Amy Keller, MS, RD, LD

Be Our Gluten-Free Guest

Be Our Gluten-Free Guest

The holidays are a time of celebrations, food and family, but they can also come with a heaping side of stress, especially for those who are on the gluten-free diet. If it’s your first holiday season since diagnosis, family dinners or work parties can feel particularly intense. While many choose to host holiday meals, which allows for more control, there are occasions where it’s necessary to be a gluten-free guest. How can you enjoy a holiday event without worry, and what strategies can you use to deal with family or friends who just don’t quite understand?

1. Breaking It Down

Traditional holiday celebrations almost always revolve around food, whether that’s a cookie swap party, after-work social or Thanksgiving dinner. The gluten-free diet can force an abrupt change in holiday traditions, and that can be uncomfortable for many. “Holidays are a time when you feel connected to family and friends, and there are a lot of traditions around food,” says Angelia Parsons, LISW, from Light the Way  Christian Counseling in Bellefontaine, Ohio. “When you can’t full participate, it’s easy to feel alienated.” She suggests that family and friends often don’t know how to react to the new normal. “There are certain struggles in life that all of us can identify with, but not everyone has had to make significant changes in their diet.”

Katie Wallace, age 24, from Findlay, Ohio, recalls her first gluten-free Thanksgiving. “It was very confusing. At that time, we were still trying to figure out how to cook gluten free, so I felt like I couldn’t eat anything at all.” Her mom, Karen, recalls feeling a lot of fear. “I made a lot of the food myself that Thanksgiving because we were going to be eating at a relative’s home and I wanted to make sure she was safe. It was so scary at that time.”

Keys to the Ketogenic Diet

Keys to the Ketogenic Diet

Even just a few years ago, a diet comprised primarily of high-fat foods such as butter, cream and bacon would have seemed a recipe for health disaster. But fat, it seems, is no longer public enemy No. 1. The very-low-carbohydrate, high-fat ketogenic diet (“keto” for short) is making waves as the latest celebrity weight loss craze. But does it work? Is it safe? Are there additional benefits to going keto for those who are also eating gluten free?

The genesis of ketogenic

Despite its recent popularity, the ketogenic diet isn’t new. Nearly a hundred years ago, it became a popular treatment for children with epilepsy, a seizure disorder. Before the 1920s, medications for epilepsy were limited and not always effective. Researchers noted that after two to three days of fasting, however, seizure activity decreased. This was thought to be a result of a metabolic change in the brain, from burning carbohydrates to utilizing ketone bodies from fat as the primary fuel.

Because long-term fasting isn’t an option, researchers discovered that depriving the brain of carbohydrates produced many of the same beneficial effects. The first documented ketogenic diet plans were similar to what is used today for seizure control, with as many as 90 percent of calories in the diet coming from fat. The diet fell out of fashion in the late 1930s as a result of the discovery of more effective seizure-control medications, although it has enjoyed a resurgence in recent years for children with epilepsy that doesn’t respond well to medications.

Ketosis

Ketosis is a normal body process that occurs when the body runs out of glucose for energy and switches to burning fat. This process produces ketones. It can occur as a byproduct of starvation, and it can also occur in those with poorly controlled type 1 diabetes. Ketosis can also result from severely limiting carbohydrates (typically less than 30 to 50 grams per day).

As the body transitions into ketosis, a person may experience some side effects. The first, known as the “keto flu,” entails a few days of nausea, fatigue, brain fog, decreased ability to exercise and increased hunger. Fortunately, these symptoms are temporary as the body transitions from burning carbohydrates to burning fat. Bad breath may also occur as blood acetone levels rise, but this usually goes away within a few weeks. People in ketosis may also experience leg cramps, constipation and elevated heart rate.

Weight, cholesterol and blood sugar benefits

Low-carb dieting is not new, with studies demonstrating that it works—at least in the short term—and is generally safe. The ketogenic diet is just the latest version to garner headlines. While studies do show that cutting carbohydrates results in weight loss, the mechanism of action remains controversial. One theory is that the higher protein content of the diet results in feeling more satisfied and therefore less hungry. This leads to taking in fewer calories overall, which leads to weight loss. Other research shows that ketosis produces beneficial effects on the hormones that trigger hunger and being in ketosis may decrease appetite.

Some dietitians even utilize it in their personal and professional practice. Franziska Spritzler, RD, CDE, author of the blog Low Carb Dietitian (lowcarbdietitian.com), began the keto diet a few years ago when her blood sugar began rising after meals. “I was thin and didn’t have any signs of insulin resistance, but my post-meal blood sugars were much higher than they should have been, even though I was eating plenty of fiber,” she says. Spritzler began to wonder if this way of eating would benefit others who struggled with blood sugar levels. “I began research on carb restriction for diabetes, and I was amazed to find many studies that supported this way of eating for blood sugar and weight control,” she says.

Spritzler sees many benefits for her patients. “Appetite is suppressed, and there is the ability to go several hours without eating. This is obviously a major benefit for those who struggle with their weight and are always hungry,” she notes. “It’s also great for busy people who don’t have time to snack and may need to delay or skip meals.”

For those with diabetes, research shows that banishing carbohydrates leads to weight loss and decreased need for diabetes medications. “For people with prediabetes, metabolic syndrome and polycystic ovarian syndrome [PCOS], eating a ketogenic diet can help keep their insulin levels under control,” Spritzler advises. “Plus, I notice that there is increased energy when eating low carb—a benefit for everyone!”

A high-fat diet may bring to mind heart disease, but the research on low-carb diets and cholesterol levels are, for the most part, favorable. Some studies on children who follow the ketogenic diet for epilepsy do show increased levels of bad cholesterol (LDL) and triglycerides, at least for the first few months after starting the plan. However, research in adults has shown that “good” cholesterol levels (HDL) rise and triglycerides decrease when cutting carbohydrates. It is important to note that the majority of studies involving the ketogenic diet are of short duration, so long-term effects are not necessarily known.

In addition to diabetes and weight control, new research may point to a role for the ketogenic diet in the treatment of certain cancers and neurological disorders such as Alzheimer’s disease and Parkinson’s disease.

Keto no-go

Spritzler does note that some people should not attempt a ketogenic diet. “There are certain conditions in which the ketogenic diet is contraindicated,” she advises. “Most of them are genetic abnormalities involving an enzyme deficiency that would have been identified early in life [see sidebar, below].” Spritzler advises those with an existing disease or condition to discuss a ketogenic diet with their doctor before starting one: “Especially patients who have a history of pancreatitis, kidney failure, active gallbladder disease, impaired liver function, impaired fat digestion, gastric bypass surgery or someone who is pregnant or breastfeeding.”

Eating gluten free and keto

The ketogenic diet restricts all grains, so it may be a natural transition for someone who is eating gluten free. Spritzler sees only benefits. “I think it’s an ideal way of eating for those with celiac disease and gluten intolerance because a strict low-carb/high-fat or keto diet doesn’t allow bread, grains or grain-based additives.”

Elana Amsterdam, New York Times-bestselling author and founder of Elana’s Pantry, a website devoted to gluten-free and grain-free recipes, also sees the connection. “If you’re already eating a healthy gluten-free diet that is free of processed foods, the next step would be eliminating grains, plus corn and potatoes, as well as fruit.” Amsterdam has found personal benefits in following the ketogenic diet. “It has helped both my gut and brain function better.”

Amsterdam recommends almond flour for those who are gluten free and eating ketogenic. “It’s a standalone flour that does not require a combination of other flours to ‘enhance’ it. It tastes incredible in baked goods and is high-fat and low-carb, making it the optimal flour for those following a keto diet.”

Giving up all grains and fruit can lead to other issues—in particular, constipation, which is already an issue for so many who need to eat gluten free. Spritzler recommends lower-carb fruits like blackberries and raspberries, as well as avocado, flax and chia seeds, cruciferous vegetables such as broccoli and cauliflower, and almonds. “To avoid constipation, I recommend getting a serving of one of these higher-fiber foods at each meal,” she advises.

Restaurants, already a challenge for those who are gluten free, may require some additional planning to remain on the keto diet. “You have to plan ahead for trips, dining out and celebrations,” says Spritzler. “Always have low-carb foods on hand in case you find yourself surrounded by high-carb foods. For example, low-carb side dishes you can try include cauliflower rice or cauliflower mash.”

Sticking to the plan

Research shows that while many people lose weight when attempting a diet, very few can keep it off.  The keto diet is no different in this regard, and straying from the very strict regimen typically means regaining lost pounds. While research supports low-carb dieting in the short term, most studies in children and adults show that long-term adherence is lacking. Spritzler admits she’s seen mixed results with her clients. “Some people do very well [on the ketogenic diet] and never go back to former comfort foods, especially after they’ve experienced its many positive effects on health,” she says. “But some can’t resist temptation, especially when they live with family members who don’t follow the diet. Others get bored with low-carb options, or they hit a weight-loss plateau that occurs with all diets.”

Spritzler urges her patients to stay positive, focusing on what they can have instead of what they can’t. “I encourage my patients to make a list of the reasons that are important to them to stay keto, and review it frequently.” Amsterdam agrees: “If you try it for a month and see that you feel better, then staying on the diet isn’t as challenging because the gains are so high. Everything in life is a trade-off.”

Genetic conditions where the ketogenic diet would be contraindicated

  • Carnitine deficiency (primary)
  • Carnitine palmitoyltransferase (CPT) I or II deficiency
  • Carnitine translocase deficiency
  • Beta-oxidation defects
  • Mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase (mHMGS) deficiency
  • Medium-chain acyl-CoA dehydrogenase deficiency (MCAD)
  • Long-chain acyl dehydrogenase deficiency (LCAD)
  • Short-chain acyl-CoA dehydrogenase deficiency (SCAD)
  • Long-chain 3-hydroxyacyl-CoA deficiency
  • Medium-chain 3-hydroxyacyl-CoA deficiency
  • Pyruvate carboxylase deficiency
  • Porphyria

Source: Franziska Sprtizler, RD, CDE

Making the Gluten-Free Diet Work for You

Making the Gluten-Free Diet Work for You

Amy Keller, MS, RD, LD, is a dietitian and celiac support group leader from Bellefontaine, Ohio.

 

 

 
Q: I was diagnosed with celiac 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 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 treats both diabetes and celiac. He or she can help you plan the most balanced, varied and enjoyable diet that meets the needs of both conditions.

Selecting foods appropriate for both diabetes and celiac 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 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 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.

Q: I was diagnosed with celiac 20 years ago and have done very well with the gluten-free diet. Recently, I decided that I’d like to also become a vegetarian. I’ve read up on it, and it seems like a healthy way to eat, especially in light of my family history of heart disease. What options do I have to get enough protein and iron without meat?

A: People choose to follow a vegetarian diet for many reasons, including health. There are many different types of vegetarians. Some continue to eat dairy and eggs (lacto-ovo vegetarian), while others eat no animal products at all (vegan). Depending on which type of vegetarian you plan to become, your nutrition needs will vary.

To get enough iron in a vegetarian gluten-free diet, try gluten-free whole grains like quinoa and buckwheat, dark leafy greens, beans and lentils, soybeans and soy nuts, and cornmeal or corn flour. Some gluten-free cereals, breads and pastas are now enriched with iron. Try to choose the enriched varieties whenever possible. You should pair foods that are high in iron with foods high in vitamin C, such as oranges and tomatoes, to help enhance the absorption of iron.

Getting enough protein is easier if you consume eggs and dairy, but even as a vegan, it’s possible with a little planning. Good sources of protein in a vegan diet include gluten-free whole grains, beans, lentils, and nuts and nut butters.

One word of caution—if you choose convenient vegetarian items like veggie burgers, veggie sausage, veggie bacon and meatless hot dogs, be sure to read the labels carefully because many are not gluten free.

 

When You’re Diagnosed With Celiac After 65

When You’re Diagnosed With Celiac After 65

Life after 65 can be full of changes—retirement, downsizing a home, grandchildren and, for some, newly diagnosed celiac. What was once thought to be a condition diagnosed primarily in children is now widely accepted as one that doesn’t discriminate based on age. In 1960, just 4 percent of adults diagnosed with celiac were over age 60. Newer research finds between 19 and 34 percent of adults diagnosed with celiac after 65, depending on the study. For some, it is a result of years or even decades of misdiagnosis. For others, celiac occurs without warning, even after seemingly lifelong gluten tolerance.

Diagnosis dilemmas

Getting the right diagnosis can be challenging for any patient, but for those over 65, physicians may not immediately think of celiac when evaluating a patient’s symptoms. For Betty Zerkle of St. Paris, Ohio, it was several years before her physicians figured out the mystery. “In 1998, I started to have problems,” she recalls. “I had diarrhea I couldn’t control; even with medication, it kept getting worse. I was tired and weak. My doctor kept treating me for reflux disease and irritable bowel syndrome [IBS].” It took a diagnosis with another autoimmune disease for her doctor to run tests for celiac—“I was finally diagnosed in 2005 at age 72.”

Symptoms of celiac often overlap with those of other conditions, which likely delays the diagnosis for many people. Older adults with celiac may also present with fewer classic gastrointestinal (GI) issues, instead experiencing other symptoms like anemia or fatigue. Anemia, which is very common in those with celiac, can also be a marker of more serious diseases such as colon cancer. This may lead to extensive testing for other conditions before a physician even considers celiac.

The tide may be changing, however. Lori Welstead, registered dietitian at the University of Chicago Celiac Disease Center, says she is seeing more patients diagnosed after retirement. “It’s really difficult to put a number or percentage on it, but I would say about 5 percent of my newly diagnosed patients are over the age of 65.”

For Vicki New of Indianapolis, Indiana, weight loss and diarrhea were her main symptoms. “My doctor was great, even though he admitted he didn’t know a lot about celiac disease. He knew how to get a diagnosis at least,” she recalls. Welstead agrees: “Within our celiac center, our physicians are more conscious about celiac disease in older patients, especially those who have not only GI symptoms and weight loss, but iron deficiency.”

Facing challenges

A life-changing diet is difficult to adopt at any age but may be particularly difficult for an older adult. For Zerkle, label reading was difficult. “Back then, I had to write letters to a lot of manufacturers to see what was safe. At the time I was diagnosed, I couldn’t buy gluten-free foods at the regular grocery store. I had to go to the health food store,” she says. “There was so much that I was afraid to eat.” Zerkle wrote letters to celiac associations for information and found a cookbook that was particularly helpful (see sidebar for Betty’s Best Tip).

For New, one challenge was sharing a divided house with her husband, Jim. “When I cook, it’s all gluten free. He has his things, like bagels and English muffins, but I’m very conscientious about cross-contamination.” She jokes, “It’s like the television show Laverne & Shirley. I write a ‘V’ on everything that is mine.” She also thinks the gluten-free label has been very helpful and that the gluten-free diet has made her a more adventurous cook. “I found a gluten-free cookbook this year for our holiday meals. I made my muffins and cornbread,” she says. “I bought a lot of ingredients from the baking area of the grocery store that I had never purchased before. It was a lot of fun, and nobody knew the difference.”

For both New and Zerkle, eating in restaurants has taken some adjustment. “I have a few restaurants that I relish,” says New, “but most restaurants have a gluten-free menu, and I call ahead and talk to them. I’ve never felt singled out in any way.” Zerkle experienced changes in her social life. “When I first got this, I didn’t tell my church friends. I just told them I couldn’t eat wheat,” she recalls. “I don’t eat out as much as other people do, but when I do, I take precautions like bringing my own salad dressing.”

No bones about it

Those with celiac may also have deficiencies in calcium and vitamin D levels. These shortfalls may be made worse by lactose intolerance, common in newly diagnosed patients. The risk of osteoporosis, a low bone mass that can lead to fractures, can be high. “I had a bone scan and was found to have osteopenia [softening of the bone] at the time I was diagnosed,” Zerkle says. “I’m finally seeing improvement now in my bone scan levels. The last one I had done, my bone density is back up to normal.” Those with lactose intolerance may still be able to tolerate lower-lactose sources of dairy, such as cheese and yogurt. Non-dairy sources of calcium include green leafy vegetables, almonds, sardines, fortified soy or almond milk, and fortified orange juice. Vitamin D, which helps the body absorb calcium, is synthesized from exposure to sunlight, and foods such as milk, salmon, sardines, shrimp and cod.

Welstead warns her patients of nutritional deficiencies associated with celiac. “Many of my patients have osteopenia or osteoporosis. They may have low vitamin D and B12 levels, which is not only due to malabsorption but also age,” she states. “We correct them with supplements and do a bone mineral density test to determine their baseline level. We also put them all on a gluten-free multivitamin with minerals and added supplements as needed.”

Nutritional deficiencies can be made worse by poor appetite at meals, a common problem among older adults. This is particularly a problem with those who eat alone frequently. Cooking a balanced meal for one person may seem like too much trouble, leading to a lack of variety and nutrients. For older adults with celiac disease, including lots of “nutrient-dense” foods, which provide a lot of nutrition per calorie, is important. Good examples of these foods include lean protein, gluten-free whole grains, fruits and vegetables, and dairy products. Less-nutrient-dense foods include gluten-free cakes and cookies, pretzels and crackers. These items are higher in calories, fat and sodium, but are not particularly nutritious. They can be used to round out a meal but they should not constitute the mainstay. For those who have trouble maintaining their weight, a high-calorie nutritional supplement shake may be appropriate. The vast majority of these products, like Boost and Ensure, are gluten and lactose free.

Constipation is a common problem in older adults, and may particularly affect those on the gluten-free diet. Eliminating wheat products, especially bran cereal, may cause a significant decrease in dietary fiber. “Before I found bread and crackers that I liked, I was constipated and needed more fiber,” says Zerkle. Healthy examples of foods high in fiber include gluten-free whole grains, such as quinoa, sorghum, millet and buckwheat, as well as fruits and vegetables. Older adults may also not drink enough fluid, which may make constipation worse. It is important to consume adequate fluid, which helps high-fiber foods move through the digestive system. Water, fruit juice, tea, coffee and soups are all good sources.

Teamwork is key

Those with celiac at any age need not only strong support from their physician but also from a registered dietitian nutritionist (RDN), pharmacist and, ideally, a support group. Welstead finds that she doesn’t have to make a lot of adjustments in the way she instructs her older patients. “I always go over their typical diet before they started the gluten-free diet, then I come up with specific recommendations to substitute their favorite foods and commonly consumed foods,” she states. “I always encourage them to bring a family member or friend if they live alone that can be an extra set of ears, as the first visit can be a lot of information to process at once.” For those balancing a new gluten-free diet with other dietary restrictions, such as a low-salt diet for heart disease, assistance from a dietitian is an absolute must.

Even though finding gluten in a medication is rare, it does occasionally happen. Older adults may take more prescription medications than younger patients, so a current list should be reviewed. Welstead says she will help her patients review their list with the assistance of the website Gluten Free Drugs (glutenfreedrugs.com), which is run by Steve Plogsted, a pharmacist, expert on gluten in medications and regular contributor to Gluten-Free Living’s Office Hours column.

New says her celiac support group and dietitian were a tremendous help. “There are a lot of fear and anxieties with celiac disease. You have to have a support group—people to talk to—who can help you with the situations that you need help with.”

Being patient

It may take more time for an older adult to see improvements in their symptoms and celiac antibodies. Welstead urges patience. “Antibody levels do seem to take a bit longer to drop in these patients, likely due to their age,” she says. “In some of these patients, they are coming in with antibody levels that are exceedingly high. We can’t expect them to drop to normal in three to six months, but this holds true for younger patients as well.”

Symptom improvement may also take time. “I certainly do feel so much better, even though it took a little while,” says Zerkle. “Don’t get too frustrated if you don’t feel better right away. Each year, I feel a bit better than the last.”

New agrees: “I absolutely do feel better. I don’t relish the weight I gained back, but there are positives and negatives to everything!”

Attitude is everything

Welstead states many of her patients are overwhelmed at the first visit, and for those without gastrointestinal symptoms, they may even be reluctant to start a strict gluten-free diet. But she has also seen plenty of successes. “Two patients that I saw in the past year were over 70 years old, newly diagnosed. One developed spreadsheets of his favorite gluten-free flour blends and was baking up all sorts of healthy gluten-free bread,” she recalls. “The other was a runner who was having trouble with energy as well as unintended weight loss before diagnosis. Now that he is on the gluten-free diet, he is back to running and has gained weight back. It was inspiring to see them adjust so well to the diet despite their age.”

New agrees that age doesn’t play much of a role in how she handles the gluten-free diet. “It’s good that I know that I have this so my grandsons can be tested on a regular basis,” she says. “It’s a life-changing event, not something that you can think about occasionally or be nonchalant with. But really, I don’t feel that being over 65 is any different than being 55 or 50. It’s not about the age; it’s about how you manage.”

 

Gluten-Free College Students Living Off Campus

Gluten-Free College Students Living Off Campus

While many college students live in dorms and other on-campus housing, others opt to move into their first apartments. For gluten-free college students living off campus, there may be excitement about having a larger variety of foods available than they may have had in campus cafeterias, dining halls and other eateries. However, an apartment living situation presents its own set of challenges, such as sharing a kitchen with roommates, cooking balanced and easy meals, and dealing with social events such as late-night pizza or fast food. Living on their own teaches life lessons that can help gluten-free college students make a successful transition to being gluten-free adults.

Getting a Good Start

A student who has managed celiac for many years will likely face different challenges than one diagnosed more recently. “A lot of how a student handles living on their own for the first time depends on where they are in their journey with celiac disease,” notes Beckee Moreland, Director of GREAT Kitchens for Beyond Celiac (see sidebar, below). “Many students aren’t diagnosed with celiac disease until they arrive on campus. What I’ve found is that those diagnosed in college often don’t get the education on the diet that they need. Many times, they may just be taking information off the internet.” Moreland strongly encourages newly diagnosed students to work with a registered dietitian nutritionist (RDN) on campus. “Without that solid education on the [celiac] disease diet, it’s not going to start off well.”

GREAT Kitchens descriptionFor Tracie Steinke, RD, LD, CDE, apartment life seems like an advantage for those on the gluten-free diet. “I was diagnosed right after college, but I think living in an apartment would be much easier than dealing with food service,” she notes. “When cooking for yourself, you have more control and variety than what you find in the dining halls.”

For Steinke, achieving an organized and proper setup was a key to her success. “I had already accumulated some kitchen items, but when I was diagnosed with celiac disease, I had to buy safe, new cooking utensils, cutting boards, colanders and more,” she recalls. “It was a good and necessary investment, but at the time it felt overwhelming.”

Learning to manage time to shop and cook is an important skill for any student, but it’s particularly essential for someone on the gluten-free diet. In many cases, this may be the first time the student has prepared his or her meals, which can be daunting. “I love to cook,” says Steinke, “but I imagine that many students feel overwhelmed by having to shop, cook and prepare healthy meals, and doing so while on a college-student budget!”

Sharing a Kitchen

Most students have experienced living with roommates while on campus, but moving into an apartment with other people brings the challenge of a shared kitchen space. Preventing cross-contamination with gluten requires a lot of communication and planning. “Moving into an apartment is often the first time that students have to communicate their needs and educate their roommates,” says Rachel Begun, MS, RDN, nutrition advocate and special diets expert. “Carefully explain the health implications of coming into contact with even the smallest amount of gluten. Once people understand the severity, they are more likely to play an active role in helping you to avoid it.”

Moreland agrees that communication is key. “Be as open as possible about the importance of safety and your concern,” she says. “Acknowledge that even though taking care of your health is your responsibility, let your roommates know that you need their help.” Moreland recommends preparing a meal together, which can help a roommate get an idea of where those cross-contamination hot spots are most likely to occur. “Sometimes just getting into the kitchen together is a good first step. Learning hands-on, roommates can see what it is that you have to do to keep yourself safe.”

While a few items may be shared safely, others should remain separate. “I had a very understanding roommate who was thankfully very conscious of celiac disease, but we decided that it was probably safest to purchase our own food, rather than sharing items, to avoid cross-contamination from things like butter, peanut butter, jelly and more,” says Steinke.

Having a separate area in the kitchen to prepare food, if possible, can also help. “If there is room in the kitchen, create a gluten-free station,” advises Moreland. “This could look a lot of different ways, but the best scenario would be a section of the kitchen that has a counter top, drawer and cabinets above and below.” Storing many separate items, however, can make an already-cramped kitchen feel even smaller, so sometimes it’s necessary to get creative. “If it’s not possible to have that much individual space, try to keep a section of the counter top as a safe zone.” If a reserved counter top isn’t possible, Moreland recommends purchasing a color-coded cutting board that can immediately cover a shared counter space, or consider utilizing other physical barriers, such as foil or parchment paper.

Even with the best planning, things can quickly go awry if one has a less-than-understanding roommate. This can require sometimes difficult conversations. “If at all possible, try to have these discussions before you move in,” advises Moreland. “Select a roommate very carefully. I find it’s best to try and find ones that have family members or friends who also have food allergies or celiac disease.” Moreland also recommends continued communication throughout the year. “Food and kitchen space aren’t the only issues between roommates, so try and schedule weekly or monthly roommate chats to discuss the best way to manage the apartment and to live together.” Steinke encourages roommates to be patient with each other. “There is a huge learning curve for people who are unfamiliar with the idea and seriousness of cross-contact, so teach as much as you can and remind them often.”

Let’s Get Cooking!

For some college students, an apartment presents their first opportunity to cook their meals. What they cook, however, varies significantly based on their level of comfort in the kitchen. If a student is new to cooking, start simple, advises Moreland. “Find recipes with less than five ingredients and less than five steps. Learn to roast a chicken—it can be the basis of so many meals.”

Steinke cooks with her budget in mind, by focusing on naturally gluten-free foods. “A dinner might include roasted fresh vegetables or a frozen bag that I can quickly steam in the microwave, a grain such as rice, potatoes or quinoa, and a protein such as meat, tofu or eggs.” (See below for quick and easy gluten-free meal ideas.) Moreland suggests baked potatoes with toppings and Greek yogurt in place of sour cream and using eggs frequently because of their nutritional content, affordability and versatility in many dishes.

Processed gluten-free foods, like macaroni and cheese or frozen pizza, may be a staple for some students. Make these choices a little healthier with some ingredient substitutions and additions. Begun recommends balancing all meals with fruits and vegetables. “Serve a side salad with the gluten-free mac and cheese or pizza, or a piece of fruit with the gluten-free frozen waffle.” Other easy ingredient switches include Greek yogurt for sour cream or dips, adding veggies to gluten-free pizza and reducing the amount of butter in mac and cheese.

gluten-free college student food tips

Equip Yourself for Success

Of course, healthy gluten-free meal preparation begins with having the right equipment available. Even with limited space, there are some kitchen “must haves” that can make safe meal preparation much easier. A dedicated toaster or toaster oven, colander, cutting board, cooking utensils such as mixing spoons, a whisk and slotted spoons are all items that can be difficult to clean and should be kept separate. The dishwasher is adequate for cleaning dishes, silverware, pots and pans. Dish towels should also be kept separate, or use paper towels.

For the more adventurous cook, other equipment may come in handy. “I’m a big fan of the Instapot,” says Moreland. “It’s kind of pricey but is a good Christmas or graduation gift. It can sauté and double as a rice cooker and pressure cooker.”

Late-night Noshing

While beer and pizza nights or midnight fast-food runs are traditions for most college students, they can be problematic for those on a special diet. “This is so hard because they are almost always spontaneous,” says Moreland. “I recommend having a plan and then a backup plan. Look for places you can go to and suggest them.” Socializing while on the gluten-free diet is a challenge for someone of any age, but particularly in college. “When I was first diagnosed, I just avoided these situations,” recalls Steinke. “It’s tough to be in settings that revolve around food and not be able to participate.”

While such situations can be difficult to deal with in the moment, it’s helpful to look at the big picture. “Rather than missing out, I decided it was worth it to go with a positive attitude and just enjoy the company of friends,” says Steinke. “I always try to eat beforehand, so I’m not starving watching other people eat, and I always carry a snack in my purse just in case.”

These situations can be educational for roommates and friends as well, says Moreland. “If your friends value your friendship and see you’re not included, maybe next time they’ll go to a place where you can eat safely.” Steinke echoes the sentiment. “While I don’t expect people to accommodate or cater to me, my friends are very understanding. If there is a restaurant where I can get at least one safe item, everyone is more than willing to go there instead.”

Moving into a first apartment is a learning experience in many ways. Success depends on planning, from the selection of roommates and preparation of a safe kitchen space to budget shopping and dealing with unexpected social events. All these experiences will prepare young adults to manage being grown up gluten free.

Amy Keller is a registered dietitian and celiac support group leader in 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.

Find more information and advice about growing up gluten free in our Kids’ Section>>>

Gluten-Free School Survival Tips

Gluten-Free School Survival Tips

 

Amy Keller, MS, RD, LD,
is a dietitian and celiac
support leader from
Bellefontaine, Ohio.

 

Q: I started making breakfast before school, but I always feel hungry by the start of third period. I usually eat cereal if i’m at home, or a gluten-free granola bar and orange juice on the bus. Lunch isn’t until 1 p.m., so by then I’m starving. Do you have suggestions on how I can make breakfast a little more filling?

A: First off, I think it’s great that you are making your breakfast. This important skill will serve you well in the future. So many kids skip breakfast, and that affects how well they perform in school. Cereal and granola bars are great starters for breakfast, but on their own, they do not provide the most balanced meal. Choose a protein with your breakfast every morning—eggs, string cheese or Greek yogurt. Enjoy cereal, gluten-free granola, toast or a bagel as your grain of choice. Top it all off with a piece of fruit instead of juice. You’ll stay fuller much longer.

If you can snack between classes, a gluten-free protein or snack bar, a handful of nuts or a piece of fruit can help keep the hunger pangs at bay until it’s time for lunch. Just be sure whatever snack you choose doesn’t need to be refrigerated.

Q:  My 14-year-old son was diagnosed with celiac at the end of last school year. We got a pretty good handle on the diet at home this summer, but now he’s playing freshman football. I know he needs to eat before games, but the pregame meal of pasta and bread isn’t going to work. How can I make sure he gets to eat safely?

A: Most kids don’t want to miss out on the camaraderie of the pregame meal, but it can be tricky. If the meal is prepared by a football parents’ organization, you might consider talking with them first, or volunteer with the group and assist with menu planning. You might discover that you are not the only parent with a player who requires a special diet. Is pasta on the menu every time because that’s what the players prefer, or would they be willing to mix it up occasionally with rice- or potato-based dishes? One football team I recently worked with did a make-your-own-burrito-bowl pregame meal, while another had a baked potato bar. Are there other naturally gluten-free items available that your son can enjoy, like fruit or salad?

Athletes need good sources of carbohydrates in their pregame meals. If you are packing food, a generous portion of gluten-free pasta, white or brown rice, or potatoes can provide that needed energy. High-fiber foods and spicy foods may not be tolerated. High-fat foods tend to sit in the stomach for a long time, so they should also be avoided right before the game. If your son has a particularly sensitive stomach, it may be better to avoid solid foods right before a game, opting instead for a healthy smoothie or shake.

Make sure your son drinks plenty of fluid before, during, and after games and practice, because dehydration can cause gastrointestinal upset, too. Choose water and sports drinks instead of juice or soda. Most importantly, try out pregame foods on training days—never try a new food or beverage on game day.

Q: My daughter is in fourth grade. The teacher likes to give out candy as rewards for good behavior and during math games. I’m nervous because most likely not all the candy choices are going to be safe. How can I approach this with her teacher? My daughter is already shy and worried about this drawing extra attention.

A: If you feel comfortable discussing it informally with the teacher, that’s a good place to start. However, you might want to consider a 504 Plan for your child. This formal document assures that there will be consistency in all classrooms and with all teachers who work with your child. Visit understood.org for more information on 504 Plans and how one might help your daughter. All of the major celiac organizations include information about how to implement a 504 Plan on their websites as well.

You can provide a bag of safe gluten-free candy, labeled with your daughter’s name, that her teacher could discreetly keep. This is also a good tip for birthday treats. While many schools now require prepackaged treats with clear ingredient lists or have eliminated sweet birthday treats altogether, it’s still a good idea to supply an emergency stash of small, prepackaged bags of cookies or other gluten-free goodies so your child doesn’t feel left out in the case of a surprise celebration. Just be sure to note the expiration date on the packages of the items you leave in the classroom so that you can can refresh them as needed.

 

For more of Amy Keller’s advice on following and thriving on the gluten-free diet, check out these Q&As:

To read resident pharmacy expert Steve Plogsted’s advice and information on gluten-free medications, check out these Q&As: