THE SPRUE-NIK PRESS

       Published by the Tri-County Celiac Sprue Support Group,
       a chapter of CSA/USA, Inc. serving southeastern Michigan

Volume 5, Number 7                                        October 1996
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          ..................................................
          : What's Inside                       Search For :
          : -------------                       ---------- :
          : Miscellaneous Notes  . . . . . . . . .  -1-    :
          : The New Shopping Guide . . . . . . . .  -2-    :
          : Assessment and Care of Celiacs . . . .  -3-    :
          : Newsletter Roundup . . . . . . . . . .  -4-    :
          : Recipe Page  . . . . . . . . . . . . .  -5-    :
          :................................................:

References Disclaimer
Miscellaneous Notes: ---------1---------- From the "prez" and "vp": Thanks to a remarkable group of board members, we had an educational and enjoyable year in '95-'96. We hope 1997 will be an even better year for all our members. We now have three diabetic celiacs so we hope to be able to also fill their needs. We are also going to try to focus on the young children in our group.--Diane Morof & Mary Guerriero. -=-=-=-=- The Gluten-Free Gang's 8th Annual Conference is coming up fast. It is on Saturday, November 16th, from 8:50 am until 2:30 pm. It is at the Children's Hospital in Columbus, Ohio. The cost is $15 for adults. Youth ages 14 and under are free. The fee covers educational materials, refreshment breaks, and luncheon beverages. Speakers include: -- Jax Peters Lowell, author of Against the Grain, is the special guest speaker -- Dr. B U.K. Li, pediatric gastroenterologist, will do an update on current research -- Steven Plogsted, pharmacist, will do an update on medications -- Mary K. Sharrett, dietitian, will do an update on diet -- Jasminka Ilich, PhD, will discuss osteoporosis and CD -- Dr. Carmen Julius will speak on HLA and autoimmune disease -- Ann Wallace, PhD, will discuss living with CD as a family There will be two separate youth sessions: -- Ages 7-14 will join the adults for Jax Peters Lowell's talk, and then take a field trip to the Center of Science and Industry. -- Ages 4-6 will attend a variety of educational and fun activities. There will be a family potluck dinner for all attendees from 1-2:30 pm. Bring a dish to share that serves eight or more. There will be a large exhibit area which will include many GF vendors selling their products and handing out information. Also, Jax Peters Lowell will be signing her book (which can be preordered with conference registration.) For more information, call Mary Kay Sharrett at (614) 722-4949 or click here to send her e-mail. Or, you can send in your registration by including a check made out to Children's Hospital. Include the following information: -- Name of each person attending -- Indicate for each person whether an adult or child. Include the age for children -- Any additional medical needs for each person -- The recipe for the GF dish you intend to bring and share at the potluck lunch. Mail your registration and check to: Community Education, Children's Hospital, 700 Children's Drive, Columbus, OH 43205-2696. -=-=-=-=- Help for Lactose-Intolerant Shoppers: "Lactose-Free Foods: A Shopper's Guide" is a booklet that lists more than 1,000 lactose-free national brand products. To get a copy, send $8.45 to Bullseye Information Services, 200 Linden St., Dept. G18, Wellesley, MA 02181.[1]
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The New Shopping Guide -----------2---------- All USA members of TCCSSG should be receiving a copy of our newly updated shopping guide along with this newsletter. It is similar in format to last year's guide. It contains no information dated prior to March 1995, and much of it was gathered within the last four months. Non-members (in the USA) can obtain a copy by mailing a $10 check, payable to TCCSSG, to: Marcia Campbell, TCCSSG Shopping Guide, 34638 Beechwood, Farmington Hills, MI 48335. Often we are asked about brands that don't appear in the shopping guide. Are these brands not GF? The answer is, we don't know. You'll notice the shopping guide does contain a section with specific brands that are not GF, according to the manufacturers. If a brand does not appear in that list, nor in the list of products that are GF, it means either: 1) the company failed to respond to our inquiries (half of them don't), 2) we didn't write to them or the address was bad, or 3) the company responded to our inquiry, but was unable to give us a list of GF products. Note that the focus of the shopping guide is products which can be purchased in grocery and health food stores. We do not include products which are strictly sold via mail-order. A list of mail-order GF vendors is included in each new member packet that we give out; you can contact these companies to get their current catalogues and price lists. Here are some other common questions we get about the shopping guide: Q: Why is there no information from Kraft or General Mills? A: Kraft will not provide a list of GF products in writing. Some people have had success in calling them regarding the GF status of a specific product, but that is as far as they will go. General Mills does not consider any of their products to be GF, due to cross-contamination problems. They are listed in the section under "Companies with No GF Products". Q: If a product is in last year's guide, but isn't in this year's, does that mean we should not use it anymore? A: Not necessarily. It could be that the manufacturer didn't answer our letter this year. If the information was dated prior to March 1995, we would have discarded it. Or the manufacturer might have decided not to provide GF information for publication. In that case, you may wish to contact the manufacturer or look at the ingredients and judge for yourself if the product is safe; or you may wish to play it safe and avoid the product. Q: Should we throw last year's shopping guide away? A: Absolutely. It is old information, and there are products that have been intentionally removed from this year's guide because they are no longer GF.
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Initial Assessment and Follow-up Care of Celiac Patients ----------------------------3--------------------------- by Peter Green, MD summarized by Sue Goldstein Dr. Peter Green is a gastroenterologist and the director of the GI Endoscopy Unit at Columbia-Presbyterian Medical Center in New York City. He has a large celiac patient base. On September 29th, Dr. Green spoke to the Westchester Celiac Sprue Support Group and presented an excellent review of the medical care an adult Celiac patient should receive. What follows is a summary of Dr. Green's presentation, compiled by Sue Goldstein, a past president of the Westchester group. (This has been reprinted with Sue Goldstein's and Dr. Green's permission.) Initial Assessment ------------------ Dr. Green sees a lot of patients who, either through their own frustration or because of physician advice, have started a gluten-free (GF) diet without obtaining a biopsy-proven diagnosis of celiac disease (CD). However, the need for a biopsy to establish a diagnosis of CD must be emphasized. CD is a lifelong illness with serious potential implications. In addition, sensitivity to gluten doesnt go away, and a radical lifestyle change is involved. You also need to be certain of the diagnosis because celiac patients families should be screened. The initial biopsy is also needed to serve as a baseline because one doesnt know what the future may involve. Basic blood work is also included in the initial assessment. Such things as anemia and liver function need to be looked for. But its very important to go further than that, and knowledge of the physiology of the small intestine should lead a physician to measure those nutrients that could be malabsorbed. CD involves the small intestine, where iron, folic acid, calcium, fat soluble vitamins (K, A, D, and E) and zinc are absorbed. These nutrients should be measured in the initial assessment and also during the course of the illness. Physicians will see patients who present with malabsorption of just one of these nutrients. If they are aware of the consequences of all these nutrient deficiencies, it will help them consider CD as a possible diagnosis. The patient should also have the celiac antibodies blood testing, but the diagnosis is still established on the biopsy pathology. In Dr. Greens experience, about 30% of celiacs have negative antibodies at diagnosis, so positive antibodies are not required to make the diagnosis. Antibodies testing often helps establish the need for a biopsy, but they also have great value in establishing a baseline so that an assessment can be made on how the patient is doing later on. All the antibodies should normalize, in time, when gluten is eliminated from the diet. What about the patient who seeks a diagnosis, but has already eliminated gluten from the diet? It is very difficult for many patients to go back on a gluten-containing diet to secure a biopsy-proven diagnosis. This can often take three to six months or longer. Columbia-Presbyterian has been talking about setting up alternative means of securing a diagnosis, such as a rectal challenge. The physician can take a biopsy of rectal tissue, and then instill gliadin extract into the rectum and do a repeat biopsy a certain number of hours afterward to demonstrate an inflammatory response similar to that in the small bowel. However, interpreting the results of the gluten challenge would require a pathologist who is very experienced, and sophisticated immunology on the cells of the rectal biopsy may be needed. Follow-up Care -------------- Soon after diagnosis and adhering to a GF diet, patients will often report an increased feeling of well-being. How well they feel--and how quickly--will also depend on what the manifestations of their disease were. For example, if the patient was iron-deficient, it will take time for the iron stores to be repleted. An assessment of vitamin and mineral levels should be part of the follow-up care. Specific deficiencies need to be addressed, treated, and monitored. Patients have been seen who have been ingesting too much of the fat-soluble vitamins, with resulting problems such as liver disease (from vitamin A toxicity), and hypercalcemia (from vitamin D toxicity) which can cause confusion, constipation, and kidney problems. Certain vitamins and minerals may need to be administered, but the patient should be under a physicians guidance as to how much should be taken. After a diagnosis of CD, a bone mineral density test should be performed to assess the condition of the bones. Reports have shown that between 50-100% of people at initial diagnosis of CD will have osteopenia or osteoporosis. Ostopenia is thinner bones, usually less than 2 standard deviations from normal. Osteoporosis involves an even greater deviation from normal.. In Dr. Greens experience, nearly 100% of the celiac patients at diagnosis will have osteoporosis. Surveys of celiac patients have shown an increased incidence of fractures prior to diagnosis and after diagnosis. If the bone mineral density is low, the patient should be referred to a bone mineral expert for assessment and specific individual treatment. For example, calcium and vitamin D needs will be addressed and monitored, and exercise and hormone replacement (in post-menopausal women) will be considered. At diagnosis, patients should get a Pneumovax, because it is very common for celiacs to have poor splenic function, which puts them at risk of developing certain bacterial infections such as pneumoccal pneumonia and meningitis. Since there is a genetic predisposition to CD, another important issue in the follow-up is screening family members for CD. Children and other first-degree relatives should have their antibodies status measured. About 10-15% of first-degree relatives have positive antibodies, and the bulk of the people with positive antibodies will have the disease, even though 50% of those people will be asymptomatic, even with a flat biopsy. What annual follow-up care should the celiac patient be getting? The most important thing is a good physical examination. Blood work, x-rays, CAT scans, mammograms and PSA tests, while valuable, do not replace a physical examination. The physical exam should include a breast exam for women, prostate exam for men, and a rectal exam for everyone. Blood work should include measurements of folic acid, calcium, and iron, and antibodies testing. Bone mineral density testing should be repeated annually for those with abnormal results, and every several years for those with normal results. Finally, patients with CD should have at least one follow-up biopsy to confirm response--normalization of the biopsy sample. Patients who are non-responders, or whose clinical situation is somewhat confusing, may need more repeated biopsies at intervals. Non-responders -------------- What about the non-responders or people who relapse? The first thing is to check the diet with antibodies testing. People may be ingesting gluten, such as in medications, and not be aware of it. They may be getting gluten from licking stamps or envelopes. They may have misinformation from food labels or manufacturers. However, the antibodies can normalize and the biopsy still look quite flat, so once again, the antibodies have only a limited value--but they are still important to measure. It is also important to check the original biopsy to make sure of the diagnosis. Not all pathologists are experienced enough to properly diagnose CD. Pathology departments, by law, have to keep the biopsies for a lengthy period of time--some keep them for 50 years. So it is important for the physician to review the biopsy sample with a pathologist who understands the spectrum of CD. The pathologist needs to know, for example, how to identify latent CD and different subtle aspects of the biopsy, such as increased intraepithelial lymphocytes. A problem that comes up in non-responders is other food sensitivities. Its very rare for people with CD to also have sensitivities to other foods that result in the abnormal biopsy. There are, however, reports of ingestion of soy protein or egg or some kind of meats that cause the biopsy not to normalize. There are other conditions that can co-exist with CD and confuse physicians. For example, pancreatic insufficiency can cause diarrhea and steatorrhea (malabsorption of fat), and bacterial overgrowth can affect absorption of nutrients. Patients may have colonic pathology. Having one disease doesnt mean you cant have another disease, and other conditions need to be investigated in the CD patient who isnt doing well. When there is no improvement in the biopsies, patients remain at the risk of developing or maintaining bone disease and vitamin deficiencies, and they are at a higher risk for malignancy. Patients who are refractory may need other therapies such as corticosteroids or immunosuppressent drugs such as cyclosporin. One doesnt engage in these therapies lightly (for example, steroids will thin the bones); being closely evaluated while on these drugs is important. Prognosis for the Celiac Patient -------------------------------- The studies that have indicated increased mortality in CD are from other countries where people have different smoking and dietary habits. It is hard to extrapolate these studies to our patient population. Dr. Green believes existing studies indicate that the mortality rate among adult celiacs is about two to three times that of the general population, and the increased mortality is found mainly in the first five years after diagnosis. After that, the mortality rate approaches that of the normal population. That tends to suggest that it is the continued ingestion of gluten that is responsible for the increased mortality. This is especially so in regard to malignancies, where the risk of diagnosis of malignancy such as lymphoma is usually highest in the first year after diagnosis, and then decreases in incidence downward until it equals that of the normal population after about five years. There is certainly the suggestion that adhering to a GF diet reduces the risk of developing a malignancy. A Final Word--Looking For Celiac Disease ---------------------------------------- Traditionally, the incidence of CD in this country, based upon epidemiological work, suggests that CD occurs in about 1 in 4,600 people. Certainly its much more common than that. Serology testing of blood donors by Dr. Fasano suggests the same prevalence as in European countries, about 1 in 300 people. Dr. Green, who does a lot of endoscopies, has found an incidence of CD in about 1 in 280 patients who were having endoscopies for reasons other than suspicion of CD. It is important, therefore, for the gastroenterologist to have a higher suspicion for the possibility of CD, and for physicians to screen for CD, particularly among their patients who have associated diseases such as Insulin Dependent Diabetes, Sjogrens, and Autoimmune Thyroid Disease.
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Newsletter Roundup ---------4-------- Compiled by Jim Lyles We exchange newsletters with several other celiac groups. In this article I will summarize some of what we've learned from our newsletter swapping. ......................................... : : : Excerpts from _Celiac Update_ : : ----------------------------- : : Fall 1996 Janet Thomas, editor : : CCA Fredericton Chapter : : 100 Epworth Circle : : Fredericton, NB E3A 2M6 : :.......................................: Guilt: I began to wonder about guilt and our celiac kids after an incident my family experienced on our summer vacation. We were spending the day on Prince Edward Island (PEI) and had packed our barbecue and food suitable for picnic meals. We discovered that PEI doesn't really have a network of picnic areas located in scenic spots. So there we were, with food but nowhere to prepare and eat it for our two hungry boys. We drove 25 miles or so back to Charlottetown and ate at Wendy's. What does this have to do with guilt? Well, on the way to Charlottetown my husband and I discussed the fact that for most families this wouldn't be a problem; they'd just pull into one of the hundreds of seafood joints to eat. For us however, meals out are difficult since it is hard to find GF food than an eight-year-old will eat. Both of us were selfishly moaning at the necessity of forgoing really fresh and delicious seafood. That's when I realized that our eight-year-old might be thinking that all the difficulties over meals were somehow his fault, for being a celiac. I began to wonder how many other times I had thoughtlessly commented on how much work it is to keep him in GF food, how much extra baking I have to do, or how difficult it is to eat out or send him to a special event. Now all of these things are a fact of life with celiac kids, but we certainly didn't intend to lay blame on our son. We were just talking. I haven't had the nerve to ask Michael how he feels about us just talking. But this I do know: Celiac kids have enough to deal with these days without parent-induced guilt so I for one am going to watch my words from now on! -=-=-=-=- Two GF Cookbooks, _Gluten-Free Anytime_ and _Gluten-Free Anytime Special_, are written jointly by Joyce Friesan and Donna Wall. _Gluten-Free Anytime_ is a must for those who wish to eat "normal" foods. Joyce and Donna have included recipes for such basics as muffins, banana bread, tea biscuits, soda crackers, pancakes, waffles, chocolate chip cookies, apple crisp, and many more. Their second book has "special" recipes such as sausage rolls, fortune cookies, fruitcake, Christmas mints, and chocolate patties. There is a whole section of heavenly recipes for chocolate lovers. For more information write to Gluten-Free Anytime, 3429-136 Avenue, Edmonton, AB T5A 2W5, CANADA. ............................................. : : : Excerpts from _CDF Newsletter_ : : ------------------------------ : : Summer 1996 Elaine Monarch, publisher : : Celiac Disease Foundation : : 13251 Ventura Blvd., Suite 3 : : Studio City, CA 91604-1838 : :...........................................: Have You Had Your Gluten Today? President Jill Morey Gaines spoke of a recent conversation with a long-time celiac. He had decided that one cannot live by rice cakes alone, what harm does a little bread, an occasional bowl of pasta, or a bagel have in the long run? When Jill asked how he felt, he said "lousy" as usual; don't all celiacs feel lousy living without gluten? Jill then warned him about all the long-term medical risks to not being GF. She bombarded him with a list of diseases that were infinitely worse that CD. She was delighted to find out later that she had made a difference with him. He had decided to try a strict GF diet and felt like a new man several weeks later. He had not realized just how bad he had been feeling. His whole outlook on life has changed. He is now leading an extremely active life and counts his blessings instead of his misfortunes. How about you? -=-=-=-=- Digestive Disease Week is the premier meeting for GI's and related specialists. It was held in San Francisco in May, and had a record attendance of 12,130. CDF had a booth in the exhibit hall where they passed out info and answered questions throughout the meeting. CDF also sponsored a session on Celiac Disease, which 400 people (mostly physicians) attended. Presenters included Dr. Martin Kagnoff, researcher at UCSD; Dr. Paul Ciclitira of England, and Dr. Michael Marsh (also of England), author of Coeliac Disease (Blackwell Publishers, 1992). -=-=-=-=- The Starch in Advil: David Kao, a medical affairs specialist at Whitehall-Robbins, reports to CDF: "After extensive research....we have been able to verify that the starches incorporated into Advil are not derived from wheat rye, oats, or barley, and that only National Formulary standard corn starches are utilized." ............................................ : : : Excerpts from _Celiac Connections_ : : ---------------------------------- : : Sept. 1996 Katie Marschilok, editor : : 4 Fairlawn Lane : : Troy, NY 12180 : :..........................................: Educating Diabetes Educators: The 1996 annual meeting of the American Association of Diabetes Educators (AADE) took place in August, with some 3,000 diabetes educators in attendance. One of the presentations at this four-day meeting was done by CDCSG. It was entitled, "Why Should Diabetes Educators Be Thinking, 'Celiac Disease'". The session gave a basic overview of the definition, symptoms, and diagnosis of CD, followed by an overview of the basic principles of the GF diet. It was well-received and many asked that it be repeated next year, along with a new session on diet instruction. The CDCSG representatives also attended a three-hour workshop entitled, "Solving the Puzzle of Gastroenterological Complications of Diabetes". There they informed all the attendees that diabetes patients with GI complaints should be screened for CD before resorting to treatment with medication. Fortunately the panel experts agreed with them, but it was disturbing that this had to be brought up from the floor instead of being a scheduled part of the workshop. [CDCSG is clearly taking seriously the task of educating the professionals to increase celiac awareness--ed.] ............................................................... : : : Excerpts from the Gluten Intolerance Group of North America : : ----------------------------------------------------------- : : newsletter: Sept. 1996 Cynthia Kupper, editor : : PO Box 23053 : : Seattle, WA 98102-0353 : :.............................................................: Digestive Disease Week Highlights: Jill Ryan summarized some of the highlights from celiac-related research presented during Digestive Disease Week conference. This conference was held in San Francisco in May: * CD may be more prevalent in the US than was previously thought. One study suggested the incidence to be as high as 1:250.[2] * A study shows CD to be associated with a high prevalence of chromosome instability. This could be related to the well-known increased prevalence of malignancies in celiacs.[3] * Sucrose levels in the blood may form the basis of a new screening test for CD.[4] ....................................................... : : : Excerpts from the Midlands Chapter 13 Support Group : : --------------------------------------------------- : : newsletter: Oct. 1996 Sandra K. Allen, editor : : Route 1 Box 707 : : Fort Calhoun, NE 68023 : :.....................................................: _The Gut Reaction_ is a newsletter that accompanies all orders shipped from the Gluten-Free Pantry. Or you can subscribe to this quarterly publication for $6 per year or $1.50 per issue. For more information, write to Gluten-Free Pantry, PO Box 840, Glastonbury, CT 06033 or call (800) 291-8386. -=-=-=-=- Bread Machine Tips: These tips come from "The Bread Doctor", a flyer from the Gluten-Free Pantry: * The dough is of the proper consistency if it produces definite lines on top as it kneads. * Too much liquid produces a floppy, gummy loaf with large holes and a flat or sunken top. * Too little liquid produces a lumpy, crumbly loaf. * Don't use the automatic cool-down cycle; cool the bread on a wire rack to prevent it from becoming gummy. * Use butter and milk instead of oil and water to add moisture and create a chewy crust. ...................................................... : : : Excerpts from the Washington Area CS Support Group : : -------------------------------------------------- : : newsletter: Sept. 1996 Becky Campbell, editor : : 1332 R Street, NW : : Washington, DC 20009 : :....................................................: _The All Natural Allergy Cookbook_, by Jeanne Marie Martin is now available in paperback from Harbour Publishing, Madeira Park, British Columbia, Canada. All recipes in this cookbook are wheat-free and dairy-free, and most are yeast-free and GF as well.
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References ---------- [1] "Health Update", _Better Homes and Gardens_, Sept. 1996, pg. 64. [2] "Endomysium Antibodies in Blood Donors Predicts a High Prevalence of Celiac Disease in the USA", T. Not, et al. 1996 Digestive Disease Week conference, abstract #4018. [3] "The Increased Chromosome Fragility in Lymphocytes of Celiac Disease Patients Could be Related to the High Prevalence of Lymphoma", A. Fundia, et al. 1996 Digestive Disease Week conference, abstract #4572. [4] "Serum Sucrose: A New Screening Test for Celiac Disease", M. A. Cox, et al. 1996 Digestive Disease Week conference, abstract #4020.
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Recipe Page -----5----- ********************************************************************** Sugar & Spice Madeleines 1/4 tsp. salt 1/2 tsp. nutmeg 2 eggs 1/4 tsp. cloves 1/2 cup sugar 1/4 cup margarine, melted 2/3 cup GF flour mix** 1 tsp. vanilla 1 tsp. cinnamon 3/4 tsp. baking powder Combine the salt and eggs in a medium bowl, and beat with a mixer at high speed until foamy. Gradually add in the sugar, beating constantly until the mixture is thick and pale (about 5 minutes). Mix the flour and spices in a bowl and stir well. Gradually fold the flour mixture into the egg mixture. Gradually fold in the margarine and vanilla. Coat a madeleine pan with GF cooking spray. Spoon about 1 Tbsp. of the mixture into each madeleine form. (Instead of a madeleine pan you may use a muffin pan, mini muffin pan, muffin top pan, etc. filled not quite half full. The batter simply needs something to hold its shape.) Bake at 400 degrees F for 8 minutes or until lightly browned. Remove the madeleines from the pan using the tip of a knife. Let them cool completely on a wire rack. Sprinkle with powdered sugar. Makes about 2 dozen. This recipe comes to us from Joan Kulka. Note: For the rice flour in the GF flour mix, Joan uses equal portions of sweet rice flour (like Mochiko) and oriental rice flour. ********************************************************************** Gingerbread Cookies 1-3/4 cups GF flour mix** 1/2 to 3/4 tsp. ginger 1/2 tsp. cream of tartar 1/8 tsp. salt 1/2 tsp. baking soda 1/2 cup butter or margarine (cold) 1-1/2 tsp. xanthan gum 1/2 cup brown sugar 1/8 tsp. cloves 1 egg (cold) 1/4 to 3/8 tsp. cinnamon 1/2 tsp. GF molasses Combine the rice flour, cream of tartar, baking soda, xanthan gum, cloves, cinnamon, ginger, and salt. Mix well. Cut in the butter or margarine until the mixture is in crumbs the size of peas. In a small bowl beat the sugar, egg, and molasses together. Add this mixture to the dry ingredients and mix until the dough pulls away from the sides. Form the dough into a flat ball shape and refrigerate for one hour. Dust some freezer paper (not wax paper) with GF flour or confectioners sugar. Put the dough on the freezer paper and sprinkle with flour or confectioner's sugar. Roll the dough to 1/4 inch thick and cut out shapes as desired. Bake at 350 degrees F for 12 minutes. Cool on a wire rack. Makes about 20 cookies. This recipe comes from Vicki Lyles. She adapted it (in desperation) from the Rolled Sugar Cookies recipe (see below), when she learned that our 5-year-old celiac's kindergarten class was going to be making gingerbread man cookies. The resulting cookies were quite good. ********************************************************************** Rolled Sugar Cookies 1-1/2 cups white rice flour 1/2 cup butter or margarine (cold) 1/2 tsp. cream of tartar 1/2 cup sugar 1/2 tsp. baking soda 1 egg (cold) 1-1/2 tsp. xanthan gum 1/2 tsp. GF vanilla, lemon, or 1/8 tsp. salt almond flavoring Combine the rice flour, cream of tartar, baking soda, xanthan gum and salt. Mix well. Cut in the butter or margarine until the mixture is in crumbs the size of peas. In a small bowl beat the sugar, egg, and vanilla (or other flavoring) together. Add this mixture to the dry ingredients and mix until the dough pulls away from the sides. Form the dough into a flat ball shape and refrigerate for one hour. Dust some freezer paper (not wax paper) with GF flour or confectioners sugar. Put the dough on the freezer paper and sprinkle with flour or confectioner's sugar. Roll the dough to 1/4 inch thick and cut out shapes as desired. Bake at 350 degrees F for 12 minutes. Cool on a wire rack. Makes about 20 cookies. This recipe originally came from Mary Schluckebier, in the Fall 1994 issue of _Lifeline_, on page 15. These cookies were the ones the children decorated at the Christmas party last year. ********************************************************************** ** GF flour mix: 6 cups white rice flour 2 cups potato starch (NOT the same as potato flour) 1 cup tapioca starch (also called tapioca flour) ********************************************************************** Tri-County Celiac Sprue Support Group Officials: ------------------------------------------------ Physician Advisor: Thomas Alexander, M.D. Dietitian Advisor: Dorothy Vaughan, R.D. President: Diane Morof Vice President: Mary Guerriero Past President: Jim Lyles Secretary: Denise Parsons Newsletter Editor: Jim Lyles Disclaimer: ----------- All recommendations, information, dietary suggestions, menus, shopping guide suggestions, medical updates, miscellaneous articles, and recipes in this newsletter are intended for the benefit of our members, readers, and the general public. No liability is assumed by the Tri-County Celiac Sprue Support Group or any of its members. Information in _The Sprue-nik Press_ has been approved by our physician and dietitian advisors. Individuals should consult with their physicians and dietitians before following any medical or dietary recommendations in _The Sprue-nik Press_. Original material used in _The Sprue-nik Press_ is placed in the public domain for the benefit of all celiacs. The information is not copyrighted to facilitate the easy exchange of celiac information. Feel free to reproduce any portion of this newsletter, unless it specifically states otherwise. All we ask is that you indicate where the information came from. _The Sprue-nik Press_ is published by the Tri-County Celiac Sprue Support Group (TCCSSG), a local chapter of CSA/USA located in southeast Michigan. Members receive this newsletter, a shopping guide, and a new member packet full of articles and useful information. Mail-in subscriptions are welcome. For subscription information, send a note to Jim Lyles.
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