Amy Jones

Game Changer: Does the Gluten-Free Diet Help All Athletes?

Game Changer: Does the Gluten-Free Diet Help All Athletes?

Tune into any sports event today, and you’ll likely see athletes who are following the gluten-free diet. Some have celiac disease or gluten sensitivity and have to follow the diet as a medical treatment. These athletes face challenges including pre- and post-game or race fueling, gastrointestinal upset, management of day-to-day nutrition and the complications of traveling.

Other athletes adopt the diet because they believe it helps improve performance, decreases gastrointestinal distress, aids in weight loss, and reduces inflammation in the body. But how many of these benefits are supported by research? And are there drawbacks when an athlete adopts the gluten-free diet when there is no medical need?

Gluten-free in sports…help or hype?

Tennis player Novak Djokovic was one of the first athletes to publicize that he used the gluten-free diet to improve his athletic performance. Since then many athletes, both those who have celiac disease and those who don’t, have also shared stories about how the gluten-free diet has helped them.

The Sport Performance Optimisation Research Team at the University of Tasmania, Tasmania, Australia, in 2015 studied about 900 athletes who don’t have celiac disease, including world and Olympic medalists and found that 41 percent were following the gluten-free diet at least half of the time. Of these athletes, 57 percent had self-diagnosed their issues with gluten, and 81percent felt the diet reduced gastrointestinal symptoms such as bloating, gas, pain, diarrhea and fatigue. A 2012 study of 279 cyclists found similar results. It was the most popular “special” diet among the cyclists, with self-reported gastrointestinal improvements in most who used it.

But does that mean that all athletes should consider trying the gluten-free diet? Jessica Pearl, R.D., a board-certified sports dietitian in New York City, advises otherwise.

“I personally don’t believe that anyone without celiac disease or non-celiac gluten sensitivity should be on the gluten-free diet. I don’t see a benefit,” she says, noting that some of her patients try the diet anyway. “Sometimes they’ll tell me they feel better off of gluten, but we come to find out it was another component of their diet that was causing digestive issues,” she says.

Indeed, a small study in 2015 also done by researchers at University of Tasmania, and the Canadian Sports Institute in Victoria, British Columbia, indicated that the gluten-free diet may have no benefit for athletes without celiac disease. Thirteen cyclists who did not have celiac disease or gluten sensitivity were studied after following a gluten-free diet for seven days and then switching to a gluten-containing diet for seven days.

It was a double blind study in which neither the researchers nor the participants knew which diet they were following. Researchers found that there was no significant difference in gastrointestinal symptoms, performance, inflammation and wellbeing. This study also suggests that what the authors called the “belief effect” may be in play; athletes adopt the gluten-free diet because they perceive it will improve health and performance benefits. This “belief effect” has been shown to actually improve performance.

Meanwhile athletes who choose the gluten-free diet to improve performance can face risks, including nutritional deficiencies. “Athletes on the gluten-free diet are at risk of eating too little fiber, as well as vitamin/mineral deficiencies,” according to Pearl. In addition the gluten-free diet may limit food choices.

A game changer

But for athletes diagnosed with celiac disease or gluten sensitivity, the gluten-free diet can have a profoundly positive effect on performance.

Brandon Button of Marysville, Ohio, was in the middle of training for his first marathon in 2011 when he noticed a problem. “Occasionally one leg would randomly give beneath me on a stride. My lack of strength became disconcerting. I began having numbness in my arms and legs more frequently, and my heart raced,” he recalls. “One day I drove myself to the emergency room thinking I was having a heart attack.” Button was found to be healthy, except that his iron level was extremely low. Subsequent tests showed he had celiac disease, and he started the gluten-free diet.

Button says his running has improved greatly since diagnosis. “Over the next year, my comfortable pace dropped almost a minute per mile, and I was able to qualify for my first Boston Marathon. It’s amazing what having red blood cells and improved oxygen exchange will do,” he explains.

Kim Bouldin, a National Academy of Sports Medicine certified personal trainer from Columbus, Ohio, began running after her celiac disease diagnosis, which came on her 33rd birthday in 2006. “I had IBS [irritable bowel syndrome] on and off for many years, but after the birth of my daughter things became much worse,” she says.  Bouldin took up running two years later and has learned to manage both the diet and training. “In preparing for my first full marathon in 2010, I learned a lot about my long-term goal, to continue running for life. I have learned to pay attention to my body, training and plan,” she says.

Potential pitfalls

For athletes with celiac disease, cheating on the diet and not being 100 percent gluten free can have consequences. Nutritional deficiencies in iron, calcium, Vitamin D, B12, zinc and folate can impact their performance.

Teen athletes, in particular, may be struggling with feeling different from their teammates and may be tempted to cheat. This may leave them feeling tired and sick during practices or games. Button offers encouragement to young athletes who may be considering this. “Restaurants and grocery stores are embracing the gluten-free diet. Take advantage of it and stick to your diet,” he says. “There is no need to cheat when there are so many good and safe alternatives.”

In her practice, sports dietitian Pearl often recommends a gluten-free multivitamin or additional supplementation while the villi of the small intestine heals. She also finds that athletes on the gluten-free diet may not eat enough carbohydrates to support activity and may fall short of recommended fiber goals. Athletes should get at least 25 to 35 grams of fiber per day, which Pearl says can be a challenge with low-fiber gluten-free breads and crackers.

“I suggest plenty of fruits and vegetables, gluten-free whole grains, legumes and nuts to meet those goals,” she says, cautioning that fiber should be introduced slowly to avoid gastrointestinal distress. Drinking adequate water is also important.

Fueling up right

Athletes need to eat plenty of carbohydrates, which can be a challenge without the typical staples of wheat-based breads or pastas.

“Pre-diagnosis I ate pretty much everything. However, given the choice between pasta and rice, I would always choose rice,” Button recalls. “I am fortunate as rice has become a staple of my gluten-free diet.”  

Traditional pre-race meals, made with gluten-free foods, are important because those final carbohydrates are stored in the muscles. When Button is home he carb-loads for marathons by eating baked beans over rice or steak or chicken over rice. Bouldin is a big fan of mixed bowls. “The night before a race, I’ll often have a larger baked potato than usual to make my meal heavier on the carbs,” she says. Bouldin recommends sticking to whole, unprocessed foods whenever possible.

On the road again

Travel is a challenge for almost everyone with celiac disease, and athletes who go to away games or out-of-state races are no exception. Pearl suggests that athletes be very open and upfront about their dietary needs. “I suggest that athletes talk to their coach, athletic trainer and team dietitian, if there is one, about the need for the gluten-free diet.” 

Bouldin brings her own food to out-of-town races. “I just don’t trust eating in a restaurant the night before a race,” she says. “I’ll bring my own gluten-free foods and nutrition bars just to be safe.” Button goes to restaurants with a specific gluten-free menu. “I’ll get a couple of sweet potatoes and broccoli at a steakhouse, and as much lemonade as they will bring me,” he says.

Race day rules

Perhaps the most important thing athletes should remember is to avoid trying any new food or drinks on race or game day. Depending on the intensity of the event, temperature and hydration, any athlete can experience gastrointestinal distress. To help avoid this, anything an athlete intends to consume should be tried out during training.

“It’s taken me a long time to figure out what works for me,” says Bouldin. During races, she eats jelly beans for fuel and drinks plenty of water. “Carb energy gels just don’t agree with me, even though they are gluten free,” she notes. 

Button uses sports drinks and carb gels and may even drink a regular soda toward the end of a marathon. But he notes that for longer races, such as 24-hour race relays, he has to rely on more solid foods such as bananas, deli meats and gluten-free crispy rice treats (See recipe page x).

After an event, it’s important to replenish carbohydrates and protein within 15 to 30 minutes. Many athletes, especially those with gastrointestinal issues, may not want to eat immediately after an event. However this is a critical time to start recovery of the muscles. Chocolate milk (or soy milk if lactose is an issue), gluten-free pretzels, sports drinks, a gluten-free energy bar or fresh fruit are all good choices for that initial post-event snack. A larger meal with gluten-free carbohydrates and protein should be eaten two hours after.

Hydration help

With all the focus on the gluten-free diet, athletes should not forget the importance of good hydration. Gastrointestinal complaints during or after an event are often the result of not drinking enough fluids.

Even if the event takes place in cool weather, it’s still important to hydrate properly. Athletes should consume fluids all day long, not just before or after practice or an event to stay properly hydrated. The best choices for hydration are water and sports drinks. A general rule of thumb is to divide your weight by two to arrive at the number of ounces needed each day. For example, a 200-pound athlete would need to drink about 100 ounces per day, or about eight 12-ounce glasses.

Juice and soda do a poor job of hydrating due to their high sugar content. Particularly in hot weather, athletes should weigh themselves before and after exercise and replace each pound lost with 16 ounces of fluid. For athletes who cramp frequently or who see salt on their skin or clothing after exercise—so-called “salty sweaters”—hydration and sodium intake are both important. Choose gluten-free pretzels or crackers with salt, pickles, vegetable juice, and gluten-free soup and broth along with plenty of fluids.

The finish line

No matter why an athlete is following the gluten-free diet, the same general rules apply. Plan ahead for meals and travel, don’t try anything new on race day, eat nutritiously before events and be sure to incorporate nutrition into recovery.

For athletes with celiac disease, healing significant damage to the intestine may take time, which can be frustrating. Button recommends being patient. “Understand it may take a while for your body to respond to you going gluten free,” he says. “You won’t necessarily have tons of energy at first, but if you stick to the diet and allow your body to catch up, you’ll be pleasantly surprised at the things you’ll be able to do.”

This article was originally published in the March/April 2016 issue of Gluten-Free Living.

Emotionally Coping With the Gluten-Free Diet

Emotionally Coping With the Gluten-Free Diet

Do you remember the moment you first heard the words, “You have celiac disease?” Maybe it was a relief—the years of unexplained symptoms and feeling miserable finally had a name.

Maybe it was a shock and felt like someone dropped a load of bricks on you. Or maybe you greeted the news with denial and the certainty the diagnosis couldn’t possibly be right.

If it was your child who was diagnosed, you might have had a whole different set of feelings, including guilt, worry and grief.

A diagnosis of a chronic illness such as celiac disease or gluten sensitivity stirs up many emotions that are likely to change and evolve over time. Giving yourself permission to experience whatever feelings you have, positive or negative, is important in learning to cope with the challenges that the gluten-free diet presents daily.

The most significant effects are likely to be on social interactions with friends, relatives or co-workers whenever food is involved. A 2012 study by Anne Lee, Ed.D., a registered dietitian and director of nutritional services for Schär USA, found that 46 percent of respondents felt that the gluten-free diet limited their social lives, 55 percent found the gluten-free diet to be embarrassing, and 33 percent reported that their family and friends did not understand their need to follow the diet.

These difficulties affect more than just emotional wellbeing; they may even affect your ability to stay on the diet. A study from the Canadian Celiac Association found that nearly 19 percent of respondents reported intentionally consuming gluten once or twice during the past year. Of that group, 13 percent reported eating foods with gluten at least once a month.

The health effects of cheating on the gluten-free diet if you have celiac disease are clear, so why would someone intentionally eat something they know is harmful to them? The answer may lie in how we cope with celiac disease and the gluten-free diet.

Common experiences

Research shows that those on the gluten-free diet have many common emotional experiences. The diet can cause a feeling of isolation or exclusion such as not being able to eat at certain restaurants, at family gatherings or at work.

The fear of being “glutened,” or coming into unintentional contact with gluten, can also contribute to this isolation. Reviewing your diet restrictions every time with restaurant staff and worrying about whether or not the meal is safe can be exhausting. Before the gluten-free diet, it may have been a pleasure to be invited out for dinner or to a lunch with co-workers. Now it’s likely a source of worry.

Depending on your personality, you may be uncomfortable or embarrassed by the extra attention or visibility the gluten-free diet creates. One study showed that men purposefully ate gluten-containing food instead of telling their co-workers about their gluten-free diet. This embarrassment can be particularly strong for teenagers, who may feel ostracized by their peers because of the diet.

Conversely some may find that the gluten-free diet causes them to be neglected or forgotten by family, friends and co-workers. Family may not be helpful in providing safe foods. Co-workers may choose restaurants without considering if there is a gluten-free menu.

Everyone with celiac disease or gluten sensitivity feels this way at one time or another. What’s important is how you deal with these feelings. Finding people who are experiencing the same loss as you can be helpful. However it’s important to try to avoid those who are “stuck” in this grief.

Diagnosis and denial

Denial is an important emotion with any diagnosis, and it may be immediate or develop over the long term.

Danna Korn, author of Living Gluten Free for Dummies, 2nd Edition and founder of the support group Raising Our Celiac Kids (R.O.C.K), says those who haven’t been properly tested for celiac disease experience the strongest denial.

“Denial can be a justification for some people to think, ‘I can just eat a little bit,’” she says. “If they haven’t been properly tested, it can be very difficult to see the importance of being totally gluten free.”

But even if you or your child has a clear diagnosis, you can still be in denial. “I don’t have diarrhea, so it can’t be celiac disease. I’m overweight so I can’t be having issues absorbing food,” you might think.

Denial may reveal itself a few weeks or months into the diet as the reality sets in.  Teenagers who have had celiac disease since they were young children may go through their own denial. “I don’t want to be different from my friends, so I will eat gluten and deal with feeling bad later,” they might reason.

Dealing with denial may be as simple as talking to someone else who is going through what you are or writing down the ways your life has improved on the gluten-free diet.

For teenagers Korn suggests parents be honest about how cheating will affect them. “If your teen plays sports, talk about how feeling sick or tired will affect the ability to play well in the next game,” she says. “Even outwardly asymptomatic teens have some symptoms [such as] fatigue, depression or anxiety.” However Korn suggests that if your teenager threatens to cheat on the gluten-free diet, it isn’t helpful if the parents react too strongly. “The more you freak out, the more they will rebel,” she explains.

Changing your thinking

Being diagnosed with celiac disease as an adult comes with its own set of challenges, but there are ways to cope. Debbie Chandler, of Bellefontaine, Ohio, was diagnosed 12 years ago. “When I was diagnosed, I said to myself that I’ve eaten all the gluten I’ve needed in my life,” she says. “I’ve had pizza and pasta and enjoyed those. Now I can find new things to enjoy.”

For Chandler socializing continues to be difficult at times, even after more than a decade, but she’s figured ways to work around it. “Instead of having our friends try to accommodate my diet at their homes, we go out to eat [at safe restaurants] with them instead,” she says.

Her family gatherings were affected almost immediately after her diagnosis. “The first few holidays were weird,” she recalls. “The first Christmas after I was diagnosed, my family catered in Italian food!”

Chandler chose to deal with it in a positive way by preparing gluten-free versions of items on the menu for herself.

Meanwhile the widespread availability of gluten-free foods in recent years has helped her feel less deprived. “There are more options, and they are more affordable every day. But I’ve also grown to like new tastes, like lettuce wraps instead of buns,” she says.

Korn agrees. “It is so much easier today than it was 24 years ago when I started into this with my kids,” she says.

Both focus on what they can have on the gluten-free diet instead of what they have given up, an attitude that’s important in coping with celiac disease and gluten sensitivity.

Korn encourages those on the gluten-free diet to remain as positive as possible. “I don’t even like the word ‘cope,’” she says, “because ‘coping’ implies that being gluten-free is a ‘bad’ thing that you have to ‘cope’ with whereas I believe it’s a great thing. The gluten-free diet can be the healthiest diet in the world.”

Educate and empower your child

When a child is diagnosed with celiac disease or gluten sensitivity, both he or she and the parents have to learn to accommodate changes the gluten-free diet requires.

Parents often struggle with guilt, fear and uncertainty about how the whole family will adjust. “A diagnosis of celiac disease in a child is often much harder on the parent than it is on the child,” says Korn, whose son has celiac disease. While it can be hard to not let your child see that guilt and sadness, she cautions parents, “Remember your kids have ears. They hear your negativity.”

Parents may even find themselves apologizing to teachers or other parents about accommodating their child’s dietary needs, communicating to a child that the gluten-free diet is something they have to be sorry about. “Don’t say, ‘I’m sorry.’ Say that we’re going to get through this,” Korn advises.

Even small children benefit from a proactive approach and should be given as much control of their diet as possible from day one.

Read labels together, even when your children are small. Korn showed food labels to her son even before he could really read. “By the time he was in elementary school, he felt comfortable saying no to things he couldn’t eat,” she says “Educate your child. Empower your child.”

Even adults diagnosed with celiac disease find it can affect the relationship with their parents. “No one knew quite what to do with me when I was diagnosed,” Chandler says. “My parents felt terribly guilty.”

She takes a hands-on approach now, helping her mother shop for food for family events and helping to prepare the meal. “I might even suggest disposable cookware just to make sure things are clean,” Chandler says.

Find support

Your partnership with your medical team can also be important in the coping process.

Accurate information about celiac disease or gluten sensitivity and the gluten-free diet will empower you to move forward.  Look for a doctor who encourages questions, and make sure you are prepared with a list when you go to appointments. A good physician will answer questions in a way that you can understand.

For accurate gluten-free diet information, find a dietitian experienced in counseling those with celiac disease. The Academy of Nutrition and Dietetics has an easy-to-use search engine for dietitians that can be found at eatright.org.

Today there’s a wealth of information available online, but always seek out reliable sources, including Gluten-Free Living. You’ll also find a list of reputable support groups, celiac disease centers and more on our website.

Your personality might dictate how helpful an abundance of information from online sources really is. For some, gathering lots of information feels empowering. But for others too much information can increase anxiety and lead to preoccupation with symptoms and issues that may never actually occur.

“At first I was online getting my information, and I was OK with it,” Chandler says, but now she relies on her local support group and dietitian.

A support group, whether in your local community or online, can help you cope, too. Chandler’s husband encouraged her to go to a support group meeting even though she was reluctant at first. “Now I’m so glad I go and can enjoy learning new things and not feeling alone,” she says.

If you choose online support, keep in mind that Internet groups are not necessarily moderated by a physician or dietitian, and misinformation and fear can spread quickly. “Be as diligent as you possibly can in gathering information, but don’t let it cause you to feel like you’re living in a bubble,” Korn says.

Rebuilding and acceptance

Since celiac disease and gluten sensitivity are chronic conditions with no cure, your acceptance of your diagnosis and the gluten-free diet are critical to long-term good health and emotional wellbeing.

How accepting you feel may not always be the same, and your attitude is likely to shift and change. But you will be more successful following the gluten-free diet if you control it instead of letting it control you, Korn advises.

Put another way, live with celiac disease or gluten sensitivity, not for it.

This story first ran in Gluten-Free Living in December 2014.

Special Occasions and the Gluten-Free Diet

Special Occasions and the Gluten-Free Diet

Amy Jones, M.S., R.D., L.D., is a dietitian and celiac disease support group leader from Bellefontaine, Ohio.

Q: My best friend is getting married this summer, and they are having a served sit-down dinner at the reception. I’m in the wedding and very excited, but the dinner has me worried. How can I get a safe meal without bothering my friend? She’s already so busy with everything else.

A: Weddings can be exciting, but they can also be stressful for guests following a gluten-free diet. Because you are in the wedding, I think it’s OK to have a conversation with the bride about your meal at the reception. You might be surprised—maybe she already thought about having a gluten-free meal available for you! If she hasn’t, you can offer to contact the caterer to ask what options might be available. Most catering companies are used to dealing with special diet requests, including gluten free. If the bride and groom have already set a menu, ask the caterer what will be served and how it might be modified to be gluten free. For example, will the entrée have a breading or sauce? If so, could a plain piece be set aside for you and cooked in a clean pan? If there is a cocktail hour before the reception, will there be veggies, shrimp or cheese available to nibble?

If the meal absolutely cannot be made gluten free, or if you don’t feel comfortable after speaking with the caterer, plan to eat a larger meal beforehand, and then bring along snacks to tide you over. If you think you’ll feel left out when it’s time for cake, also plan to bring along a sweet treat to enjoy!

Q: My daughter is going on an eighth-grade field trip for three days to Washington, D.C., this spring. It’s the longest she’s been away from me since her celiac disease diagnosis five years ago. She’s very comfortable with the gluten-free diet and will speak up for herself, but I’m still a little worried. Are there any steps I can take to help make sure she has a fun, safe experience?

A: School field trips, especially ones that involve overnights and meals away from home, can be worrisome for any parent. If a tour company is managing the trip, give them a call to see which restaurants the students will visit on the trip, as well as which hotel they are staying in. If the restaurants have gluten-free options, ask if students will be allowed to order from the menu. If there will be opportunities to eat in local restaurants, consider contacting the local celiac support groups for recommendations.

Ask whether your daughter can bring an extra carry-on bag with snacks and shelf-stable meals; these present a good option when a gluten-free menu isn’t available. Gluten-free pretzels, energy bars, popcorn, fruit cups, tuna packets and peanut butter are all easy and portable. If she has access to a microwave in the hotel, little cups of gluten-free macaroni and cheese will also work. Don’t forget to send plastic spoons and napkins, too!

If breakfast will be eaten at the hotel, there may be gluten-free bread or bagels available, but she still should bring toaster bags because the toaster in the breakfast area will likely be shared with regular bread and bagels. Yogurt, fruit, boiled eggs, cheese and gluten-free cereal with milk are a great way to start a day of sightseeing. Also consider sending packets of instant gluten-free oatmeal or grits that can be mixed with hot water.

Q: My new co-workers invited me to a cookout. I would love to go, but this is my first summer on the gluten-free diet, and I’m a little bit nervous. What kind of things should I watch out for?

A: A summer cookout can be a lot of fun, and you can eat safely with a little planning. If you choose to disclose that you are on the gluten-free diet before the cookout, it may help open a dialogue with your hosts about basic cross-contamination prevention. For example, you can ask about squeeze bottles of condiments or making sure there are enough serving utensils, so they don’t get moved around from dish to dish.

Be sure to bring a gluten-free dish to enjoy; salad, chips and salsa, or even a dessert are all good choices. That way, if you are uncertain about other foods, you will have something to eat. If at all possible, stick to meat that is plain. Chicken, beef and many (but not all) hot dogs are gluten free. If you don’t know what ingredients the marinade contains, it’s best to steer clear as some contain soy sauce or beer. Some seasoning blends also contain wheat, so try to get a piece of meat that has not been preseasoned.

Take foil with you and ask the host to wrap your meat or veggies before cooking on a shared grill so you’ll enjoy all that grilled flavor without the risk of cross-contamination. Bring a gluten-free bun or tortilla, or wrap your sandwich in lettuce. Be cautious with side dishes like baked beans or salads that may contain hidden croutons. Avoid veggie burgers as many contain wheat. Ketchup, mustard and mayonnaise in squeeze bottles are safe choices. If adult beverages are being served, bring along a safe choice like gluten-free beer or hard cider. 

-By Amy Jones 

Gluten-free labels and disclaimers

Gluten-free labels and disclaimers

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Amy Jones, M.S., R.D., L.D., is a dietitian and
celiac disease support group leader from
Bellefontaine, Ohio.

 I’m confused about statements like “made on shared equipment” or “made in a shared facility.” Does this mean that the product is contaminated with gluten? Are the food companies just trying to cover themselves in case I get sick? How can they label such products gluten free?

Allergen advisory statements like these certainly can be confusing. However, products with such a statement on their packaging do not necessarily contain gluten. Remember that food manufacturers are not required to put allergen advisory statements on packaging. Some manufacturers may choose to, but others may not. This differs from food allergy labeling (i.e., contains eggs or peanuts), which is required.

The FDA’s gluten-free labeling rule states that as long as the final product contains
less than 20 parts per million of gluten, the product may be labeled gluten free.
The FDA also states that allergen advisory statements are not meant to take the place of cleaning equipment or other cross-contamination prevention. In short, a company can’t be lax in its procedures and just put an allergen advisory statement on the label to protect itself.

I read online that sourdough bread might be safe for those with celiac disease. Is this true?  

Unfortunately, this is not true.  Sourdough bread (or any other bread made from fermented wheat flour) is not safe for those with celiac disease or non-celiac gluten sensitivity. You might have come across information about a 2011 study involving two people who ate sourdough bread. While they didn’t experience digestive symptoms after eating the bread, it is important to note that they still suffered intestinal damage.

The fermentation process used to make sourdough may reduce gluten content, but not to a safe level. In fact, testing shows that some of these breads contain extremely high levels of gluten. Those with celiac disease or non-celiac gluten sensitivity should avoid sourdough products.

I bought a box of a new brand of gluten-free granola bars yesterday, but when I got it home I noticed that the ingredients list includes “barley malt extract.” I thought barley wasn’t allowed on the gluten-free diet.  

First of all, great job double checking the ingredients list even though the product was labeled gluten free. It’s always a good idea to look at the ingredients a product contains, especially one you’ve never purchased before. Some manufacturers believe that barley and malt are allowed in products labeled gluten free as long as final testing indicates less than 20 parts per million of gluten. However, the FDA has stated that barley and malt are not allowed in a product labeled gluten free. Your granola bars are mislabeled and should be reported to the FDA. Go to fda.gov/safety/reportaproblem/consumercomplaintcoordinators/default.htm to find contact information for your state’s FDA consumer complaint coordinator.

Last week my sister brought over a bag of buckwheat flour that she found at a discount store. I know that buckwheat is a naturally gluten-free grain, but I don’t see “gluten free” anywhere on the label.
Is this safe to eat?

You are correct that buckwheat is a naturally gluten-free grain, but I would not recommend that you use this particular bag of buckwheat flour. A 2010 study showed that some naturally gluten-free grains are at risk for contamination with gluten. This may happen in fields, on trucks or in processing plants. In light of that study, experts recommend purchasing grains and flours specifically labeled gluten free. Even if it’s a naturally gluten-free flour like buckwheat, you should still look for the gluten-free label.

I went to my favorite Italian restaurant last night and was surprised to see they had a gluten-free menu! I was just about to order when I saw the disclaimer that they could not guarantee that there would be no cross-contamination with gluten in the kitchen. I was so upset. Does that mean this gluten-free menu is useless for me?

I can understand your worry, especially in an Italian restaurant where there would be a higher risk of contact with gluten. However, many restaurants have procedures in place to prevent cross-contamination. It’s a good idea to ask questions. For example, are they using separate containers of sauce and toppings for gluten-free pizza? Do they prepare the gluten-free pizza on a separate countertop or clean baking sheet? How do they separate the gluten-free pizza from other pizzas in the oven? Do they use a separate pizza cutter? Do they use a separate pot with clean water to boil gluten-free pasta? Do they drain the noodles in a separate colander? Are their cream-style sauces thickened with flour? If the restaurant offers gluten-free bread, is it heated separately from the regular bread? Is the finished pizza or pasta served on a different color plate or
in some other way to indicate that it is gluten free?

Asking questions will allow you to decide if you feel comfortable ordering from the gluten-free menu. 

Making the Gluten-Free Diet Work For You

Making the Gluten-Free Diet Work For You

A Q&A With Dietitian Amy Jones:

Q. I was diagnosed with celiac disease five years ago, then went for my annual physical last week and found out I also have type 2 diabetes.  My mom, aunt and grandfather all have it, but it was still a surprise. How am I going to manage a gluten-free diet along with a diet for my diabetes?

A. Getting a diagnosis of type 2 diabetes can be overwhelming, and you are correct that family history plays a role in its development.  Ask your doctor to refer you to a registered dietitian nutritionist (RDN) who has experience treating both diabetes and celiac disease. He or she can help you plan the most balanced, varied and enjoyable diet that meets the needs of both conditions.

gluten-freeSelecting foods appropriate for both diabetes and celiac disease may seem daunting at first, but the diets really can work well together. Selecting balanced meals including lean meats and protein, whole grains, dairy, fruits, vegetables and healthy fats can go a long way in controlling your blood sugar. Pay attention to the Nutrition Facts panel, with particular focus on the amount of total carbohydrate. You and your dietitian, diabetes educator or physician will work together to decide how much carbohydrate you should have at each meal and snack. People with diabetes often focus on the grams of sugar in a food, and while that’s just fine to note, the carbohydrate total is most important. Once you know how many grams of carbohydrate you should have at each meal, check the Nutrition Facts panel to see if the food you’re selecting fits into that carbohydrate budget.

Also, don’t forget about exercise. Getting moderate exercise for 30 to 60 minutes every day is a great way to control blood sugar. I tell my patients it’s the cheapest diabetes medicine available!

Q. I was diagnosed with celiac disease six months ago. I was a little underweight at that time, so I was happy to initially gain some weight on the gluten-free diet. But now it seems I can’t quit gaining, and it’s really upsetting me. I used to be able to eat whatever I wanted and not gain a pound. How do I make it stop?

A. Your experience of gaining weight on the gluten-free diet is a common one, unfortunately. Just like you were initially, many are thankful to gain some weight; but that can quickly turn to frustration when the extra pounds don’t stop piling on. Several factors play a role in weight gain on the gluten-free diet. Many gluten-free foods are higher in calories and fat than their gluten-containing counterparts. When your celiac disease was undiagnosed, you were likely experiencing malabsorption, which made it possible to eat bigger portions without gaining weight. Now that your body is absorbing food better, you‘re seeing that unwanted weight gain.

What works for one person in terms of losing weight may not work for another. If you are comfortable tracking what you eat and drink, using either a phone app or food diary can increase your awareness of the calories you consume. Research shows that keeping track of what you eat is very effective for weight loss. But if the thought of writing everything down makes you a little crazy, adopting a more mindful eating approach might work better for you. Pay attention to how your body feels and try to eat when you are gently hungry instead of waiting until you are starving, when you’re much more likely to overeat. As you eat, check in with yourself every few bites to assess how full you are. It can take 20 minutes for your brain and stomach to recognize fullness, so simply slowing down can help you eat less.

-Amy Jones, M.S., R.D., L.D., is a dietitian and celiac disease support group leader in Bellefontaine, Ohio.

Follow the Mediterranean Example

Follow the Mediterranean Example

A diet rich in grains, veggies and fish
that’s easily made gluten free

 

When you picture foods from the Mediterranean, you might imagine colorful fruits and vegetables, hearty breads, pasta, fish and, of course, red wine.  But did you know that the Mediterranean style of eating is one of the healthiest, if not the healthiest, in the world?

While the Mediterranean diet is not new, it is gaining popularity in the United States. U.S. Dietary Guidelines released in 2015 recommend a Mediterranean style of eating.

Incorporating more Mediterranean-style foods can improve the nutritional profile of the gluten-free diet, while providing other health benefits to manage or prevent chronic diseases such as heart disease and diabetes. Keep in mind that physical activity is part of the Mediterranean way of life too.

Rich in history and health

Ancel Keys, Ph.D., was the first researcher to promote the Mediterranean style of eating, following the Seven Countries Study conducted shortly after World War II. The study examined the eating habits of almost 13,000 men in different areas of the world.

Keys and his colleagues found that people who lived in areas such as the Mediterranean, where it was common to eat a diet high in fruits, vegetables, fish, grains, beans, herbs, spices and healthy fats, had better cardiovascular health than those in the United States.

Since then the Mediterranean diet has been proven to offer many health benefits, particularly in the areas of heart disease and diabetes. A 2015 study from Harokopio University in Greece showed that a Mediterranean-style diet can reduce the risk of heart disease by 50 percent, an effect even more protective than exercise. There is some evidence that metabolic syndrome, a precursor to diabetes and heart disease, can be reversed by the Mediterranean diet.

A 2015 analysis of nine studies that involved nearly 1,200 patients found that people with Type 2 diabetes who ate a Mediterranean-style diet had improved blood sugar control, better cholesterol and triglyceride levels, better control of blood pressure, and improvements in weight. A 2014 Italian study found that the Mediterranean diet can slow the progression of diabetes, and yet another study showed a reduction in the development of diabetes-related eye disease.

But the benefits don’t end there. Additional studies have shown the Mediterranean diet improves cognitive function, eye health, sleep apnea and weight-to-body-mass index. The diet also reduces the risk of developing Alzheimer’s disease and inflammation in the body and helps prevent cancer.

Back to basics

The Mediterranean diet emphasizes whole grains, fruits, vegetables and healthy fat, but fish and seafood are eaten frequently, with poultry, eggs and cheese allowed in smaller amounts. Red meat and sweets are meant to be treats and aren’t eaten regularly.

Red wine is allowed in moderation—one five-ounce drink for women and two for men—along with plenty of water. Daily exercises, both strenuous and light, are important additions. And the diet encourages the social experience of eating shared meals.

 

Health benefits for those with celiac disease

The health benefits of the Mediterranean diet extend to those with celiac disease. “A Mediterranean diet is a great way to supply some of the nutrients that a standard gluten-free diet might otherwise be lacking,” says Kelly Toups, R.D., program manager for  the Whole Grains Council and Oldways, a nonprofit food and nutrition education organization.

A small study published in January 2016 in the European Journal of Clinical Nutrition found that those with celiac disease who followed gluten-free and Mediterranean-style diets were able to improve their nutritional status without becoming overweight or obese.

Weight gain can be an unwelcome consequence of following the gluten-free diet, but adoption of a Mediterranean diet can counter this side effect. A 2011 study in the American Journal of Medicine showed that those on the Mediterranean diet lost more weight than those on a traditional low-fat diet.

Med Diet Pyramid

And a 2010 study published in the American Journal of Clinical Nutrition showed that the diet reduces weight gain thought to be related to aging. Toups advises patients looking to lose weight to base their meals on the Mediterranean diet pyramid, making vegetables, whole grains and pulses including peas, lentils and chickpeas the basis for each recipe. Olive oil should be used as the primary fat, and fruits, nuts and fish added for flavor.

“There is no need to count calories or grams of different nutrients if the diet is based on filling, nutrient-dense foods,” she says.

In addition, the Mediterranean diet may have benefits for those with anemia, a common problem for those newly diagnosed with celiac disease. A 2009 study in the International Journal of Food Sciences and Nutrition found that adolescent boys who switched from a regular diet to a Mediterranean diet had increased absorption and retention of iron, even though the amount of iron in their diet did not increase.

As always, anyone who has anemia should work with their medical provider or dietitian to determine if an iron supplement is necessary. However, a Mediterranean diet can go a long way in keeping iron stores at proper levels,
even without red meat.

“The traditional recipes and food pairings of the Mediterranean diet serve as a blueprint for nutritionally balanced meals,” Toups notes. For example, not only are lentils, spinach, chickpeas and sardines all good sources of iron, but they are staples of the Mediterranean diet. They are also usually prepared with vitamin
C sources, such as tomatoes or red peppers.

“Combining these foods can help increase the absorption of the non-heme iron,” according to Toups. Non-heme iron, the type of iron available in plant foods, is less absorbed than iron from animal foods. Other Mediterranean staples are even more impressive. A cup of canned white beans, for example, provides nearly half of the
recommended daily value for iron.

Great grains

Whole grains play a big role in the Mediterranean diet, and though they are usually wheat based, it’s easy to substitute gluten-free choices.

In general those on the gluten-free diet have trouble getting the recommended amounts of whole grains. A 2005 study by Tricia Thompson, R.D., showed that nearly 37 percent of men and 79 percent of women had this problem.

While more gluten-free products are now made with whole grains, many products still rely heavily on rice flour. And gluten-free consumers are just beginning to work whole grains into their diet plans.

Toups recommends polenta made from whole-grain cornmeal. “It was a staple in Italian and Greek Mediterranean traditions and is the perfect vessel for any assortment of legumes or seasonal vegetables,” she says.

You can also toss quinoa with tomatoes, olive oil, lemon juice and parsley for a gluten-free twist on the classic tabbouleh salad. Toups also recommends using whole-grain gluten-free breads and crackers for spreads such as hummus and utilizing gluten-free whole-grain pasta for a quick weeknight meal.

“Gluten-free steel-cut oats are my favorite secret weapon for making creamy, whole-grain risotto, although parboiled brown rice makes a suitable stand-in,” Toups notes. A gluten-free label on grain products is assurance that they meet the Food and Drug Administration standard for gluten-free food.

Oil change

Olive oil is used daily in the Mediterranean diet as the primary source of fat. It is high
in monounsaturated fats, as opposed to the saturated fats that are found in animal
fats such as butter.Butter-Olive oil substitution chart

The American Heart Association says that while the Mediterranean diet may contain as much as 25 to 35 percent fat, more than half of those fat calories
come from monounsaturated fats—due largely to the extensive use of olive oil.

For a light flavor for salads or vegetables, select extra-virgin olive oil. For frying and roasting, virgin olive oil works well. When purchasing olive oil, look for the bottling date and avoid any that is more than 18 months old. Additionally look for the words “cold pressed” because cold pressing oils keeps all of the health benefits and preserves flavor. Olive oil should be stored in a dark, cool place at home.

Olive oil can be used to toss gluten-free pasta, sauté vegetables or cook scrambled eggs. Add it to popcorn in place of butter and use it to marinate poultry or fish and as a dip for gluten-free breads. Olive oil can also be used instead of butter in gluten-free baking.

Ideas for busy people

Adding another diet on top of the gluten-free diet may seem complicated, but it’s actually quite easy. Both use naturally gluten-free foods as building blocks.

Lentils can be added to soups or stir-fry or substituted for rice in stuffed peppers. You can make your own
veggie burgers with lentils, quinoa, gluten-free oats and spices. Use whole-grain gluten-free pasta to make traditional spaghetti or baked ziti. Leftovers are great for a quick lunch the next day.

Canned salmon can be made into fish cakes by combining it with onions, egg, salt and pepper. Hold the mixture together with mashed potatoes or gluten-free panko crumbs.

Avocados are a versatile Mediterranean “superfood” full of healthy fats. Spread mashed avocado on a slice of gluten-free whole-grain toast or add diced avocado to omelets, vegetable salads or fruit salad made with berries, apples and mango. You can also slice avocados and layer them on sandwiches or in wraps.

Hummus, which is made from chickpeas, makes a great substitute for mayonnaise on sandwiches and in tuna and chicken salad or deviled eggs. It also works as a dip for vegetables instead of more fattening ranch dressing. Spread hummus on a gluten-free tortilla or bagel. To make a healthier pizza, top gluten-free crust with hummus, add vegetables and olives, and top with feta before baking. Serve hummus with gluten-free whole-grain crackers for a quick snack.

Greek yogurt is a good option for those who have lactose intolerance, as it is lower in lactose than other dairy products. Use it as a topping for vegetables or a bowl of gluten-free oatmeal finished with a layer of fruit. Substitute Greek yogurt for sour cream in dips or as a topping for baked potatoes. It also works in smoothies and can be topped with honey and walnuts for a delicious dessert.

If you rethink your approach to snacks, you’ll soon find that healthy nuts and seeds are as quick and portable as the packaged products you’re used to eating. And they can easily be incorporated into recipes.

Add chopped peanuts to gluten-free pasta or roasted vegetables for extra flavor and crunch. Spread peanut butter on gluten-free waffles, or combine with Dijon mustard and honey to create a dipping sauce for gluten-free chicken tenders. Add walnuts to gluten-free oatmeal or cooked buckwheat cereal, or make a morning
smoothie with Greek yogurt, peanut butter, honey and walnuts.

You’ll find more ideas on how to easily incorporate Mediterranean foods into your gluten-free diet on the Oldways website, oldwayspt.org.

A happy table

One of the joys of the Mediterranean diet is its emphasis on eating as a social activity. For those who are gluten free and often feel left out when others gather around the table, this part of the Mediterranean diet can be refreshing.

“An important aspect of the Mediterranean diet is sharing food in the company of friends and family, savoring the social interaction as much as the delicious flavors,” Toups says. “The Mediterranean diet is about food from a simpler time, where unfussy mixed dishes brimming with seasonal vegetables were the norm.

“Don’t overlook a nice soup and salad combo. Soups and stews were a very resourceful way for Mediterranean families to incorporate local or leftover produce into healthy, hearty meals.” Toups also encourages people with celiac disease to select gluten-free pasta when it’s available at a restaurant. Ask to have it topped with olive oil, tomato sauce, veggies, or seafood and fresh herbs.

Small steps

Research shows making even the smallest steps toward a Mediterranean-style diet can lead to benefits. A recent study presented at the American College of Cardiology showed that every one point increase on a Mediterranean diet score—which measured how closely those in the study followed the diet—was associated with a 3 percent drop in the risk of heart disease.

If it seems overwhelming to make a wholesale change, try one step toward the Mediterranean diet every week. For example start by using olive oil for cooking instead of vegetable oil. Then add more beans and nuts over the next few weeks. Since these foods contain more fiber, be sure to drink more water to avoid constipation.

The Mediterranean diet can help relieve the culinary boredom some people feel on the gluten-free diet because it includes such a wide variety of foods prepared in simple but flavorful ways. Before long you’ll be enjoying your food more and feeling better than ever at the same time you are improving the nutritional quality of your diet.

 

Sorghum Pasta Salad with Oregano, Feta Cheese and Cucumbers

SERVES 12

 

Sorghum pasta salad

Ingredients
• 9 cups water
• 1 tablespoon sea salt, plus a dash for boiling
• 3 cups sorghum
• ¾ cup chopped fresh oregano
• 6 scallions, white and tender green parts, chopped
• ¾ cup extra-virgin olive oil
• 9 tablespoons freshly squeezed lemon juice
• 3 tablespoons grated lemon zest
• 3 cups chopped English cucumbers
• 1 cup toasted pine nuts
• 3 cups crumbled feta cheese
• ½ teaspoon ground red pepper

 

Directions
Bring the water and a dash of salt to a boil in a large saucepan and add the sorghum. Simmer uncovered for
30-40 minutes or until all the water is absorbed and the sorghum is the consistency of cooked rice. Cool to
room temperature, fluffing with a fork occasionally.

In a medium bowl, combine the oregano, the scallions, olive oil, lemon juice, lemon zest, cucumbers, pine
nuts, feta cheese, red pepper and salt. Add the cooked sorghum and mix.

Recipe courtesy of Oldwayspt.org

 

 

Easy, Quick and Healthy: Your Family’s Recipe for Successful Eating

Easy, Quick and Healthy: Your Family’s Recipe for Successful Eating

Don’t eat from a drive-thru for a hasty meal or sacrifice health for valuable time. Use these tips to prepare delicious, nutritious food—quickly.

The juggling act

Modern families have more demands on time than ever before. Combine a long workday with after-school practices, games or other activities, and many families struggle to get a quick, healthy dinner on the table. In many cases, the traditional sit-down family dinner has been replaced by quick bites in restaurants, at ball fields or even in the car.
Of course, these challenges aren’t unique to families who eat gluten free, but adding a dietary restriction can make
a challenging task seem overwhelming.

Drive-thru and takeout meals are more popular than ever before, but they can be problematic for those on
the gluten-free diet. Fewer options, increased cost and the inherent risk of cross-contamination are all issues
when eating away from home. In addition, restaurant meals are often high in calories and fat—even those from
fast-casual restaurants like Chipotle. Some of these establishments may seem to be a “fresh” and healthier option, but a study in the May 2016 Journal of the Academy of Nutrition and Dietetics found that meals at such fast-casual restaurants contained significantly more calories than traditional fast food.

How can busy families put emphasis back on healthy meals this school year, while still accommodating busy family schedules? How can families save time without relying heavily on processed, convenience or restaurant foods? And finally, how can kids take an active role in healthy snacking at home and on the go?

Planning for success

Planning ahead can go a long way in accomplishing the goals of healthy meals. “If I’m trying to figure out what to
make for dinner at 4:30, it’s all over,” jokes Jen Graham, mom to Melissa, Paige and Colton, of North Lewisburg, Ohio.

Photo by Kelly Heasley Photography, LLC
Photo by Kelly Heasley Photography, LLC

“I do at least a one-week and sometimes a two- or three-week meal plan,” says Graham. “It helps me with my grocery shopping and planning ahead.” Try to find a less busy time on a weekend to sit down, either alone or ideally with input from other family members, and make a plan for the week. How many dinners will be at home? How many on the go? What ingredients could be prepared ahead of time or even cooked during the day?

Keeping dinners simple can help with the planning process. Lara Field, registered dietitian and owner/founder of FEED—Forming Early Eating Decisions (www.feedkids.com)—encourages her clients to create balance, including fruits, vegetables, lean proteins, low-fat dairy and gluten-free whole grains. “Take an inventory of the family favorites, maybe eight to 10 options, and rotate through these choices for one to two months,” Field advises. “Make sure all family members put in their two cents and voice their favorite meals so that everyone participates in planning.”

If only one or two members of the family are following the gluten-free diet, this can pose more of a challenge. For this reason, it may be beneficial to serve gluten-free meals for everyone, with additions of gluten-containing foods as needed. For example, everyone can enjoy gluten-free pasta with sauce, which saves preparation time and also reduces the risk of accidental cross-contamination. “There are two of us that have to eat gluten free, but everyone in the house eats that way now, except for regular bread on sandwiches,” Graham notes. “It’s made things a lot simpler.”

It’s also a good idea to have three to five “emergency” meals that can be quickly prepared if a last-minute snag in the evening schedule has family members arriving home later than planned. Scrambled eggs, gluten-free granola and yogurt, grilled cheese or a gluten-free bagel with peanut butter are quick and can even be prepared by an older child or teenager.

Making convenience healthy

Convenience foods often get a bad reputation for being unhealthy; however, some can be very good choices
and help facilitate a healthy meal. Janelle Smith, M.S., R.D.N., “Ask the Dietitian” for the Celiac Disease Foundation, suggests utilizing convenience foods that help cut preparation time. “Pre-cut vegetables and fruits are just as nutritious and require far less preparation.” She also advises her clients to look for gluten-free foods that are
fortified or enriched with vitamins and minerals, as well as ones that contain whole grains instead of just starches. Frozen fruits and vegetables are also examples of healthy convenience foods. In some cases, frozen vegetables may be nutritionally superior to fresh, without the disadvantage of spoilage before they can be used.

Field suggests utilizing other healthy convenience foods. “You can purchase par-boiled whole-grain brown rice or quinoa, rotisserie chicken (be sure to select one labeled gluten free), steam-in-bag vegetables, fresh fruit, and you have dinner!”

Consider making your own items that can become convenience foods later. Preparing ingredients ahead of time and utilizing your freezer can make quick dinner preparation a snap. “I always have stuff in my freezer,” says Graham. “I try to freeze sweet corn and green beans in the summer, but I have found that I can also freeze cooked ground beef and chicken. I cook extra and freeze them in portions I can later use for spaghetti sauce or casseroles.” Graham has found that cooked rice and quinoa freeze well, although she suggests utilizing the microwave to thaw them. “It seems counterintuitive, but I have found the microwave works much better. On the stove, they tend to be mushy.”

Field suggests simple changes that can make kid-friendly foods easy and healthy, such as preparing gluten-free chicken nuggets with chicken tenders coated in amaranth flakes or gluten-free whole-grain corn flakes. These can be frozen and then cooked for a quick weeknight dinner. Kid-staple macaroni and cheese can be made with brown rice or quinoa pasta, topped with heart-healthy olive oil and Parmesan cheese. Pizza can be made easily with a ready-made gluten-free crust, sauce and veggies. Kids can become involved in prepping their own pizzas on individual gluten-free crusts.

Leftovers and planned-overs can also be great options for busy nights. Consider making a larger batch of minestrone soup or chili, meatballs, turkey or beef burgers that can be reheated for main dishes throughout the week. If you have more time on Sundays to cook than during the week, make items that take longer and then pre-portion them out for a weeknight dinner.

Consider a Tapas-style menu—small dishes that everyone can share—later in the week to use up leftovers. A meal can even be as simple as sliced deli meat, cubed cheese, hummus, gluten-free whole-grain crackers, and sliced fruit and veggies.

Slow-cooked convenience

Slow cookers can be used for full meal preparation or for preparing specific ingredients to use in other dishes. Smith suggests keeping it easy and naturally gluten free. “Chili, potatoes and meatloaf cook well in a Crock-Pot™.” She also suggests prepping items ahead that can be quickly put in a Crock-Pot on hectic mornings before school or work. Graham says she uses her Crock-Pot primarily for preparing meats and poultry that she can later shred, although,
“I do use my Crock-Pot to make roast with carrots and potatoes, a naturally gluten-free meal my whole family enjoys.” Graham and Smith both caution that pasta recipes may not work as well in the Crock-Pot because gluten-free noodles may not hold up as well and become mushy.

Field suggests utilizing the Crock-Pot to make gluten-free oats for busy mornings (see below for recipe). She also suggests preparing chicken breasts with salsa, which can be shredded for tacos, salads or baked potato toppings.

Other kitchen equipment, like food processors and blenders, may also ease preparation and reduce waste. “I save
the heels of my expensive gluten-free bread and use my food processor to make breadcrumbs that I can use in
other recipes,” says Field. Smoothies in the blender, with fresh or frozen fruits and yogurt, are also quick, kid-pleasing breakfasts. “My kids like the smoothie, and even the pickiest kid can’t tell if there is spinach or blueberry in it.”

A healthy haven

There are a bevy of gluten-free snack foods available—a blessing and a curse for families who are trying to eat healthier but still want convenience. “Many families that I meet with in my one-on-one counseling are frustrated about the amount of ‘junk’ their kids are exposed to on a daily basis,” Field says. “But the reality is, if we don’t buy it, they won’t eat it.” She suggests making home a healthy place, and keeping the not-so-good-for you items as an occasional treat. Smith suggests pairing a convenience food with a healthier food, like gluten-free cookies and a piece of fruit, or pairing gluten-free crackers with almond butter or a slice of cheese. Graham relies on seasonal fresh fruit for snacks, and suggests having pre-cut items to make it easy for kids to grab a healthy snack. She also recommends keeping cheese, yogurt, berries, fruit and nuts ready to go. “My kids also really go for flourless muffins [see below for recipe], which I can make when a bunch of bananas is going bad.”

For kids who are away from home for several hours in the evening, portable snacks are a must. Smith likes to encourage trail mix. “It’s tasty and seems like a treat, but it’s made up of whole foods.” If refrigeration is available,
she suggests hummus with veggies or turkey roll-ups made with lettuce and cheese on gluten-free tortillas.
Invest in a cooler bag and ice packs, or even freeze water bottles to keep items cold. Kids who are old enough
can take an active role in selecting and packing their own items, cleaning out their snack bags and preparing ice
packs for the next day.

Bars are another option. “I think a natural nut or dried fruit-filled bar is the best choice,” says Field. “It provides lasting energy for sports and is a great tide-me-over snack.” She recommends Kind or Lärabars. Graham adds, “The only time I use granola bars is when we are on the go. It’s so much easier.” For younger children, she suggests applesauce or other fruit pouches.

Turning challenges into changes

While it may seem like a lot of work to plan meals in advance, the time saved on busy weeknights will be worth it. Browse blogs and Pinterest for new recipe ideas. Get kids involved in meal and snack planning and prep to set a healthy eating example, as well as build skills for their future. Utilize kitchen equipment that can help prepare items that take longer to cook. Don’t be afraid of all convenience foods; many are healthy timesavers. Finally, don’t beat yourself up if even the best plans go awry occasionally. Just return to your planned meals as soon as you can. Even with the increasing demands on family time, eating well should be a priority. Your recipe for successful eating should combine both planning and flexibility.

RECIPES

Slow-Cooked Oats

Courtesy of Lara Field, MS, RD, LDN
Prep: 5 Minutes
Cooking time: 8-10 hours


Ingredients

  • 1 tablespoon coconut oil
  • 4 apples, chopped
  • 2½ cups gluten-free oats
  • 2 cinnamon sticks or ½ teaspoon cinnamon
  • 4 cups unsweetened almond milk
  • ¼ cup brown sugar

Directions

Grease Crock-Pot with coconut oil. Add all ingredients but do not mix. Cook on low for 8-10 hours.

Crock-Pot Meatloaf

Courtesy of Janelle Smith, MS, RDN, “Ask the dietitian” for the Celiac Disease Foundation


Ingredients

  • 2 pounds ground beef, bison or turkey
  • 1 medium onion, finely diced
  • 3 tablespoons gluten-free Worcestershire sauce
  • 1 teaspoon garlic salt
  • 1 teaspoon salt
  • 1 teaspoon pepper
  • 2 eggs, lightly beaten
  • ¾ cup dry gluten-free breadcrumbs
  • ¼ cup ketchup
  • 2 tablespoons brown sugar
  • 1 teaspoon ground mustard
  • ½ teaspoon gluten-free Worcestershire sauce

Directions

Mix ground beef, onion, Worcestershire sauce, garlic salt, salt, pepper, eggs and breadcrumbs well in large bowl. Shape into rectangle or oval that won’t touch the sides of the Crock-Pot. Place in Crock-Pot; cover and cook on low for 6 hours or high for 3 hours.

Whisk ketchup, brown sugar, mustard and Worcestershire sauce in a small bowl; spoon sauce over meatloaf and warm in Crock-Pot for last 15 minutes. Let stand 10 minutes before cutting. Serve with asparagus or broccoli sautéed in olive oil with a dash of garlic salt.

Find more slow cooker recipes at http://celiac.org/slow-cooker-recipes/

Stovetop Mac N’ Cheese With Broccoli (pictured above)

Serves 4-6

Ingredients

  • 12 ounces gluten-free pasta, your favorite kind
  • 4 cups broccoli florets
  • ¼ cup butter
  • 3 tablespoons gluten-free all-purpose flour
  • 1⅓ cups low-fat or whole milk
  • 1 teaspoon salt
  • ½ teaspoon garlic powder (optional)
  • ¼ teaspoon black pepper
  • 3 cups grated cheddar cheese

Directions

Bring a large pot of water to a boil and cook pasta according to package directions. When pasta is 3 minutes from being done, throw the broccoli florets into the pot. Drain pasta and broccoli and let sit in the colander while you make the cheese sauce.

Melt the butter in the pot you cooked the pasta in, over medium heat. Once the butter is melted, add the flour and stir until combined. Add the milk, salt, garlic powder and pepper, and cook until sauce has thickened, 3-5 minutes, stirring regularly.

Once sauce has thickened, add in the cheese and stir until it has melted and a smooth sauce has formed. Add the pasta and broccoli back into the pot and mix until everything is evenly coated with the cheese sauce.

 

MOM TO MOM: Jen’s Favorites!

“The kids’ favorite! Flourless Muffins”

“My go-to basic baking resource.”

“Our favorite pizza crust, and it freezes well. I do the first bake, let it cool, wrap it and freeze it. The day I use it, I top it and bake it an extra few minutes. Good way to do mini individual pizzas, too.”

“For special treats and baking.”

 

Amy Jones is a registered dietitian and celiac disease support group leader in Bellefontaine, Ohio. She is the chair of the Dietitians in Gluten Intolerance Diseases practice group for the Academy of Nutrition and Dietetics. She also serves on the dietetic advisory board of Gluten-Free Living and is a regular contributor to the magazine.

 

 

Packing Lunch With Nutritional Punch

Packing Lunch With Nutritional Punch

Make the grade with healthy options for your child

Another summer has come and gone, and kids are returning to the classroom and to school lunch. Providing a safe gluten-free lunch is always the first priority, but a healthy lunch can also go a long way to providing the good nutrition your child needs every day.

If this is your child’s first school year gluten free, you may be struggling to find healthy replacements for the gluten-containing foods that he or she used to eat. If you are a more experienced gluten-free parent, you may be struggling to come up with fresh new ideas, or you may be letting your older child or teen have more freedom to make their own choices at lunch.

Gluten-free diets are often lacking in some key nutrients. Gluten-free breads, cereals and pastas are typically not enriched with B vitamins, folic acid, thiamine, riboflavin, niacin and iron the way similar gluten-containing foods are. The gluten-free diet is also at risk of being low in fiber as most people get the majority of their fiber from wheat-, rye- and barley-based foods. The diet may also be low in calcium, especially if your child is struggling with lactose intolerance.

Here are some tips to help you think outside the lunch “box” and start the school year off on a healthy note.

Build a lunch

Because weekday mornings can be so busy for many families, coming up with a basic plan for packed lunches can take pressure off parents to come up with ideas at the last minute. If your child is old enough, having a plan can also allow them to participate in assembling lunch.

Amy Macklin, R.D., founder of Gluten Free Roots, a website and gluten-free diet
consulting service, suggests developing a Balanced Lunch Checklist. The checklist builds on the basics of healthy gluten-free lunches: lean protein, fruits, vegetables, gluten-free whole grains and low-fat dairy. Ask your child to write down examples of their favorite foods in all these categories and develop a weekly lunch plan based on the checklist.

brighter-checklist

Simple sandwiches

Many kids are accustomed to having a sandwich at lunch, and the carbohydrates in sandwich bread are a great source of energy. However making a sandwich can be a real challenge if your child has not yet found acceptable gluten-free bread.

Macklin says that finding gluten-free bread that looks as close to regular bread as possible is important. “Because some gluten-free bread slices can be small, try to buy a loaf that is closer to full size, or consider baking your own bread,” she advises. To get extra nutrition, opt for gluten-free enriched breads whenever possible.

If your child isn’t crazy about sandwich bread, be creative with a gluten-free bagel, corn or other gluten-free tortilla or an English muffin. Macklin suggests shaking up sandwiches even more. “Try lettuce leaves or do lunchmeat and cheese roll-ups. You can make lunch with a crunch by adding a carrot, raw green been, red pepper or pickle in the center,” she says.

Protein power

Include a good source of protein in every lunch. Protein helps keep kids full longer, and meat sources of protein can provide needed iron and Vitamin B12. Gluten-free deli meats are easy and appealing, as are boiled eggs, chicken or tuna salads, beans, low-fat cheeses, nut butters such as peanut or almond butter, and fruit smoothies made with Greek yogurt.

Leftovers are also great for lunches, especially if your child has easy access to a microwave.

Sheila Kite says her 17-year-old daughter Olivia, who has had celiac disease since she was 9, took a thermos with steamed shrimp or pasta salad for lunch when she was in elementary school. “My goal was to make Olivia feel like she had a ‘special’ lunch that was even better than what other kids were eating,” Kite says.

Kids’ tastes also mature over time, which has been Sheila’s experience with Olivia. “Now she’ll take a leftover pork chop, roast, gluten-free lasagna or macaroni and cheese,” Kite says. “When she was a freshman, she didn’t feel comfortable using the microwave at school, but now she does.”

Vegetable adventures

Many kids struggle to find vegetables they like. For younger children, standby recipes such as Ants on a Log—celery and peanut butter, topped with raisins—can be made even more nutritious by varying the vegetable and the filler. For example try red pepper strips or a cucumber sliced lengthwise and top it with hummus instead of peanut butter.

Celery filled with chicken or tuna salad can also be a good way to serve more vegetables while also providing protein. Slice carrots, celery, cucumbers and cherry tomatoes and serve them with dips. “There is nothing wrong with using dip in moderation if that helps your child eat more vegetables,” says Macklin.

Older kids may be developing a taste for salads. Try to choose darker leafy green vegetables instead of iceberg lettuce. The darker greens provide more folic acid. If your child prefers iceberg lettuce, even sneaking in a few spinach or romaine leaves is a good place to start.

If salad is the main course for your child’s lunch, be sure to include protein such as chicken, nuts, beans or eggs. Some non-meat forms of protein, chickpeas and beans for example, are good sources of iron and fiber.

Fruity fun

Fruits are a great place to get creative, and most kids will accept a wide variety. Fruit kabobs are fun, easy and can be served with a good source of protein and calcium such as yogurt. Try wrapping a banana in a gluten-free tortilla with peanut butter.

A fruit quesadilla can also be kid-friendly with sliced fruits between two gluten-free tortillas topped with peanut butter or low-fat cream cheese. Add fruit to low fat cottage cheese, or top apple rings with peanut butter and gluten-free oats. If your child isn’t crazy about whole fruits, a fruit smoothie, dried fruit or an 8-ounce cup of 100 percent fruit juice provide variety and nutrition.

Delicious dairy

Dairy products provide needed calcium for growing bones. However some kids with celiac disease may struggle with lactose intolerance at least temporarily. The good news is that most aged cheeses, including cheddar and Swiss, are very low in lactose and may be tolerated very well. Lactose-free milk or fortified soy, almond or coconut milks can help provide necessary calcium and Vitamin D. Non-dairy sources of calcium include dark green leafy vegetables, almonds, tofu and calcium-fortified orange juice.

Occasional treats and snacks

Both Macklin and Kite agree that there is room for occasional treats in a healthy gluten-free lunch. “When my boys have field trips, I might let go of nutrition for the day and let them have fun foods like nachos or a sugary drink,” Macklin says.

She recommends including a small treat in your child’s lunch once or twice a week as part of the Balanced Lunch Checklist. An appropriate treat would be a bite-size candy bar, single-serve bag of chips or a small gluten-free cookie, she says.

It’s also important to keep a stash of snacks in the classroom. “If there is a surprise birthday treat or another special occasion snack, I make sure that Olivia has a snack in her backpack like cookies or fruit snacks so she’s not left out,” Kite says.

Macklin also recommends considering your child’s age when packing lunch. “My boys are getting older now and need more food than they did when they were little,” she says.

If your child has appropriate snacks for the time between school and sports or band practices, he or she won’t get hungry and be tempted to make bad choices from vending machines or fast food.

“Olivia played on a travel volleyball team, and we wanted to make sure she had plenty of safe choices available during a day of games,” says Kite. “We packed fruit, beef jerky, carrots, cheese sticks, and even peanut butter cups as a treat.”

Keeping it safe

Cafeteria tables can be messy places, so Macklin recommends including extra napkins or paper towels in your child’s lunch. “Have them eat off the napkins or paper towels, or even directly out of their lunch box to avoid contamination with crumbs from other kids’ lunches,” she says.

Keep hot foods hot with a thermos. If your child has access to a microwave, teach your child to cover the food with a paper towel during cooking. Kite recommends investing in plenty of cold packs for lunches and snacks. And Macklin notes, “A frozen container of yogurt can also help keep things cold.”

School’s out

Many schools serve lunches fairly early in the day, so kids are usually hungry when they get home. If your child is older and home alone for a bit after school, he or she can take some responsibility for a healthy afterschool snack. Just remember, it doesn’t have to be complicated to be healthy.

“Olivia’s favorite afterschool snacks are fruit or a slice of cold gluten-free pizza,” says Kite. Keep ready-made healthy snacks available, and keep chips and other junk foods out of sight. Pre-cut fruits and vegetables, yogurt, string cheese, trail mix or gluten-free crackers and peanut butter are all healthy grab-and-go options.

The start of the school year is always hectic, and sometimes packing a healthy lunch can be just one more thing on a busy parent’s morning to-do list. But with some pre-planning, input from your child whenever possible and attention to some key nutrients, it can be easy to kick off the healthiest school year yet.

Amy Jones, R.D., leads a celiac disease support group in Bellefontaine, Ohio. She is the chair of the Dietitians in Gluten Intolerance Diseases practice group and writes a recurring column on nutrition for Gluten-Free Living. She is also on the magazine’s Dietetic Advisory Board.