Study Finds Celiac Disease Increasing in U.S.

And GFNYC Wonders Whether Breastfeeding is a Factor

A recent Mayo Clinic/University of Minnesota study, "Increased Prevalence and Mortality in Undiagnosed Celiac Disease" (Gastroenterology, July 2009), concludes that "During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years."

Reports Josephine Marcotty in the article "Study confirms increase in wheat gluten disorder (Minneapolis Star Tribune, July 1, 2009):

The findings contradict the prevailing belief that a sharp increase in diagnoses of wheat gluten intolerance has come about because of greater awareness and detection, and raises questions about whether dramatic changes in the American diet have played a role.

"It's become much more common," said Dr. Joseph Murray, the Mayo Clinic gastroenterologist who led the study. No one knows why, he said, but one reason might be rapid changes in eating habits and food processing over the last half century.

"Fifty years is way too fast for human genetics to have changed," Murray said. "Which tells us it has to be a pervasive environmental influence."

Non-scientist that I am, I'm curious as to whether breastfeeding/formula feeding patterns have been a factor in this apparent change. In the article "Infant Feeding in the 20th Century: Formula and Beikost" (Journal of Nutrition, 2001), Samuel J. Fomon of the University of Iowa includes a chart showing that "commercially prepared formulas began to replace home-prepared formulas" starting in 1950.

And the Swedish study "Breast-feeding protects against celiac disease" (American Journal of Clinical Nutrition, May 2002) took note that

A major finding of this study was the lower risk of celiac disease in infants who were still being breast-fed than in infants who had discontinued breast-feeding at the time when gluten-containing foods were introduced into the diet. The risk was even lower in those infants who continued breast-feeding also beyond the time at which gluten was introduced. Larger amounts of gluten at the time of gluten introduction increased the risk, but for any given amount the type of food given was not important.

This study also noted that

It was suggested as early as the 1950s that breast-fed infants have a later onset of celiac disease, and this view was later shared by others. Furthermore, it was shown in case-referent studies based on prevalent cases that children with celiac disease had been breast-fed for a significantly shorter duration than had referents. However, the question was raised of whether the association of celiac disease with breast-feeding is direct and causal or indirect through postponed introduction of infant formula or a reduced amount of dietary gluten consumed.

Currently, as per this article by Nancy Lapid of about.com, doctors recommend that to prevent celiac disease, at least during infancy, "It is prudent to avoid both early (before 4 months) and late (7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed, inasmuch as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy."

Here's Dr. Murray on celiac disease.



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Hasselbeck on Rachael Ray and Larry King Live

Plus Reviews and Reactions

Here's a summary of Elisabeth's appearance on the Rachael Ray Show, where Rachael gushed about BabyCakes cupcakes. And here she is on Larry King Live. As you can see from the Larry King transcript, the interview covered a range of subjects over more than 17 minutes, with the diet coming up around the mid-point.

In related news, the very respectable Celiac Disease Foundation (CDF) expressed concern about inaccuracies in Elisabeth's book and appearances. It's true that Elisabeth has repeatedly called celiac disease an allergy (even though people often call it an allergy, it is technically an autoimmune disease), but when Larry King asked her about that she replied, "It is an autoimmune disease."

It's becoming clear, I think, that Elisabeth's book campaign includes risks as well as benefits. She's raising awareness about celiac disease but her language isn't entirely precise and some of her information is spotty or out-of-date. As has been the case in the past, it is up to organizations such as the CDF and the rest of the gluten-free community to try to separate the wheat from the chaff (er, the gluten from the diet?) and do our best to clarify what needs to be clarified.

Here are reviews of The G-Free Diet from Nancy Lapid, Sure Foods Living, and At Home With Books.

"Hospital Stays Made Safe"

GIG Offers an Online Dietary Guide

I continue to feel that "there ought to be a law" when it comes to providing medically appropriate food to people in institutions such as hospitals, nursing homes, and prisons. It just seems to be common sense that people on medical gluten-free diets receive gluten-free food in medical institutions—or anywhere else where they have little or no ability to control food procurement or preparation.

So far there's no such law, but at least the Gluten Intolerance Group (GIG) recognizes the problem. As has been reported, including Nancy Lapid's Celiac Disease Blog, GIG recently created an online guide called Hospital Stays Made Safe [PDF]. It's not a cure-all, but at least it's a step in the right direction.

And it's one of numerous online publications offered by GIG. Check 'em out!

For an idea of what we're up against, here's a glimpse of some "normal" hospital food. (The footage comes from across the proverbial pond, where Prince Charles and Coeliac UK have also advocated on behalf of hospital patients.)



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Erin Gone Gluten-Free!

Have you been gluten-free in Ireland? I haven't—yet. At some point I'd like to pay a visit to the Emerald Isle and get a taste of the gluten-free food there.

Ireland has a reputation for having a high proportion of people with celiac/coeliac disease, but studies seem to suggest an overall rate of 1:120—perhaps slightly higher than average, although some localities might have significantly higher concentrations.

The Coeliac Society of Ireland (CSI) serves gluten-free people from its base in Dublin and its branches throughout the country. It offers lists of accommodating restaurants and lodgings, but so far it does not "vet" those places.

The Balleymaloe Cookery School, located on an organic farm in County Cork (the home of Delicious Foods) offers short healthy gluten-free cooking classes for people with coeliac disease. Owner Darina Allen co-authored the book Healthy Gluten-Free Cooking with Rosemary Kearney.

Getting back to Dublin, I still remember a profile of Roly's Bistro chef Colin O'Daly that appeared in the Fall 2002 issue of Gluten-Free Living, before the magazine went glossy or had a blog—which offers a St. Patrick's Day blog post featuring recipes for Irish Soda Bread and Irish Potato Candy.

Want more recipes? Nancy Lapid offers links to Irish (and Chinese?) dishes here.

Mary's Gold Crackers

Plus Award-Winning Recipes
























The above picture shows renowned chef Jacques Pépin with Mary's Gone Crackers co-founder Mary Waldner at this summer's Fancy Food Show hosted in Manhattan by the National Association for the Specialty Food Trade's (NASFT). At the food show, Mary's Gone Crackers won the Specialty Outstanding Food Innovation, Gold Award for Outstanding Cracker of 2008.

Yes, that's right: Gluten-free crackers got the gold in the cracker category! Will wonders never cease? (I hope not.)

While they were in town for the food show, Mary and her husband and partner, Dale Rodrigues, hosted a dinner (chaperoned courtesy of publicist Rachel Kay) at the GFRAP restaurant Lumi that was attended by myself, Erin Smith of Gluten-Free Fun and the New York City Celiac Disease Meetup Group (NYCCDMG), Nancy Lapid of About.com, and Cynthia Beckman and Dr. Peter Green of the Celiac Disease Center at Columbia University (CDCCU). While we waited for our orders, we munched on sticks and twigs piled atop our table. That might sound a little primitive unless you know that Mary and Dale recently branched out and added Sticks & Twigs to their product line. The "gluten equivalent" of these hearty and crisp snacks might be sesame sticks—so keep them in mind for dips and appetizers as well as attacks of the munchies.

A funny thing about our get-together was how some of us were virtually bubbling over with ideas about Mary's Gone Crackers—they should be vitamin fortified, they should come with something to educate people about what "gluten-free" means, etc. But the bottom line is that Mary's Gone Crackers are fine as they are—and that Mary's Gone Crackers has a very good track record in terms of working with reputable gluten-free causes, including the Celiac Disease Foundation (CDF).

In fact, I think I first tasted the crackers because they'd been donated as refreshments at an event featuring Dr. Green (more recently, Sticks & Twigs samples were in the goody bags at the recent "Chill and Grill" CDCCU fundraiser in Queens), but the products really won me over after I used a coupon to buy some for myself at my local health food store. A 13-cracker serving contains 12% of the daily value of dietary fiber, 6% of the daily value of iron, and 4% of the daily value of calcium. And, as I've just learned this week, the Herb flavor goes well with peanut butter.

I've also heard some musings of combining the crackers with chocolate, but I haven't gone there yet.

Meanwhile, across the Atlantic, Coeliac UK (CUK) named two winners in its Gluten-Free Chef of the Year competition, part of its Food Without Fear campaign. Vanessa Scott, of the Norfolk hotel-and-restaurant Strattons, won with her cheesy Twice-Baked Binham Blue & Potato soufflé [PDF]; Christine Bailey, a journalist and chef trainer [see article here], won with her Apricot and Orange Polenta Cake [PDF]. Catering student Sophie Haskins received "outstanding achievement" recognition for her Oshi Sushi [PDF].

Congrats to all!

Photo courtesy of the NASFT

In Praise of Breastfeeding

Dr. Melissa Bartick—a friend of mine who also happens to be a breastfeeding advocate—recently had an article, "Let's Get Serious About Promoting Breastfeeding," published in The Huffington Post. She mentions The Ten Steps to Successful Breastfeeding as outlined by the UNICEF/WHO Baby Friendly Hospital Initiative in the United States.

I'm not an expert on the subject, but I'm amazed that breastfeeding would even need advocacy. If anything, I'd think that formula feeding would "need" it. And I suppose the formula feeding does get some very effective advocacy from marketers who stand to make profits from pushing formula on people who don't really need to use it. The preponderance of evidence suggests that, in many cases, breastfeeding is healthier for children as well as economically and environmentally advisable.

Anyway, with today being the end of World Breastfeeding Week, I figure this is a good time to return to the subject as it relates to celiac disease. As Nancy Lapid points out, the current wisdom is that breastfeeding with a slow introduction to gluten between the fourth and sixth months can significantly reduce or postpone the emergence of celiac disease among infants. As I've mentioned previously, Swedish findings on this subject were dramatic, appearing to eliminate a very large number of infant cases—though not all of them. (Note that the recommendation is different than the "exclusive breast-feeding for the first six months" practice suggested by some breastfeeding advocates. This discrepancy needs to be addressed!)

Breastfeeding isn't easy for all women, but coaches can address many problems women face regarding breastfeeding.

Breastfeeding advocates argue that public policy support of breastfeeding as a form of preventative care can save money in the long run by protecting children from health problems. A similar "economic" case can be made for public policy that supports at least stalling celiac disease through strategically timed breastfeeding. And a similar case can be made for getting more people screened and properly advised regarding celiac disease. In other words: Enabling people on gluten-free and other medical diets to receive insurance coverage for visits to dietitians and nutritionists should save money in the long run, and encourage professionals to become better informed.

Here's a simple, silent tribute to breastfeeding from Burlington, Vermont.



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BLOOD FOR BASEBALL!

Not As Creepy As It Sounds

Celiac disease does not disqualify people from donating blood. If you don't believe me, check out the FAQs at the University of Maryland Center for Celiac Research (UMCCR) and Nancy Lapid of About.com.

This Wednesday from 10am to 5pm you can give blood at the Diamond Club of Shea Stadium and get something in return: two tickets to a Mets game in August!

The New York Mets and the New York Blood Center will host their annual in-season Blood Drive on Wednesday, July 30, in the Diamond Club of Shea Stadium from 10 a.m. - 5 p.m.

Each donor will receive a pair of tickets to a select Mets 2008 home game in August, the Mets final season at Shea.

As Nancy suggests, bring your own drink and snack—just to be on the safe side.

FREE OFFER: THE ULTIMATE GUIDE TO GLUTEN-FREE LIVING

The Ultimate Guide to Gluten-Free Living, a booklet (the size of a memo pad) published by the Celiac Disease Center at Columbia University (CDCCU), is available free to those who respond to an offer before this Friday, July 25, 2008.

You can find out more about the offer at Nancy Lapid's Celiac Disease Blog.

For a more extensive source about celiac disease, check out Celiac Diseae: A Hidden Epidemic by Dr. Peter Green of the CDCCU and science writer/film producer Rory Jones of the Westchester Celiac Sprue Support Group (WCSSG).

"GLUTEN-FREE" REDEFINED

"Codex Alimentarius" sounds like it could be a product meant only for women, but it's actually an international "food code" developed by FAO (Food and Agriculture Organization) and WHO (World Health Organization).

The Codex Alimentarius Commission recently issued a new set of guidelines for defining gluten-free. "The new benchmark dictates that food labeled gluten-free may not contain wheat, rye, barley or oats, and its gluten level may not exceed 20 milligrams per kilogram," states a July 1, 2008 Reuters item.

This represents a significantly more stringent standard for many countries, according to Nancy Lapid, celiac disease specialist at About.com and recent table companion of mine at a dinner hosted by Mary Waldner and Dale Rodrigues of Mary's Gone Crackers.

It is up to individual countries to come up with their official standards, but there is probably good reason to think that many of them will comply with this stricter definition.

Dietitian Tricia Thompson commented on the draft of the revision here.