• Dental enamel defects: Patches of grey, yellow, white or brown on the teeth, and/or teeth that are deeply pitted, grooved or misshapen. The defects are found on both sides of the mouth or on both upper and lower teeth, not just on one or two. Cavities may be common because of weak enamel.
• Canker sores: Frequent, painful, open sores in the mouth. They are small and usually white or yellow.
• Atrophic glossitis: A smooth, painful tongue.
• Cheloisis: Cracks and scaling around the lips.
• Oral lichen planus: Inflammation of the mouth’s mucous membranes, characterized by painful white or red patches, or open sores.

When It’s Worse Than a Cavity

People with celiac disease who do not follow the gluten-free diet are at increased risk of not just dental problems, but cancers of the mouth, pharynx and esophagus. A study in the medical journal Gut found that celiac patients who did not follow a strict gluten-free diet had a nearly 10-fold risk of developing oral cancer compared to people who did stick to the diet, who had the same risk as the general population. If you have celiac disease, make sure to inform your dentist and dental hygienist.

See also: Celiac Disease’s Toll on Your Teeth

Here was the issue: Back in 2009 a few students at Lesley University in Cambridge complained that their civil rights were being violated under the Americans with Disabilities Act because the university made no accommodations in either the meal plan or other food services for celiac disease and food allergies. At least one student with celiac disease had to purchase the meal plan, though it didn’t have gluten-free options.

The Department of Justice thought the complaint had merit and investigated. The DOJ’s conclusion: “Food allergies may constitute a disability under the ADA.” The department specifically noted the damage that repeated consumption of gluten can do to those with celiac disease, “leading to vitamin deficiencies that deny vital nourishment to the brain, nervous system, bones, liver and other organs”.

The administrators at Lesley University, a private university known for its education and arts programs and a neighbor to ivy league Harvard University, could see the seriousness of the DOJ’s position. They decided to settle.

Under the agreement, announced with little fanfare at the end of December, Lesley U. said it would amend its food services policies to provide gluten- and allergen-free food options in its dining halls, work with affected students on individualized meal plans, allow pre-ordering of safe meals and set up a dedicated space for preparing and storing allergen-free foods. The food services staff are now undergoing training on allergy issues, and the university has agreed to pay the students who complained $50,000 in compensatory damages.

This is big-time accommodation and a big win for the food allergy and celiac communities. It serves notice that those on medically restricted diets have a right to eat where they learn without fear that their food will make them seriously, potentially dangerously ill. It acknowledges that students with allergies and celiac should be able to live in a dorm setting and rely on the food service personnel to have the knowledge and inclination to make them a meal that hasn’t been cross-contaminated.

But it’s not entirely clear yet how far-reaching the implications of the Lesley agreement will be. After the quiet release of this agreement, legal scholars, educators and others are now debating this.

To help understand the bigger picture of the Lesley U. agreement, Allergic Living columnist Gina Clowes is interviewing the senior counsel from the Department of Justice on this case and ADA legal specialists for the magazine’s Spring edition. I think readers will find it fascinating to learn more about this important precedent. I know I will.

Entering its third year of national distribution, Allergic Living magazine is bolstering its editorial presence with the addition of Alisa Fleming as Senior Editor.

Fleming is an accomplished writer and the author of Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance and Casein-Free Living. She is also the founder of GoDairyFree.org, North America’s No. 1 dairy-free website.

“We’re thrilled to have Alisa on board,” says Gwen Smith the magazine’s Editor. “She brings outstanding ideas, knowledge and passion to Allergic Living‘s coverage of food allergies and intolerance.” Fleming will continue her popular No Dairy, No Gluten recipe feature in the magazine, but “in the role of senior editor, Alisa gets to show her skills well beyond her great food writing,” Smith says.

Since its launch across the United States in the spring of 2011, Allergic Living magazine has grown rapidly and gained a reputation for editorial excellence. Smith is a former senior editor of national magazines and newspapers, many of Allergic Living’s writers are well-known health journalists, and its expert columnists include allergists Dr. Scott Sicherer (Mount Sinai School of Medicine), Dr. Hemant Sharma (Children’s National Medical Center) and Dr. Clifford Bassett (Allergy & Asthma Care of New York), as well as dietitian and celiac expert Shelley Case. For the Canadian edition, regular allergist columnists are Dr. Susan Waserman (McMaster University, Hamilton) and Dr. Wade Watson (IWK Health Centre, Halifax).

Other expert voices include the National Foundation for Celiac Awareness (NFCA), the Asthma and Allergy Foundation of America (AAFA), FAAN (now FARE, the Food Allergy Research & Education organization) and Anaphylaxis Canada.

From family feuds with relatives who don’t “get” serious food restrictions to social concerns like dating and eating out and societal issues like bullying and avoiding allergens at school, Allergic Living is the go-to magazine for managing the real issues facing those with allergic or celiac disease.

For the 2013 publishing season, the magazine plans to tackle issues such as marital stress and food allergies and the mystery of adult-onset allergies. Meantime, the magazine’s food editors are already testing dozens of inspired new allergy-friendly recipes – while their journalist colleagues have begun work to uncover the latest on research progress. As well, readers can look forward in 2013 to smart advice on reducing toxins and allergens in the home and even the tricks to allergy-friendly gardening.

“We are privileged at Allergic Living to work with the best in the fields of food and environmental allergies and celiac disease,” Smith says. “And in her new role, Alisa Fleming will help us to set the bar even higher for the incredibly helpful articles we can deliver to readers.”

For more about Allergic Living magazine, including the newly released Winter edition, contact: editor@allergicliving.com.

View a sample edition of the magazine here.

Using a standard method of determining risk factors for these cancers, Dr. Jonas Ludvigsson and his research team compared data from more than 17,000 women with confirmed celiac disease to that from about 88,000 women without the condition.

They found women with celiac were 15 percent, 40 percent and 11 percent less likely to develop breast cancer, endometrial and ovarian cancer respectively. What’s more, the decreased risk was greater when they excluded patients who were within their first year of diagnosis.

Ludvigsson told Allergic Living that one possible link between celiac disease and a reduced incidence of female cancers is a tendency among celiac patients to have a lower body mass index (BMI). Breast cancer, in particular, has been associated with obesity and a high BMI.

The expert suspects the decreased risk of ovarian cancer may be linked to early menopause in many women with celiac disease. Fewer ovulations in their lifetimes may be the reason.

Interestingly, the risk of lung cancer did not vary between celiac and non-celiac patients in this research. This is likely “because the smoking pattern of Swedish women does not seem to differ between celiac women and non-celiac women,” says Ludvigsson. More studies of celiac and cancer are planned.

First published in Allergic Living magazine.
© Copyright AGW Media Inc.

For an affordable subscription right to your door, click here.

Mute and truculent, the boy sat across from Dr. Alessio Fasano. His parents had brought the 5-year-old to see the pediatric gastroenterologist at the University of Maryland because of he suffered from bloating and other gastrointestinal problems. But the child had autism spectrum disorder and the only way he could express the discomfort he felt was through violence, through throwing things and pounding his little fists.

It was the mid-1990s. Fasano, who’d recently moved to Baltimore from Italy, gently drew the boy’s blood to test for antibodies linked to celiac disease, an autoimmune condition in which the body virulently rejects gluten, a protein in wheat, barley and rye products. When the test, and later an endoscopy, both proved positive, he prescribed the only treatment for the disease: a gluten-free diet.

Over the next six months, the boy transformed in such dramatic fashion that his speech therapist was spurred to write Fasano a letter. “What did you do?” she asked. “I’ve been treating him for three years and couldn’t get two words out of him. Now, he doesn’t stop talking!”

For Fasano, now head of the university’s Celiac Disease Center and a star in the world of celiac research, the solution had been simple.

“It was like this boy was living in a parallel world, trying to communicate with others through a thick veil,” he says. “He did not have to make up developmental milestones so much as have that veil lifted. Once it was gone, there was no stopping him.”

While few turnarounds are as extreme as this boy’s, the case does demonstrate how the body can react to gluten in severe and unexpected ways, far beyond common symptoms such as diarrhea, constipation and stomach bloat.

His interest piqued, Fasano reviewed small studies of gluten’s association with autism and keenly observed his own patients for patterns. This led him to the preliminary observation that a gluten-free diet may help about 20 per cent of the children with autism spectrum disorder or ASD. This is the catch-all term used for mysterious developmental conditions that range in severity and are characterized by varying degrees of social deficits and repetitive behaviors.

Not that the kids with a response to gluten have undiagnosed cases of celiac disease; rather, Fasano suspects gluten sensitivity. This is a relatively new medical diagnosis with a wide range of symptoms similar to those seen in celiac disease, but without untreated celiac’s association with osteoporosis, infertility and other serious health issues.

“We can’t help all kids with autism,” Fasano cautions of the gluten and ASD research. “But that help, when it comes, can be pretty dramatic, not just for the child but for the whole family.”

Next page: Investigating the ‘leaky gut’

Dr. Joseph Murray, lead author of the study published in Clinical Gastroenterology and Hepatology, said the results clearly show that celiac patients are not being tested frequently enough to ensure that no complications have arisen due to the disease. For example, osteoporosis and anemia may develop if patients are continuously exposed to even small amounts of gluten. Since strict avoidance of the protein is difficult, testing is crucial.

In a news release, Dr. Murray said, “It should not be different from other chronic conditions for which medical follow up is a given such as liver disease, inflammatory bowel disease or even gastroesophageal reflux disease. Anecdotally, patients with celiac disease often feel they are on their own in the management of celiac disease.”

The study looked at data on 122 celiac patients who were diagnosed between 1996 and 2006 and the number of follow-up exams they received between six months and five years after their initial diagnosis.

Dr. Margot Herman, who also worked on the study, said in a video that the American Gastroenterological Association’s guidelines recommend that celiac patients to receive periodic visits with a clinician, dietitian, as well as blood and other testing. But in reality, she notes, in a five-year period, only about one-third of patients receive this kind of care.

As well, fewer than a quarter of the patients in the study had bone density scans  in the five years after diagnosis. “It was remarkable how little follow-up these people were getting,” Dr. Herman said.

“Our study points out an area for improvement in medicine, and particularly for these patients in terms of their long-term disease management,” she said.

By Donna Washburn and Heather Butt

Makes 15 slices (1 per serving)

Ingredients

• 3/4 cup sorghum flour – 175 mL
• 2/3 cup amaranth flour – 150 mL
• 1/3 cup flax flour – 75 mL
• 2/3 cup potato starch – 150 mL
• 1/3 cup cornstarch – 75 mL
• 1/4 cup granulated sugar – 60 mL
• 2-1/2 tsp xanthan gum – 12 mL
• 2 tsp bread machine or instant yeast – 10 mL
• 1-1/2 tsp salt 7 mL
• 1/2 cup cracked flaxseed – 125 mL
• 1/2 cup unsalted raw sunflower seeds – 125 mL
• 1-1/4 cups water – 300 mL
• 3 tbsp vegetable oil – 45 mL
• 2 tsp cider vinegar – 10 mL
• 2 eggs, lightly beaten
• 2 egg whites, lightly beaten

Method

1. In a large bowl or plastic bag, combine sorghum flour, amaranth flour, flax flour, potato starch, cornstarch, sugar, xanthan gum, yeast, salt, flaxseed and sunflower seeds; mix well and set aside.
2. Pour water, oil and vinegar into the bread machine baking pan. Add eggs and egg whites.
3. Select the Dough Cycle. As the bread machine is mixing, gradually add the dry ingredients, scraping bottom and sides of pan with a rubber spatula. Try to incorporate all the dry ingredients within 1 to 2 minutes. When the mixing and kneading are complete, remove the kneading blade, leaving the bread pan in the bread machine. Quickly smooth the top of the loaf. Allow the cycle to finish. Turn off the bread machine.
4. Select the Bake Cycle. Set time to 60 minutes and temperature to 350°F (180°C). Allow the cycle to finish. Do not turn machine off before taking the internal temperature of the loaf with an instant-read thermometer. It should be 200°F (100°C). If it’s between 180°F (85°C) and 200°F (100°C), leave machine on the Keep Warm Cycle until baked. If it’s below 180°F (85°C), turn on the Bake Cycle and check the internal temperature every 10 minutes. (Some bread machines are automatically set for 60 minutes; others need to be set by 10-minute intervals.)
5. Once the loaf has reached 200°F (100°C), remove it from the pan immediately and let cool completely on a rack.

Tip: we tried this bread with sprouted flax powder, flax meal, ground flaxseed and flax flour. All yielded acceptable loaves.

Variation: Substitute raw hemp powder for the flax flour and Hemp Hearts for the flaxseed.

Gluten-Free Cycle

If your bread machine has a Gluten-Free Cycle, you will need to make these adjustments:

1. Warm the water to between 110°F and 115°F (43°C and 46°C).
2. Warm the eggs and egg whites (see the Technique Glossary).
3. Follow the recipe instructions, but select the Gluten-Free Cycle rather than the Dough Cycle and Bake Cycle.
4. At the end of the Gluten-Free Cycle, take the temperature of the loaf using an instant-read thermometer. It is baked at 200°F (100°C). If it’s between 180°F (85°C) and 200°F (100°C), leave machine on the Keep Warm Cycle until baked. If it’s below 180°F (85°C), turn on the Bake Cycle and check the internal temperature every 10 minutes. (Some bread machines are automatically set for 60 minutes; others need to be set by 10-minute intervals.)

Excerpted from 125 Best Gluten-Free Bread Machine Recipes by Donna Washburn and Heather Butt.

Like this recipe? See the Ancient Grains Bread recipe.

By Donna Washburn and Heather Butt

Makes 15 slices (1 per serving)

Ingedients

• 1 cup sorghum flour – 250 mL
• 3/4 cup amaranth flour – 175 mL
• 3/4 cup cornmeal – 175 mL
• 1/4 cup quinoa flour – 60 mL
• 1/2 cup tapioca starch – 125 mL
• 1/3 cup packed brown sugar – 75 mL
• 1 tbsp xanthan gum – 15 mL
• 3/4 tsp bread machine or instant yeast – 4 mL
• 1-1/2 tsp salt – 7 mL
• 1-1/4 cups water – 300 mL
• 2 tbsp vegetable oil – 30 mL
• 1 tsp cider vinegar – 5 mL
• 2 eggs, lightly beaten
• 2 egg whites, lightly beaten

Method

1. In a large bowl or plastic bag, combine sorghum flour, amaranth flour, cornmeal, quinoa flour, tapioca starch, brown sugar, xanthan gum, yeast and salt; mix well and set aside.
2. Pour water, oil and vinegar into the bread machine baking pan. Add eggs and egg whites.
3. Select the Dough Cycle. As the bread machine is mixing, gradually add the dry ingredients, scraping bottom and sides of pan with a rubber spatula. Try to incorporate all the dry ingredients within 1 to 2 minutes. When the mixing and kneading are complete, remove the kneading blade, leaving the bread pan in the bread machine. Quickly smooth the top of the loaf. Allow the cycle to finish. Turn off the bread machine.
4. Select the Bake Cycle. Set time to 60 minutes and temperature to 350°F (180°C). Allow the cycle to finish. Do not turn machine off before taking the internal temperature of the loaf with an instant-read thermometer. It should be 200°F (100°C). If it’s between 180°F (85°C) and 200°F (100°C), leave machine on the Keep Warm Cycle until baked. If it’s below 180°F (85°C), turn on the Bake Cycle and check the internal temperature every 10 minutes. (Some bread machines are automatically set for 60 minutes; others need to be set by 10-minute intervals.)
5. Once the loaf has reached 200°F (100°C), remove it from the pan immediately and let cool completely on a rack.

To make this recipe egg-free, omit eggs and egg whites from the recipe. Add 4 tsp (20 mL) powdered egg replacer with the dry ingredients. Increase yeast to 2 tsp (10 mL). Increase water by 1/4 cup (60 mL). This flavorful egg-free loaf is shorter than some.

Tip: You can use 1/2 cup (125 mL) liquid whole eggs and 1/4 cup (60 mL) liquid egg whites, if you prefer.

Gluten-Free Cycle

If your bread machine has a Gluten-Free Cycle, you will need to make these adjustments:

1. Warm the water to between 110°F and 115°F (43°C and 46°C).
2. Warm the eggs and egg whites.
3. Follow the recipe instructions, but select the Gluten-Free Cycle rather than the Dough Cycle and Bake Cycle.
4. At the end of the Gluten-Free Cycle, take the temperature of the loaf using an instant-read thermometer. It is baked at 200°F (100°C). If it’s between 180°F (85°C) and 200°F (100°C), leave machine on the Keep Warm Cycle until baked. If it’s below 180°F (85°C), turn on the Bake Cycle and check the internal temperature every 10 minutes. (Some bread machines are automatically set for 60 minutes; others need to be set by 10-minute intervals.)

Excerpted from 125 Best Gluten-Free Bread Machine Recipes by Donna Washburn and Heather Butt.

Like this recipe? See the Sunflower Flax Bread recipe.

Having a relative with celiac disease increases your risk of developing celiac, but many parents, siblings and family members are resistant to getting tested.

Earlier this year, NFCA collaborated with the Celiac Center at Beth Israel Deaconess Medical Center (BIDMC) in Boston to address that challenge through guiding the work of Claudia Dolphin, a graduate student from Emerson College’s Master’s in Health Communication program. Claudia’s research project “Screening for Health: Attitudes and Beliefs of Non-Participants in Disease Testing” examined the thoughts and attitudes of family members who had not been tested for celiac disease despite having a relative with the disease.

The study revealed that many family members were unaware that undiagnosed celiac disease often presents without any outward symptoms, and 64 percent of those surveyed said they would get tested for celiac disease if a family member asked them to.

In response to those results, Claudia developed the tools for diagnosed individuals to talk with their family members about celiac disease testing. NFCA is excited to announce the launch of this content in the form of new webpages and a Printable Guide. In addition, there is a new webpage and Guide to help your family members talk to their doctors about getting tested for celiac.

The NFCA and BIDMC teams hope that these new resources will help you begin this important conversation with your relatives. It could be a life-saving chat!

View the new webpages:

Celiac Disease in Families – Includes a Printable Guide that family members can bring to their doctors
Talking to Your Family About Celiac Disease Testing – Includes a Printable Guide with talking points to start your conversation with relatives
Who is at Risk? – Lists risk factors for celiac disease, including family history