Mary Beth Schweigert

Slow-Cooked Bone Broth May Offer Health, Healing Benefits

Slow-Cooked Bone Broth May Offer Health, Healing Benefits

Jenna Drew describes her childhood as a “revolving door” of chronic illness. Whether she was sick with bronchitis, a fever, migraine, stomach ailment or just plain tired, one thing always made her feel better: chicken soup.

Drew, a certified fitness coach and personal chef in New York City, was diagnosed with celiac disease as a young adult. Now one of her go-to foods—both for herself and her clients—is bone broth, a souped-up version of the piping hot cup of comfort that never failed to soothe her as a child.

Bone broth is the nutrient-rich liquid that results from slow-cooking or simmering animal bones in water for up to 24 to 48 hours. A growing number of fans, including chefs, nutritionists and professional athletes, say bone broth contains minerals and protein that promote digestive health, bolster the immune system and strengthen joints, among other benefits. It’s also naturally gluten free.

“Typically during the fall and winter months, I have bone broth on a daily basis,” Drew says. “I’ve noticed healthier skin, tougher nails, less overall inflammation and reduced leaky gut symptoms, like brain fog.”

Drew also happens to love bone broth’s distinctive rich taste.

As cold and flu season approaches, Drew isn’t the only believer in bone broth’s ability to heal. Melinda Dennis, R.D., nutrition coordinator of the Celiac Center, Beth Israel Deaconess Medical Center, Boston, features bone broth prominently at her Delete the Wheat gluten-free wellness retreats. Consuming bone broth is a nourishing way to offer a nutrient-packed food source to the small intestine and the body, she says.

“Bone broth offers many minerals—calcium, phosphorus, magnesium, silicon and sulfur and trace minerals in a way the body can easily use,” Dennis says. “It is also high in glycine, a protein, which is very soothing to the brain.”

Easy and popular

Home cooks can assemble bone broth quickly in a slow cooker with just a few basic ingredients: the animal carcass, water, vegetables and seasonings. The broth can serve as a base for soups, stews and gravies, but Drew and many other broth believers sip steaming mugs unadorned, as a meal, snack or a.m. eye-opener.

Bone broth has been called “the new coffee” by Epicurious.com. Restaurants in larger metropolitan areas sell the hearty hot beverage to go, much like a standard cup of Joe. Fans who line up at Brodo’s New York City takeout window pay up to $9 for a cup of bone broth, which the restaurant bills as “the world’s first comfort food.” Brodo notes that all of its broths are gluten free. Other companies, including The Brothery in California—the lucky owner of the domain name bonebroth.com—deliver bone broth straight to regular customers’ doors.

Bone broth’s high-profile fans reportedly range from NFL quarterbacks to mixed martial arts fighters. ESPN.com reports that Los Angeles Lakers star Kobe Bryant drinks bone broth every day to increase energy and reduce inflammation.

The new kale?Slow-Cooked Bone Broth Gains in Popularity

Kaayla T. Daniel, co-author of Nourishing Broth: An Old-Fashioned Remedy for the Modern World, says bone broth isn’t just a fad. Daniel, who has a doctorate in nutritional sciences and certification from the International and American Associations of Clinical Nutritionists, says people all over the world have used similar techniques and ingredients to make broth literally since the Stone Age. The use of soups and “meat teas” for health and healing also is universal, she says, with historical figures from Hippocrates to Florence Nightingale espousing broth’s healing powers.

“The news media is calling broth ‘the new kale’ and ‘the new juice,’ but…if it’s a fad, it’s the oldest ‘fad’ ever,” Daniel says. “[Broth] went out of fashion for a while, with the advent of processed, packaged and fast foods. [But] it’s always been valued by gourmet cooks. Julia Child, for example, always kept her stockpot going.”

Now broth is back, in a big way. Daniel chalks up bone broth’s current moment in the sun to the “real food,” “whole food” and “slow food” movements, as well as “nose-to-tail eating,” popularized by Fergus Henderson in London.  Bone broth is a staple of the popular Paleo diet, whose creators consider it a “nutrient-rich superfood.”

“People who go gluten free because of celiac disease or gluten sensitivity are almost always in need of gut healing,” Daniel says. “I can’t think of any food more healing to the gut than old-fashioned bone broth.”

Depending on the circumstances, Dennis says she might recommend that people with celiac disease start with a few tablespoons of bone broth, increasing as tolerated to several cups per day. Like anything else, bone broth is best consumed in moderation, she adds.

“When one of my patients is ill—losing weight, not tolerating many foods and finding it difficult to stomach solid foods in general—I may suggest the short-term use of bone broth…to help them over the rough patch,” Dennis says. “In some cases, it is one of the few foods someone can tolerate, and they build up their diet from there with well-cooked rice, vegetables and small amounts of protein.”

All it’s cooked up to be?

Amy Jones, R.D., who chairs the Dietitians in Gluten Intolerance Diseases practice group for the Academy of Nutrition and Dietetics, generally takes a more cautious approach to bone broth.

“There’s no hard evidence that it helps leaky gut or inflammation,” she says. “There just isn’t a lot of research behind it.”

A moderate amount of bone broth is probably safe, she says, but she’s uncomfortable recommending it to clients without more information on the nutritional benefits and lead content.

On the positive side, Jones says athletes in particular may benefit from the extra hydration, protein and small amount of sodium in bone broth. It’s also a nutritionally superior choice when compared to a high-calorie beverage, such as a full-fat latte. Making bone broth brings people back into the kitchen, which is always a good thing, she says, and adding vegetables can pump up its nutritional value.

“Bone broth is certainly a gluten-free choice, and we always want more of those,” Jones says. “If a person with celiac disease asked me, I would say it’s probably not going to hurt you. …But don’t expect it to cure your immune system or heal your knee pain.”

Tips for making bone broth

Bone broth isn’t difficult to make. It just takes time.

Here’s some advice to help simplify broth-making.

Make it yourself. Store-bought broths usually contain higher amounts of sodium and other added ingredients. Plus, most people agree that homemade broth tastes better. 

Follow a recipe. Making bone broth takes hours, so don’t wing it. To reap the most nutritional benefits, be sure to do it right.

Go natural. For the “cleanest” broth, start with organic vegetables and meat and bones from animals that are grass-fed and raised without antibiotics and hormones.

Take a hands-off approach. Whip up a batch of bone broth with a slow cooker. Just add a few basic ingredients, turn it on and you’re done.

Skim, strain and chill. Skim off the impurities that rise to the surface after the broth boils. Strain the finished broth, chill and remove excess fat from the top.

Think ahead. Save time by making one big batch of bone broth. Freeze small portions in ice-cube trays for later use.

Use the right proportions. If your broth lacks flavor, you may have added too few bones and too much water.

Three Cheers for Gluten-Free Beer

Three Cheers for Gluten-Free Beer

As market expands, choices grow and gluten-removed brews join the party 

When the founders of Bard’s Tale Beer Co. were diagnosed with celiac disease, gluten-free beer didn’t exist. Determined not to miss the fun of enjoying a beer with family and friends, they decided to create their own gluten-free brew.

After much experimentation, the duo discovered a particular cultivar of sorghum could serve as an ideal stand-in for the gluten-containing barley in traditional beer. Their gluten-free brew tasted so good, they shared it with other beer lovers who have celiac disease.

gluten-free beerNothing beats a cold beer on a hot summer day. But not too long ago, beer lovers with celiac disease or gluten sensitivity faced a nearly impossible choice: go without their favorite brew or risk getting sick. Gluten-free beer debuted as part of a niche market offered by a handful of breweries. Now beer lovers who follow a gluten-free diet have a rapidly growing number of choices.

“The market [for gluten-free beer] has grown with the increased diagnosis of celiac disease and the gluten-free diet trend for individuals without celiac disease or other gluten sensitivity,” Bard’s president and CEO Brian Kovalchuk said. “With that growth came a number of new brewers to satisfy consumer demand.”

Like the two friends behind Bard’s, many brewers of gluten-free beer have a personal connection to celiac disease. The Utica, New York, company has grown from its humble homebrew origins to now distribute its Bard’s Gold in 36 states and five Canadian provinces.

In the past few years, new gluten-free breweries have opened, and existing brewers have expanded their product offerings and distribution areas. Others have introduced beers made with barley and other traditional ingredients that are processed to remove gluten. The brewers of these “gluten-removed” beers say they offer a great option for people who have milder gluten sensitivity or choose to follow a gluten-free diet.

The U.S. Food and Drug Administration (FDA) regulates beer made with gluten-free ingredients and requires anything labeled “gluten free” to contain less than 20 ppm of gluten. The Alcohol and Tobacco Tax and Trade Bureau (TTB), which regulates beer made with barley and hops, does not permit gluten-removed beer to be labeled as “gluten free.” The label may state that the beer was processed to remove gluten, but it also must note the possibility that trace amounts of gluten remain.

Lori Welstead, M.S., R.D., L.D.N., Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, said the gluten-removed beers that recently have flooded the market taste very similar to traditional beers and often are preferred over gluten-free brews. However, she said, experts generally do not consider gluten-removed beers to be safe for people with celiac disease.

“Some individuals with celiac disease may react to the gluten in gluten-removed beers,” Welstead said. “Of course, some patients swear they can tolerate these beers, but each patient is different, and some do not have overt symptoms upon ingestion of gluten.”

New Planet Beer Co., a Boulder, Colorado, maker of gluten-free beers since 2009, introduced two gluten-removed brews earlier this year. President and general manager Pedro Gonzalez said there is room in the market for both gluten-free and gluten-removed beers. However, he said unclear and sometimes misleading marketing practices have contributed to confusion among consumers, who may not recognize or understand the difference between the two types of beer.

“More and more consumers are figuring out what is safe for them to drink,” Gonzalez said. “Hopefully the market will recognize both segments of the category—gluten free and gluten reduced—and hopefully breweries are ethical and promote their products correctly.”

Gluten-free breweries expand products, distribution

Ground Breaker Brewery and Gastropub, a 100% gluten-free facility in Portland, Oregon, offers a growing assortment of brews including Pale Ale, Dark Ale, IPA No. 5 and Ollalie Ale, as well as seasonal beers.

“When we started [in 2011], we were the only dedicated gluten-free craft brewery in the United States,” said James Neumeister, Ground Breaker’s head of research and development. “While we still are the only dedicated gluten-free brewpub, there now are several dedicated gluten-free breweries offering a wide variety of styles.”

Until recently, Ground Breaker’s beers were available primarily in the Northwest. Earlier this year, the brewery announced distribution in Vermont and Maine. Ground Breaker has future expansion plans in New England and other parts of the country, Neumeister said, but details are unavailable at this time. Ground Breaker products also are available through Bring on the Beer, which can ship to most U.S. states.

“Distribution has always been challenging for us outside of the Northwest,” he said. “Some distributors do not believe that people are looking for gluten-free beer, let alone the variety that we provide. In many cases, they think that a few gluten-free macro lagers and ciders should be all the gluten-free community needs.”

While the number of smaller gluten-free breweries clearly has grown, beer giants haven’t ignored the trend. Introduced in 2006, Anheuser-Busch Inc.’s Redbridge was the first nationally available gluten-free beer and remains among the most visible. Anheuser-Busch worked with Beyond Celiac, then known as the National Foundation for Celiac Awareness, to develop Redbridge, which is made without wheat or barley.

MillerCoors’ Coors Peak Copper Lager and the new Coors Peak Golden Lager are made with all-natural ingredients that do not contain gluten or GMOs, including brown rice malt, brown rice, pure pea protein, caramel and hops. Both brews, which are certified gluten-free by the Gluten-Free Certification Organization, currently are available in the Seattle and Portland metropolitan areas.

Other MillerCoors products are brewed at the same facility, but the company says on its website it takes “great care to isolate production of Coors Peak to ensure it is 100% naturally gluten free.” The facility is certified by the Gluten Intolerance Group, and the beers are tested by a third-party laboratory.

The expansion trend isn’t universal. Delaware’s Dogfish Head Brewery discontinued Tweason’ale, its only gluten-free beer, earlier this year. Tweason’ale, which was made with strawberries, honey and sorghum, first hit shelves in 2012 and was distributed in about 30 states.

“We wish it was a better seller, but it wasn’t to be,” Dogfish Head said in response to Gluten-Free Living’s inquiry.

‘Gluten-removed’ beers join the market

Omission Brewing co-founder Terry Michaelson and brew master Joe Casey’s wife have celiac disease, which kept them from fully enjoying some of their favorite social activities. Michaelson and Casey made it their personal mission to develop traditional beers for people on a gluten-free diet, launching Omission in 2012.

“Omission is the first craft beer brand in the United States focused exclusively on brewing great- tasting craft beers with traditional beer ingredients, including malted barley, specially crafted to remove gluten,” brand manager Steven Hallstone said.

Omission’s gluten-removed lager, pale ale and IPA are brewed in Portland, Oregon, and Portsmouth, New Hampshire, and are available nationwide. Like other craft beers, Omission is brewed with malted barley, hops, water and yeast, Hallstone said. An enzyme called Brewers Clarex breaks apart the gluten protein chains, he said, and the beers are packaged in a closed environment to eliminate any cross-contamination risk.

 “Both Terry and Joe’s wife have been drinking Omission for years without incidents or reactions, and they now can be a part of the regular drinking occasions that they once were excluded from,” he said.

New Planet Beer president and general manager Gonzalez said New Planet is the only nationally distributed American craft brand that produces both gluten-free and gluten-removed beers. Two gluten-removed beers, Seclusion IPA and Tread Lightly Ale, joined New Planet’s gluten-free Blonde, Pale and Raspberry ales earlier this year. Both new brews begin with less gluten than conventional beers, then are brewed and fermented with an enzyme to break up gluten, he said.

New Planet wants to cater to beer drinkers including its founder—who has celiac disease—as well as the increasing number of people who may be sensitive to gluten but do not need to avoid it completely, Gonzalez said. New Planet brewed the gluten-removed beers for tap room customers for several years before offering them in cans to satisfy the demands of fans.

“New Planet wants to be inclusive,” he said. “More people drink reduced-gluten than gluten-free.”

Consumer confusion: What is safe?

Critics say gluten-removed beers can cause confusion for consumers, particularly when the brews are offered in the gluten-free section of a store or menu.

Dietitian Welstead—who recently was diagnosed with celiac disease herself and misses the taste of traditional beer—said testing for gluten isn’t valid for gluten-removed beers. The formula that removes gluten from the beer also breaks up the amino acid sequence [or protein] that is necessary to adequately test for gluten, she explained.

“At this time, considering the risks of gluten-removed beer, it is advised to avoid these until further testing can provide a clearer picture for those with celiac disease,” Welstead said. “It currently is a confusing situation and may place those with celiac disease at risk if these gluten-removed beers are consumed frequently.”

Gluten-free beers are a safer option for people with celiac disease, she said, because the brews never contain gluten from the start of production and carry no risk. She advises beer drinkers to read labels carefully and verify a product is gluten-free, not gluten-removed, to ensure they make a safe choice.

Omission and other makers of gluten-removed beers say they want to offer choices for people with varying levels of gluten sensitivity. Omission is committed to transparency, Hallstone said, which includes testing beyond what is required and posting the results online at omissiontests.com. To date, every batch of Omission has measured at levels less than 10 ppm, the lowest level detectable by the best test available, he said.

“We remain committed to progress, transparency, education and the fostering of choice for celiac and gluten-intolerant persons who love the taste of a great malted barley-based beer that [has] been crafted to remove gluten,” Hallstone said. “Our goal is to provide consumers with as much information as possible to help individuals make the decisions that are right for them.” GF

Mary Beth Schweigert is a freelance writer in Lancaster, Pennsylvania.

When the Gluten-Free Diet Packs on the Pounds

When the Gluten-Free Diet Packs on the Pounds

 GFL_BeWell_Page_1

Trying to lose weight on the gluten-free diet? 

Eating healthy is only half the battle — staying fit really moves the needle.

Click here to receive our free year-round guide to staying fit and healthy on the gluten-free diet.

 

 

 

Denise Czer gained 40 pounds before she was diagnosed with celiac disease—and she knows exactly why: She was afraid of getting a stomachache.

Czer, of San Diego, suffered from severe abdominal pain and other unpleasant symptoms when she ate certain things. Consequently, she often filled up on starchy foods like potatoes, which didn’t bother her stomach but offered little in the way of nutrition.

Once Czer was diagnosed with celiac disease 13 years ago, she tried several approaches to losing weight.

Some diet plans didn’t offer gluten-free food choices. She struggled with the self-discipline required to stick with others.

“I was just desperate to lose weight,” she says. “I had tried everything.”

Czer finally found success with the Medifast meal-replacement plan and help from an independent health coach.

The Medifast plan is convenient and easy to follow, she says, with plenty of certified gluten-free options to keep her satisfied. Czer lost 40 pounds in four months, and she’s kept it off for five years.

“It’s putting yourself into a structure where you don’t have to think,” she says of Medifast. “We are all so busy. We all need healthy, fast food options. Grabbing a gluten-free [weight-loss] product that’s not going to cause a stomachache or a reaction is liberating.”

Losing weight can be difficult for anyone, but the challenges are magnified for people with celiac disease or gluten sensitivity.

Many existing weight-loss plans aren’t an option for someone who has to follow a gluten-free diet.

But with a few caveats, some popular weight-loss plans can work in tandem with a gluten-free diet. A few diet companies are creating food and recipes targeting the growing number of people with celiac disease or gluten sensitivity.

Nearly half of Medifast’s 100 meal replacements and snacks are now certified gluten-free, and Weight Watchers, already known for its flexibility, published a get-started guide that includes gluten-free recipes.

Lori Welstead, a registered dietitian from the University of Chicago Medicine who works with the University of Chicago Celiac Disease Center, says people with celiac disease often lose weight before or soon after diagnosis.

But a gluten-free diet isn’t guaranteed to be healthy, she says, and many people quickly regain the weight, especially if they often reach for high-calorie processed foods.

“What we see now versus 10 years ago is more obese, overweight and morbidly obese individuals [being] diagnosed with celiac disease,” Welstead says. “It’s quite an interesting phenomenon.”

Peter Green, M.D., director of the Celiac Disease Center at Columbia University, New York, says people with celiac disease can successfully lose weight on diet plans if they follow expert advice and focus on eating nutritious food.

That doesn’t mean it’s easy to do.

People with celiac disease face a double whammy if they want to lose weight, Green says. “They have to be gluten-free and restricted in calories. The food has to be satisfying, as well as providing fiber and adequate nutrition.”

More weight-loss companies are recognizing this dilemma and taking steps to help.

Aransas Savas, Weight Watchers’ director of field communication, says a weight-loss plan’s convenience and flexibility are especially important for someone who already has to follow a restricted diet.

When you have any sort of medical condition or allergies, when you think about trying to lose weight, it can get really complicated and overwhelming,” she says.

Why weight can creep up after diagnosis

Once a person is diagnosed with celiac disease and goes on a gluten-free diet, the lining of the small intestine begins to heal, allowing the body to absorb more nutrients and calories, Welstead says.

“If [someone with] celiac disease is gaining weight, this is due to the fact that they are now efficiently absorbing their foods,” she says, which also can lead to higher cholesterol and blood pressure.

High-calorie, high-fat, gluten-free processed foods, which are far more prevalent today, are often to blame for post-diagnosis weight gain, Welstead says. “Gluten-free doesn’t mean low fat or low calorie,” she notes. “Although the gluten-free processed foods taste much better than those of 10 years ago, they can be double the calories of gluten-containing products.”

Gluten creates flaky, fluffy or crunchy textures in foods, she explains.

When companies eliminate gluten from processed foods, such as cookies and crackers, they substitute other, often not-so-healthy, ingredients.

People who are newly diagnosed with celiac disease should be aware of the possibility of weight gain and choose naturally gluten-free fruits and vegetables instead of processed foods, high-calorie carbohydrates and fats, Green says.

“The thing that sells these [processed] products is taste,” he says. “If [manufacturers] take out one of the things that contributes to taste, which is gluten, they often add a lot of the other stuff, which is salt, sugar and fat, to maintain the taste.”

EA Stewart, a registered dietitian in Del Mar, California, says a gluten-free diet can be very healthy with proper planning and the right nutrients.

But there are some things people should keep in mind, particularly if they’re also trying to lose weight.

Those who have celiac disease have to avoid a large number of foods, so they should make sure to get enough fiber and other nutrients, especially iron, calcium, zinc, vitamin D and B vitamins, she says. A multivitamin is generally a good idea.

A celiac disease diagnosis is a lot to take in, Stewart says. People who are newly diagnosed have to learn how to deal with issues that range from avoiding cross-contamination to finding gluten-free restaurant options.”Putting a super-restrictive [weight-loss] diet on top of that makes it even more stressful,” she says.

People on gluten-free diets who want to lose weight sometimes make the mistake of cutting or completely eliminating carbohydrates, which provide filling fiber and can prevent overeating, Stewart says.

“Yes, they might lose weight [by cutting out carbs], but how long can they sustain this kind of diet?” she says. “What will their energy level be like? How much balance are they getting?”

Popular plans: What can and can’t work with a gluten-free diet

People with celiac disease or gluten sensitivity would have to make lot of changes for many diet plans to be viable choices, Stewart says. Nutrisystem does not offer a gluten-free plan, a spokeswoman says. The Jenny Craig weight-loss plan is not open to those with celiac disease, according to the company’s website.

And Slimfast, which is based on the consumption of diet shakes for several daily meals, discourages gluten-free consumers. “Because the ingredients we purchase could potentially be cross-contaminated with wheat or another common ingredient, we cannot guarantee our products are gluten free,” the company says on its website.

Low-carb diets, like Atkins or South Beach, and other plans that emphasize protein, fruits and vegetables over grain-based foods, might be easier for someone on a gluten-free diet to follow, Stewart says.

But in general, she recommends a balanced diet over one that is low in carbohydrates.

The Atkins website notes that its diet plan can work well for those who are gluten free because of its emphasis on avoiding foods high in carbohydrates, including wheat, barley and rye.

The South Beach Diet advocates a similar low-carb approach. However a spinoff of the diet, Gluten Solution, it is not entirely gluten-free and not recommended for people with celiac disease.

When it comes to established plans, Stewart recommends the heart-healthy Mediterranean diet, which emphasizes fruits, vegetables, grains, nuts, olive oil and grains.  “For anybody, and especially someone with celiac disease, it’s a healthy, balanced and reasonable diet,” with lots of protein and complex carbohydrates, she says. “It’s a ton of food, so you won’t feel deprived.”

Loren Cordain, Ph.D., a leading expert on Paleolithic diets and founder of the Paleo movement, says the Paleo diet is a good fit for people with celiac disease or gluten sensitivity because it is gluten-free by its nature. He dedicates a chapter in his most recent book, The Paleo Answer, to celiac disease and gluten sensitivity.

People on the Paleo diet eat foods consumed by our long-ago ancestors, including meats, fish, seafood, poultry, eggs, nuts, and fresh fruits and vegetables. They avoid refined sugars, whole grains, dairy products, salt and canned and processed foods.

“The Paleo diet is a lifelong way of eating to improve health and wellbeing, and reduce the risk of common chronic diseases and obesity,” Cordain says.

Weight Watchers caters to people on a GF diet

Weight Watchers, which allows dieters to eat a variety of foods and awards a certain number of “points” for each, has always been a good option for people who need to follow a gluten-free diet, Savas says.

“Weight Watchers is notable in that it is flexible and adaptable,” says Savas, who lost weight on the plan and has been a Weight Watchers leader for 12 years. “The magic of this is it’s a plan for anyone who eats.”

Weight Watchers now offers a tool providing guidance for people on gluten-free and other restricted diets.

The What to Eat booklet, available at Weight Watchers meetings and weightwatchers.com, includes new menu plans and shortcuts, with a focus on gluten-free, vegetarian and low-carb meals.

Weight Watchers has noticed and hopes to help the growing number of people who follow gluten-free diets due to celiac disease, gluten sensitivity or personal preference, Savas says. It’s easy to postpone making a healthy lifestyle change, she says, and What to Eat provides new dieters the direction they need to simply get started.

“We are all flooded with information all the time about what it takes to lose weight,” Savas says, noting the complication dietary restrictions add.  “It can get overwhelming.”

Weight Watchers’ booklet designates easy-to-make gluten-free dishes for breakfast, lunch and dinner with a brown “GF” logo and lists them in the index.

Other dishes in the booklet can be made gluten free with a single swap, such as skipping the toast that goes with a veggie omelet.

“The food is actually enjoyable,” Savas says. “To be able to do that while eating a gluten-free diet and losing weight is very exciting.”

Medifast offers more gluten-free foods

Registered dietitian Jennifer Christman, clinical nutrition manager with Medifast Inc., says the plan is a good fit for people with celiac disease or gluten sensitivity. Dieters eat five portion-controlled meal replacements and one “lean and green” meal per day. Carbohydrates, such as bread and pasta, are discouraged.

“The meal replacements are all fortified with vitamins and minerals, which is really important for someone on a gluten-free diet,” Christman says. “[The lean and green meal] has fruits and vegetables and lean protein, which are perfect for someone with celiac disease or gluten intolerance.”

Product-development manager Tim Chinniah says Medifast started its gluten-free line about four years ago. About 40 of the company’s 100 meal replacements and snacks are now certified gluten-free by the Gluten Free Certification Organization. They include brownies, pancake mixes and ready-to-eat cereal.

“We actually got on it much earlier than others,” Chinniah says. “If it’s not gluten free already, we’re looking at how to make it gluten free.”

At a Medifast production facility in Owings Mills, Maryland, workers are vigilant against cross-contamination.

Containers of rolled oats are clearly marked with an orange “wheat” label to indicate that they might have been cross-contaminated at some point from the field to the factory.

Designated scoops are used for any ingredients that contain allergens. In the test kitchen down the hall Chinniah and his staff develop new products that are gluten free and nutritionally balanced. Great taste is also a goal.

“If it doesn’t taste good, people won’t eat it,” says food scientist Fatima Disu, who is also a chef.

Success story Denise Czer is now global director of Take Shape for Life, a network of independent health coaches who help people lose weight using the Medifast plan. She still eats two or three Medifast meal replacements every day.

“[Medifast] has helped me maintain my weight all these years,” she says.

 

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Gluten-Free Recipes

Mary Beth Schweigert is a regular contributor to Gluten-Free Living. She last wrote about GMOs and the gluten-free diet. She is a newspaper reporter in Lancaster, Pennsylvania.

Bam! Gluten-Free Goodness from the Lagasse Girls

Bam! Gluten-Free Goodness from the Lagasse Girls

LagasseEmeril Lagasse’s daughters on their cookbook, their famous dad and their dream of a gf cooking show

The irony is hard to miss: the two daughters of celebrity chef Emeril Lagasse can’t enjoy many of his signature dishes.

Jessie Lagasse Swanson has gluten intolerance and her sister, Jilly Lagasse, has celiac disease. The diagnoses were a big blow to the foodie sisters. After all, it’s hard to imagine New Orleans staples made by their father — like gumbo or po’ boys — without wheat flour.

After going gluten-free, the Lagasse girls, as they call themselves, quickly grew tired of eating rice cakes. They tinkered with family recipes, eventually figuring out the secret to revamping their old favorites to fit a gluten-free diet.

Now they’re sharing what they learned in “The Gluten-Free Table”, a cookbook they published last fall. Emeril – himself the author of several cookbooks and host of cooking shows on the Food Network and Cooking Channel – wrote the foreword and contributed 10 recipes.

Swanson, the older sister by two years, is a former certified public accountant who lives in New Orleans with her husband and two young sons. Lagasse, a makeup artist who has worked on her father’s TV shows, divides her time between New Orleans and London.

“The Gluten-Free Table” is just the beginning for the Lagasse sisters. Gluten-Free Living recently talked to them about the cookbook, their famous father and plans to expand their gluten-free empire.

Mary Beth Schweigert: What’s it like to be the daughter of a famous chef but need to follow a restricted diet?

Jessie Lagasse Swanson: I think it’s funny, but I really believe all things happen for a reason. It really helped our father become a lot more aware of dietary restrictions. It’s nice to see how his sensitivity for that has grown over the years. It’s helped him with empathy.

Jilly Lagasse: At first it was quite difficult, and I think our dad just thought we were trying out some new crazy diet as usual. Soon he saw just how ill I would get if I did accidentally get ‘glutened,’ and that this was no fad diet but a serious medical condition that forced us all to change the way we cooked and ate. Now the whole family prefers to have gluten-free quinoa for our big Sunday dinners. What’s really sweet is whenever we go out to eat, either my dad or my little brother, E.J., will passionately tell the wait staff that I have celiac disease and cannot have any gluten.

MBS: When were you diagnosed?

JLS: In 2000, my father took me to Italy for my 21st birthday. I lost 10 pounds. I was sick the whole time. It was really, really difficult. Finally I went to a doctor and she listened to my whole story and said, ‘You had a lot of wheat products over there in Italy, didn’t you?’ … It turned out I have a sensitivity to gluten and a host of other foods. It took six months of me being really, really sick for somebody to figure it out.

JL: I wasn’t properly diagnosed until 2004, when I moved to London. My new doctor asked if I had any ailments. As soon as I gave him my laundry list of symptoms, straight away he said it sounded like celiac disease (or coeliac, as it’s spelled there) and that it would be just a simple blood test to find out. Within two weeks of getting my diagnosis and strictly following a gluten-free diet, my whole life and body had changed.

MBS: How did you react to your diagnosis?

JLS: I was devastated. I went to this itty, bitty Whole Foods on the end of the French Quarter. I remember going there and thinking, ‘What am I going to do? I can’t eat anything. I don’t even like vegetables.’ After that initial panic period, it was really fine. It just took a little more effort. I was able to compensate with other things that I enjoyed.

JL: At first, my reaction was complete shock and confusion. So you’re saying I’m allergic to bread? And pasta? Really? Then it was the panic of how will I be able to eat anything or anywhere? After getting advice from my sister and doing lots of online research, my panic and confusion slowly melted into joy and excitement. I finally knew that something really was wrong with me and that now my body might start to heal. Getting properly diagnosed changed my life, and I don’t know if I’d be here today without it. I can’t imagine just how ill I would be.

MBS: What was the biggest struggle for you?

JLS: For me honestly the hardest thing was going out to eat. At the time I was single and in my 20s. I went out to eat seven nights a week. I never ate at home. All of the sudden, I would go out and nobody knew about gluten sensitivity or how to answer whether something was gluten-free or not. It took a long time to figure out what I could eat safely. Now everybody knows about it. Restaurants advertise on their menu that they have gluten-free offerings. And the products. The regular grocery store has a whole row that’s gluten free. How far we’ve come in 10 years.

JL: I had to change the entire way I lived my life. We are very much a food family, as you can imagine, and food, cooking, going out to eat — that is all joy to me. Changing how I approached all that took a bit of time and adaptation. At the time of my diagnosis, celiac disease wasn’t as known, and the cookbooks that were out were just boring, to be honest. I didn’t want a life of rice cakes. I still wanted all the food I had grown up eating and sharing with my foodie family. The struggle is what fueled Jessie and me to write a gluten-free cookbook.

MBS: What is your favorite of your father’s dishes? Is there a gluten-free version, and is it as good as the original?

JLS: If I had to pick one, it would be baked stuffed shrimp. He used Ritz crackers for that nice buttery, salty part of the filling. I think that was my favorite thing that he made for us. I actually did it in the book. I used gluten-free butter-type crackers.

JL: This is so tough because everything he makes is my favorite. But my all-time favorite Daddy dish would have to be his Christmas Gumbo, chock-full of duck and spicy Cajun andouille sausage. We have successfully made a delicious gumbo in our book that is pretty darn close, and I actually prefer it. Just don’t tell him that.

MBS: Which of your father’s conventional dishes is the hardest to turn down?

JLS: The only one — and we’re working on it right now but haven’t quite got it — is a really good fried fish or chicken. Down South, people fry everything. I have to admit I actually sometimes cheat and have his fried fish. I just cannot quite get (the gluten-free recipe) right.

MBS: Does your dad make any special gluten-free dishes just for you?

JL: He is just the best when it comes to catering to our food allergies. Whenever I’m home and he is cooking for the family, it will always be a gluten-free meal that we all eat together. He does this incredible veggie and pork stir fry with bean thread noodles that is legendary in our family. Also, he’ll make a big pot of Bolognese sauce that he serves with gluten-free quinoa.

MBS: When you were growing up, did you feel like it was expected that you would be a good cook?

JLS: Our dad thought cooking was an important skill for us to have. He’s a great teacher. I would spend hours watching him and ask a lot of questions. He very patiently answered them. By the time I was in my mid-20s, I had a pretty good culinary portfolio. My sister had it more as a natural gift. When we were kids, she could just throw stuff together and it would usually come out tasting really well. Me, I had to actually learn it.

JL: I do think it’s just something that comes naturally to me, and I was more than likely to be a good cook just from all the time I spent in the kitchen watching and helping my father. I was always interested and fascinated by it all and just wanted to learn more and more. I remember begging my father to let me go to work with him at the restaurant. I was relentless. He finally gave in and let me go and help out in the pastry department. There I was, a little gal in the kitchen with a piping bag full of whipped cream and an arsenal of fresh mint that I got to finish plates off with. I thought I had gone to heaven.

MBS: Where did the idea of the cookbook come from?

JL: The idea really was born out of frustration that Jessie and I both were feeling at the time of our diagnoses. Here we were, having to adapt to a new culinary life, and we couldn’t find one decent cookbook — well, what we considered to be a helpful and useful cookbook. Sure, there were baking books with ingredient lists that would send me into an anxiety attack. There were books of ‘everything on a rice cake, rice cake sandwiches, chocolate rice cakes, rice cakes with eggs.’ We refused to accept that gluten free had to be flavor free. So we embarked on a five-year journey of adapting all our favorite dishes that we still wanted to eat and be able to enjoy.

MBS: How did your dad react when you told him you were doing a cookbook?

JLS: We told him when it was done. It took five years for the whole thing to come together. We said, ‘Dad, here’s the book.  It’s actually finished. Do you want to write the foreword to it?’ He was surprised. He is supportive, but he doesn’t do it for us. He’ll help us, he’ll contribute recipes, and he’ll write the foreword. But he’s not going to call a publisher for us. He’s not going to get his friends to write it for us. It makes the end result a lot more fulfilling. You earn it, and it’s not just handed to you.

MBS: What’s it like to work with your sister on a book?

JLS:We had our good times and our bad times. We had our moments of ‘Wow, we did this,’ and ‘Oh my gosh, I don’t ever want to talk to you again.’ If you had to balance it out, it was a really good experience. It helped with our relationship in a lot of ways. It taught us a lot about each other. It gave us an opportunity to spend a lot of time together when we hadn’t really had that since we were kids.

JL: It was great to get to work together on something we are both so invested in and feel so passionately about. It was very typical sibling stuff though. We had tears, we had laughter — we had it all, honey. For me, it was a wonderful experience and one I hope we get to experience again.

MBS: How did you come up with the recipes in the book?

JLS: They’re mostly the foods we actually cook for our families on a regular basis. A lot are cornerstones of our everyday cooking lives. It’s a pretty diverse table of contents.  At the same time, we’re real people. We’re not going to pretend we have time to make a gluten-free Ritz cracker from scratch. If there’s a good gluten-free product out there, we’re not going to re-create the wheel.

JL: I like to think of the flavor profiles I like and try to create something new and exciting from scratch. I love to take the dishes I enjoy eating in my daily life and elevate them a bit or put my own twist on them. It’s a lot of trial and error for me, a lot of experimenting – but that is the fun for me as well.

MBS: What is your favorite gluten-free recipe?

JLS: The baked stuffed shrimp is my favorite. If I had to pick another one, it would be the smothered pork chops or the cornbread and andouille dressing. But I probably have a favorite or two from each chapter.

JL: The gluten-free recipe that I am most proud of in our book would be our version of our Great Grandma Cabral’s Banana Nut Bread. It’s one that took me ages to crack, but once I did, it was like I was transported right back to being a child in her kitchen and taking a bite of her famous banana bread. It is a complete food memory and makes me think of her every time I bake it. I love that people can live on through their recipes and the memories you have while eating them.

MBS: Is there a gluten-free dish that you haven’t yet perfected?

JLS: Really right now it’s the fried chicken. … We’ve got the spices and seasonings right but just can’t get the texture.

JL: We have yet to master the perfect gluten-free French bread loaf, which is absolutely essential for another dish that we have yet to master: a gluten-free fried shrimp po’ boy. We’ll crack it eventually. It just takes time, patience and a lot of gluten-free flours.

MBS: What kind of response have you gotten to the book so far?

JL: We’ve gotten a wonderful reception within the gluten-free community, and everyone seems to be enjoying it. We get people asking for another one, so I guess that’s a good sign.

MBS: What’s next for you? Are there any other books in the works?

JLS: We’re exploring our options. We’re looking into doing some of our own packaged products. We’re working on a new cookbook with classic comfort foods, like green bean casserole and stuffing for Thanksgiving. We’re just really trying to educate people in any way that we can.

JL: We have a lot of exciting things in the works. We’re slowly but surely trying to build our little gluten-free empire. There is a lot of gluten-free goodness to come from the Lagasse girls.

MBS: Any plans for a TV show?

JLS: We have some feelers out there for that right now. I think we’re open to anything.

JL: I would love to see a gluten-free food program on television, be it a cooking program or a travel program. It’s time. That’s my dream, to be part of putting gluten-free food on the map and on TV. Plus, I think we might know someone who could offer a bit of advice on that.

When Celiac Disease Comes With Age

When Celiac Disease Comes With Age

Cynthia Grenham works long hours as a realtor outside Boston.

But not too long ago, she couldn’t get through most days without taking a nap.

Grenham had other puzzling symptoms, including stomach upset and severe skin irritation. Sometimes her brain felt so foggy, she struggled to find the right word to express what she wanted to say.

Grenham’s father had died from complications of celiac disease. But she never thought that could explain her own symptoms.

“Nobody picked up on it,” she says. “Nobody tested me.”

Five years after her symptoms started, Grenham was finally diagnosed with celiac disease, at the age of 65.

Many people mistakenly believe that older adults can’t have celiac disease, and that if they do, they can’t benefit from treatment, says Alice Bast, founder and president of the Philadelphia-based National Foundation for Celiac Awareness.

But recent studies show that about 2 percent of older adults have celiac disease, which is double the rate for the general population. Research also indicates that the risk for celiac disease rises with age.

“People think, ‘I can’t have celiac disease because I’m too old,’” Bast says. “No matter what age they are, if they have signs, symptoms or family members with celiac disease, they need to get tested. It’s critical.”

A 2009 Mayo Clinic review of recent research found that 50 is the median age for a diagnosis of celiac disease. But one-third of new patients are diagnosed after age 65.

Daniel A. Leffler, M.D., a gastroenterologist with the Celiac Center at Beth Israel Deaconess Medical Center in Boston, says he and his colleagues routinely diagnose people in their 60s, 70s and even 80s.

“Ten years ago you’d have to search far and wide for somebody diagnosed over age 60,” Leffler says. “Now it’s pretty common.”

Seniors with celiac disease encounter an average delay in diagnosis of 17 years, the Mayo Clinic review found. That’s up to three times longer than the delay faced by younger peers.

Once diagnosed, older adults with celiac disease face a unique set of challenges, ranging from financial to social. They might struggle to adapt to—and afford—a gluten-free diet. Limited mobility can prevent frequent grocery store trips, and failing eyesight can make it difficult to read the small print on food labels.

Medically speaking, older adults’ intestines tend to heal more slowly from damage caused by years of undiagnosed celiac disease, Leffler says.

“The response is not as quick or complete as it is for younger individuals,” he says. “They face a tougher road right off the bat.”

But Grenham is proof that seniors with celiac disease can live full and active lives. After following a gluten-free diet for five years, Grenham no longer has skin or neurological problems, and her energy has returned. “I’m a completely changed person,” she says. “I’m 70 years old and get tired at times, but I don’t have to do this 4 o’clock nap thing. I go, go, go.”

 

Getting a diagnosis

Research clearly shows that people can develop celiac disease at any age, even if they’ve tested negative before, says Ronni Alicea, a New Jersey registered dietitian who specializes in celiac disease and seniors.

It’s possible to develop celiac disease as a teenager and not be diagnosed until age 90, she says. A person also could develop symptoms at age 85 and be diagnosed at 86.

There are several reasons that seniors might face a delay in diagnosis. Older adults usually show symptoms that are similar to those in younger celiac patients, Leffler says. But the Mayo Clinic review found that older adults sometimes show less prominent gastrointestinal symptoms and more atypical symptoms as Grenham did.

Older adults are more likely to have other medical problems, which also can complicate diagnosis, Leffler says. Gastrointestinal symptoms could be caused by another medical condition or a side effect from a prescription drug.  Some symptoms originally could be attributed to normal aging.

“It can be confusing to tease out what’s related to celiac disease when a person has other medical problems,” he says.

For people who’ve suffered symptoms for a long time, a celiac disease diagnosis can come as a relief, Leffler says. But someone who’s had symptoms for 30 years might also feel frustrated that their fairly straightforward problem took so long to diagnose. Seniors who are newly diagnosed should not panic, Leffler says.

“Almost everyone diagnosed has had [celiac disease] for a long time,” he says. “Realize it’s not an emergency. It takes time. Nobody gets the gluten-free diet right overnight.”

Staying positive can make a big difference, Bast says. Focus on the foods you can eat, not the ones that are now off-limits. Bast met one man who was diagnosed at age 93. Once he adapted to the gluten-free diet, he said he felt 20 years younger.

“You can feel better and improve your quality of life at any age,” she says.

 

A team effort

Successfully managing celiac disease as an older adult requires support from a multidisciplinary team. Connecting with professionals and a good support group can help seniors feel better and stay independent, Bast says.

“You have to advocate for yourself,” she says. “Be empowered and not ashamed. Ask for help.”

Your doctor and a registered dietitian with expertise in celiac disease can provide guidance through the transition to a gluten-free diet. Seniors who live in a retirement community should meet with the nutrition professional on staff.

Clear the pantry and refrigerator of gluten. Then check the medicine cabinet.

“Seniors tend to take a lot more medications,” Bast says. “In addition to gluten being in food, it can also be hiding in your medications.”

Although most prescriptions are gluten free, according to Steve Plogsted, a pharmacist at Columbus Children’s Hospital, a few are not. Gluten is used as a filler in some drugs. Since these inactive ingredients don’t have to be listed on prescription labels, it can be difficult to determine which drugs contain gluten. Also inactive ingredients can change and the same ones are not used from manufacturer to manufacturer of a medication. That means seniors have to check all medications regularly. Leffler recommends referring to Plogsted’s website, glutenfreedrugs.com, which is widely recognized as the best source of information about gluten in drugs. Plogsted also writes a recurring column in Gluten-Free Living which answers readers’ medication questions.

Safely managing medications can be overwhelming for an older adult with celiac disease, particularly if there is memory loss, Bast says. That’s why it’s important to have a pharmacist on your team. Set up a meeting to review your medications and identify any potential problems.

 

Retirement living

Seniors who are “shopping” for a retirement community should choose one where the kitchen staff is trained and gluten-free protocols are in place, Bast says. Ideally the community will have a registered dietitian and pharmacist on staff.

“You want to make sure if you are going to live somewhere, that you can eat and be accommodated, especially if you’re not as mobile,” she says.

Alicea, the R.D., suggests that seniors meet with the food service director at any prospective new home. Ask if the staff has handled a gluten-free diet before or if they are willing to learn. Don’t stop there.

“Ask to speak to other gluten-free residents,” she says. “They’ll be the ones to tell you what’s really going on.”

At one community, Alicea met seven residents with celiac disease. None were happy with the kitchen’s gluten-free offerings, a good indication the home was not a good choice for someone looking for gluten-free accommodations.

Seniors who decide to move shouldn’t settle for a handshake, Alicea says. Make sure the community’s pledge to provide gluten-free meals is noted in your contract.

 

Following the diet

Many seniors embrace the transition to a gluten-free diet because they feel so much better. Others are intimidated about trying something new.

Newly diagnosed seniors might be reluctant to alter a lifetime of dietary habits, Leffler says. In general, the longer you do anything, the harder it is to change.

“When you’ve been eating a certain way for 50, 60, 70 years and you suddenly have to make dramatic changes to what you can eat, that can be very traumatic,” he says.

Following a new diet can be especially challenging for older adults with memory loss, Alicea says. Those with dementia, in particular, require close supervision.

Some newly diagnosed seniors might decide they would rather live with celiac symptoms than change their diet. But, Alicea says, “The consequence for not following the diet is you’re just not as healthy.”

Having to follow a special diet can lead to a sense of isolation, especially for homebound seniors. Dining out or attending social events that involve food might not seem worth the effort. Celiac disease support groups can be a great source of companionship for older adults, Alicea says.

When Grenham, the Massachusetts realtor, was first diagnosed, her husband approached her new diet with caution. She initially cooked one meal for herself and another for him.

Now that Grenham is more skilled at cooking gluten-free dishes, she and her husband eat the same meals about 95 percent of the time. He still won’t eat gluten-free bread, and she doesn’t blame him.

“We eat very well,” she says. “I always want to show people it’s not that difficult.”

 

Keeping expenses in check

Grenham works with newly diagnosed celiac disease patients through her support group, the Healthy Villi. She often takes her new friends to the grocery store and points out gluten-free products that are worth the money.

No matter what their age, most who are newly diagnosed experience sticker shock, Grenham says. But the cost of a gluten-free diet can be especially burdensome for seniors on a fixed income.

“It’s very, very expensive. There are no two ways about it,” she says, noting a loaf of bread can cost $7 and a pound of pasta $4.

Grenham recommends websites such as Gluten Free Saver and Gluten Free Mall to people with limited budgets or mobility. (See our story on saving money through online shopping.)

Seniors who have trouble getting to the grocery store on a regular basis can make it easier on themselves with some simple substitutions, Bast says. For example, canned vegetables, which cost less and keep longer, can be a good alternative to fresh.

Family or friends of an older adult with celiac disease should check in regularly to make sure their loved one’s kitchen is stocked with nutritious gluten-free foods, she says.

Seniors with celiac disease can successfully manage their diet without ever buying more expensive ready-made gluten-free products, Alicea points out.

“If you can’t afford to buy processed [foods], you’re not going to starve,” she says. “Naturally gluten-free foods are abundant.”

Some older adults depend on senior centers or Meals on Wheels for food. Social service agencies currently aren’t required to provide gluten-free food, and many lack the resources to do so, Alicea says.

 

The road to recovery

Recovery often comes more slowly for seniors with celiac disease, Leffler says. Healing generally slows with age, and many older adults unknowingly had celiac disease for years before diagnosis.

“Clearly the older you are, the more medical problems you have, and the harder it is for the intestines to heal from celiac disease,” Leffler says.

Seniors generally have the same associated conditions that can afflict celiac patients of all ages, he says. Age and a delay in diagnosis sometimes can lead to more serious conditions, including autoimmune disorders and some cancers.

Seniors with a delayed diagnosis are likely to have longstanding nutritional deficiencies, Alicea says, particularly involving absorption of nutrients. This can lead to conditions such as bone disease and anemia, and often calls for extra supplements. (See our story on celiac disease and bones.)

Seniors who are diagnosed but still have stomach pain or diarrhea should not assume that celiac disease is to blame, she says. Another condition, such as lactose intolerance or diverticulitis, could be the culprit.

“People blame celiac disease and sometimes don’t seek medical attention when they should,” Alicea says.

Since her celiac diagnosis, Grenham has developed multiple food allergies, including to fresh fruit and shellfish. She dines out only when she absolutely can’t avoid it. When she visits friends or neighbors, she brings her own food.

“I have to be extremely cautious,” Grenham says. “Fortunately one thing I’m not allergic to is wine.”

Armed with a glass of red and a box of gluten-free crackers, she can take on any challenge.

 

 

Mary Beth Schweigert is a Lancaster, Pa., newspaper reporter who covers health, food and other lifestyle topics. She previously wrote about new healthcare laws and celiac disease for Gluten-Free Living.

This article was originally published in our May/June 2013 issue. All information was correct at time of publication.