10 Things you might not know about celiac disease

May is Celiac Disease Awareness month. You probably hear a lot about celiac disease but how much do you know? Do you think gluten-free is blown out of proportion? Are some people eating this way as a fad? Maybe. But the reality is not many people understand what celiac disease is and how important it is to be aware of the symptoms. Before I get into the details, let me give you a quick overview of celiac disease and what it can do to your body.

Celiac disease is an autoimmune disease in which eating gluten (the protein found in wheat, barley and rye) causes the villi in the small intestine to be flattened. You can picture the villi like little fingers waiting for food and absorbing it into the bloodstream. Celiac disease causes the villi to be flattened so that the food molecules pass through the small intestine in large pieces. This means that the nutrients of that food are not absorbed properly and, in some cases, causes your body to think the food is almost like a pathogen. Besides the obvious stomach issues (aka Irritable Bowel Syndrome or IBS) or lack of growth due to malabsorption (often referred to as "failure to thrive"), celiac disease can manifest itself with itchy or dry skin (what is known as eczema), joint pain, brain fog, headaches, depression, and about 100 other symptoms. Scary, yes? In 7 years, I have learned a lot.

I put my daughter on a gluten-free diet in 2007 because of her severe eczema based on the recommendation of a naturopath. At the time, I had not heard of celiac disease. Around 2008, I became aware of the disease but always associated it with severe abdominal pain, diarrhea, and children who stopped growing. Since she had none of these symptoms, I never thought she could possibly have the autoimmune condition that can be the cause of hundreds of other autoimmune disorders like Hashimoto's (which runs in my family) or Grave’s disease, type 1 diabetes, rheumatoid arthritis or conditions like anxiety and infertility.

In 2009 (actually exactly 5 years ago today, I wrote my first article about it), I went on a gluten-free diet because I felt better eating that way. I would describe my gastro intestinal (GI) symptoms as mild; I had lived with them all of my life and thought it was normal (gas, bloating, and intestinal cramping). I never thought to have myself tested for the disease before I went off of gluten (now I wish I had). For the past 5 years, I have been what I called gluten-sensitive or “gluten-free lite”. I would eat gluten occasionally and suffer from a range of symptoms depending upon what and how much I ate. But I never, in a 1,000 years (as the saying goes) thought I could possibly have celiac disease; until recently.

In all of the advocacy work I do, I mostly focused on people who had severe GI issues or children who stopped growing. I had no idea of the range of symptoms, which goes from intense to asymptomatic (scary). What we are learning now is that someone with mild symptoms, like mine, could have celiac disease.

A year later, when my son was 6, he was exhibiting the GI symptoms I used to have. At that point I knew more so he was tested for celiac disease; the blood test came back negative. However we did an additional test and found he had a sensitivity to gluten; his Secretory Immuno Globin Antibodies or SIGA) were very low. His symptoms were mild in comparison to many other people but were still affecting him. We took him off of gluten and in 3 weeks, he felt much better. But, I never really was 100% strict with him or any of us. I never thought I had to. At that point, I did understand the severity of celiac disease and was sympathetic to those who suffered. If I heard of anyone who had severe GI symptoms, I would suggest they get tested for celiac disease. I also started meeting more and more people who were like me, those who realized they had a sensitivity to gluten. I still did not know that many people with celiac disease.

In those years, I got better and better at gluten-free cooking and baking. I created recipes using 100% gluten-free ingredients. I began to understand cross-contamination and learned more about celiac disease, even if I didn't think I had it. More recently, I wrote and published a cookbook, a lifelong dream, and gave talks about how to cook in this fashion. But in recent months, I started learning more details about the disease.

Do I have celiac disease? I don't know but I do know that I carry one of the genes. I'm hedging my bet for now and treating myself more like someone with the disease because if I do have it, small amounts could be doing damage that I can't see. If there is a test that can be taken without ingesting gluten, I might do it. For now, I'm happy to stay off of it. I'm also going on 2 years of not being sick past a small head cold. That right there is reason enough.

Here are some things I did not know about Celiac Disease that might surprise you:

1. It's hereditary. If your dad's sister has celiac disease, you could have it or get it at some point. If blood relation has it, you are at risk. Plain and simple. The big issue is that many of us don't know we have it.
2. There are 2 genes for celiac disease; HLA-DQ2 and HLA-DQ8. Whether you have one or two of these genes doesn't really matter; you are still at risk. However, having the gene does not mean you have celiac disease. What you do with the information is a personal decision. You can find out whether or not you are a gene carrier with a genetic test, either blood or a cheek swab. This is an accurate test compared to the blood tests of today. Great segue.
3. You can ask your doctor to order a celiac blood panel for you. However, a negative blood test does not always mean you do not have celiac disease. In other words, there have been many people who test negative yet still have it. Looking at other factors such as genetics and symptoms might be a better indicator. You can also get an endoscopy which is a more accurate test.
4. You may not have celiac disease but still be gluten intolerant. There is a condition called Non Celiac Gluten Sensitivity or NCGS. People in this category can have symptoms just as severe as someone with celiac disease. If you know gluten makes you feel bad, why risk the damage?
5. Eating a little bit of gluten can make someone with the disease very ill. If you have ever eaten out with a friend who has celiac disease, this is why they ask so many questions. Be their advocate and be supportive. When their food touches a crumb or is fried in the same fryer as that chicken tender, this is called cross contamination and it can make them sick. The same goes for your house. Another hidden source of gluten is in ingredients so read the label. I recently found gluten in a bottled Caesar salad dressing which was upsetting because I almost missed it. This is why I cook a lot.
6. Some people with celiac disease have no or very little symptoms and these symptoms are not always related to your stomach. This is probably the biggest challenge in diagnosis. Some times it is obvious but often it is not. I met a girl who went to the doctor because her finger was hurt. After talking to her doctor about her health, history and general well-being, it came out that her sister was diagnosed with celiac disease. The (intuitive) doctor said “Let's just test you for it” and sure enough, she had celiac disease. She otherwise would have been walking around with it until probably something bad happened. 
7. We really do not know how many people have celiac disease partially because of point #6 and partially because doctors are just now being educated to look for other symptoms. This is why celiac disease awareness is so important.
8. If you think you might have celiac disease, get tested before going off of gluten. The options are a blood test to see if you have the disease or a genetic test to see if you carry the gene. Beyond the blood test, you can also get a biopsy or endoscopy. Another reason doctors may do this is to see the damage that has been caused by the disease.
9. From what we know, a stressful situation such as sickness, or a physical or emotional incident can turn it from off to "on". For these people, they had the gene but didn't have the disease. Many people say “but I have eaten wheat my whole life without a problem.” That might have been true but now, wheat or gluten can be poison to your body. If you find that you have been sick for a while and it seemed to start after a certain incident (birth, a virus, etc), get tested.
10. The fix for celiac disease is eating a 100% gluten-free diet. In the world of medicine and disease, this is a pretty good “cure”. However, the celiac disease might have kicked off other autoimmune disorders so you might not be out of the woods. This again, is another reason why it is so important to be aware of the disease and stop eating gluten if you think you might have it.

If you read this and think, “that could be me”, please get tested. Since the disease can lead to so many other life threatening diseases, it's important to be diagnosed.

If you do need to eat gluten-free, do not consider your life to be over. There are so many resources, groups, products and other options, you will be amazed. Finding the right ones, though, might be a challenge. Take a look at my product recommendations page on my website (coming soon) or how to get started with gluten-free. Yes, there are adjustments to be made but you can do it.

Think you won't be able to eat pizza, cake and bread again? Think again! Check out my gluten-free cookbook, The Warm Kitchen, for all of the recipes you need to feel like you are home again. If this article helps one person, it will make everything I do worthwhile. Thanks for reading. Please leave a comment if you have enjoyed this or found it helpful.

-Amy Fothergill

The best gluten-free chicken tenders

Without a doubt, these are better than anything I or my children have ever had in a restaurant! Well, in my humble opinion, that is. When I make these, I make a double batch. We use half for the meal and I either freeze the rest or use it for lunches or leftovers.

You can use this recipe for fish or almost any other protein, even tofu! For our family, I use a dairy substitute like almond milk to make it dairy-free. Although a few years back some people thought eggs were in the dairy category, they actually are not. Dairy refers to anything that comes from a cow. I'm also providing an egg-free substitute as well as this can be another allergen many children and even adults can't tolerate.

Want something a little more sophisticated? Try serving them with an apricot Dijon sauce (yes, that's in my cookbook, The Warm Kitchen) or a sriracha or sesame oil mayo. Getting ready for the game? Toss these with your favorite buffalo wing sauce. So many possibilities! Does your child like ranch dressing but can't have dairy? Try Follow Your Heart's vegan ranch dressing.

Give it a try and don't be afraid to fry these. I fill a big pan with about 1/4"-1/2"of oil since I don't fry too often. It's so worth it. Let me know how you like them.

For more gluten-free recipes like this, check out my cookbook, The Warm Kitchen!

Gluten-Free Chicken Tenders 

Makes about 12-16, depending upon the size of the tender

1 pound boneless, skinless chicken breast or tenders

2 tablespoons white rice flour

2 tablespoons potato starch

1/2 tsp sea salt

1/4 tsp each black pepper

1 large egg or egg substitute (see below)

1 tablespoon milk or milk substitute, plain and unsweetened

2 cups gluten-free corn flakes, crushed or ground in a processor (measure first, then crush)

1-2 tablespoons olive or vegetable oil

Egg Substitute: to make 1 egg, mix 1 tablespoon of ground flaxseed with 3 tablespoons warm water in a bowl. Set aside for 5 minutes.

1. Slice chicken breasts into strips; if using tenders, proceed to the next step. Pat dry if wet.
2. Mix flour, starch, salt, and pepper in a shallow bowl. Place egg or egg substitute and milk in another shallow bowl and beat lightly. Place corn flake crumbs in another shallow bowl.
3. Bread the chicken. Take 3-4 pieces of chicken and first dip in flour mixture. Shake excess. Dip in egg and then corn flake crumbs. Place breaded chicken on plate or tray until all chicken is coated.
4. Place 1 tablespoon of oil in a large sauté pan. Heat to medium heat. Add one piece of chicken to the oil. If chicken does not make a sizzle sound, let the pan heat up more. Add chicken pieces but don’t crowd pan. Don’t move chicken; allow to brown. Turn once and cook until heated through. Place on a piece of paper towel on a plate and place chicken on this plate to absorb some of the oil. Use more oil if needed.
5. To keep tenders warm or to crisp up, place tenders on a baking sheet and place in a 350°F oven for 5-10 minutes.
6. Serve with So Simple Tomato Sauce, Spicy Orange Sauce, or Barbecue Sauce (see cookbook). 

Dairy-free cooking tips

Whether you eat dairy-free out of choice or necessity, you'll find different substitutes out there based on what you're making. I cook and bake gluten and dairy-free for my family and I.  While I refer to the substitutions as dairy-free, it's actually casein that we're avoiding. Casein is the protein found in milk that many people cannot tolerate. Here are my top tips for how to get through it.

Drinking Milk
Please don’t believe the Dairy Board. We don’t need milk; we need calcium. Yes, milk has a lot of protein but there are other sources for that as well. There would not be so many dairy intolerances/allergies if our bodies needed milk. I am not a scientist, nor a dietician but my personal feeling is that we are probably drinking too much milk which is why, now, many of us can’t tolerate it. So, if you can’t drink milk, what is there?

Today there are many options:

•    soy (but I cannot tolerate)
•    rice (a little too thin for drinking)
•    almond (I like it but not good for those with nut allergies; here is a video on how to make it)
•    coconut (one of my preferred milk subs; very creamy)
•    flax (this is a new one; look for it in your supermarket's refrigerated section)
•    hemp (some people love this but it has an aftertaste I don’t care for)
•    oat (not a bad sub but for those with a gluten intolerance, it might not be an option)

Did I miss any? That is a pretty comprehensive list. Many of these milks come in different varieties like vanilla and chocolate. Many also have added sugar. Sure it tastes better, but you might not need the extra calories. My daughter’s favorite is unsweetened vanilla flavored almond milk and uses it in her cereal. Hopefully you can find a substitute that you like.

Also, if you are also avoiding gluten, be sure to check the label before purchasing any soy milk. Some brands contain gluten from a barley extract!

Cooking with Milk Substitutes
Drinking sweetened milk can be tasty but you don’t want to cook with it! Make sure to check the label and look for plain, unsweetened milk for cooking with 1 gram of sugar (or less). If soy is not a problem for you, it’s one of the best substitutes for milk in things like soups and creamy stews. Coconut is a close second as well. I have started making my own almond milk occasionally and recently tried it in a creamy mushroom sauce. You could not tell it was not dairy! Rice milk is very thin so you might need some extra fat or some extra thickening. You can thicken it by either cooking it down a bit or by adding a slurry (equal parts of a starch like corn and water). There are also many creative milk substitutes like cashew cream and avocados. It all depends upon what you are making. Try experimenting with some different ingredients.

Baking with Milk Substitutes
For baking, if you use a sweetened alternative milk, you might need to reduce the sugar in the recipe by 2-3 tablespoons. If you find the finished product sweet in anyway, it’s acceptable to reduce the sugar. As far as type of milk, I prefer to use milk substitutes with some fat in them so the baked good is not too dry. This is why I prefer coconut or almond milk. For things like pancakes and waffles, almost any milk will do.

Dairy-Free Substitutions for Desserts
Many traditional dessert recipes use butter so finding a good alternative is important.

Common substitutions:

• There are butter substitutes which are sold in a stick. These can be used in place of butter in cookies but honestly, they aren’t my favorite. You have to use what you like.
• Vegetable shortening, like Spectrum™, works really well in cakes and for frosting. I like the organic variety that is not hydrogenated. Keep it at room temperature. When I make cakes, I usually beat the butter or shortening with the sugar to get the batter fluffy. The shortening should be slightly warm to make this process easier.
• Coconut oil works really well in madeleines. It’s not bad in cake but can make it a bit greasy due to its low melting point. Make sure to heat it first so it is easy to measure, then cool slightly.
• For baking, you can usually substitute a vegetable oil like canola or sunflower for the butter, even if the recipe does not call for melted butter. I have successfully used safflower oil instead of butter for cookies. The texture will be slightly different. Always test your recipe.

Dairy Substitutions for Cooking

For cooking, use olive or another vegetable oil instead. For something with more mouthfeel, use coconut oil. The virgin coconut has a coconut flavor. If you don’t like that flavor, use the non-virgin.

Check out some of my recent blog entries for more ideas for cooking dairy-free

Easy tamale pie: gluten-free and dairy-free

Gluten-Free Dairy-Free Tuna Noodle Casserole 

Gluten-Free (and dairy-free) Rolled Sugar Cookies

San Francisco Gluten-Free Allergen-Free Expo Finds and Goodies

If you didn't have a chance to make it to the Gluten-Free Allergen-Free Expo this past weekend (Jan 25/26, 2014), here's a quick review of some of the new (and "old") products and companies that are hitting the market.

This is just a no-brainer. If you haven't been to Zest Bakery in San Carlos and you are gluten-free, get there now! Many of their products are also dairy-free (like their sandwiches unless you get cheese), vegan and even paleo. 

 Based out of Dallas, TX, Local Oven is changing the way food service looks at gluten-free. In almost any restaurant in that area, you an get their gluten-free rolls and buns. Wouldn't that be nice! Look for their products in supermarkets as well.

 I am quite fond of Canyon Bakehouse products. It was nice to see them with a larger presence this year. If you haven't had a chance, try their whole grain bread. We use it for sandwiches all of the time. I also like their focaccia bread.

G-Free Foodie delivers boxes of gluten-free items perfect for any foodie! KC is a local to California and knows her stuff. I love her recipes and ideas as well.

Kyra is really making a name for herself. Besides her wildly popular bakery, Kyra's Bake Shop in Oregon, she also has a line of gluten-free cake mixes (chocolate is our favorite) and a new cookbook. She is a 3 time winner of the Food Network's Cupcake Wars with her gluten-free cupcakes. If you need a decadent treat, this is where to go.

 I didn't get a very good photo of the booth for The Inn on Randolph. It's a lovely bed and breakfast located in Napa, CA and is 100% gluten-free. That's my friend Jeff; he teaches gf classes there.

Kettel Krakkers is a fairly new company that was also at last year's expo. I really like the taste of these gluten-free crackers. If you see them, give them a try. The ingredients are organic.

A new "kid on the block", these gluten-free, whole grain mixes were both at the fancy food show and this expo. Amazing Foods For Life is a smaller company which is trying to bring their mixes to the mainstream. They taste great and their team is very enthusiastic! All mixes come with instructions on how to be made dairy-free and vegan.

When I first went gluten-free for my daughter in 2007, Kinnikinnick was there. I tried their bread and recently bought their bagels. The bagels were soft and chewy and tasted great toasted. I love their cookies; the closest thing to an Oreo you can get but gf and df!

I am so fortunate to have been able to get to know Dr. Amy Burkhart over the past year. She is not only a doctor but a registered dietitian as well. She specializes in celiac disease and gluten intolerance/sensitivity. Besides her medical credentials, she is just an all around nice person. She's located in Napa, CA.  

Mary Capone from Bella Gluten-Free always makes me smile. Her products have been on the market for a number of years. Her baking mixes create delicious breads, cakes, pizzas and other treats. Look for them in your grocery store or order on-line from their site.

Enjoy Life Foods is another established company. What I like about them is that their products are safe from the top 8 allergens so you don't need to check the label each time. These are some new bars they have come out with. My children liked the S'mores the best. 

Enjoy Life Foods makes the Plentil chips you see.

My other good friends from all of the expos are Freedom Foods. Look for a blog post and giveaway coming soon. That's Michael (who I like to call Marco because of his thick Aussie accent) and Fred. They are always enthusiastic to discuss their products. I like the products because they are low in sugar and salt and do not contain GMO ingredients. My kids like them simply because they taste good. Win-win in my book.

You will be seeing more of Viviana's gluten-free pastas. They have been working hard to make their delicious gluten-free pasta available in more and more places. If you see it, pick up a package and give it a try. Look for a blog post coming soon from me.

I wish I had taken more photos of this booth. I love the ladies from Natural Decadence Bakery as well as their story. I wrote a blog post about them last year. Their products are delicious and made with so much love! Definitely give them a try.

Sadie is well known for her sourdough bread. I'm sorry, let me rephrase that...delicious gluten-free sourdough bread! I love seeing Bread Srsly become bigger and available in more and more places. 

Ivy's Garden (yes, that's Ivy) is another gluten-free friend who I have become acquainted with over the past year. Her gluten-free frozen products are simply delicious. 

New to the expo this year is Bacano Bakery. They are based in Oakland and sell at farmer's markets and cafes in the bay area. They make a variety of products (see below and be ready to drool); some contain dairy; others are dairy-free and even vegan. Of the samples I tried, I liked the multi-grain bread the best. No, I did not try the danish!

There were MANY more vendors who I didn't either get a chance to talk to or just didn't get their picture. I also liked Luce's Artisan Bread Mix. I bought a bag to try at home. They just came out with a buckwheat mix but did not have it there (darn).

I don't have her picture but do check out my friend Erica Dermer's page Celiac and the Beast. She also just wrote a (very funny) book.

Here is another review with some more vendors from my friend Sandi at Fearless Dining.

If you eat gluten-free or are considering it, I would suggest going to an expo to see what's on the market. Many people still think they could never be gluten-free because there are no good products. That is no longer the case.

Leave a comment with your thoughts or if there was a vendor that you liked in particular. Thanks!

Gimme 5 Campaign

If you know me, you know I do not normally promote fundraising within my blog. This is an exception. My friend Cindy is an incredible, positive person. I often complain about managing gluten and dairy-free kids. This is nothing compared to what they have to endure. Read the story below and hopefully you will agree. If you can take a minute to even donate $5.00, that would be a big help:

Did you know that giving a tax-deductible donation as little as $5 can help two energetic boys and their family have some piece of mind in their fight against life-threatening food allergies? Carson (age 6) and Benjamin (3) both live with life threatening food allergies. Benjamin was diagnosed with an anaphylactic
allergy to peanuts and almonds, as well as asthma in November 2011 at only 18 months old. Benjamin also has a dairy allergy as well as a severe gluten intolerance. Benjamin's asthma complied with his life threatening allergies puts him at extremely high risk. Carson was diagnosed with a life-threatening allergy to almonds in November 2012 at age 5. Since then our daily lives require emergency medicines in tow at all times. We are never more than an arms length away from the life saving medicine.

Going out to eat as a family has been severely restricted. We currently have two places that we trust. Trips to stores include avoiding isles with peanuts, the bakery and other high risk areas. When we do get invited to birthday parties, it takes multiple conversations with the party planners to ensure there are no nut products to be consumed. As you can see each part of our daily life needs to be mapped out cautiously. It brings a lot of stress an anxiety to precious young boys, who should be carefree.

For the first time these activities are within our reach with the help of an Allergy Alert dog from Angel Service Dogs, Inc. (ASDi) named Gia. An Allergy Alert Dog will add another “defense” against peanuts/almonds that we, as parents, can’t provide. This dog is being trained to sniff out peanuts/peanut oil and almonds/almond oil on items such as a shopping carts, bowling balls, movie theater seats, playgrounds, play areas and common places others would take for granted as being “safe.”

Your donations for Gia will be used to train Gia, fly Carson and Benjamin's family to Colorado to meet Gia, and have an intensive 10-day training. Any funds received in excess will go to ASDi™ and will be used for training other dogs for families in need.
Your donation is tax deductible whether it is $5, $50 or more. You can donate on-line here or your donations can be made via check to:

Angel Service Dogs, Inc.
3815 Highview Drive
Colorado Springs, CO 80908

Thank you in advance!