Catherine McCord on her New Smoothie Cookbook

Catherine McCord's The Smothie Project
Smoothie Project: The 28-Day Plan to Feel Happy and Healthy No Matter Your Age by Catherine McCord

For anyone looking to try something new, the answer might start with a blender and a book. This might sound like an interesting combination, but that blender that so many of us bought to make a milkshake one-time years ago can take on a whole new purpose with a little help from Catherine McCord’s new cookbook the Smoothie Project.

McCord, the founder of the family and food brand Weelicious, has devoted an entire book to the smoothie in all its many forms. From recipes for tropical smoothies like On Vacation to green smoothies such as Green Sunshine to decadent smoothies including Banana Split, she sets out to share recipes that demonstrate the versatility and excitement that can happen when you take real food and blend it together.

For McCord, a mom of three, smoothies mean a lot to her family. She first started having smoothies during her second and third pregnancies when she was having trouble with nausea. She says they were her “lifeline” during this time. Soon after, her husband was taking one with him on his way out the door for 16-hour days.

Smoothies took on even greater importance when McCord’s son began not feeling well several years ago. She got creative and began collaborating with him on smoothies for breakfast. He soon felt better, the whole family began drinking smoothies, and the result is the Smoothie Project.

For anyone familiar with Weelicious, it is clear that McCord has taken the passion she gives every day to her followers and brought it to the pages of this cookbook. Just like the many naturally gluten-free (or easily adaptable to be) on Weelicious, McCord’s book is very much the same. Even if something does not say gluten-free, like her Blueberry Muffin smoothie recipe that calls for oats, one can simply use certified gluten-free oats. 

Before blending up one of her recipes, she walks readers step by step on how to set up their kitchens. She discusses everything from the differences between blenders, cups and straws to have on hand, and how to stock your pantry.

McCord recently called in from California to share insights into how smoothies went from her family to yours and also kindly shared two recipes from the book.

Can you talk about what inspired you to begin making smoothies?

My son started having headaches and nausea, and he is not a kid that complains. This just persisted to the point that I didn’t know what to do going to doctors and nutritionists trying to figure out what was happening to him. He became a vegetarian by choice when he was 5 years old so as many mothers do, especially with a vegetarian child, I found myself doing deeper into pancakes and waffles and crepes for breakfast and cheese, and I realized at the end of the day he wasn’t getting a lot of what he needed. I read this book Cure Your Kids with Food and there was a line about smoothies.

And so the next day I created this sheet that had little pictures of fruits and vegetables and proteins and I gave it to him and said you can put anything you want here in the smoothie. The next morning we tried it, he loved it, and I would give him the sheet every day for a week until it became habit and within three weeks, all of his symptoms went away. And that was almost five years ago.

Every day we still have a smoothie. At least I know for myself, for my kids, that by doing that you can invisible high five yourself that you’ve had one or two vegetables, one or two fruits, brain-building protein, so everything goes in this glass. The secret is its actually really delicious. 

As this was happening, were you surprised by the evolution?

I was just doing it for my son’s health and for ourselves. Then what ended up happening was we would be having our smoothies, we would prop Gemma, who was 10 months old at the time, on the counter or I’d be having her on my hip, and she would sit there and bob her head and try to take sips, or put her mouth on our straws. And then next thing we know we would prop her on the counter as we were having breakfast and she would suck down a 10-ounce smoothie in 2 seconds flat. I started putting it on Instagram and it just caught on. People started calling her the smoothie baby. 

At what point did you realize this bigger than your family?

I would say a year, year and a half into it was when I created a hashtag (#smoothieproject) and was posting more and more of it. I would post a different recipe on Instastory every day and people shared they were screenshotting the recipes, and asking, “Can’t you just make a cookbook.” I was working on another project and never thought about it. It’s a true passion project. It’s been so my fun. Even my kids have been taking the book and sharing the pages they want.

You had a wealth of smoothie recipes. Were some of the recipes developed specifically for the book?

Smoothies are a funny thing. To perfect a recipe for a smoothie, it’s true culinary work. There are certain flavor combinations. Everyone has a different palate. There is literally something for everyone. 

Were you surprised by any flavor combinations that have merged beautifully together?

Throwing a whole lemon – lemon and lemon peel – in a smoothie. It’s been fun the past two weeks, since the book came out, for the Blueberry Magic Lemonade recipe, I keep getting messages, “Am I really supposed to put it all in?” I say put it all in. It makes it really zippy and fresh, but there is nothing bitter in it. Another one is putting persimmon to make Secret Mango Creamsicle.

Are there a couple of recipes that readers should definitely check out?

The Cotton Candy smoothie. It’s my version of healthy pink milk with strawberries and frozen cauliflower – it’s really classic. There are some that are a little bit more obscure such as Awake. I think a lot of people don’t know you can absolutely put coffee in the smoothies as your liquid. So that is a fun one for anyone who want more of a mocha flavor. Pure Gold has some lime zest and some turmeric. 

For selective kids (and adults), which smoothies do you recommend trying first?

First and foremost I would say hand the book to the kid because the pictures are really inspiring. Berry Vanilla Shake, which is strawberries and raspberries and you don’t taste the frozen cauliflower, but you get a vegetable in there, that is really popular. The decadent chapter, its dessert, but they are really, nutritious, but the best part is they’re so delicious. We make them after dinner for dessert. 

How many different types of glasses do you have in your home?

They’re a lot of glasses. 

Do you think the type of glass impacts the experience?

I think your cup, your vessel, is important. I love glass straws. It is so funny to say this but a glass straw, it feels different compared to plastic or paper or even metal.

What do you hope readers take away from the book?

I hope that everyone is educated a little bit more, finds an ingredient, and is able to have an aha moment. It’s a 28-day challenge and that’s just really based on my own experience with my son, by seeing how making this one change made all the whole of difference in how he felt, how all of us felt. It’s just changing one meal a day. 

(This interview has been edited for length and clarity) 

Learn more about the Smothie Project on Amazon!

Check out McCord’s Cotton Candy smoothie recipe!

Check out McCord’s Super Greens smoothie recipe!

Make Meals Fast: 3 Ingredients for Stress Free, Gluten-Free Eats

With autumn in full swing and holidays around the corner, it can be hard to find time to make quick, satisfying gluten-free meals and snacks. What might make cooking even harder these days is daylight savings time ending very soon. How then does one go about preparing fast and delicious meals and snacks?

I truly believe the key is experimenting and getting creative in the kitchen. The more creative I get, the more my gluten-free menu grows and the more choices I have for breakfast or that afternoon nibble. My creative approach is far from gourmet. Although I will say, it often feels gourmet when I sit down to eat.

What is my creative approach?

I make sure my fridge and pantry are stocked. My kitchen staples include lots of fruits and vegetables, proteins, and a variety of gluten-free carbohydrates ranging from bagels to pasta to crackers. I always have yogurt on hand and make sure that there is a prepared protein at all times in my fridge. It might be as simple as a hardboiled egg or it could be leftover steak. By having protein ready to go, I free up time to develop an idea without worrying about how much time it will take to make, say, chicken.

I like to think about the foods I enjoy eating. Then, I think about whether any of them might pair together well. By working in this way, I will often be surprised to find how foods I had never thought to combine, pair together quite well.

I never measure or cook with precision. I feel out the ingredients and figure out how much I might like or need. Some days the amount I use may differ from another. I am also flexible on ingredients. If I am out of one vegetable, I use a different one. The flexibility to try a new ingredient might make me realize I like the meal or snack better.

What do I do with my creativity in the kitchen? Here is a peek into my kitchen staples.

Celiac Disease Diagnosis: Reasons to be Thankful

For someone who has just received a gluten-sensitivity or celiac disease diagnosis, the news can be both welcome and overwhelming. With so much to learn about the gluten-free diet, it can be easy to focus on what one has to give up versus what one gains. But as we observe Celiac Disease Awareness Month, take a moment to focus on the wonderful things that happen following a diagnosis.

Health and happiness

As Michael De Cicco-Butz knows well, the most important gain a diagnosis leads to is health. Twenty years ago, after years of not feeling well, a celiac diagnosis changed his life.

Bright Side michael dcb“It was hands-down one of the best things to ever happen to me,” says De Cicco-Butz, who works as a consumer insights executive and runs the gluten-free luxury blog

“Prior to my diagnosis I was actually not well and had no idea what was going on,” says De Cicco-Butz. “I would sometimes get ill when I would eat or drink something. There seemed to be no rhyme or reason as to when it would happen.”

When De Cicco-Butz was diagnosed with celiac, his world completely changed. “At face value it seems obvious, but in actuality my celiac diagnosis was the most empowering experience of my life,” he explains. “It may sound strange, but it allowed me to live the life that I wanted to on my terms—not having to worry about the effects that gluten was having on my health.” Today, he travels the world and shares his gluten-free experiences—particularly with hotels, restaurants and airlines—with Gluten Free Mike’s readers.

Like De Cicco-Butz, Jules Shepard, the owner of and an advocate for the gluten-free community, also feels positively about her diagnosis in 1999. “I’m happy that I have a celiac diagnosis,” says Shepard, who, like many others, was not diagnosed right away. Physicians could not determine the cause of her symptoms or even agree on a diagnosis. Today, she feels very fortunate to have “people respect the celiac diagnosis” because, as she explains, not everyone gets that respect from those around them.

Bright Side jules shepardShepard’s diagnosis presented a chance to focus not just on eliminating gluten, but on looking at her whole diet. Before her diagnosis, she explains that she “knew where food came from, but didn’t dwell [on it].” Following the gluten-free diet, which entailed spending a lot of time reviewing ingredients and labels, got her thinking about what she was putting in her pantry and, more importantly, her body.

“My personal life [was] affected by celiac in a good way,” Shepard notes. Once on the gluten-free diet, her food awareness “skyrocketed,” leading her to become a “much healthier person” because of changes she made to her lifestyle, including eating out less and regularly cooking at home with fresh, locally sourced ingredients whenever possible.

She is “thrilled to have had [her] eyes opened” to new ways of thinking about food through her celiac diagnosis, and continues to make eating healthfully a priority.

Beyond health, a diagnosis offers the chance to meet many new people and develop meaningful friendships. Often, these friendships begin with a desire to find others who understand the gluten-free diet.

Making connections

Erin Smith received a celiac diagnosis as a toddler in the early 1980s, when much less was known about celiac disease and far fewer gluten-free options were available. The challenges Smith faced have helped shape her life.

“Growing up with celiac and being a kid with celiac is hard but, in the pre-internet era where there was no communications other than your parents or your doctor, I found it really difficult,” Smith explains. Not until her teen years did she find a support group and have the opportunity to meet others with celiac. These early experiences played an important role after she graduated from college. “My whole kind of motive as an adult was to build a community that I didn’t have as a kid,” she explains.

To that end, Smith has focused on community building. First she got involved with the New York City Celiac Disease Meetup Group. “I wanted to socialize in Manhattan, and I wanted to drink and go out with people my age that knew what I was talking about,” she says. “And so I started going to these meetup events on a regular basis, and it was never a pity party. It was always like, ‘We are socializing and we also happen to eat gluten free.’ So that was really important for me.”

When she took over running the group, she found she received as much as she gave. “With the meetup group, you know, as much as I put into it, I got a lot out of it. I met a lot of really awesome people…that have become really good friends.” This experience solidified her desire to be an advocate within the community, and she sought out additional opportunities to inspire others through her own gluten-free experiences.

In 2007, she launched her website,, where she wrote about her gluten-free experiences and gained a large following. “I called it Gluten-Free Fun because, you know, I always just knew living life as someone with celiac who is gluten free, and I didn’t know any other way of life.” Smith never let celiac stop her, and she did not want anyone to feel left out because “there are still many things you can eat and places you can go” on the gluten-free diet. Always a proponent of gluten-free travel, she found a dearth of information on the topic.

In 2011, she launched a second site,, devoted to all things gluten-free travel. The site “shares tips of how to travel around the whole world and be gluten free.” It focuses on “cities that are more gluten-free friendly, ways to put together an itinerary so you’re not scrambling at the last minute to find places to eat” and other important details. As with everything Smith does, she is connecting with a whole new group of people through the site and expanding both her own personal community and the much larger gluten-free one.

Like Smith, Craig Pinto’s celiac diagnosis led him to pursue opportunities that have allowed him to focus on meeting new people. “I think it caused an extremely positive shift,” says Pinto of his diagnosis in 2000. He feels strongly that “just meeting the people [in the gluten-free community] along the way was a great outcome” of his diagnosis.

Pinto’s celiac diagnosis also allowed him to return to football, where for several years he was the field goal kicker for the New Jersey Revolution indoor/arena football team. “I was able to play sports again, and in playing sports I was able to meet new people,” he explains.

When traveling with the team, he often received questions about why he ate differently. “Ultimately,” he explains of his team travels, “they all ended up being good chances to educate” his teammates and anyone he met about celiac disease and the gluten-free diet.

Between making inroads in the community and through football, Pinto found that he enjoyed reaching out to other people and focusing on education. This ended up significantly affecting his life, when he started wondering “how can I make this into something that I can work at every day?”

Pinto became interested in making a difference through the nonprofit world, where he currently spends a great deal of his time both professionally and personally. He served as president of the National Celiac Disease Society, a nonprofit formerly known as the Kicking 4 Celiac Foundation that focuses on raising celiac awareness. Through the organization, he worked on community programming and also helped provide high school seniors with scholarships to help them defer the costs of the gluten-free diet.

Just like starting over

When it comes to looking at the additions to one’s life following a diagnosis, De Cicco-Butz says, “I like to say that my life started again when I was handed my diagnosis. Being able to hit the reset button was something that I am truly thankful for, because I finally was able to experience a new normal, and being normal has, quite literally, never felt so good.”

Want to learn more about celiac and following a gluten-free diet? Read “What is Celiac Disease?” and “The Basic Gluten-Free Diet.”

Routine Blood Draw Leads to a Celiac Diagnosis

When Brian Bosworth, MD, was an internal medicine resident in the fall of 2002, he went in for a routine checkup with an internist. What he did not realize at the time was that the appointment would lead to a diagnosis of celiac disease. 

“I went in to see my internist for a regular checkup, and as part of the normal history and physical, she did some quote-un-quote routine labs, or screening labs, which included a blood count, a cholesterol level, looking at kidney function, electrolytes, liver tests  and some vitamins,” said Bosworth, now chief of medicine, NYU Langone Health Main Campus, Tisch Hospital. 

He shares that “everything was normal—my history and all of the lab work was pretty much normal, with the exception of two or three of my liver tests, [which] were slightly elevated.” Given his knowledge of medicine as an internal medicine resident, he found the elevated liver tests surprising. His liver tests were run again approximately three months later, and they remained elevated. Bosworth’s doctor referred him to a gastroenterologist to be evaluated.  

His evaluation included “an ultrasound of my liver, which was normal, as well as a number of tests for chronic liver diseases,” he shares. The GI also tested him for celiac disease since, as Bosworth notes, “celiac disease can sometimes cause abnormal liver tests in the pattern that I had, which were an elevated AST and ALT, which are transaminase enzymes that are made by the liver.” When the results came back, there was something unexpected.

“All of those liver-specific tests came back negative, but my celiac serologies were through the roof.” Bosworth had an endoscopy and biopsy, and was found to have subtotal villus atrophy and was diagnosed with celiac disease. Of note, he had already been accepted to a fellowship in gastroenterology at the time of his diagnosis. 

Blood draws tell a story 

Bosworth’s celiac disease diagnosis began with a regular checkup at the internist. It was his internist who spotted the elevation in the liver tests and referred him to a gastroenterologist for further investigation. 

His road to diagnosis demonstrates that there is no one path to a celiac disease diagnosis. It also serves as an example that, for some individuals, routine labs run at a checkup can provide important information that can lead to testing for celiac disease. While for him it was elevated liver tests, there are several values in bloodwork that might indicate a patient should be tested for celiac disease. 

“There are several common blood test abnormalities that might lead to a diagnosis of celiac disease, including anemia (which follow-up testing may reveal deficiencies in iron, folic acid, or vitamin B12), elevated liver enzymes or low HDL (‘good’) cholesterol,” explains Benjamin Lebwohl, MD, MS, director of clinical research, The Celiac Disease Center at Columbia University. “People with celiac disease can present with any of these abnormalities, and it is reasonable to test for celiac disease if these abnormalities are picked up on routine testing.” 

The question arises whether there are any statistics on how many patients are diagnosed because of routine bloodwork. “Statistics on this topic are hard to come by,” says Lebwohl. The inability to quantify patients diagnosed via routine blood draws is because of crisscrossing of symptoms and how they come to a physician’s attention.

For example, as Lebwohl notes, “some patients with iron deficiency may come to medical attention due to fatigue, while others may have the condition picked up on routine testing, but they may both be classified as having ‘non-classical’ celiac disease, which is a large category that encompasses both types of patients.” Additionally, “others may feel well but then be found to have iron deficiency, and then (after diagnosis of celiac disease) discover that in retrospect, they had significant fatigue. So categorization of such patients has been difficult.”

The role of an internist 

Given that an internist may be the first person to recognize abnormalities in blood tests, it’s important to consider the role they play in their patients’ healthcare.   

Sandy Balwan, MD, an internist at Northwell Health, refers to internists like herself as “the quarterback of all the services” since they get the ball rolling, so to speak. They are there for “the whole person” and to provide both a “physical as well as mental health check” for their patients. She notes that at a checkup, the questions asked are “universal,” meaning they are asked to all patients, providing the opportunity “to have an objective conversation with the patient without passing judgement.”

For internists, blood tests can tell an important story. Balwan explains that “bloods can reveal that something is happening” and provide “early signs before [a] patient is experiencing any symptoms,” and this offers, as she refers to it, the opportunity to conduct “surveillance.” 

When a physician has the results, they can “have an even more in-depth conversation” with the patient and, if necessary, discuss the next course of action. 

One of the very important roles an internist can play for their patient is as a navigator. Balwan refers to it as a partnership between the physician and patient.  “You need to partner with someone who can help you navigate the healthcare system,” she explains, whether it is for finding a specialist or explaining what takes place at an age-appropriate screening.

Perspective on diagnosis 

Bosworth’s diagnosis 17 years ago was a mixture of emotions. “It was definitely a surprise to me when the serologies came back,” and he notes that at that time “the awareness of celiac disease was much, much lower, and the concept of a gluten-free diet or gluten-free foods was quite uncommon.” Being an internal medicine resident at the time of his diagnosis also meant that he found “so many aspects” of his path to diagnosis “fascinating.” 

Bosworth feels very fortunate that his bloods were run. “I’m very glad that they were sent and that I was diagnosed when I was because after diagnosis and meeting with a nutritionist and going on a gluten-free diet, I also had a bone density scan done, a DEXA scan.” The results showed that his bone density was “essentially 4.7 standard deviations below that of a healthy 30-year-old male.” This meant he was in the osteoporosis zone and was at risk for serious bone issues.

His diagnosis also provided a unique perspective as a physician. “Certainly being on the patient side of things gives you a different awareness and sensitivity to challenges that patients face,” he shares. “I think that being able to give good insight into a gluten-free diet for patients…is important and really strengthens that therapeutic alliance that I form with patients who have celiac disease or gluten intolerance.”

Thinking about celiac disease

Given that there is no single symptom or path to a celiac disease diagnosis, it’s important to consider how individuals who are screened  because of values from routine blood draws fit in to how we think about celiac disease. 

“Individuals who are tested and diagnosed with celiac disease based on abnormal lab values may not have obvious symptoms of celiac disease but these findings are signs of celiac disease and the damage that is occurring in the body,” explains Maureen Leonard, MD, MMSc, Clinical Director, Center for Celiac Research and Treatment. 

For these individuals, the lab values actually might not have been there only symptom. “Often these patients, once properly diagnosed with celiac disease, find that once on a gluten free diet, symptoms they did not notice like reflux, abdominal pain, fatigue, peripheral neuropathy, and joint pains may improve.” 

As far as the role of an internist, Leonard notes that they are “a strong ally in celiac awareness and diagnosis” as are many others in the healthcare field. “As gastrointestinal doctors we must also do our best to help educate our patients and our colleagues including those who are internists, rheumatologists, OB-GYN, endocrinologists and  the list goes on. Since celiac disease is systemic and can affect any part of the body, it is important that physicians in all specialties are aware of the symptoms and signs of celiac disease.”

Susan Cohen is a New York freelance writer and a regular contributor to Gluten-Free Living.

Dining Out With Celiac Disease During Pregnancy

During pregnancy, women need to make a number of dietary adjustments. Between eating more from certain food groups, limiting others and avoiding certain foods altogether, a pregnant woman with celiac might wonder where dining out gluten free fits into her pregnancy and whether she should approach it differently.

“Though there are additional dietary precautions that all pregnant women are advised to take,” notes Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University, “there are no additional restrictions regarding the gluten-free diet that apply to pregnancy. One should always take sensible precautions to avoid cross-contamination, pregnant or not.”

While dining out is something that anyone with celiac gives a great deal of forethought to, it warrants special attention as it applies to pregnant woman.

Personal matter

During pregnancy, every woman will make choices that she feels comfortable with when dining outside the home. Mother of two Sue Moller made a personal decision to tweak how she dined out with celiac during pregnancy. “When eating out while pregnant, I definitely changed some habits,” Moller explains. “I was less willing to ‘take a risk’ on a [restaurant I was unfamiliar with] and only frequented places I fully trusted with their knowledge of safe gluten-free [preparation]—separate utensils, separate prep areas, change gloves, et cetera—and ate out less often.”

She notes that she was very thorough in how she approached communicating her needs and what she ordered. “I asked more questions than normal and would stick to ordering things that I considered safer, such as things that didn’t need to go on a shared grill or in the same oven.”

Moller notes that she did not speak to either her obstetrician or gastroenterologist about dining out during pregnancy. While pregnant with her eldest, she had been on the gluten-free diet for almost six years and “was pretty confident in my knowledge of eating gluten free and the issues surrounding this.”

Jessica Iselin, a registered dietitian with celiac, approached dining out similarly to Moller while pregnant. “I tended to stick with restaurants I already felt comfortable with from a gluten-free standpoint,” Iselin says. She also took the time to do her research before dining out. “Calling ahead was helpful if I had questions about specific menu items and wanted to be assured before I arrived at the restaurant.”

Additional dietary restrictions

For a woman with celiac, the most dramatic adjustments when it comes to eating—whether at home or at a restaurant—result from pregnancy dietary guidelines. “I recall in early pregnancy feeling somewhat overwhelmed with additional considerations when eating out,” explains Iselin. “I’ve had celiac disease most of my life, so I’m very used to scouring menus and asking all the appropriate questions about ingredients and cross-contamination.” Eating out during pregnancy “meant additional considerations, like making sure the queso fresco in my Mexican food and the goat cheese in my beet salad were pasteurized” as well as “avoiding raw sprouts and high-mercury fish,” she says.

Iselin credits those around her for helping to ensure she ate safely during pregnancy. “Luckily, my husband and friends were helpful and didn’t mind when I had to think out loud, ‘Is it gluten free and safe for pregnant folks?’”

Listeria. One of the big concerns for pregnant woman is consuming food items that could contain the bacterium Listeria. “Unlike most other bacteria, Listeria can grow in refrigerator temperatures,” explains Amy Keller, MS, RDN, LD, a dietitian and celiac support group leader in Bellefontaine, Ohio. “Pregnant women are more at risk for contracting listeriosis [the infection caused by Listeria] than those who are not expecting.”

What foods can pose a risk? “Listeria can be found in ready-to-eat refrigerated items such as hot dogs, lunch meat and unpasteurized dairy products [raw milk and soft cheese, for example],” says Keller. “For this reason, it is recommended that deli meats/hot dogs and other precooked foods are heated to a minimum temperature of 165° F and avoid unpasteurized dairy and smoked seafood.”

Mercury. Another important consideration for pregnant women is mercury content in fish. “Choose fish that is low in mercury, such as cod, salmon, haddock, shrimp, scallops and canned light tuna,” Keller advises. “These fish can be eaten safely [in 4-ounce servings] two to three times per week. If you choose grouper, halibut, canned albacore tuna or snapper, for example, limit that fish to one serving per week.”

Some fish should not be consumed during pregnancy. “Avoid king mackerel, swordfish, shark, marlin, tilefish [from the Gulf of Mexico], orange roughy and bigeye tuna,” Keller says. Make sure that fish is fully cooked before consuming. Avoid raw and undercooked fish altogether. For those with any questions on eating fish during pregnancy, Keller recommends the U.S. Food and Drug Administration’s Advice About Eating Fish chart.

FDA Fish advice chart

Speaking with your physician

Pregnant women should discuss celiac with their obstetrician. “It’s good to have a very open and transparent relationship with your obstetrician,” says Janet M. Choi, MD, reproductive endocrinologist and medical director of CCRM New York fertility clinic. “Anything that’s health related that can impact the health of the mother and the pregnancy is crucial.”

Given the role that gastroenterologists (GIs) play for individuals with celiac, is it critical for a woman to inform her GI that she is pregnant? “It can be helpful to involve a gastroenterologist during pregnancy, particularly if new symptoms such as heartburn or constipation arise,” notes Lebwohl. “It is also very important that a woman planning a pregnancy take a daily prenatal vitamin, particularly given that the gluten-free diet can be deficient in folic acid, which is essential for a developing fetus.”

During pregnancy, women should speak with their physician to ensure they are meeting both their pregnancy and individual nutritional needs.

The social aspect

Eating out is not the only way to dine with friends. A meal in can be just as—if not more—fun. Iselin spent plenty of time doing so during her pregnancy. “I also often opted for dinner-party or potluck-style gatherings with friends and family to cut back on restaurant eating a bit with the dual purpose of limiting possible gluten exposure or foods that might not be safe during pregnancy and to save money” because, let’s face it, as she notes, “babies are expensive.”

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Steps Toward Health in the New Year

Even though any day is a great day to start taking proactive health measures, the start of a new year is seen as the chance to really start focusing on health. In many respects, individuals with diagnosed celiac do not need Jan. 1 as a reminder because every day is about making choices to stay healthy by living a completely gluten-free life.

At the same time, while maintaining a gluten-free diet is necessary for one’s wellbeing with celiac, it’s only one piece of a much larger health puzzle. Gluten free or not, everyone needs to focus on taking care of themselves. The new year just happens to present a natural time to think about everything from the connection between food and disease to making healthy lifestyle choices such as not smoking and exercising regularly.

Health is a huge, overarching topic, and no article can cover every aspect of it. The goal here is to provide an overview of aspects to think about in the year ahead. As with everything health-related, speak with a health-care professional to figure out what your individual needs might be and how best to handle them.

The role of diet in health

Diet plays a significant part in staying healthy. For individuals with celiac, first and foremost, eating a completely gluten-free diet is crucial. “Staying on a strict gluten-free diet is key to being healthy in celiac disease,” explains Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University.

The types of foods included in one’s gluten-free diet, though, can be cause for concern. “While the gluten-free diet can result in alleviation of symptoms, it is not inherently healthy. Without a careful effort to have a diverse and fiber-rich food source, it can lead to nutritional deficiencies, constipation and weight gain,” says Lebwohl.

The food a person consumes has a direct connection to the development of other conditions. As a result, individuals with celiac need to make smart eating choices. “Having celiac disease does not preclude us from also getting diet-related diseases such as obesity, diabetes and heart disease,” notes Rachel Begun, MS, RDN, nutrition advocate and special diets expert.

In the long term, diet can play a huge role in health. “If someone does not eat a balanced diet, over time your body will pay the price,” says Laura Manning, MPH, RD, CDN, clinical nutrition coordinator at Mount Sinai Hospital in New York. “It is OK to have processed food here and there, but to have it on a regular basis will potentially add a lot more calories, salt, fat and sugar that you don’t need.” Eating such foods regularly has a cost. Manning explains, “When these foods are consumed too consistently, you can put yourself at risk for high blood pressure, high cholesterol and diabetes—all of which can lead to major medical issues that can be prevented with some simple dietary changes.”

Every individual has a different road to diagnosis and different needs because of it. “Everyone’s needs are going to be different, as some have nutrient deficiencies, some may have other conditions to consider, and some may be overweight while others are underweight,” Begun says. As a result, “I recommend that all people diagnosed with celiac disease see a registered dietitian knowledgeable in the gluten-free lifestyle so a healthy eating pattern can be established and the individuals’ needs can be addressed,” says Begun. When it comes to finding a registered dietitian well-versed in the gluten-free diet, Amy Keller, MS, RD, LD, emphasizes that “It’s worth doing . . . even if you have to travel a little bit.”

One of the overall health concerns that can arise on the gluten-free diet is weight. Lebwohl notes there are several reasons for weight gain following a celiac diagnosis. “When gluten is eliminated, the intestinal villi gradually heal, and this can result in an increased ability to absorb calories.” Then there is the issue of the ingredient profile of some gluten-free foods. “Gluten-free substitute foods often have more calories than their gluten-containing counterparts,” Lebwohl warns, and this is connected to another reason for weight gain—“a diet low in fiber may diminish the state of feeling full, increasing hunger and caloric intake.”

When it comes to eating, individuals sometimes try to find a substitute for everything they were eating. “The biggest thing I see, a lot of my patients kind of gravitate toward trying to replace everything they’ve ever enjoyed, and they end up with a diet full of high fat, high sugar,” explains Keller. As a result, “they take in less-nutritious foods or they end up taking in more calories than they intended.”

When it comes to patients who need to gain weight following the diagnosis, Keller notes, “You want to regain the weight in a healthy way—protein, healthy fats, whole grains, those types of things, rather than necessarily cookies, cakes and pretzels.”

A well-rounded diet

So what does a well-rounded diet include? “A well-rounded diet means that your meals are consumed on a timely basis and they contain the major food groups: whole grains/starches, fruits, vegetables, lean proteins and healthy fats,” says Manning.

As Begun notes, “The ironic thing is that many of the foods we recommend to the general population for a healthy diet are naturally gluten free, including fruits, vegetables, dairy, beans, nuts, seeds, eggs, fish and moderate amounts of meat and poultry.” When it comes to the gluten-free diet, “The only category where recommendations must be tailored,” she points out, “are grain-based foods, and there are plenty of gluten-free whole grains to choose from, including all rices, quinoa, millet, corn and certified gluten-free oats.”

Whole grains are an important part of a well-rounded diet. Someone who is eating “the whole grain versus the packaged food,” says Manning, “will benefit from the higher fiber content, and all the nutrients remain intact before it is all processed away. This helps with better blood sugar control and [is] less likely to add unwanted pounds.”

Gluten-free whole grain products are more readily available these days. “It used to be it was very difficult to find a whole-grain gluten-free item, and that’s not the case anymore,” says Keller. The same can be said for fortified gluten-free foods. “The nutritional profile of some of these processed foods…are improving with fortification and things like that to make them similar to their gluten-containing counterparts. But people need to not assume. They need to read the label and look for iron-fortified cereal and look for something that is not high in sugar.”

An important aspect of one’s diet is to “eat a minimum of five fruits and vegetables a day,” explains Manning, and to think about variety as well as what types of produce are growing closest to your home. “It helps to also have lots of different colors in the fruits and vegetables you choose as well as trying to eat seasonally and locally. This will also optimize your nutrition because the nutrient retention will be at its highest.” When it comes to hydration, “drink mostly water, not sugary beverages,” she says.

Keller notes that “getting calcium and vitamin D are huge.” She says that anyone with lactose intolerance should find ways to obtain these nutrients from non-dairy foods, also citing protein as a vital component. “We know protein is satisfying, particularly if someone is trying to lose weight. Protein is a satisfying thing, so making sure they’re getting adequate protein in their meals [is key].”

Additionally, she says iron is something to think about. “Most of my patients end up sort of starting in that iron-deficient category, so making sure that they are getting good sources of iron [is crucial].” Keller shares that “you want to pair anything like that, that’s high in iron, with something that’s high in vitamin C. So my example is pairing a hamburger with a cup of tomato soup to help absorption of that iron with the vitamin C.”

Thinking about heart health

Taking care of one’s heart is very important. “Like anyone else, adults with celiac disease should have their blood pressure and cholesterol checked and addressed,” explains Lebwohl.

When it comes to heart health, getting checked out is the only way to know what is happening inside. “Most people walking around with elevated blood pressure [are doing so] without knowing it,” says Guy L. Mintz, MD, FACC, director of cardiovascular health and lipidology, North Shore University Hospital, associate professor of medicine, School of Medicine at Hofstra/Northwell and NYU School of Medicine. As a result, “it is important to have your blood pressure checked on a regular basis.”

Blood pressure is a concern because of its impact on the heart. “High blood pressure causes blood vessels to constrict instead of dilate,” says Mintz. “When the vessels constrict, more internal damage can occur, allowing for more cholesterol to build up inside these vessels.”

With cholesterol, Mintz explains, “It is important to know your cholesterol numbers. These are done as part of a routine blood test. There is total cholesterol, triglycerides, HDL cholesterol (good cholesterol that is protective for heart disease) and LDL cholesterol,” which Mintz explains is “bad cholesterol”—and a good way to remember that is “‘L’ is for lousy.”

This cholesterol is certainly lousy. “LDL is associated with heart disease,” Mintz says. “Think of LDL as ‘sticky cholesterol’ because it penetrates in the walls of blood vessels, causing progressive blockages in these arteries. You want to keep your LDL cholesterol level low and your HDL cholesterol high.”

Weight also plays an important role in heart health. “Being overweight is associated with multiple risk factors for heart disease,” says Mintz. “These include high blood pressure, high cholesterol, increased risk for prediabetes or metabolic syndrome, and diabetes. Some obese patients develop sleep apnea, which is when a patient temporarily stops breathing or develops shallow breathing at nighttime.” Sleep apnea can cause a number of problems and “is associated with irregular heartbeat” as well as “daytime fatigue and, in some cases, snoring.”

He says, “Improving the risk factors for heart disease can reduce the chance of a heart attack by decreasing inflammation and cholesterol buildup in the blood vessels.” Part of reducing risk is diet. Mintz points out, “General dietary tips include reducing daily total cholesterol to less than 200 milligrams [mg] per day, no added salt and try to keep your sodium-salt intake to less than 2,300 mg of sodium per day.” One great way to reduce sodium intake is to cook at home because, as Manning notes, “eating more home-cooked meals can help to lower your chances of excessive salt and fat intake that so many processed foods contain.”

As with anything health-related, Mintz states that “each individual should have their risk factors and diet evaluated, to personalize a lifestyle program that will succeed for them.”

Risks of smoking

While the dangers of smoking are widely known, individuals continue to smoke, including individuals with celiac. “There are patients who take extensive measures to stay strictly gluten free and yet continue to smoke cigarettes,” says Lebwohl. In addition to causing cancer, smoking also damages the heart and blood vessels, along with just about every other organ in the body. “Smoking promotes irritation or inflammation of the blood vessels in the heart and further promotes cholesterol buildup,” explains Mintz. Additionally, “smoking has been associated with an increase in heart disease in women.”

Get moving

The benefits of exercise are body wide. As Manning notes, “It is an integral part of wellness that needs equal attention to diet.” She points out that ”Getting daily exercise can help keep you mobile, build lean muscle mass, increase bone density, increase your cardiovascular level and lower your risk for chronic disease.” The concern about bone density is important, particularly as people get older. “Exercise helps to maintain muscle for balance and bone density to prevent fractures,” Manning explains. In addition to the physical benefits, “exercise is also a great way to relieve stress,” she says.

“Regular exercise can lower blood pressure, reduce cholesterol, lower blood sugar, promote weight loss and make the heart stronger,” explains Mintz. The heart is a muscle, and it becomes stronger with regular aerobic exercise, such as running, swimming or bicycling, leading to improvement of the risk factors for heart disease and reducing cholesterol plaque formation in the arteries of the heart.

So how much exercise is necessary for heart health? Mintz says, “I tell my patients to maintain the rule of 4s. This is 40 minutes of regular continuous aerobic activity 4 times a week to achieve 4 benefits: improvement in blood pressure, blood sugar, cholesterol and weight, as well as strengthening the heart.”

While 40 minutes might sound like a lot, it’s easier to achieve than one thinks. “You do not need to run,” says Mintz. “Walking is as good as running. The goal is to increase your heart rate above its resting level and continue for at least 40 minutes.” People can get creative with how they accomplish their exercise. “I have patients that live in apartment buildings and do not have access to [workout] facilities [so they] walk throughout the apartment for 40 minutes without stopping.”

Healthy changes take time

Change is always hard, especially when it comes to health. Keller notes, “Any little change you make that you can sustain is a good change—maybe it’s a change that you make over the next six weeks [such as] adding one or two fruits and vegetables every day. I mean, that’s a huge change for people.”

When it comes to working on health, doctors play an integral part and want their patients to succeed. Mintz sees the patient and doctor relationship “as a team approach, and I support [my patients] throughout the journey, including the highs and lows. Our goals are the same, and it’s important to understand that each person’s journey is unique.”

Steps for a healthier 2019

From eating a well-balanced diet to finding ways to be active, there are many steps that can be taken to be healthier in 2019. To figure out what is best for you, it’s important to speak with a health-care professional and come up with a plan together.

  • A well-rounded gluten-free diet includes gluten-free whole grains, fruits and vegetables, protein from animal sources such as eggs, fish and poultry, as well as plant-based protein sources such as beans, nuts and seeds.
  • Get your cholesterol and blood pressure checked.
  • Quit smoking.
  • Work a bit of physical activity into every day. It can be something as simple as walking, and the benefits extend across the body.

Remember, change takes time, and any positive change you make—and maintain—is a step in the right direction!

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.


Your Essential Holiday Helper

From parties to presents, the holiday season is a wonderfully exciting time and also quite a busy one. With so much to do to spread cheer among family and friends, we wanted to help you navigate this festive but hectic time of year.


Whether you are the only member of your family with celiac or hosting more gluten-free diners than not, the holidays should be about celebrating this season of joy. Just as you navigate the rest of the year gluten free, you can do the same during the holidays. All it takes is a little forethought.


Planning holiday meals

Gathering loved ones around the table to celebrate is one of the most wonderful aspects of the holiday season. After a year of juggling work and school, the time between Thanksgiving and New Year’s is a chance to concentrate more on spending time with friends and family.

As you know, gathering for special meals can get complicated when you have celiac, gluten intolerance or other dietary restriction. You might wonder if the spread will include gluten-free options, cross-contamination will be a concern or you should offer to bring something.

Whether you are host or guest, you will need a plan. Approach planning with a positive attitude—your opportunity to contribute something special.

When possible, offer to host the meal. Sometimes family and friends are relieved to be guests and not hosts. Who doesn’t love arriving to a home filled with aromas of a delicious meal? While hosting entails a lot of responsibilities, overseeing the menu and preparation actually allow you to relax knowing that your meal will be safe and worry free. This is also a fantastic opportunity to show everyone how delicious gluten-free cooking can be, and you might even inspire others to start making these dishes when you are their guest.

If you are not the host, you will need another kind of plan. This is especially true if you have recently been diagnosed and just begun a gluten-free diet. If this is the case, family and friends are not yet experienced with gluten-free cooking. At a point, many of them will master gluten-free recipes, find tasty gluten-free products and become knowledgeable about cross-contamination. There is, however, a learning curve, and it will take time for everyone to understand what hosting a person with celiac entails.

Whether your family and friends are novices or pros at hosting a gluten-free diner, the best thing to do is plan ahead. Talk with the host about the dishes planned for the meal. Ask if there are gluten-free options or whether anything can be tweaked to omit gluten. You can even offer to come over early and help with the preparation.

Ask if you can bring anything, even if it’s just for you. Some hosts might even prefer you to bring your own safe option to enjoy so they don’t have to worry about cross-contamination in a hectic kitchen. While this might be a little frustrating, honesty is the best policy. If someone feels they cannot provide a gluten-free plate, that is OK. The most important thing during the holiday season is being together—not whether you are eating the same meal as everyone else.

Gluten-free dining family style 

For Karen of Healthy Gluten-Free Family (, food and family go together. “On a personal level, both my husband and I come from big Italian families where food is important, especially around the holidays, where there are lots of longstanding traditions,” she explains. Even after her son was diagnosed with celiac eight years ago, the family found a way to continue their traditions gluten free.

“We have been fortunate in that both our families have embraced and supported our son’s celiac disease. So much, if not all, of the food at holiday celebrations is now gluten free,” she says. “It started with just making sure his favorite dishes plus ones we thought he would like to try were gluten free. Now just about everything is gluten free or has a gluten-free alternative, even at large family events.”

For example, Thanksgiving dinner will feature a turkey with gluten-filled stuffing, but she will make sure her son has a roast chicken and gluten-free stuffing. “He is just as happy [with this option],” she says. The family prepares the core sides—including mashed potatoes, cranberry sauce and the like—gluten free, and her son also always has a gluten-free dessert.

Like Karen, Michael De Cicco-Butz, founder of the gluten-free luxury lifestyle website, also comes from a family where, as he notes, “food was always at the center of our holiday traditions.” This is still very much the case for him after being diagnosed with celiac more than two decades ago, as well as a shellfish allergy.

De Cicco-Butz shares that his family has been instrumental in ensuring that his holidays are as rich and delicious now as they were prior to his diagnosis. “I have now been [a] diagnosed celiac for more years than not, so it is just part of who I am now, and thankfully my family has worked so very hard over the years to learn about the disease and make sure that our holiday meals go off without a hitch.”

Part of what makes this season so special is that he comes from an Italian family and he is married to a Bermudian, and both sides have wonderful traditions that De Cicco-Butz can enjoy gluten free.

His mother has worked hard over the years to come up with a gluten-free version of the Italian dessert struffoli. “I now enjoy a gluten-free version of a dessert that evokes so many wonderful childhood holiday memories in each bite,” he says.

The years that he celebrates the season in Bermuda, his in-laws make sure he is well fed. In fact, as he notes, “my in-laws have not only introduced me to their holiday traditions, they have lovingly created gluten-free versions to make sure I never have to go without.” From serving a gluten-free cassava pie to using arrowroot for the gravy to his father-in-law making a gluten-free version of his famed stuffing, De Cicco-Butz’s in-laws have mastered the gluten-free diet for him.

Thanks to all of his family’s efforts, De Cicco-Butz has a wonderful perspective on his celiac diagnosis. “The holidays are all about family, and I honestly believe that my celiac diagnosis has brought my families even closer together. In my family, food is synonymous with love, and there is no greater love than a family looking out for each other and making sure everyone can enjoy traditions past.”

Attending holiday parties at restaurants and venues 

From friends-giving to work parties, the period between Thanksgiving and New Year’s sees numerous celebrations at restaurants and catering venues. When attending a holiday party at such establishments, do not assume that gluten-free options will be available. Plan ahead to make sure a holiday party is spent in good cheer—not worrying whether there will be gluten-free options or spending the evening hungry if there is nothing available.

Lindsey Schnitt, a professional living in New York, was diagnosed with celiac disease 10 years ago. In that time, she has learned how to navigate attending events in all sorts of environments.

When it comes to parties given by family or friends, she says they always make sure to have options for her. The same is true when it comes to her work colleagues. “I’ve been lucky enough that the people I work with and the friends I’m social with point me out or have already spoken [to the establishment] before I show up to a party I’m not planning.”

For work-related holiday events at a restaurant or venue where the host may not know her needs, Schnitt will take the time to reach out to the establishment beforehand. “For me, I’m outspoken,” she explains. “I have no problem asking beforehand, calling the restaurant” to introduce herself and explain the gluten-free diet. She notes that when reaching out, “you always have to find the right person to speak to” about the gluten-free diet, especially regarding cross-contamination.

Schnitt takes the time to explain cross-contamination and why it poses a problem for her. She will let them know that “I get very sick from cross-contamination.” Once she has reviewed all aspects of gluten-free dining, she will evaluate whether she can eat something already on the party menu or something else can be prepared for her.

Schnitt has important words of advice about asserting oneself and one’s needs: “I think it’s important to be vocal and to know that it’s OK to be gluten free, and I find now that it’s been 10 years for me, I just need to remind myself to be as strict as I was on day one.”

Regardless of whether or not there will be gluten-free options available, Schnitt always eats beforehand and makes sure to carry a bar with her in case. In fact, she has a terrific outlook on attending parties: “I always go in hoping I’ll have a second dinner, but I certainly don’t expect that.”

Gluten-free holiday reminders

When gathering for the holidays with family and friends, if there is going to be gluten on the table, one has to think about cross-contamination. Cross-contamination can occur as easily as putting the stuffing spoon in the bowl of roasted carrots, which started out gluten free but now will have gluten-containing stuffing crumbs. 


If your host is preparing both gluten-filled and gluten-free dishes, make sure safeguards are in place to prevent cross-contamination during both cooking and serving. In the kitchen, clean cutting boards, strainers, pots and pans should be used when cooking or heating food (since often dishes are prepared the day before or earlier that day). Ensure nothing is prepared or heated on a surface that has just been used for a dish containing gluten. For some, this might mean designating a spot in the kitchen where only gluten-free items will be cut and prepared as well as using labels to help identify dishes that do or do not contain gluten. 


When it comes to dining, if the meal is being served buffet style, make sure to serve yourself first before there are any risks for cross-contamination. If items are being passed around the table, make sure that you either take first or ask if it would be possible to have everyone pass around the gluten-free items first, before the gluten items are shared. 


If you are ever worried that dishes might become cross-contaminated during the meal, make yourself an additional small plate so you will have the option to take seconds without having to worry.

Extraintestinal Celiac Symptoms in Kids

Headache, short stature, bone and joint issues, mood changes and other
non-gastrointestinal problems could be signs of celiac

Years ago, celiac in children was associated with malabsorption, watery diarrhea and loss of both weight and muscle. However, these symptoms are less likely today. In fact, when this set of symptoms presents itself, explains Alessio Fasano, MD, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, “we call students—you know residents, fellows—and say, take a picture here, you’re not going to see this anymore.”

While gastrointestinal symptoms still occur in children with celiac, the presentation has shifted. “We see kids with stomachache, or vomiting, or even constipation [with] no diarrhea that have celiac disease. They’re still classified as GI [gastrointestinal] symptoms, but they are so vague that they can be labeled as IBS [irritable bowel syndrome], they can be labeled as chronic constipation,” says Fasano. The symptoms are “not as straightforward [as] the typical malabsorption presentation with…watery diarrhea, weight loss, muscle wasting, and so on and so forth.”

Coupled with a change in the gastrointestinal presentation, another change is afoot for children with celiac. “In the past, the GI symptoms were the most frequent way that celiac disease [presented] in pediatrics. Not anymore,” notes Fasano. Presently, “it’s not unusual—actually it’s more frequent than before—that kids may present with extraintestinal symptoms, and the top of the list,” he notes “is anemia and, with that, chronic fatigue.” Those are just two of a longer list of extraintestinal symptoms, which afflict parts of the body other than the digestive system. The increase in rates of extraintestinal symptoms in children warrants a deeper look.

A deeper look

The term extraintestinal might be a new one, even for those who received their celiac diagnosis years ago. Rather, you may be more familiar with the phrases “typical” versus “atypical” in regard to presentation of celiac.

Fasano notes that symptoms closely associated with malabsorption were considered “typical” because the diarrhea, weight loss and a big belly were the classic signs of celiac. “That nomenclature has been abandoned,” he says, “[and] now we talk about intestinal/extraintestinal symptoms and the reason why…the GI presentation of celiac disease is not typical anymore.”

According to Fasano, roughly 60 percent of children with celiac exhibit intestinal indications while 40 percent experience extraintestinal symptoms. There is, he notes, a “gray area” in that some children will present with both gastrointestinal and extraintestinal symptoms.

In children, bone issues can indicate celiac. “Certainly patients with recurrent fractures or bone fragility [are] worth…screening for celiac disease,” says Norelle Rizkalla Reilly, MD, assistant professor of pediatrics at Columbia University Irving Medical Center and director of pediatric celiac disease at the Celiac Disease Center at Columbia University.

Related to fracture and bone health, children can experience “joint issues—joint complaints with swelling or without swelling—that seem to materialize and increase over time concerning the difficulties to do their sport and physical activities that they used to.”

Growth in general, and as it pertains to puberty, is another area of concern. Children “can present with issues dealing with failure to thrive so they’re short or…girls can have late menarche, so they start their periods much later than they’re supposed to,” says Fasano.

Reilly adds, “Just realizing that your child’s shoe size hasn’t increased” or he or she “hasn’t gone up a size in clothes [when expected]” could indicate a problem with growth.

Additionally, children can present with a rash that can be “very painful to deal with,” says Fasano. “The skin manifestation can be the classical dermatitis herpetiformis [DH, the most common skin symptom of celiac]…[but it could also be] a form of skin reaction [that is] not necessarily DH…more in the eczema category,” he explains.

Often-overlooked symptoms

“Probably the most intriguing—and now ramping up—way that the disease presents itself is with behavioral or neurological symptoms,” says Fasano.

Both Fasano and Reilly mention headaches. “[There is] probably under-recognition of the possibility of celiac disease in somebody with recurrent headaches,” notes Reilly.

With changes in behavior, “some kids…have more than normal mood swings. Others…show clear signs of anxiety and depression,” Fasano reports. “It’s not unusual for us to have kids …come to our clinic [who have] been worked out by…a psychiatrist [or] psychologist and put on the typical medication,” but the symptoms do not go away. When this happens, “eventually, either the family or the health-care provider starts to think about the possibility of something unusual, and they question the possibility of celiac disease.”

For children in this zone, it’s almost a process of elimination to determine the root cause of the problem. Fasano says, “If [a child is] depressed or anxious, you start by [asking whether] anybody else in the family [deals] with the same problem. [Did] anything happen in the family? Did something happen at school—is the [child] being bullied?” As he points out, if there is not “a clear…reason why this kid [is starting] to have changing…moods, you need to open your eyes to the possibilities and…go to the second tier of possibilities,” which can entail screening for celiac.

The relationship between the gut and the brain will likely receive more attention going forward. “The gut-brain axis is such a hot topic nowadays,” says Fasano. “And celiac disease is a good paradigm of how this cross-off between the gut and the brain is not one-way, as we believed before, that the brain influences the gut function—it can be the other way around. The gut can influence brain functions.”

Pinpointing extraintestinal symptoms 

With extraintestinal presentations covering such a wide range of signs, it can be hard to pinpoint when a symptom is connected to celiac. How is celiac, as opposed to another condition, determined as the cause?

“That’s the major challenge that we face on a daily basis when we deal with the diagnosis of celiac disease,” says Fasano. “It is very, very challenging. You need to have your level awareness,” which means that “celiac disease [is] in your radar screen, otherwise you usually miss it,” which is “the reason why we always advocate that low threshold to screen for celiac disease.”

When it comes to figuring out whether a child’s symptom is connected to celiac, Fasano explains that “the proper way to approach [a] problem in medicine is to think in terms of hierarchy of possibilities, from the most frequent to the most severe.”

This type of approach is warranted when evaluating concerns about “deceleration in weight gain or growth,” says Reilly. For example, if parents think that their child “may not be growing as expected, it’s always worth a check-in to make sure that [his or her rate of growth is] OK, especially as kids get closer to puberty or for kids that are very young.”

It remains unknown whether delayed puberty is directly linked to celiac “because in some cases delayed puberty can be hereditary,” Reilly says. However, when such a delay occurs in an adolescent with celiac, “we view it as a good thing [because he or she] still has some growth potential,” she explains. “We have [an] opportunity for recovery [following a diagnosis] in that sense.”

Asymptomatic Celiac Disease

When then 15-year-old Sam Frolichstein-Appel’s family went to the University of Chicago Celiac Disease Center in 2011 for a family screening, there were no indications that he might have celiac. His uncle, Michael Frolichstein, host of “The Celiac Project Podcast,” had been diagnosed with celiac after what Frolichstein-Appel describes as “a lifetime of symptoms that doctors couldn’t place.” But it was one of Sam’s brothers, Abe, who was experiencing “some gastrointestinal issues,” Sam explains, and the family was “wondering if he could also have celiac.” At the Celiac Disease Center, Sam and Abe, along with their brother and 2-year-old cousin, were screened for celiac.

Several days later, Sam’s parents called him downstairs to share the results. “My response, without even thinking, was to immediately blurt, ‘It’s Abe, right?’” Even though his brother had been experiencing gastrointestinal symptoms, it was Sam’s blood work—not Abe’s—that had come back positive for celiac. The news was so unexpected for him, and in that moment, he says, his parents “just looked at me until I realized that I had been called downstairs for a reason, and not Abe.”

Sam had every reason to be surprised by the screening’s results. “I had never fathomed that I could have it, as I was always fairly healthy and had never had problems with eating or my diet,” he says. “There was no indication that I wasn’t absorbing nutrients until my endoscopy showed that my villi were entirely worn down.”

What is asymptomatic celiac disease?

Celiac disease has symptoms that range from gastrointestinal to neurological to dermatological and beyond. While many individuals who are diagnosed exhibit symptoms, not everyone does. In fact, just like with Sam, a diagnosis of celiac does not necessitate the presentation of symptoms. These individuals go about their lives without anything feeling wrong. That, however, does not mean that gluten is not causing problems.

“Asymptomatic celiac disease is [found in] an individual that, despite positive antibodies, despite the damage in [the small] intestine as showed by endoscopy, you will not experience any signs or symptoms,” explains Alessio Fasano, MD, director of the Center for Celiac Research and Treatment at MassGeneral Hospital for Children and professor of pediatrics at Harvard Medical School.

The question arises, why do some people present as highly symptomatic and some without any signs at all? Presently, this is not yet understood, says Fasano: “There is still a lack of understanding why some people, despite the inflammation there, they don’t have symptoms.” Right now, he explains, “the general wisdom that probably will be correct is that the [small] intestine is a long tube; in an adult, it’s an average [of] 20 feet long, and when we do the endoscopy, we look at only the first few inches. So it’s intuitive that if your damage is only at the very beginning and the rest of the intestine is spared, you may be more in the asymptomatic group.”

When it comes to asymptomatic celiac disease, the true absence of symptoms can be put into question because everyone has a different perspective on how they feel. Due to this, Fasano says, “It’s hard to say, because the definition of symptoms or lack of symptoms, it’s a threshold that is very subjective, and people have a different way to perceive if they’re healthy or not.” He says “this line is not black and white;” rather, “it’s very finicky” and leads to trying to figure out if someone is truly asymptomatic. He will, as he explains, “dig into details if really this individual is asymptomatic by asking, ‘Do you have some extra gas? Are you tired more than often? Do you have issues with bloating on and off?’ And I can go through the list.”

Are you truly asymptomatic?

Fasano finds some patients diagnosed as asymptomatic will feel differently after they begin the gluten-free diet. “They come back and say ‘Oh boy, I didn’t realize I was so tired. I thought because I had kids to deal with and I wake up at 6 o’clock in the morning’” and this was the source of their fatigue. Other patients have told him, “You know, that extra gas, I thought everybody had this kind of gas. Now I feel less bloated and less gas, less stomachache and so on and so forth.”

The reality is that “it’s very, very difficult, particularly when we talk about subjective symptoms, to establish who is truly asymptomatic,” Fasano explains. However, he notes, “such an entity exists. We are aware about that because of this screening in family members that are higher risk with celiac disease,” which leads to the diagnosis of a family member. Since celiac runs in families, it’s important for family members to be tested. When it comes to screening for celiac, the “top priority would be first-degree relatives,” says Fasano. “So mom, dad, brother, sister. There is also a slight increase with second-degree relatives, so uncles, aunts, cousins, niece, nephew, grandparents, they also need to be screened.”

Individuals with asymptomatic celiac disease can also be detected when “somebody has comorbidity that we know to be associated with celiac disease, let’s say somebody with Hashimoto’s, type 1 diabetes, Down syndrome,” Fasano explains. As a result, these individuals will be screened for celiac whether or not they have symptoms.

Just as symptomatic celiac can be diagnosed at any age, so, too, can asymptomatic celiac disease. “Children can be as asymptomatic as adults, but the risk of starting puberty with active celiac disease (even without symptoms) with the subsequent impact on their final growth is a concern that deserves even more attention to properly identify asymptomatic subjects among them,” explains Fasano.

Starting the diet after diagnosis 

According to Fasano, “The real question that everybody that’s been diagnosed with celiac disease with no symptoms is: ‘What is my investment for going on a gluten-free diet? Why should I do that? I feel well. I don’t want to go on a diet,’” he says. The answer has to do with the consequences of long-term inflammation and therefore, “you try to do interactive intervention…to prevent the consequences of a chronic inflammatory autoimmune process [that left] ongoing will eventually lead to.”

This is a conversation Fasano often has with teenage patients who have been diagnosed with asymptomatic celiac disease. When they ask why him why they should follow the diet, he tells them frankly, “You can have diarrhea, you can lose weight or you can develop diabetes, or you can have Hashimoto’s, or you can have the bones that will break, or, worst-case scenario, very rare but possible, you can develop cancer.”

Individuals diagnosed with asymptomatic celiac disease need to begin the gluten-free diet to prevent further damage. “So, if you are already in a situation in which you have a condition that is creating an autoimmune issue to your gut, it’s obvious that it’s only a question of time that this will eventually, sooner or later, result in signs or symptoms that can affect your lifestyle,” Fasano explains. Due to this, “you will be much better to prevent what can happen down the road by going on a gluten-free diet rather than to wait until the storm comes to your doorstep.” In other words, “It’s much more complicated to fix something that is already broken.” So, he notes, “there is a strong incentive” to following the gluten-free diet “because you have return on [your] investment.”

The question arises whether someone diagnosed with asymptomatic celiac disease should approach the gluten-free diet differently than someone who has been symptomatic. “Those with and without symptoms need to consider the same nutritional principles—balance, variety and, most of all, staying 100 percent gluten free,” explains Amy Keller, MS, RDN, LD.

Additional issues

She notes that a lack of symptoms can add extra issues. “I think those with asymptomatic celiac disease do face an additional challenge, however, in terms of staying motivated to be compliant. If you don’t have immediate negative feedback from consuming gluten—you don’t have an upset stomach or diarrhea—it can be easier to say ‘one bite won’t hurt.’”

To help adjust to the gluten-free diet, she recommends finding a few new favorites and indulgences. “It’s important to look at substitutions that may make life a little easier or happier. If you enjoy pretzels at lunch, find gluten-free ones that you enjoy,” she says. However, Keller notes, “don’t let the gluten-free diet be a license to have a ‘junky’ diet if you didn’t have one before. Keep half your plate fruits and vegetables, add in lean protein, dairy if you tolerate it and gluten-free whole grains.”

Post-diagnosis perspective

Sam noticed some changes following his diagnosis. “Even though I didn’t exhibit symptoms,” he says, “I felt better after removing gluten from my diet.” Once on the diet, “I had a noticeable increase in energy and felt generally healthier.” But he also wonders if there might also be “a placebo effect.” Either way, he is now a healthy and busy college student who has a great deal of perspective on his diagnosis and the ways it has enriched his life.

While the diet took some adjustment, he finds that it has empowered him. He says, “Celiac has forced me to advocate for myself in a unique way that I wouldn’t have achieved if I hadn’t been forced to. This advocacy extends beyond dining and into other aspects of my life, and has been surprisingly beneficial.”

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

When You Have Celiac But Gluten Isn’t Causing Your Gastrointestinal Issues

What happens when an individual with diagnosed celiac experiences gastrointestinal (GI) symptoms? GI issues such as bloating, constipation and diarrhea are common celiac symptoms, so an individual may assume such discomfort is the result of inadvertently consumed gluten or cross-contamination. While this certainly could—and for some individuals, will—be the case, gluten may not be the cause of these symptoms for others.

“Though the majority of patients with celiac disease have a marked improvement or resolution of symptoms after starting a gluten-free diet, about a quarter to a fifth of patients at any given time report that they have either persistent symptoms (i.e., the symptoms did not entirely go away) or recurrent symptoms (i.e., the symptoms initially improved and then came back),” explains Benjamin Lebwohl, MD, MS, director of clinical research at the Celiac Disease Center at Columbia University. “This is one of the most common reasons people seek evaluation at a celiac disease center. The most common cause of these symptoms is gluten exposure, but there are a number of other causes.”

Something feels “off”

Not every GI symptom is cause for concern. Individuals with diagnosed celiac can experience GI episodes like anyone else. “It is common for patients with celiac disease to assume that an episode of gastrointestinal distress is due to gluten exposure, but they are prone to the same kinds of episodes of food poisoning or gastroenteritis as everyone else,” says Lebwohl.

One’s dietary choices, for example, can lead to GI upset. As Laura Manning, MPH, RD, CDN, clinical nutrition coordinator at The Mount Sinai Hospital, points outs, certain items in larger quantities—such as alcohol, sugar or even too much coconut oil—can cause diarrhea in some individuals. Manning also notes that choices within the gluten-free diet can lead to constipation.

“Very often, someone will embrace the gluten-free diet/lifestyle and then purchase a lot of foods that are packaged—gluten-free cookies and breads and so forth”—and these products contain refined flour as opposed to whole-grain ingredients, Manning says. While these items taste good, splurging on them “can also lead to constipation.”

For these patients, Manning will review their dietary habits and suggest healthier alternatives. “I probably can identify that they have a lot more processed gluten-free products in their diet and will have them switch over to whole grains in their most wholesome form, as opposed to milling down the flours,” she says. She recommends that patients focus on including whole grains such as quinoa and brown rice, fruits and vegetables, and also increase their hydration.

Accidental gluten ingestion might not explain recurring GI distress in someone with celiac. “When these [symptoms] occur frequently, gluten exposure is a possibility, but it is important to consider other causes beyond celiac disease,” says Lebwohl. “This should be done with the guidance of a clinician experienced in the management of celiac disease.”

Is gluten the culprit?

The first step in determining whether frequent GI symptoms are caused by gluten exposure is visiting a physician.

First and foremost, explains Rupa Mukherjee, MD, attending gastroenterologist at Beth Israel Deaconess Medical Center in Boston, it is “important to make sure that the diagnosis [of celiac] has been confirmed, since there are other causes for villus atrophy, or inflammation of the small bowel, that can overlap with celiac.”

Following a confirmed celiac diagnosis, “The first step would be making sure through a meticulous dietary evaluation that there isn’t gluten exposure from some source that the patient is not aware of,” she says. To obtain this dietary history, Mukherjee says that “it’s often helpful to do this under the guidance of a celiac dietitian—someone trained and experienced in celiac-related dietary issues.”

“I generally ask every patient of mine with celiac disease what their gluten reaction is—if they even have one, since not everyone does,” says Mukherjee. “Some patients can be asymptomatic, and for them, that’s very frustrating because they don’t know if and when they have been exposed to gluten.”

Those patients who do experience symptoms “have a good sense of what their gluten reaction is, so they can tell soon after eating out if they were exposed to gluten or not.” She also points out that “the symptoms that characterize a patient’s gluten reaction can change with time.”

A patient should share every symptom with his or her physician, and disclosing new symptoms is especially crucial. “But it’s important to put it into perspective that if a patient develops a new symptom, such as constipation, that this is not necessarily due to having celiac disease or getting exposed to gluten,” Mukherjee says. “In these cases, it’s important that the patient discusses new symptom onset with their physician or gastroenterologist.”

Once it has been determined that a patient with confirmed celiac is not being exposed to gluten yet is still experiencing GI distress, Mukherjee says, “there are other etiologies/conditions for ongoing symptoms that need to be considered and evaluated for.”

Two possible causes

A patient with diagnosed celiac who is strictly adhering to the diet but experiencing diarrhea and abdominal cramps could have microscopic colitis. The condition, Lebwohl explains, occurs when “the colon (large intestine) becomes inflamed on a microscopic level—the naked-eye appearance of the colon is normal (or sometimes slightly red) on colonoscopy, but biopsies show injury.”

The cause of this condition varies, “but in some patients medications such as anti-inflammatory medicines such as ibuprofen can be a trigger,” says Lebwohl. However, gluten could still play a role. “In people with celiac disease, gluten exposure can sometimes be a trigger [of microscopic colitis].

“There are several medications that are used to treat microscopic colitis, including bismuth (i.e., Pepto-Bismol), and, in some cases, medications that decrease inflammation in the intestine such as budesonide,” says Lebwohl. For individuals with microscopic colitis caused by taking anti-inflammatory medicines, “simply stopping the medication is often sufficient to result in improvement.”

Another possible condition, small intentional bacterial overgrowth (SIBO), occurs when there are excessive bacteria in the small intestine.

“Small intestinal bacterial overgrowth occurs when the quantity of bacteria that live in the small intestine increases,” Lebwohl explains. “In the normal state of affairs, bacteria are most abundant at the end of the small intestine (the ileum), but in SIBO, bacterial quantities increase closer to the middle of the small intestine (jejunum).” As a result, a person can experience “difficulty digesting fats and impaired absorption of certain nutrients, such as vitamin B12.”

Diagnosis and treatment of SIBO are relatively straightforward. According to Lebwohl, “this condition is most commonly diagnosed via a breath test that measures bacterial quantities after ingesting a sugar compound (glucose or lactulose), and can be treated with a course of antibiotics.”

Irritable bowel syndrome

Individuals with diagnosed celiac could also have irritable bowel syndrome (IBS). IBS is a functional bowel disorder, a condition “defined by the presence of typical symptoms [that] span everywhere from the mouth all the way to the anus,” explains William D. Chey, MD, FACG, AGAF, FACP, RFF, medical director of the Michigan Medicine Bowel Control Program.

“[Functional bowel disorders] are multifactorial in terms of their cause,” Chey says, meaning that determining the specific reason such conditions occur is often not possible. “It would be wonderful to be able to say to you, well, they’re all related to abnormalities in the ways the bowels contract and in motility, or they’re all related to problems with brain/gut interactions and a visceral sensation in the GI tract to any of a variety of different kind of stimuli to any kind of food or stress. But the reality is they’re more complex than that. So while those types of factors are important, a host of other factors likely also play a role.”

Functional bowel disorders are quite common. “Probably on the order of 30 to 40 percent of people in the general population have GI symptoms at some point in time over the course of the year,” says Chey. “Probably 20 to 30 percent will qualify for a formal diagnosis of one of those functional GI disorders.”

IBS is “defined by the presence of abdominal pain and altered bowel habits, and that can be either diarrhea, constipation or a combination of both,” Chey explains.

IBS is a tricky condition to diagnose. “I think what distinguishes IBS is the frequency and severity and burden of illness associated with a person’s GI symptoms,” Chey says. “IBS is defined by the presence of abdominal pain and altered bowel habits, and when patients are having those symptoms frequently, let’s say on a weekly basis, and they’re severe enough to be affecting a person’s quality of life, to me, that constitutes an illness burden that is consistent with the diagnosis of IBS.”

A hallmark of IBS is that illness burden. “Somebody that’s having fairly frequent symptoms [that are] affecting their ability to be able to carry out their activities, those patients…should get evaluated to make sure they have IBS,” Chey says, and not the “number of things that can mimic IBS but that are treated very, very differently than IBS.”

It is important to note that celiac can be misdiagnosed as IBS. “There is clearly a small subset of patients who are mistakenly diagnosed with conditions like IBS but are subsequently found to have celiac disease, and when they go on a gluten-free diet, they get complete resolution of their symptoms,” explains Chey.

As Lebwohl notes, “Irritable bowel syndrome is present in 10 to 15 percent of the population, far more common than celiac disease (which is present in a bit under 1 percent of the population), and so it’s quite common for people with celiac disease to also have irritable bowel syndrome.”

Mukherjee points to a study at the Beth Israel Deaconess Medical Center, which found “in our cohort of patients with celiac disease, that nearly 10 percent of patients had irritable bowel syndrome as a concurrent condition that was likely propagating their celiac symptoms.”

IBS can occur at any point in individuals with celiac. “It can predate the diagnosis of celiac disease or occur at a later time after the diagnosis of celiac disease,” explains Mukherjee. “Certainly a patient who has celiac disease for years and is symptom free on a gluten-free diet with normal lab results can develop a motility disorder as a separate condition….”

Currently, there is no one-size-fits-all treatment for IBS. Some individuals experience tremendous benefits on the FODMAP diet (see sidebar). FODMAPs are a group of “fermentable carbohydrates naturally occurring in foods that are essentially healthy for us, but for some reason certain people cannot tolerate them and they get extreme pain, gas, bloating, constipation and diarrhea when they’re eaten in such large quantities,” explains Manning.

“With FODMAPing, you can learn what your trigger foods are,” she says. “The FODMAP diet will eliminate all of those fermentable carbohydrates for a short period of time.” Manning advises that “it does have to be done with the guidance of a dietitian that has some expertise in it.” After elimination, “give yourself a chance to settle down, and then you work each fermentable group back in strategically to be able to figure out what those trigger foods are.”

The goal through this removal and reintroduction, Chey explains, is “to determine a person’s sensitivities to individual FODMAPs and then tailor a person’s diet based upon that reintroduction information to establish their maintenance diet. And that’s what they stay on. They don’t stay on the full elimination diet.”

The diet has been quite successful. “Probably almost 60 percent of patients with IBS get relief from their bloating and pain with low FODMAP,” says Chey. “That being said…a significant proportion of patients don’t get better with low FODMAP.”


Acid reflux, commonly known as heartburn, occurs when the stomach contents reflux, or back up, into the esophagus—the tube that spans from the mouth to the stomach—and sometimes into the mouth. When this condition persists, it is also called GERD (gastroesophageal reflux disease).

“Any patient with celiac disease that is under good control on a gluten-free diet can develop another GI condition like GERD with time that is not necessarily related to their celiac disease, in the same way that someone can develop a food sensitivity, such as lactose or soy, with time,” Mukherjee says. “I see this frequently in my GI clinic.”

For patients experiencing acid reflux, diet and lifestyle choices can play an important role. Manning offers heartburn patients a number of tips to reduce foods and drinks “that would irritate the stomach lining and/or cause more reflux,” including fried items, citrus fruits and large quantities of coffee and tea.

When it comes to lifestyle, she also notes the importance of avoiding eating late at night as well as eating small, frequent meals instead of three large ones. Daily routine can also affect heartburn. “I ask people what they do for a living,” she says. Specifically, she asks, “Are you sitting at a desk in a bent-over position all day? Do you eat at your desk?” These are important aspects to cover, because food cannot pass through the GI tract nearly as easily as it would for someone who goes for a quick walk after eating. Even clothing can have an impact on symptoms. Manning asks patients, “Are your pants very tight? Do you wear a tight belt? Those are also really subtle, but they can make a huge difference.”

Patients with another type of heartburn, functional heartburn, “don’t necessarily have evidence of acid reflux,” says Chey. This means that they “have symptoms that for all the world look like acid reflux, but there’s no identifiable evidence of acid reflux.” These individuals, Chey says, “respond to behavioral techniques, so deep relaxation techniques or cognitive behavioral therapy seem to work just as well as any of the medications we have.”

Food intolerance and malabsorption

Food intolerance or malabsorption can also cause GI issues. In individuals with celiac, Manning notes that “a lot of patients also have a lactose intolerance. That’s super common.” For these individuals, “…the most common symptom of lactose intolerance is diarrhea, gas, bloating.” To determine whether lactose is causing the symptoms, “I’ll have to tease that out and see whether they are having copious amounts of lactose.”

Another possible cause of GI distress is malabsorption of fructose, a type of sugar. “Patients who suffer from fructose malabsorption cannot absorb fructose completely in their small intestine,” says Mukherjee. “This can be experienced as abdominal pain, cramping, gas, bloating, abdominal distension. Diarrhea can develop due to the undigested particles of fructose. “

When this malabsorption occurs, “the undigested or leftover fructose travels to the colon, where it is fermented by colonic bacteria. The bacteria produce gas, which causes the intestines to swell.” When it comes to treating this, she says that management hinges on “limiting high-fructose foods or, in other words, a low-fructose diet. It is often helpful to start a low-fructose diet, also called the FODMAP diet, with the help of a dietitian.”

If you’re experiencing frequent GI distress in spite of following a gluten-free diet, don’t assume hidden gluten is the culprit. Visit your doctor. Together, you can determine the cause of your symptoms—and effective treatments.

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Celiac Parents and Gluten-Eating Kids

Most parents lean over to help their small children with everything from being fed to cutting and holding their food. For celiac parents, though, mealtime is not as simple as letting their child stick his or her fork on their plate after they have been indulging in something with gluten. They cannot simply break their child’s big piece of gluten-containing pizza into smaller pieces and then go back to handling their own gluten-free food. How do parents with celiac avoid cross-contamination when their children are eating gluten?

Why it’s important for kids who can eat gluten to eat gluten

Celiac runs in families. Given the nature of the disease, parents might have questions about their children and eating gluten, especially introducing it. “We used to think there was some critical window that, if you got gluten in, that you could kind of hold off or decrease your risk for developing celiac disease in an at-risk individual. But we’ve since learned that’s not really the case,” explains Jacqueline Jossen, MD, assistant professor, division of pediatric gastroenterology, Mount Sinai School of Medicine. “The general recommendation is to introduce gluten just as you would start introducing other foods to babies between four and six months of age.”

As far as genetic testing for celiac, “some parents really want to know early, and those parents can seek it out,” she says. “But otherwise, the general screening recommendation starts at around 3.” Every family is different and, as Jossen notes, “some parents don’t necessarily want to know, and that’s fine [when it comes to gene testing]. In these cases when the parent [who has a child with a first-degree relative with celiac] doesn’t want to know the result of a gene test, then they should be screened as if they have a positive gene every two to three years.” When it comes to eating gluten, “regardless of whether or not they have the gene [for celiac], unless they have celiac disease there’s really no reason to adjust their diet,” notes Jossen.

Beyond it not being medically necessary for a child without celiac to be on a gluten-free diet, there is a big nutritional reason. “The gluten-free foods are really much higher in fat and sugar and much lower in fiber and enriched grains than the gluten-containing counterparts,” explains Jossen. “You have to read your labels. Even if it’s a product that’s stating it’s gluten free, not every gluten-free product is created equal. Comparing fat and sugar content and then, with grains, just looking at the label and seeing if they contain B vitamins, if they contain folic acid, niacin, these are things that are enriched in gluten-containing grains that are not necessarily in gluten-free products.”

In addition to making sure kids have access to nutrients they need, like the enrichment that occurs in gluten-containing products, kids who do not need to follow a restricted diet should not be put on one because that puts social strain on them. “And then, for kids, remember, there’s this social aspect of it,” Jossen explains, since “gluten is a big part of most kids’ diets, and when you go to school or daycare and snacks are provided, it can become a very socially isolating thing to be kept on a very restricted diet.”

Jossen understands firsthand what it’s like for a parent to be the only one with celiac in a household as she has celiac and her husband and daughter do not. She is very familiar with setting up a kitchen that works for her and her family. “I have this one spot where all the gluten is, but you know it’s not easy with a toddler. She makes a mess,” Jossen says.

“[Kids] want to share. That’s why [my husband and I] double team [during mealtime when it contains gluten],” she explains. While most of the food in their home is gluten free, Jossen has a variety of prepackaged snacks that she can bring along for her family if they are out and craving something with gluten in it.

Expectations vs. reality

When an adult is diagnosed with celiac prior to having children, he or she might have preconceived notions about what it would be like to have a child who can eat gluten. Sue Moller, who was diagnosed with celiac in 2005 and had her eldest in 2012, had concerns about how to handle the gluten-free/gluten dynamic between parent and child.

“I was much more concerned before I had my kids,” she says in reference to how she would handle her children eating gluten while being gluten free herself. “And now it’s, really, it’s pretty OK. … I don’t even think I can pinpoint a time that I’ve got glutened [because of handling gluten foods with the kids].”

Moller and her husband have a 5-year-old son and 2-year-old daughter, and the family has found a balance between what works for the kids’ needs and for mom. Her husband said if the children were to have celiac, they would become an entirely gluten-free household. “Right now, I’m the odd man out, so I have everything separate [as the only member of the family with celiac],” she explains. While she is the only one, “anything we cook, we make pasta, it’s gluten-free pastas.” The entire family enjoys gluten-free chicken nuggets, which her kids actually prefer. Recently, they refused gluten-containing chicken nuggets that her husband prepared.

When it comes to eating, she is realistic that getting kids to eat is hard, and she wants as little restriction on their diet as possible. “In the beginning, I didn’t want this stuff in the house,” Moller says, referring to gluten. However, she changed her mind as she realized “there’s the stuff you want them to eat and there’s the stuff they’re actually going to eat. I think you realize you’re going to lose that battle very quickly,” she explains.

For this reason, gluten is a big part of her kids’ diet, and she is always careful around it. Moller even allows her kids to play with Play-Doh, knowing that it contains gluten. “I like them to do it because it’s a kid thing to do. It gets everywhere,” but she handles it just as she handles their eating gluten, with a thorough clean-up and lots of hand washing on her part.

Moller credits the support of her husband, who has “been with me from the beginning” of her celiac, which was diagnosed two weeks before their wedding. As a result, Moller says her husband is “just as well versed in all things related to celiac and cross-contamination.” He often takes the lead on meals containing gluten with the children. “My husband tends to position himself close to them [so if he has to rip something or cut something for the kids, he can do it] so I can avoid crumbs.”

Gluten free is a family effort

Brian P. Bosworth, MD, FACG, chief of medicine at NYU’s Langone Medical Center at Tisch Hospital and professor of medicine at NYU School of Medicine, was diagnosed with celiac in 2002, two years before his eldest was born. At that time, he and his wife made the decision to have a predominantly gluten-free household.

“When I was diagnosed, we made the entire kitchen gluten free with new cutting boards and new pots and pans and really made everything that we were going to be cooking and preparing gluten free,” Bosworth says. The only gluten in the house were gluten-containing cereal and gluten bagels for his wife, toasted in a different toaster. When his children were born, they continued the same kitchen setup, where the only gluten was cereal and bread for his wife and kids.

When his two kids were younger, one of the very important things he recognized was “separation of their food and separation of my own food,” he says. “I was definitely conscious of the fact that when I was involved in any of those activities [involving feeding my children or helping them with food], that I wouldn’t also be eating at the same time so as not to contaminate my own food and [I washed] my hands very frequently in the middle and when we were done,” he explains. Bosworth was also very aware if food fell on tables and counters to assume there might be crumbs.

Over time, the Bosworth family has really found a routine. He emphasizes how important it is for the whole family to participate. “Our decision to make the entire kitchen gluten free,” he explains, as “opposed to making it a regular kitchen and trying to carve out a little gluten-free area was very helpful [for the entire family]. It wasn’t a way of segregating myself and the rest of the family as much as this is how we function as a family.” he says, which has worked very well for them. This inclusiveness is something they continue when traveling, always having a gluten-free snack that everyone can enjoy. This way there is no concern about someone cross-contaminating the bag.

For Bosworth, this support extends beyond how the family eats. This includes his kids understanding why their dad must be gluten free. “We started taking them out to restaurants when they were really young,” he says. They would hear him explain celiac to servers, as well as to others when they went to people’s homes, and through these experiences they began to understand celiac. “So it was just part of a normalized process. This is what daddy can eat, this is what he can’t and we all have to be very careful.”

Bosworth and his wife have been upfront with their kids that if they make an error in the kitchen and cross-contaminate anything, just to let them know. “They were very good about coming to one of us if they made a mistake and put [a] knife in the wrong thing or used the gluten-free cream cheese on a bagel. We said, ‘That’s OK, thank you for telling me.’ It was always very positive reinforcement,” he notes.

Thinking ahead

Moller is already thinking ahead about how the kitchen setup might have to change now that her son is in kindergarten. “My son is starting to get to that stage [when he is starting to engage with the kitchen a bit more independently],” she explains. While before, “I didn’t have to worry about [my son or daughter] grabbing the wrong peanut butter, [this is something that I have now started to think about].”

However, just as all families make changes as the kids grow, she, too, will do the same. Moller is already thinking about moving the designated gluten-free peanut butter to a higher shelf.

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.


Celiac and Your Skin: Dermatitis Herpetiformis

Celiac can manifest itself in many ways. For some individuals, their symptoms occur on the skin in a condition known as dermatitis herpetiformis (DH). In these instances, the path to a celiac diagnosis begins with the diagnosis of DH.

Dermatitis Herpetiformis Symptoms

DH has a specific set of symptoms. Patients will have “bumps or blisters…clustered together…[that] appear bilaterally on the forearms, elbows, knees, buttocks and hairline,” explains Robyn Gmyrek, M.D., board-certified dermatologist at Union Square Laser Dermatology in New York. The “bilateral” appearance she refers to means that a patient’s DH symptoms will develop, for example, on both knees.

According to Nicole Seminara, M.D., assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Langone Medical Center, the bumps and blisters characteristic of DH are “intensely itchy [and] people usually scratch them off before they ever present to a doctor.” As a result, Seminara says, “It’s uncommon to see an intact blister with this disorder.”

Instead, patients’ skin will “look like [it has] been scratched to pieces,” notes Seminara. When no bumps or blisters are present, “it’s more the history of intense itch coupled with the distribution that leads us to the diagnosis [of DH]. The diagnosis is then confirmed with a biopsy.” Another important aspect of DH is age. It tends to develop in patients who are in their 30s or 40s.

The Celiac Link

The connection between DH and celiac is something dermatologists “are very aware of…and take very seriously,” says Seminara. “If I have a patient with DH,” she says, he or she is “always sent to [a gastroenterologist]” to be tested for celiac.

“The great majority of patients with DH have celiac disease as defined by duodenal biopsy showing villous atrophy,” explains Benjamin Lebwohl, M.D., M.S., director of clinical research at The Celiac Disease Center at Columbia University. “The remainder may have a normal- or near-normal-appearing duodenal biopsy but nevertheless have their DH triggered by dietary gluten, which is why DH is sometimes referred to as ‘celiac disease of the skin.'”

As is often the case with celiac symptoms, the potential for misdiagnosis is high. “This is because not all people with DH will have typical lesions, and the rash may come and go,” explains Gmyrek. The rash can be misidentified and “is commonly diagnosed as eczema or an allergic contact dermatitis by both patients and physicians.” She says that “if you have been diagnosed with eczema, have a lot of itching and you are not responsive to topical treatments…you should consider getting tested for celiac disease and biopsied to rule out DH.”

The Key to Relief

When it comes to healing DH, the gluten-free diet is key—as is patience. “[Patients] have to be very strictly gluten free, and [the healing is] a slow process,” says Seminara.

Gmyrek also emphasizes the importance of patients being aware of the healing timetable. “Patients need to know this because they expect that within a week or two of being gluten free, the rash will be gone or they will stop getting new lesions,” explains Gmyrek. That expectation can cause problems because when the lesions have not gone away soon after starting the diet, patients think “that they must somehow be getting gluten in their diet because the rash is not gone yet.” In fact, Gmyrek says, “It can take one to two years even with a strictly gluten-free diet for the skin rash to totally resolve.”

The drug Dapsone can help ease discomfort caused by the rash. “[Dapsone] decreases the body’s immune response and therefore the rash,” says Gmyrek. “Patients feel relief within 48 to 72 hours of taking this medication.” However, the drug does not replace a gluten-free diet. “Taking Dapsone does not cure DH [because] only a gluten-free diet forever will rid the patient of DH,” says Gmyrek.

Even when strictly adhering to the diet, skin lesions may still appear. Gmyrek points out that iodine, which is important to normal thyroid health, “will often cause skin lesions in patients with DH.” She emphasizes that “iodine does not adversely affect patients with celiac disease who do not have DH and should not be eliminated in those patients.” For those with DH, Gmyrek recommends that “patients use non-iodized table salt or sea salt, which has less iodine than iodized table salt, until their DH has resolved.”

Celiac and pregnancy

Many women wonder about issues regarding celiac and pregnancy. When it came to trying to get pregnant, Brynne Cramer had some worries. “Because I have celiac disease, I was initially very concerned about my ability to conceive and carry a healthy baby to full-term,” says Cramer, who runs the blog Gluten-Free Hungry Gal.

Symptoms of undiagnosed celiac disease include infertility and recurrent miscarriage. Cramer was diagnosed four years prior to trying to conceive. But she was still anxious over the impact celiac might have on her fertility and a pregnancy. “I was very nervous,” she explains. “It’s part of the reason we decided to start trying for a baby at a younger age [26].”

Given infertility and miscarriage are symptoms of undiagnosed celiac disease, it’s logical to question whether they could extend into diagnosed celiac. Would these issues continue once diagnosed and adhering to a gluten-free diet? Expanding upon that initial thought, a larger question arises about whether diagnosed celiac fits into pregnancy: Do celiac disease and the gluten-free diet affect pregnancy?

Undiagnosed vs. diagnosed

The risks associated with pregnancy are different before after a celiac diagnosis. “Most of the issues that have been described regarding pregnancy outcomes in celiac disease have been found in undiagnosed celiac disease,” explains Benjamin Lebwohl, M.D., M.S., director of clinical research at The Celiac Disease Center at Columbia University, by email. “That is to say, patients with undiagnosed [and therefore untreated] celiac disease appear to have an increased risk of outcomes such as miscarriages or difficulty conceiving.”

As Lebwohl notes, “The cause of infertility and pregnancy complications in people with undiagnosed celiac disease is not certain, but there are a number of explanations.” Current knowledge centers around how celiac affects the body. “Chronic inflammation and/our malnourishment in the mother may be poorly conducive to successful pregnancy. In addition, laboratory studies have shown that the antibody in celiac disease [tissue transglutaminase] may bind to placenta cells and cause harm”

Following diagnosis, the risk changes. “In those with diagnosed celiac disease who have already started the gluten-free diet, the risk largely goes away,” Lebwohl says. The good news, he explains, is that once diagnosed, “much of the worrisome information out there about fertility and birth outcomes is thankfully no longer relevant.”

Even with such a marked reduction in risk, could length of time from diagnosis factor into conception or pregnancy? For example, will a pregnant woman who was diagnosed a number of years ago and has already done a great deal of gut healing on the gluten-free diet have fewer complications than a pregnant woman who was only recently diagnosed and whose gut is still healing?

“A few years ago, we [The Celiac Disease Center at Columbia University] published an analysis of Swedish patients, comparing women whose intestines had healed to those who had persistent intestinal damage [possibly due to occasional gluten exposure], and found no differences in birth outcomes,” explains Lebwohl. “In both groups, the rates of miscarriage or premature birth were quite low, actually. This underscores the idea that the main time of increased risk is before a celiac disease diagnosis.”

The key to a pregnancy with celiac—and is the key to the disease in general—is adherence to the gluten-free diet and consistent follow-up care. “It is important to stick to a strict gluten-free diet prior to and during pregnancy, and to be up to date with routine celiac antibody and nutrient checks,” advises Lebwohl.

The gluten-free diet and pregnancy

Depending on factors such as ingredients and the absence or presence of nutrients, gluten-free products can be less nutritious than their gluten equivalents. This raises the question of whether a woman with diagnosed celiac needs to approach her prenatal care differently because she is on a gluten-free diet.

“Though the gluten-free diet can sometimes be a vitamin-deficient diet, and folic acid is a particular concern with regard to the developing fetus, the recommendation is the same for celiac patients as non-celiac patients: take a daily prenatal multivitamin,” says Lebwohl.

Folic acid, found in fortified foods such as cereal and in vegetables such as leafy dark greens, is crucial in general, and especially during pregnancy. As the Centers for Disease Control and Prevention (CDC) states on its website, “Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.” When it comes to pregnancy, the CDC explains, “Folic acid is very important because it can help prevent some major birth defects of the baby’s brain and spine (anencephaly and spina bifida).”

The nutritional focus during pregnancy is the same regardless of whether one needs to eat gluten free. “All women need to be conscious of their nutrition when they are pregnant,” explains Amy Jones, M.S., R.D., L.D. “Ideally, getting your nutrition in order before you get pregnant is best.” For someone with celiac, this would mean “being well controlled on the gluten-free diet” as this “can go a long way in helping to ensure a healthy pregnancy.” Should a woman have any nutritional deficiencies, Jones says to “work with your physician and dietitian to get those corrected, ideally, before you conceive.”

Regardless of celiac, pregnant women often experience constipation in their second or third trimester. For alleviating constipation, Jones points out that “the higher fiber of whole grains may be beneficial.” When eating gluten-free whole grains, Jones says, “be sure to drink enough fluid when you are consuming high-fiber foods.” The benefits of gluten-free whole grains extend beyond fiber. “For example, teff has a lot of calcium, and quinoa has a lot of iron and protein,” Jones notes.

The calcium found in teff and dairy products is an important nutrient during pregnancy. Jones mentions that “for pregnant women who have celiac disease who may be lactose intolerant, it’s important to find a good source of calcium and vitamin D.” For those who can tolerate some lactose, she points to yogurt and cheese, which are both low in lactose. “Supplementation of calcium and vitamin D may be necessary as well,” she says.

Welcome news

Cramer learned firsthand that her diagnosed celiac did not prevent her from getting pregnant or carrying a baby to term. “To my surprise, we got pregnant very quickly,” says Cramer. “I was anxious at every appointment,
but things kept checking out wonderfully.”

Throughout her pregnancy, Cramer found herself feeling like “a typical pregnant woman.” This included enjoying random indulgences—buffalo sauce and chocolate milk. She recommends that pregnant women with celiac “find what gluten-free foods hit the spot and indulge every once in a while. We give up so much already as celiacs—depriving yourself during pregnancy seems silly.”

Cramer and her husband welcomed a beautiful and healthy baby girl last summer.

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Photos: SYDA Productions / Shutterstock; Africa Studio / Shutterstock

Where Diagnosed Celiac Disease Fits into Pregnancy

When it came to trying to get pregnant, Brynne Cramer had some worries. “Because I have celiac disease, I was initially very concerned about my ability to conceive and carry a healthy baby to full-term,” says Cramer, who runs the blog Gluten-Free Hungry Gal.

Symptoms of undiagnosed celiac disease include infertility and recurrent miscarriage. Although Cramer was diagnosed four years prior to trying to conceive, she was nevertheless anxious over the impact celiac disease might have on her fertility and a pregnancy. “I was very nervous,” she explains. “It’s part of the reason we decided to start trying for a baby at a younger age [26].”

Given infertility and miscarriage are symptoms of undiagnosed celiac disease, it’s  logical to question whether they could extend into diagnosed celiac disease. Would these issues continue once diagnosed and adhering to a gluten-free diet? Expanding upon that initial thought, a larger question arises about where diagnosed celiac disease fits into pregnancy: Do celiac disease and the gluten-free diet affect pregnancy?

The gluten-free diet and pregnancy

Depending on factors such as ingredients and the absence or presence of nutrients, gluten-free products can be less nutritious than their gluten equivalents. This raises the question of whether a woman with diagnosed celiac disease needs to approach her prenatal care differently because she is on a gluten-free diet.

“Though the gluten-free diet can sometimes be a vitamin-deficient diet, and folic acid is a particular concern with regard to the developing fetus, the recommendation is the same for celiac patients as non-celiac patients: take a daily prenatal multivitamin,”explains Benjamin Lebwohl, M.D., M.S., director of clinical research [MF1] at The Celiac Disease Center at Columbia University, by email.

pregnancyFolic acid, found in fortified foods such as cereal and in vegetables such as leafy dark greens, is very important in general, and especially during pregnancy. As the Centers for Disease Control and Prevention (CDC) states on its website, “Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.” When it comes to pregnancy, the CDC explains, “Folic acid is very important because it can help prevent some major birth defects of the baby’s brain and spine (anencephaly and spina bifida).”

The nutritional focus during pregnancy is the same regardless of whether one needs to eat gluten free. “All women need to be conscious of their nutrition when they are pregnant,” explains Amy Jones, M.S., R.D., L.D. “Ideally, getting your nutrition in order before you get pregnant is best.” For someone with celiac disease, this would mean “being well controlled on the gluten-free diet” as this “can go a long way in helping to ensure a healthy pregnancy.” Should a woman have any nutritional deficiencies, Jones says to “work with your physician and dietitian to get those corrected, ideally, before you conceive.”

Regardless of celiac disease, pregnant women often experience constipation in their second or third trimester. For alleviating constipation, Jones points out that “the higher fiber of whole grains may be beneficial.” When eating gluten-free whole grains, Jones says, “be sure to drink enough fluid when you are consuming high-fiber foods.” The benefits of gluten-free whole grains extend beyond fiber. “For example, teff has a lot of calcium, and quinoa has a lot of iron and protein,” Jones notes.

The calcium found in teff and dairy products is an important nutrient during pregnancy. Jones mentions that “for pregnant women who have celiac disease who may be lactose intolerant, it’s important to find a good source of calcium and vitamin D.” For those who can tolerate some lactose, she points to yogurt and cheese, which are both low in lactose. “Supplementation of calcium and vitamin D may be necessary as well,” she says.

Welcome news

Cramer learned firsthand that her diagnosed celiac disease did not prevent her from getting pregnant or carrying a baby to term. “To my surprise, we got pregnant very quickly,” says Cramer. “I was anxious at every appointment, but things kept checking out wonderfully.”

Throughout her pregnancy, Cramer found herself feeling like “a typical pregnant woman.” This included enjoying random indulgences—buffalo sauce and chocolate milk. She recommends that pregnant women with celiac disease “find what gluten-free foods hit the spot and indulge every once in a while. We give up so much already as celiacs—depriving yourself during pregnancy seems silly.”

 Cramer and her husband welcomed a beautiful and healthy baby girl last summer.

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Staples of the Community

These companies have been around for decades, but they don’t rest on their laurels, as they continue to develop fun, new and delicious gluten-free products.

marketThe gluten-free marketplace is constantly changing. Each trip to the grocery store offers an opportunity to discover new gluten-free brands and products. However, for those newly diagnosed with celiac disease or gluten sensitivity and just starting out on the gluten-free diet, every gluten-free item on shelves—whether new to the market or celebrating two decades on it—is new for them.

A number of companies have a long history of serving the gluten-free community, many of which were founded in the 1980s and 1990s, when gluten-free consumers had far fewer options available to them. At that time, they filled a very important void, which they continue to do in 2017.

One of those early companies, Pamela’s Products, was founded in 1988 after Pamela, who does not have gluten intolerance but had experience with the gluten-free diet through her family’s natural food bakery, saw a need for gluten-free products and focused on providing them. Almost 30 years later, the company now offers a wide selection of cookies, baking mixes and bars, including Figgies & Jammies for those craving a fig cookie. Three of Pamela’s Products—the Baking & Pancake Mix, Ginger Cookies with Sliced Almonds and the Peanut Butter Cookies—have been on the market since the very beginning.

Like Pamela’s, the brand Glutino has been around for decades. Founded in 1983, the company has been providing a range of products to the gluten-free community for more than 30 years and today offers everything from toaster pastries and pretzels to crackers, pizzas and cookies. One of its product lines, Glutino Gluten Free Pantry Baking Mixes, has deep roots of its own. Beth Hillson founded Gluten-Free Pantry in 1993 and joined Glutino in 2005. The mixes cover the gluten-free gamut, starting with an all-purpose flour mix and a favorite sandwich bread mix as well as a double chocolate brownie mix.

Foods by George products have been made with love since 1991. The company was founded by a husband and wife, George and Ceil Chookazian, after Ceil was diagnosed with celiac disease. The Chookazians were the first to offer gluten-free ravioli and manicotti on the market, then branched out into new products that they are still well-known for today, including their Plain English muffins, which are so versatile you can have one for breakfast or use it as a burger bun, brownies, and cinnamon and currant English muffins. Foods by George also offers a pecan tart, crumb cake, pound cake and cheese pizza.

Kinnikinnick Foods Inc. recently celebrated its 25th anniversary. The company has come a long way since its small beginnings, when one of the founders realized the difficulty of finding gluten-free products. From that encounter, Kinnikinnick was born, beginning with two types of bread and English muffins. Since 2000, the company has been making donuts, a harder-to-find gluten-free treat, in such mouthwatering flavors as cinnamon sugar, chocolate, vanilla, maple and pumpkin spice. Kinnikinnick also started producing new Soft Donuts with Vanilla Icing.

Tinkyada brought lots of gluten-free pasta to the late 1990s. The company that introduced brown rice pasta in 1997 today offers 18 pasta products in either brown rice or organic brown. The pastas are available in a variety of shapes and sizes, including spaghetti, penne, spirals, shells, fusilli and elbows. Two of their products, Vegetable Brown Rice Spirals and Spinach Brown Rice Spaghetti, incorporate the vegetables and colors that make a bowl of pasta exciting, fun and full of possibilities.

The dawn of the millennium brought with it Enjoy Life Foods. Since 2001, the company has filled a crucial need in the gluten-free marketplace. Not only are the company’s products gluten free, they are also free of dairy, peanuts, tree nuts, eggs, soy, fish and shellfish. Given the number of individuals on the gluten-free diet who have additional allergies and sensitives, this company’s entrance to the marketplace affected the lives and taste buds of thousands. While Enjoy Life no longer offers its original products, its cookies, bars and baking mixes reflect the benefits of the knowledge base built up over 15 years of providing gluten-free and allergen-free products.

While not a completely gluten-free company, Nature’s Path has a longstanding commitment to the gluten-free community. The company was founded in the mid-1980s and is known for its organic cereals and snacks. A number of the company’s cereals, including Mesa Sunrise Flakes, Whole O’s, Crispy Rice and Honey’d Corn Flakes, were formulated to be gluten free from the start. Nature’s Path also produces an extensive line of kids’ cereals called EnviroKidz. With a nod to the environment and taking care of the planet, these cereals capture flavors that kids crave, such as Lightly Frosted Amazon Flakes, Chocolate Koala Crisp and Peanut Butter Panda Puffs.

With so many of these staple companies continuing to grow and expand—not to mention countless more developing quality gluten-free food—this is an exciting time to be gluten free. GF

Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.

Bone Symptoms of Celiac Disease

Celiac disease can manifest in many different ways. While symptoms can affect the whole body, those involving the gastrointestinal system receive greater attention. However, for some individuals, the state of their bones holds the key to diagnosis.

“Patients with celiac disease very frequently have osteoporosis and fractures,” explains endocrinologist Emily Stein, M.D., associate research scientist and associate attending physician at Hospital for Special Surgery in New York City. “These are often the first signs of celiac that bring a patient to diagnosis. Patients with celiac may not have any gastrointestinal complaints but come to seek medical attention because of a low-trauma fracture.”

bonesFor patients with undiagnosed celiac disease, fractures, osteopenia and osteoporosis develop as a result of nutrient deficiencies. “People with untreated celiac disease are pre­disposed to malabsorption of both calcium and vitamin D,” says endocrinologist Jessica R. Starr, M.D., assistant professor of medicine at Columbia University Medical Center. Calcium and vitamin D are essential for healthy bones, and when they are not absorbed, deficiencies can attack the bones.

When it comes to the skeleton, celiac bone symptoms overlap with other conditions. As a result, undiagnosed celiac may not be considered, because in some instances “people are presumed to have osteopenia due to vitamin D deficiency or osteoporosis due to aging/menopause, but celiac disease should definitely be considered as well, especially if the
patient has anemia or any relatives with autoimmune disease,” notes Starr.

The structure of the medical field itself plays a part in compounding the celiac bone story. “In our super-specialized world of medicine, people with bone pain or fractures may be seen by orthopedists or pain management doctors. They may follow with rheumatology or even endocrinology,” explains Starr. “A lot of specialists are good at managing their area of expertise but are not necessarily trained to think ‘outside the box’ and think of other possible pathology that may be causing the bone issues [that the patient is experiencing].”

Physicians should consider testing for celiac disease based on factors such as age, family history or the inability to
explain deteriorating bone health. Stein points out that “it is important to think about celiac in patients with unexplained osteoporosis and fractures, especially younger patients.” Starr says screening should also take place for “anyone with severe vitamin D deficiency or unexplained anemia and osteoporosis.”

Following a diagnosis, keeping an eye on a patient’s bone health remains important. Starr recommends that “gastroenterologists seeing celiac patients send them for bone density screening at time of diagnosis and follow up the bone density testing every few years, especially if it is abnormal.”

Even though bone health is impacted prior to a celiac diagnosis, Stein says the damage  actually can get better once on a gluten-free diet. “Interestingly, the bone disease in patients with celiac disease improves dramatically in just one year of following a gluten-free diet.”

— Susan Cohen

Canadian Celiac Association warns against gluten-free Cheerios

In spite of General Mills releasingfive varieties of gluten-free Cheerios in Canada this summer, the Canadian Celiac Association (CCA) recommends that “people with celiac disease or gluten sensitivity DO NOT consume the gluten-free labeled Cheerios products at this time because of concerns about the potential levels of gluten in boxes of these cereals.”

Oats are naturally gluten free but they are highly susceptible to cross-contamination with gluten-containing grains such as wheat and barley. This can occur in the fields, during harvest and while being transported. For oats to remain gluten free, they need to be grown and processed very carefully to maintain separation, thereby preventing cross-contamination.

gluten-free cheeriosThe CCA website endorses three brands of gluten-free oats that are grown on dedicated fields then harvested, stored, transported and processed in gluten-free facilities. “These companies have demonstrated to independent parties, trained GFCP [Gluten-Free Certification Program] auditors and GFCP technical personnel that both their processed oats and finished products meet Health Canada’s standard for gluten free and are safe for individuals with celiac disease,” according to the CCA

The oats used in gluten-free Cheerios are not kept separate from field to factory. Instead, General Mills utilizes mechanical technology to sort regular commercial oats from wheat and barley. The CCA has concerns about this method, saying “It is very difficult to remove gluten-containing grains from oats using optical and technical technology alone because barley and wheat are similar in size, shape and color as oats. Broken kernels present in the grain also add to the sorting challenge.”

The CCA’s scientific advisors also have concerns regarding so-called “hot spots” of high contamination in the mechanically sorted oats. Gluten contamination in-oat is not distributed evenly through a batch, and questions remain about what this means from box to box and the ability to detect contamination.

“Based on the information provided to date, our scientific advisors are not convinced that the testing procedures described by General Mills are sufficient to detect these contamination ‘hot spots’ in the oats and oat flour or in the boxes of cereal that may contain contaminated oats,” says the CCA. As a result of uneven gluten distribution in a given batch, “some boxes of cereal in the market may be safe for people with celiac disease while others contain significant gluten contamination that has not been detected using current testing protocols.”

When contacted, General Mills offered their assurance on the gluten-free status of the Cheerios. “We are confident our Cheerios that are labeled ‘gluten free’ meet the gluten-free standard in Canada, which is less than 20 parts per million of gluten in the product,” Mike Siemienas, Manager, Brand Media Relations for General Mills, wrote in an email. “At General Mills, food safety and the health of our consumers is our top priority. We perform extensive testing of our Cheerios products throughout production to ensure they meet and exceed Health Canada’s standard.”

In their published notice, the CCA states they are “receptive to evaluating any additional information that General Mills is willing to disclose. Until then, the CCA stands by its advice that people with celiac disease or gluten sensitivity should not consume Cheerios products in spite of the gluten-free claim.”

-Susan Cohen

Into West Africa

Kate McNamara had just started her dream job when she received a diagnosis of celiac disease. It would have been a challenge for anyone, but McNamara faced an additional complication. She had to figure out how to eat gluten free in West Africa.

McNamara, who lives in New York City, works for a foundation that does charitable investing around the world, and her job requires her to travel to urban and rural areas of West Africa every month or two.

Although she describes celiac disease as “overwhelming for all aspects of your life,” McNamara was determined not to let it interfere with her career.

 “[Celiac disease] isn’t a thing that is going to stop me from doing what I’ve dreamt of,” she says. When she accepted her job, she made a point to learn about the local cuisine in the areas she would visit, including whether there were any gluten-free options.

West AfricaMcNamara discovered that wheat flour is not commonly used in West African cooking, good news when you’re gluten free. But Maggi bouillon cubes, which contain wheat, are a recipe staple there, so gluten-free options can be hard to come by. McNamara realized she’d have to bring gluten-free items in her suitcase.

Now seasoned at traveling to West Africa, McNamara has a routine before and during each trip. She packs plenty of food for the 12- to 20-hour flights, which often include getting on multiple planes. Her go-to staples focus on foods high in protein and include StarKist tuna packets, Krave jerky and EPIC protein bars. Over time she has developed relationships with local restaurants and has begun dining out.

“I have restaurants that I got to know, and they will cook me plantains in new oil [that’s not cross-contaminated] and a clean pan, or grill me a piece of fish on foil,” McNamara explains. She makes sure to spell out her exact needs when eating in a restaurant.

 “I physically write out a note each time, just to make sure I am safe,” McNamara says. She has high praise for Zane “Zato” Abraw, a server at the Coconut Grove Regency Hotel in Accra, Ghana, who “goes above and beyond to make me safe meals,” she explains.

Like many who are diagnosed with celiac disease, McNamara relies on and credits her support system. “I have amazing family and a great medical team and a really supportive employer,” she says.

McNamara hopes that her story can help others who might think celiac disease limits what they can do. “I think you have to not be afraid, to be willing to hustle and fight each minute of every day to do your dream job,” she says. Then she was off to West Africa again.

—Susan Cohen 

Going gluten-free at ice cream and frozen yogurt shops

Ice cream and frozen yogurt are the perfect indulgences for these long, late summer days, and gluten-free options abound. However, as with many foods, you need to be aware of the difference between purchasing either product in the supermarket and ordering at an ice cream or frozen yogurt shop.

The supermarket offers the chance to read the ingredients label and take your frozen treat home, where you can put it in your own bowl, use your own spoon and douse it in your own toppings. On the other hand, choosing from the range of flavors at the ice cream or frozen yogurt shop requires you to ask numerous questions and be wary of the potential for cross-contamination that exists in everything from scoopers to toppings.

When it comes to frozen yogurt, “people with celiac disease can never assume a flavor is gluten free,” explains Rachel Begun, M.S., R.D.N., culinary nutritionist and gluten-free lifestyle expert. “Frozen yogurt may seem like a gluten-free food because it’s not grain-based, but gluten-containing ingredients are used for many different reasons in the food industry.”

Frozen YogurtAmy Jones, M.S., R.D.N., L.D., empha­sizes the importance of checking frozen yogurt ingredients. “The plain vanilla flavor may be safe, but it’s still wise to check the ingredient list,” she says. “Watch for words that indicate wheat—typically easy to find—and barley. Barley can be trickier to find on the ingredient list, so watch for words like malt, malt flavoring or malt extract.” If the store does not have information on its ingredients, Jones suggests choosing a different place.
Begun recommends asking if the machine has been sterilized between flavors
as the machine dispensing today’s vanilla could have held yesterday’s cookie dough.

As with frozen yogurt, it’s important to check an ice cream’s ingredients and manufacturing process to make sure it’s gluten free. Also remember that opting for hard-packed ice cream over soft serve or frozen yogurt introduces the potential for cross-contamintion because of the requisite scoop, which could be going straight from one flavor to the next.

“If the store carries gluten-containing flavors like cookies and cream or cookie dough, there is the risk that the gluten-free flavors have already been cross contaminated well before you got there,” Jones notes. The store may have used the scooper that was just in the cookie dough for the vanilla. So even if you are able to ascertain a particular flavor’s gluten-free status, Begun points out, “you will need to ask diligent questions to ensure no cross contact has occurred.”

Verify that a new, properly cleaned scoop is used when serving the gluten-free selections. “If the ice cream server can’t ensure no cross contact has occurred for the full use of the gluten-free flavor bin, ask if they are willing to open a new bin and use a sterilized scooper,” Begun says.

When it comes to toppings, Begun points out it may be difficult for ice cream or frozen yogurt shops to confirm whether the sprinkles and other goodies are gluten free if they purchase these items from other manufacturers. And even if the toppings are gluten free, cross-contamination is a big issue due to their proximity to one another. ”I’d be very concerned that toppings can get so easily mixed together—so easy to drop cookie pieces into a container of sprinkles,” notes Jones. “I’d probably advise avoiding the toppings, unless, again, they can provide [them] out of a fresh container with a clean spoon.” But that doesn’t mean you have to settle for naked ice cream or frozen yogurt—Jones recommends simply bringing your own toppings.

While a trip to the ice cream or frozen yogurt shop requires a bit of groundwork, individuals with celiac disease or gluten sensitivity should not feel like they have to avoid it. ”Going out for ice cream is a summer tradition for many people, and just because you have celiac disease, it doesn’t mean you have to stay home,” Jones says. ”Ask questions, determine if you are comfortable with the answers—and enjoy!”


—Susan Cohen

Neurological Symptoms of Celiac Disease

The list of symptoms related to celiac disease covers the entire body. While gastrointestinal symptoms are often at the forefront, the nervous system can also be affected by the disease.

But many patients with neurological symptoms and their doctors don’t make the connection.

“There is a lack of general awareness of the neurological manifestations of celiac disease among patients as well as physicians,” explains Norman Latov, M.D., Ph.D., a professor of neurology and neuroscience and the director of the Peripheral Neuropathy Clinical and Research Center at Weill Cornell Medical College.

“Adult patients often present with neurologic symptoms in the absence of gastrointestinal symptoms, so celiac disease may not come to mind,” according to Latov, who has a clinical and research interest in peripheral neuropathy and has done celiac disease research.

Small fiber neuropathy is the common symptom involving the nervous system. “It typically presents with numbness, tingling or painful burning, stinging or electric-shock like sensations, usually in the arms or legs, but sometimes [in] the torso or face,” Latov says. Small fiber neuropathy can also cause dizziness or feeling faint when standing up, sexual dysfunction, abnormal sweating, bladder symptoms, hair loss or skin changes.

General lack of familiarity with small fiber neuropathy complicates the picture for patients with undiagnosed celiac disease. Their symptoms are often dismissed or misdiagnosed as fibromyalgia, so the association with celiac disease may be missed, according to Latov.

And small fiber neuropathy is only one of the neurological symptoms of celiac disease. “Less-common neurological conditions include cerebellar ataxia with unsteadiness or incoordination, seizures or neuropsychiatric disorders,” he says. Headaches are another potential symptom, but their prevalence adds a layer of complexity when it comes to diagnosis. “Headaches are common in the general population, however, so that it’s difficult to know whether gluten is the cause or only an aggravating factor,” Latov says.

The presence of neurological symptoms raises questions about whether there is a connection between the brain and the gut.

 “As in the gut, the neurological manifestations are also thought to also be due to inflammation,” Latov notes. Currently there are two theories on why neurological symptoms develop. In both, Latov says, “stimulation of the immune system by gluten in the diet would increase the inflammation in both the gut and nervous system.”

The good news is neurologists are beginning to become more aware of this brain-gut connection. “It is improving but very slowly,” Latov says, noting education of both patients and doctors is important. “Perhaps with greater awareness, neurologists will play a larger role in the diagnosis of celiac disease.”

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How to Talk to Your College Roommate About the Gluten-Free Diet

Greek Yogurt Makers Skip the Added Vitamin D

If you’ve been including Greek yogurt in your gluten-free diet, you might have noticed that it often is not fortified with Vitamin D.

That’s one significant way it differs from regular yogurt. Greek yogurt also has a thicker texture and more protein than other types of yogurt.

Vitamin D is an important nutrient because it contributes to healthy bones, so you might wonder why it’s absent from Greek yogurt, which is gaining in popularity and the amount of shelf space it’s given in supermarket refrigerated cases.

Greek YogurtGreek yogurt is often produced in a traditional way that focuses on straightforward ingredients. FAGE, for example, starts with milk that does not contain Vitamin D.

“Our milk is not fortified with anything, including Vitamin D. FAGE Total is made with a family recipe that dates back to 1926; it contains no added sweeteners, thickeners, preservatives, powdered milk, powdered cream or powdered protein,” says Russell Evans, director of marketing for FAGE USA. “Just milk, cream and live active cultures to create all-natural FAGE yogurt.”

Chobani also focuses on producing traditional Greek yogurt. But there is a slight difference between these two brands. Chobani begins production with milk that contains Vitamin D but reduces the amount during processing. The end product contains twice as much protein as regular yogurt and also provides calcium, potassium and other vitamins and minerals.

 “Chobani Greek Yogurt is a real food made with only natural, non-GMO [genetically modified] ingredients. Because increasing the Vitamin D content would require the addition of synthetic Vitamin D, we choose not to fortify our products in an effort to provide a nutritious, delicious yogurt consisting of just a few, natural, simple and easily-recognizable ingredients that people can trust,” the company says.

“The big bonus of Greek yogurt is the protein factor. I don’t find it to be the most wonderful calcium and Vitamin D source. And that’s OK. That’s probably not really the intention,” explains Amy Jones, R.D., of Bellefontaine, Ohio.

She notes that dairy products come with a set of expectations related to calcium and Vitamin D. “There’s that impression when you eat dairy products that you’re getting all the calcium and Vitamin D you need. And that’s not the case with all dairy products,” Jones says.

In fact the best source of Vitamin D is cod liver oil. “Most people are not going to eat cod liver oil,” says Jones.

If you are looking for a brand of Greek yogurt that does fortify with Vitamin D, consider General Mills’ Yoplait. “Unlike some other Greek yogurts, Yoplait Greek, Greek 100, Greek 100 Whips! and Plenti provide an excellent source of Vitamin D,” says Mike Siemienas, General Mills manager of brand media relations. He notes the yogurts provide 20 percent of the daily value of Vitamin D recommended for adults.

But Rachel Begun, R.D., of Boulder, Colorado, says you have to consider the entire nutritional profile of any yogurt.

“You have to look at the whole package—the nutrition facts panel and the ingredients—to determine if a yogurt is healthy,” she says. “Just because a yogurt is fortified with Vitamin D doesn’t mean it is healthy. A yogurt fortified with Vitamin D can be loaded with added sugars, artificial colors and flavors.”

Greek yogurt raises the same nutritional concerns. “The problem is Greek yogurt has gotten a little bit of a ‘health halo’ where everybody assumes every Greek yogurt is a healthy choice, and it’s just not,” notes Jones. “Unfortunately, a lot of the Greek yogurt makers…have turned these Greek yogurts into more dessert-type yogurts.”

She pointed out that unflavored plain yogurt does not present these worries.

—Susan Cohen

A New Voice in the Celiac Conversation

Skip the Pasta: Veggie Noodles Are Healthier and Naturally Gluten-Free

Gluten-free consumers have gotten used to a growing variety of pastas, made from corn, rice, quinoa, chickpeas or a combination of products, some from mainstream pasta makers.

But who would have predicted that pasta made from vegetables would become the hot new trend and fit so nicely in the gluten-free diet? Thanks to a few ingenious kitchen tools everything from zucchini to carrots and beets is being turned into a new kind of noodle.

Noodles made out of vegetables are often called spiralized vegetables because of the way they are made. When zucchini is used, the end result is referred to as zoodles. This healthy new kind of pasta is popping up in recipes all over the Internet, from Instagram to Facebook and Twitter.

A number of companies offer products to turn produce into pasta, but they come in two basic types—a simpler hourglass-shaped spiralizer or a spiralizer with a crank and several blades.

One of the most popular options is the Veggetti, an hourglass version available on for about $15, as well as at in Bed Bath & Beyond and some supermarkets. In a matter of minutes, the gadget can turn zucchini into spaghetti for tonight’s dinner. Another version of this style, the Spiralizer, is also sold at for about $14. The Paderno World Cuisine Tri-Blade Plastic Spiral Vegetable Slicer, available on for about $29, is a popular upscale spiralizer.

If you’re looking to save storage space and like simpler kitchen tools, a julienne vegetable peeler  such as the Precision Kitchenware tool for about $9 at, creates thin vegetable sticks that can also be used as pasta.

In addition to being fun to make, spiralized vegetables have a nutritional advantage over most pasta. “The nutrition benefits of any noodles made out of vegetables will be the same as a steamed or cooked version of the vegetable,” says Lauren Slayton, a register dietitian who is director of Foodtrainers in New York City.

Greta Breskin, a registered dietitian based in North Carolina, says it’s important to pick vegetables that pack a strong nutrition punch. “I recommend using a variety of bright-colored vegetables like beets, carrots and purple potatoes to increase the variety of phytonutrients on your plate,” says Breskin.

In addition to having a good vitamin and fiber profile, spiralized vegetables have fewer calories than bean, corn, quinoa and other gluten-free pastas. “From a caloric standpoint,” Slayton says, “spiralized vegetables are a home run.”

Plus, they’re an excellent way to get kids eating veggies. “Letting kids help out with transforming vegetables into noodles can be an effective way to expose them to new foods. If they are involved with making it, they are more likely to try it,” Breskin says.

Hungry Root Gluten-Free Veggie NoodlesIf this new kind of pasta seems intriguing but sounds like too much work, consider Hungryroot, a newly launched gluten-free, vegetable-centric company that offers vegetable noodles with accompanying sauces that can be prepared in 7 minutes.

Chef Franklin Becker of the gluten-free restaurants The Little Beet and The Little Beet Table in New York is a partner in Hungryroot. He says inspiration for the company came from a desire to “combine vegetables with our need for comfort food.”  The company currently ships throughout the Northeast, Mid-Atlantic and most of the Midwest and Southern states.


Day in the Life: Jess Madden – doctor & celiac disease patient

Patient Celiac 2
Jess Madden and her four children

On a daily basis, Jess Madden experiences two sides of medicine. As a neonatologist with celiac disease, she has the dual identity of being both a doctor and a patient.

At work, she cares for the smallest and newest patients. In her personal life she becomes the patient as she manages celiac disease, an experience she shares on her blog, The Patient Celiac.

The name of the blog is a nod to her double role, but it also refers to her need to be patient while continuing to find her way on the gluten-free diet.

After years of being sick with undiagnosed celiac disease, Madden finally received a diagnosis in 2010. Like many others, she had a lot to learn at the start. Although she thought she was doing well, in 2012 she developed neurological symptoms and realized she needed a more in-depth understanding of the disease. And The Patient Celiac was born.

Madden, who lives in Green Bay, Wisconsin, with her husband, four children and a niece, offers a unique perspective to her blog readers.

She writes about celiac disease research and studies, sharing what she discovers in terms that are easy for her readers to understand. Her quick grasp of complicated topics and her ability to translate information clearly in rapid-fire tweets at the International Celiac Disease Symposium caught the attention of Gluten-Free Living’s editor. Madden subsequently wrote several stories for the magazine.

Patient Celiac 3
Jess Madden

In addition to the medical side of celiac disease, Madden often writes on her blog about celiac disease and her family. And with four little ones, that means keeping an eye out to see if any of her children develop symptoms.

This Sunday, Madden will add another celiac disease dimension to her life when she runs the New York City Marathon as part of the Celiac Disease Foundation’s Team Gluten-Free. This will be her third marathon, but her first running in the widely-known New York City race.

As she was preparing for the race, Madden shared what a typical day is like for a doctor, mother, blogger and marathon runner.

What time do you wake up?
I wake up between 4:45 and 7:00 a.m. And that just depends on if I am motivated to run or go to yoga before my kids wake up.

What’s for breakfast?
I either eat a bowl of gluten-free oatmeal and some fruit, or I make a smoothie and use whatever I can find in the fridge. It’s usually kale, berries, almond milk, and I’ll throw yogurt in or almond butter. I drink a lot of coffee.

What is your morning routine?
Usually, it’s pretty hectic getting three of my four kids and my niece off to school between eating breakfast, getting dressed and making sure they have their homework. I am getting ready for work, too. Luckily, I wear scrubs to work. The kids are out the door by 7:45 a.m. I leave the house at 8:00 a.m., and my workday starts at 8:30 a.m.

What’s an average day like for you?
I work in a neonatal intensive care unit (NICU). From 8:30 a.m. until about 2 p.m. we do what’s called “rounding.” I go “bed side” and see every baby in the unit. I examine them, make a plan for the day for each one, update the family and write a daily progress note.

It’s broken up because if there is a high-risk delivery or a premature baby being born, we leave the NICU to help out. I do consultations, and then I make a lot of phone calls. Until I leave at 4:30 p.m., I do administrative work, catch up on emails, or I start to read articles on celiac disease.

I work night shifts about six times a month and that’s when I work on my blog. Most of my writing is done at 1:00 a.m. I’ll post to my blog at 3 in the morning and the same with my Facebook posts and tweets on Twitter. The nurses I work with in the NICU are so used to hearing about everything I’m writing about. They have been very involved in the process, too. Some of them help me proofread posts.

When I work at night, it’s not the typical day I just described. On those days, I spend a lot of my time with my 2-year-old. I use those days for catching up on life. The next day I sleep during the day.

What’s for lunch?
Lunch is usually leftovers from dinner the night before. I am really fortunate right now that my husband is doing all of the cooking. If I forget to bring lunch, we have a doctors’ lounge and one of the members of the food services team also has celiac disease and will leave me gluten-free food. Sometimes I get a salad and hard boiled eggs.

Is there anything surprising about your day?
Things can get really hectic at a moment’s notice in neonatology. I never know when a woman is going to come in and deliver a premature baby. It’s an environment where things can change really rapidly. You can have a baby who is fine and gets really sick all of a sudden.

What’s for dinner?
We are a totally gluten-free home. Our typical rotation includes chicken or seafood, enchiladas and pizza.

What’s your favorite part of the day?
My favorite parts of the day are when we eat dinner together as a family and then the time between dinner and getting my kids tucked into bed.

Where do you find inspiration for your blog posts?
It’s twofold. I search a lot on PubMed [medical literature and journals] looking at the recent journal articles. When something catches my eye, I start reading. I also get a ton of emails from readers with questions or anecdotes, which will lead me to do research and write a post. Initially, more of my inspiration was from published journals, but now it’s coming more from readers.

What is it like to reverse roles and go from a doctor to a patient?
Other than when I gave birth, it’s really the first time I have ever been in the patient’s position. That’s been really eye opening about how much room there is for improvement in patient/doctor communication and in terms of determining difficult diagnoses, as celiac disease can often be. I think it has made me much more empathetic with patients and their families.

My blog’s name is a play on words because I try to be patient with things, but I have a tendency to not be. In terms of healing, I do have to have patience.

What has blogging brought into your life?
Outside of the food services team member with celiac disease, I don’t know many people with celiac disease. For me, it’s an outlet. It’s been a way to connect with people all over the world who also have celiac disease. I feel connected to a community I never knew existed.

This weekend you are running in the NYC marathon. When do you have time to train?
It’s all over the place. Some days I get up really early and run. I also have been known to run really late at night. I have a safe route through town, and I wear reflective gear and run at 10:00 p.m. It just depends on if I am working days or nights. I flip the training.

 Have you thought about what crossing that finish line might feel like?
I think it’s going to be incredible. I am excited that my body healed enough that I finally was able to get to the point to run a marathon. It’s like I am running for everyone I know and have encountered with celiac disease. I just feel really honored to be able to do it.

(This interview has been edited for length and clarity.)

Susan Cohen is a regular contributor to Gluten-Free Living.


Gluten-free Halloween Cookies

I stopped by Tu-Lu’s Gluten-Free Bakery’s New York shop to learn how to decorate eyeball sugar cookies for Halloween. The shop’s cookie and cake decorator taught me how to transform plain round gluten-free cookies into spooky eyeballs.

A lesson on making royal icing was the first step, followed by instructions on how to use the icing to create the “eyeball.” Follow along and you’ll be able to make these gluten-free Halloween cookies, and any other design you have in mind, for kids of all ages this Halloween, too.

About Royal Icing
While many of us grew up decorating cookies with a store bought buttercream icing, it’s not the best icing for decorating sugar cookies. “If you look at sugar cookies you can tell which is a basic buttercream and which is royal icing,” Tu Lu’s decorator explained. “The difference comes down to thickness. Royal icing creates a thinner icing base to decorate than buttercream. It’s the key to creating complex designs.”
Royal icing can be made with egg whites or meringue powder, confectioners’ sugar and water. For those who have not made royal icing before or who don’t feel comfortable using raw egg whites, meringue powder is a great option. Royal icing can be tinted any color. My Tu Lu’s teacher recommended using gel coloring because it works better than the more typical liquid food coloring, which changes the consistency of the icing.

I learned you have to do two things to use royal icing successfully. First, you have to create a “dam” on the cookies using royal icing with a slightly thicker consistency. It will serve as a boundary for the next round of icing. After the dam has hardened, the next step is to add flood icing, known as flooding the cookie, which creates a smooth plane. The flood icing can be thought of as the cookie’s canvas.

What You Will Need:

Pre-made plain round sugar cookies
Royal icing (recipe here)
Gel dyes (colors including: blue, red, and black)
Pastry bags or plastic bags for icing (one for dam, one for flood and one extra)


Prepare royal icing
Follow the directions for making royal icing. Make sure to sift the confectioners’ sugar as its being added so that it will not clog the pastry tips when decorating. Since the icing for the dam requires a little extra confectioners’ sugar, split the icing into two bowls or containers – one for the dam and one for flooding. Place a damp towel over the flood icing to prevent it from drying out.

Add the extra confectioners’ sugar to the icing for the dam. When it’s ready, pour into a pastry bag and add a tip. If using plastic bag, cut a small hole in one corner. Make sure to squeeze out any visible bubbles in the bag.

Make the dam
Outline the cookie’s border to create the dam. Let the icing sit for a few minutes to harden.

Halloween cookies 4
Flood icing
Once the dam hardens, take the flood icing, which has less confectioners’ sugar, and place in a pastry bag with a tip or plastic bag with a small hole. Once the icing is ready for use, spread the white icing over the surface of the cookie. This is called flooding the icing. Use a toothpick to help smooth out any bumps or bubbles on the icing. Once smooth, let the cookies sit to harden.

Halloween cookies 5

Add the details
While the flood icing is hardening, add blue gel to some of the royal icing and mix.

Halloween cookies 6

Start by creating a circular dam with the blue icing. Give the icing a few minutes to harden and then fill in the circle with the blue icing and let sit.

Halloween cookies 8 better eyeball

While icing is hardening, place a few drops of red gel on a surface. Using either a paintbrush, Q-tip or toothpick, make lines to create veins in the eyes.

Halloween cookies 9

Once the icing for the eyeball has hardened, place a few drops of black gel on a surface and add in a circle for the pupil and lines around it. Allow this icing to harden. Wait up to 10 hours before bagging the cookies to be sure the icing is hard and the cookies don’t stick to each other.

Susan Cohen is a regular contributor to Gluten-Free Living.

Gluten-free baker smells success

George Chookazian
George Chookazian
Photo printed with permission of the Culinary Institute of America

George Chookazian starts his days much like he did when he was a kid, before the sun is up. Now, Chookazian’s early wake up is necessary in his dual role as a baker and entrepreneur.

Chookazian co-owns Foods by George with his wife Ceil, who has celiac disease. Every weekday, he oversees the baking and distribution of their line of gluten-free products at the company’s dedicated craft bake house in Mahwah, N.J.

Once the baking begins, so does the fun. Chookazian gets to smell and taste everything from cinnamon currant English muffins to brownies, pound cake, pizza and more.

The story behind Foods by George is one of love and necessity. When George and Ceil began dating in 1989, he was working in finance, and cooking was a hobby. As their relationship grew, he began to share his passion for cooking with Ceil. The problem was the more they ate, the sicker she got.

Then Ceil was diagnosed with celiac disease, and Chookazian started on a mission to make delicious gluten-free foods. He opened Foods by George in 1991 and trained at the Culinary Institute of America’s Baking and Pastry Arts program to hone his skills.

In the middle of a recent busy workday, Chookazian shared what his typical day is like. He reflected on the gluten-free community, noting that he never imagined it would grow as much as it has.

What time do you wake up? 

Foods by George brownies 2I get up at about 4 a.m. I’ve always been an early riser. Even as a kid, I used to get up at 6 a.m.

What’s for breakfast?

During the week, it’s really quick. I just have a bowl of cereal and a cup of coffee. We are always popping good stuff out of the oven [at work], so I’m always going to eat something later. On any given day, we have two to three types of English muffins, blueberry muffins and brownies.

 What time do you get to work?

We live 15 to 20 minutes away, so I’ll be in by a quarter to five. I’ll start getting things set up for the crew, which comes in at about 5:30 a.m.

 What’s an average day like for you?

Usually by 7 a.m. I’m in the office ordering ingredients, talking with suppliers, brokers, distributors, working out promotions, setting up appointments and meetings and overseeing production. I probably get at least 200 to 300 emails a day. We are a regional company, and our products are available in supermarkets and health food stores in the Northeast, Midwest and Southeast.

We just picked up a new chain in Texas, our first entry there, and they are taking English muffins.

I’m always creating new items. So, I try to spend some time each week tinkering. If I have something in particular I’m working on, I might be working on it every day. I usually leave work by 4 p.m.


Is there one product you’re especially involved with during production?

The things that really charge me up are English muffins. I always loved yeast raised items. To me, that’s a work of art because you are dealing with yeast, which is a microorganism, and it has a life of its own. You talk to any good artisan bread baker, and it’s the simple fact of time and temperature. You are taking ingredients and you are mixing thing ups, and when you are dealing with yeast, the end product is completely different than all those ingredients before yeast was added.

 Do you taste test throughout the day? 

Everything and I’m suffering from that. I do it because I like it and, of course, I want to make sure everything is as I want it to be, both in looks and texture.

What’s for lunch?

I will throw our pizzas into the oven quite often because our crew loves them. I always bring in leftovers like roasted vegetables, grilled chicken and salad.

Is there anything surprising about your day?

It’s possible that people might not see that I’m so involved in the day-to-day running of the company. The one thing I always enjoyed and that means a lot to me is the relationships with my ingredient and packaging vendors. It’s part of what I enjoy doing. They are always there to help me out.

Cinnamon currant muffins
Cinnamon currant muffins

What’s your favorite part of the day?

On the personal side, when I see racks of English muffins coming out of the oven. The smell is just absolutely phenomenal, particularly the cinnamon currant. You get the smell of sugar and cinnamon wafting through the bakery. Anytime a product comes out of the oven, there is nothing better going on around here. I will admit from the business side, I do like seeing palettes of product going onto distributor’s trucks.

 What’s for dinner? 

I can work a 12-hour day and go home and cook for an hour and a half. It’s always been a creative outlet for me. I love to grill so I will do pork, chicken, fish. I do a lot of rotisserie items. I roast a lot of vegetables. On a Sunday, I’ll spend hours cooking for the week. This summer was amazing with vegetables. We had a cucumber and tomato salad almost every day. We don’t do pasta that much. I’ll cook mostly rice, risotto and quinoa.

What’s it like to have been part of the gluten-community for 23 years?

I never imagined it to grow to the extent that it’s grown. When I started out doing this, the diagnosis rate was 1 in 5,000. Then it was in 1 in 3,000. Then it was 1 in 1,000. Now, we are at 1 in 133. I go back and give credit to the early pioneers: the support groups, the doctors and the individuals who worked so hard. We are all benefiting from them.

It’s been remarkable to see the interest created by both companies and individuals. I remember even 5 years ago, some of the retailers I contacted didn’t want to have anything to do with gluten free. Now, every single one of them has at least three freezer doors of gluten-free foods and non-frozen shelf space. There really are so many good products. It’s so much easier for families now.

 How has Foods by George changed you?

It’s brought out the creative part of me. It brought out the entrepreneur in me to grow a business.

 What does baking for the gluten-community mean to you? 

I love it. A psychologist might say I have a deep need to be wanted. It’s a tremendous feeling, particularly when there are so many companies out there. When people are still interested in our product, it’s so rewarding and thrilling.

 Guest blogger Susan Cohen is a freelance writer who often contributes to Gluten-Free Living. This is the 7th in her Day in the Life series.

(This interview has been edited for length and clarity.)


Sharing a Kitchen When You’re Gluten Free

gluten-free kitchen
Our usually crumb-free shared kitchen

I recently started sharing an apartment with my boyfriend, and we’ve focused a lot of attention on the kitchen. Kitchen organizing is an important part of every move, but in our case it’s getting extra emphasis because I have celiac disease. We need to set up a kitchen that works for both of us, but most important is a safe gluten-free space. After three years of living on my own in a completely gluten-free apartment, I forgot what it’s like to live with gluten in my own home, where crumbs, cross-contamination and having two of many items became a distant memory.

I’m finding it’s an adjustment to be around gluten at home again. And since our New York City apartment is near a bagel store, you could say I even smell gluten when I open our windows each morning. Yes, the bagel store down the street vents in our direction and wafts right in.

I do see the irony and the humor in this: someone with celiac disease whose windows let in the smell of fresh bagels along with the sunlight. But I have to admit that ever since I was diagnosed 14 years ago, I’ve been more bothered than pleased by the aroma of fresh baked bread and bagels.

Beyond that, I’m adjusting to  seeing items that contain gluten in my cabinets. A box of “magically delicious” Lucky Charms, obviously my boyfriend’s, sits on one side of our large kitchen cabinet while boxes of gluten-free cereal are on the other. Our freezer has already had a gluten-free makeover and has lots of gluten-free frozen items. It’s boardering on being as full as my supermarket’s gluten-free freezer section.

Meanwhile, my retro Cuisinart toaster and his toaster oven are peaceably sharing space. Although two toasters are a sign there is gluten in the kitchen, I love what a two-toaster home symbolizes for us: a step forward in our relationship.

gluten-free kitchen
One kitchen, two toasters

But there are still some things to work through, so I turned to dietitians Pamela Cureton and Rachel Begun for suggestions.

Cureton, RDN, LDN, at the Center for Celiac Research at Mass General Hospital for Children, gave me an overview of the foundations for anyone sharing a kitchen. Here’s her advice.

  • Thoroughly clean kitchen counters before making a gluten-free product. Use clean cooking and serving utensils and don’t share them between gluten-free and gluten-containing foods
  • Prepare gluten-free foods first.
  • Use a separate slotted toaster.  If using a toaster oven instead, use foil or a clean tray for gluten-free items.
  • Avoid “double dipping” in common condiment jars. Use squeeze containers or purchase separate jars and label them gluten free.

Since sharing is the big challenge, the good news is my boyfriend and I have slightly different palettes, which eliminates some potential cross-contamination. I never put cream cheese on my gluten-free bagels so he can double dip all day. Meanwhile, my hummus, tzatziki, and Greek yogurt dips are for vegetables and gluten-free chips only.

Rachel Begun, MS, RDN, registered dietitian nutritionist and gluten-related disorders expert, suggested open communication as the best way to work out any potential differences sharing a kitchen might create.

“Just like you communicate clearly to the restaurant staff about the proper precautions to take, I recommend having a conversation up front rather than assuming things will take shape along the way,” she explained.

Begun also emphasized the importance of figuring out what is important in the kitchen and communicating this clearly. “Since you are the person whose health is at risk, it’s up to you to decide what you are and aren’t willing to compromise on and making your requests clear,” she said.

This week marks nearly two months of sharing our home.  I’m happy to report sharing a kitchen has been pretty seamless. My boyfriend is knowledgeable, careful and mindful of keeping things safe for me. He even has his own gluten-free favorite foods.

It does help that he is the neatest person I know. Even before I moved in, he was always quick to clean up crumbs. Now, if there is a crumb anywhere it’s gluten free. In other words, I missed a spot.

If that’s our biggest kitchen problem, I will take it.


Susan Cohen is a regular contributor to Gluten-Free Living. She recently celebrated fourteen years on a gluten-free diet.


















A Day in the Life: Celiac disease expert Alessio Fasano

A typical day for Alessio Fasano, M.D., a world-renowned expert on celiac disease and gluten sensitivity, doesn’t seem to exist.  This isn’t surprising given his many roles, or hats as he describes them, at Mass General Hospital for Children and in the gluten-free world at large.

Fasano 2
Alessio Fasano juggles administrative work with research and patient care

As director of the Center for Celiac Research, chief of the division of pediatric gastroenterology and nutrition and associate chief of the department of pediatrics research, Fasano spends his days overseeing research, working with physicians, seeing patients and handling numerous administrative duties.

Although his days are full of responsibilities and discoveries, he begins and ends them like many of us. Fasano says he has to have his coffee in the morning, and in the evening he enjoys cooking dinner. He’s even tapped into WhatsApp to communicate with colleagues, friends and family.

 Fasano, who grew up and was educated in Italy, recently described what his atypical days are like.  Although he noted that every day is different, his pursuit of knowledge through research and his commitment to helping those in the gluten-free community are common threads.

 What time do you wake up? 

In general about 6 to 6:30 a.m.

 What’s for breakfast?

I have my cup of espresso, first and foremost. I am not able to do anything intellectual unless I make my espresso.

I typically put on the espresso machine and then I get my newspaper. By the time the coffee is ready, I start to read the news. In general, that’s my breakfast. Honestly, I am not a role model when it comes to eating a healthy breakfast. I would not recommend this to anybody. But that’s the way I function.

 Do you check your email in the morning?

I go through my emails very quickly because I have connections, friends and collaborators all over the world in different time zones. I see if there is anything urgent. If I have time, I read the Italian news.

What time do you get to work?

It depends on the day of the week, in general between 7:30 and 8:00 a.m. Some days I have commitments even earlier than that.

celiac disease
Fasano in the lab at the celiac center

 What’s an average day like for you?

Every day is different, but every day I systematically manage problems. There is always something that I have to fix and take care of. I have to deal with administrative issues with physicians, the center and the lab. I typically spend a fair amount of time with folks if they have troubleshooting problems with experiments or issues in the clinic.

And I go to meetings — a lot of meetings. I don’t like that, but I spend a fair amount of time pushing papers back and forth. Almost every day I have an interview like this one because of my new book, Gluten Freedom. A lot of people ask me about that.

There are days when I am more focused on the lab. People come on a weekly basis to discuss their research with us. Thursdays are totally dedicated to clinic, and from 9 a.m. until 7 p.m., I see patients.

In general, in terms of commitments and finishing rounds, my day is over at about 6 p.m., and between 6 and 8 p.m., I do charts and catch up with the rest of the stuff that I was unable to do during the day. Then I get back home.

If I have stamina, I go running. I cook dinner, I watch the news and at midnight, I go to bed.

I also travel a lot. When I travel, all of this goes off the plan. Then I’m always in the catching up mode, and I always have stuff on my desk.

 What’s for lunch?

Nothing. Unless there is a lunch meeting and lunch is provided and I have to be there, I do not have lunch. Again, I am not a healthy eating role model. Maybe over the years my stomach shrank, but definitely I do not have the time.

 Is there anything surprising about your day?

You know that’s the beauty of my job. I really never know what the day holds for me. It’s always a little bit of a surprise. Good surprise. Bad surprise.

Do you have a favorite part of the day?

Six in the evening. That’s when I have a little bit more time for myself to really wrap it up with the turmoil of the day. It really stems from the fact that I wear so many hats. I’m division chief and director of the lab. I run the celiac center, and there is a lot of stuff going on.

 If you don’t eat breakfast or lunch, what’s for dinner?

Well, I need to really make sure that the dinner is the right meal. One thing that I love is to cook. I don’t like to clean, but I like to cook. So I really take time to cook from scratch. I never eat stuff that is precooked or is made in the microwave.

In general, good food doesn’t need much time to be made. Twenty minutes, you should be fine. I make a lot of vegetables and fish. I’m trying to use whatever is available.

For example, yesterday I had eggplant that was really getting to the end of the line and needed to be used. So, I carved the eggplant to take out the inside and sautéed it with red and green pepper. I put this mix put back into the eggplant and baked it in the oven for 45 minutes. Then I added some gorgonzola cheese on top. I have to say, it was a heck of a dish, particularly the gorgonzola crust I made by broiling it for a few minutes. By the way, this was gluten free.

I have a son in Florida. He’s also a heck of a cook. We exchange WhatsApp messages in which he sends me plates that he did, and I ping back with mine.

What have you learned from the gluten-free community? 

I don’t live with celiac disease or gluten sensitivity, so the more I deal with people and meet with them, the more respect I have for people who do live with these conditions.

 Has researching celiac disease and serving as a physician in the gluten-free community changed you?

Big time. I have to say, you try to put yourself in people’s shoes. You realize that it has an impact on the person, his or her social network and family. You think about the challenges for the person depending on age. I really believe that treating the patient with his or her complexities gives me a different perspective.

 What does helping the community mean to you? 

This is a tough job. You live your life in the fast track. The failures by far surpass the successes. The stamina to continue working comes from the community that you serve. If you go back and you think about it, many, many times as a physician, as a researcher you really face failures that will make you consider things.

I have to fail 100 times to have one success. There is a lot of frustration. There is a lot of sacrifice. There is a lot of behind the scenes work. The only reason you keep going is because someone writes you a thank-you note saying you made a difference in their life. That is really what the community gives. I don’t think it’s just me, but everybody who does a job with passion and dedication.

Guest Blogger Susan Cohen is a freelance writer who often writes for Gluten-Free Living. This is the 6th in her Day in the Life series.

(This interview has been edited for length and clarity.)


A Day in the Life: A Gluten-Free Advocate

Alice Photo 1For Alice Bast, founder and president of the National Foundation for Celiac Awareness, it’s not an exaggeration to say that no two days are alike.

Her role takes her around the country to make sure those with celiac disease and gluten sensitivity get the information and support they need. Her work within the gluten-free community is matched in importance by her efforts to raise awareness outside of it.

Bast was diagnosed with celiac disease 21 years ago after spending years trying to find the source of health problems that led to a stillbirth, multiple miscarriages and a baby born at only 3 pounds. These years were also marked by debilitating physical symptoms and mental and emotional strain.

In 2003 Bast founded NFCA, which is based in Philadelphia, to make sure no one else would have to go through the same thing.

We talked in June about what her atypical “typical” day looks like. And she emphasized that one thing that’s always the same is her attempt to make a difference on behalf of the gluten-free community.

What time do you wake up? 

I wake up at 5:45 a.m. I take my medication because I have thyroid disease. I have to wait a half an hour until I can eat. It’s a fact of the matter. Then I work out. I’m pretty athletic. I either go for a run or go into our basement and get on the stepper.

What’s for breakfast?

When I’m home, breakfast is typically a smoothie that has lots of greens and good stuff in it, or I’ll make myself eggs. When I’m on the road, it’s a whole different routine. During May, which is Celiac Awareness Month, I was probably only home for about five days. Otherwise, I traveled for speaking engagements and conferences.

After breakfast, I water the plants and feed the birds. I get ready for work so I can be there by 8:30 a.m.

Do you check your phone, email or social media before you get to work?  

I used to go right to my computer and phone and start emailing, texting and checking Facebook. Now, it depends on what’s going on in my life.

If I have something on my mind I can’t help it, and I go to my email. I don’t look at Facebook in the morning because I will never get to work. I look at my phone to see if my kids have sent me a text message. I don’t have breakfast with them anymore because they are 21 and 27 and away from home. They know that’s a great time to reach me.

Once I pick up my Android I start reading emails. I have to admit, eight days out of 10, I do a cursory review of my emails. I do get about a 150 emails a day and a number of phone messages.

When I get to the office, I don’t sit and answer emails all day long. I work with our communications group for social media because I have to run the organization.

Alice Photo 2 What’s an average morning like for you?

I do tend to go to shows and conferences a lot. I’m not always in office, but when I’m in the office, it’s busy. My schedule is pretty much booked solid.

We have two programs areas: our diagnosis campaign and our healthcare outreach. There is always the GREAT restaurant training, and right now we have a grant from the Food and Drug Administration to study gluten and medications.

So, I typically have morning meetings whether they are phone calls or face-to-face. I do make sure that I chunk out time in my day so I can take a step back and look at the big picture. I spend time working with my board of directors and do some strategic planning.

What’s for lunch? 

Even though we have people in the office who don’t have celiac disease, to make our lives uncomplicated, our lunchroom is completely gluten free.

I don’t know if there is a typical lunch, but I always make food from scratch and eat very healthfully. If I have salmon the night before, I’ll bring salmon in. I used to love to eat yogurt, but I feel like I have overdone that.

Some days I make a salad and put everything on it. It might be goat cheese or cranberries. I try to eat from my own garden. We have snap peas now and just had fresh asparagus. I love avocado and will cut it in half and slice it and eat the entire avocado.

Some days are very different. For example, an Irish gluten-free bread company had come in, and we got samples. So, I actually made myself a grilled cheese sandwich.

 What’s surprising about your day?

When I get overwhelmed with technology, I like to go into the woods for a walk. People see me dressed up in a suit all the time. They don’t see the side of me that is pretty basic.

If I’m struggling with something, my best thinking is done when I go into nature. For some people that “aha” moment comes when they are asleep. The “aha” moment comes from me when I’m taking a walk in the woods.

My husband loves to cook. That may be surprising. He shares the responsibility. I’m very lucky. He loves to experiment with all kinds of grains. He’s taught me how to be a better cook.

What’s your favorite part of the day?

My favorite part is when we feel that NFCA has had a win. A win for us is when someone tells us a story of how we’ve helped them. At a Phillies’ game recently a little boy put his arms around my leg and said, “Thank you for my gluten-free hot dog. In a bun!” It’s the little things, the thank you, that let you know you have made a difference.

But we work a lot on the big picture. We are working with scientists and on empowerment and education. Every once in a while you stop and say, “Wow, that’s pretty incredible knowing that I made a difference.” When it comes down to it, I do this because I want to help people. I want them to be healthy.

The other favorite part of my day is spending time with my family and being able to talk about what’s important to all of us. Just simply holding hands.

How late do you work?

We are in a building with many other offices. When I walk out to the parking lot, my husband asks, “Why are you always the last one?” My staff is also always the last to leave. They are very dedicated, and I am really fortunate.

 What’s for dinner?

Believe it or not, we are having turkey tonight. I don’t think we’ve ever had turkey in June before, but my husband put it in the oven because we hadn’t cooked this turkey. And we have a fair amount of people to feed tonight. My daughter is coming with her fiancé and his parents. I set the table over the weekend because I’m too busy to get to it tonight. We’ll also have salad and fresh vegetables.

What have you learned from working in an advocacy role? 

I’ve learned that it’s very complicated, and you need to have patience.

How has founding and serving as NFCA’s president changed you?

It gives me appreciation for the little things in life. It takes a team to make a difference, but one person can contribute in a way that has impact. It gives me hope for the future.

Guest blogger Susan Cohen regularly writes the New for You column for Gluten-Free Living and also contributes to the In the Mix column.

(This interview has been edited for length and clarity.)

A day in the life of gluten-free restaurant manager Brad Holtzman

Brad Holtzman, a partner and the general manager of the gluten-free restaurant, Taquitoria, on New York City’s Lower East Side, is relatively new to the gluten-free community.

Taquitoria 2
Photo by Evan Sung
Brad Holtzman, far right, runs gluten-free Taquitoria with his partners.

Still, he thinks he understands what gluten-free diners want. “They just want to eat good food,” he says to explain what he has learned about the gluten-free community since Taquitoria opened.

Holtzman and his partners, Barry Frish, the restaurant’s Culinary Director, and Matthew Conway, are bringing taquitos- rolled and fried tacos – to a diverse clientele of New Yorkers that includes those on the gluten-free diet. The restaurant also serves what Holtzman describes as “the rowdy crowd,” who frequent Taquitoria on Fridays and Saturdays when it’s open until 4:00 a.m.

When the trio set out to open a restaurant, one of their goals was to introduce taquitos, a San Diego specialty, to New Yorkers. They knew that gluten-free diners are always looking to find a new spot. Holtzman, in particular, was well aware of gluten-free needs from working at other establishments. “A day wouldn’t go by without there being some sort of special request or eating restriction or severe allergy,” he explains.

So the restaurateurs made a conscientious decision to be gluten free. All of Taquitoria’s taquitos are made with corn tortillas and the ingredients were kept simple. Nothing unnecessary was added. “We’re hoping to provide a fresh product for people in need of a gluten-free dining option,” Holtzman says.

On the last day of winter, I headed downtown to Ludlow Street to find out what a typical day is like for Holtzman. I arrived at 4:00 p.m., just as he was preparing to open the restaurant.taq home page

What time do you wake up? 

I wake up at 9:30 a.m. or 10:00 when I’m lucky.

What’s for breakfast?

In the winter I have espresso.

What do you do before the restaurant opens? 

My workday starts no later than 11:00 a.m. when I start getting the restaurant ready.

We basically have two businesses here. We have a restaurant and we also run a full-fledged catering business. Both of these businesses require a lot of hands on work, a lot of organization, attention to detail and communication. 

What are your responsibilities during business hours? 

I maintain the image of our restaurant, keep the peace, answer food questions, allergy questions and describe what a taquito is. Without realizing it, we opened a restaurant where half of our New York food population doesn’t even know what a taquito is.

I’ll do anything from cooking taquitos to mopping the floor to counting the register to taking your order to making deliveries on a bike, by foot, whatever it takes.

How many taquitos do you eat a day? 

I limit myself to 10 taquitos a week in an effort to not look like a taquito.

How many taquitos do you sell each day?

It varies, but anywhere from 500 to 1,000.

Does your patronage change throughout the day?

Absolutely. And it changes throughout the week.

Earlier in the day, we certainly have a neighborhood feel. We have built really nice relationships with most of the people who live and walk by here on Ludlow Street. We have finally mastered the art of the half-wave so you don’t actually have to say hello four different times a day.

Fridays and Saturdays, we sell a majority of the taquitos at night. If we really had to, we could open the doors at midnight and just stay open for five hours. After midnight on the weekends, people are hungry and want a good, inexpensive dining option. The taquitos are three for $5. (More info about the restaurant is available here.)

What’s surprising about your day?

It always surprises me how our food can impress anyone even the most savvy food professionals. It’s just as satisfying to us to be able to feed a 20-year-old at four in the morning as it is to feed an executive chef or head sommelier from a fine restaurant. We knew they would like it, but to this extent it still blows us away.

What’s the last thing you do at the restaurant? 

As we finish mopping the floor and counting the register, we play a song called Runaway by Pusha T and Kanye West. It just organically became a “thing.” We all play the air-piano together during the intro. Afterwards, we finish up, we lock up and leave.

What time does your workday end?

At the latest, 4:30 in the morning. I get home from work, and frequently I see people on the way to work.

How has managing this restaurant changed you? 

Obviously I expected a lack of sleep and free time. The ability to connect with people over something as simple as an order of taquitos is definitely unexpected. The look on people’s faces when they taste our product honestly makes me feel good inside.

Also, leading a staff, some of whom are younger and some of whom are older than I am, is new. I never had the opportunity in this industry to be in a leadership position. Now having the opportunity to lead a staff every night feels great. We rally around each other and have each other’s backs and work really hard to go shoulder to shoulder until the finish line at the end of the day.

What have you learned from managing a gluten-free restaurant? 

I have learned that you can really make somebody’s day. We make the day for people who are often told. “No.” I’ve seen this many different times, but one case in particular stands out.

A couple walked into the restaurant at around 11:00 p.m. on a weekend. They were looking at the menu, then turned around and started to walk out. I interjected, “May I please help you with anything. Do you have any questions?” They both told me and I quote, “Oh, we can’t eat here. I’m so sorry. We recently both went gluten free.”

I looked at them and I said, “Well, as a matter of fact, our entire restaurant is gluten free.” They looked at me like I was joking or lying to them. And then I said, “I promise, I will show you every product we use in house. We use yellow corn tortillas and there isn’t flour anywhere.”

They were blown away. They shared an order of five taquitos, went out to the bars and came back later that night and each ordered another order of five.

There aren’t many restaurants at this price point with this quality of food where someone who has celiac disease, someone who is vegan and a fraternity guy coming home from the bars can enjoy the same dining experience.

(This interview has been edited for length and clarity.)


Guest blogger Susan Cohen regularly writes the New for You column for Gluten-Free Living and also contributes to the In the Mix column.


A day in the life of Jennifer Goodhue of Tu-Lu’s gluten-free bakery

Tully & Jen - Website
The women behind Tu-Lu’s, Tully Phillips (left) and Jennifer Goodhue (right)

Jennifer Goodhue keeps Tu-Lu’s Gluten-Free Bakery running like a well-oiled machine. As chief operating officer of Tu-Lu’s New York City location, she oversees all aspects of the bakery. Goodhue, who has celiac disease and a passion for baking, originally worked in finance, and her background has proven invaluable in the day-to-day operations.

A visit to see how she spends her day seemed perfect given that we are fast approaching Valentine’s Day, with its devotion to all things sweet.

Goodhue joined Tu-Lu’s in June 2011 after being introduced to the bakery’s owner and founder, Tully Phillips. Philips, a graduate of Le Cordon Bleu in Austin, TX, opened the bakery in February 2010, two years after receiving a diagnosis of gluten-intolerance.

Phillips was motivated by the fact that the city, at that time, didn’t have a dedicated gluten-free bakery. “I was having a hard time finding a place to buy a delicious cupcake…in New York of all places!” she shared by email. “That’s when I decided to open Tu-Lu’s in February of 2010. It’s hard to believe we are coming up on our four- year anniversary.”

Since launching her first bakery, Philips moved to Dallas where she has opened two more Tu-Lu’s locations.

On a blistery January day, I bundled up and headed downtown to Tu-Lu’s on East Tu-Lu's Cupcake Stand Pic11th Street in New York City to spend the morning with Goodhue, who kindly opened the door for me before regular bakery hours.  Truth be told, she also opened up a folding chair so I could sit alongside her while she worked at the desk in her office downstairs.

This provided the perfect opportunity to watch her start the workday and see her financial and organizational skills in action. My view was very colorful since I could see stacks of containers filled with sprinkles in a rainbow of hues. And I could smell baked goods being prepared upstairs.

Goodhue noted that she has habit of counting everything, “If I am on a walk, I count how many geese there are,” she said. She puts her number skills to good use keeping track of everything at Tu-Lu’s from how many of a specific cupcake were sold yesterday to which items were most popular last Valentine’s Day.

(A full list of the bakery’s mouthwatering Valentine’s Day offerings at the New York store is available here and the Dallas locations here.)

Here’s a glimpse of her typical day at the bakery.

 What time do you start your day?

My morning routine starts at 5:00 a.m. with the gym at 5:30 a.m. and I stay there until 7:00 a.m. Afterwards, I either drive into the city or catch the 7:18 a.m. train from my home in Katonah, New York.

What’s for breakfast?

I usually have this every weekday:  gluten-free rolled oats with half a banana, some almond butter, some cinnamon and cacao nibs and three hardboiled egg whites. That is my protein/fuel/carb ratio to get me through a stretch of time. I usually eat as I do the scoop and bake list.

What’s the scoop and bake list?

The scoop list outlines the specific items and quantities baked for a specific day.  Our bakers reference this list so that they know exactly what to bake in the morning and how much of a certain item is needed. For example, 36 coffee cakes or 24 vanilla cupcakes are needed.

What’s happens when you get to the bakery?

I greet my team and check in. Then I look at all the special orders or wholesale orders for the next day to determine quantity projections for the bakery case. This dictates how much of a certain item and which specific item our bake team should bake in the morning.

When making the list, I look at the weather. Is it going to be another blizzard? I will access numbers and look at how we did the day before. How many loaves of bread did we sell? Are there cupcakes left? If a certain product has a surge, I definitely want to include that item in the case. If it were a holiday, I would take that into account and increase our numbers.

Once a week, I open the bakery myself. It is important to see a few different perspectives at the bakery including the perspective of the customers and my employees.

Valentine’s Day is coming up. How do you prepare and what are you selling?Tu-Lu's V-day cookies

Every holiday, I go back and look at the numbers from the year before. For example, exactly how many Raspberry Linzer cookies did we sell? Today (the day of our interview) is three weeks out from Valentine’s Day and I am going to have a conversation with the bake team to further prepare.

Valentine’s Day is a big cupcake holiday.  The biggest cupcake holiday we have. This year, we are making cute four-inch cakes in heart shaped pans. You can choose chocolate or strawberry. We have vegan cake options as well. We sell boxes of cookies that spell out “LOVE”. I actually just ordered Valentine’s Day sprinkles.

The packaging is important too. We have some fun packaging. Our heart-shaped sugar cookies are packaged in clear cellophane bags and tied with festive Valentine’s ribbons.  Our “LOVE” shaped sugar cookies come in a white window bakery box, so that you can see the cookies inside.  They sit on pink crinkle paper and are tied with a Valentine’s grosgrain or organza bow.

The store is festively decorated with pink and red heart banners. There are also owls holding hearts, as a nod to the bakery mascot!

 How does Tu-Lu’s use social media as part of the bakery business?

I love the social media aspect and getting something we just created spun out there. For example, each Thursday we roll out our cupcake flavor of the week and put it up on Instagram, Twitter and Facebook. A lot of customers come into the bakery and announce that they saw our cupcake flavor of the week and are excited to try it!  

What’s in your lunch?

I usually bring lunch from home. I bring quinoa, sweet potato or brown rice with vegetables – spinach, green beans, celery or cucumber – with chicken. I finish lunch by eating two dates. I love occasionally getting quinoa salad at a store nearby. If I really want a treat I get a smoothie.

 What does the rest of your day look like?

I always take notes and make to-do lists. It helps me be prepared and stay organized. I am always looking around and assessing our inventory. We have tons of supplies and ingredients, so there is a lot to take into account. Do we need eggs? Do I need to order cupcake liners? Do we have enough buttermilk?

Do you sample sweets during the day?

I sample when we are experimenting. Saturday is my personal sweet day. After dinner I have dessert. I think about what I am going to eat all week!

 Anything surprising about your job?

There is a whole other side to running a bakery. It’s not always cupcakes and frosting. When you run a business, you deal with it. My day yesterday was dealing with a radiator that wasn’t producing any heat. My employees were freezing and we were all wearing long Johns! It’s especially imperative that I maintain a positive and upbeat attitude when these situations arise, as it really sets the tone for my team and our customers.

 What time does your workday end?

When you run a business, your day never ends.  There’s always an email to write, phone call to return, spreadsheet to update, new idea to set into motion, etc.  I always make myself available to my team and am constantly checking-in when I am not at the bakery.  Since we stay open until 10:00 p..(and 10:30 p.m. on Fridays and Saturdays) I am in communication with my employees that late at night since I like knowing how things are going and if it’s been busy. So really, my day ends when I go to sleep!

How has your job influenced your life? 

My days are filled doing something that I am passionate about — making gluten-free items accessible to people.  It’s hard work, and my days are long, but I like what I do!

Next up, we’ll find out what it takes to run a national organization.

(This interview has been edited for length and clarity.)

Guest blogger Susan Cohen regularly writes the New for You column for Gluten-Free Living and also contributes to the In the Mix column. 


A Gluten-Free Day in the Life of Jules Shepard

Jules2I’ve always been curious about what goes on in the daily lives of the people whose names are so familiar in the gluten-free world.

What’s it really like to run a gluten-free bakery or other business? What goes on behind the scenes to keep a support group going?  Most importantly, how do you make time for all the Facebook posts and tweets on Twitter?

In a series of blog posts, beginning with this one, I’ll share what movers and shakers in the gluten-free world say about what their day is like.

Jules Shepard is a jack of all gluten-free trades. She founded Jules Gluten Free, a gluten-free flour and baking mix business, authors gluten-free books, hosts an Internet radio show, is an eHow Presenter, manages her multiple very active social media accounts and travels the country to talk about living gluten free. In 2011 she  co-founded 1 in 133, a campaign that lobbied the Food and Drug Administration for gluten-free labeling standards, a campaign that paid off with labeling standards set to begin this year.

We’re very excited to have Shepard speak at the upcoming Gluten-Free Living Conference in Orlando, April 4 -6. She’ll be a featured presented at Blogger U, a one-day event designed for bloggers who write about gluten-free food, the lifestyle and more. Shepard, who pens the very popular blog, Jules Speaks Gluten Free, will share tips on how to make your blog more successful and widely read.  She’ll also be one of the experts in the conference panel discussion on all thing gluten free.

I spoke to Shepard last month when she called me from her home near Baltimore after a busy morning getting the kids ready for school and doing some early social media work. Shepard’s 12-year-old son and 8-year-old daughter do not have celiac disease like their mom but are gluten-free appreciators.

We talked about her gluten-free journey, which she described as having some unexpected turns.. “It’s been this process where I never set out to do these things, but the opportunity presented itself,” she explained. Here’s what Shepard had to say about her typical day.

 What time do you start your day?

My day starts at 6:45, but 6:36 if you want to know the truth.

What’s your morning routine?

I start working on packing lunches and getting breakfast ready and feeding my cats and checking my phone to see if any text message came in. I try not to get on the computer yet because then I am consumed. I go get my son out of bed. That takes a long time. I feed him and get his lunch packed. Teeth brushed and we are out the door by 7:45 a.m. Then I pick up carpool and drive to school and then come home and wake up my daughter, get her ready and take her to school.

What’s for breakfast?

Often times I just make a protein shake with Vega One  powder in a chai tea flavor that is so good. I just keep not finishing it and putting it back in the microwave to heat up.

Sometimes I make a green tea and add chai powder or have coconut yogurt with homemade granola or KIND granola or Jules oatmeal. I love to put in nuts and flax meal and berries.

Do you check email, Facebook or Twitter first?

I always check email first. Facebook is way more insane than Twitter when it comes to responding to people who’ve posted comments.

 What’s a typical morning in the office like?

I called you when I was finally done catching up with email, Facebook, Twitter. I do social media at least three hours before I get caught up every day. Then I can start doing other things. On a day like today, I have my radio show that I have to get ready for and record.

Everyday I am in the kitchen. I have a weekly recipe that I have to come up with. I have to write the recipe and photograph it and eventually post it on the blog. I have to do that at least once a week. That takes a lot of time.

Simultaneously, I am working on product development. Right now, I am emailing back and forth with the food manufacturing plant asking can if they can tweak one of my products.  There are products I have been working on for years.

Next, I do a lot of videos for eHow. They send ten recipes ideas at a time, and I have to write gluten-free recipes based on the idea. eHow sends a video crew down from New Jersey, and I record 10 cooking videos in one day. I can be preparing for three weeks for the filming.

Then I’m a mom. My kids get home in the afternoon and usually I try to be on the computer until they get home and then do kitchen stuff from then on so I can hang out with them.

 What’s for lunch? Dinner?

If I am not eating leftovers, my very favorite thing for lunch is gluten-free flatbread with a veggie burger, hummus, mustard and chips. I always make a double or triple batch of flat breads and put them in the freezer. I stick one in the oven on broil for a few minutes to warm and toast it up.

 For dinner, every week we have something a bit different and some old standbys.  Our old standbys every week are tofu tacos for my kids. I love them too.  We grill salmon once a week with a ton of vegetables like eggplant, zucchini, tomatoes, carrots and portobello mushrooms.

For at least two others nights, we have leftovers. I cook a big pot of quinoa and stir the grilled vegetables and salmon into the quinoa. I add San-J Thai peanut sauce and stir it in. My kids won’t eat salmon without it! It’s good cold or hot.

Then I usually saute some shrimp or something one night. We do a lot of things with black beans. I make quesadillas for my kids. I love almond cheese (Jules and her daughter are both lactose-intolerant).  Other nights might be gluten-free beer battered fish sticks or salmon noodle casserole. I love plantains so I’ll do fried plantains. We make homemade pizza once a week.

What time does the workday end?

Well, it’s funny. It doesn’t. I’m in the kitchen working and then I make dinner. Often I’ll tweet or post photos on Instagram of what I’m making for dinner to inspire people about what they can be making. After I put my kids to bed, I come back and do more social media work and that can go anywhere from 9 until midnight. I try to make sure I go to bed around midnight.

 Thank you Jules for sharing your workday! Also, can I come to dinner?

 (This interview has been edited for length and clarity.)

 Next up we talk to a gluten-free sweet treat expert just in time for Valentine’s Day.

Guest blogger Susan Cohen regularly writes the New for You column for Gluten-Free Living and has also done features for the magazine, including the most recent on gluten-free 20-somethings.

Millennials making their way

gfbloggers1GF 20-somethings on jobs, grad school, roommates & dating 

Two summers ago, Lindsey Schnitt’s date reached across the table to take a taste of her dinner. He didn’t know that because she has celiac disease his fork carried some risk of cross-contaminating Schnitt’s gluten-free meal.

While they were dating, Schnitt, now 22, helped him learn about the disease and the gluten-free diet and did not have to worry again about a fork potentially ruining an evening. After that first dinner, her date always made sure they went to restaurants with gluten-free choices, Schnitt says.

Dating and going out with friends, jobs, business lunches and trips, graduate school and roommates are among the myriad of challenges 20-somethings with celiac disease or gluten intolerance face as they meld gluten-free lifestyles with being truly out on their own for the first time.

One thing most of them already know is that being gluten free means continually adjusting and learning to handle new situations. That’s the positive attitude Schnitt and others her age who are gluten free bring to this exciting phase of their lives.

Samantha Hamroff, Jeremy Reich and Candice Clifford are also young adults with celiac disease or gluten sensitivity. They and Schnitt say learning how to be independently gluten free started in college. Now they are transitioning fairly easily to new lives in the workplace, the city and in graduate school.

They don’t see themselves as all that different from friends who’ve graduated and are out in the real world. They face the same experiences, transitions, questions and concerns of any 20-something. They just happen to do it while gluten free.

“I am finding my 20s have been full of so many transitions,” Clifford explains. “There is so much to adjust to as I’ve moved out of my teens and into young adulthood.”

GF goes to the office

Jeremy Reich

When Reich, 26, graduated from Columbia University in 2009, his first job as a consulting analyst required him to travel frequently. Often, Reich would be told on Friday that he would be leaving Sunday for a week away on a project. The short notice meant Reich had to quickly research his gluten-free options in a new city.

He credits having been diagnosed with celiac disease as a child for his ability to adjust quickly and advocate for himself.

“Best thing to learn — start paying attention, start asking questions,” he explains. Reich’s ease with the gluten-free diet also stems from growing up in a household with a strong gluten-free role model. His mother, Beth Hillson, also has celiac disease and is a pioneer in the gluten-free community, having founded the Gluten-Free Pantry, one of the early gluten-free baking mix companies. Hillson is currently working on a book that will include details on being gluten free in your 20s, and her son is likely to find his experiences on her pages.

But Reich, who has moved on to his second job, also attributes his gluten-free travel success to his work team. He felt comfortable telling them he has celiac disease, and they have been very supportive. He makes restaurant suggestions for the group and selects regional cuisines that are gluten-free friendly such as Thai and Indian. And he knows which chain restaurants have gluten-free menus.

“Getting a meal from P.F. Changs and knowing you don’t have to think about it is really comforting,” he says.

It also helps that Reich is not the only member of his team on a gluten-free diet.

“The funniest part is that we’ll go out to lunch together sometimes and I’ll get to be a nagging gluten-free mother. I’ve caught myself several times saying, ‘That’s not gluten free,’ and pushing them to order something else or leave something on the plate,” he explains.

But even when a new job does not include travel, being gluten free still requires planning as Schnitt is learning. She graduated from Pennsylvania State University in 2012 and within months began working in the entertainment industry in New York City.

“I feel myself in this little transitional phase,” she says. Her daily work schedule fluctuates, and some days she is at work from 8 a.m. to 6 p.m.

With a long day in the office, Schnitt brings meals to work and also makes sure to keep lots of snacks at her desk, including gluten-free protein bars and bagel chips. Her co-workers have definitely picked up on gluten-free cues. They even made sure she had something delicious from a gluten-free bakery on her birthday.

“Two girls I work with had Tu-Lu’s delivered to the office so I would have cookies and treats,” Schnitt says.

GF in Graduate School

Candice Clifford

After her freshman year at the University of Scranton, Clifford, now 23, was diagnosed with gluten-sensitivity and also found out she needed to be dairy-free.

Clifford’s diagnosis inspired her blog, Embrace G-Free, where she shares her thoughts about her journey and connects with the greater gluten-free community. Clifford is part of a larger group of gluten-free bloggers and Twitter users in their 20s. Schnitt also has a blog, Young Wild and GFree, and Hamroff blogs with her sister as the “Celiac sisters.”

“In a way, my blog has helped me not only empower other people but to empower myself to live my best life. To not feel so held back,” Clifford says.

She is following that philosophy while working on her master’s in school counseling at Scranton. She hopes to work with children and adolescents who have been diagnosed with celiac disease, gluten sensitivity or food allergies. “Through my own struggles I have recognized the need and importance of obtaining the emotional support after being diagnosed,” Clifford explains.

Although Clifford is still attending the same university she went to as an undergraduate, she is having an entirely different experience as a graduate student. One big change is that her support system of friends and her twin brother, who also attended Scranton, moved away after graduation.

“This year I’m learning with new people, and I had to educate them about gluten sensitivity,” Clifford says. She is also adjusting to a graduate schedule that includes evening class. Clifford plans ahead so she has meals ready for before or after class. “I like to plan out meals to budget for grocery shopping,” she explains. This cuts down on stress and allows her to focus on academics.

Hamroff, 23, who has celiac disease, is also a graduate student pursuing a master’s degree at New York University after graduating from the University of Michigan. Attending school in New York gives her access to the city’s numerous gluten-free options, and she likes being close to her family on Long Island.

Still, Hamroff ’s schedule includes long days at school, and it’s not always easy to find quick gluten-free meals near the NYU campus. She brings lunch with her every day and saves eating out for after class. And her classmates understand her gluten-free needs.

“I had a Hanukkah party with my grad school friends, and everything was made gluten free,” Hamroff says.


Lindsey Schnitt and Samantha Hamroff

For many young adults, first apartments still include roommates and figuring out how to share a kitchen.

Hamroff lives with a friend from college. Although her roommate is not gluten free, she has a nut allergy, so there is a mutual understanding between the two about cross-contamination and being careful in the kitchen.

Reich also lives in New York with roommates who are not gluten free. He says living in suites in college helped prepare him for a shared kitchen. His current roommates know what’s involved, including the things they have to do to prevent cross-contamination. They often enjoy his gluten-free cooking, including a recent experimentation with gluten-free Chinese pizza.

Schnitt’s new roommate in New York is also supportive. “She reads ingredients and tries to get a better handle on things,” Schnitt says.

Meanwhile Clifford is living on campus in a suite. She loves having a dishwasher and does not share her kitchen equipment or food with her roommates. Still, the kitchen is not completely gluten free, and Clifford is thinking about what kind of living arrangement might better suit her once she is done with graduate school.


Of course being a 20-something is about more than work or school or how to prepare three meals a day. It’s a time of life filled with going out with friends and dating.

Going out has gotten easier as gluten-free beer and cider have become much more common in restaurants and bars. A number of restaurants have gluten-free menus or options which means gluten-free young adults can socialize with friends and feel like part of the group.

“When my friends plan birthday dinners, they make sure there are gluten-free options at the restaurants,” Hamroff explains.

When it comes to dating, Reich says you have to expect you might not be the only one with food intolerances. “Everyone has his or her restrictions,” he says. With increased awareness of the gluten-free diet, understanding of it is changing, he notes.

“People get it now if you bring it up,” Reich says.

While the gluten-free diet is likely to come up during a date, Schnitt says it should not be the main focus. “You teach people about it. Almost a talking point. Interesting conversation to have,” she explains. Hamroff agrees, saying a date should be about getting to know each other. And that sometimes means taking the focus off of food and forgoing dinner.

“Wine bars are awesome,” Reich notes.

For dinner dates, Schnitt does her research ahead of time. But if a date has already picked a restaurant, she tries not to change the plans. “As long as I can have a salad and grilled chicken, I’ll be fine,” she says. And sometimes the dates do their research. “I’ve gone on dates where the other person made sure the restaurant has glutenfree options,” Hamroff says.

Another solution is preparing a meal at home. “Nothing nicer than cooking dinner together,” Reich says.

Clifford does not think the gluten-free diet should be an impediment to dating.

“The more years I live gluten free, the more I find myself comfortable with the situation. I look at is as, if this is this the right person to be with, we will figure it out,” she concludes.

The Future

Like all adults in their 20s, Schnitt, Hamroff, Reich and Clifford are thinking about their futures.

While they don’t know exactly where their jobs or schooling will lead, they know they can handle whatever comes along, gluten-free style.

Susan Cohen, a 20-something who has celiac disease herself, is a freelance writer living in New York. She regularly writes the New for You column in Gluten-Free Living.


20-somethings on social media

Young adults flock to Facebook, Twitter and blogs to share their insights on living gluten free. Here’s a list of some you should check out.

Embrace G-Free
Graduate student Candice Clifford shares positive energy, empowerment and resources through her posts and poems.

Lindsey Schnitt, whose friends call her “the schnittuation,” blogs about food, restaurants and events.

Celiac Sisters
Samantha and Brooke Hamroff, sisters diagnosed when they were 16, list their favorite eateries and share other news.

G-Free Laura
Laura Hanley posts advice, product reviews and delicious recipes.

Gluten Freeways
Stephen, a young foodie who’s never let the glutenfree diet stop him from eating out, focuses on restaurants in San Diego, where he lives, and those he visits in his travels. Every blog ends with “Do you love it or do you love it?” That says something about his attitude.

CC Gluten Freed
CC Bonaduce empowers readers with her social and political activism, encouraging gluten-free communities throughout the country.

Sprinkles & Allergies
Bethany Trainor tackles her multiple food allergies with mouth-watering recipes and encouragement for readers.

Celiac Teen
Since the age of 15, Lauren McMillan has blogged about how she “let go of the gluten” in her journey with celiac disease.

College Student with Celiac
College undergraduate Chynna Foucek posts friendly anecdotes and recipes.