pain may be related
to the intestine’s rejection (or malabsorption) of food. In the older person, problems of arthritis and osteoporosis
are not thought to be related. One
is located in the joints and one is in the bones.
Q:
Are all forms of diabetes mellitus autoimmune diseases?
A:
No, the more common form of diabetes is caused
by insulin resistance and is not autoimmune; it is generally referred to as
non-insulin dependent diabetes and is sometimes called Type II diabetes.
Only about 10 percent of the cases are autoimmune; these are the cases that are
referred to as insulin-dependent diabetes and are also referred to as Type I
diabetes and juvenile diabetes. Present diagnosed cases of persons with
celiac disease who also have Type I diabetes is represented to be less than 2
percent of the total number of diagnosed celiacs by [NIH] National Institutes of
Health data.
Q: What are the symptoms of Crohn's Disease?
A: Crohn’s
Disease is a chronic inflammation involving any part of the intestinal tact, usually
the small intestine where it joins the colon (terminal ileum).
It
may, however, involve any part of the entire alimentary canal from
mouth to anus.
While both conditions are autoimmune diseases and both may run in the
same family bloodlines, Crohn’s Disease is not related to Celiac Disease and
the gluten-free diet is not beneficial.
Crohn’s
often is manifested by abdominal pain and diarrhea, but is typically
complicated by intestinal fistualization or obstruction or both.
The diagnosis of Crohn’s is established by history, X-rays of the
intestines and /or endoscopies with biopsy. The
most frequent mucosal lesion found in the intestine of a patient with active
Crohn’s disease (as with ulcerative colitis), is crypt injury.
This injury takes the form of cryptitis and subsequently crypt abscesses
consisting of polymorphonuclear cells. Treatment
is difficult because the etiology of the disease is unknown.
Various drugs utilized are intended to suppress the body’s
reaction—inflammation—to the disease. Typically
no drugs are 100% effective. Surgery
may be used to relieve complications of the disease, but unfortunately may not
cure the problem.
Q:
Is there a genetic relationship between celiac disease and thyroid
disease?
A:
Clinical studies supported by laboratory studies indicate a genetic
or inherited predisposition to celiac disease and to certain kinds of thyroid
disease. However, a strong
relationship between celiac disease and thyroid disease from a genetic aspect
has not been recognized. There are
multiple reports or research studies of patients with both celiac disease and
thyroid disease. (more typically hypothyroid,
an under active action of the thyroid).
Q:
Is there a connection between gluten intolerance and vision problems?
A:
There is no recognized, direct association between disturbances in
eye function and celiac disease. There
are, however, indirect relationships as the consequence of
malabsorption—especially of Vitamin A, during the active phase of the disease.
Vitamin A deficiency is associated with the development of impaired vision at
night, so-called “night blindness.”
Q:
Do persons with celiac disease seem to have a problem with regulation of
their body heat? I have cold hands
and feet even when I am warmly dressed day or night.
A:
The subjective sense of heat and cold is frequently unassociated with
changes in recorded body temperature and is not specific for any disease
process. Such problems do commonly
occur in persons with thyroid disorders, during the transitional period of
menopause, during or following emotional disturbance states, and in people who
are undergoing a change in weight. Usually
patients who are losing weight will experience sensations of cold, and people
who are gaining weight, especially above the upper limits of normal weight, will
complain of excessive heat. There
is not thought to be a specific relationship to celiac sprue.
However, an accompanying thyroid condition along with the celiac
condition may be quite relevant to having cold hands and feet.
Q:
What can you tell me about peripheral neuropathy [tingling and numbness
in my hands and feet] that occurs mostly at night?
A: Diffuse numbness and tingling are symptoms that may be the result of a peripheral neuropathy. There are many causes of peripheral neuropathies, among which are vitamin deficiencies. The lack of the B group of vitamins (water-soluble) is frequently associated with these symptoms. Deficiencies of the fat soluble vitamins (A, D, E and K) are more commonly seen in non-tropical sprue [celiac disease] because of the marked impairment of fat absorption during active phases of the disease, and therefore, the loss of these vitamins in the stool.
If the peripheral neuropathy features of numbness and tingling are secondary to vitamin deficiency, relief is usually obtained by injection of the deficient vitamins or, with restoration of small bowel function, oral administration of the appropriate vitamins. In situations of a prolonged vitamin deficiency, such as Vitamin B-12 and folic acid, the symptoms may persist despite vitamin replacement. In addition, because factors other than vitamin deficiency may give rise to peripheral neuropathy symptoms, the oral or injectable administration of these drugs may not be associated with any benefit.
Primary care physicians can manage most of the nutritional deficiency
based peripheral neuropathy symptoms. If
the problem is complex, a neurology consultation may be required.
In most cases, it is best to work with a team of physicians which
includes both the gastroenterologists and the neurologist.
Q:
What is the cellobiose-mannitol test and how does it related to the
diagnosis of celiac disease?
A:
The test measures the permeability of the small intestine mucosa to
different size molecules (cellobiose, large; mannitol, small).
In untreated celiac disease, the mocosa is more permeable to large polar
molecules and less permeable to small polar molecules.
The two molecules are given simultaneously.
They are absorbed intact, not metabolized and excreted in the urine
(5-hour collections). The relation
of cellobiose-mannitol to urine excretion is increased in celiac disease (as
well as in regional enteritus) relative to patients with normal small bowel.
The test is considered to be more sensitive and more specific than the
D-xylose absorption test.
Q: What is the D-xylose test and what contribution does it make to the diagnostic evaluation for celiac disease when it is used?
A:
D-xylose is an aidopentose (5-carbon sugar) which is not normally
present in the diet. Approximately 50% are absorbed intact from the upper small
intestine. It is poorly metabolized
and approximately 50% of the absorbed amount is excreted in the urine intact.
Most adult celiac patients with active disease poorly absorb sugar;
therefore blood levels and urine excretion of D-xylose are low in most but not
all patients. The test is used as a
screening procedure for small intestine malabsorption disorders but is not
specific for celiac disease. Its
sensitivity for detecting celiac disease in children is less than in adults.
The test may not be included in the evaluation for the diagnosis of
celiac disease.
Q:
Can a woman with celiac disease who is on a gluten-free diet and doing
well expect to have a normal pregnancy and delivery?
A:
If the nutritional status is good to excellent and there are no other
medical problems, the risk factors should be no greater than those for women in
the general population in the same age group.
Q:
What about leaky gut syndrome?
A:
Two conditions cause alkaline phosphatase to increase in the
blood—liver hepatitis or the disease of the bones called osteomalacia
(softening of the bones). The latter condition (osteomalacia) is likely to be more of a
problem for persons with celiac disease than osteoporosis [although osteoporosis
does occur in selected patients]. Alkaline phosphatase can be fractionalized to
give more information about the condition of the bones.
Osteomalacia (called rickets in children) may be corrected with
appropriate dosage of vitamin D for some patients.
A gradual softening and bending of bones with a varying severity of pain
characterize the condition; the softening occurs because the bones contain
osteoid tissue that has failed to calcify, due to lack of vitamin D or renal
tubular dysfunction. The disease is more common in women than in men, and often
appears to begin during a pregnancy. Symptoms
may be back pain, collapsed spine or muscle weakness.
Because of many variances involved, the interested celiac patient should
discuss their symptoms and potential secondary condition with their physician.
Q:
Who should have a gluten-challenge and should it necessarily be done
under a physician’s monitoring and care?
A:
The challenge is done when the diagnosis for celiac disease is
uncertain and the results of the biopsy are ambiguous.
The length of time for the challenge may be 2 or 3 weeks or longer.
The test and preparations for the test which generally include diet need
to be done under a physician’s supervision and then be concluded with a
biopsy.
Q:
What is candida and how is it diagnosed?
Are symptoms similar to celiac disease?
How is it treated?
A:
Candida is a yeast or fungus organism.
Infections are infrequent and tend to occur in people who are
malnourished or in whom the immunological system is not functioning properly.
It is treated with specific antibiotics.
Q:
Is it typical for celiacs to experience nausea and fatigue on hiking and
long walks? I often get sick when
I’m exercising at the gym.
A:
If celiac disease is in the active state for you, then nausea and
exertion associated with fatigue are common symptoms.
Such symptoms are not specific for sprue and are associated with a wide
variety of medical problems. If the
symptoms are intensive and/or progressive, re-evaluation should be conducted by
the patient’s monitoring physician.
Q:
Will I have a problem with my insurance company after I have been
diagnosed with celiac disease? Will
they be likely to drop me because I now have what some may term as a chronic
illness?
A: It is not
likely that you will ever have any problem whatsoever with your insurance
company.
If you do have a special situation, there are providers of life insurance for individuals who have genetic conditions. The concept behind these types of programs is one that affords individual underwriting based on actual medical status without prejudice to any particular “genetic” condition. Several programs are currently available; information can be obtained by writing to the following address:
Alliance of Genetic Support Groups
38th and R Streets, NW
Washington, DC 20057 Tel:
202/625-7853
In addition, many state departments of insurance will have
information or can make appropriate referrals within your own area and for your
state.
Q:
Could I be credited with extra-withholding items on my income tax
deductions for costs related to celiac disease?
A: The answer to this question may change from one year to another as the allowable deductible items are redefined and the total dollar amount for deductibles changes.
Records of expenditures for medical prescription items and the differential costs for gluten-free foods need to be maintained. Most celiacs find that after keeping weekly records of all foods included in the “prescription diet” (the gluten-free diet) and adding costs for prescriptions, that the total amount does not add up to the amount allowed for medical and related expenses. However, families with children and individuals with higher than average medical and medicine costs have found that total costs do exceed the suggested deduction. They then will profit from the diary of record keeping and the physician statement that is required.
Check with your local tax service or your state tax commission to learn
the details of records needed and for record keeping in your state.
Learn also which items are allowed and up to what level.
For most celiacs, the allowable deduction is typically greater than the
total of costs for medical and prescription costs above insurance even with the
added differential costs for foods to satisfy the definition of the prescribed
gluten-free diet.
Q:
Can celiacs use the organic sweetener sold in the market sometimes as
Sipal?
A: No, definitely not. But all of their literature advertises it as gluten-free. Their large 4-color poster as the health food store also advertises it as gluten-free. However, this is not false advertising. The international standard for a product to be termed “gluten-free” requires a maximum of 0.3% rate of gluten for all proteins. SIPAL is a wheat-based grain sweetener that contains only 0.11% gluten and can therefore be considered as gluten-free. Celiacs who wish to remain on the gluten-free diet, however, should not be using a product with this amount of gluten; those celiacs who have chosen to be on a gluten-restricted diet might not have overt reactions on ingestion of this product. They may, however, then need to look forward to a series of problems that could include lymphoma.
A second misconception represented in SIPAL’s literature states that there is no gluten to be found in either corn or rice. They have missed the important point that corn contains the protein zein, and rice contains the protein oryzenin. The difference which their dietician, food scientist or home economist has missed is that the amino acid chains are in a different order in corn and rice protein and thus not toxic as they are in wheat, barley, rye, and oats.
Look for SIPAL to be listed as an artificial sweetener, a flavor
enhancer, flavoring agent, etc. Whenever
you are dealing with ingredient terms for which you do not have a definition and
for which you do not know the base from which the listing has been derived, you
will be making a better choice to omit that particular food.
Q:
Why am I having a problem with natural butter flavor?
I am a celiac, I have a bit of DH showing up in my hair when I get into
some hidden gluten and I’m lactose intolerant.
A:
My off-the-cuff answer is that you are not aware that many of the natural
butter flavorings contain nonfat dry milk.
The actual butter flavoring may be less than 3 to 5 percent of the total
product; it is the bulk of the product that is made up of dry milk.
Thus, with the lactose intolerance problem, you should never be using any
of the several flavoring agents based on milk.
You may also need to watch out for terms such as casein, whey or calcium
caseinate. Many persons may not
realize that these ingredients are derived from cow’s milk.
Q:
The test results from the immuno-allergist I’m seeing show that I’m
continuing with a high sensitivity to soy; now this sensitivity is also showing
up sporadically in corn. But the reactions are up and down. Sometimes I seem to be okay, and sometimes not.
What information can you share? I’m
a celiac who gets on very well on the gluten-free diet if it does not contain
soy or products derived from soy.
A:
You will note that the Kellogg company now has an additional statement on
their corn flakes boxes which indicates that “the corn used in the product may
contain traces of soybeans.” And
that statement needs to be made because it is impossible to achieve complete
separation of corn and soybeans because they are grown on the same farms.
You may need to review with your gastroenterologist and the immuno-allergist
whether or not you might need to eliminate both soy and corn from your diet at
the same time. Typically, the
dietary treatment for these kinds of additions to the clinical diet are not
something you can work out for yourself; the help and monitoring of a physician
and dietitian will be essential.
Q:
What are some common symptoms of irritable bowel syndrome?
A:
Symptoms usually begin in young adulthood.
A definition of the condition may take 3 to 4 months.
It generally involves abdominal pain which is relieved by a bowel
movement, associated with a change in the frequency of movements, or linked with
a change in stool consistency—and at least three of the following: bloating or
distension, the passage of mucus, changes in stool form, alterations in stool
frequency, or difficulty in passing a movement.
However, no one of these symptoms is unique to irritable bowel syndrome.
Some can result from inflammatory bowel disease; gluten intolerance such
as celiac disease; allergies to certain foods or a specific ingredient such as
lactose from milk, fructose sugar from fruits or sorbitol an artificial
sweetener or caffeine from coffee. Since
the disease is complex and since some of its symptoms mimic other disorders, it
is very necessary to work with a physician to monitor medication, possible
lifestyle changes, and all of the related therapies that may be indicated.
Q:
What’s the guar gum story?
A: Guar gum is typically not recommended for use by celiacs except under physician direction. While guar gum is an excellent binder and works well with gluten-free flours, it also is used medically as an aid to relieve constipation. It is often suggested for celiacs who have an occasional problem with hard stools. Guar should not be a choice for patients who have a tendency toward having diarrhea. Several commercial food companies stock a bread product that uses guar gum as a binder. This bread can be an excellent choice for persons who have been advised by their physicians to use this stimulant.
Secondly, case histories are now surfacing which may help us learn more
about this product. In one case, a
child of four years stopped having diarrhea after omitting breads and cookies
that contained guar. In four cases
of refractory sprue, all patients felt their overall condition was improved when
they were off guar-containing breads. In
a care center, an 80-year-old man was released after getting his gluten-free
diet regulated; while that diet change included a number of items, it did
include omitting guar. So, for two
reasons: 1 – that guar is used as a relief for constipation and 2 – that
guar is a reported problem for selected celiacs, guar should not be a choice for
celiacs unless advised by their physician.
Q:
I’m a newly diagnosed celiac and am having problems with molds.
So, after many weeks, I finally caught on that I shouldn’t be using
yeast in my bread baking efforts. Now,
I’m finding that I don’t know the difference between baking soda, baking
powder, and cream of tartar. What
should I be using with what?
A: If you first understand that the leavening or the rising process is the result of the reaction between acids and alkalis, with the liberation of carbon dioxide gas–you’ll know the basics.
Baking soda (often referred to as sodium bicarbonate) is fairly alkaline and can be of use alone for a number of batter doughs if the dough or batter is sufficiently acid to react with it. It can function as the sole leavening agent in recipes in which you are using yogurt or sour milk for example. So, when I’m using soda, I often add two tablespoons of yogurt or a similar amount of soured buttermilk.
Baking powders contain both baking soda and an acid in the form of salt
crystals that dissolve in water. If
you are working with batter that has a low acid level, you can use both soda and
baking powder or an acid to work with soda.
Most baking powders are described as “double acting” because the
leavening process is a two-stage affair. At
room temperature, one group of compounds produces an initial set of gas bubbles
when mixed with the liquid ingredients. Then, during baking, a third ingredient,
which reacts at much higher temperatures, expands the bubbles so that they are
large enough to impart a light texture to the finished product.
It occurs late enough in the baking process that the structures do not
collapse.
The home baking powder (not the commercial baker’s baking powder)
contains a combination of mono-calcium phosphate and sodium bicarbonate for the
first phase of the leavening process and sodium sulfate for the second leavening
process.
Cream of tartar is used as a stabilizer.
It is often used as an acid to stabilize egg whites.
It will, however, delay the formation of foam and thus would decrease the
volume of egg whites. That is why
directions usually advise whipping egg whites to a foamy state before adding a
stabilizer such as cream of tartar.
Q: My father, who is 78, was hospitalized recently for what turned out to be what we feel is out-and-out product labeling misinformation. Once he was off the so-called wheatless bread made from spelt flour; he was greatly improved after only a week or so of being back on a gluten-free diet. He had been a bed patient for the past 5 months and had developed a severe lack of energy and had lost interest in everything–including his family. But with this correction in his diet for only a few months, he is revitalized again. We can hardly believe the dramatic change. He’s driving again, he’s doing his daily walks, and he’s up 12 to 15 hours a day. In short, he’s a new person and back to his old active lifestyle. And he’s off spelt!
My question of you: Why are
the companies who promote spelt allowed to advertise their products as
wheat-less? How can they get by
with this kind of misrepresentation? An
older person such as my father was taken in with their misleading advertising
and nearly died. Even the dietitian
at the hospital didn’t know that spelt is another name for a common low-gluten
wheat. And, the people at the
health food store are totally taken in with the very well done “wheat-less and
wonderful” advertising literature.
A: Even my desk dictionary defines spelt as follows: “a primitive species (Triticum spelta) of wheat with grains that do not thresh free of chaff.” How can any one of us miss that spelt is wheat? But hundreds of us do. The common wheats listed in freshman level nutrition tests include Triticum aestivum, T durum, T monococcum and T spelta. All of the Triticums represent varieties of wheat. And, of course, that means gluten at various levels and with varying levels of gliadin. And, if ingested by celiacs, will mean varying levels of toxicity, which may be hidden for some patients or very apparent to others, as in the case of your father.
Take seriously the message that spelt is a low-gluten wheat.
If you are to be on the clinical diet for gluten-free foods, then you
should be avoiding spelt in all forms: organic, dried, washed, and “combined
with honey to make it gluten-free.”
Q:
I’m the proud owner of a new mill and am now grinding six grains for
use in my diet. Now I would like to
make my own self-rising flour. Can
you share a recipe?
A: I’m not sure that I have a good answer, but can share with you the portions that I am currently using. To make one cup of self-rising flour, I am combining rice flour ground on fine, salt, and GF baking powder. I’m using very cheap non-enriched rice for the base. I use seven-eighths cup of rice flour, one and a half teaspoons of GF baking powder, and a scant one-eighth teaspoon of salt. You can double or triple the amounts depending on how much self-rising flour you need for the recipe. I would not suggest adding xanthan gum to your self-rising flour mix until you are ready to actually use the product. Xanthan is best stored in the freezer in a separate container since it may promote a taste change or rancidity within a flour mixture. Add xanthan to the product at the time of actual mixing and preparation for baking.
For a cake flour mix, I am using the following portions: one cup of rice
or milo flour ground twice on fine, two tablespoons of corn starch, one half
teaspoon cream of tartar, and three tablespoons of potato flour.
I freeze this mixture in two-cup portions.
I’m using it for both cookie and cake recipes.
Q:
Is sodium starch glycolate really a potato starch?
A:
Not always. While it is often derived from potatoes, it could be made
from any of the starch bases including wheat starch as the base or as an
additive. Some companies are now
listing sodium starch glycolate as “non-specific” which is likely a better
descriptor for this ingredient when the source is not known or available from a
secondary distributor. Note also
that this ingredient may be in a product and be described under the Codex
Alimentarius of the World Health Organization definition as being gluten-free
since it would make up less than 5% of the bulk weight of the finished product.
Thus, it would meet the international guidelines for their present
definition of “gluten-free.”
It is critical then to note that the designation of gluten-free on a product or mix from a foreign country does not always mean
that the product does not include gluten-containing ingredients.
In reality, it may only be gluten–restricted (or gluten-containing with
the amount unspecified).
Q:
What do you know about the coating being used on French-fries?
A:
While we do not have access to either the recipes or to an of the
ingredient listings for any commercial outlets since they remain confidential
trade secrets, we do know that french-fries from most any vendor which uses a
coating do contain a small amount of wheat starch.
Since the amount of wheat starch is less than the 5% level, it can then
be defined as gluten-free under the present standard (code definitions) being
used. Our strong suggestion is that
all commercial fries, which are represented as having a coating, should not be
included as choices for the diet of the celiac.
In three contacts made with local vendors, there was no knowledge of
coatings being used; however, a check with regional or division offices
indicated that coatings were in use for each of these stores.
Q:
What’s the story on mono- and di- glycerides?
I saw something in the press that caused me to believe I should be more
watchful when I know these ingredients are present.
A:
What you have seen in the press is based on research being published
within the past year on fatty and trans-fatty acids.
While the whole story may not yet be known, several researchers now feel
that we must view mono- and di- glycerides with caution and question content of
those particular product ingredients. This
is a change from what we were saying even a year ago; we will now need to
reverse what we have previously said in print to the current thinking that
interprets glycerides when in selected combinations with fatty acids to be a
potential non-gluten toxicant for celiacs.
(Or, a potential stimulus for a reaction seen as intolerance.)
Four researchers contacted indicate that “more pieces of the puzzle are
emerging” and that more information will be available both in professional
journals and in the press in the near future.
Q:
I’m taking a multiple vitamin and two herbal products and a food
supplement suggested by my health food store that are supposed to boost my
energy level and the immune system. But,
I haven’t seen much change yet. Which
food supplements should I be taking as a celiac?
A: First and foremost, you
need to be discussing this issue with your monitoring physician.
Perhaps you need to think through why you might need any of these
products and if a need were present, which product or preparation would be most
helpful to you. Make that decision
together with a physician who knows your present health status and understands
that celiac disease is your primary illness.
Consider that in recent years, preparations known as “dietary
supplements” are non-regulated and can be sold without the rigid control and
monitoring the FDA has over pharmaceuticals (prescription and non-prescription
medicines). Reports of adverse
reactions to such preparations have so alarmed FDA officials that they are
moving to either force changes in labels, require pure ingredients, or perhaps
stop the sale of some food supplements and herbal products altogether.
The primary concern is the safety of these products for the consumer and
especially for the consumer who has an illness.
At this time, people see labels that claim products are “all natural”
or “herbal” and believe that they are safe.
That remains a very risky assumption.
On the negative side, FDA officials reported that over 800 people were
treated in 1995 for disorders linked directly to “health food” preparations.
Symptoms ranged from heart attacks to seizures to a broad range of
non-specific upsets. A total of 17
deaths were reported. At this time,
there is a strong case for “the buyer to beware.”
Q:
What is your position on the use of melatonin supplements by diagnosed
celiac patients.
A: Over-the-counter sales of melatonin, a hormone supplement, have been banned in Canada by the government. The formal statement indicates the government wants scientists to have proven its safety in human trials before offering it to the public for non-regulated use.
In the U.S., however, use of melatonin supplement appears to be up to
one’s own discretion; the FDA reports that their offices have received only a
handful of complaints up to this point. Side
effects can include nightmares, next day grogginess, headaches, and various
forms of mild depression. Claims
that melatonin can slow the aging process and prevent cancer and heart disease
still is unproven in human subjects.
Melatonin is produced in great abundance by the brain’s pineal gland when we are children, but that production drops off steadily as we age.
The national Institutes of Health are spending over $5 million a year on
some 57 melatonin studies, so we will eventually know more about what melatonin
can and cannot do. But results of
these studies are still several years down the road.
In the meantime, people who should NOT take a chance taking melatonin
include those with severe allergies, autoimmune diseases which include
nontropical sprue [celiac disease], autoimmune-system related cancers, breast
feeding mothers, women who are pregnant or trying to become pregnant, and
children–especially children and pre-adolescents.
As with other vitamins and food supplements [nutritionals], the celiac patient is best
advised to use these products only through the advice and monitoring of a
physician who knows the patient and their particular condition.
One, you will then be taking what is appropriate and recommended for you
and the needs your body represents at this time; and two, you won’t be
spending money for preparations which may not be needed or appropriate.
Source:
Dan Orien, M.D., Program Chief, National Institutes of Health.
Q: Our 4-year-old son
isn’t doing well with the gluten-free diet and hasn’t gained weight in the
past couple of months. There may be
some learning problems, impaired hearing and sever sinusitis as well.
Where can we get some questions answered?
A: Why don’t you start with the Department of Gastroenterology at your state university medical center. Call the university for an information number and then ask to talk with the chair of the department of gastroenterology; he or she can then refer you to a pediatric gastroenterologist who works with children who have non-tropical sprue [celiac disease].
In the university setting, you may then be able to put together a medical team which includes a gastroenterologist, an immunologist and an allergist (if all are indicated) to review the several additional problems you are describing.
When you are in a low-population state, the university resource may be
your best choice; and, at least will be an excellent place to start your quest
for information and referral; once you have more of the problem identified with
your physician, you can then make the choice for the best medical base for
further monitoring.
You may want to be sure to keep non-tropical sprue [celiac disease] as
the primary diagnosis for your son so that the needs for this condition aren’t
lost as you look at and review secondary problems.
Q:
What can you tell us about cow’s milk protein intolerance?
I think that our doctor is telling us that each of our three kids has a
different kind of milk intolerance, but we aren’t too clear on what this
means.
A: Cow’s milk protein intolerance is attributable to one or more of a variety of milk problems. In fact, cow’s milk contains over 25 separate proteins, which have been shown to be capable of inducing specific antibody production in humans.
Symptoms of the intolerance vary from one patient to another but
reactions fall largely into two categories.
Some infants and toddlers react quickly while others have what is
referred to as “the delayed reaction.”
Quick-onset reactions, like vomiting, diarrhea, urticaria and
anaphylaxis, are easier to diagnose than the delayed responses but still present
diagnostic problems for the physician as the gastrointestinal symptoms may be
difficult to differentiate from those of other common childhood diseases.
Once cow’s milk protein intolerance had been diagnosed, it is usually
necessary to exclude the protein form the diet, although some infants, sensitive
only to the heat-labile proteins, may be able to tolerate heat-treated milk.
But substitute milk formulas are widely available and are usually based
on soy protein or they may include casein and whey hydrolysates.
Unfortunately, some infants are also intolerant to these products as
well, although the incidence and the precise mechanism of this kind of
intolerance has not been fully defined and researched.
Cow’s milk protein intolerance is a real problem, but it is important
to stress the need for proper medical diagnosis of this condition.
Parents always need to be reminded that there are considerable dangers in
the unsupervised use of restrictive diets–especially for infants and children.
Further, there is a probability of lactose intolerance for some few
children. This would mean that the
body in not able to produce lactase to break down the lactose in milk.
While some observed digestive problems related to milk might appear to be
similar, the parent needs to be sure that the right problem is being addressed
with the appropriate clinical diet and follow-up.
For sure, please don’t try out an adult treatment pattern on a child
since you may only further complicate the problem; and, as your physician has
already pointed out, you may have three slightly differing problems and
definitions of intolerance. And,
for each one, you may need to match up with a slightly different clinical diet.
Source:
T.J. David. Food and Food
Additive Intolerance in Childhood. pp
22-48. Blackwell Scientific Publications.
Q: What information can you provide on the use of Rice Dream products produced through Imagine Foods of California?
A:
Since an enzyme which is grown on various grains including barley is used
to convert complex carbohydrates in brown rice to naturally occurring sugars,
gluten may exist in all of the final Rice Dream products.
Thus, the celiac who wishes to be on a prescribed gluten-free diet should
not use any of the Rice Dream products since the company has been kind enough to
share with us that they cannot guarantee the absence of gluten in their
products. Rice Dream and its
related products should be on your non-allowed food listing for the gluten-free
diet.
Q: I have been on a food
elimination pattern for about three months and still have not been able to
decide which foods may be causing problems for me.
I am both gluten and lactose intolerant.
Is there a possibility that olive oil could be a problem
A: Olive oil in pure
form is very fine for the gluten-free diet.
However, it is often difficult to find olive oil in a pure form unless
you check it out with the distributor or the producer and have knowledge that it
is not from a recycled batch. Locally,
the two most reasonable brands both have one of four extender oils added and
with these oils, they then become gluten-contaminated; the company is very good
about sharing that an extender oil may be added to the batch, but may not know
which oils or in which amounts. It
is then necessary to check out the olive oil for 100 percent purity.
The most expensive oils are olive oil in pure form.
But, as a rule of thumb, that is not a safe answer for the celiac.
Thus, olive oil needs to be checked out for additives, colorings, and for
any extender oils that may have been added.
Q: I am a newly diagnosed
celiac and am working with a dietitian to try and figure out which foods should
be eliminated from my diet. I think
I have a good understanding of gluten-free and lactose-free, but what does
having a mold allergy add to the considerations for elimination
A: We would suggest that you work out three level (or structures) that represent eliminations from your diet. The first level would represent gluten-free and the second level, lactose-free. Then, you are now adding a third level which is related to molds. Your dietitian will be a good resource for foods relating to molds.
The big one for most of us with a mold allergy is to eliminate yeast; that takes out yeast breads and moves you then into batter breads that use soda and/or gluten-free baking powders. Vinegars and their several associated products would also need to be eliminated; that would likely include pickles, mayonnaise, and a number of salad dressings. But lemon and lime juice, even pear and peach juice make good substitutes for creative salad dressings. You would also need to omit mushrooms as a very common mold. Most celiacs who are mold-sensitive cannot tolerate xanthan gum that is used as a binder in many breads and pastries. You should eliminate xanthan if you have a confirmed mold allergy or sensitivity.
When you finish up your food listing, you may then also work on a
medication listing with your pharmacist. That
would include several antibiotics that are mold based.
You would also want be sure that this allergy is noted for both your
medical chart and for your medical records with your pharmacy.
Q: Can you give us some of the common names for wheat? I appreciate receiving the grains listing, but I need a review on wheat and what it might be called on a label.
A: There are several that we know of; but please don’t think that our listing is an exhaustive report. There are many grains included in the extended wheat family.
· Kamut: an ancient Egyptian term for wheat; may also be called King Tut's Wheat; it is a fairly large-sized grain and is often a novelty at county fairs within the U.S. Kamut is not wheat-free [nor gluten-free] as you might see it advertised and as it is typically represented.
Greunkern:
usually translated as German green wheat; but it actually is spelt.
The grain is harvested when immature, it is given an initial threshing,
and then kiln dried. We often see it advertised as “green grass” or as green
corn. We receive letters indicating
that consuming green corn is the way to cure celiac disease.
The distributors represent that the protein in an immature wheat is not
harmful to celiac patients. At this
point, we have no university-based research or physician recommendation for any
use of greunkern (or spelt) in any of its several forms immature or mature
states
·
Maize
or maise: In the U.S., we generally refer to
maize only as the grain, corn. However,
some foreign countries refer to maize as a “corn wheat” meaning the head of
the wheat stalk. So, you do need to
check out maize as a listing to learn if the reference is to one of the wheats
or to corn.
Q: My husband and his mother
are the celiacs; I’m just married into this family, and we now have our first
child who might also be a pre-celiac according to the hospital clinic
evaluation. Why are you telling us
that we should check out with our pediatrician before feeding any honey to our
newborn son? We’re organics, and
we don’t want to depend on any processed foods for our diet.
Honey is one of the best natural foods available.
I grew up on honey; why is it now so bad all at once?
Or is it some food fad you are promoting?
A:
Only because honey has been associated with infant botulism.
(See the study: Infant Botulism a 1 Week of Age: Report of Two Cases. Pediatrics. Vol
92, No1. July 1993.)
Infant botulism is a serious condition appearing between 0.2 and 11.7
months of life according to a recent U.S. survey. (See
the Pediatrics. 1993.
p 17.) The American Academy
of Pediatricians recommends honey not be fed to infants in the first year of
life since botulinum spores in honey may result in infant botulism.
(Risk Factors of Infant Botulism in the United States by J. Spika, et al,
AJDC, Vol 143, July 1989.)
From this research and from this direction of physicians and the American
Academy of Pediatrics, we must then clearly interpret that honey is not
appropriate for infants less than 12 months of age.
You, however, should check with your own pediatrician for recommendation
and direction and base your decision on those directives.
Q: Which denture adhesives
are okay for use by celiacs? I’ve
been sick off and on for about six months, so my doctor suggested that I stop
using a denture adhesive; and, that was it.
I’m okay again. But, I
could wear my dentures all the time of I could find a gluten-free adhesive.
A:
There are a couple of products that are gluten-free for which we have
information from our local college of pharmacy.
However, the usual precaution needs to be in place: check ingredients
before using.
Orifix (original) continues to be gluten-free; Orifix (special) however
does contain grain flours to add extra adhesive and is not recommended for use
by celiacs. Proctor and Gamble have Holdfast (regular) which contains
grains; their Holdfast (Extra Strength) does not contain grain and their
Fixident is also gluten-free.
You may wish to discuss with your doctor the potential use of an ostomy
bond. Karaya powder (a gum from a
tree) works well for some people. Before
using over-the-counter ostomy products, however, you may wish to discuss with
your physician which base product for an adhesive would be a better choice for
you and the sensitivities you represent.
Q: My friend and I both use
the same gastroenterologist at the state university; she was diagnosed about ten
years ago and was told that zanthan gum was okay for use in her diet; I was
diagnosed four months ago and was told not to include zanthan in my diet.
Which answer is correct?
A: Both answers are
likely correct. You may have some
sensitivity or intolerance to some of the sugars such as sucrose that is found
in trace amounts in zanthan derived from corn; you may also have a sensitivity
to corn protein and could then have a lowered tolerance for zanthan. Or you may
have mold sensitivity, which is not too uncommon for newly diagnosed celiacs.
You mentioned that you are lactose intolerant; you may then also have
sugar intolerance in the first months after being diagnosed.
As your physician monitors your condition and the progress you are
making, you may find that these intolerances are lessened or drop off entirely. So, after the first months (6 to 18) on the gluten-free diet,
your physician may suggest that you can then add zanthan to your diet.
You may wish to review with your physician the intolerances and
sensitivities found at the time of your diagnosis and how those will be
monitored with you for a more definitive answer.
Q:
What is the condition of refractory sprue?
A: Patients who at first respond and appear to do well on the gluten-free diet may subsequently relapse despite maintaining the diet treatment. Such patients are then seen as being “refractory” to diet therapy. Some refractory patients with celiac disease will typically respond to treatment with corticosteroids or other immunosuppressive drugs such as azathioprine, cyclophosphamide or clyclosporine. In other cases, there is no response to either drug nor to diet treatment and malsbsorption may be progressive.
Q:
What is meant by lectin interaction?
A: “It has been suggested that primary abnormality in the composition of the surface glycoproteins on epithelial cell apical membranes results in exposure of distinctive sugar residues that selectively bind toxic gliadin fractions in celiac sprue patients. The gliadin fraction might then damage the intestinal epithelium, much as cytotoxic plant lectins damage cells after binding to their surface glycoconjugates. That plant lectins are capable of damaging intestinal epithelium has been clearly demonstrated.” (see Lorenzsonn V and Olsen WA. In vivo responses of rat intestinal epithelium to intraluminal dietary lectins. Gastrointerology 82:838, 1982)
Quote from Sleisenger and Fordtran, Gastrointestinal Disease: Pathophysiology Diagnosis Management, 5th Ed, WB Saunders, 1993, p 1084.
Q: Over the summer, we have become fond of cooking several meats with the addition of vinegars and alcohols. With a bit of Herb de France and a half-cup of alcohol, a chicken breast takes on an entirely new vintage. Something that I had thought was rather dull has now become exciting for my palate. But alas! The last couple of times, the same recipe combinations appear to be causing lots of those old symptoms. What can you tell me about the use of alcohol in cooking foods for celiacs?
A: It is generally assumed that alcohol added to foods will evaporate during the cooking due to the low boiling point for alcohol. However, there is a study conducted by researchers at the University of Idaho who examined the retention of alcohol in six recipes reviewed that adds critical information.
Indeed, these researchers must have been in your kitchen! In their laboratories, they found that cooking with alcohol always resulted in some but not total loss of alcohol in the finished product. One of their observations is that the differences found in the retention of alcohol in cooked foods may be in the heat treatment. Pan size also influenced the amount of alcohol retained; the larger the pan size, the greater the loss of alcohol. Longer cooking times also decreased the amount of alcohol that remains.
With these
conclusions, the celiac must then choose to use only the allowed GF alcohols in
cooking. The Burgundys, the dry Sherrys, Crčme de Cocoa, Grand Marnier,
the orange liquers, etc. are NOT going to be allowed. Can you try a
white wine, a white rum, a potato vodka, a non-colored tequila, and perhaps make
up a listing of the several vinegars that could be used as well. With such
an action, your problem with non-allowed alcohols should be over.
Q: Our child was diagnosed with celiac disease while in pre-school and is now in third grade. There may have been some growth in these past 17 months, but overall growth and physical development appears to be slow; he continues to be the smallest child in the class; and, he has poor to very poor coordination, pincher movements, and ability to stand in line for very long. He does above average in most learning tasks and academics, but is often so tired out that he needs rest periods between classes. He appears to have good attention span and is learning. He has a weak grasp in both hands, poor muscle control, and doesn't write well. This week we are dealing with his newest nickname, "the itsy-bitsy spider." What can you share about his potential for growth?
A: Any child with a disorder of the gastrointestinal tract who fails to demonstrate appropriate linear growth and weight gain during a 6-month to 1-year interval should be evaluated by a physician [in your case, your pediatric gastroenterologist] for growth faltering. The physician will likely obtain information about the child's previous growth patterns, parental heights, gastroentestinal symptoms, and use of medications and nutritionals. The physician also will measure the child's height and weight and perform a physical examination. The physician may request laboratory X-rays, or special endoscopic procedures to determine why the child has growth faltering.
Aggressive treatment of the primary gastroentestinal disorder, as well as the secondary nutritional deficits, may prevent or reverse the growth faltering process. Parents should provide the child with a well-balanced diet that parallels the recommended dietary allowances for protein-energy, vitamins, and minerals that are within the dictates of the strict GF diet as prescribed by the physician. Frequent small meals or snacks that reflect the child's food preferences and the prescribed gluten-free diet may be necessary to supplement the child's usual dietary intakes. In selected instances, physicians may recommend alternative feeding techniques such as internal tube feedings or intravenous alimentation. Parents may balk at the possibility of this type of aggressive nutritional support, but they rapidly become "believers" of the therapy when they experience the positive effects of nutritional supplementation on their child.
Acceptance, total acceptance of this child and each one of your children as they are--is cardinal for all "well children." It becomes imperative when there may be an illness or notable developmental problems involved such as you have described. And emphasis on what he can do rather than what he can't do is important. Don't dwell on the problems for which he has no control. And, on those parts of the problem that are obvious. The attitude of the parent needs to be that of acceptance and not move onto the potential development of the sick child syndrome. It should be helpful for you and your child to work through the evaluation and the present status with your pediatric gastroenterologist in a matter-of-fact way. Since you live close to a state university medical center, you may wish to work out several sessions with appropriate staff in pediatrics so as to broaden your understanding and skills in dealing with this kind of long-term illness.
For most children and
their parents, it is helpful to discuss what tasks you plan to work on today--at
home, for school, for the job, etc. Work toward being a caring, sharing,
communicative family. For this child, the tasks for the day may need to be
broken down into much smaller pieces. Perhaps with a listing, and then
with follow-up to know what has been accomplished and what remains to be worked
on. And what will carry over to the next list. Make working on a
task, talking about a task and how to try to approach it as worthwhile.
Try one way and then another. Don't dwell on nor emphasize failures--there
are always plenty of them. Learn to take them in stride--for you and with
your child and your family. If one approach doesn't work out, be up to the
challenge to find another approach and keep trying. Your general
philosophy of life and how you handle this illness and its associated
developments, the handling of change, not making it today, and how you handle
and process your attempts and efforts, are far more important than whether you
win or lose. And, in your case, whether you and he perceive he is winning
or losing.
Q: Our married son and his wife returned from missionary assignments in South America this month--his wife is doing quite well on the gluten-free diet which she learned to manage as a teen when she had the diagnosis on non-tropical sprue [celiac disease]. Our son, however, is very ill and extremely weakened with what has the temporary diagnosis of tropical sprue. What are we dealing with in tropical sprue?
A: A workable definition of tropical sprue: it is a chronic disorder acquired in a tropical area that is characterized by abnormalities of both small bowel structure and small bowel function that become more severe. Eventually these symptoms almost always will lead to the development of nutritional deficiencies, and are either ameliorated or cured by a treatment pattern that includes folic acid and/or tetracycline.
Typically, tropical sprue takes into consideration all or some of the following general features:
1] Most persons with tropical sprue have gastrointestinal symptoms; those persons who may have only sub-clinical symptoms do not.
2] The abnormalities of intestinal structure and function in tropical sprue get relentlessly worse until specific therapy is instituted. Those in sub-clinical malabsorption appear to vary over time--either improving or worsening.
3] The intestinal malabsorption in tropical sprue consistently becomes so severe that it eventually results in the development of nutritional deficiencies, whereas the milder defects in sub-clinical malabsorption result in deficiencies only among those whose dietary intake is marginal or inadequate. The best "medicine" may be to get back on a regular well-balanced diet.
4] The intestinal abnormalities of sub-clinical malabsorption eventually spontaneously revert to normal when the patient concerned moves back into a temperate zone. But, those with tropical sprue do so only rarely, if ever.
5] The
intestinal abnormalities in tropical sprue nearly always improve with
specific therapy with folic acid and/or tetracycline. This response is
unusual in persons with sub-clinical malabsorption. In the evaluation, the
physician needs to determine not only the illness, but make an approximation
regarding the level of the illness and the aspects to be treated.
Q: What is meant by "having your prescriptions compounded so as to avoid gluten and other contamination from colorings, dyes, and an excipient?
A: Compounding pharmacists make the product fit the patient and their particular needs. Customizing products eliminates undesired compounds and components that may have an adverse effect for a patient. Together with your physician, a compounding pharmacy can prepare prescription and non-prescription medications to meet specific needs of a diet and an illness such as celiac sprue. Simply stated, compounding is the mixing of two or more substances to formulate a finished product in the proper dosage form for a particular patient. The compounding pharmacy can put together liquids, capsules, creams, ointments, injectables, suppositories, insufflators, and much more.
For the celiac patient, it is often necessary to eliminate the major excipient which may be something such as lactose or a modified starch. The need may relate to colorings, dyes, preservatives, sealers, emoluments, as well as the excipient used which would be toxic for the celiac patient. A common rejection for a medication prescribed for celiac patients is the sealer that may me made up of wheat starch. Or, it simply may be that your physician is prescribing a smaller dosage of a particular drug that is not available in "one-fourth amounts" other than through compounding.
The patient
using a compounding pharmacy may need to question the capsule container used for
the finished product. Clear get caps may have been replaced with caps
containing yellow dye. Be aware that selected cardboard containers may
have been sealed inside with a wheat starch or wheat flour. When
discussing the prescription with your physician, ask that the container for the
prescription also be prescribed as non-toxic to meet your own particular needs.
Q: It appears that I am an MSG-reactor. At first I felt sure that I knew how to handle the problem; now, however, after becoming ill again and again, I'm wondering if you can help with some explanations. Do you have any listings of foods to avoid?
A: The MSG-reaction is a reaction to free glutamic acid that occurs in food as a consequence of manufacture. MSG-sensitive people do not react to protein [which contains bound glutamic acid] or to any free glutamic that might be found in unadulterated, unfermented food. Reactions to MSG are dose related, i.e., some people react to even very small or to trace amounts. MSG-related reactions may occur immediately after ingestion or after as much as 48 hours later. For the celiac patient, there may be confusion as to whether the reaction is gluten- or MSG-related.
|
The following ingredients ALWAYS contain MSG |
| Glutamate | Textured protein | ||
| Monosodium glutamate | Hydrolyzed protein | ||
| Mono-potassium glutamate | any protein that is hydrolyzed | ||
| Glutamic acid | Yeast extract | ||
| Calcium caseinate | Yeast food | ||
| Sodium caseinate | Autolyzed yeast | ||
| Gelatin | Yeast nutrient |
|
These ingredients OFTEN contain MSG or create MSG during processing |
| Flavors & Flavorings | Malt extract | Whey protein |
| Natural flavors | Seasonings | Whey protein isolate |
| Natural pork flavoring | Carrageenan | Whey protein concentrate |
| Bouiloion | Soy sauce | [any protein fortified] |
| Natural beef flavoring | Soy sauce extract | Protease |
| Stock | Soy protein | Protease enzymes |
| Natural chicken flavoring | Soy protein concentrate | [anything enzyme modified] |
| Broth | Soy protein isolate | Enzymes |
| Malt flavoring | Pectin | [anything ultra-pasteurized] |
| Barley malt | Maltodextrin | [anything fermented] |
Hidden MSG is not limited to use in food
Reactions have been reported to soaps, shampoos, hair conditioners, and cosmetics. The most common hiding places are in ingredients that begin with the word "hydrolyzed" and in ingredients describes as "protein" or "amino acids."
Disodium guanylate and disodoium inosinate are expensive food additives that work synergistically with inexpensive MSG. They would probably not be used if there were no MSG present.
Binders, fillers, and/or carriers [used in "enriched" products, for example, and flowing agents, may contain MSG but are not always mentioned on labels.
MSG should not be found in, or on products labeled "ORGANIC." But autolyzed yeast and citric acid are found in some "organic" products, and "hydrolyzed" ingredients are being used in some "organic" fertilizers.
MSG-type reactions have been reported following ingestion of fish, seafood, and poultry, that have been rinsed with phosphates. A phosphate rinse for meats is also available in the market and at many grocery stores. Rinses are not mentioned on food labels.
There have been some reports of reactions to sugar and some salt and to meat that has been wrapped in or has been sold in a package with cryovac.
Just as poultry [especially "fresh" turkey], can be "basted" with an MSG-containing substance, meat can be injected with MSG. Some restaurants are now using and advertising "basted steaks."
When "broth" is sold as "broth," its ingredients must be listed on the label. However, when "broth" [or any other product] is used AS AN INGREDIENT IN SOMETHING ELSE, its ingredients do not have to be disclosed.
Salad mix [at the vegetable counter or at your local grocery store], and pre-washed vegetables may have been rinsed in citric acid.
MSG has been found in wax used on raw [non-organic] produce. A question remains whether this wax can be washed or peeled off. [a check at one grocery in Omaha, Nebraska noted these waxed vegetables: cucumbers, zucchini, turnips, rutabaga, and squash sections; the radishes at this particular store had been dipped in a water solution containing citric acid].
Drinks, candy, and chewing gum are also potential sources of hidden MSG. Also aspartic acid, found in ASPARTAME [Nutra-Sweet] ordinarily causes MSG-type reactions in MSG-sensitive people. Aspartame is found in some medications INCLUDING CHILDREN'S MEDICATIONS. Check with your pharmacist. A review with the manufacturer is often needed to complete the information picture.
Binders and fillers for medications, nutrients, and supplements, both prescription and non-prescription, enteral feeding materials, and some fluids administered intravenously in hospitals may contain MSG. Chicken pox vaccine and other vaccines contain MSG.
Reactions have been reported to produce that has been fertilized or sprayed with MSG. AuxiGro is an example of a spray that contains 29.2 % MSG. The state of California has approved spraying of wine grapes with AuxiGro, i.e., with MSG.
The new labeling game is to label hydrolyzed proteins as pea protein, whey protein, corn protein, etc. If a pea, for example, were whole, it would be identified as a pea. Calling an ingredient pea protein indicates that the pea has been hydrolyzed, at least in part, and that processed free glutamic acid is present.
Low-fat milk products often include milk solids that contain MSG. [best to always choose whole milk if the celiac has MSG sensitivity and water it down of use less].
MSG reactions have been reported from produce [especially potatoes] fertilized and/or sprayed with MSG-containing products.
MSG Places Selected Humans at Risk
Epidemiological studies represent that at least 25 percent of the population react to monosodium glutamate. It is also recognized that these reactions range from mild and transitory [or not recognized] to debilitating and life threatening.
MSG-sensitive consumers react to free glutamic acid [or free glutamate] that occurs in food as a consequence of a manufacturing process--regardless of the name of the ingredient that contains the manufactured free glutamic acid [MSG]. The Food and Drug Administration has even acknowledged that consumers refer to all free glutamic acid as MSG. Yet, consumers who choose to avoid MSG have great difficulty in doing so, because more that 40 different food additives contain MSG without disclosure.
Scientists have not determined the mechanism [s] that cause MSG reactions. It is known that the reactions are sensitivity reactions, i.e., reactions to a toxin or poison, as opposed to allergic reactions. It is known that MSG-sensitive consumers react to glutamic acid only in its free form, and only if it has been released from protein through a manufacturing process.
It is known that free glutamic acid found associated with unadulterated protein, and glutamic acid bound in protein or freed from protein during normal digestion is L-glutamic acid only, while free glutamic acid found in processed food contains both L-glutamic acid and D-glutamic acid, and may also contain ppyroglutamic acid, mono- and di-chloro propanols, and/or heterocyclic amines. The propanols and heterocyclic amines are thought to be carcinogenic.
MSG-sensitivity is difficult to diagnose because the reaction is not IgE-mediated,
because individual tolerance levels vary [every case appears to be unique and
different]. and because MSG reactions may occur anywhere from immediately to 48
hours following ingestion. The key to diagnosis lies in the fact that an
individual typically responds to MSG with the same reaction [s], and after the
same elapsed time each time that MSG ingestion exceeds the individual's
tolerance level. At this time, there has been no systematic study to
determine the minimum amount of MSG needed to cause an adverse reaction, and
researchers have not yet found the mechanism [s] underlying sensitivity to MSG.
Source: Truth in Labeling Campaign, Darien,
IL. For additional information, see also their web
site: http://www/.truthinlabeling.org
Check with your physician for potential reactions, side effects, and problems
that may arise for you as a celiac
patient.
Q: I notice on the insurance form returned to me after my diagnosis with celiac disease that there is a sub-diagnosis of alopecia areata. The dietitian didn't know the term and neither of us found this term in the dictionary. Can you help?
A: The term alopecia
areata refers to hair loss. Since each case of celiac sprue is unique
and appears to act out differently in different patients, hair loss may not be a
symptom but for a very few patients. When we think of celiac sprue as a
malabsorption syndrome, then we can have a better understanding of a symptom
such as hair loss.
Q: I noticed that the package of grated cheese we used last week for a pizza topping listed cellulose as an ingredient. What would that be made of? Or what does it contain?
A: Cellulose is a carbohydrate polymer of D-glucose. In actuality, it is the structural material of plants, such as wood pulp or a plant fiber such as cotton. In a pure form, it should then not contain a protein that would be made up of gluten [or of an offending or toxic gliadin]. Cellulose is commonly added to foods as an extender or as an agent to improve viscosity, smoothness, or binding qualities. You might "react a bit" if the label on your cheese stated that cotton fiber has been added; when the label reading is cellulose, you may not give it a second thought.
The question that some scientists have raised regarding the ingestion of cellulose is in relation to its *hydrolyzed format. [*hydrolysis: a chemical reaction in which water reacts with another substance to form two or more new substances]. Secondly, cellulose can be decomposed to glucose by the enzyme cellulase [a fungus] or by hydrolysis. So, it may then be found in two additional formats.
Cellulase is an enzyme complex produced by the fungi Aspergillus niger and Trichoderma viride which is capable of decomposing cellulosic poly-saccharides into smaller fragments, primarily glucose. It has been used as a digestive aid in medicine and is also used in the brewing industry [especially in select beers]. Research has been devoted to experimental application of cellulase to the disposal of cellulosic solid wastes. The resulting glucose can be fermented to ethanol, used to grow yeast for animal-feed proteins, or used as a chemical feedstock. Chemically, there should be no carryover of the acting fungus to the finished product; however, when selected individuals who have trehalose intolerance [mold intolerance] claim to have mild reactions, the question can then be raised as to the causal factor and if it might have been the minuscule carryover of the mold or a reaction to yet another ingredient.
Q: What
does the gluten actually do in the gut? What
happens when the so-called offensive gliadin gets to the jejunum [or the small
intestine]?
A:
It is thought that persons with celiac disease have
certain genetic components [Human Leukocyte Antigen [HLA] class I alleles] that
appear to promote an inflammatory response to gliadin [that is, a protein
fragment of gliadin with a specific order of amino acid sequences] on contact or
as it is absorbed. This toxicity
[this response] flattens, shortens, causes the villi to be knob-like, causes
mal-function of the shag rug-like, fingerlike projections known as villi, at the
point[s] where nutrient absorption takes place. The result is malabsorption or impaired and lessened nutrient
absorption. The tiny hair-like villi are miracles of/for absorption and
extremely complex with the end [top] and the concentric rings or sections of
each villi having a different task for absorbing nutrients, vitamins, and
minerals. Thus, celiac disease is
typically referenced as a Malabsorption Syndrome?
Q: And my next question, what are the consequences—what should one expect
with a non-diagnosed case of celiac disease?
A: It would be a long and detailed story. Long-term malabsorption of
nutrients, including vitamins and minerals can lead to a myriad of varied
problems. Common among them would
be damage to bones and
teeth;
damage to nerves and perhaps nerve endings; damage to the functioning of the
liver; likely loss of weight; and there are studies that suggest that this kind
of patient would be more vulnerable to taking on lymphoma and selected
intestinal cancers.
Actual symptoms for the illness might include diarrhea, perhaps instead
constipation, likely cramping, symptoms common to a number of gastrointestinal
problems and conditions which mock celiac disease, There could be joint pain,
fatigue, depression, low to severe energy loss, and a few patients may take on
lesions of the skin known as dermatitis herpetiformis.
Or, none of these symptoms may appear at all; however intestinal injury
to the villi can occur with or without symptoms. No two cases appear to be alike
so one size does not fit all.
Q: Will
the genetic alteration of wheat and other cereal grains that supposedly will
then have eliminated the gliadins that cause a toxic reaction we know as celiac
disease be at all helpful for celiacs?
A: The
assumption is that grains that are freed of the offending amino acid sequences
in the gliadin-containing grains that have been found to be toxic would then
[when altered] not cause a sensitivity or toxic reaction in celiac patients.
This is a basic assumption for a series of grain research projects related to
genetic alteration. Whether the
wheat can be freed of these toxic sequences and whether the resulting product
will fit the needs of some, a few, or all celiac patients remains an assumption
until proven and tested to be effective.
Note also that there are research projects moving ahead to enhance rice
and to modify soybeans as well as the wheat and other cereal grain studies.
Just how these newly developed grains will fit into the diet of celiac
patients is an unknown. The theory
and the hope is that several altered grains will come into the market within
this decade that will add to the diet and/or provide a more regularized diet, a
diet that can include more of the cereal grains—when/if these grains have been
effectively altered to remove their offending toxicity.
Q: I
have lactose intolerance but still have problems with lactaid milk and with the
lactaid pills suggested by my dietitian. Do
I have still another problem or what should I be doing to handle this situation?
A: It
is my understanding that lactaid in milk and/or the lactaid tablet formations
handle most, but not all of the lactose found in milk.
[thus, in actuality there is still some lactose in the lactaid-treated
milk] You as a celiac should be
using a milk substitute not a milk altered with lactaid which does only part of
the job. Your villi are sensitive,
your absorption system is too sensitive and still causes the reactions common to
lactose intolerance. While some
celiacs with a lowered sensitivity levels may get on okay with lactaid milk, our
recommendation is to make the choice to use one of the several milk substitutes
found in the market if you have a diagnosis of lactose intolerance.
Go for a milk substitute that is totally free of lactose.
Q: What
is sago? Should I become more
interested in using this product since it is now available in our health food
store?
A:
Sago
is known as palm metroxylon sagus. [derived
from the sago palm tree]. It has a
light gray color, is rather bland but can be used in baking on its own or as a
part of the whole for a flour mix. It
works well when added to pastry dough and especially well when added to pizza
dough. It may be best used in
products in which a strong seasoning can be used such as in pizza, a pumpkin
pie, or in a spice cake. It works
well to use as a part of the thickener for puddings, but again for a stronger
flavoring such as chocolate. I
would classify sago as not being a good binder but is an aid to binding; it is
not an easy product with which to work in a dough mixture but it provides a
taste change and since it is typically reasonable in price, it then helps to cut
the cost down for a gluten-free baked product.
I like using sago in flatbreads seasoned with onion or dill weed. [brush
pieces with olive oil and a seasoning and heat or grill].
I find myself using it as a flour, however, and not as a starch.
Hard tack breads with caraway or a combination of herbs or citrus
peelings are excellent choices for using sago.
It does A-okay when added to the dough for fry-bread—at home or at
camp. Both the normals and the
celiacs came back for seconds.
And, of course, you should become interested in using sago; add a bit
here and there whenever it’s sitting near your mixing bowl.
Q: Our celiac preschool 4-year old has grown to an age in which she is fond
of and likes the taste of spices, but we are having a problem with her favorite,
cinnamon. We have been told that
cinnamon is on the “allowed food list,” but haven’t found the use of
cinnamon to be acceptable either for me or for my daughter.
We are perplexed since we are following the printed guidelines “to the
letter.” Can you help?
A: My guess is that you may be using a cinnamon product that has been laced
with a cereal grain as an additive. And
it is possible that this could be wheat flour that also has been dyed with the
entire lot for that batch.
So then the product would have the potential toxicity for the celiac with
both the cereal grain and the dye [a dye likely based on a lake] that have been
added. I would suggest that you consult with a company such as
Schilling or Watkins and learn which products they can ship to your area or to
your grocery outlet. Their customer
service representative can help to find a source for a pure product.
Or, you can consult with one of the several commercial food vendors who
produce gluten-free products and ask about their source for pure spices; or,
work out an order with them from their offerings.
Third, the commercial outlet known as The Spice Company has also
been a good source for pure products.
From mail and internet questions we receive, along with cinnamon, you may
also find problems with turmeric, dry mustard, paprika, chili powder, and curry.
So you may also want to do a careful check on those products at the same
time that you search out an acceptable source for cinnamon.
Be especially wary of combination seasonings such as grill seasonings,
chili seasonings, the special peppers, and seasoned “whatever;” there are
dozens of new packet seasonings coming into the market that appear to be
excellent products, but not for use by the celiac since many in addition to
having gluten content also have artificial, natural, or assorted flavorings that
have been added.
Q: What
is the problem with instant cream of rice?
It is so tasty but also brings back some of the classic symptoms for
celiac disease that I experienced prior to diagnosis.
A: It is likely that in addition to being gluten intolerant that you may also lactose intolerant; and the problem then lies in the lactose [milk content] that has been added to instant cream of rice. You will find that several of the instant products such as instant cereals, breakfast drinks, instant potatoes, and most instant soups contain lactose. You may also need to check out salad dressings, margarine if used, as well as cream cheese and some of the peanut butters for the potential of lactose content.
The biggest surprise for me was to find lactose added to selected vitamins and
in selected over-the-counter and prescription medications--including antibiotics
and in artificial sweeteners. So, in addition to gluten content also check
for lactose content should this milk sugar be a problem for you.
Q:
What is your understanding of the new Food and Drug Administration [FDA]
regulations related to food supplements? Is
there now a safety regulation regarding their use?
It
would appear that manufacturers might easily measure up to the concept that
wheat is wheat [or whichever of the 3900 or so ingredients for supplements you
may wish to list], and that this may not be a big issue.
But what kind of wheat, at what level of nutrient content, etc., etc. is
not covered. The second area is the
stickler, however. Many ingredients
are purchased from third- and fourth-hand vendors without having a history of
the product attached. No one may
actually have the knowledge as to whether this product was stored in a moldy
environment, if the product was sprayed for fungus or for insects. Or, for that matter how it has been packaged.
Thus, the “adulteration” requirement is a tough one for the
manufacturer. And, of course,
contamination or any kind of adulteration for an ingredient is of a critical
importance to the consumer.
There
continues to be nothing in the new legislation regarding safety, side effects of
a product, or potential drug and chemical interactions. No one of these three areas is covered in the new regulations
and similar helpful information will not be required. Thus, in answer to the second part of your question, safety
regulations and suggestions were not included in this new legislation.
If a manufacturer chooses to add safety information, that would be a
voluntary effort beyond any of the new requirements that will be put into place.
Thus,
under the law, you as a consumer are on your own when you choose to take food
supplements and add these items to your diet.
You will find good and detailed explanations, but you will need to learn
and perhaps learn before ingesting a supplement if this product fits into and
with your present intake of foods, medications, and other supplements.
And, if, indeed, this particular product may be an inhibitor or if it may
interact negatively or excite an existing condition.
As with over-the-counter medications, you may then wish to review with
your monitoring physician the need for and the product choice before ingesting
or use.
Q:
I’m going in for my annual physical; what test or examination do I ask
for to learn if I am a celiac?
A:
You may wish to discuss this question first with your physician and
work with the methodologies available to you in your area.
Most often [typically] blood tests for selected antibodies are a first
step. Next, if any of the tests are positive, perform a small bowel
[jejunal] biopsy in which tissue samples are taken for microscopic evaluation.
If that evaluation is positive, there would likely then be a plan
developed to work out a gluten-free diet to fit your needs.
To
the second part of your question, you may wish to consult with the section of
gastroenterology at your state medical center for monitoring and follow-up.
You can do that through a referral from your local physician or clinic.
Or, you can call direct and make your own arrangements.
Q:
Who are the celiacs who will have a problem with iodized salt?
A:
It is my understanding that we need to consider three general
categories of celiac patients for use of plain salt [and no iodized salt]:
the celiac patient who also has dermatitis herpetiformis [DH}; the celiac
patient who has hypothyroidism; and, the celiac patient who has the celiac
condition but neither DH nor hypothyroidism, but has a sensitivity to seafood.
The celiac patients within these three general categories will [almost
always] do better with the use of plain salt.
That can be sea salt or the cheaper non-iodized table salt available at
most grocery stores.
For
the second part of your question as to why some clinics are suggesting the use
of plain salt for all celiacs, I do not have an answer.
I am surmising that these physicians and dietitians are feeling that
non-treated products are a better choice for celiac patients or that present
evaluation may not be clear as to whether a sensitivity exists, thus the
recommendation for avoidance of iodized salt products.
Q: Can you recommend a
laxative that will work for a celiac with hard stools?
A:
I could easily make a suggestion, however, 9 or 10 times out of 10,
it would likely be bad to harmful information.
Q: What can you tell me about genetically engineered plants and
how the foods derived from those types of plants relate to the diet for celiacs?
A:
It’s a
rather complex answer and I’m not sure that we have enough medically-reviewed
research information available to do a good job of answering your question
adequately at this time.
Further, I am not sure that I personally understand some parts of the
“answer,” so can only share my own impressions. I hope these comments will
be helpful.
[based on writings of Belinda Martineau, Ph.D., and from FDA,
EPA, USDA and Cornell University
bulletins; and physician consultation].
Genetically engineered crops are created by inserting “foreign” genes
[foreign genes are a set of genes referred to as genetic
information which has been isolated from an organism or plant other than the
crop or plant being genetically- engineered] into the cells of
a host plant and then carefully coaxing those cells with growth hormones and
nutrients to develop into plants.
It is necessary for the newly-developed and emerging plant to develop
into a mature plant that is also fertile for there to be progeny. These new
plants are referred to as biotech plants.
When these biotech plants develop seeds, the seeds would be transformed
by virtue of the newly acquired traits coded in the foreign genes.
These “new” seeds can be stored and sown just like the seeds from the
original or conventional plant. At the same time that research is being
conducted with genetically-engineered plants, animals are also being
genetically-engineered using similar techniques.
Farmers and state experiment stations at our universities have always
been crossbreeding crops [plants] and animals.
The examples of hybrid corn, higher yielding corn, corn with better
starch are plants that have been cross-bred to develop a desired or improved
trait.
Most industry representatives, federal regulators, and plant scientists
who support bioengineering express that it is a more precise and a controlled
extension of traditional breeding methods.
But there is an important difference between genetic engineering
and the traditional breeding:
that is, the origin of the added genes.
Using traditional methods, breeders can only move genes between members
of the same, or closely related species.
For example, disease-resistant genes from a wild tomato species have been
crossbred into domesticated tomato varieties.
A genetic engineer, however, can use genes from any plant or animal
source.
For example, with genetic engineering, a flounder gene could be inserted
into a tomato to make the plant frost-resistant.
Do tomatoes at the supermarket already contain animal genes?
No.
No from both researchers and from the FDA.
Plants that have been genetically engineered have never been
commercialized or introduced into the consumer market.
The world’s largest biotech agribusiness, Monsanto of St. Louis and
other cities of the USA, has pledge never to use genes from animals or humans in
genetically-engineered food products.
Genes from bacteria, not animals or humans, furnish the traits found in
most of the biotech crops.
For example, genetically-engineered corn and cotton plants produce their
own insecticides with derived from Bacillus thuringiensis, or Bt bacteria.
Second example:
Monsanto’s Roundup Ready bean, canola, and cotton plants survive
spraying with Roundup herbicide because they contain a bacteria gene that
renders them resistant to the active ingredient of the herbicide.
All of the major crops currently in the genetically-engineered seed
market can either tolerate a particular herbicide, produce their own herbicide,
or do both; and all contain bacteria genes.
Is eating bacteria safe for celiacs?
There’s nothing intrinsically unsafe about eating bacterial genes.
We likely eat and take in some bacteria with each salad and in our
drinking water every day.
But the potential problem for celiacs is that some bacteria and/or
proteins can cause allergic reactions or be toxic.
These two considerations are thought to represent the food safety risks
that are associated with biotechnology and with genetically-engineered foods for
the celiac patient.
Therefore, foreign proteins produced in genetically-engineered crops are
tested to determine whether they look or behave like known toxins and allergens.
A second level of concern and a potential problem is that a foreign
protein from a genetically-engineered crop might “escape” and then be able
to poison man or animal or contaminate other plants.
A subset of this consideration of escaping is that such a situation has
the potential to create herbicide-resistant weeds that would become or could
become a significant environmental concern.
Two well-known incidents represent proteins in genetically-engineered
products that have become problems.
1]
A research group at Cornell University found that Bt proteins
could kill Monarch butterfly caterpillars in a laboratory setting.
That raised the question if Bt corn pollen could kill Monarchs and
of course, why wasn’t this question answered before the product was released
for use.
2] The other protein problem was Cry9C , the specific Bt protein
engineered into StarLink corn. As every celiac knows from experience, proteins
that cause human allergies tend to resist digestion, and Cry9C survived a
bath in simulated gastric juices long enough to concern the EPA.
While unable to rule out the possibility that StarLink corn might cause
allergic reactions in people, the agency approved it in 1998 only for animal
consumption.
But by the summer of 2000, StarLink had found its way---perhaps via
grain-mixing on the farm or at the mill, or possibly through cross pollination
in the field---into food products for human consumption.
Afterward, the Centers of Disease and Prevention [CDC] found no evidence
that anyone who had consumed corn products possibly containing StarLink
subsequently became ill because of Cry9C.
Food safety, therefore was not the immediate issue.
But insufficient regulation was.
Manufacturers
are NOT REQUIRED to label products with genetically-engineered
ingredients, nor are they doing so VOLUNTARILY.
The industry currently is regulated by three government agencies.
Under this system, genetically-engineered foods are shoehorned to fit
existing laws
established to regulate traditional products.
For example, the U.S. Department of
Agriculture
[USDA] considers most genetically-engineered crops to be “plant pests” until
developers submit data demonstrating otherwise.
The U.S. Food and Drug Administration [FDA] considers Bt corn and
potato pesticides to be regulated by the EPA.
And after reviewing the first genetically-engineered food and proclaiming
is safe prior to its appearance on the market in the 1990s, the FDA noted that
companies did not need to seek its approval for genetically-engineered
plant-derived foods unless the food contained food additives.
This “voluntary consultation” remains the FDA’s policy today.
Thus, the question remains:
Is anything being done to improve how these foods are monitored?
Since the StarLink situation [fiasco], the industry has joined nonprofit
environmental groups to call for stricter regulation of genetically-engineered
foods. Kraft
Foods, for example, marketer of Taco Bell taco shells, which had been
contaminated with StarLink corn---Monsanto, professional scientific societies,
and others now support the idea of having mandatory, rather than voluntary
process at the FDA to deal with biotech foods.
A proposed rule for a “mandatory pre-marketing notification” process
for genetically engineered foods is still under review at the FDA.
A number of policy and legal issues remained unsolved, including the
FDA’s authority---or lack thereof---to enforce mandatory notification.
The USDA recently tightened controls on so-called “pharm” crops
[defined as plants bio-engineered to produce pharmaceutical drugs or industrial
chemicals] after soybeans intended for the food supply were contaminated by corn
that was engineered to produce veterinary drugs for livestock.
Following an outcry from the food industry, as well as consumer and
environmental groups, the USDA issued new measures to prevent pharm crops from
entering the food supply.
These include planting pharm crops farther away from other crops, better
training for farmers, equipment dedicated to pharm crops, and more frequent
government inspections.
Consumer advocates say the new measures are a start, but tighter
regulations are still needed.
The only sure way to know
your food doesn’t have biotech components is to buy products labeled
“organic.”
Look for produce and processed products labeled “organic.” By
law these food items can’t incorporate any genetically-engineered materials.
Read the Label.
[have you heard that directive before?]
While foods that contain genetically-engineered components aren’t
labeled, many products that don’t contain
them are. Some
manufacturers, and even some retailers label food as not containing
genetically-engineered ingredients.
More clues are found on the small stickers on loose produce.
Conventionally grown produce has a four-digit code [for example:
1234]; the number 9 precedes the code on organic produce [91234]; while
the number 8 precedes the number on genetically-engineered fruits and vegetables
[81234].
Buy Local or Grow Your Own.
If your local supermarket doesn’t have much organic fare, hit the
neighborhood farmer’s markets.
Manufacturers are not required to label products with
genetically-engineered ingredients, nor are they doing so voluntarily.
Since the public is, for the most part
fairly receptive
to genetically-engineered products, this is surprising [perhaps shocking].
Last year [2002] 71 percent of U.S. consumers polled by he International
Food Information Council said they would be likely to purchase
genetically-engineered produce. But
consumers also have indicated they would like to know when their food contains
genetically-engineered ingredients; 93 percent of respondents in an ABC News
poll said they want genetically-engineered foods labeled.
Overseas---especially in several European countries---genetically
engineered foods face a much stiffer competition.
The European Union recently lifted a 5-year ban on the introduction of
new genetically-engineered foods as long as they are clearly labeled.
However, many consumers in European countries oppose genetic engineering
and are unlikely to buy genetically-engineered foods.
What lies ahead?
Despite consumer demand for the Flavr-Savr tomato, the world’s
first genetically engineered whole food was a financial flop primarily because
of Calgene’s inability to handle the distribution side of the tomato business.
But the same might be true of other biotech foods that offer direct
consumer benefits.
If the industry were to shift its focus from genetically-engineered foods
for purposes of livestock health and pest control toward engineering them to
taste and nutritional qualities for people, consumers
might then welcome the technology.
Crops that are currently engineered to improve nutrition address public
health concerns in third-world countries. Pro-vitiamin A-containing “golden
rice” and “golden mustard” are earmarked for Asia, where vitamin A
deficiencies are responsible for severe health problems.
Nutritionally enhanced crops with appeal in first-world countries such as
an oilseed crop that would produce vegetable oil with heart-healthy omega 3
fatty acids---are still in the early research stage.
It isn’t apparent from several research experiment stations and
companies contacted that any biotech foods with direct consumer benefits are
being prepared for commercialization at this time.
There does appear to be several ongoing funded projects directed to food
crops engineered to produce drugs, the area of pharm foods.
It doesn’t appear that there are any regulations in committee or under
consideration regarding policy and control.
It would appear that the immediate future might bring more controversy to
the ongoing biotech debate.
Source:
Cooking Light, October 2003, pp 48 – 58.
Facsimile: (402) 553-3266
U.S. Mail:
Celiacs, Inc.,
PO Box 31144
Omaha, NE 68131
info@e-celiacs.org
Updated on 02.23.03 webmaster@e-celiacs.org