Gluten-Free Calamari: April Fools?

One of my biggest challenges of eating gluten-free (GF) can be dining out, especially at my favorite seafood or Italian restaurant. (What's Gluten? Click here.) My stomach moans and mouth waters when the waiter presents the loaded basket of heavenly scented fresh bread or crispy rings of fried calamari, and I inwardly pout (okay, perhaps I outwardly whine) as I am left to sip my water, which is often the only GF item at my place setting. This week, however, while in Boston, I had a delightful surprise on the waterfront at the famous Legal Sea Foods.

A large group had dashed over for lunch during our full conference day. I asked if they had GF labels on their dishes, and the waiter immediately swapped out my menu for one that highlighted the GF choices. To be honest, I was skeptical when I saw fried fish as part of the choices, but happily, the waiter clearly was educated about special diets, and I had my pick of numerous dishes. He took our orders, then came back with drinks and the infamous bread basket. As he set it down, however, he smiled at me and said- unsolicited- "no worries, your gluten-free rolls are in the oven and I'll be back with them in a few minutes"! I squealed with delight, much to the amusement of my new friends and colleagues, I might add...

Ultimately, I ended up eating at Legal's not once or twice but literally four times in three days (a definite first for me for ANY restaurant) and the icing on the proverbial GF cake was that last night I discovered FRIED CALAMARI on the list! This was the best calamari I have ever had, GF or "regular". Yum!

BOTTOM LINE: More and more restaurants are offering GF options- be sure to ask your waiter! AND...if you're in Boston (or anywhere there is a Legal Sea Food), you've gotta go to Legal's and have the GF Calamari!

PS. First of the month, so change those AIR FILTERS (especially here in Austin- the oak is out of control!)

25 Grams of Fiber? Yes, You Can!

"But Doctor, there is NO POSSIBLE WAY that I can eat 25g of fiber in one day!"

I hear this response frequently when I am talking to my patients about a high fiber diet. Yes, we recommend eating 25g of fiber daily. No, it is not impossible! In truth, most Americans average way less than 10 or even 5g of fiber in their daily diet, but that is a reflection of all the convenience food that we consume. If you have coffee & a donut for breakfast, burger & fries & soda for lunch, and spaghetti & meatballs & buttered white rolls for dinner, you don't need a calculator to figure out your fiber was <5g! The good news is that it's really not hard to bump up that fiber. Here are some "tricks" to raise it:

1. Focus on fruits & vegetables (yes, it always comes back to this!) Nearly every serving of these will be at least 2g of fiber. An apple or pear~4g, berries~4-5g, banana~ 3g, broccoli ~3g, carrots ~2g, and corn or a baked potato~ g. Obviously if you get your 5-10 servings of these per day, you've got your fiber covered before you add in ANY bran muffins!

2. Choose whole grains for your breads, pasta & rice (brown)- that will add a few grams of fiber per serving (check the label!)

3. Pick a high fiber cereal that doesn't taste like tree bark, and rotate that in to your diet as both breakfast cereal and snacks (toppings on yogurt or as "croutons" on salads.) Bran Buds, for example, pack a whopping 12g of fiber in 1/3 of a cup!

4. If you like tortillas (and who doesn't?) check out some high fiber choices for your breakfast tacos (instead of toast)- Mission Carb Balance, for example, has tortillas with over 10g of fiber each!

5. Include nuts & beans (think hummus!) in your diet, too- 1/2 c of most beans will be 6-8g of fiber.

High fiber diets help prevent (or treat) constipation, lower cholesterol and triglycerides, and improve your gut health. There is no need to subsist on stale high fiber bran muffins to easily maintain the recommended 25g of fiber per day. Even if you are gluten-free, you can see how this is truly "do-able".

BOTTOM LINE: Push up your vegetable & fruit servings and choose whole grain complex carbs, and soon you'll be on your way to better health through a high-fiber diet!

What a Chef! Sicola's in Austin

I need to take time today to have a "commercial" for Sicola's: A Culinary Experience in Austin, TX. Last night I was at a Journal Club meeting there, and the before our talk, the waitstaff was circulating with luscious looking appetizers. Since I am still GF (Gluten Free), I will admit to feeling a bit deprived as I politely passed them up. Not wanting to appear rude for turning down multiple choices, I told one of the waitresses that if I were not gluten-free, I'd grab them in a moment.

Within a few minutes, the same lovely waitress returned, letting me know that indeed, the rest of the evening's menu was completely GF. I was pleased she would go to that trouble, and happily sipped my wine. However, that was not all. A little bit later, another waitress came over and told me that the chef was excited to CREATE a GF appetizer just for me! Can you believe that? In the throws of preparing a gourmet meal for fifty people, he stopped and literally experimented simply to allow someone with a special diet to enjoy an appetizer. Amazing!

I wish I could tell you exactly what the appetizer was, but I CAN tell you that it involved goat cheese and a non-wheat crumb coating, and it was DELICIOUS! I have never felt so pampered. Apparently, Stephen Sicola (the amazing chef) is creating specialized dishes to cater for all kinds of special diets, including youth with diabetes. Very cool!

BOTTOM LINE: If you live in Austin and have a private dining party to plan, call Sicola's and book it now!
PS. If you follow a special diet, it never hurts to ASK for something a bit off the menu when you dine out, so give it a try!

Gluten-Free Christmas Wish

WOW! My Christmas came early this year, when Disneyland (gotta love the Mouse!) actually replaced a fast food restaurant (Mc D) with-get this- a DELICIOUS BAKERY called Babycakes NYC that is completely GLUTEN-FREE and vegan, to boot! While perhaps this bakery belongs in the Magic Kingdom's Fantasy Land, it is actually located in Downtown Disney. What a wonderful addition for all the patrons who have celiac disease (remember, it's 1 in 100 Americans!) or are gluten-intolerant, as well as those who have opted for a vegan diet.

Looking at the Babycakes NYC website will definitely stir up your appetite, as you drool over delicious appearing donuts, cupcakes and assorted pastries. This is an ideal time to remind everyone, though, that "vegan, gluten-free, and organic" do not equate with LOW CALORIE! Babycakes offers TREATS AND SWEETS, which are DESSERTS and should be enjoyed in appropriate portions.

BOTTOM LINE: Cheers to Disney for welcoming a delicious bakery for their health-conscious (and/or special health needs) Disneyphiles!

Gluten-Free Decadence

After talking about gluten-free diets and celiac disease this week, I want to be sure no one is left with the impression that you need to feel completely deprived if you must be gluten-free (GF). Can you ever eat at a restaurant? Is every GF food expensive?
No worries, there are plenty of delicious and reasonably priced choices out there!

Primarily, I want to again encourage you to take advantage of EVERY SINGLE fruit and vegetable, all of which are completely and totally gluten-free! Have a banana smothered in ice cream and topped with whip cream for dessert- yummy! Gluten-free chocolates are a bit more challenging to find, but absolutely out there.

Dining out? Last night, I had a business dinner at a lovely French restaurant...where most dishes appeared to be topped with a white sauce (that usually has flour in it.) Yes, I had to pass up the fragrant loaves of French bread, but I simply enjoyed my glass of wine and ordered a salad by asking for lettuce, tomato and a vinagrette-no croutons- (which was delicious!) and trout grilled and topped only with butter and lemon. The waiter and chef didn't flinch a bit when I asked for these off-menu choices, and I think I was possibly the only one who left the table not stuffed to the gills! I also could have chosen the steak, and had a baked potato instead of the french-fried version. Admittedly, I passed up dessert, but could have asked for strawberries and whipped topping- but I was pleasantly full.

Craving pasta? This was challenging, but I found a spiral pasta that is a quinoa blend that I can truly say I PREFER to regular pasta. Pizza is still leaves a bit to be desired, but I have even found a delivery pizza service that has very passable GF dough for only $5 extra- well worth it for me, though I order regular dough for my family.

I have blogged earlier about some wonderful baking GF products and cookbooks, and without a doubt, you can find all sorts of GF bagels, donuts, cakes, cookies.

BOTTOM LINE: Never fear, you can consume deliciously decadent GF foods and drinks with a little thought and willingness to venture off the printed menu- ASK THE WAITER/CHEF!

PS. The chef in this picture, Michael Marchitelli, is ironically an ITALIAN chef in Crested Butte, CO- Eat at his Gourmet Noodle for some AMAZING food! I'm not promising GF pasta, but I can attest from my pre-GF days that every item on the menu is delicious, and there are definitely GF options!

Gluten-Free for Weight Loss?

Many people think going gluten-free is a great way to diet in order to lose weight. Not surprisingly, it can be a pleasant side effect if you are overweight and diagnosed with celiac disease. It makes complete sense that if you simply ELIMINATE breads, cakes, pastries, pastas, cookies and breaded or coated foods (think chicken nuggets, french fries, meatballs) your calories will shrink dramatically!

I would likely approve any diet that reduces processed foods and complex carbohydrates, but I am MORE excited about diets that not only decrease those items, but INCREASE fruits and vegetables. Here is the trick with not only a gluten-free diet, but a vegan or vegetarian diet. Keep it HEALTHY by upping the produce (veggies and fruit) and NOT merely replacing everything you are "giving up" with a manufactured version that is GF (or CF, or Veggie-free).

For example, there are many gluten-free breads, crackers, cookies and treats out there. Very few of them happen to be low calorie and/or "good" for you- BUT- saying gluten-free somehow implies healthy and nutritious, doesn't it? It's that health-food store seal of approval when we see labels proclaiming a food item is "free" of something "BAD".

Ultimately, however, in the battle of the bulge, it still comes down to calories IN vs. calories OUT, regardless of the quality of those calories. So, enjoy those GF pancakes and breads in moderation, but don't pursue the search for the GF Twinkie, okay? Push up the produce and reap the rewards.

BOTTOM LINE: Eating gluten-free CAN be an incredibly healthy diet, rich in nutrients from fresh vegetables and fruit plus a protein source and GF carbs in moderation, but gluten-free does NOT equal low calorie!

Gluten-Free Diet

This week I am talking about celiac disease, which requires a life-long commitment to a gluten-free diet. So, what the heck does that involve? Well, gluten is a protein found in all forms of wheat, as well as related grains such as barley and rye. What is made with wheat? At first glance, it feels like EVERYTHING has wheat.

Most cereals, breads, cookies, muffins, cakes, dough (think pizza), buns, and pastas, etc. ALL are classically made using wheat flours. Happily, though, there are more and more foods in these categories that are made with rice, corn and potato flours- all of which are gluten-free. In almost every grocery, there is a small (and ever-expanding) section of gluten-free "bread" products and mixes. Check out my "commercial" for delicious gluten-free pancakes, for example- yum! And rice-flour cereals such as Rice Chex are still on the menu, though ones like Rice Krispies that sound gluten-free (GF) may not be (because of additives like malt.)

More importantly, though, there are tons of delicious, healthy foods that are naturally gluten-free. Practically the whole perimeter of the grocery store: every fruit and vegetable (think MORE!), dairy, nuts, and meat are all GF. Our bodies don't NEED gluten nor any of the treats/sweets/doughs that our MOUTHS or minds may crave...

I think the biggest challenge of GF eating is baking. There does not seem to be a simple recipe substitute- at least not "replace one cup of wheat flour with one cup of brown rice flour" style. Because of the TEXTURE, you need to make blends involving rice flour, potato starch and tapioca flours, for example. I have found a great baking cookbook that I would recommend: Gluten-Free Baking Classics, by Annalise Roberts- try the delicious lemon pound cake!

If you are committed to a GF diet, make an appointment with a registered dietician to really learn all the nuances of this meal plan. Here in Austin, I recommend Daniela Knight, RD, to help you with this transition.

BOTTOM LINE: Gluten-free diets are rich in fruits, veggies and protein, and can be supplemented with carefully chosen gluten-free baked goods.

Celiac Disease: Do I Have It?

This week I am talking about celiac disease, a very common problem that affects 1 in 133 Americans. With non-specific symptoms such as fatigue and abdominal bloating, how can it be diagnosed? As is often the case, it is not as clear cut as you might think.

The first caveat is that you must EAT wheat (gluten) for the whole month before you are tested to get the most accurate evaluation. Blood tests are performed that check your antibodies, including the most sensitive test (meaning it will miss the fewest cases, but may have some false positives) anti-tTG (anti-tissue transglutaminase antibody.)

The doctor must also test your IgA levels (immunoglobulin A) because if you are not making adequate IgA, you could test negative for celiac disease even though you have it. Additional blood tests include anti-endomysial antibody (EMA-IgA) and anti-deaminated gliadin peptide (DGP – IgA and IgG).

Ultimately, the diagnosis will need to be confirmed not only with a blood test, but with a small bowel biopsy which is done through endoscopy. The biopsy will look directly at the lining of the gut and determine what level of damage exists.

Alternatively, you can choose to follow a strict gluten-free diet, and if your symptoms resolve, it is likely you have celiac disease (or at least gluten-intolerance.) This is obviously less specific and accurate, but is certainly a good starting place.

BOTTOM LINE: If you are concerned you may have celiac disease, talk with your doctor about getting a simple blood test to help determine if you should go gluten-free.

Celiac Disease and GF: What is it?

You may have noticed a new section cropping up on menus in restaurants these days- the gluten-free choices. What's up with that? Celiac disease. This disease is very common in the United States, affecting 1 in 133 people. In people with this disease, eating gluten (the wheat protein) causes an auto-immune reaction that damages the small intestine, causing poor absorption of food and nutrients.

What symptoms show up? Diarrhea is the classic symptom, but it turns out there are probably more cases of celiac disease without diarrhea. The symptoms are often rather nonspecific: fatigue, irritable bowel, anemia, vitamin deficiencies, and osteoporosis. There is, though, one symptom that is 85% specific for celiac disease-a rash called dermatitis herpetiformis, DH for short. This rash has nothing to do with herpes, however (nope, no STD talk in this topic!) This rash is intensely itchy, symmetrical eruption on the face, buttocks, elbows and knees.

The good news is that celiac disease can usually be treated with dietary changes alone-no medications required! The bad news is that gluten is found in many products beyond the obvious wheat breads and cereals, so to completely avoid gluten requires significant effort and education. Stay tuned this week for more about Celiac disease diagnosis and diet.

BOTTOM LINE: Problem: Celiac disease, a very common challenge. Answer: Gluten-free diet.

Gluten-Free Heavenly Pancakes! ( A Brief GF "Commercial")

Okay, forgive the interruption in talking about the secret stash of medicines doctors keep in their cabinets- I guess you can consider this a commercial, though I personally do not stand to profit! However, I had to break in because this morning, my kids and I devoured the most DELICIOUS GLUTEN-FREE pancakes!

Over the weekend, which teaching girl scouts about celiac disease and wheat allergies (and earning the "Let's Get Cooking" badge), the girls and I discovered a new brand of Gluten-free flours and mixes. We made chocolate chip muffins using "King Arthur's GF Muffin Mix" with soy milk (Vanilla Silk milk- because that's what was in our fridge- so these were "GFCF"-gluten free casein free) and let me tell you, they were scrumptious! And not, "wow, that's really good FOR GLUTEN-FREE", but actually delicious, in and of themselves! They had an almost sugar cookie flavor (perhaps some almond extract?) taste, and a moist, delicious, cup-cake texture. No grit!

After that success, last night I purchased a box of the pancake mix from the same maker, and voila- this morning's feast! Forget butter and syrup when you've got cool whip and fresh strawberries. We all wolfed down round one, and went back for second helpings. I showed a bit of restraint and grabbed this picture before finishing my second one...

For the record, I'm sure there are many new GF mixes and products that are delicious. We like the Betty Crocker GF Brownie mix, for example. But we've also tried a bunch that have flopped, so I wanted to share this latest success story for the ONE in ONE HUNDRED Americans who have celiac disease.

BOTTOM LINE: Gluten-free does not mean giving up all your favorite foods (especially breakfast)- try some new GF recipes, mixes, and products and share with me the ones you love!

Loving St. Louis- and it's Gluten-Free!

Wow- what a city! But it really feels more like a town, because everyone is SO FRIENDLY! If you haven't visited here yet, make plans to include it on your next family vacation. What is there to do?
First, of course-The ARCH- yes, in BOLD- gotta ride the tiny pod (they call it a tram, but that implies space to me...) to the top and catch the magnificent view of the town. This will certainly cure (or cement) your fear of heights.
In the shadow of the Arch is the Old Cathedral (formally known as the Basilica)-thanks to them for playing my mother's favorite hymn on Mother's Day (Let There be Peace on Earth.)
The Zoo- can you believe it's FREE?? Trails wind around through lush foliage as you view the animals. I was impressed that the kids' meals come with a choice of a healthy sides such as broccoli or applesauce. AND you can buy FRUIT SMOOTHIES at the Zoo!
Say Hello to Spike the cat at Left Bank Books.
For the grownups, there are Casinos- who knew? Stop in at the SLeeK in Lumiere's and tell Rusty hello from me as you order up a fabulous, thick steak.
Enjoy Saturday night live broadcasts with Lance from Y98- he is "Mr. St. Louis".
I had a GLUTEN-FREE pizza to die for at Pi (like the number)- special thanks to Tuck, our perky waitress.
And SWEET news- Ted Drewes Basic Frozen Custard is...GLUTEN-FREE! (Simply ask for a clean spindle). I love this town!
Look out for Fredbird and cheer on the Cardinals.

Special thanks to Dr. Teresa Knight, my friend and amazing tour guide- you go, "Gyno-Gal"!
BOTTOM LINE: St. Louis is a marvelous town that manages to celebrate the past and focus on a healthy future at the same time.
Thank you, St. Louis!

Yummy Allergen-free cookies!

Okay, since I put in a pitch for Girl Scout Cookies, and that left out a chunk of our society that cannot eat them, here is my balancing plug. Gluten-free cookies have become fairly plentiful. In both the major grocery stores where I shop, there is now a gluten-free section that includes breads, pastas, and yes, COOKIES! Certainly, I find a greater selection in Whole Foods or Central market, but HEB and Randalls are steadily catching up.
For the past couple months, I have been trying to follow a gluten-free, casein-free, soy-free diet (long story, but not for weight issues.) I absolutely LOVE baking, and needless to say, skipping wheat flour and dairy limits my standard recipes!
Cheers to Leslie Hammond, author of "Enjoy Life's Cookies for Everyone!" This cookbook is designed to avoid the eight major food allergens: gluten, wheat, dairy, egg, soy, tree nut and peanuts. No small task! As you flip through the book, beautiful pictures have you drooling and dying to make these delicious treats. Leslie does a nice job, too, of letting you know how to stock your pantry (and where to buy these ingredients.)
I am a tough critic on cookbooks, and I will confess the first cookie I made looked spectacular, tasted very good, but was hard as a rock. (I will say, though, I'm going to try it again because it has such potential ;0) The second cookie, however, the "Chompin' Choco Chip Banana Bars" were so good that they disappeared immediately, despite my protests to the rest of the family that these were MY cookies!
BOTTOM LINE: Check out "Enjoy Life's Cookies for Everyone" to make homemade allergen-free treats!