Happy Summer, MetroCeliacs!!!
Summer is a more difficult planning time for restaurants and speakers as it is a busy time for members, making it difficult to get a good turnout, and for restaurants, making it almost impossible to get them to plan anything for us. We decided to suspend summer activities and resume everything in the Fall. Although this post is a bit behind the times, here is the wrap up of all the questions posed on the evite to this event.
We were very excited to welcome Lara Field, a registered dietician, to answer questions we had in lieu of our July MetroCeliacs meeting. She was gracious enough to answer them for us and the evite and her presentation follow.
Around this time, more news came to our group. Sherwyn's Health Food Store and proud sponsor of many many of our MetroCeliac meetings, has closed. We are sorry to see it go as Gail was always an enthusiastic provider and supporter of Celiacs around Chicago, especially of our MetroCeliacs. We would like to thank her and Sherwyn's for their enthusiasm, their efforts, their sponsorship and their openness to learning about celiac, trying new products and always being behind everything we did as a group. THANK YOU GAIL! WE MISS YOU!
Evite:Do you have any questions about celiac disease or how to accurately follow the gluten free diet? Are there any myths that you would like to prove or dispel? Now that it is grilling season, do you want info regarding cooking on the grill and enjoying bbq sauce? What ingredients are in some of our favorite grilling items (brats? marinades?) that we need to be wary of, if any?
Now would be a great time to come and have your questions answered. Lara is looking forward to answering any questions on ingredients, foods, preparations, living GF...anything you can think of that you have always wondered and not had a forum to discuss.
Lara, answering our group's questions on the evite, responded:Metroceliacs Lara Field, MS, RD, LDN
Nutrition Questions – 8/2/06 Clinical Dietitian
Specializing in Celiac DiseaseWhat vitamin/mineral deficiencies are celiacs at risk of developing?Depending on when celiac disease was diagnosed, and the extent of the damage to the villi, vitamin deficiencies can vary. Celiac disease is commonly found in the duodenum, which is the first portion of the small intestine, where we absorb nutrients such as iron, calcium, magnesium, and zinc; therefore if this part is affected, these are the nutrients that may become deficient over time.However, as the damaged bowel is healed, vitamin absorption, which was once impaired, becomes corrected.
After healing is complete, long-term consumption of a gluten-free diet could put someone at risk for vitamin deficiencies if they consume too much of the wrong foods. Many gluten free products are made with flours including white rice flour, potato starch, tapioca starch, and corn flour; these commonly are not enriched with vitamins as compared to gluten containing products (IE: Total ™Cereal provides 100% daily value of vitamins and minerals). Vitamins included in enrichment of gluten containing grains are mostly B vitamins (thiamin, riboflavin, niacin, folate) as well as iron. In my opinion, lately gluten-free food manufacturers are experimenting more with alternative grains including quinoa, amaranth, Montina (Indian rice grass), and many bean flours which have superior nutrition to that of white rice, and potato, and many products are being enriched with vitamins as well.
I am unaware of any over the counter (OTC) test that celiacs can use to measure vitamin levels in their blood, and personally I am not sure if I would trust something like this if it were available. Frequently, blood tests are subject to misinterpretation because they need special equipment to analyze the result, or someone specially trained in how to interpret the outcome. Also a blood test may only capture a “snapshot” of your body’s current state, but miss the big picture of something that may be going on for sometime. You may want to assess if you are showing signs of nutrient deficiencies before inquiring with your doctor about what blood tests are available, because these blood tests performed by your physician may be quite costly. Some signs of common vitamin and mineral deficiencies are scaling of skin, easy pluckable hair, poor wound healing, slick tongue, and weakness. Most importantly, with a balanced diet, one that incorporates a variety of fruits, vegetables, lean protein, dairy, and whole gluten-free grains and a multivitamin/mineral supplement, vitamin deficiencies are less likely to occur.
FOOD GROUP
SERVING SUGGESTION
TIPS FOR HEALTHY EATINGBreads, Cereal, Rice, and Pasta
6-11 servings per day
(depending on age, and weight status)
1 slice brown rice bread
½ cup cooked quinoa, buckwheat
½ cup cooked rice, cereal
¾ cup ready-to eat gluten-free cereal
Look at the Nutrition Facts Food Labeling on foods to determine the fiber content of the product. A healthy choice would contain >3 grams fiber per serving.
Choose grains such as white rice or rice pasta less often than foods made with quinoa or buckwheat; these products contain more fiber and protein than products made with white rice
Fruit
2-3 servings per day
½ cup fresh, frozen, or caned fruit
1 medium sized apple, orange, pear
¼ cup dried fruit
½ cup juice (4 ounces)
Choose fresh fruit for snacks
If eating canned fruit, choose fruit in its own juice, instead of in heavy syrup
After a trip to the grocery store, wash and cut up produce so it is ready to eat, and can be grabbed quickly from the refrigerator
Drink fruit juice in moderation – children not consume more than 6 ounces per day
Vegetables
3-5 servings per day
1 cup raw leafy vegetables
1 cup cooked or chopped raw vegetables
¾ cup vegetable juice
Choose dark green leafy vegetables instead of lighter varieties (iceberg)
Cook vegetables for a short amount of time in shallow water (1 inch) in a covered pot to retain nutrients – vegetables should still have a bite to them
Meat, Poultry, Fish, Beans, Eggs, and Nuts
2-3 servings per day
2-3 ounces cooked lean meat, poultry, or fish
½ cup cooked legumes (beans, peas, lentils)
1/3 cup tofu
2 Tbsp peanut butter
1 egg = 1 ounce lean meat
(limit to approximately 2-3/wk)
Choose lean meats more frequently
Trim all visible fat from meats, take the skin off poultry
Limit high fat processed meats such as bacon, sausages, salami, bologna, and cold cuts
Milk, Yogurt, Cheese, and other Dairy Products2-3 servings
1 cup milk (8 ounces)
6 ounces yogurt
1 ½ ounce cheese (Swiss)
½ cup cottage cheese
Choose low fat dairy products
Try white cheese instead of yellow varieties (Swiss is a better choice than cheddar)
If dairy products are not tolerated well, try lactose free milk, or Lactaid tablets when eating dairy
If unable to consume milk or alternative dairy products, calcium should be replaced in the form of supplement such as calcium citrate
Fats, Sweets, and Oils
Use sparingly
1 tsp margarine, butter
1 Tbsp oil
Choose oils such as canola (rapeseed), olive, or safflower instead of palm, and coconut oil
Try light margarines with no trans fat – trans fats tend to increase blood cholesterol, these foods are high in hydrogenated oils
Consume baked products, sweets, candy in moderation
How much can celiacs rely on vitamin supplements to meet their daily vitamin intake needs?
When discussing supplements with any individual, including people with celiac disease, it is always recommended to get adequate nutrition from foods first, and supplement the diet with a multivitamin/mineral supplement. A diet rich in fresh fruits and vegetables, that also includes low fat dairy products and lean protein is what is recommended for all healthy individuals, including people following the gluten-free diet. Please see following for tips on a healthy diet.
Are oats okay?There has been a lot of ongoing investigative work researching the appropriateness of oats on a gluten-free diet. However, in my opinion, and the opinion of Dr. Stefano Guandalini and the University of Chicago Celiac Disease Program, oats are not recommended at this time. There are no safe oats that are mass produced currently.
Cross Contamination
Thompson, Journal American Dietetic Association, 2003
Three brands of oats studied: McCann’s, Country Choice, Quaker
Found varying levels of gluten contamination
Størsrud, European Journal of Clinical Nutrition, 2003
Tested commercially available oat products - Sweden
Found gluten contamination at various levels
Europe and North American Companies
In the process of offering pure, uncontaminated oat products under strict government regulations
Cream Hill Estates from Canada -
http://www.creamhillestates.com/Developed in collaboration with the Canadian Celiac Association, Health Canada and Agriculture Canada
Will be available in Canada and the US
Despite the fact that you may not be experiencing symptoms by eating oats, you may not be maintaining the health of your villi. If you choose to consume oats, or other foods that may have the potential for cross contamination, I would recommend repeating anti-tissue transglutaminase antibodies (tTG) every year, if you are not doing so already.
So many gluten-free foods are made with white rice and sugar...many of the vitamins and minerals we miss out on by not eating wheat…what foods can we eat to make up for that?
The following are excellent nutrient-rich grains/seeds that would be beneficial to include in a gluten-free diet:
Amaranth
Bean flours (garbanzo, fava, pinto, navy, white or black bean)
Brown rice
Buckwheat (make sure it is pure – no wheat flour added)
Flax seed
Montina (Indian rice grass):
http://www.montina.com/Quinoa
Rice bran
Soy
An important point about “missing out on by not eating wheat” is to put wheat products in perspective. A healthy diet includes whole wheat products for their fiber content in addition to the benefits of enrichment (niacin, riboflavin, thiamin, folate). However, many gluten-free grains actually contain more fiber per serving than gluten containing varieties. Making good choices in your grain servings is important; choosing products that include ingredients from the above list will achieve this. Goal fiber intake is approximately 25-35 grams per day. It is important to look at the fiber content per serving of a product and as I stated previously, aim for at least 3 grams per serving. Fiber is also found in fruits and vegetables, which are naturally gluten free, affordable, and easy to find anywhere!
What is gluten rice and is it okay to eat?Gluten rice or glutinous rice is short grain rice that has fat, round grains with higher starch content than other long or medium grain varieties. When cooked, it tends to be very moist, causing the grains to stick together, hence the term gluten or glutinous which means “sticky”. This does not indicate the presence of wheat, rye, or barley, and is safe to consume.
Supplements?
I would recommend a complete multivitamin and mineral supplement for all persons following the gluten-free diet due to the potential vitamin and mineral deficiencies that may exist with healing villi, and from the potential loss due to the change in the diet (restricting wheat). These are the following that I would recommend at this time. However, please note that these supplements were verified at the time of this publication, and I would check to ensure the gluten-free status on your own prior to consumption. When choosing a supplement, it is important to choose one that meets, but does not exceed 100% Daily Value of most vitamins and minerals. We gain a lot of vitamins and minerals from our food supply, even a gluten-free diet, especially if it is rich in fruits and vegetables.
Freeda Vitamins –
http://www.freedavitamins.com/Wyeth Consumer Healthcare –
Centrum Advanced, Centrum Performance, Centrum Silver, Centrum Liquid, Centrum Chewables:
http://www.centrum.com/Caltrate 600, Caltrate 600+D, Caltrate 600+Soy, Caltrate 600 Plus Chewables, Caltrate 600 Plus, Caltrate Colon Health:
http://www.caltrate.com/Nature Made -
http://www.naturemade.com/Mead Johnson Nutritionals –
http://www.meadjohnson.com/Poly-Vi-Flor, Poly-Vi-Sol, Tri-Vi-Sol, Tri-Vi-Flor, Fer-In-Sol
Mission Pharmacal –
http://www.missionpharmacal.com/Citrical, Citracal Caplet+D, Citracal 250+D, Citracal Plus with Magnesium
McNeil Nutritionals
Viactiv Soft Calcium Chews (w/vitamin D and K)
http://www.viactiv.com/Does wheatgrass juice have gluten?Wheatgrass, is the grain from which wheatgrass juice is made, which comes from sprouted wheat berries. Therefore, I would avoid wheatgrass, and wheatgrass juice, because it is gluten containing.
Gluten Free Restaurant Suggestions in Chicago:At the time of this publication, these restaurants were noted to have gluten free options. Please confirm the status prior to your arrival.
Adobo Grill, Chicago, 312-266-7999, GF Menu
Bistro 110, Chicago, 312-266-3118
Da Luciano, River Grove, IL , 708-453-1000, GF Menu
Everest , Chicago, 312-663-8920
Frontera Grill, Chicago, 312-661-1434
The Golden Chef, Wheeling, 847-537-7100
Thyme, Chicago, 312-266-4300
Vinci, Chicago, 312-266-1199
Chain Restaurant’s
Ben Pao,
http://www.benpao.com/, GF Menu
Buca Di Beppo,
http://www.bucadibeppo.com/Legal Sea Foods, Inc,
http://www.legalseafoods.com/, GF Menu
California Pizza Kitchen,
http://www.cpk.com/Carabbas Italian Grill,
http://www.carabbas.com/, GF Menu
Flat Top Grill,
http://www.flattopgrill.com/Fogo De Chao,
http://www.fogodechao.com/Outback Steakhouse,
http://www.outback.com/, GF Menu
PF Chang’s China Bistro,
http://www.pfchangs.com/, GF Menu
Stir Crazy,
http://www.stircrazy.com/Wildfire,
http://www.wildfirerestaurant.com/, GF Menu
IronIron is a mineral found in food that is essential to hemoglobin, which carries oxygen throughout our body. If iron levels are low, symptoms can include fatigue, irritability, or decreased appetite.
Foods rich in iron include:
Amaranth (1 cup) = 14.8 mg Buckwheat flour (1 cup) = 4.9 mg
Pumpkin seeds (1/2 cup) = 10.4 mg Soybeans (1 cup, cooked) = 8.8 mg
Oysters (3.5 oz, canned) = 6.7 mg Spinach (1 cup, cooked) = 6.4 mg
DRI for Iron: 19-50 yr old female = 18mg/d; 19-50yr old male = 8mg/d; 50+ yr =8mg/d; pregnant = 27 mg/
Consuming a vitamin C source (red peppers, citrus fruits) with iron assists in absorption of the mineral
ProteinProtein requirements vary with body size. Adults need approximately 0.8-1.0 g/kg body weight (Kg = weight in lbs/2.2). Protein powders and shakes are a good choice if you find it difficult to get protein from food sources in your diet; however, many times these powders contain too much protein for a healthy adult to receive in one day. Protein in excess can cause kidney damage due to over production and excretion of nitrogen, which is the breakdown product of protein.
Omega 3 Fatty AcidsOmega-3 fatty acids are polyunsaturated fatty acids found in oil from oily fish and vegetable sources such as the seeds of flax, walnuts, lingonberry, among others. Omega-3 fatty acids can also be found in the fruit of the acai palm (hearts of palm). Omega-3 fatty acids are classified as essential because they cannot be synthesized in the body; they must be obtained from food.
Research has not indicated a specific quantity of Omega 3 fatty acids to consume per day, however it is recommended to consume fish in your diet at least 2 x/week. Specific fish high in omega 3 fatty acids are: salmon, herring, mackerel, and sardines.
Marathon Training!For any of you who are training for the marathon, good luck! I am also training for this year’s Chicago Marathon and am looking forward to the big day, October 22!
Training diets are important to provide adequate fuel for training, to optimize recovery of glycogen stores, and to maintain fluid and electrolyte balance. In terms of celiac disease, there are no specific recommendations in particular to the disease state, as long as you are in remission. If not, your body is not only trying to repair your damaged villi, but also working overdrive to recover from muscle glycogen depletion from exercise.
Carbohydrates, protein, fat, and fluids are all important for the athlete. Basic recovery nutrition for endurance athletes and team sports:
Replenish carbohydrates within 30 minutes of exercise
General goal is 1.5 g CHO/kg
Can add up to 10 g protein
Rehydrate with fluid and sodium (sports drinks)
Please consult your medical provider prior to competition to ensure you do not have any outstanding medical issues.
Lara Field, MS, RD, LDN – Pediatric Dietitian
Children's Memorial Hospital - Department of Clinical Nutrition
2300 Children's Plaza, Box 23
Chicago, Illinois 60614
Phone: 773-975-8841
lfield@childrensmemorial.org
THANK YOU, LARA, FOR YOUR ANSWERS TO OUR QUESTIONS!
Email Lara or call her with additional questions or for more information on the answers she provided.
