Everything you need to know about coeliac disease
Living Gluten Free
A beginners guide that will reveal how living "G" free can help you lose weight today! This is not a fad diet, or short term weight loss program that sometimes makes you worse off than before you started. This is a necessity for some people and is prescribed to 1 out of every 100 people on earth by doctors and health professionals.
Celiac Disease Foundation (CDF) Celiac Sprue Association (CSA) P.O. Box 31700 Omaha, NE 68131 Phone 402-558-0600 Phone (toll-free) 877-272-4272 Fax 402-558-1347 Website csaceliacs.org E-mail celiacs csaceliacs.org The Gluten Intolerance Group (GIG) 31214 124th Ave., SE Auburn, WA 98092 Phone 253-833-6655 Fax 253-833-6675 Website gluten.net E-mail info gluten.net
Celiac disease, also known as celiac sprue and gluten intolerance, is a genetically based autoimmune disease characterized by sensitivity to proteins found in the cereal grains wheat, barley, and rye. Having a genetically based disease means that the potential to develop the disease was inherited from one or both parents. Having an autoimmune disease means that the body's own immune system damages tissues of the body when presented with something it views as harmful. In the case of celiac disease, the body views certain proteins found in wheat, barley, and rye as harmful. Many of the nutrients found in the food we eat are absorbed in the small intestine. The lining (also called the mucosa) of the small intestine contains tiny hairlike projections called villi, which aid in the absorption of nutrients. In the case of celiac disease, these villi may become shortened, or blunted. If the villi become blunted, the body may become unable to properly absorb several nutrients, including...
The good news is that, while people with untreated celiac disease may not absorb enough calcium, there is nothing about a gluten-free diet that should limit calcium intake. The primary sources of calcium in the American diet milk and cheese are readily available to persons following a gluten-free diet. However, as mentioned earlier, many people with celiac disease have a usually temporary secondary form of lactose intolerance and cannot digest the sugar in milk products. If this describes you, there are still plenty of foods you can eat that contain calcium. In addition, many people with celiac disease also are on other special diets, including low fat and vegetarian. If you are on such a diet, it is still possible to get all the calcium you need. The next section will help you do just that.
Many people experience an adverse reaction to gluten, the principal protein in many cereal grains. The symptoms have long been associated with the digestive tract however, other parts of the body can be affected and are currently being used in the diagnosis of gluten sensitivity. Celiac disease is the diagnosis made as a physician brings together many of the hallmark and perhaps more obscure symptoms. Celiac disease can occur at any time in a person's life and often the onset is triggered after surgery, viral infection, emotional stress, pregnancy or child birth. The impact of celiac disease can affect several areas and systems of the body often making the diagnosis challenging. In fact the symptoms associated with the digestive tract can mimic other digestive disorders. Symptoms often include For some people, gluten sensitivity can led to very frustrating skin condition called dermatitis herpetiformis or DH. This condition, typically involving blistering and itching is more common on...
Gluten-Free Diet A Comprehensive Resource Guide, rev. ed. Regina, SK Canada Case Nutrition Consulting, 2006. Green, Peter H. R., and Rory Jones. Celiac Disease A Hidden Epidemic. New York HarperCollins, 2006. Korn, Danna. Wheat-Free, Worry-Free The Art of Happy, Healthy Gluten-Free Living. Carlsbad, CA Hay House, 2002. Lowell, Jax Peters. The Gluten-Free Bible The Thoroughly Indispensable Guide to Negotiating Life Without Wheat. New York Henry Holt & Co., Owl Books, 2005.
Another food-related condition (less common than lactose intolerance) is gluten-sensitive enteropathy, better known as celiac disease or gluten intolerance. Celiac disease is a chronic disorder found in genetically susceptible individuals who exhibit severe intestinal distress after eating anything made with gluten, a protein found in wheat, rye, barley, and oats. People with this condition must follow a lifelong diet, avoiding all offending foods, or suffer the potential for malnourishment from chronic diarrhea and nutrient malabsorption. As you can imagine, life on this diet is no picnic A bowl of pasta, a bagel, cereal, crackers, or even a slice of bread can send a celiac's intestines into a sumo-wrestling match. Obviously, with the tremendous amount of food restrictions, members of the gluten-free club should consult a knowledgeable nutritionist. What's more, become best friends with your local health food store It's celiac-friendly and will generally carry the specialty items you...
Osteoporosis, as well as other, less severe forms of bone disease, may be a complication of long-term untreated celiac disease, because the body cannot properly absorb calcium and vitamin D. (Vitamin D enhances the absorption of calcium and is necessary for the proper formation of bone.) Osteoporosis is a bone disease characterized by low bone mass and structural changes within the bone that weaken it and increase the risk of fracture. There are several risk factors for osteoporosis, including inadequate calcium intake and poor absorption of calcium. Before diagnosis, people with celiac disease often experience malabsorption as a result of damage to the lining of the small intestine. Consequently, their bone mineral density or peak bone mass may not be optimal. Once you are diagnosed with celiac disease and your issues with malabsorption have been resolved on a gluten-free diet, it is important that you consume recommended amounts of calcium to help improve your bone mineral density.
A gluten-free diet can contain enough fiber, but you will have to make an extra effort to choose foods that are good sources of fiber. Most Americans consume only half the recommended amounts of dietary fiber. Furthermore, in a typical American diet, grain foods (typically, yeast bread, ready-to-eat cereal, pasta, and flour) contribute over 25 percent of an adult's intake of fiber. Many people with celiac disease do not consume the recommended number of servings of grain foods. Processed grain foods that are included in a gluten-free diet may not be good sources of fiber many gluten-free grain foods are made from refined flours and starches, which contain very little fiber.
With the proper food choices, a gluten-free diet can provide enough iron. However, a person following a gluten-free diet may find it more difficult to consume enough iron than a person following a typical American diet. This may be especially true for premenopausal women between the ages of nineteen and fifty, who require more than twice the amount of iron as similarly aged men. In the United States, grain-based foods account for a third of an adult's daily intake of iron, largely because of enrichment most wheat-based grain foods are enriched with iron, and most mainstream breakfast cereals are fortified with iron. However, as mentioned, most refined gluten-free grain foods are not enriched, so this source of iron is not readily available to people with celiac disease. While whole grains also are an important source of iron, many gluten-free foods are made using refined flour and starch, so they contain very little iron.
Finally, the United States is about to have a legal definition of the term gluten free on food labels. This ruling has been a long time in coming and should make life easier for all people with celiac disease. The information provided in this section explains what the gluten-free label will mean in the United States. When this book went to press, there were no specific FDA regulations in place regarding use of the term gluten free on food labels. Currently, if a product is labeled gluten free, it generally means that it does not contain any ingredients made from wheat, barley, or rye (and usually oats). However, under the Food Allergen Labeling and Consumer Protection Act of 2004, the Food and Drug Administration must issue a rule regarding the definition and voluntary use of the term gluten free for labeling purposes by August 2008. A proposed rule has already been released. The FDA's Rule for Gluten-Free Labeling A proposed rule for the use of the term gluten free for food-labeling...
There is nothing inherent in a gluten-free diet that makes it more (or less) likely to be high in fat. Nonetheless, studies on the nutritional composition of gluten-free diets have found fat intake to be higher than recommendations. The reasons for this are mul-tifaceted and include below-recommended intake of grain foods. In fact, some studies have reported that when gluten-containing grain foods are removed from the diet, people tend to replace them with high-fat foods instead of gluten-free grain foods. For overall health and well-being, people with celiac disease should make sure they are consuming recommended amounts of grain foods and pay attention to the fat content of their diet, especially as it concerns saturated and trans fat. Any diet that contains full-fat dairy products, processed snack foods, and fatty meat products may be high in unhealthful fat. In addition, while a high-fat diet doesn't necessarily translate to excess body fat, it certainly increases the likelihood...
The Celiac Disease Awareness Campaign of the National Institutes of Health (http celiac.nih.gov) Celiac disease information from the National Digestive Diseases Information Clearinghouse (http digestive.niddk.nih .gov ddiseases pubs celiac) National Institutes of Health Consensus Development Conference Statement on Celiac Disease (http consensus.nih .gov 2004 2004CeliacDisease118html.htm)
Whether or not you are new to the gluten-free diet, you may feel confused by some of the conflicting information out there about what grains can and cannot be eaten on a gluten-free diet. To top things off, you may have never heard of some of the grains you are supposed to be eating, such as teff. The information provided here will help you sort out the grains you can and cannot eat and introduce you to some of the less familiar grains. A gluten-free diet as followed in the United States does not contain protein from wheat, barley, rye, or hybrids of these grains. All other grain foods, with the possible exception of oats, are considered safe to include in a gluten-free diet. Oats are discussed in detail in Chapter 2. Grains That Can't Be Eaten on a Gluten-Free Diet All other grains (with the possible exception of oats) can be eaten on a gluten-free diet. *The Food and Drug Administration is proposing to allow wheat starch in products labeled gluten free as long as the final food...
This recipe is courtesy of Evelyn Tribole, M.S., RD, a nutritionist, author, and mother of a son with celiac disease. Visit Evelyn's website at evelyntribole.com. According to Evelyn's son Connor, these muffins are awesome and better than any store-bought muffin. This recipe uses a gluten-free baking mix, which is handy if you are just starting to experiment with gluten-free baking. Evelyn's preferred mix is Pamela's Baking and Pancake Mix, which is based on brown-rice flour, but you can substitute any gluten-free baking mix just make sure that at least the first ingredient is a whole grain. This recipe also calls for flaxseed, a great source of fiber and heart-healthy omega-3 fatty acids. Flaxseed is carried in natural-foods stores, or you can order it from Bob's Red Mill and Arrowhead Mills (see Appendix A). Evelyn also recommends using eggs fortified with omega-3 fatty acids. These eggs should be available in your local supermarket. Preheat oven to 350 F. Line a 12-cup muffin tin...
We have learnt in the course of many years' experience in the treatment of cases of celiac disease that it makes a great difference to the patient what kind of starch-containing foodstuffs are included in the diet in particular whether or not wheat is used. Willem-Karel Dicke, Dutch pediatrician and early advocate of the gluten-free diet for the treatment of celiac disease, 1953 Most likely, you are reading this book because you or someone you know has celiac disease. If that's the case, it may help you to know that you or your loved one is in good company. Years ago, celiac disease was considered rare in the United States. However, research conducted by Alessio Fasano at the University of Maryland Center for Celiac Research now tells us that the prevalence of celiac disease in the general U.S. population is 1 in 133. This is similar to the prevalence of celiac disease in parts of Europe. In Italy, for example, it has been reported that 1 in 250 people has celiac disease, and in...
Pasta, tortillas, bagels, whole-wheat bread great sources of starches, other nutrients, and perhaps fiber. Yet, those with gluten intolerance need to build their healthful eating plan with other grain products. Gluten intolerance also referred to as gluten-sensitive enteropathy or celiac disease is an intestinal disorder and not a true food intolerance. For those who have it, the body can't tolerate gluten (a form of protein) in wheat, rye, barley, and perhaps oats. For people with gluten intolerance, consuming gluten damages the small intestine lining, and the damaged intestine can't absorb nutrients as well. For those with gluten intolerance, the risk for malnutrition, especially among children, is high. Other potential risks premature osteoporosis, colon cancer, autoimmune
With the proper food choices, a gluten-free diet can provide enough folate. However, it may be more difficult for a person following a gluten-free diet to consume recommended amounts of folic acid from enriched food than for a person following a more typical American diet. In the United States, most refined wheat-based flour, bread, pasta, and breakfast cereals are enriched or fortified with folic acid. However, because most refined gluten-free grain foods are not enriched, this source of folate is less readily available to people following a gluten-free diet.
Gluten-free foodstuffs, substituting important basic foodstuffs should supply approximately the same amount of vitamins and minerals as the original foodstuffs they replace. A gluten-free diet can be a nutritional powerhouse and provide you with all the nutrients necessary for a healthful diet. However, the typical gluten-free diet as generally followed in the United States may be lacking in certain nutrients, including the B vitamins thiamin, riboflavin, niacin, and folate, the minerals iron and calcium, and dietary fiber. In addition, a gluten-free diet (just like any American diet) has the potential to be high in fat, including trans and saturated fat.
With proper meal planning, a gluten-free diet can provide enough thiamin, riboflavin, and niacin. However, a person following a gluten-free diet may find it harder to consume enough of these vitamins than would someone following a typical American diet. In the United States, grain-based foods account for approximately 30 percent of an adult's daily intake of thiamin, riboflavin, and niacin, largely because of the enrichment of these foods with B vitamins. In contrast, as stated in the sections on iron and folate, most gluten-free breads, pastas, and breakfast cereals are not enriched or fortified.
Genisoy Soy Protein Bars When this book went to press, Chunky Peanut Butter Fudge and Creamy Peanut Yogurt did not contain any gluten-containing ingredients. (Genisoy's other soy protein bars are not gluten free.) Genisoy Protein Crunch Bars When this book went to press, Chocolate, Raspberry, Peanut Butter, and Chocolate Chip did not contain any gluten-containing ingredients. Always check labels to be sure product formulations have not changed. These bars are fortified with several vitamins and minerals, including calcium, thiamin, riboflavin, niacin, folic acid, and iron.
This recipe is courtesy ofCynthia Kupper, RD, a nutritionist and the executive director of the Gluten Intolerance Group of North America. Cynthia dedicates this recipe to Bette Hagman, a cookbook author known as the Gluten-Free Gourmet and one of the pioneers in gluten-free baking. The recipe calls for Bette's Gourmet Four Flour Blend (a flour blend developed by Bette Hagman) andMontina Pure Baking Supplement. The flour blend, which is a mixture of garfava flour, sorghum flour, cornstarch, and tapioca flour, can be ordered from Authentic Foods. Montina Pure Baking Supplement, which is a flour milled from the seed of Indian rice grass, can be ordered from Amazing Grains. For contact information, see Appendix A.
You may not be familiar with (much less have tried) the gluten-free whole grains quinoa, amaranth, buckwheat, millet, teff, or sorghum. Nonetheless, these grains really are delicious and easy to cook and bake with. See Chapter 6 for delicious recipes incorporating gluten-free whole grains. To familiarize yourself with these grains, you may want to take the following advice * Each week, choose a new grain to experiment with. If you like to bake, purchase a small bag of flour as well as a small box of the whole grain or seed. Many producers of gluten-free whole grains sell starter packs to help consumers experiment with their products. See Appendix C for retail sources of whole grains. * Cook the grain, using the recipe provided on the side of the box. Or use a basic pilaf recipe, using the new grain you are trying in place of the rice. For added flavor, use gluten-free chicken or vegetable stock in place of water.
Nuworldamaranth.com) Creamy Brown Rice Farina (Bob's Red Mill, bobsredmill.com) Erewhon Brown Rice Cream (U.S. Mills, usmillsinc.com) Gluten-Free Mighty Tasty Hot Cereal (Bob's Red Mill, authenticfoods.com) Bob's Red Mill Gluten-Free Hearty Whole Grain Bread Mix (Bob's Red Mill, bobsredmill.com) Gluten-Free Pantry Brown Rice Baking Mix (Gluten-Free Pantry, glutenfree.com) Gluten-Free Pantry Multi Grain Bread with Seeds Mix (Gluten-Free Pantry, glutenfree.com) Gluten-Free Pantry Whole Grain Bread Mix (Gluten-Free Pantry, glutenfree.com) Only Oats Muffin Mix (Only Oats, onlyoats.com) Only Oats Pancake Mix (Only Oats, onlyoats.com) Pamela's Amazing Wheat-Free Bread Mix (Pamela's Products,
Joint Fao Who Food Standards Program Codex Committee On Nutrition And Foods For Special Dietary Uses. Draft Revised
Narrative review Celiac disease Understanding a complex autoimmune disorder. Annals oflnternal Medicine 142 (2005) 289-98, available at www.annals.org cgi reprint 142 4 289 .pdf. Arentz-Hansen H, Fleckenstein B, Molberg O, Scott H, Koning F, Jung G, Roepstorff P, Lundin KEA, Sollid LM. The molecular basis for oat intolerance in patients with celiac disease. PLoS Medicine 1(1) (2004) e1. Campbell JA. Diet therapy of celiac disease and dermatitis herpetiformis. World Review of Nutrition and Dietetics 51 (1987) 189 233. Catassi C, Rossini M, Ratsch I-M, Bearzi I, Santinelli A, Castagnani R, Pisani E, Coppa GV, Giorgi PI. Dose dependent effects of protracted ingestion of small amounts of gliadin in coeliac disease children A clinical and jejunal morphometric study. Gut 34 (1993) 1515-19. Celiac Sprue Association. CSA Recognition Seal Program. CSA website, Chartrand LJ, Russo PA, Duhaime AG, Seidman EG. Wheat starch intolerance in patients with celiac disease....
Gluten may be found in many products, ranging from the obvious (food) to the less obvious, such as medication. This section provides an overview of the categories of products that may contain gluten. Processed Foods That Contain Gluten * Malt vinegar (Note Whereas malt vinegar, which is made from barley malt, is not gluten free, other vinegars including distilled vinegar, cider vinegar, wine vinegar, and balsamic vinegar are gluten free.) Communion Wafers. In general, Communion wafers are made from wheat. However, low-gluten and gluten-free varieties may be special-ordered. Canon Law dictates that Communion wafers used to celebrate the Eucharist must contain some amount of wheat. The Benedictine Sisters of Perpetual Adoration have developed wheat-starch-based low-gluten Communion wafers that comply with Canon Law. Rice-based Communion wafers are available from Ener-G Foods, Inc. Low-gluten Communion wafers made from wheat starch are, I believe, safe for persons with celiac disease to...
Very few studies have been conducted on the nutritional adequacy of the gluten-free diet, and to date, only one of these studies has evaluated the diet in the United States. The U.S. study assessed the intake of fiber, iron, calcium, and grain foods of adults with celiac disease. Notable findings included below-recommended intake of dietary fiber, iron, calcium, and grain foods among the majority of female participants. In fact, recommended amounts of fiber, iron, and calcium were consumed by only 46 percent, 44 percent, and 31 percent of women participants, respectively. The situation was a bit better for men, but 12 percent and 37 percent of male participants did not consume recommended amounts of fiber and calcium, respectively. While all readers should be mindful of the nutritional adequacy of their diet, women in particular should pay close attention to their intakes of these nutrients. The following sections will show you how to avoid the nutritional pitfalls of the gluten-free...
Gluten-free diet A comprehensive resource guide. Regina, Saskatchewan Case Nutrition Consulting. www.glutenfreediet.ca Shelley Case, RD, has a helpful Web site for people with celiac disease. www.glutenfreemeals.com This site is for people with celiac disease who don't like to cook. Visit the Web sites for the Celiac Disease Foundation, The Gluten Intolerance Group of North America, and the National Institute of Diabetes and Digestive and Kidney Diseases for more information, resources, and links about celiac disease.
Celiac disease is an inherited autoimmune disease that usually affects several organs in the body before it is diagnosed and treated. When a person with celiac disease consumes any food, beverage, or medication containing wheat, barley, rye, and possibly oats, his or her immune system is triggered and responds by damaging the lining of the intestinal tract. As a result, symptoms include recurrent abdominal pain, bloating, diarrhea, weight loss, lactose intolerance, and malnutrition, often accompanied by nonintestinal symptoms such as anemia and fatigue. Some people have no symptoms whatsoever. It is the gluten that is in wheat, barley, and rye, that causes the disease. Gluten is found in breads and other baked goods, where it provides strength, elasticity, and the structure needed to hold dough together and seal in the gases produced during fermentation, allowing the dough to rise. Staples of the gluten-free diet include Alternative flours such as rice flour, potato starch, whey...
Carlyle-Gauthier, Rachel, and Billie McCrea. Gluten-Free Mama's Best Baking Recipes. Longwood, FL Xulon Press, 2007. Fenster, Carol. Gluten-Free Quick and Easy From Prep to Plate Without the Fuss. New York Avery, 2007. Hagman, Bette. The Gluten-Free Gourmet Cooks Comfort Foods Creating Old Favorites with the New Flours. New York Henry Holt & Co., Owl Books, 2005. -. The Gluten-Free Gourmet Cooks Fast and Healthy Wheat-Free Sarros, Connie. Wheat-Free, Gluten-Free Reduced-Calorie Cookbook. New York McGraw-Hill, 2004. Shepard, Jules E. D. Nearly Normal Cooking for Gluten-Free Eating A Fresh Approach to Cooking and Living Without Wheat and Gluten. Charleston, SC BookSurge Publishing, 2006. Washburn, Donna, and Heather Butt. The Best Gluten-Free Family Cookbook. Toronto Robert Rose, 2005. -. Complete Gluten-Free Cookbook 150 Gluten-Free, Lactose-
Corn gluten meal contains around 60 CP and is a by-product of wet milling of corn, most of which is for manufacture of high-fructose corn syrup. Being high in protein, it is often compared to animal protein ingredients during formulation. The protein is merely a concentration of the original corn protein component brought about by removal of the starch in the endosperm. There are, in fact, two products often manufactured during wet milling, the alternate being corn gluten feed which contains only 20 CP, due to dilution with various hull material. In certain regions of the world, the two products are merely called 'corn gluten' and so this must be differentiated based on protein content. Corn gluten meal is very deficient in lysine, although with appropriate use of synthetic lysine sources, the product is very attractive where high nutrient density is required. Gluten meal is also very high in xanthophylls pigments (up to 300 mg g) and is a very common ingredient where there is a need...
This recipe is courtesy of Jane Roberts, who like her three children, Andrew, Emily, and Claire, has celiac disease. Thank you also to Jane's sister Carol Shilson, executive director of the University of Chicago Celiac Disease Center, for putting us in touch. This recipe is a tasty alternative to chicken and rice. 1 tablespoon gluten-free Worcestershire sauce xh teaspoon cracked pepper 1 teaspoon gluten-free dry mustard 2 cups water or gluten-free chicken broth 1 tablespoon plus 1 teaspoon olive oil
This recipe is courtesy of Veronica Alicea, RD, a nutritionist specializing in celiac disease and a consultant to several producers of gluten-free foods, including Enjoy Life Foods and Heartland's Finest. The recipe calls for navy bean flour. Using bean flours in recipes is an easy
Desserts sometimes can be the trickiest part of the meal for persons with celiac disease. Indian pudding is a traditional dessert that just happens to be made without gluten-containing ingredients. This recipe was passed down from my grandmother, Betty Hatch. Serve this dessert with a little vanilla ice cream on a cold winter's day. It is sure to be a hit
This recipe is courtesy of Evelyn Tribole, M.S., RD, a nutritionist, author, and mother of a son with celiac disease. Visit Evelyn's website at evelyntribole.com. This recipe uses a gluten-free baking mix, which is handy if you are just starting to experiment with gluten-free baking. Evelyn's preferred mix is Pamela's Baking and Pancake Mix, which is based on brown rice, but you can substitute any gluten-free baking mix just make sure that at least the first ingredient is a whole grain. This recipe also calls for flaxseed, a great source of fiber and heart-healthy omega-3 fatty acids. Evelyn also recommends using eggs fortified with omega-3 fatty acids, available in your local supermarket. Preheat oven to 350 F. Lightly coat two baking sheets with gluten-free nonstick cooking spray.
This high-fiber recipe is courtesy of Trisha Lyons, RD, a nutritionist specializing in celiac disease at the MetroHealth Medical Center in Cleveland, Ohio. The recipe may be used as an entree or a side dish. Additional vegetables may be added as desired. 2 cups gluten-free chicken broth
This recipe is courtesy of Natalie Mazurets, M.S., RD, a nutritionist who has celiac disease. It is a traditional Ukrainian stuffed-cabbage recipe that was passed down from Natalie's grandmother to her mother and then to her. Natalie's grandmother told her that in the Ukraine, people ate only what they could grow or raise on their own farms. That included fruits, vegetables, and meat. They canned, pickled, or smoked whatever they could, so food would be available in the winter. This recipe includes the most common staples available to people on the farm. This is one ofNatalie's favorite meals, and luckily for her (and us), it has always been gluten free.
Anemia can be defined as a decrease in the amount of hemoglobin in the blood. Hemoglobin is a protein found in red blood cells that carries oxygen to all the tissues of the body. Folate is required to make red blood cells, and without adequate amounts of folate because of poor dietary intake or poor absorption, red blood cells cannot develop properly. Folate-deficiency anemia is referred to as a macrocytic, megaloblastic anemia. This means there are low numbers of large, underdeveloped red blood cells that contain lower than normal amounts of hemoglobin. People with untreated celiac disease may not properly absorb folate or folic acid. When you are diagnosed with celiac disease, you should be assessed for both types of anemia folate-deficiency anemia and iron-deficiency anemia.
This recipe is courtesy of Jane Roberts, who together with her three children, Andrew, Emily, and Claire, has celiac disease. Thank you also to Jane's sister Carol Shilson, executive director of the University ofChicago Celiac Disease Center, for putting us in touch. This is the perfect fall muffin recipe Preheat oven to 350 F. Use 2 muffin tins or loaf pans sprayed with gluten-free cooking spray.
This recipe is courtesy of Natalie Mazurets, M.S., RD, a nutritionist with celiac disease. It is a modified version of a recipe developed by Natalie's father when she was a child. When Natalie first started making these burgers, she added fresh vegetables. When she was diagnosed with celiac disease, she had to find a substitute for bread crumbs and decided on a combination ofcornmeal and quinoa flakes. Natalie also suggests making these burgers with canned tuna.
This recipe is courtesy of Anne Lee, M.S. Ed., RD, nutritionist at the Celiac Disease Center at Columbia University. This piecrust is great for savory pies such as spinach pie and quiche. The recipe calls for nut meal. You can purchase this ingredient at natural-foods stores or make your own using a coffee grinder.
This recipe is courtesy of Mary Schluckebier, M.A., a home economist and the executive director of the Celiac Sprue Association. These bars are absolutely decadent The recipe calls for brown-rice syrup. Gluten-free brown-rice syrup is available from Lundberg Family Farms (see Appendix A). 2 tablespoons gluten-free brown-rice syrup
This recipe is courtesy ofCynthia Kupper, RD, a nutritionist and the executive director of the Gluten Intolerance Group of North America. It's one of Cynthia's favorite recipes easy but great, a wonderfully nutritious snack or breakfast cereal. Sorghum grain is cooked the same way as rice and can be cooked overnight in a slow cooker or rice cooker. Cooked sorghum can be stored covered in the refrigerator for three to five days for a fast addition to any meal.
You can increase your intake of folate by eating a variety of gluten-free foods. These include foods enriched with folic acid and foods that naturally contain folate. Foods Enriched with Folic Acid. As previously discussed, eating foods that have been enriched with folic acid is very important if you are a female capable of becoming pregnant. Even if you do not fall into this category, folic acid from enriched foods or supplements (see Appendix A for a listing of manufacturers of gluten-free supplements) is more easily absorbed than folate from food. While most manufacturers of gluten-free flours, breads, pastas, and breakfast cereals do not enrich their products, a few do. Appendix C lists enriched gluten-free foods and their manufacturers. The following table gives the folic acid content of some enriched gluten-free foods available from several companies. Gluten-Free Food Sources of Folic Acid
This recipe is courtesy of Alice Miller, who cooks delicious and completely gluten-free meals for her friends. According to Alice, this soup will cure any cold. The recipe calls for either brown-rice noodles or buckwheat noodles. If you choose buckwheat noodles, make sure they are made using 100percent buckwheat flour. Alice also recommends using homemade chicken stock (she is a purist when it comes to cooking), but if you want to use store-bought broth, just make sure it is gluten free.
This recipe is courtesy of Elizabeth Di Biase, RD, who is gluten intolerant. She makes eating fun and exciting by developing her own recipes in which gluten-free grains are combined with foods and spices that are naturally gluten free. Elizabeth says this recipe is very flexible, and she often improvises and changes the amounts and types of spices and seeds to suit her taste. If you want a Mediterranean flavor, she recommends using oregano, extra garlic, and fresh parsley in place of the cumin, cinnamon, and cilantro.
According to the American Heart Association, high blood levels of the amino acid homocysteine are linked to an increased risk of coronary artery disease. There is some evidence to suggest that homocysteine traveling through the circulatory system may damage the walls of the arteries, leading to the development of fatty deposits. Folate is necessary to change the amino acid homocysteine into the amino acid methionine. If too little folate is available, blood levels of homo-cysteine will increase, so not getting enough folate in your gluten-free diet could put you at a greater risk for cardiovascular disease.
This recipe is courtesy of my mom, Betsy Spurr, and is dedicated to my dad, Robert Spurr. This recipe was inspired by many restaurant meals my parents ate while vacationing in Santa Fe, New Mexico. This recipe calls for liquid smoke most varieties should be gluten free, but check labels just to be sure. 2 V cups water or gluten-free chicken or vegetable broth
To increase your intake of iron, consume a variety of gluten-free whole and enriched grains, as well as lean meat, poultry, fish, legumes, vegetables, and fruits. Whole-Grain or Enriched Gluten-Free Grain Foods. In the following table, various grain foods made from corn and rice are grouped together to show that whole grains and enriched grains contain more iron than refined, unenriched grains. Notice that teff and amaranth are iron superstars
If you do not consume milk products, it is recommended that you consume foods fortified with calcium, such as calcium-fortified orange juice, calcium-fortified energy bars, calcium-fortified soy products, and other calcium-fortified nonmilk beverages, such as those made from rice and nuts. Some gluten-free grain foods (including breads, bagels, and granola cereals) also are fortified with calcium. Products include those made by Enjoy Life Foods and Glutino. For a listing of manufacturers of enriched and fortified gluten-free foods, please see Appendix C.
These muffins are a favorite of my niece Brooklyn, who eats gluten free, as well as her brother and sisters, who don't have to eat gluten free but sometimes do so anyway (especially when delicious food is around). This recipe is courtesy of Judi Kopsack, Brooklyn's mother.
Worldwide, wheat starch is one of the most controversial foods in the gluten-free diet. If you live in the United States, you may be confused about why the Food and Drug Administration is considering allowing wheat starch in foods labeled gluten free. A large part of the controversy over wheat starch concerns the threshold level of tolerance for gluten what amount of gluten In some countries, including those in the United Kingdom and Scandinavia, specially manufactured gluten-free foods may contain what is often referred to as Codex wheat starch. This wheat starch has been specially processed to remove all but trace amounts of protein. Codex wheat starch is an example of a food that naturally contains gluten but has been rendered gluten free or gluten-reduced through processing and complies with the Codex Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten, an international standard described later in this chapter. While Codex wheat starch still contains very...
* Limit consumption of processed foods high in total fat, saturated fat, or trans fat. Always check the Nutrition Facts label and ingredient list for trans fat. If a product contains this type of fat, do not buy it. Instead, find a comparable product made without trans fat. Also, some gluten-free snack foods are very high in fat. Always check labels, and choose products with lower fat content.
We need some fat in our diets to be healthy. We just don't need a lot of it. When we follow a gluten-free diet, the nutritional composition of our diet may change. Unfortunately, if we consume fewer carbohydrates because many familiar grain foods are off limits, we may increase our fat intake by adding fatty foods to replace the foods we can no longer eat. However, awareness of this pitfall can help you avoid it. The information in this section will help you limit your fat intake as well as choose the right kind of fat.
Gluten-Free Living Quarterly magazine for people with celiac disease and dermatitis herpetiformis. Ann Whelan, Editor Publisher 560 Warburton Ave., 2nd floor Hastings-on-Hudson, NY 10706 Phone 914-231-6361 Website glutenfreeliving.com E-mail info glutenfreeliving.com intolerances, and sensitivities, including celiac disease. Peggy A. Wagener, President Publisher P.O. Box 2126 Northbrook, IL 60065 Phone 847-480-8810 Website livingwithout.com E-mail Editor LivingWithout.com
Some persons with celiac disease, especially those who are newly diagnosed, may have a secondary form of lactose intolerance. Lactose is a type of sugar found in milk. To be digested, it must be broken down in the small intestine by the enzyme lactase. Persons newly diagnosed with celiac disease may have low levels of lactase as a result of damage to the lining of the small intestine. As the small intestine heals in response to a gluten-free diet, the lactose intolerance will naturally resolve. Until it does, a lactose-reduced or lactose-free diet is generally recommended. Because individuals with lactose intolerance may avoid milk products, and because milk products are a major source of calcium in the American diet, persons with celiac disease who also are lactose intolerant may not consume enough calcium.
Another area of worldwide controversy over what constitutes a gluten-free diet is the use of oats. If you were diagnosed with celiac disease several years ago, you were probably told not to eat oats. If you were diagnosed more recently, you might have been told that certain brands of oats are OK for you to eat. So are they OK or not The information provided in this section will help you answer that question for yourself. Whether people with celiac disease can safely eat oats is not easily answered. Historically, oats have not been included in gluten- free diets in the United States. However, recommendations on oat consumption are changing as a result of well-designed studies conducted since 1995 that indicate that most people with celiac disease can safely eat moderate amounts of oats uncontaminated with wheat, barley, or rye. In the United States, many physicians and dietitians are advising patients that moderate amounts of certain oat products can be included in their diet. In...
This recipe is courtesy of Jane Roberts, who like her three children, Andrew, Emily, and Claire, has celiac disease. Thank you also to Jane's sister Carol Shilson, executive director of the University of Chicago Celiac Disease Center, for putting us in touch. This recipe is oh, so, kid friendly Preheat oven to 350 F. Spray a baking sheet lightly with gluten-free nonstick cooking spray.
At one point or another, many of us wonder if we're getting enough iron, especially if we're feeling tired or run-down. Perhaps you were diagnosed with iron-deficiency anemia before or at the same time as you were diagnosed with celiac disease. Fortunately, although some sources of iron may not be readily available to you on a gluten-free diet, iron abounds in many foods that are available.
Many people with celiac disease do not consume enough calcium, a mineral found in the body primarily in the bones and teeth. To emphasize that point, it's worth repeating some data I mentioned earlier in this chapter in a study of the nutritional intakes of people with celiac disease in the United States, 69 percent of women and 39 percent of men did not consume recommended amounts of calcium. Regardless of whether you drink milk, there really is no reason to have low calcium intake plenty of calcium-
This recipe is courtesy of Mary Schluckebier, M.A., a home economist and the executive director ofthe Celiac Sprue Association. This is not your average pork chop and rice recipe It calls for sweet rice flour, which can be ordered from Bob's Red Mill. V teaspoon gluten-free dry mustard 1 teaspoon salt
* Two whole-grain gluten-free rice cakes topped with peanut butter and sliced banana, served with low-fat milk * Low-fat yogurt mixed with gluten-free enriched or whole-grain cereal, served with orange juice * Poached egg on toast, using gluten-free enriched bread or whole-grain waffle, served with low-fat milk and dried apricots * Gluten-free enriched bagel topped with low-fat ricotta cheese and sliced strawberries, served with cranberry juice * Gluten-free whole-grain waffle topped with maple syrup and blueberries, served with low-fat milk * Turkey club served on gluten-free enriched or homemade whole-grain bread, served with a piece of fruit and seltzer water * Whole-grain gluten-free rice cakes topped with peanut butter and jelly, served with a piece of fruit and glass of low-fat milk * Whole-grain gluten-free flatbread topped with hummus, served with tomato-mozzarella salad and seltzer water * Open-faced grilled cheese and tomato sandwich, served on an enriched gluten-free bagel...
This recipe is courtesy of Mary Kay Sharrett, M.S., RD, clinical dietitian at Children's Hospital in Columbus, Ohio, and founder and dietitian advisor to the Gluten Free Gang, a celiac support group of central Ohio. She received a version of this recipe more than twenty years ago. Pizza is a fun way to eat vegetables, but tasty gluten-free crusts can be difficult to find. The crust is based on whole-grain brown rice, which you can find in any grocery store. Some toppings are suggested, but any will do. Experiment
The complete Food Allergen Labeling and Consumer Protection Act of 2004 is provided at this website of the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition (www.cfsan.fda.gov dms alrgact.html) The online publication Advice to Consumers Food Allergen Labeling and Consumer Protection Act of 2004 Questions and Answers is available at this website of the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition (www. cfsan.fda.gov dms alrgqa.html) The FDA's complete proposed rule for use of the term gluten-free
* Oatmeal (gluten-free), cooked, xh cup ounces of grain foods How many ounces of your grain foods were whole grains (Gluten-free whole grains include whole cornmeal, whole corn flour, popcorn, brown rice, brown-rice flour, wild rice, oatmeal, buckwheat groats, buckwheat flour, amaranth, amaranth flour, millet meal, millet flour, quinoa, quinoa flour, sorghum, sorghum flour, teff, teff flour.)
This recipe is courtesy of Alice Miller, who cooks delicious, completely gluten-free meals for her friends. I know these cakes are absolutely delicious, because I have been lucky enough to have Alice make them for me. Alice recommends using organic ingredients whenever possible.
I can't stress enough the importance of consuming enough folate, especially if you are a woman capable of becoming pregnant. Adequate folate consumption is so important that in 1996 the Food and Drug Administration added folic acid (the synthetic form of folate) to the list of vitamins and minerals that must be included in enriched grain foods. Unfortunately, as I've previously stated, most refined gluten-free grain foods are not enriched. However, with careful planning, you can still get the folic acid you need.
This recipe is courtesy of Nancy Patin Falini, M.A., RD, LDN, a nutritionist and the author of Gluten-Free Friends An Activity Book for Kids. These bars are absolutely delicious and much tastier and heartier than the gluten-containing variety made with whole wheat flour and oats. The quinoa flakes add a crunchy, nutty texture andflavor that is especially nice for those unable to eat nuts in addition to gluten.
Not every athlete can carbohydrate load on pasta, breads, and cereals. About 1 in 133 people has celiac disease, a disorder in which the body can't tolerate gluten, a protein found in wheat, rye, barley, and sometimes oats (if the oats get contaminated with wheat during processing). In these people, gluten triggers intestinal inflammation and eventually can interfere with the absorption of nutrients, including iron and calcium. Gluten intolerance easily leads to anemia (if iron is not absorbed) and osteoporosis (if calcium is not absorbed). Celiac disease can be difficult to diagnose because the symptoms vary from person to person. Some people experience diarrhea others complain about constipation and bloating. Your best bet is to talk with your doctor if you are having intestinal problems or have other niggling health concerns including unexplained fatigue, infertility, and lactose intolerance. For athletes, fueling without gluten can be a challenge. You can still carbohydrate load,...
For further info on celiac disease, write to Celiac Disease Foundation 13251 Ventura Blvd., Suite 3 For further reading on life without gluten or wheat, order Incredible Edible Gluten-Free Foods for Kids Sheri L. Sanderson Woodbine House, 2002 1-800-843-7323 www.woodbinehouse.com Kids With Celiac Disease Danna Korn
Nutrigenomics offers a huge opportunity to customize what people eat for their unique genetic makeup. The goal the potential to slow and even prevent all kinds of diseases-some directly nutrition-related, such as celiac disease, diabetes, obesity, cancer, and heart disease, others not, such as sickle cell disease, cystic fibrosis, and Alzheimer's disease-for those at risk. Understanding functional foods and nutrigenomics goes hand in hand, as science reveals the unique ways that foods' many substances work and interact within body cells.
There are no consistent associations between any particular food and specific syndromes, although some foods are more likely than others to induce enteropathy, such as cow's milk and soy, and others usually induce immediate hypersensitivity, such as peanut. The incidence of gastrointestinal food allergy is greatest in early life and appears to decrease with age. However, analogy with celiac disease, in which late-onset enteropathy is more likely to be clinically subtle, suggests that the increase in colonic salvage that occurs with age may mask true food-sensitive enteropathy. Although enteropathy can cause significant failure to thrive, complex multiple allergies may also occur in the presence of normal growth.5 Acute allergic reactions to wheat are very uncommon, although wheat anaphylaxis has been described,103 and an ra-gliadin has been characterized as the likely sensitizing antigen in children with immediate reactions.104 By contrast to the relative rarity of immediate...
On the suckling's GALT (see above) may contribute to the establishment of oral tolerance not only against the indigenous microflora, but also against dietary antigens, such as gluten. Antibodies to gluten peptides are present in breast milk (Juto and Holm, 1992) and breast-feeding has in fact been shown to protect significantly against the development of coeliac disease in children, an effect that is unrelated to the time of solid food introduction (Brandtzaeg, 1997a). Early exposure to cow's milk has been suggested to be associated with predisposition to type 1 (insulin-dependent) diabetes, and investigations have particularly focused on immune stimulation by bovine serum albumin (Karjalainen et al., 1992), -lactoglobulin (Dahlquist et al., 1992) and insulin (Vaarala et al., 1999). In a recent study, short-term breast-feeding and early introduction of cow's milk were found to be associated with progressive signs of type 1 diabetes-related autoimmunity (Kimpim ki et al., 2001).
. what wheat gluten is, and how it's used in cooking Wheat gluten, also known as seitan, is wheat protein. It has a chewy, meaty texture, making it a good, protein-rich ingredient in casseroles, soups, pasta sauces, and other recipes calling for chopped or ground meat or poultry. Look for wheat gluten in specialty stores. Caution People with gluten intolerance should avoid wheat gluten. See Gluten Intolerance Often a Lifelong Condition in chapter 21.
Like your medication, a doctor-prescribed eating plan-perhaps sodium-modified, high-fiber, gluten-free, or blenderized liquid-is essential to healthcare and disease management. In the world of medicine, a special meal plan is part of medical nutrition therapy. If your doctor prescribes a special eating plan as part of your treatment for whatever conditions you might have Get enough guidance so you can successfully comply. Ask for a referral to a registered dietitian for help in planning and monitoring your nutrition needs. You need an approach that matches your physical and personal needs and your food preferences. Caution Let your doctor or dietitian know about any supplements you take.
Special dietary requirements plural noun the requirements of someone who has a restricted diet, e.g. who is vegetarian, vegan, eats only kosher or halal food, is pregnant or breastfeeding or has wheat, gluten or nut allergies spelt flour noun flour made from an ancient variety of wheat with a high gluten content and a hard husk that makes it difficult to mill
Cereal grains produce a vast array of proteins (including albumins) however, the most interesting proteins may be gliadin and glutenin. When these proteins are mixed with water, such as when we make dough, gluten is formed. Gluten provides the structural basis for the network that traps gases produced by yeast when dough rises. Soy lacks these proteins, and ingredients need to be added to soy flour to make it rise to a light bread. Gluten continues to be a topic of interest as many people either experience an allergy or intolerances to foods that contain it. We will discuss gluten intolerance in the FAQ Highlight at the end of this chapter.
The isolation of protein from natural sources began as early as 1747 when Beccari reported on the isolation of gluten from wheat flour.2 However, the discovery of specific AAs started in 1806 with the isolation of asparagine from asparagus shoots. By 1935, with the isolation of threonine, all of the AAs commonly found in natural proteins had been isolated. The industrial production of isolated AAs began in 1909 when L-glutamic acid was first extracted from a hydrolysate of wheat gluten. This marked the beginning of marketing the sodium salt of L-glutamic acid (monosodium glutamate) for use as a flavor enhancer in Japan. Initially, the major commercial use for isolated AAs was for food flavoring. After 1950, as lower-cost production methods were developed, isolated AAs were used in a variety of new ways such as in pharmaceuticals, animal feeds, and the nutritional enhancement of human foods.3
Today's supermarkets sell all the foods you need for a healthful, vegetarian diet-even vegetarian convenience foods. You don't need to shop elsewhere, but specialty stores may carry less common items (such as textured soy protein, quinoa, kosher gelatin, and wheat gluten). Wheat germ, bran, and wheat gluten (seitan)
3) The proteins found in grains, especially gluten, are extremely hard to digest. We are after foods that are easy to digest, thus making the body many times more efficient. Eating high grain diets puts a big strain on the digestive system, a problem a lot of Vegetarians have. Rice doesn't contain gluten but it does have phytic acid. Because of this it is best to cook rice for longer periods. After it has boiled for 10 minutes turn down the heat and let it cook for at least 1 hr and even longer.
Other Investigators have used semipuri-fied and practical diets supplemented with crystalline amino acids to estimate the amino acid requirements of certain fish. The semi-purified diets have usually included an imbal-anced protein as the major source of the dietary amino acids, e.g. zein (Kaushik, 1979) or maize gluten (Halver et al., 1958 Ketola, 1983), which are deficient in certain amino acids. Practical type diets utilize normal feed ingredients to furnish the bulk of the amino acids. These may be formulated with a fixed amount of intact protein and the remaining protein equivalent is made up of crystalline amino acids (Luquet and Sabaut, 1974 Jackson and Capper, 1982 Walton et al., 1984a). The various problems inherent in using these types of diets to assess the amino acid requirements of fish have been discussed elsewhere (Wilson, 1985).
Because the lactating mammary glands are part of the integrated mucosal immune system (Fig.14.4), milk antibodies will reflect antigenic stimulation of MALT in the gut as well as in the airways, as mentioned earlier. The secretory antibodies are thus highly targetted against infectious agents in the mother's environment, which are those likely to be encountered by the baby during its first weeks of life. As mentioned previously, antibodies against various dietary antigens, such as gluten and cow's milk proteins, as well as against other potential allergens (Casas et al., 2000), are also often present in breast milk. The possible role of these IgA antibodies for the clinical presentation of immune-mediated adverse reactions to food in the infant will be discussed below.
Protein bodies plural noun roughly spherical structures consisting of protein encapsulated in a membrane, present in all seeds, including cereals. i gluten, glutenin, gliadin (note They cannot be broken mechanically but water causes them to swell and break open, which is what happens in germination and in dough production.)
Feed proteins vary in their amino acid compositions and are also characterized by different rates of degradation in the rumen. This leads to considerable variation in the profiles of absorbed amino acids. Generally, feed protein containing a high level of sulphur-containing amino acids that is less degradable in the rumen would result in increased wool production. For example, canola (rapeseed) meal and lupin seed both contain similar and high levels of crude protein, but canola meal is less degraded in the rumen (AFRC Technical Committee on Responses to Nutrients, 1993) and contains more Met than lupin protein (20 vs. 4-10 g kg-1 protein Hill, 1991). Merino lambs fed a diet containing canola meal grew 7-64 more wool than sheep fed a lupin seed diet (Masters et al., 1998 White et al., 2000), and the response depends on the level of intake and the proportion of canola meal in the diet. Similar positive responses to canola meal diets were observed in pregnant or lactat-ing Merino ewes...
Antibodies to various dietary antigens, such as cow's milk proteins (Savilahti et al., 1991) and gluten (Juto and Holm, 1992), are also present in breast milk. However, little is known about the preferential site where soluble luminal antigens exert immune priming. Thus, dietary proteins may be taken up mainly through the extensive epithelial surfaces covering the diffuse immunological effector tissue of the intestinal mucosa rather than by M cells, and may therefore be largely transported to the mesenteric lymph nodes. As discussed below, their fate and possible immune-inductive or tolerogenic effects will depend on how they are handled locally and whether they reach lymph or portal blood (Brandtzaeg et al., 1987 Sanderson and Walker, 1993 Brandtzaeg, 1996a).
Is generally prolonged in constipated subjects. There are many causes of constipation, with diet one of the common reasons, particularly low-NSP diets, gluten-free diets, 'low-residue' diets and enteral feeds. Treatment of simple constipation is usually in the first instance by dietary means. The principle is to increase fermentable carbohydrates in the diet, especially NSP from whole-grain cereals. Thus, diet has a major role to play in controlling bowel habit.
Dietary folate deficiency has been previously associated with poor socio-economic groups but now is thought to exist in 5-10 of the population of most communities. Intestinal absorption is impaired in those with coeliac disease or tropical sprue which if left untreated can lead to folate deficiency (Scott, 2000) (see also section 3.33). Pregnancy is associated with increased folate catabolism, particularly in the second and third trimesters, when it exceeds intake. Women who enter pregnancy with adequate stores or receive prophylaxis during pregnancy will avoid deficiency. Haemolytic anaemia, a condition with increased cell division, can also lead to folate deficiency (Scott, 2000). Anticonvulsant drug therapy is associated with folate deficiency but the mechanism is not known (Scott, 2000). It was suggested that the drugs cause folate malabsorption or excretion of folate through hepatic enzyme induction but this theory has now been discarded. Chronic alcoholics usually have folate...
This notion accords with the increased frequency not only of infections, but also of atopic allergy and coeliac disease seen in subjects with permanent selective IgA deficiency (Burrows and Cooper, 1997), although compensatory over-production of SIgM may apparently counteract the adverse consequences of their absent mucosal IgA responses, particularly in the gut (Brandtzaeg et al., 1991 Brandtzaeg and Nilssen, 1995).
Increase of Ig-producing immunocytes and activated lamina propria CD4+ T-cells seen in untreated patients (Scott et al., 1997). However, the increase of TCR7 8+ IELs in coeliac disease could instead reflect that they are cytotoxic cells involved in the clearance of microorganisms or damaged epithelium to preserve the surface barrier (Brandtzaeg, 1996a Groh et al., 1998 Hershberg and Mayer, 2000).
Originally, the syndrome of IDI was described by Avery et al in 1968, based on the following features diarrhea occurring in a newborn younger than 3 months of age, lasting more than 2 weeks, with three or more negative stool cultures for bacterial pathogens.1 Most cases were managed in hospital, using intravenous fluids while the diarrhea was persistent and intractable, with a high mortality rate from infection or malnutrition.2 Recently, the term 'severe diarrhea requiring parenteral nutrition' was proposed.3,4 Within this group of pathologies, two major subtypes can be differentiated. The first group is made up of patients with 'protracted diarrhea of infancy' (PDI), which subsides despite its initial severity. PDI can result from a specific immune deficiency, a sensi-tization to a common food protein (e.g. cow's milk or gluten), or it can be secondary to a severe infection of the digestive tract (post-enteritis syndrome). The second group is characterized by an 'intractable...
Varioliform gastritis Celiac disease seemingly diverse groups of disorders (Table 7.2), among them celiac disease, where this type of gastritis is very prevalent (see below). An association between lymphocytic gastritis and celiac disease has been reported in both adults and children. Lymphocytic gastritis is found in up to 45 of adults with celiac disease, with a range of prevalence from less than 10 to 45 . Wolberg et al identified ten of 22 adult patients with lymphocytic gastritis characterized by marked infiltration of the surface and superficial pit epithelium by lymphocytes, primarily T cells, with sparing of the deep glandular epithelium both in the antrum and in the body. The lamina propria showed an infiltrate of plasma cells, lymphocytes and rare neutrophils.41 Recently, it has been shown that the pattern of involvement of the gastric mucosa is predictive of duodenal villous atrophy. Patients with corpus-predominant lymphocytic gastritis are unlikely to have duodenal...
It is evident that any change in amino acid classification brings about a change in N content of both amino acid groups and, consequently, a change in E T ratio. Arginine, due to its high N concentration, exerts the most significant effect. Thus Roth et al. (1994b) who classified arginine as non-essential estimated the optimum E T ratio for growing pigs to be 0.45. However, when the data by Roth et al. (1994b) were recalculated with arginine as essential, the optimum E T ratio increased to 0.59. It is also evident that any estimates of optimum E T ratio are only justified when the essential amino acid pattern is ideal relative to the requirement. Any departure from the ideal pattern results in the partial degradation of essential amino acids, with the released nitrogen being used for the synthesis of non-essential amino acids or excreted. It follows that the essential amino acids present in excess relative to the requirement should be regarded as sources of nonessential N (Moran et...
Collagenous gastritis is an extremely rare disorder of unknown etiology, To date, fewer than ten cases have been reported in the literature. The condition is characterized by deposition of a subepithelial collagen band greater than 10 im in thickness. The disorder was originally described by Colletti and Trainer in a 15-year-old girl with refractory H. pylori-negative chronic gastritis.55 It has been reported either as an isolated entity or with synchronous collagenous colitis, collagenous duodenitis, lymphocytic colitis or celiac disease. Clinical features, such as epigastric pain, vomiting, anorexia, postprandial fullness and weight loss are reported. Endoscopic findings include diffuse nodularity, patchy or diffuse erythema, erosions and frank ulcers with hemorrhage. The diagnosis relies on mucosal histology, usually of the fundus and corpus, sharing discontinuous subepithelial collagen deposition with entrapped capillaries and fibroblasts, in association with mild glandular...
Diagnosis may be easily performed from light microscopic examination of a duodenal or jejunal biopsy specimen. On hematoxylin-eosin staining, the mucosa appears flattened with hypoplastic villus atrophy. PAS staining reveals an abnormal brush-border pattern with positive-staining material within the apical cytoplasm of enterocytes (Figure 1.1). A valuable new tool for the light microscopic diagnosis of MVID was recently proposed.22,23 CD-10 is a membrane-associated neutral peptidase, shown to have a linear brush-border staining pattern in normal small intestine. In contrast to this surface staining in different controls (normal intestine, celiac disease, autoimmune enteropathy, allergy), all MVID cases revealed prominent intracytoplasmic CD-10 immunoreactivity in surface enterocytes22,23 (Figure 1.2). Similar results were obtained with PAS, polyclonal carcinoembryonic antigen and alkaline phosphatase, three stains known to show cytoplasmic staining of surface enterocytes in MVID.23 On...
Crypts often have an abnormal aspect with dilatations such as pseudocysts and abnormal regeneration with branching11 (Figure 1.6). The study of basement membrane components demonstrated an abnormal laminin and heparan sulfate proteo-glycan deposition at that level, compared to biopsy specimens from patients with celiac disease or autoimmune enteropathy.11 Relative to the controls, there was faint and irregular laminin deposition at the epithelial-lamina propria interface, while heparan sulfate proteoglycan depositions were large and lamellar, suggestive of abnormal development of basement membrane at the origin of the epithelial abnormalities. On the other hand, we observed an increased immunohisto-chemical expression of desmoglein in IED, and ultrastructural changes of desmosomes, which were increased in length and number (Figure 1.7).37
KATHY I am definitely not a breakfast person and only eat it under sufferance. I am not really interested in serious food until about 12 pm, and then I am looking for something savoury. Over the years Jan has persuaded me to eat a healthy breakfast to see me through the morning and I do see the logic. However I still prefer something light such as fruit and a handful of almonds, or if I am really lashing out I will have a bowl of gluten-free muesli like the recipe on page 27. That's about it for me
It may seem paradoxical that mucosal disorders, such as inflammatory bowel disease (IBD) and coeliac disease, appear to depend, at least initially, on putative Th1-cell-driven pathogenic mechanisms (Scott et al., 1997 Brandtzaeg et al., 1999d), while atopic (IgE-mediated) allergy originates from Th2-cell responses (Brandtzaeg, 1997b Corry and Kheradmand, 1999), which generate the essential cytokines IL-4 and IL-13 (early phase) as well as IL-3, IL-5 and Although the immune system in the airways also responds to antigen stimulation in the presence of danger signals (infection or inflammation) with a Th1 profile (Holt and Stumbles, 2000), an increasingly prominent Th2 profile generally develops as the basis for IgE-mediated (atopic) respiratory allergy (Hattevig et al., 1993 Holt et al., 1999) in individuals with a hereditary predisposition (Anderson and Cookson, 1999 Barnes, 2000). This skewing towards Th2-cell responses may be influenced by the so-called 'lymphoid' DC type, recently...
In a series of studies, Abe et al. (1997, 1998, 1999) evaluated amino acid deficiencies in young Holstein calves that were consuming solid feed. The calves were trained to suckle such that amino acid treatments could be fed as liquids and pass, via the reticular groove, directly to the abomasum. These workers did not attempt to quantify the animals' requirements for amino acids, but rather determined which amino acids were limiting. For smaller calves (75 kg body weight) fed maize-soybean meal diets (156 g kg-1 crude protein), methionine, lysine and tryptophan were marginally deficient (Abe et al., 1998). However, for similar calves fed maize-maize gluten meal diets, lysine was observed to be deficient (Abe et al., 1997). In contrast, larger calves ( 150 kg body weight) did not appear to be limited by essential amino acid supply when fed either maize-soybean meal (Abe et al., 1999) or maize-maize gluten meal diets (Abe et al., 1997). methionine limited performance. Graded levels of...
A semipurified diet (Table 13.2) based on AA-fortified maize gluten meal (CGM) was developed in our laboratory (Peter et al., 2000) for use in studying the requirements for several AA. True digestibility of AA was determined in the high-protein CGM sample used (Table 13.3), and the same sample of CGM was used for all AA bioassays. Using 10.7 g kg-1 digestible lysine as a requirement reference point (Han and Baker, 1991, 1993), the CGM basal diet was fortified with essential AA so that all essential AA other than the one being studied would meet or slightly exceed the ideal AA ratios of Baker (1997) shown in Table 13.1. Levels of leucine and aromatic AA (phenylalanine + tyrosine), however, exceeded their ideal levels because of the surfeit levels of these AA in CGM. L-Glutamate Table 13.2. Composition (as-fed basis) of complete (fortified) diet used to determine amino acid requirements of chicks fed a maize gluten meal semi-purified diet3 6. Maize gluten meal (CGM)0 183.40 aThe diet...
Manufacturers were able to meet the demand for high calorie, low protein food products because patient adherence to their high calorie supplements was not always consistent. Lprotein wheat starch flour (Cellu-low Protein Baking Mix, Chicago Dietetic Supply, La Grange, IL Paygel-P Wheatstarch Flour and Dietetic Paygel Baking Mix, General Mills, Minneapolis, MN) was used to make bread, muffins, cookies, cakes and pancakes. A 40-g slice of low-protein bread supplied 0.2 g protein and 115 calories. The caloric content could be increased further with the addition of butter or margarine and jelly. However, because of the lack of gluten in the wheat starch, few patients and dietitians were able to make an acceptable bread product. Some recipes added whipped egg whites to decrease density and improve texture. Low protein pasta (Carlo Erba, Milan, Italy
Successful studies have recently been completed on determining the amino acid requirements of penaeid shrimp (Table 23.12). Previous attempts to quantify the requirements had resulted in only limited success (Deshimaru and Kuroki, 1974 Akiyama, 1986). This was due primarily to the lack of a water stable diet that would resist leaching while being slowly consumed by the shrimp. Chen et al. (1992) were able to determine the arginine requirement by using a microencapsulated diet. Fox et a I. (1995) cova-lently bound increasing levels of supplemental lysine to wheat gluten in order to determine the lysine requirement in Penaeus varmamei. Millamena et al. (1996a,b, 1997, 1998, 1999) were able to utilize amino acid test diets containing casein, gelatin and crystalline amino acids. The crystalline amino acid mixture was initially coated with gelatinized carboxymethyl cellulose and then k-carrageenan was gelatinized to form a homogeneous gel and added to the completed diet mixture. Feeding of...