Researchers from Italy and the United States have analyzed the entire genome, or DNA structure, of the grain and have shown it to be free of gluten on a molecular level. This confirms earlier reports, studies and successful food challenges which all suggested the cereal contains no gluten and is considered safe for those with celiac disease.

Because the sorghum genome was only recently published, until now scientists had no way of proving on a molecular level that the grain was safe for people living with celiac disease. Allergic Living reminds, however to always check the label in case of potential cross-contamination.

In the West, sorghum has traditionally been used as feed for livestock, while in Africa and parts of Asia it has been used as a food for people for a long time. Farmers have developed ‘food-grade’ sorghum, which is meant for human consumption and is already used in a variety of products including some tortillas and flours. It can even be popped, like popcorn.

The researchers note in their report that in addition to being gluten-free, sorghum is nutritious, making it an ideal option for those with celiac disease. Previous studies of sorghum have suggested it may have a wide range of health benefits, including slowing the growth of tumors, reducing cholesterol levels and having higher levels of anti-oxidants than other grains and fruits. Other benefits as a gluten replacement include its low cost and neutral taste.

Of course, she did have to get her wisdom teeth removed, which wouldn’t be fun. But that was it. At least, it was until her pre-college physical with her family doctor this past June. That turned her world upside down.

Her mom, Lisa Fraimow, had asked the doctor to check for everything from vitamin deficiencies to antibody levels and her thyroid – the latter because Lisa was herself in remission from Graves disease, an autoimmune disorder that involves the thyroid. Marisa knew her mom was just anxious about her moving to a dorm nearly 200 miles away. Besides, she figured she’d be fine.

Blood test results showed otherwise. Marisa had practically no vitamin D, crucial for the development of healthy bones and teeth. What’s more, her system contained antibodies that indicate celiac disease, the hereditary autoimmune disorder in which the body virulently rejects gluten, a protein found in wheat, rye and barley.

Marisa couldn’t believe she had celiac disease – she felt fine. Tired, occasionally, but that was it. Now, on the cusp of college, she was already different from classmates she didn’t yet know. Her own body had turned against her.

Marisa had a version of celiac disease known as “silent” or “latent” – people with it have no symptoms that point to a disorder affecting the digestive system. In fact, some may have no symptoms at all. Yet, even in its “silent” form, celiac disease can take a toll on multiple organs with varying of degrees of severity. The long list of associated symptoms includes skin rashes, mouth sores, osteoporosis, infertility and even lymphoma, a type of cancer that affects the cells in the immune system.

Exact statistics on how many people are walking around with silent celiac disease are hard to come by but, as demonstrated in scientific literature, a whopping 10 percent of those closely related to someone with celiac disease may have it without suspecting a thing. “If you have celiac disease,” says Dr. Peter Green, founder of the Celiac Disease Center at the Columbia University Medical Center, “it’s important that your family get tested, too.”

***

BEFORE she was diagnosed, Marisa already knew about the presence of gluten in all sorts of foods, cosmetics and pharmaceutical products because her older sister Nadina, like so many North Americans, had eliminated the protein from her diet the year before. To support Nadina, she’d even done a senior class project on gluten-free desserts, creating recipes that included dark chocolate apple cake – her favorite.

But a crash course in the disease itself, one in the family of autoimmune disorders that also include multiple sclerosis, Type 1 diabetes and her mom’s own Graves disease, would teach this freshman a lot more.

Like how the rejection of gluten was causing damage to finger-like protrusions in the walls of her small intestine called villi, necessary for her body to properly absorb key nutrients like iron, folic acid and vitamins D and B12. Or how her slight fatigue could have been a sign all along. How the diagnosis is done in two phases: the blood screening and, if that proves positive, an intestinal biopsy. And how the only treatment is to go completely gluten-free.

Next: Going Gluten-Free

Free of: All top allergens and gluten-free.

Ingredients

• 2.2 lbs (1 kg) stewing beef
• 1 ⁄ 4 cup (60 mL) vegetable oil
• 2  medium white onions, diced
• 12 cloves garlic, whole and peeled
• 4 carrots, peeled, diced
• 4 celery stalks, diced
• 12 button mushrooms
• 1 ⁄ 4 cup (60 mL) tomato paste
• 4 bay leaves
• 8 thyme sprigs
• 6 cups (1.5 L) beef broth [Look for allergen-free, gluten-free brand]
• 2 cups (475 mL) red wine [Substitute: use 2 more cups of stock instead]
• 12-14 baby potatoes

Method

1. Heat oven to 350° F. In a Dutch oven or large pot, heat oil over high heat. In 2-3 batches, brown meat and transfer to platter.
2. Add onion, garlic cloves, carrots, celery and mushrooms to pot. Sauté 4-6 minutes on medium heat.
3. Stir in tomato paste; cook 2-3 minutes.
4. Add the herbs, stock and wine to the pot. Bring to boil, return beef to pot, cover with an oven-proof lid or foil. Place pot in oven and cook for 1 hour.
5. Meanwhile, boil potatoes until lightly cooked. Drain, set aside.
6. Add potatoes to stew. Cook a further 1½ hours in oven.
7. Ladle into soup bowls; serve and enjoy.

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

A: Quinoa (pronounced “keen-wah”) was a staple of the Incas who called it “the mother grain”. It is not actually a grain but a seed from a broad-leafed plant that is closely related to the weed lamb’s quarters and to spinach. Numerous varieties are grown in South America, and more recently in North America as well.

The quinoa seed looks like a cross between millet and sesame seed and is protected by a bitter, resin-like substance called saponin, which should be rinsed off before cooking. Some companies remove the saponin (like NorQuin brand) making it pan-ready, but quinoa is sold in several forms. (See below.)

It is a nutritious, gluten-free alternative that contains more high-quality protein than any other grain or cereal. In fact, its protein quality is comparable to that of dried skimmed milk. Quinoa is also high in iron, magnesium, phosphorus and zinc, and is a source of calcium, B vitamins and fibre.

How to Use:
• side dish instead of potatoes or rice
• in salads or pilafs, stuffing, casseroles
• thickener for soups, stews and chili

Cooking Tips
• rinse quinoa in cold water, drain.
• In a saucepan with a tight lid, bring 1 cup of quinoa and 2 cups liquid to a boil. Simmer for 15 minutes or until liquid is absorbed.
• let stand covered for 5 minutes.
Makes 3 cups.

How to Use:
• breakfast cereal
• substitute for up to 1/3 of the g-f flour in a cookie, muffin or bread recipe
• add to pancakes or waffles

Cooking Tips:
• add 1⁄3 cup flakes to 1 cup boiling water and boil 1 ¹⁄_² to 2 minutes, stirring frequently.
• remove from heat and cool. Then add chopped nuts, dried fruits and brown sugar.
• Or in microwave: high heat for 2 to 2 ¹⁄_² minutes.

How to Use:
• in baked items such as breads, muffins, pancakes, cookies, biscuits

Cooking Tips:
• has a slightly nutty, strong flavour so best combined with other g-f flours. Use no more than 25 per cent quinoa flour in recipe

How to Use:
• as a side dish or in salads

Cooking Tips:
• Follow directions on package.
Cooking time varies.

A: Celiac disease, also known as celiac sprue or gluten sensitive enteropathy, is an inherited digestive disorder affecting between one in 100 and one in 200 people worldwide. With this disease, specific proteins in wheat, barley and rye (collectively known as “gluten”) damage a person’s small intestine, so nutrients are not well absorbed. Gluten can also affect other parts of the body.

The symptoms are many, and vary in different individuals. They range from abdominal pain and bloating, to nausea, diarrhea or constipation, migraines, difficulty digesting lactose, weight loss or easy bruising. Since these symptoms can be common to other conditions, people with CD are often misdiagnosed with irritable bowel syndrome, lactose intolerance, chronic fatigue syndrome, diverticulosis (a condition of weakness in the walls of the colon), ulcers or allergies. Those with CD often suffer for years before a correct diagnosis is made.

Celiac disease can develop at any age, even in the senior years. It may be triggered by a viral or gastrointestinal infection, pregnancy, severe stress or surgery. If CD is untreated, it can cause nutritional deficiencies and increase the risk of osteoporosis, intestinal cancers, neurological disorders, infertility, as well as possible development of other autoimmune disorders. Celiac disease can occur in combination with Type 1 diabetes, auto-immune thyroid disease, autoimmune hepatitis, Down syndrome and Turner syndrome. If a person has any of these disorders and celiac symptoms or a family history of CD, that person should be screened for the disease.

Once a family doctor suspects CD, you should be tested. The doctor can order specific blood screening called tissue transglutaminase (TTG) and endomysial antibody (EMA). However, these tests are not 100 per cent accurate, the only way to be certain that you have CD is to undergo an intestinal biopsy. This procedure should be done by a gastroenterologist in a hospital outpatient setting. It is essential to get the testing done before starting on the GF diet, as this can interfere with making an accurate diagnosis.

Once the diagnosis is confirmed, the person with CD must stop eating all foods and ingredients derived from wheat, rye and barley. This is challenging as gluten is found in a wide variety of foods. Fortunately, many foods are naturally gluten-free, including plain meat, fish, poultry, eggs, legumes, nuts, dairy products, fruits and vegetables, and as well there are gluten-free flours and starches that can be substituted for wheat, rye and barley. And if you do prove to have CD, you will also come to appreciate the numerous gluten-free specialty products now on the market.

Celiac Symptoms

• abdominal pain, bloating and gas
• indigestion/reflux (heartburn)
• nausea and vomiting
• diarrhea, constipation or both
• lactose intolerance
• weight loss (CD can occur in obese individuals)
• chronic fatigue and weakness
• iron, folate and/or vitamin B12 deficiency
• other vitamin and mineral deficiencies
• bone and/or joint pain
• easy bruising of the skin
• swelling of hands and feet
• migraine headaches
• canker sores
• menstrual irregularities
• infertility (in both women and men)
• recurrent miscarriages
• elevated liver enzymes

Additional Symptoms in Children

• irritability and behavioural changes
• concentration and learning difficulties
• failure to thrive (delayed growth and short stature)
• delayed puberty
• dental enamel abnormalities

Charts from: Gluten-Free Diet by Shelley Case

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. See www.glutenfreediet.ca. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group.The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.

A: Gluten-free diets can be limited in variety, with white-rice bread, rice cakes, rice crackers and white rice as staples. Also, many commercial gluten-free products such as breads, cereals, pasta and flours are low in iron, B vitamins and fibre because they are made with refined flours and starches such as white rice flour, cornstarch, tapioca and/or potato starch. Following are some tips to help boost the quality of your diet.

Go for Enriched: Food regulations in Canada and the United States allow for enrichment of gluten-free foods. Check the ingredient listing to see if a product contains added vitamins and minerals.

Whole Grains, Fibre: Incorporate whole grains into your diet wherever possible. They contain the entire grain seed – the bran, germ and endosperm, which has more vitamins, minerals, protein and fibre than refined grains. Fibre can play a role in the prevention of coronary artery disease, diabetes and colon cancer. To prevent abdominal pain and gas, gradually increase your fibre intake and drink plenty of fluids.

Iron and Bones: Those newly diagnosed with celiac disease often have iron deficiency anemia because they have not been able to absorb adequate iron and other nutrients. A strict gluten-free diet will allow the intestinal villi to heal and nutrients to be absorbed properly. But the length of time for this varies, so it’s important to get plenty of iron-rich foods. Bone disease is common in those with celiac disease. You should eat three to four servings of low-fat milk products each day. If you are unable to consume enough dairy products, talk to your doctor or dietitian about calcium and vitamin D supplements.

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. See www.glutenfreediet.ca. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group. The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.

Makes 1 Loaf/24 Slices
Gluten-free

Ingredients

• 2 tbsp (30 mL) yeast (2 packages)
• 6 ^_1/2 cups (1.6 L) warm water
• 1 ^_1/2 lbs. (680 kg) teff flour (about 4 1/2 cups or 1 L)

Method

1. Dissolve the yeast in 1⁄4 cup (60 mL) water.
2. Combine the teff flour, yeast and the rest of the water in a large bowl. Mix well. Ensure that no clumps are left at the bottom or side of the bowl.
3. Cover the dough with plastic wrap and let it ferment for 2 to 3 days at room temperature. (Those with sensitive stomachs may consider making the injera the same day rather than waiting for 2 to 3 days. It will have a slightly “sweet” taste but that is considered normal.)
4. Drain off the water that has risen to the top of the dough.
5. Gradually add fresh warm water to the dough, just enough to make a thin smooth batter (like pancake batter); mix well. Cover the batter and let it stand until it rises, approximately 10 to 25 minutes.
6. Heat a 10-inch (25 cm) skillet or frying pan until a drop of water bounces on the pan’s surface.
7. Scoop about 1⁄3 cup (85 mL) of the batter and pour it into the pan quickly. Swirl the pan so that the entire bottom is evenly coated. Cover the pan quickly and let the injera cook for 1 to 2 minutes. (Injera does not easily stick or burn.) Remove the cover and wait for a few seconds. It is cooked when bubbles or “eyes” appear all over the top. If your first try is undercooked, cook the next one a little longer or use a smaller amount (1⁄4 cup or 60 mL) of batter. Do not turn the injera over in the pan. Use a spatula to remove the cooked injera and place it on a clean towel.
8. Let the injera cool and then stack on a serving tray. Do not stack hot as they will stick together.
9. Continue making the injera until the batter is finished.
10. Injera should be soft and pliable so that it can be rolled or folded like a crêpe or tortilla. Properly cooked, injera will be thinner than a pancake but thicker than a crêpe.

Nutritional Analysis
1 serving = 1 slice

Calories: (kcal) 105
Carbohydrates: (g) 21
Dietary Fiber: (g) 2
Fat: (g) 1
Protein: (g) 4
Iron: (mg) 2
Calcium: (mg) 54
Sodium: (mg) 7

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. See www.glutenfreediet.ca. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group. The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.

A Following a strict gluten-free diet can be challenging whether you’re away from home or in your own kitchen. While it’s not necessary for everyone in the household to go on a gluten-free diet or to eliminate gluten-containing items entirely, there are a number of ways to ensure your safe food doesn’t become contaminated with gluten. Here is some advice on how to store and prepare food in a gluten-aware kitchen.

Storage

• Keep all gluten-free products in separate containers.
• Use bright stickers to label everything that is and should remain gluten-free. Or purchase “gluten-free” stickers from the Canadian Celiac Association’s website.
• Have a separate spot in your cupboard and refrigerator for the gluten-free foods.
• Store gluten-free flours and grains in your cupboard above gluten-containing foods. Flour dust and bread and cracker crumbs can easily end up on or in gluten-free containers and boxes if you’re not careful.
• Buy your own containers of items such as butter, peanut butter and jam. Label them “gluten-free” to prevent other household members from dipping crumby knives from toast and sandwiches into a container.
• Use squeeze bottles for condiments such as ketchup, mustard and mayonnaise.

Preparation

• Have your own toaster. Or, use a toaster oven, with a rack that can be removed and thoroughly washed. Another option is to buy reusable toaster bags for gluten-free bread that can be placed in a regular toaster. (You may purchase them online, such as at ElPeto.com’s “store”.)
• Make sure the counter area you will be using is freshly washed and free of crumbs or flour dust. Have a separate cutting board that is only for gluten-free items.
• Thoroughly scrub pots, pans and utensils that have cooked other foods before using with gluten-free foods. It’s a good idea to have a separate set of utensils and other items for gluten-free baking (e.g. wooden spoons, sifter, bread machine).
• Don’t boil gluten-free pasta in the same water that cooked gluten-containing pasta. Have a separate colander to drain gluten-free pasta, as it is difficult to remove traces of pasta from a colander.
• Use separate utensils (knives, lifters, serving spoons, tongs) when preparing and serving gluten-containing and gluten-free items.

With a bit of planning and a lot of labeling, you can safely eat gluten-free alongside the rest of your family.

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. See www.glutenfreediet.ca. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group.  The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.

Gluten-free foods are popping up everywhere and the gluten-free diet is being promoted for everything that ails you. In order to separate the “wheat from the chaff” let’s look at the facts.

Celiac Disease
Gluten is a protein found in wheat, rye and barley. For those with celiac disease, gluten damages the lining of the small intestine causing a wide range of symptoms such as bloating, abdominal pain, diarrhea, constipation, gas, fatigue, migraines, depression, mouth ulcers, and bone and joint pain. Left untreated, the disease can lead to osteoporosis, anemia, infertility and even cancer. The only current treatment for celiac disease is a strict gluten-free diet for life.

Gluten Sensitivity
Recent research has revealed that some people may have non-celiac gluten sensitivity (GS). This condition can result in gastrointestinal symptoms such as bloating, gas and diarrhea (which also can occur in celiac disease). However, GS does not lead to nutritional deficiencies or the development of other complications. The prevalence of GS is unknown and the only way to diagnosis it is by ruling out celiac disease and wheat allergy. If tests for these are negative, a trial gluten-free diet, along with a symptom diary, may help to determine whether GS is causing the symptoms. Like celiac disease, the treatment of GS is a strict gluten-free diet.

Wheat Allergy
For those with wheat allergy, consumption of wheat triggers the release of IgE antibodies from various cells in the body. This causes an allergic reaction, with symptoms that can include hives, tingling of the mouth, abdominal pain, vomiting or diarrhea and a drop in blood pressure and breathing difficulties, which can be life-threatening in some cases. It is essential to eliminate wheat but, with an allergy, the other gluten-containing grains, rye and barley, can be consumed (as long as there is no “may contain” warning about the presence of wheat). The good news is that many children will outgrow a wheat allergy.

Autism Spectrum Disorders
The gluten-free, casein- free (a protein found in milk) diet, also known as the “GFCF diet”, has been advocated for those with autism spectrum disorders (ASD). Anecdotal reports from parents claim that the GFCF diet improves their child’s communication skills, reduces or eliminates gastrointestinal symptoms and/or improves their overall well-being. However, there is limited scientific evidence supporting the use of the diet for ASD. A recent report in the medical journal Pediatrics recommended that further research needs to be conducted, as only one placebo-controlled study of  the GFCF diet in 15 children with ASD has been published. This study did not find any differences in measures of severity of ASD symptoms, communication and social responsiveness in those on the diet.

Nevertheless, the Pediatrics report also indicated there is a possibility that a subgroup of individuals with ASD may respond to various dietary interventions, which is why well-designed studies over an extended period of time are essential to answer the questions. As the GFCF diet is complex and difficult to follow, especially since many children with ASD are picky eaters and have other food sensory issues, it is critical that families work with a registered dietitian to prevent nutritional inadequacies if they choose to put their child on the diet.

Weight Loss
A gluten-free diet has also been recommended by celebrities and others for weight loss. This is ironic because many processed gluten-free foods are higher in sugar, fat and calories. Healthy gluten-free whole-grains such as amaranth, buckwheat, millet, quinoa, sorghum, teff and brown rice can be part of a weight loss diet, but eating entirely gluten-free is not necessary, and can also be quite expensive.

Bottom Line
Individuals with celiac disease and gluten sensitivity need to follow a strict gluten-free diet for life. Whether the diet should be used for other conditions is controversial. Regardless of the health concerns, it is important to incorporate more nutritious gluten-free whole grains in the diet because many gluten-free packaged foods are made with refined flours and starches which are low in iron, B vitamins and fibre. Also it is essential to consult with a registered dietitian with expertise in the gluten-free diet to ensure that your diet is not only healthy, but safe. For more information see www.glutenfreediet.ca.

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and author of Gluten-Free Diet: A Comprehensive Resource Guide. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group. The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.