What
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Gluten Free Diet
Related
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Frequently Asked Questions
- What is the prevalence of celiac disease in Utah?
- Is celiac disease an intolerance or allergy?
- Are small amounts of gluten allowed?
- Are oats allowed?
- Is vinegar okay?
- What about bread or wafers as part of a worship service such as the Sacrament or Communion?
- Where can I find authoritative, accurate, and up-to-date information about the gluten-free diet?
- How can I convert wheat based recipes to gluten-free?
- What can I do with leftover bread?
- Do I need to adjust the recipes on this site for high altitude?
- What Is Dermatitis Herpetiformis?
1. What is the prevalence of celiac disease in Utah?
 | The prevalence of Celiac Disease in the United States for average healthy people: 1 in 133 people, or 2.2 million people 1 |
| Estimated prevalence of Celiac Disease in Utah: 17,000 people (Note: this is based of off 1 in 133, the prevalence is higher in European descendents.) |
| The prevalence of Celiac Disease in the United States for African, Hispanic, and Asian Americans: 1 in 236 1 |
| European decent population (non-Hispanic/Latino white) in the United States: 69.1% 2 |
| European decent population (non-Hispanic/Latino white) in Utah: 85.3% 2 |
| Average time for a symptomatic person to be diagnosed with Celiac Disease in the United States: 11 years 1 |
Sources:
2. Is celiac disease an intolerance or allergy?
Celiac Disease involves the inability to digest gluten and an immune response,
but it does not fit the description of a simple intolerance or a common allergy.
The following description of food intolerance and food allergy is taken from
information published on the Food
Allergy Network FAQ:
A food intolerance is an adverse food-induced reaction that does not involve the immune system. Lactose intolerance is one example of a food intolerance. A person with lactose intolerance lacks an enzyme that is needed to digest milk sugar. When the person eats milk products, symptoms such as gas, bloating, and abdominal pain may occur.
A food allergy occurs when the immune system reacts to a certain food. The most common form of an immune system reaction occurs when the body creates immunoglobulin E (IgE) antibodies to the food. When these IgE antibodies react with the food, histamine and other chemicals (called mediators) cause hives, asthma, or other symptoms of an allergic reaction.
Although people with celiac disease lack enzymes needed to digest gluten properly, celiac disease is more than a typical food intolerance because it does involve an immune reaction. However, celiac disease is not considered a typical allergy because it does not involve an IgE immune response. Rather, IgA and IgG antibodies are triggered when a person with celiac disease ingests gluten.
An excellent fact sheet about food allergies and intolerances is available from the National Institute of Allergies and Infectious Diseases at http://www.niaid.nih.gov/factsheets/food.htm
3. Are small amounts of gluten allowed?
In the United States, the standard for the gluten-free diet is 'zero tolerance' for ingested gluten. An interesting discussion on this topic is summarized by the Celiac List owners at http://www.enabling.org/ia/celiac/mxgluten.html
| A theoretical maximum daily tolerable amount of gluten: 4-40 mg.1 |
| Weight of a grain of rice: 40 milligrams (too little to taste, one crumb is too much) 2 |
- What is the Maximum Allowable Amount of Gluten? (Compiled from discussions on the Celiac Professional List)
- Tom Sciacca: How big is a milligram; Gluten Free Living Nov/Dec 2001 pg.
4. Are oats allowed?
At this time, oats are not recommended for a gluten-free diet in the US due to an abundance of caution and possible contamination from barley and wheat. An article worth reading is Dr. Don Kasarda's Celiac Disease and Safe Grains.
5. Is vinegar okay?
In the past, distilled vinegar (or white vinegar) has been listed as unsafe for people with celiac disease by the major organizations in the United States, but not by organizations in any other countries. This position changed in 2001. The Gluten Intolerance Group® and the Celiac Disease Foundation now state that all vinegar (except malt vinegar) is safe for people with celiac disease to consume. The American Dietetic Association has also stated in their most recent publication that vinegar is gluten-free.
Below are internet hyperlinks to various articles and posts supporting the conclusion that distilled alcohol (and distilled vinegar made from distilled alcohol) is gluten-free.
|
An on-line copy of Ann Whelan's landmark article on vinegar: Are All Vinegars Safe for Celiacs? |
|
Post from the Celiac Disease List: a chemical engineering professor who also has celiac disease |
|
Post from the Celiac Disease List: A very detailed explanation of the manufacture of vinegar by Richard Abrams |
|
Post from the Celiac Disease List: A short post summarizing information given by J. A. Campbell, Ph.D. |
6. What about bread or wafers as part of a worship service such as the Sacrament or Communion?
Maintaining a gluten free diet can be intrusive in may aspects of life. This holds true for many whose worship service includes partaking of wheat based bread or wafers.
It is not advisable for celiac patients to partake of gluten containing substances as part of their worship service (see American Journal of Clinical Nutrition: The Widening Spectrum of Celiac Disease). Instead, people with celiac disease should talk with their religious leaders and find an appropriate alternative. Leaders and members of all religions in Utah are invited and encouraged to send comments to be posted here to help their respective congregations. Send these comments to info@gfutah.org.
Catholic Church: Here is a link to some general information at Scott Adam's site: Celiac Disease and the Catholic Church.
The Church of Jesus Christ of Latter-Day Saints: There is no official church policy concerning the Sacrament and those with celiac disease or wheat allergy. But after talking with both local and general authorities, we offer the following advice.
The Sacrament consists of both the bread and the water (see Matthew 26:26-28, 3 Nephi 18:1-12). In the Doctrine and Covenants, it states clearly that substitutions can be made for the bread (see D&C 27:2). Members of the Church of Jesus Christ of Latter-Day Saints should work with their bishop or branch president to ensure that a gluten-free substitute (i.e. gluten-free bread or rice cake) is administered. Care must be taken to avoid cross contamination.
7. Where can I find authoritative, accurate, and up-to-date information about the gluten-free diet?
The Gluten-Free Diet, Revised Edition
by Shelley Case
An excellent resource book available at bookstores everywhere.
Manual of Clinical Dietetics, 6th Edition
(American Dietetics Association)
This 6th edition, updated and revised in 2000, contains the current medically accepted diet for celiac disease in the United States. Information from the chapter on Celiac Disease may be available through your local hospital dietician.
Quick Start Diet Guide for Celiac Disease
(Gluten Intolerance Group)
Available online at http://www.gluten.net/diet.asp.
8. How can I convert wheat based recipes to gluten-free?
To replace 2 Tbsp (wheat) flour as a thickener, use 1 Tbsp cornstarch , 1 1/2 Tbsp sweet rice flour, or 2 Tbsp of gluten-free flour mix. It is necessary to stir these flours with a bit cold liquid before heating otherwise the starch will make little lumps that will not mix in. Cornstarch has no noticeable flavor and is preferred when a clear (not cloudy) sauce such as sweet and sour sauce is desired. Sweet rice flour has a mild sweet flavor and is preferred by some in creamy sauces such as creamed soups.
To replace 1 cup of (wheat) flour in baking, use 1 cup gluten-free flour mix plus 1/2 tsp of xanthan gum. Cookies, cakes and pastries often work well with 1/4 tsp or less of xanthan gum per cup flour mix. Yeast breads and pizza doughs need up to 1 tsp xanthan gum per cup flour mix. Gluten-free baked goods may need a little extra baking powder for leavening and extra egg for binding. Vinegar or lemon juice is often used to soften and improve the texture of gluten-free baked goods.
9. What can I do with leftover bread?
Gluten-Free bread works well fresh for 1 day, refrigerated 3 days, and frozen about 3 weeks. Slice bread before freezing and remove bread from freezer one slice at a time as needed. Warm refrigerated or frozen bread in the microwave for a few seconds to soften.
Day old bread works well as toast, French toast, and in grilled sandwiches.
Make older refrigerated or frozen bread into crumbs. Bread crumbs are used in stuffing, fried chicken, meat loaf, and other casserole recipes.
10. Do I need to adjust the recipes on this site for high altitude?
Most of the recipes on this site were developed in Utah along the Wasatch Mountain Range, so it is not necessary to adjust for high altitude. However, if in areas of very low altitude, it may help to raise the temperature, increase raising and baking times, and/or increase the leavening of some baked goods.
11. What Is Dermatitis Herpetiformis?
DH (Dermatitis Herpetiformis) is a blistery, itchy rash that is caused by the body's immune reaction to the gluten protein. Gluten is found in wheat, rye, and barley. When a person with DH ingests these grains, the body produces an immune reaction, which collects in the skin and causes this rash. A person who has DH has Celiac Disease.
See the Gluten Intolerance Group for more information.
Dermatitis Herpetiformis and Utah
John J. Zone, M.D., Chairman and Professor of Dermatology at the University of Utah, has published several articles about Dermatitis Herpetiformis. This excerpt comes from the research page of the UUHSC Department of Dermatology website:
"Bullous or blistering diseases may result from an abnormal immune system response. Utah has a large population of genetically susceptible people to this disease. John J. Zone, M.D. is an internationally recognized research and clinical expert in two such diseases called Dermatitis Herpetiformis and Linear IgA Bullous Disease. Dermatitis Herpetiformis is caused by sensitivity to wheat products and often occurs in families. John J. Zone, M.D., Laurence J. Meyer, M.D., Ph.D. and Kristin M. Leiferman, M.D. are exploring the genetic basis and immunological mechanisms of these diseases with the hope of improving disease detection and therapy."