“There is nothing wrong with you. It’s all in your head.”
“All your basic test results are normal. It must be just stress related.”
These are some of the responses that members of the Celiac Disease Support Group at WakeMed Cary Hospital heard from friends, family and even physicians.
I help run the group, whose members suffer from a variety of symptoms and often struggle to get a correct diagnosis. One member told me: “I went through my life not knowing what was wrong, because I got different results from different medical facilities and doctors.”
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Even when a diagnosis is made, patients may not receive enough information. One member said she was told to go on the Internet and find out things on her own.
Family and friends can fall short of being supportive and understanding; holidays can be particularly stressful. Members recall hearing such comments as, “Oh, she’s coming! What am I going to feed her?” and “Just have a small bite. It’s not going to hurt you!”
What is celiac disease?
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein found in wheat, rye and barley. When the body does not absorb nutrients properly, a person becomes malnourished, no matter how much food one eats.
One in 100 people worldwide have celiac disease and many more have gluten sensitivity. It is estimated that about 2.5 million people are undiagnosed. Symptoms may include abdominal pain, bloating, diarrhea, constipation, unexplained weight loss or weight gain, anemia and depression.
Celiac disease is an autoimmune disorder. If left untreated, it can lead to vitamin and mineral deficiencies, osteoporosis, infertility and miscarriage, epilepsy and migraines, growth issues and intestinal cancers. Celiac is also hereditary; if someone in your immediate family has it, you are more likely to have it.
Facts about gluten-free labeling
There is no treatment other than strictly following a gluten-free diet. It becomes imperative for those diagnosed with celiac to be able to identify gluten-free foods.
In 2013, the Food and Drug Administration announced its long-awaited gluten-free food labeling rule. To be labeled gluten-free, a product must contain less than 20 parts per million of gluten. All FDA regulated foods, drinks, and dietary supplements are subject to the rule. Foods not covered are meat, poultry, unshelled eggs, imported products, distilled spirits, wine and malted beverages. No symbol has been approved by the FDA to identify food that meet its gluten-free standard. Restaurants are encouraged to label foods but there is no requirement.
Since there are a wide variety of foods that are not covered, it becomes important to learn how to read ingredient labels and avoid cross contamination.
Eating a healthy diet
The fundamentals for healthy eating apply even for a gluten-free diet. A gluten-free cookie is still a cookie. Eating a balanced diet to get all nutrients is important for long-term health.
▪ Eat foods that are naturally gluten-free. Eat a variety of protein from lean meats, beans, lentils, nuts and nut butters. Focus on colorful vegetables and fruits.
▪ Try gluten-free whole grains, such as millet, quinoa and brown rice.
▪ Limit packaged and processed foods.
▪ Limit eating out. If you dine at a restaurant, make sure the the food is prepared in a gluten-free area of the kitchen.
Parul Kharod is a clinical dietitian and is the facilitator of the Celiac Disease Support Group at WakeMed Cary Hospital. Reach her at firstname.lastname@example.org
Gluten-free Resources in the Triangle
Here is a list of some local businesses that cater to those adhering to a gluten-free diet.
Restaurants: Lugano Ristorante in Cary, Uncle Maddio’s Pizza Joint in Cary, Bella Monica in Raleigh, Zoes Kitchen in Raleigh and Morrisville, zpizza in Cary and Raleigh, and Primal Food & Spirits in Durham.
Bakeries: Sugar Buzz Bakery in Cary sells gluten-free cupcakes, and cakes by special order; Sugarland in Raleigh and Chapel Hill sells gluten-free cupcakes and can do special orders; and DaisyCakes in Durham sells gluten-free cupcakes.
Local products: Raleigh’s Five Points Baking Co. sells gluten-free cookies and snacks, (fivepointsbakingco.com); Our House Deliciously Gluten Free, a division of House-Autry Mills in Four Oaks, sells gluten-free baking, pancake and waffle mixes (OurHouseGF.com); Morrisville-based Good Rub sells organic gluten-free spice rubs and seasoning blends (good-rub.com); and Cary-based Jim’s Own Sauce sells gluten-free barbecue sauces, (jimsownsauce.com).
Celiac Disease Support Groups: WakeMed Cary Hospital Celiac Disease Support Group, 919-350-2351; The Raleigh Celiac Support Group meets every other month at Rex Hospital. The next meeting is 7 p.m. July 16. Info: www.raleighceliac.org. For more, go to glutenfreeinnc.com.
Parul Kharod and Andrea Weigl
Chickpea Flour Crepes with Mango Relish
Bob’s Red Mill chickpea flour is sold at Whole Foods stores and some Harris Teeters. All real cheese is gluten-free but avoid processed cheese products or ones with seasonings; avoid ones containing malt, dextrin, starch and modified food starch. Adapted from a recipe shared by Parul Kharod.
1 mango, peeled and diced
1 medium red onion, peeled and finely diced
1/2 teaspoon ground cumin
3/4 teaspoon salt, divided
1/2 teaspoon cayenne pepper or paprika, divided
1 cup chickpea flour
3/4 to 1 cup water
1/4 cup chopped cilantro
1/2 teaspoon vegetable or corn oil, plus more for frying
1 cup grated cheddar cheese, optional if making crepes
Make mango relish: combine mango, onion, cumin, 1/4 teaspoon salt and 1/4 teaspoon cayenne pepper in a medium bowl. Let sit for 1 hour.
Combine chickpea flour, 1/2 teaspoon salt and 1/4 teaspoon cayenne pepper in a medium bowl. If you want a thicker pancake, add 3/4 cup. If you want a thin crepe you can fold, add 1 cup water. Add cilantro and oil. Let batter rest for 15 minutes.
Preheat a non-stick skillet or cast iron skillet over medium-high heat.
Make pancakes: add 1/2 teaspoon oil or more to the hot skillet. Add 2 tablespoons batter for each pancake. When bubbles appear in the center of each pancake, flip over. When cooked through and brown on both sides, place on a plate and cover with foil to keep warm. (You can also keep them warm by placing them in an oven-proof dish in a 200 degree oven until ready to serve.)
Make crepes: pour 1/4 cup batter into the pan. Pour 1/2 teaspoon oil around the edges. Cover and cook for 1 minute until bubbles appear in the center. Flip pancake over, and sprinkle one half side with about 2 tablespoons cheese. Fold over the other half of the pancake over the cheese (like making a cheese quesadilla). Cook for a minute until the cheese melts. Flip again if needed to crisp the outside.
Serve hot with relish on the side.
Yield: 4-6 servings.