As Allergic Living previously reported, the actress, who has celiac disease, parted company with the CBS network in a dispute over her work schedule for the TV hit show Blue Bloods. The dispute arose after Esposito asked for a reduced workload due to health concerns related to her celiac disease.

But now Esposito has recast herself in the role of gluten-free baker, and appears excited to be offering New Yorkers her gluten-free baked goods – with a side of celiac disease advocacy. As a bonus, everything in the bakery is also made without soy, peanuts, dairy and refined sugar. Some products are also promoted as nut-free, yeast-free, and/or vegan-friendly.

Esposito is no newcomer to creating good gluten-free food. She has been blogging and sharing celiac recipes on her website jennifersway.org for some time, which also hosts the bakery’s site. Esposito was only diagnosed with celiac disease a few years ago after suffering with a long list of mysterious symptoms:

“It was years of trying to figure out what was wrong, to the point where I lost a tooth, my hair was falling out, I couldn’t stand up, I had such severe panic disorder”, she told NBC’s Today.

Esposito can still be found on TV, too. She and her bakery are part of a reality show called Playing with Fire, which follows chefs trying to succeed in New York City. The show premiered on The E! Network in March.

In 2012, Allergic Living reported that Esposito’s job dispute involved her request for a reduced work schedule because of her need for vitamin IVs and general exhaustion related to her recovery from the health toll of the years of undiagnosed celiac disease. CBS first put her on unpaid leave, saying that her part-time schedule made her “unable to perform the demands of her role”.

Since leaving the show, Esposito has said that she considers the bakery and her advocacy efforts to be a new, rewarding chapter in her life.

Dennis learned to scour ingredients labels on foods and to be diligent eating outside her home. With vigilance, the rash soon disappeared. It was reasonable to assume that the gastric symptoms – bloating and alternating diarrhea or constipation – would go away, too. But oddly, they didn’t.

Dennis, who was 25 at the time, knew that she’d worked hard to be gluten-free – it had to be something else. She squared her shoulders and began to experiment, eating small amounts of different foods to gauge her body’s responses. Dairy was definitely causing her to feel bloating. It turned out that, along with celiac disease, she’d become lactose intolerant, which meant she was unable to properly digest the sugar found in dairy products.

“I could eat yogurt and get away with hard cheeses,” says Dennis, a dietitian who holds a Master of Science in nutrition and health promotion and helped to found the celiac center in 2004 at Boston’s Beth Israel Deaconess Medical Center. But in those early months, Dennis had to cut most dairy products out of her diet.

She is not alone. One out of every 100 people in North America is thought to have celiac disease while Dr. Peter Green, the director of the Celiac Disease Center at Columbia University, says that between 10 to 20 per cent of those with the autimmune disease also have differing degrees of lactose intolerance – creating a double diet whammy to manage.

Gluten’s Internal Toll

While research on the relationship between celiac disease and lactose intolerance is scant, an intriguing Italian study was published in the journal Digestion in 2005. In it, researchers screened 54 people who had tested positive for lactose intolerance but showed no other symptoms for celiac disease, and a control group of 50 blood donors.

Those who had the antibodies associated with celiac disease underwent further intestinal biopsies to see if there was damage to the villi, the finger-like projections that line the intestinal wall and act as gatekeepers for nutrients to enter the body.

The findings were startling: 24 per cent of the patients with lactose intolerance had damaged or atrophied villi, a sure sign of celiac disease, compared to a mere 2 per cent of the control group. Today, Dr. Peter Green says there’s a “very sensible recommendation” that all patients who test positive for lactose intolerance should be examined further for celiac disease before they are placed on a dairy-free diet.

He is concerned, however, that too many doctors and dietitians automatically advise lactose intolerant patients to avoid dairy – a kneejerk response that fails to take into account that celiac disease may be the real culprit.

By shortening or completely flattening the villi, celiac disease disrupts the uptake of life-sustaining nutrients, and can lead to other serious conditions – from malnutrition to anemia, osteoporosis and even cancer. The villi also contain lactase, the enzyme necessary to process lactose, the sugar in dairy. So when the villi are damaged, dairy intolerance is often the result.

Next: Understanding secondary lactose intolerance

Start Your Day with a Healthy Breakfast

Studies prove it: those who skip breakfast tend to overeat later in the day – often resulting in weight gain. So fuel your body with a healthy breakfast such as: a gluten-free cold cereal made with a nutritious grains like amaranth, brown rice, buckwheat, millet, quinoa or teff and topped with fresh fruit. Compare cereal nutrient levels in the comprehensive chart I created for Allergic Living magazine. (Canadians, see this version.)

For a hot cereal, make a tasty bowl of oatmeal from pure, uncontaminated oats with raisins and slivered almonds. Try a smoothie with low fat yogurt, fresh or frozen fruit, ground flax, dash of vanilla and honey. Or bake and freeze muffins from a healthy gluten-free mix.

Next: Portion sizes

The chips, made by Pepsico Canada, for the most part have always been made without gluten, but now customers can be assured that Lay’s facilities and manufacturing processes have been verified by a third party. (Only one variety, Lay’s BarBQ Flavour, won’t bear the new CCA logo.)

Paul Valder, the consultant developing the CCA’s certification program, says this is just the first of a number of certified products consumers will see over the coming months.

The CCA is in discussions with a major retailer for certifying its private label line, and also in the gluten-free pipeline are: a national brand that makes crackers and cookies, a national bakery, and a generic drug manufacturer.

Gluten-Free Lime Cupcakes
Made with almond and coconut flour, these fresh-tasting cupcakes can be topped with your favorite frosting and extra lime zest for a decorative touch.

Simon’s Seriously Fruitcake
Use your favorite gluten-free flour in this fruity cake that’s perfect for the holiday season (and tasted nothing like store-bought).

Easy Allergy-Friendly Fudge
Free of all top allergens, this simple fudge recipe makes a decadent gluten-free dessert.

Gluten-Free Raspberry Tarts
Let fresh, in-season raspberries shine in this simple yet elegant dessert.

Gluten-Free Strawberry-Rhubarb Cobbler
Celebrate spring with this fruity dessert recipe that uses gluten-free flours.

Gluten-Free Fresh Raspberry and Fig Galette
This free-form pie (no fancy pie plate required) teams up summer-fresh raspberries and figs.

Gluten-Free Pumpkin Pie
Dairy-free options make this fall favorite suitable for just about anyone.

Gluten-Free Chocolate-Dipped Macaroons
Buy the best-quality dark chocolate for ultimate flavor in these crowd-pleasing coconut bites.

Raspberry Fool
Fold pureed raspberries with freshly whipped cream for this easy, refreshing summer dessert.

Visit Allergic Living‘s main recipe page for more gluten-free recipes, many free of top allergens, plus learn more about the magazine and how you can get a copy.

Now the Canadian Celiac Association is trying to make its mark with a big new gluten-free certification program, which would enable celiac or gluten sensitive consumers to simply look for the new CCA gluten-free symbol, plunk a food package into the shopping cart and head off to the next aisle.

“Let’s face it, people get frustrated with having to read labels and look for ingredients,” says Jim McCarthy, the CCA’s executive director. “If this mark says this is safe, then I can just pick it up to eat and that’s fine.” Under the CCA program, everyone from the multinational to the small cookie maker can enroll for a fee to go through the rigorous qualifying program – with plant testing and annual third-party audits – to prove their gluten-free worthiness.

Reaching critical mass for the number of products bearing the CCA seal will be essential to success. Paul Valder, a consultant working with the CCA on the certification launch, reports strong interest from major multinational brands and also among grocery chains with private brand gluten-free products. “One multinational is asking us: ‘Can we get it to market in eight weeks, 10 weeks?’ So there is that kind of urgency,” he says.

But there is one hurdle to getting  CCA-sanctioned products to market: the definition of the term “gluten-free”. You might think that was zero gluten, but zero is difficult to achieve 24/7 in food processing, given the ubiquity of gluten. It used to be that scientists could only test to 20 parts per million (ppm) of gluten, and since no health risks to persons with celiac have been found to date at or below that threshold level, under 20 ppm became the safe level in Canada, Europe and other parts of the world.

Or is it the safe level in Canada? At a CCA strategy session on the certification program in late March, some manufacturers were astounded to learn that the Canadian Food Inspection Agency (CFIA) is now interpreting regulations to mean that zero ppm is now the definition of gluten-free. (New gluten food tests can now detect gluten down to the 3 to 5 ppm range). CFIA acknowledges this is the case, while a senior spokesman for Health Canada confirmed to Allergic Living that “from a health and safety perspective, we’re happy with a 20 ppm cutoff.” Confused yet? The manufacturers at the March meeting sure were.

“It’s concerning that Health Canada and CFIA aren’t of the same mind on this,” says Daniel Mattimoe, the senior manager of quality and regulatory affairs at Campbell of Canada. While Campbell’s has stringent gluten-free and tests to undetectable levels, he notes that for a smaller company, a surprise test reading of 7 ppm could now trigger a technical recall.

“You’re putting that company in a bind,” he says. “Food safety is No. 1, you don’t argue with that. But that’s the concern at 20 ppm. Below that, it becomes a regulatory issue and the right thing is to do is what CFIA tells you to do. But that could be financially devastating.”

Fortunately, Health Canada and CFIA both told Allergic Living they are trying to resolve their differences. McCarthy and the CCA are certainly pressing them to do so both in fairness to the food makers, and for the consumers. Those folks who will be out on a certified buying binge once all those “official” gluten-free products start hitting the shelves.

From the Summer 2011 issue of Allergic Living magazine.

-hot dogs
-frozen burgers (meat, chicken, fish)
-seasoned or dry roasted nuts
-pumpkin and sunflower seeds
-potato chips
-cheese spreads
-soups
-Worcestershire sauce
-baking powder
-canned cake frosting
-chocolate bars
-regular beer, ale and lager
-baked beans
-sauces, marinades, salad dressing
-specialty prepared mustards
-cooking spray
-baking powder
-soups, broths, bouillon cubes
-candies, chocolates, chocolate bars, licorice
-malt vinegar

Other Names

-food starch
-seasoning
-hydrolyzed vegetable protein

Source: Shelley Case, RD, author of Gluten-Free Diet

Shelley Case is a consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. She is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and Gluten Intolerance Group.

Building Tolerance

Dr. Bob Anderson, a gastroenterologist in Melbourne, Australia, is heading the research on a celiac vaccine. His work focuses on desensitizing patients by injecting them with gluten peptides, amino acids that gang up to produce the immune reaction. “The idea is if you give one injection, you will activate a response but if you repeat it, you can use it as a treatment,” he tells Allergic Living.

Anderson has focused on a treatment that would allow people to eat gluten because he knows it’s hard to avoid the protein, no matter how diligent you are. He points to research that suggests about half of patients who are following gluten-free diets still have substantial damage in their small intestines. Results from the Phase I safety trial with patients should be compiled and ready by the middle of this year.

Gluten-free Wheat

The effort to change the very makeup of wheat is centred at Washington State University. Dr. Diter von Wettstein, a professor in the department of crop and soil sciences is trying to neutralize the parts of gluten that cause the immune reaction in the first place. The goals are to produce a celiac-friendly wheat that contains lysine, an essential amino acid often deficient in the grain, which would help to maintain the wheat’s baking texture and elasticity when it was made into dough.

“Creating new cultivars of wheat, arguably the most important crop grown … will be of tremendous benefit not only for sufferers of celiac disease, but for all consumers of wheat and wheat products,” von Wettstein said.

Popping a Pill

Research to develop a celiac “pill” includes trials taking place at Leiden University in The Netherlands, where Dr. Frits Koning and his team are testing a drug derived from a common fungus that can be found on decaying vegetation. Known as an AN-PEP, it is thought to break down both the gluten proteins and the T-cell peptides in the small intestine, preventing an adverse reaction. They’ve found the enzyme to be safe in humans, but haven’t yet proved its effectiveness.

In Baltimore, Dr. Alessio Fasano and his team have developed a pill that, rather than break down gluten, prevents gluten particles from penetrating the lining of the small intestine. Fasano says to imagine the small intestine as a gated community, with a protein called zonulin opening and closing the gates. In people with celiac disease, the gate is left ajar. A person would take the drug before eating, to block the release of zonulin. Phase III clinical trials for the pill are on hold, as the biotech firm that was to conduct them is struggling with funding. Fasano may partner with a larger firm. “One of the best assets of a scientist is perseverance. This drug could potentially be the next blockbuster. You have to have faith.”

First published in Allergic Living magazine.
To subscribe or order a single issue, click here.

A: Dermatitis herpetiformis is a skin disease caused by an intolerance to gluten. It is a form of celiac disease, the inherited autoimmune intestinal disorder that affects between one in 100 and one in 200 people worldwide. Gluten, found in the grains wheat, rye and barley, damages the small intestine and can also affect other body systems, such as the skin. About 10 per cent of celiacs will also have dermatitis herpetiformis (DH).

Although most people with DH have varying degrees of small intestinal damage, many will have no or few bowel complaints typically associated with celiac disease.

The DH skin rash burns and itches intensely. It is symmetrically distributed and usually found on the elbows, knees and buttocks. It also can appear on the back of the neck, upper back, scalp and hairline. Groups of small blisters will form that will erupt into small red lesions.

The condition typically appears between the ages of 20 to 45, but can occur at other times. It is most common in people of northern European descent and rare in Asians and African-Americans.

DH is often misdiagnosed as other skin conditions such as herpes, eczema, contact dermatitis, hives or psoriasis and treated with a variety of topical creams. The only way to diagnose DH is a skin biopsy from unaffected skin adjacent to blisters or lesions. A biopsy of the small intestine, normally used to diagnose celiac disease, is not essential if the skin biopsy tests positive for DH.

Next: Managing dermatitis herpetiformis