World without wheat

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HEALTHY APPETITES

fitness, nutrition, and lifestyle habits as nature intended Thousands of food products are taboo for millions of Americans who can't tolerate gluten. Should you be going cold turkey on wheat?

WHEAT, ESPECIALLY WHOLE WHEAT, is a cornerstone of a healthful diet. Yet it's problematic — and, at worst, downright dangerous — to those whose immune systems can't handle wheat proteins.

At age 40, Mark Dumas, a California banker and father of two, realized he had lost 25 pounds in 18 months without even trying. He felt OK, but he was getting very bloated after meals, with more and more emergency trips to the bathroom. Tests came back normal, except for a low level of protein in the blood. Finally, his G.P., trained as a gastroenterologist, put the clues together and ordered two final exams. The diagnosis: a genetic autoimmune disorder called celiac disease or celiac sprue.

In celiac, the consumption of gluten, a protein found in wheat and a few other grains, causes the body to attack the intestines. Antibodies produced in reaction to gluten ultimately attack other tissues and organs, such as the liver and skin. Dumas had a rash that doctors insisted was rosacea, which disappeared, along with his other symptoms, once he eliminated gluten.

"Now that doctors are recognizing other symptoms as celiac, they've been diagnosing many more people," says Sara Fazio, M.D., instructor in medicine at Harvard Medical School and a member of the NIH celiac panel.

Once considered rare, celiac disease actually afflicts about l percent of the population, according to a panel convened by the National Institutes of Health this year. Add in people who have wheat allergies or intolerances and you're looking at millions who should pass on the breadbasket. (See "Wheat's Your Problem?" on page 40.)

is it an allergy?
Although a wheat allergy involves the immune system, it's very different from celiac. "In allergies, the body decides — usually in early childhood — that one or more wheat proteins are harmful and it creates IgE antibodies," says Scott Sicherer, M.D., associate professor of pediatrics at Mt. Sinai School of Medicine in New York. "The next time the child eats wheat, the immune system releases massive amounts of chemicals, such as histamine." The resulting symptoms affect the skin, gastrointestinal tract, and/or the respiratory or cardiovascular systems.

More difficult to diagnose are food intolerances. "It could be an allergic reaction or an inability by some people to digest components of wheat properly," says Robert Wood, M.D., professor of pediatrics at Johns Hopkins School of Medicine. Stress also may be a factor.

"For decades, I suffered from nasal congestion and chronic sinusitis, and was given antibiotics that had a profoundly poor effect on my digestion — it just got worse and worse," says Carol Fenster, Ph.D., author of Wheat-Free Recipes & Menus. "Finally, a food allergist suggested I stop eating wheat. It worked; as long as I avoid wheat, I have no symptoms. I don't have a classic allergy, and I don't have celiac, so I must be reacting to wheat in some other way."

traces of wheat
The solution seems obvious: Once you find you have a sensitivity to a food, give it up. But, as Mark Dumas discovered, it isn't easy. "After I was diagnosed, I went to my pantry and there wasn't one thing I could eat," he says. "Everything had a trace of wheat in it — even the vitamins."

Eating out isn't just ordering a burger without a bun. "Most sauces are thickened with wheat," Dumas sighs. "The other day I quizzed a waiter on the halibut, which was topped with sun-dried tomatoes. It sounded good, until it came with the tomatoes encrusted with bread crumbs." He also has to be wary of cross-contamination; for example, french fries, which he can have, may harbor wheat from breaded nuggets cooked in the same oil.

The safest approach is to cook your own food. "Since his diagnosis, I've become a pretty good cook, or at least an inventive one," says Alicia Dumas, Mark's wife. "Most of our meals look like the South Beach Diet: chicken, fish, lots of vegetables. Fortunately, Mark likes potatoes and rice, and I've found a rice pasta that's pretty good, especially if it's smothered in sauce." She even gets separate butter tubs, so no crumbs get in Mark's spread.

The couple scans health-food stores and gluten-free Internet sites. Among their favorite finds: Chopin potato vodka, Newman's Own glutenfree Fig Newmans, and gluten-free frozen entrées from Amy's Kitchen. Baking mixes have been disappointing.

That's why you've got to make them yourself, says Fenster. She's developed a number of wheat-flour substitutes based on corn, rice, or bean flour, sorghum, and potato starch. "My two golden rules of wheat-free baking: Use xanthan gum to prevent foods from crumbling or hardening, and use potato starch, which makes for a light texture," Fenster says. "People often mix this up with potato flour, which is very heavy. Get that one straight!"

wheat-filled
There's wheat in some hot dogs, imitation crab, even ice creams. This summer, legislation was passed requiring that by 2006, food labels must clearly state whether a product contains wheat, peanuts, or other food allergens. Until then, sensitive people must be familiar with the many names indicating the presence of wheat or gluten — including barley, rye, triticale, durum, enriched flour, graham flour, semolina, spelt, kamut, einkorn, farina, and faro. Oats don't contain gluten, but may be grown and processed in conjunction with wheat and could be contaminated. The following items or ingredients contain wheat or gluten:

alcohol made from wheat (beer, ale, and some hard liquors)
beverages and coffee substitutes (like Postum)
bran (except corn bran)
bread crumbs
bulgur
cereal
cereal extract
couscous
cracker meal
gelatinized starch
gravy (thickened with wheat flour)
hydrolyzed vegetable protein
malt
matzo meal
modified food starch or modified starch
monosodium glutamate (used in meat tenderizers and Asian foods)
salad dressings (often thickened with wheat starch)
seitan
soy sauce
surimi
vegetable gum
vegetable starch
Worcestershire sauce
wheat-free
Just because you can't eat wheat, you don't have to — and shouldn't — strike all grains and starches from your diet. Here are options for those with celiac disease. (People with wheat allergy or wheat intolerance, but not those with celiac, can often add barley and rye products, too.)

amaranth (cereal, pasta)
arrowroot flour
bean flour
buckwheat (flour, pancakes, groats)
corn (fresh, flour, bran, popcorn, flakes, grits)
flax (flour and meal)
millet (side dish, flour, cereal)
potato (vegetable, flour)
quinoa (side dish, cereal, pasta)
rice (including hot rice cereal and puffed rice)
sorghum (flour)
soy (flour, hot cereal)
tapioca (pudding, flour)
wheat's your problem?
Negative reactions to wheat run the gamut from mild indigestion to chronic pain to anaphylactic shock. Learn more with our guide to the three most common wheat-related maladies.

Beauty Wisdom — Healthy appetites

wheat-free pizza: SERVES 6
This thin-crust, cholesterol-free pizza with fat-free sauce is one of Carol Fenster's most popular recipes. You can substitute your own favorite gluten-free sauce; just simmer it to thicken before using.

cooking spray
1 tablespoon active dry yeast
2/3 cup brown rice flour or garbanzo/fava bean flour
1/3 cup tapioca flour
2 tablespoons dry milk powder or nondairy milk powder
1 teaspoon xanthan gum
1 teaspoon guar gum
½ teaspoon salt
1 teaspoon unflavored gelatin powder
1 teaspoon Italian seasoning
2/3 cup warm water (110°F)
½ teaspoon sugar
1 teaspoon olive oil
1 teaspoon cider vinegar rice flour for sprinkling Pizza Sauce (see
below) favorite gluten-free pizza toppings
Preheat the oven to 425°F. Spray a 12-inch nonstick pizza pan.
In a medium bowl, using a mixer with regular beaters (not dough hooks), blend the yeast, flours, dry milk powder, xanthan and guar gums, salt, gelatin, and Italian seasoning on low speed. Add the water, sugar, oil, and vinegar. Beat on high speed for 1 minute. If the beaters bounce, the dough is too stiff; add water, 1 tablespoon at a time, until the dough no longer resists the beaters. The dough must be soft. (You may mix the ingredients in a processor for easier blending.)
Place the dough on the prepared pizza pan. Liberally sprinkle the dough with rice flour, then press the dough into the pan, continuing to sprinkle the dough with flour to prevent it from sticking to your hands. Make the edge thicker to contain the toppings.
Bake the crust for 10 minutes. Remove from the oven. Spread the crust with sauce and toppings. Bake for 20 to 25 minutes longer, until the top is nicely browned.
pizza sauce: MAKES ABOUT 1 CUP; 6 SERVINGS
1 8-ounce can tomato sauce
½ teaspoon dried oregano
½ teaspoon dried basil
½ teaspoon dried rosemary
½ teaspoon fennel seeds
1 clove garlic, minced (or use ¼ teaspoon garlic powder)
2 teaspoons sugar
½ teaspoon salt
1 Combine all the ingredients in a small saucepan and bring to a boil over medium heat. Reduce the heat to low and simmer, uncovered, for 15 minutes. Use the sauce to top the pizza crust.

PER SERVING (crust and sauce): 173 calories, 2 g fat, 5 g protein, 39 g carbs, 895 mg sodium, 3 g fiber.
Reprinted by arrangement with Avery, a member of Penguin Croup (USA) Inc., from Wheat-Free Recipes & Menus by Carol Fenster, Ph.D. © 2004 by Carol Fenster.

to your health Alcoholic beverages have traditionally been omitted from the gluten-free diet, says author Carol Fenster, Ph.D., but distilled spirits like scotch and bourbon are safe because gluten peptides cannot survive the distillation process. Beer, on the other hand, contains gluten and is not distilled. Vinegar and liquid vanilla are distilled and therefore safe; however, malt vinegar must be avoided because the barley-flavored malt is added back in after distillation.

For more information, contact the American Celiac Society/Dietary Support Coalition (amefceliacsoc@onebox.com); the Celiac Disease Foundation (celiac.org); the Celiac Sprue Association (csaceliacs.org); the Gluten Intolerance Group (gluten.net); or the National Digestive Diseases information Clearinghouse (digestive.niddk.nih.gov/ddiseases/pubs/celiac). For online grocery shopping, go to glutenfreemall.com, glutensolutions.com, or glutenfree.com.

Legend for Chart
A-
B-celiac disease
C-wheat allergy
D-wheat intolerance
A
B
C
D
what is it?
Intestines treat gluten as an enemy, forming auto-antibodies against it
that rally immune cells to attack the body's own cells and tissues. In
the fray, the intestines become damaged.
The immune system mistakenly responds to wheat as a harmful substance
and creates IgE antibodies to it. The next time wheat enters the body,
an allergic response is triggered.
This is a catchall phrase for reactions to wheat that aren't full-blown
allergic responses and aren't celiac disease.
symptoms
Bloating, diarrhea, vomiting, abdominal pain, and weight loss. "Some
people develop dermatitis herpetiformis [a rash on the extremities],
osteoporosis, anemia, delayed puberty, infertility, vitamin
deficiencies, oral ulcers, depression, and additional autoimmune
disorders," says Sara Fazio, M.D. Left untreated, celiac doubles the
risk of premature mortality.
Itchy tongue, vomiting, diarrhea, hives, eczema, and asthma. At its
most severe, wheat allergy can trigger anaphylactic shock, which can
be fatal. Symptoms usually occur within minutes to two hours after
exposure.
Reactions can be wide-ranging, mimicking conditions like ulcers and
infections, and can take hours to appear, which makes diagnosis
difficult. Common symptoms include fatigue, nasal congestion, hives,
headaches, migraines, stomachaches, itching, eczema, and achy joints.
prevalence
About 3 million Americans have celiac disease, which can strike at any
age.
As many as n million Americans suffer from food allergies. Wheat is one
of the most common irritants.
No exact number for how many people suffer from food intolerances has
been confirmed.
testing
It can take a number of tests to verify celiac, starting with a blood
test for the antibodies TTG or EMA. If your test is positive, the next
step is an upper endoscopy, where biopsies of the small intestine are
taken. Doctors look for shrinking of the villi, hair-like structures
lining the intestines that absorb nutrients, as well as associated
inflammatory cells. If suspect changes are found, and going on a
gluten-free diet clears up your symptoms, you've got a definitive
diagnosis.
For a suspected wheat allergy, doctors recommend the following
tests:
Skin prick. A food extract is placed on your skin, then the area
is scratched. A positive test (you'll get what looks like a mosquito
bite within 15 minutes) may be a sign of wheat allergy.
RAST. A blood test for the specific IgE antibody to wheat.
Oral food challenge. After eliminating the suspected food from your
diet, you eat a tiny bit of it, gradually upping the amount. This is
best done "blinded" (by hiding the flavor in another food or putting
food in a capsule) and only under a physician's supervision.
Probably the best way to test for wheat intolerance is to rotate wheat
in and out of your diet while keeping a food diary to track changes
and reactions. Other common tests for food sensitivities —
including cytotoxicity testing (adding allergens to a blood sample),
sublingual challenge (putting diluted allergen under the tongue), and
the subcutaneous provocation challenge (injecting allergen under the
skin) — are not supported by research, according to the National
Institute of Allergy and Infectious Diseases. The RAST test won't work,
since only allergies produce the IgE antibody. treatment Lifelong
adherence to a gluten-free diet. Avoid wheat and wheat-related grains,
such as barley, rye, spelt, kamut, and triticale. (Oats do not
technically contain gluten, but are often contaminated with wheat during
farming or processing.) Once gluten is out of the diet, 70 percent of
patients have noticeable clinical improvement in about two weeks, says
Fazio, though the intestines may take years to fully recover. Avoid
wheat and wheat-related grains. Epinephrine is used to control severe
allergic reactions. Low-dose immunotherapy stimulates the production of
T-suppressor lymphocytes that reduce allergic reactions. Vitamin C has
natural antihistamine properties; quercetin (paired with bromelain for
better absorption) also may be helpful. Most wheat-allergic children
grow out of the condition. Avoid wheat and wheat-related products. For
mild cases, nutritionists may recommend an elimination/rotation diet, in
which the offending food may be eaten once every four days; over time,
the reaction to the allergen can decrease.
PHOTO (COLOR): Bake a savory wheat-free pizza at home (recipe on page 42).

~~~~~~~~

By Janis Jibrin, R.D.

Photograph by Pornchai Mittoingtare

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