THE SPRUE-NIK PRESS
Published by the Tri-County Celiac Sprue Support Group,
a chapter of CSA/USA, Inc. serving southeastern Michigan
Volume 8, Number 10 December 1999
**********************************************************************
...........................................
: What's Inside :
: ------------- :
: Miscellaneous Notes :
: Gluten-Free Product Evaluations :
: Michigan Celiac Awareness Day :
: Travel to Germany and Austria :
: 1999 CSA Conference Report :
: Reflections from a Newcomer :
: Update on Current Diagnostic Dilemmas:
: Safety Issues in the Human Food Chain:
: Role of the Small Bowel Biopsy in CD :
: Celiac Disease and Psychiatry :
: Inflammatory Bowel Disease :
: One Loaf, Many Breads :
: Take Guesswork Out of Making Breads :
: Stress: Use the Mind/Body Connection :
: Substitution Solutions :
: Nutritional Concerns in the GF Diet :
:.........................................:
References
Disclaimer
Miscellaneous Notes:
--------------------
President's Corner: I want to take this opportunity to wish each and
every one of you the best of the Holiday Season. Please have a
healthy, gluten-free holiday. Again, take the extra time to check
with your family members to ensure that what you are eating is
gluten-free. Be sure to NOT eat the filling of a pie with gluten
crust, or any turkey that has been stuffed with gluten bread stuffing.
There were 13 of us that attended the Celiac Awareness day in Lansing,
and I can only encourage each of you to try to attend next year. It
will again be in October, and if we know ahead of time, possibly we
can get some information out to our libraries, newspapers, etc. The
more people that are aware of Celiac Disease, the better our lives
will be.
Five of us attended the Columbus conference and it was wonderful as
usual. It's great fun meeting old friends and also making new ones.
We had the chance to meet Ann Whelan and really enjoyed that also.
She is very upbeat and a great asset to the Celiac community.
I strongly urge you to attend a conference next year. We have great
opportunities emerging. Happy Holidays to all of you.--Mary Guerriero
Return to the Table of Contents
Gluten-Free Product Evaluations
-------------------------------
At our May 1999 meeting we passed out bags to each attendee containing
gluten-free (GF) products. The items were free, but there was one
catch: Over the course of the summer you were expected to fill out an
evaluation sheet and rate each product you sampled.
We now have the results tabulated from those evaluations. Some
products were plentiful, appearing in many of the bags. Other
products were scattered about rather thinly, so that only a handful of
bags received them. So you need to keep in mind that the more votes
an item received, the more reliable the rating. Accordingly, I'm
presenting the results in three groups: Items which received at least
5 votes, items which received 2-4 votes, and items which received only
1 vote. Within each group I've listed the items rated best first.
The scale went from 1 (Superb) to 5 (Wretched). (Actually we used the
words "Like" and "Dislike" on the evaluation forms, but we editors
like to embellish things a bit.)
The majority of the items were given good ratings; only a handful came
in at 3.0 or worse. This suggests that the "state of the GF market"
has improved dramatically over the last few years. Five years ago
there would have been far fewer products included in your sacks, and
I'm sure the average ratings would have been much lower. So let's
give a collective "Hip, hip, hooray" to all of today's GF vendors, and
here's hoping they keep up the good work!
Items With 5 or More Votes # Votes Avg. Rating
-------------------------- ------- -----------
Kozy Shack Chocolate Pudding . . . . . . . . . . . 7 1.1
Lundberg Farms Sesame Tamari Rice Cakes . . . . . 6 1.5
Dietary Specialties Crackers . . . . . . . . . . . 25 1.6
Dietary Specialties Pretzels . . . . . . . . . . . 20 1.7
Mrs. Leeper's Corn Elbows . . . . . . . . . . . . 6 1.7
Lundberg Farms Buttery Caramel Rice Cakes . . . . 6 1.8
Freeda's Zinc Lozenges . . . . . . . . . . . . . . 16 1.9
Legumes Plus Meatless Lentil Chili . . . . . . . . 5 2.0
Mrs. Leeper's Rice Vegetable Twists . . . . . . . 10 2.0
Mrs. Leeper's Rice Spaghetti . . . . . . . . . . . 7 2.1
Tamarind Tree Vegetable Jaffrazi . . . . . . . . . 8 2.1
Lundberg Farms Brown Rice Pasta (Spaghetti) . . . 11 2.2
Legumes Plus Wild Rice Lentil Soup . . . . . . . . 6 2.3
Lundberg Farms Country Wild Rice . . . . . . . . . 5 2.4
Tamarind Tree Navratan Korma . . . . . . . . . . . 7 2.6
Tamarind Tree Palak Paneer Spinach & Indian Cheese 8 3.0
Tamarind Tree Channa Del Masala Lentils w/Veg. . . 5 3.8
Tamarind Tree Dal Makhani Lentil Chili . . . . . . 5 4.0
Items With 2-4 Votes # Votes Avg. Rating
-------------------- ------- -----------
Kozy Shack Rice Pudding . . . . . . . . . . . . . 3 1.0
Kozy Shack Vanilla Pudding . . . . . . . . . . . . 3 1.0
Lundberg Farms Wild Blend Rices . . . . . . . . . 3 1.0
Mrs. Leeper's Corn Spaghetti . . . . . . . . . . . 3 1.0
Kozy Shack Tapioca Pudding . . . . . . . . . . . . 4 1.5
Mrs. Leeper's Corn Vegetable Raditore . . . . . . 2 1.5
Cybros Mock Rice Bread . . . . . . . . . . . . . . 3 1.7
Mrs. Leeper's Corn Rotelli . . . . . . . . . . . . 3 1.7
Lundberg Farms Brown Rice Penne Pasta . . . . . . 4 1.8
Pamela's Shortbread . . . . . . . . . . . . . . . 4 1.8
Cybros Rice & Raisin Bread . . . . . . . . . . . . 2 2.0
Tamarind Tree Alu Chole . . . . . . . . . . . . . 4 2.3
Pamela's Biscotti . . . . . . . . . . . . . . . . 2 2.5
Mrs. Leeper's Corn Cracked Pepper Cavatappi . . . 3 2.7
Pamela's Ginger Cookies with Almonds . . . . . . . 3 2.7
Lundberg Farms Brown Rice . . . . . . . . . . . . 3 3.7
Items With 1 Vote Rating
----------------- ------
Bi-Aglut Penne Pasta . . . . . . . . . . . . . . . . . . . . . 1
Cybros Shortbread Swirl Cookies . . . . . . . . . . . . . . . 1
Dietary Specialties Bran Muffin Mix . . . . . . . . . . . . . 1
Gluten Free Delights Lemon Bar . . . . . . . . . . . . . . . . 1
Gluten Free Delights Coffee Cake . . . . . . . . . . . . . . . 1
Gluten Free Delights Raspberry Swirl . . . . . . . . . . . . . 1
Glutano Apricot Bars . . . . . . . . . . . . . . . . . . . . . 1
Lundberg Farms Sushi Rice . . . . . . . . . . . . . . . . . . 1
Miss Roben's Cake Mix . . . . . . . . . . . . . . . . . . . . 1
Miss Roben's Crunchy Chocolate Chip Cookie Mix . . . . . . . . 1
Miss Roben's Sugar Cookie Mix . . . . . . . . . . . . . . . . 1
Miss Roben's Brownie Mix . . . . . . . . . . . . . . . . . . . 1
Pamela's Chocolate Shortbread . . . . . . . . . . . . . . . . 1
Pamela's Ultimate Hazelnut Biscotti . . . . . . . . . . . . . 1
Cybros Rice Nuggets . . . . . . . . . . . . . . . . . . . . . 2
Cybros Rolls . . . . . . . . . . . . . . . . . . . . . . . . . 2
Dietary Specialties White Bread Mix . . . . . . . . . . . . . 2
Lundberg Farms Rice Cakes Tamari with Sea Weed . . . . . . . . 2
Pamela's Ultimate Chocolate Nut Biscotti . . . . . . . . . . . 2
Cybros White Rice Bread . . . . . . . . . . . . . . . . . . . 3
Kingsmill Coconut Cookies . . . . . . . . . . . . . . . . . . 3
Mrs. Leeper's Lasagna . . . . . . . . . . . . . . . . . . . . 4
Pamela's Ultimate Crystalized Ginger Biscotti . . . . . . . . 4
Return to the Table of Contents
Michigan Celiac Sprue Awareness Day
-----------------------------------
by Tom Sullivan
On Thursday, October 28, a bright, sunshiny fall day, about 25 people
gathered on the steps of the state capital in Lansing, Michigan.
About half were from the local Michigan Capital Celiac/DH Group and
half arrived in a three car caravan from the Tri-County group to
support the Capital Group's efforts and success in having the day
proclaimed as Celiac Sprue Awareness Day by Governor Engler. The
first step was to troop, en masse, to Governor Engler's office to
thank him for the proclamation. Unfortunately he was out of the
office at the time but we all signed a thank you note that his staff
said they would see that he received.
The next stop was at Representative DeWeese's office for a second
thank you. Proclamations by the governor must be sponsored by a
member of the house or senate. Dr. DeWeese was the sponsor of the
Celiac Sprue Awareness Day proclamation. When we arrived, he was in
session in the house. His staff accepted our thank you note and
suggested we go to the house gallery were they would try to contact
him. Dr. DeWeese, from the floor of the house chamber, had us stand
in the gallery and be recognized. He then met us outside the chambers
for a few minutes' conversation. He already is planning next year's
proclamation and having the attendees be recognized from the floor of
the house as well as having a speaker for the group address the
representatives. Congratulations to the Michigan Capital Group, and
keep up the great work!
The group then split up into two's and three's to see their own
senators and representatives as well as other departments and offices.
The highlight of the day was when Mary Guerriero entered the public
relations office just after a phone call had been received from a
newspaper reporter requesting information about this "Celiac Sprue
Day" and the person taking the call didn't have a clue. Never being
one to let an opportunity to raise public awareness pass by, Mary and
her group educated the office about Celiac Sprue, provided them a
wealth of information, and left knowing the person was going to call
the reporter right back with the straight scoop. That's awareness.
But the best part of the day was saved for the end when about 65
people gathered in the Kellogg Center for a delicious, worry-free,
gluten-free (GF) dinner prepared and served with impeccable style by
the Michigan State student chefs and volunteers. Everyone enjoyed the
meal, including Professor Carl P. Borchgrevink of the Michigan State
University School of Hospitality Business who supervised the student
project. He indicated to Tom Sullivan at the end of the meal that the
project had been a great learning experience for everyone, himself
included, and he intended to incorporate it into the curriculum. More
awareness.
Michigan Capital Group did a great job in raising awareness this year.
Keep it on your calendar to help support them next year with even
bigger and better efforts.
Return to the Table of Contents
Travel to Germany and Austria
-----------------------------
by Regina Kukielka
My husband and I planned a tour of Germany and Austria with Trafalgar
to which, as a Celiac, I was not looking forward. But I faxed diet
instructions to Trafalgar and made copies of the German language
restaurant card I had found in a previous issue of The Sprue-nik
Press.<1> I took along some gluten-free (GF) crackers and rice cakes.
Noel, the tour director had never heard of this condition, but when I
explained it to him, he realized that it was not just a fad diet. He
did a wonderful job of planning the menus. There was another Celiac
lady on this tour but she was embarrassed to ask for this strange type
of diet. She asked for a dairy-free diet and planned on eating what
she could on her plate. After she met me, and realized that she was
not the only one in the world with this condition, she accepted the GF
meals also.
Noel called ahead to the restaurants and showed a copy of my German
restaurant card to the cooks. But the wonderful thing about Europe is
that most cooks understand the diet. Usually we got plain meat/fish,
potato/rice, vegetable, and fruit. At the food stands I ate salad,
potatoes fried with onions, or fruit. I got to enjoy roasted
chestnuts for a snack.
One restaurant owner told us we would get a GF meal because his cook
has Celiac Disease. Joan, the other Celiac and I had the most
wonderful meal with soup and all the works. (I never eat soup in a
restaurant.) The owner of a Hungarian restaurant said "not to worry",
so we took a chance and ate the goulash, sauerkraut, and sauce he
recommended on our meat and potatoes and we were fine. The sauce was
out of this world.
I did not bring along any candy, and I was afraid to eat the European
candy. One day I think I was having a goodies withdrawal; I was
depressed. I walked into a coffee shop in Oberammergau and asked if
they had any cake with no flour. I really didn't expect the man to
say yes, but he did. I thought "sure, this is just a
misunderstanding". But he said wait, I don't speak English well. He
called a young lady to speak to me and she said that her uncle makes
GF cakes and cookies. She's sure they are GF because she can't eat
gluten either. I had a piece of this sinfully rich layer cake and
Joan had something made with egg white and no dairy. Then the young
lady opened up a case with GF cookies made with Marzipan. Joan and I
bought most of the store's supply of GF goodies to take with us. We
were in heaven.
This was a learning experience for the tour director, and of course
most of the people on the tour learned something about Celiac Disease.
They tried to look after us and help us remember to ask about
ingredients. One lady (bless her soul) told me to be sure that I
don't drink that special Wheat Beer. I didn't have the heart to tell
her that we can't drink any beer.
Return to the Table of Contents
1999 CSA Conference Report
--------------------------
by Janet Armil and Carolyn and Tom Sullivan
The 22nd Annual CSA Conference was held in Atlanta, Georgia, on
October 1-3, 1999. In general, it was a slower-paced gathering in an
atmosphere of pleasant civility and helpfulness. As can be said for
any gathering or conference, things happen. Yes, speakers were absent
or late because of traffic accidents or other impediments; and yes,
breakfast was not prepared or served where it should have been. But
at no time were the staff anything but smiling, polite to a fault, and
pitching in from all over to help make the conference a success.
In addition, Saturday's lunch included a mini-travelogue through the
far east with Mr. Jeffrey Alford from Toronto, Canada. Mr. Alford
is the author of The World of Rice and Flat Breads. He and his wife,
Naomi Dagurd, also co-authored two cookbooks that could belong in any
celiac's kitchen library--Flat Breads and Flavors: A Bakers Atlas,
William Morrow & Co., New York, 1995; and Seductions of Rice, C.
Artisan, New York, 1998.
Combine beautiful weather with excellent food, serve both in copious
quantities, and you have, all in all, a busy and enjoyable week-end.
Return to the Table of Contents
Reflections from a Newcomer, Janet Armil, celiac and TCCSSG member
---------------------------
I've been to many professional conferences as a teacher and
psychologist, but this is the first time I've attended a conference
for personal reasons. Those reasons weren't even lofty; I went for
the food and the getaway, and if I learned something, it would be a
bonus. (Hey, what can I say? I needed a vacation.). Not only did
the conference meet my expectations for food and escape, I really did
learn something, and I had a good time. The good time came from
communing with hundreds of other gluten-free people (I felt so
normal!) and hearing from a myriad of professionals who are dedicated
to the diagnosis and understanding of celiac disease. I felt happy
and hopeful.
What follows are highlights from several of the talks.
Return to the Table of Contents
Update on Current Diagnostic Dilemmas: Celiac Disease, Matthew S. Z.
------------------------------------------------------ Bachinski,
M.D., Gastroenterologist, Department of Medicine, Section of
Gastroenterology, Medical College of Georgia, Augusta, GA
The following individuals should ALWAYS be screened for CD because
they are considered AT RISK for the disease:
* First degree relatives of celiac patients (8-10% will have CD
also). These include parents, children, and siblings.
* Anyone with autoimmune endocrinopathy.
* Anyone with IgA deficiency.
* Anyone with IDDM (Type 1 diabetes). (Many diabetics have chronic
diarrhea often labeled as "diabetic diarrhea". Diagnosis of CD
and adherence to a GF diet decreases the risk of cancer and helps
manage the patient's diabetes).
* Anyone with CTD (Connective Tissue Disease).
* Anyone with Down's Syndrome.
The following individuals should consider screening for CD as a
possible diagnosis for their condition:
* Anyone of short stature (8-10% will have CD).
* Anyone with infertility problems. (in 2.7% of the cases, one of
the couple has CD.)
* Anyone with intractable seizures.
* Anyone with unexplained anemia (as shown by fecal occult blood).
* Anyone with abnormal liver tests.
* Anyone with osteoporosis and/or alopecia (baldness).
* Anyone with a lymphoma (an untreated CD patient has a 20-120 fold
increased risk).
The gold standard for CD diagnosis is the small bowel biopsy. The
sensitivity of any screening test is the percentage of times it is
positive in the presence of CD when compared to the gold standard.
The specificity of a screening test is the percentage of times a
positive (abnormal) result is predictive of the disease (in other
words, what percentage are "true" positives). In response to a
question, Dr. Bachinski stated that screening is not the gold
standard because of the missed positives (i.e., false negatives). The
lab screens the blood for anti-endomysial antibodies (EMA) and anti-
gliadin antibodies (IgA and IgG). The newer tissue transglutaminase
test (tTg) is a more reproducible screening test with a sensitivity of
98% and a specificity of 95%. It is now limited to special order
availability but Dr. Bachinski thinks it will become the new standard
for CD screening. [Ed. note: These tests are of use ONLY when the
patient is still consuming gluten. Going on a GF diet first makes the
tests essenti ally meaningless.] Dr. Bachinski stated further that
if anyone is referred to his clinic because of suspected CD, even if
the blood tests are all negative, he considers that a biopsy is still
required.
Return to the Table of Contents
Safety Issues in the Human Food Chain, Richard (Dick) H. Dougherty,
------------------------------------- Ph.D., Food Processing
Specialist, Department of Food Science & Human Nutrition, Washington
State University, Pullman, WA
The Center for Disease Control estimates that there are 76 million
cases of food-borne illnesses per year. Some pathogens that can and
do show up in our food chain include E. coli, Listeria monocytogenes,
salmonellae, toxoplasma, giardia, cryptosporidia and campylobacter.
The first three account for about 74% of the recorded deaths (about
1500). In recent years outbreaks have occurred in meat products, raw
juices, produce, dairy products, cereals, and seafoods. The reasons
for the increase in reported outbreaks include:
* Our ability to detect pathogens (disease-causing organisms) at low
levels has improved significantly.
* Information generation and dissemination is better, faster and
wider through phone, fax, radio, television, and the internet.
* Testing and monitoring techniques have been improved
significantly.
* The reporting of problems by both the manufacturers and the
governmental agencies is more complete.
* The microorganisms themselves are changing.
* The food chain systems, especially distribution, are changing.
What was once available only in season from the adjacent truck
farm is now available from somewhere in the world year round.
The sources of pathogens in the food chain can be anywhere from the
raw materials to the ingredients to the people/workers and the
equipment/transportation. Some of the worst problem areas include
sponges, cutting boards, pipes and areas of that nature. But the
worst area is spices because they are never cleaned and cannot be
washed down with water. The only method for cleaning is irradiation.
There are two methods for making food safe. The first is to keep the
bugs out by washing or cleaning the product. The second is to kill
the bugs before consumption by either cooking the product well or
irradiating it heavily.
From the consumer standpoint, Dr. Dougherty suggested the following
cautions: First, understand what the true risks are. Then, know what
the options are. After that, know your foods and your food sources.
And finally, control what you can.
The people who are at highest risk with any food borne pathogen are of
course children, elderly and anyone with a severely depressed immune
system. The foods which present the highest risk to people are
uncooked meat, poultry, seafood and eggs as well as raw milk. Sprouts
present a moderate risk as a food. However, there are no controls on
them and no one knows what to do.
Because most pathogens are on the outside of food products, the best
protection is to clean and wash everything. In the case of meats,
such as steak and hamburger that require cooking, different rules
apply. Steak, because it is heated well on the outside, is generally
safe. Hamburger, because the outside of each strand of meat is mixed
throughout, is not safe unless it is heated all the way through or
cooked well.
Dr. Dougherty ranked the risks as follows:
1. Highest risk: uncooked meat, poultry, seafood or eggs, and raw
milk.
2. Moderate risk: sprouts and raw milk cheeses.
3. Low risk: fresh produce, cooked meats, and filled pastries.
4. Lowest risk: canned foods, pasteurized food (milk, juices),
breads, and pastries.
Public policies or attitudes will determine what trade-offs we make.
Because we will never be able to attain 100% safety, we must determine
1) how safe is safe?, 2) how much risk are we willing to accept for
the desired level of safety?, and 3) how many dollars are we willing
to spend? Consumers are the link between these questions. They help
decide by the choices they make.
In response to questions Dr. Dougherty indicated:
* Based on the FDA cleaning standards, he does not see crop
contamination as a problem.
* He is not sure about oranges but any pathogens would probably be
on the outside only.
* The FDA website is http://www.fda.gov.
* Organic foods are a quality issue, not a safety issue.
* Imported foods must meet the U.S. standards the same as domestic
products.
* He personally does not wash all fruits and vegetables. It depends
on the situation you are in.
Return to the Table of Contents
The Role of the Small Bowel Biopsy in Celiac Disease, Cynthia S.
---------------------------------------------------- Rudert, M.D.,
Board Certified Gastroenterologist, former Assistant Professor of
Medicine Division of Digestive Diseases at Emory University, private
practice specializing in Celiac Disease, Atlanta, GA.
The usual diagnostic procedure for Celiac Disease (CD) is a good case
history, serology and then a small bowel biopsy. Dr. Rudert obtains
at least 12-15 samples in each biopsy and sometimes uses a pediatric
colonoscope to get deeper. Some patients, however, have bowel x-rays
after serology to rule out other diseases such as Crohn's disease.
Dr. Rudert has found that one of four of her Crohn's patients
actually has CD. She has also found that CD mimics ulcerative
colitis.
Blood testing has been found to absolutely correlate with TOTAL
villous atrophy. The tissue transglutaminase test is now being done
with the anti-endomysial blood test by some labs. However, the
endomysial antibody tests have a poor correlation with PARTIAL villous
atrophy, which leads to the conclusion that one should not completely
trust serology. The results should be taken with a grain of salt.
There was a workshop of interested CD professionals that convened in
Marina del Ray, CA in Feb, 1999 to examine blood testing standards in
the U.S. The participants included Joe Murray (Mayo Clinic), Chris
Maldorf (Netherlands), and Don Kasarda (USDA). It was determined that
there are many labs involved but no standards and no 100% match
between labs. A celiac standards group was established to examine the
situation yearly and establish national laboratory standards for CD
blood testing.
There are two rules for small bowel biopsy. If doing an endoscopy-for
ANY reason-do a CD biopsy. When doing a biopsy, get multiple
samples--more is better. An endoscopy can look normal in most cases
but a biopsy is always required because the diagnosis of CD is
microscopic, not visual.
Return to the Table of Contents
Celiac Disease and Psychiatry, Dr. Newport [ed. note: Dr. Newport
----------------------------- was an addition to the printed program
and his credentials, unfortunately, were not obtained.]
There are many psychosomatic diseases and many diseases with
psychiatric implications. There is little research on Celiac Disease
(CD) and it's psychiatric manifestations, so we must learn from other
illnesses and apply it to our expectations in the unfolding of CD.
CD in a child may look like Attention Deficit Disorder (ADD) and we
can deal with this by educating health professionals. There may be
more than one problem. If you treat ADD only and don't get good
results, then look for something else.
Earlier dementia in Alzheimer's Disease may be caused by CD.
The relationship between a known medical problem and psychiatric
symptoms can be the result of one of three conditions:
1. It can be the result of the stress of the medical condition. For
example, the diagnosis of the medical condition can induce
depression and/or anxiety. Or the illness changes the patient's
lifestyle inducing stress and resultant problems.
2. The biological illness itself may be the direct cause. For
example, cancer can spread and attack other parts of the body.
Or a malabsorption condition can affect memory or other
activities.
3. The treatment regimen can cause a problem. The medicines used to
treat cancer, for example, can have disruptive side effects. Or
a diet can manage an illness but unbalance other aspects of the
patient's well being.
The issue is when to diagnose psychiatric problems, e.g., if a patient
is diagnosed with cancer, don't they have a right to be depressed?
Both cancer and depression can cause loss of weight, sleep problems
and/or pain.
The first step is to maximize the medical treatment including patient
education and involvement with support groups.
The next step is to treat the psychiatric symptoms with the current,
vastly improved, depression/anxiety medications. One must be careful
with any drug interactions; cautious with the dosage level-start low
and increase slowly- and patient awaiting results. If these two steps
produce no response, one must look deeper for the cause.
His take home message was: CD could produce extreme despondence,
especially when dealing with restaurants.
Dr. Newport knew of no studies of schizophrenia and CD since the
1970's and that data showed no connection.
Return to the Table of Contents
Inflammatory Bowel Disease, Charles A. Sninsky, M.D.,
-------------------------- Gastroenterologist, Associate Chief,
Section of Gastroenterology, Vanderbilt University, Nashville, TN
Inflammatory Bowel Disease (IBD) can present a diagnostic dilemma.
There is an "Indeterminate Colitis" which may have features of both
ulcerative colitis, a superficial condition of the large bowel, and
Crohn's disease, an inflammation and scarring in the small and/or
large bowel. These are the two diseases in the category of IBD.
Other conditions may mimic IBD. Listening to the patient's symptoms
is helpful in arriving at a correct resolution.
The age of onset for IBD is anywhere from 2 to 70 years with the peak
at 20 years of age. Considering IBD as an altered immune state, some
of the etiological factors that could affect the immune system include
infections, environmental influences, drugs, smoking, diet, genetics
or psychogenics.
The systemic complications of IBD can include the eyes, liver, kidney
stones, joints, skin lesions and short stature in children. But the
reason why ulcerative colitis can present strictly locally at the
rectum or encompass half the large bowel or all of it is still not
known.
The goals of the treatment of IBD are:
* control of the patient's symptoms
* support of good patient nutrition and growth
* emotional support
* treatment of any external manifestations
* prevention of occurrence or recurrence of the condition
IBD is an immune system disregulation. The treatment is to slow down
the immune system with medications. Unfortunately, 12% of patients
don't even fill their prescriptions because of cost, side effects or
how often drugs are prescribed.
Stress does not cause IBD. It can, however, aggravate the condition.
There is a Crohn's and Colitis Foundation (CFFA) to help patients
cope.
Surgery is may be required if there are complications of IBD or if the
IBD is refractory to medical management (i.e., doesn't respond to
treatment).
Q: Are there a large number of patients with CD and IBD?
A: No.
Q: What about iritis? Is the link with colitis or CD?
A: Iritis is an inflammation of the eye. It is another immune system
response.
Q: Is there any connection between IBD and colon cancer?
A: YES! The longer period of time one has Crohn's or ulcerative
colitis the more chance for cancer. The odds increase 1-2% per
year for each year over 10 that one has the disease.
Return to the Table of Contents
One Loaf, Many Breads, Beth Hillson and Elizabeth Reed, The
--------------------- Gluten-Free Pantry, Glastonbury, CT
Beth and Elizabeth demonstrated how many tasty treats could be created
from a basic bread mix (e.g., their own French Bread Mix): pizza,
baguettes, hamburger rolls, and pigs-in-blankets. [author's note: We
got to eat them. Yummy!]
The recipe for pigs-in-blankets is:
Mix together the following ingredients:
3-1/2 or 3-3/4 cups baking mix
1-3/4 cups water
4 Tbsp. butter
Then beat 4 Tbsp. more of water into the mix to thin it.
Spear a half-inch piece of GF hot dog, cheese, or ham on a toothpick.
Smear the thinned mix on the speared food to coat it. Bake the coated
food in the oven at 400 degrees F until browned and cooked through.
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Taking the Guesswork Out of Making Breads, Bette Hagman, Celiac and
----------------------------------------- Author of _The Gluten-Free
Gourmet Bakes Bread_, Henry Holt & Co., New York, NY, 1999
[Author's note: This article is severely constrained by the copyright
laws applying to Bette's books and the materials used in her
presentation. I was, however, impressed by the amount of information
and the clarity and simplicity of the presentation. I consider the
book an excellent reference.--Carolyn Sullivan]
Bette began by saying that the companies keep changing models of bread
machines to keep sales up. Probably the biggest change that celiacs
need to make is to eliminate the stirdown and second rise as our
breads do not need it.
She has come to believe that if the protein content of GF
(Gluten-Free) bread can be made similar to bread with wheat, then
similar results can be obtained and cup for cup substitution in wheat
recipes can be used. She finds that using her new formula she does
not get hungry as quickly and the nutrient value goes up. The new
formula (number 4 on page 40, with some xanthan gum added) is:
Garfava bean flour 2/3 part (from Authentic Foods)
Sorghum flour 1/3 part (from Jowar)
Cornstarch 1 part
Tapioca flour 1 part
The new book explains flours. Bette has added nutritional information
and dietary exchanges for each recipe (very helpful for diabetics).
She has not abandoned the old formulas and refers to previous recipes
at the end of each chapter. [Author's note: I have noticed the trend
toward the use of bean flour in other GF recipes including those of
Sandra Leonard.--Carolyn Sullivan]
All of Bette's recipes are tested by members of the celiac community.
[Author's note: Vicki Lyles of our group was one of the testers for
her latest cookbook.]
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Using the Mind/Body Connection to Reduce Stress, Kay H. Coker, LCSW,
----------------------------------------------- MSW, Clinical Social
Worker, The Emory Clinic, Emory Health Care, Emory University,
Atlanta, GA
There is a total interrelation between the mind and the body with
neuropeptides providing communication between them at the cellular
level. What is required is techniques to access this communication.
Feelings are stress. Chronic illness provides an additional stress
over the usual catastrophes of life. The number and kind of stressful
events is not the problem. Rather, our perception of them is. We can
usually manage the big events. It is the small ones that trigger us
into overload.
Mindfulness Based Stress Reduction is discussed online at
http://www.MBSR.com.
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Substitution Solutions, Jay Berger, Tech Support and General Manager,
---------------------- Miss Robens, Frederick, MD
First, you have to know WHY a recipe calls for a given ingredient to
ensure that your substitution will contribute the same characteristic.
The same ingredient may be used for different reasons in different
recipes.
Second, does your substitution differ in water content from the
original (e.g., butter vs margarine or whole milk vs skim milk)?
Third, make and evaluate only one substitution in a recipe at a time.
Fourth, because GF baking is unforgiving, keep in mind these general
rules:
* Measure accurately
* Use all ingredients at room temperature
* Use the right equipment (e.g., a powerful mixer)
[Author's note: The Fall 1999 issue of _Sully's Living Without_
contains an article by Ms. Berger on "Substitution Solutions". To
subscribe, call (630) 415-3378 or visit their website at
http://www.livingwithout.com.]
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Nutritional Concerns in the Gluten-Free Diet, Lee G. Jimenez, MA, RD,
-------------------------------------------- Nutrition Support
Dietitian, Medical College of Georgia, Augusta, GA
The absorption of nutrients can be affected by active CD. Mr.
Jimenez pointed out that GF products are NOT required to be vitamin
fortified. He had four recommendations for all celiacs:
* Educate yourselves
* Continue close medical nutrition follow-up
* Comply strictly with the diet
* Take a vitamin-mineral supplement daily [Individual nutrient
deficiencies should be determined and treated.--Dorothy Vaughan,
TCCSSG Dietitian Advisor]
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References
----------
<1> The Sprue-nik Press, vol. 7, no. 8, Nov/Dec 1998, pg. 21.
Return to the Table of Contents
Tri-County Celiac Sprue Support Group Officials:
------------------------------------------------
Physician Advisor: Thomas Alexander, M.D.
Pediatric Advisor: Robert Truding, M.D.
Dietitian Advisor: Dorothy Vaughan, R.D.
President: Mary Guerriero
Vice President: Sue Gentilia
Past President: Diane Morof
Finance Committee: Tom Sullivan
Secretaries: Marilynn Ponto
Pat Michael
Web Page Editor: Pam Murphy
Newsletter Editor: Jim Lyles
Contributing Editors: Tom & Carolyn Sullivan
Group E-mail address: tccssg@yahoo.com
Group web page: http://community.mlive.com/cc/celiac
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 tccssg@yahoo.com.
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