You've just been diagnosed with celiac disease -- most likely after years of stomach pain, irregularity, hazy brain, weight loss; the symptoms seemed endless. Now that you know the reason for your poor health, your first reaction may be relief, but soon the questions will start.
"I didn't know what [celiac disease] was," said Pat Wilke, 55, of Lackawanna, who was diagnosed in August. "All I knew was that I couldn't eat regular food so I was eating salads, fruits, and then I went shopping and bought a couple things gluten-free. I'm slowly working my way around it. The bread is the hardest."
Celiac disease is a genetically linked autoimmune disease with an environmental trigger. Eating certain types of protein -- commonly called gluten -- sets off a response in your body that causes damage to the small intestine and prevents absorption of nutrients, explains Shelly Asplin, nutrition coordinator for Celiac Sprue Association/USA.
Out of all the autoimmune diseases -- diabetes type 1, thyroid, Addison's, rheumatoid arthritis -- celiac is the only one with a treatment, according Dr. Alessio Fasano, director of the University of Maryland Center for Celiac Research.
A gluten-free diet -- containing no wheat, barley, spelt or rye -- is the prescription.
That means no pizza, pasta or pierogi. Beer is out. Most chocolate, too.
What are you supposed to do?
Gather at the table of the gluten-free, and be sure to reserve a seat because the numbers are rapidly growing. In Buffalo, 19,323 people either have celiac disease or are sensitive to gluten. In the past five years, increasing numbers of newly diagnosed have joined the Western New York Gluten-Free Support Group, according to Cliff Hauck, president.
"The environment is changing too fast for people to adapt," said Fasano, explaining the increasing incidence. "Today's grains are different, more toxic. In addition, fermentation that once took 24 hours is now done in three to four hours."
The process of fermentation, Fasano said, reduces or eliminates toxins such as lectins and tannins, and greatly reduces anti-nutrients such as phytic acid and protease inhibitors. It also improves vitamin content.
Fasano, along with Asplin, spoke at a workshop last month that featured a vendor fair and a gluten-free lunch with tiramisu dessert.
Dennis Nahabetian of Orchard Park called the workshop an eye-opener.
"It was very comforting to be around people who completely understood," said Nahabetian, 46. In the past four years, Nahabetian dropped 50 pounds, felt run-down and was often sick. Once his celiac diagnosis was confirmed, Nahabetian launched a gluten-free diet.
The gluten-free diet is highly restrictive, and like many people who are newly diagnosed, Nahabetian has learned through trial and error.
"I love to bake bread and pizza dough," Nahabetian said. "I'm a good baker so I started looking up recipes for celiac bread. Little did I know it was the hardest thing to do. You almost have to be a chemist.
"There's a lot of resistance," he added, "but I made gluten-free mac and cheese and it passed the test: The kids will eat it."
Cutting wheat, barley and rye from the diet poses a costly challenge. Elaine Rothfus, registered nurse and registered dietitian, suggests substituting these grains:
Quinoa: As a seed, it can be used in salads and casseroles; as flakes in hot cereal, and as flour in baked goods blended with other gluten-free flours. It is also made into pasta. Quinoa has more high-quality protein (like dried skim milk) than other grains and cereals. It is also high in iron and is a source of B vitamins, calcium and dietary fiber.
Amaranth: Can be eaten as a hot cereal or as a side dish like rice. At 15 grams of fiber per cup, prepared, it may be too high in fiber during the initial stage of the gluten-free diet. It is also high in protein and iron, and is a source of calcium and B vitamins.
Buckwheat/Kasha: Despite the name it is not related to wheat, but it is a member of the rhubarb family. The kernel is called groats and can be processed in several ways -- as a side dish or hot cereal (cream of buckwheat). Buckwheat is a good source of protein and dietary fiber, iron and B vitamins.
"It initially costs a lot to buy the individual flours to make gluten-free baking flour," said Rothfus. "But compare the cost to that of a five-pound bag of premixed gluten-free baking flour, which ranges up to $14."
The demand for gluten-free products is rising, with their appeal going beyond the ranks of celiac patients. Health-conscious eaters and parents of autistic children have also helped to boost sales of gluten-free products by 20 percent in the past five years, according to the National Foundation for Celiac Awareness. More than 1,000 new gluten-free foods and beverages were introduced in 2008.
The U.S. Food and Drug Administration is in the final stages of establishing a definition for "gluten-free" to be voluntarily used by food manufacturers on product labels. It would assist those who have celiac disease and their caregivers to more easily identify packaged foods that are safe to eat.
> Strawberry Almond Torte
Nonstick cooking spray
2 cups gluten-free flour mixture
1/2 teaspoon salt
1 teaspoon baking soda
3 teaspoons baking powder
1/2 cup plus 1/3 cup butter, softened
1 1/4 cups granulated sugar
2 teaspoons vanilla
2 tablespoons mayonnaise
2 tablespoons orange juice
1 cup plus 1 to 2 tablespoons whole milk
4 ounces almond paste
1 tablespoon amaretto (or milk)
1 1/2 pints strawberries, sliced, sweetened with 1 tablespoon sugar
1 8-ounce container nondairy whipped topping, thawed
Preheat the oven to 350 degrees. Spray two 9-inch cake pans with flour-free cooking spray.
In a medium bowl, sift together the flour mixture, salt, baking soda and baking powder. Set aside.
In a large mixing bowl, use the mixer to cream 1/2 cup of butter and the sugar together until they're fluffy. Add the eggs, one at a time, mixing well. Blend in the vanilla, mayonnaise and orange juice. (The mixture may look curdled.)
Slowly add the dry ingredients alternately with 1 cup of milk, blending well.
Spread the batter in the prepared pans. Bake the batter at 350 degrees for 25 minutes, or until a toothpick inserted in the center comes out clean. Cool the cakes completely before filling the layers.
Break the almond paste into small pieces and place it in a small mixing bowl. Use the mixer to whip together the almond paste and the remaining 1/3 cup of butter on low speed until the ingredients are blended. Whip in the amaretto (or milk) and the remaining 1 to 2 tablespoons of milk until the paste mixture is of spreading consistency.
Place 1 cake layer on a serving dish. Spread the almond paste mixture over that layer. Top the paste with half of the whipped topping and then half of the strawberries.
Place the second cake layer on top of the first. Spread it with the remaining whipped topping, and arrange the remaining strawberries in an attractive pattern on top. Cover and refrigerate.
Per serving: calories: 204; total fat: 22g; saturated fat: 13g; cholesterol: 107mg; sodium: 466mg; carbohydrates: 59g; fiber: 3g; sugar: 31g; protein: 5g.
(From "Gluten Free Cooking for Dummies," Wiley)