APRIL 2017

an e-Magazine of the Gluten Intolerance Group

APRIL 2017

A magazine intended to educate and support individuals with celiac disease and other gluten-related disorders. National Office: Monday-Friday 8am-4pm PST 31214 124th AVE SE Auburn, WA 98002 P: (253) 833-6655 F: (253) 833-6675 www.gluten.org [email protected]

GIG Board of Trustees: Chairperson: Kim Kelly Chair of Assessment: Kim Kelly Vice Chairperson/Finance Committee: Michael Campbell

Vice Chairperson / Assessment Committee:

Magazine Staff: CEO: Cynthia Kupper Publisher: Nichol Creach Editors: Lola O’Rourke, MS, RDN Michelle Spano Graphic Designer: Nichol Creach

Medical Advisory Board: Adult GI: Joseph Murray, MD (Rochester, MN) Michael Schuffler, MD (Seattle, WA) Cynthia S. Rudert, MD, FACP (Atlanta, GA)

Pediatric GI: Alessio Fasano, MD (Boston, MA) Chair of Planning and Resources Ivor Hill, MD (Winston-Salem, NC) Committee: Eric Zitaner Edward Hoffenberg, MD (Denver, CO) Secretary: Madelyn Smith Michelle Pietzak, MD (Los Angeles, CA) Treasurer: Jonyce Bullock Dentistry: Board Members at Large: Cindy Hylton, DMD (Mt. Pleasant, SC) Patrick Deglon

Adele Fosser Christopher Rosbough Gary Gracia Niraj Jetly Ondina Grigorescu Shelia Cafferty

Nutrition: Shelley Case, B.Sc., RD (Canada) Mary K. Sharrett, MS, RD (Columbus, OH)

The Mission of the Gluten Intolerance Group is to empower the gluten-free community through consumer support, advocacy, and education. The content of this magazine has been reviewed by a health professional; however this does not substitute for consultation with your personal physician or other healthcare professional. Advertisers agree to adhere to the Gluten Intolerance Group standards for advertising when purchasing space in this publication. Business of the Gluten Intolerance Group is conducted on behalf of its members by the Board of Trustees.  Opinions expressed in this publication do not necessarily reflect those of the Gluten Intolerance Group. Affiliate Relationships: GIG is an active member of the following organizations as a representative and for the benefit of all persons with celiac disease and other gluten-related disorders: American Autoimmune Related Diseases Assoc. (AARDA) Dietitians in Gluten Intolerance Diseases (DIGID) National Institute of Arthritis, Muscular and Skeletal Diseases (NIAMS) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) To subscribe to this magazine click here. If you would like to request permission to reproduce an article from this publication, please send inquiry to [email protected].

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THE MEDITERRANEAN DIET

KITCHEN TOOLS TO REPLACE

NABISCO RITZ CRACKERS, ORIGINAL*

SCHÄR

VEGETABLE & CHEESE FRITTATA

MEXICAN FOOD

PLAY BALL

RICE IN THE GLUTEN-FREE DIET

RESEARCH UPDATE

CELIAC AWARENESS MONTH

CELIAC DISEASE FACTS

The Mediterranean Diet By Katherine Ratliff, MS The Mediterranean diet has become a popular way of eating for many, and for good reason. Since the 1980s, research has consistently shown the Mediterranean diet to be one of the most successful and sustainable diets to support overall health and wellbeing. If following a Mediterranean-style diet in addition to a gluten-free diet sounds intimidating, fear not. There are many ways to incorporate lessons from the Mediterranean that can improve your health without requiring too much additional time or effort. In fact, it’s a natural fit in many ways, since so many components of the Mediterranean diet are naturally gluten-free. Based on traditional eating patterns of this region, the Mediterranean diet emphasizes plant-based meals with a focus on vegetables, 5

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fruits, whole grains, legumes, fish, nuts, and olive oil. In addition, regular physical activity and meals spent with family and friends are also at the center of a Mediterranean lifestyle. It is believed to be this combination of diet and lifestyle that provides many of the health benefits attributed to the Mediterranean diet. Health Benefits Associated with the Mediterranean Diet For those with celiac disease, controlling inflammation through a gluten-free diet is key to healing and optimizing health. While removing gluten is essential to controlling the autoimmune, inflammatory processes of celiac disease, including healthy foods such as those from the Mediterranean diet can also help keep inflammation at bay.

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The anti-inflammatory nature of the Mediterranean diet also supports the cardiovascular system and heart health. One major study assessing the health outcomes of the Mediterranean diet found that adherence to this style of diet was associated with a 39% reduction in stroke risk, compared to a lowfat diet. An additional study using the same data also found that individuals following the Mediterranean diet showed improvements in blood sugar control, blood pressure, inflammation, and cholesterol levels. More recent studies have examined the benefits of a Mediterranean diet beyond heart health. A meta-analysis of 12 studies with over 1.5 million subjects found that greater adherence to a Mediterranean diet is associated with a significant improvement in health, including a 6% reduction in incidence and mortality of cancer and 13% reduction in incidence of Parkinson’s and Alzheimer’s diseases. Furthermore, a 2017 article published in the Journal of Neurology found those who more closely follow a Mediterranean diet were less likely to lose brain volume as they age. A Gluten-Free Mediterranean Diet Being gluten-free can easily fit in with a Mediterranean-style diet, and as discussed above, a Mediterranean diet provides many additional health benefits for those who are gluten-free. While traditional Mediterranean fare focuses on whole grains, including whole wheat bread and pasta, there are many other delicious gluten-free whole grains that can and should be included. Whole grains Quinoa, amaranth, buckwheat, millet, and brown rice are all excellent gluten-free whole grains. In their whole forms, these grains provide fiber, B-vitamins, magnesium, iron, 6

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and selenium. Wheat-based products that are not whole grain are often fortified with some of these nutrients to make up for the vitamins and minerals lost during processing. Unfortunately, gluten-free products that are not whole-grain are generally not fortified with the same nutrients. Therefore, choosing whole grains is even more essential to support health and prevent nutritional deficiency. When grocery shopping, look for breads and pastas made with gluten-free whole grains such as quinoa. Chickpeas, part of the legume family, can also make excellent gluten-free Mediterraneanstyle products and are a great way to add more protein to your meals. Look for pasta made with chickpea flour or try making your own Socca, a Mediterranean gluten-free flatbread. Scroll down to the bottom for more Mediterranean-style recipes and ideas.

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Vegetables and Fruits Including a wide variety of fresh fruits and vegetables is at the core of the Mediterranean diet. In fact, residents of Greece often consume nine servings of fruits and vegetables per day. If this sounds overwhelming, start by aiming for ⅓ to ½ your plate fruits and vegetables at every meal and you’ll be well on your way. Fruits and vegetables are rich in fiber, vitamins, minerals, and phytonutrients, including antioxidants. These all play an important role in supporting overall health and preventing disease.

and poultry at least twice a week. Legumes, including lentils and beans, are good sources of protein, and are also abundant in fiber and B-vitamins. In fact, it is likely the inclusion of high fiber foods, such as legumes, whole grains, and vegetables that play such an important role in the heart health benefits of the Mediterranean diet.

Given the region's proximity to fresh seafood, it is no wonder that consistent intake of fish is such an important aspect of the Mediterranean diet. Seafood, especially fatty fish such as salmon, mackerel, and tuna, are Eat the rainbow. Fruits and vegetables excellent sources of omega 3 fatty acids. get their color from their vitamin and These essential fats play an important role in phytonutrient content. For instance, orange- reducing inflammation and supporting brain colored vegetables, such as carrots and health. Looking for a simple yet delicious sweet potato, contain a nutrient called beta- way to prepare fish? Check out the fish en carotene, which supports your eye, heart, and papillote recipe at the end of this article. immune function. A colorful plate is a simple way to help ensure you are meeting your Healthy Fats micronutrient needs. Olive oil is likely the most well-known component of the Mediterranean diet. Protein However, it is not the only fat that A Mediterranean diet emphasizes plant-based contributes to the Mediterranean’s health protein sources with the inclusion of fish benefits. Nuts, seeds, and avocado also

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to the Mediterranean diet. Research has shown that antioxidants, including a specific polyphenol called resveratrol, may provide the health benefits associated with red wine. Polyphenols, a type of phytonutrient, may reduce cardiovascular disease risk by protecting the lining of blood vessels. In addition, studies have found that all types of alcohol support heart health by reducing LDL and increasing HDL cholesterol. Despite the above potential benefits, it is important to note that current research does not recommend starting to drink to prevent heart disease.

play a large role. Abundant in mono- and polyunsaturated fats, these foods support heart health by reducing LDL cholesterol, lowering triglyceride levels, and improving blood flow and vessel health. Olive oil also contains specific phytonutrients called phenols that are believed to provide additional benefit. It is these phenolic compounds that also give olive oil its distinct grassy taste. When purchasing olive oil, look for extra virgin olive oil to ensure all the valuable antioxidant-rich phytonutrients are still present. Labels such as "light" or "extra light" refer to oils that have undergone more processing, which reduces, if not destroys, the phenolic compounds naturally found in olive oil. Red Wine Some research indicates that red wine, when consumed in moderation (1 drink/ day for women and 2 drinks/day for men), provides additional heart health benefits 8

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10 Tips for Starting a Gluten-Free Mediterranean Diet Make half your plate produce: Choose a variety of colorful fruits and vegetables to allow for a diverse array of micronutrients. Snack wisely: Pick whole foods such as fresh fruits and vegetables, nuts, and seeds as snacks. These nutrient-rich foods will keep you feeling full and satisfied between meals, while also providing your body with the beneficial nutrients that make the Mediterranean diet so healthy. Choose whole grains: Start by making a large batch of a gluten-free whole grain for the week. Use your creativity skills and see how many different ways you can use this grain. Need ideas? Check out the GIG Whole Grain webpage (https://www.gluten.org/resources/ diet-nutrition/gluten-free-grains/ ). Try Meatless Mondays: If including more plant-based meals sounds intimidating, start with one meal a week. Meatless Mondays can be a fun way to involve your friends and family in your new endeavor. Try making black bean tacos or homemade lentil patties. Include healthy fats: Cook with avocado oil (high heat) and olive oil (low-moderate heat) to incorporate more heart-healthy fats into your meals. Choose nuts and seeds as snacks. Try a new type of seafood each month. A PR I L 2 0 17

Sip on hydrating fluids: Staying hydrated is key to a healthy and happy digestive system. A Mediterranean diet is naturally high in fiber. To help keep things moving, make sure to enjoy hydrating fluids, such as water and tea, throughout the day. Spice it up: Add flavor to dishes by using fresh or dried herbs and spices, rather than salt. This will provide more depth to your meal, while also reducing sodium content. Try one new recipe each week: Following a gluten-free diet can be challenging enough, let alone adding an additional layer. Start gradually by including one new Mediterranean-style recipe each week. This way you can slowly build up your repertoire without becoming overwhelmed. Enjoy food with family and friends: Community is key to creating successful and sustainable habits. Whether you are enjoying a meal with your family or meeting other gluten-free individuals, building community allows a meal to be both nutritional and emotional nourishment. Include joyful movement daily: You don’t have to go to the gym every day to stay active! Find a form of movement that brings you joy. Whether it’s dancing, yoga, hiking, or biking, finding physical activity that you enjoy will help you develop a life-long habit.

References: −− Cardiovascular benefits and risks of moderate alcohol consumption. Up to Date. https:// www.uptodate.com/contents/cardiovascularbenefits-and-risks-of-moderate-alcoholconsumption. Accessed March 16, 2017.

Recipes Socca Flatbread http://nourishedkitchen.com/socca-recipe/ or https://iquitsugar.com/recipe/caramelisedleek-apple-rosemary-socca/ Tuna and White Bean Salad with Kale Pesto http://sweetcayenne.com/tuna-and-whitebean-salad-with-kale-pesto/ Fish en Papillote https://www.fromachefskitchen.com/ mediterranean-fish-en-papillote/

−− Mediterranean Diet. Oldways. https:// www.oldwayspt.org/traditional-diets/ mediterranean-diet. Published 2015. Accessed March 16, 2017.

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−− De Lorgell M, Salen P, Martin J, Monjaud I, Delaye J, Mamelle I. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after 1 myocardial infarction. Final report of the lyon diet heart study. Circulation. 1999;9(4). doi:10.1097/00019616-199907000-00016. −− Estruch RCB, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New England Journal of Medicine. 2013;368(14):1279-1290. doi:10.1056/nejmoa1200303. −− Luciano M, Corley J, Cox SR, et al. Mediterranean-type diet and brain structural change from 73 to 76 years in a Scottish cohort. Neurology. 2017;88(5):449-455. doi:10.1212/wnl.0000000000003559. −− Mediterranean diet: A heart-healthy plan. Nutrition and healthy eating. Mayo Clinic. http://www.mayoclinic.org/healthy-lifestyle/ nutrition-and-healthy-eating/in-depth/ mediterranean-diet/art-20047801. Published May 3, 2016. Accessed March 16, 2017.

−− Mozaffarian, D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation. 2016; 133:187-225. −− Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. British Medical Journal. 2008;337(sep11 2). doi:10.1136/bmj. a1344. A PR I L 2 0 17

The Tools to Replace in Your Gluten-Free Kitchen You ditched the bread, nixed the crackers, and are a label-reading expert. However, gluten may still be lurking in your life if you have not replaced these items. Buy new and distinguish them as your gluten-free arsenal to keep yourself safe from contamination from previous use. WOODEN UTENSILS Wood is tricky to clean (the same reason why wooden cutting boards are not ideal for cutting raw chicken). Even in the dishwasher, the wood fibers could harbor sticky gluten and enter your food with the next stir.

CUTTING BOARDS No matter what they are made of, be cautious of cutting boards. While germs can be cleaned from them, gluten settled into crevices may not. Do not take a risk and use your former bread board with your new gluten-free loaf or fresh veggies.

COLANDERS, STRAINERS, & FLOUR SIFTERS We are sure you do not scrub each hole individually, right? Starchy pastas can leave residue behind and it is not worth the risk, especially with tiny, mesh-like strainers.

TOASTER We know, a whole new toaster?! Trust us, this one tops the list; those crumbs will stick to your bread—and then your insides! You can also try toaster bags, but for around $10, a new toaster is better for peace of mind (and body).

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NONSTICK PANS Nonstick coatings scratch over time, no matter how careful you may be. The same way gluten sneaks into crevices on cutting boards, it can settle in there.

WOODEN ROLLING PINS Great Aunt Gertrude will understand that her generations-old rolling pin is now a relic. Pushing flour into that wood all those years could spell disaster for your gluten-free pies.

Use with Caution CAST IRON The jury is still out on whether gluten clings to cast iron. Due to the nature of typically washing without soap and texture of the iron, it may be worth investing in another.

WAFFLE IRON Waffle irons can be tricky to clean with all those grooves. Unless the plates come out and go in the dishwasher, you may want to buy another.

POT HOLDERS/OVEN MITTS You may not remember touching the crust of that pizza when you pulled it out of the oven, thanks to that handy oven mitt! However, you may not realize that same mitt touched your gluten-free pizza later on. Wash in between use or buy separate ones.

MUFFIN TINS & CAKE PANS These can be tricky to clean and really get into every crevice, mostly due to their shape and design. If you really do not want to buy a new set, your best defense is to use cupcake liners and parchment paper.

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Nabisco Ritz Crackers, Original* Directions 1. Preheat your oven to 375°F. Line rimmed Light, buttery, and salty Ritz crackers are baking sheets with parchment paper and quite possibly the best cracker to pair with set them aside. cheese. Imagine the surprise of your guests 2. In a large bowl, place the flour, baking when they see gluten-free you munching powder, sugar, paprika, and ¼ teaspoon on one of these with a nice slice of Gouda. of kosher salt, and whisk to combine well. Using a pastry blender or two Ingredients 1 cup (140 g) all-purpose gluten-free flour knives, cut the chopped, chilled butter 1 ½ teaspoons baking powder into the flour mixture until it resembles ½ teaspoon (6 g) granulated sugar small pebbles. Add the vegetable oil and ½ teaspoon smoked Spanish paprika stir to combine. Add ¼ cup of the water, ¼ teaspoon kosher salt, plus more for stirring until the dough begins to come sprinkling together. Add more water by the half4 tablespoons (56 grams) unsalted butter, teaspoonful as necessary to bring the chopped and chilled dough together. Transfer the dough to 1 tablespoon (14 g) canola oil a piece of plastic wrap, and place in the ¼ cup to ½ cup (4 to 8 fluid ounces) cold refrigerator to chill for about 10 minutes. water 3. Remove the dough from the refrigerator, 2 tablespoons (28 g) unsalted butter, place between two large sheets of melted unbleached parchment paper, and roll Makes about 25 crackers

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out until a bit more than ⅛ inch thick. Using a scalloped-edge 1 ¾-inch round cookie cutter, cut out shapes. Place about 1 inch apart from one another on the prepared baking sheets. With a toothpick, poke four to six holes in each cracker, toward the center to help them rise. Gather and reroll the scraps to cut out more crackers until you’ve used up the dough. 4. Place the baking sheets, one at a time, in the center of the preheated oven and bake until the crackers are just beginning to brown, about 7 minutes. Remove from the oven, brush the crackers with the melted butter, and sprinkle with salt. Allow to cool on the baking sheet. They will crisp as they cool. The crackers can be stored in a sealed glass container at room temperature and should maintain their texture for at least 5 days. For longer storage, seal them tightly in a freezer-safe wrap or bag, and freeze for up to 2 months. Defrost at room temperature. Excerpted from Gluten-Free Classic Snacks: 100 Recipes for the Brand-Name Treats You Love by Nicole Hunn. Copyright © 2015. Available from Da Capo Lifelong Books, an imprint of Perseus Books, LLC, a subsidiary of Hachette Book Group, Inc. *Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book and Da Capo Press was aware of a trademark claim, the designations have been printed in initial capital letters.

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Schär

Best in Gluten-Free! In 1922 Dr. Schär began developing products aimed at promoting a healthy diet for young children with digestive disorders. The company’s expertise contributed to the development of the first high-quality glutenfree foods and beginning in 1981, working in close collaboration with doctors and celiac organizations, was developed into a full range of gluten-free products. This is when Schär was born. With a dedicated focus on the development and production of gluten-free foods, the company became a market leader in Europe just a few decades later. Today, Dr. Schär is getting even closer to its goal of becoming the leading food specialist for special dietary and nutritional needs in Europe, and now in the US & Canada as well. Our success has been driven by two things: firstly, to offer solutions to the dietary problems people with gluten intolerance have to face (particularly regarding the choice & availability of relevant products), and secondly, to constantly satisfy the need for the best possible quality and to improve this constantly. As a pioneer in the area of gluten-free nutrition, Dr. Schär has highly valued well-founded research and development right from the very beginning. While our research team concentrates on long-term strategic projects and investigates new raw ingredients and technologies, our 14

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development team creates more than 30 new or improved products and recipes each year. Of course, before any new product goes into production, it is tested by trained testers for flavor, perfect texture, aroma, and appetizing appearance. Each of our gluten-free products is always benchmarked against the best tasting conventional foods in every category. This is the only way to ensure that our consumers are always completely satisfied – from gluten-free pizza to a comprehensive product line of breads, pasta, cookies, and crackers. Schär currently has over 40 products in its portfolio for the US. You might have heard of our famous Artisan Baker bread, or our delicious Honeygram cookies. Be sure to look for us in your local grocery store, or let your Store Manager know that you want more Schär! We hope you enjoyed Schär’s history. Be sure to visit our website at www.schar.com to learn more about our products, see our recipes, and read our articles about a glutenfree lifestyle. You can even use our store locator, which is found by scrolling down on our Home Page. For even more info, giveaways, ‘Ask a Dietitian’ events, and more, follow us on Facebook and Instagram! A PR I L 2 0 17

Vegetable & Cheese Frittata Serves 8-10 people Ingredients 4 potatoes, cubed and par-boiled 2 Tbsp butter 1 Tbsp vegetable oil 6 slices American cheese ½ cup cheddar cheese ½ cup grated parmesan cheese ⅓ cup diced onion 1 head of broccoli, chopped into bite-size pieces 1 cup grape tomatoes Salt, pepper, and garlic powder to taste 10 eggs 2 cups baby spinach ¼ cup heavy cream or milk (optional) Directions Par-boil cubed potatoes until tender when poked with fork and grate cheese. 15

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In a large frying pan, heat butter and oil until pan is hot. Add onion to pan, sauté and add potatoes; cook for 8-10 minutes until crispy. Add broccoli and cook for a few minutes until tender. Add tomatoes and cook until softened. Add some garlic powder to taste. While the vegetables cook, beat eggs in a large bowl until fluffy, about 2 minutes. Stir in spinach, heavy cream/milk, and all cheeses to eggs. Turn heat to low and add egg mixture to pan, using spatula to move eggs around to cook evenly. Add salt and pepper to taste, cover and let cook for at least 5 minutes on low. When eggs look set on the bottom, use a plate large enough to hold the frittata and cover the pan and place it face side down over frittata. Flip the frittata onto the plate, then slide it back into the pan to cook the other side. Cover and cook for a few more minutes until set. Slice and serve warm. A PR I L 2 0 17

Mexican Food

Healthy, Delicious– & (Mostly) Gluten-Free! Whether you are in the mood for that flavorful zing, celebrating Cinco de Mayo, or are just looking to spice up your diet, Mexican food has a lot to offer. Did you know most Mexican food is naturally gluten-free? With simple, inexpensive ingredients and tons of options, it is one of the most versatile cuisines for those who are gluten-free. Follow us south of the border to uncover all that Mexican food has to offer! Beans Beans are a core staple in many Mexican dishes, and for good reason. They are packed with protein and fiber, keeping you full and satisfied for hours, and don’t break the bank! Beans are one of the best ways to elevate your meal to the next level nutritionally, sometimes for less than a dollar a can! It’s great to keep some cans on hand for last minute dinner prep, but for even better flavor and savings, cook up a batch of beans at home: you’ll be surprised at how simple it is. Lean Meats Slow cooked chicken, ground beef, and pork are meats that lend themselves nicely 16

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to Mexican dishes. Many dishes have sauces, rice, and vegetables. A little meat goes a long way. Corn Tortillas Perhaps one of the most iconic and versatile components of Mexican cuisine is the corn tortilla. Made from ground corn and naturally gluten-free, the possibilities are endless. You can use them as a wrap around your favorite fillings, make melty quesadillas, or even fry or bake them to make crispy taco shells! Rice White, yellow, or brown, rice is a hearty addition to Mexican dishes. Many people enjoy it mixed with beans and seasoning as a side dish, but a current trend is using rice as a base for burrito bowls—essentially deconstructed burritos in bowl form! Start with rice, toss in your favorite vegetables, protein, salsa, beans, and cheese, and you have a simple meal that does double duty for lunch and dinner all throughout the week. Salsa A classic condiment for virtually any Mexican food, what’s not to love: big on flavor and nutrition and low in calories. 17

With so many variations to choose from (green, pico de gallo, mango) you’ll never run out of options and may just start having salsa alongside other everyday meals too. Cheese While Mexican food is flavorful enough to go without cheese, many people love the contrast of creamy, melty cheese to the spice of Mexican food. It’s also another source of protein. Bonus: the dairy in cheese can also combat some of that spice if things get a little too heated. Vegetables Vegetables are a big component in Mexican food, and are usually cooked and flavored so wonderfully that you don’t resent eating them. Peppers cooked to perfection in spices, sautéed onions, zesty tomatoes… these are veggies done right. Spices Jalapeño, chipotle, cumin, cilantro, serrano – our mouths are on fire just thinking about these spices unique to Mexican food! A little goes a long way, and can take a bland meal of chicken, rice, and beans and transform it into a showstopper.

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Play Ball!

Finding the Best Gluten-Free Options at the Ballpark By Chris Rich, Vice President of Development, GIG

I am at peace on a baseball diamond. I don't know if this comes from the four years that I played baseball when I was a kid, the recent years that I have coached both my son's baseball and my daughter's softball teams, or a combination of both. Whatever the source, there is something about watching a game on a summer's day, be it from the dugout or from a bleacher seat at my favorite team's cathedral-like stadium, that takes all of my worries away. The recent start of this season has been a mix of emotions for me. The Chicago Cubs, a team that I have followed for the past 20 years, are defending World Champions (something that no one has said for over a century). My Cubbies friends and I have been riding a wave of euphoria for the past five months and getting to watch them play again helps to renew those memories of an unforgettable season. On the flip side, my son, after playing baseball for the past eight years, has been recruited by his school volleyball coach to play a sport that better takes advantage of his physical attributes. I'm so proud of him trying something new and instantly succeeding but the baseball fan in me was a little sad in seeing him hang up his cleats for the last time. 18

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Regardless, he and I can still go to baseball games and we love to do so any chance that we get. We have a minor league team in our town but several major league teams surround our area. Even my Cubs are a reasonable distance away and often travel to play the teams located closer to us. My son and I have so much fun going to games that we have made a pact to try to make it to all 30 major league ballparks together during the course of our lives. A tall task but a wonderful thing to think about. What we do have to take into consideration when planning these visits is my son's gluten-free diet, as he was diagnosed with celiac disease in 2013. Most ballparks have the basic stadium food, some of which is safe for anyone following a gluten-free diet. Options include Cracker Jacks, cotton candy, peanuts, bottled water, and soda. It is nice to have these "fallback" options but many stadiums have seen and heard the needs of the gluten-free community and are adding more variety to their offerings. Below is a listing of some of the standouts, as taken from GlutenFreePhilly.com and the official web sites of these major league baseball teams. A PR I L 2 0 17

Chicago Cubs at Wrigley Field Of course I'm starting with the Cubs. They are my and my son's favorite team and we had the privilege of going to a game there last year for his birthday. The Cubs have bun-less hot dogs and bun-less hamburgers located behind a designated section at Wrigley but the hidden gem is Decades Diner. Located on the main concourse towards the corner in right field, the Decades Diner serves gluten-free hot dogs, hamburgers, and chicken sandwiches. Though my son is not old enough to drink, I did note that they also serve up some hard ciders at the Diner bar area. Gluten-free and a Cubs win? Yes, please.

Toronto Blue Jays at Rogers Centre We go North of the Border for this stadium's excellent gluten-free options. Thanks to a variety of gluten-free beers, beef brisket, jerk chicken, fresh whole fruit, and three bean chili, Canada's pro team is doing gluten-free the right way.

Los Angeles Angels at Angel Stadiums of Anaheim The Angels have added some variety to their food court items located behind first and third base at their ballpark. Options include a veggie dog, black bean burger, and the reason that this stadium makes the list, a hummus platter!

Baltimore Orioles at Orioles Park at Camden Yards Last, but definitely not least on this list, are the gluten-free offerings at Camden Yards. Located right near the Baltimore Harbor, this ballpark offers some mindblowing options. Bacon on a stick, beef & steak tacos, Pad Thai, gluten-free pizza, BBQ turkey, beef, and pork sandwiches... wow. This is one stadium that does not disappoint.

Texas Rangers at Globe Life Park in Arlington The Rangers aren't messing around when it comes to healthy gluten-free options. If you are looking for something "less processed", you can find gluten-free wraps, fresh fruits, salads, pistachios, and beef jerky. Oh yeah, they also have gluten-free cookies available if you are craving a sweet treat. Minnesota Twins at Target Field Not only do the Twins have bun-less hot dogs and grilled chicken throughout the park, but you can also get gluten-free options such as Kettle Chips, Talenti Gelato and...wait for it....a pork chop on a stick! 19

Los Angeles Dodgers at Dodgers Stadium It sounds like if you are a gluten-free baseball fan in the Los Angeles area, your teams are treating you the right way. Joining the Angels on this list, gluten-free offerings at Dodger stadium include corn on the cob, veggie wraps, tacos, and sushi (without the soy sauce, of course).

I've only highlighted 7 of the 30 major league baseball parks but all of the team's stadiums list some type of specialty diet concessions on their websites. Does your major league team have some great gluten-free options that I didn't find or mention here? If so, let me know at chris. [email protected]. I would love to have the opportunity to experience your favorite gluten-free ballpark food with my son when we travel to your city.

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Rice in the Gluten-Free Diet Virtually every nutritionist will agree that variety is one cornerstone of a healthy diet. Consumption of a wide variety of foods helps ensure adequate nutrient intake. Variety also reduces risk of potential effects related to negative characteristics of any one particular food. Most of us realize that enjoying a decadent high fat dessert every once in a while is okay, but that doing so on a regular basis would likely have adverse effects related to too much fat and calorie intake. Is rice something that consumers also need to be aware of in this regard? Some research has indicated this may be the case. In the case of rice, it is not nutrients that are of concern, but potentially harmful levels of heavy metals. And since rice is a commonly consumed gluten-free grain, this question is especially relevant for those of us who are glutenfree. Even if a bowl of rice is not something you regularly consume, you may be eating more than you think in the form of glutenfree processed foods. It is known that rice contains higher levels of arsenic, as well as other heavy metals such as mercury, than do other grains. At the same time, it is known that these heavy metals can have adverse health effects, depending upon levels of exposure, specific types of substances, and other factors. So, are these levels of arsenic and other metals in rice something which should be of concern to rice eaters? To start with, why 20

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do these metals accumulate more in rice? Arsenic is an element and can be present in water and soil. It is known that rice generally contains higher levels of arsenic and various other heavy metals than other foods, due to the plants' capacity to absorb these elements more efficiently from soil and water. Levels vary among different types of rice, and depending upon where the rice was grown. Since rice is often a mainstay of a glutenfree diet, the question has been posed by researchers of whether those on a gluten-free diet actually have higher accumulated levels of these metals in their systems. One recent study looked at data from 7,471 participants in the National Health and Nutrition Examination Survey (NHANES); of these, 1.2% self-reported that they were on a gluten-free diet. The researchers looked at both urinary and blood biomarkers of exposure to toxic metals, and found higher concentrations of arsenic, cadmium and mercury among those who were on a gluten-free diet. The authors speculate that rice may be contributing to these higher levels of metal biomarkers. The researchers also note that the health implications of low-level arsenic and mercury exposure from food sources are uncertain, but that additional future studies are warranted. Another study which also utilized NHANES data looked at brown and white rice consumption in relation to urinary arsenic levels. This study group consisted of 6,677 adults. Results showed that consumption of both types of rice was associated with higher levels of urinary arsenic. These researchers also note, however, that additional studies and data are needed to verify their findings. 21

More research is needed to learn more about the potential risk of arsenic and other heavy metals in rice. In the meanwhile, a prudent course of action is to avoid over-reliance on rice. When you do cook rice, arsenic levels can be reduced by rinsing the rice prior to cooking, and cooking in a large quantity of water (six to one ratio) and draining before consumption. When it comes to dinner side dishes, there are numerous delicious and nutritious alternative options now widely available: millet, quinoa and teff, for example, can be easily found and prepared. And fortunately, many gluten-free processed foods now utilize other grains in addition to or in place of rice, including sorghum, quinoa, teff and amaranth. Find more information on gluten-free grains and how to prepare them here. https://www. gluten.org/wp-content/uploads/2016/05/ EDU_GFGrains_4.25.16.pdf. References −− Bulka CJ, et al. The Unintended Consequences of a Gluten-Free Diet. Epidemiology Publish Ahead of Print. DOI: 10.1097/EDE.0000000000000640 −− Raehsler SL, Choung RS, Marietta EV, Murray JA. Accumulation of Heavy Metals in People on a Gluten-Free Diet. Clin Gastroenterol Hepatol. 2017 Feb 18. pii: S1542-3565(17)30186-6. doi: 10.1016/j. cgh.2017.01.034. [Epub ahead of print] −− Tchounwou PB, Yedjou CG, Patlolla AK, Sutton DJ. Heavy Metals Toxicity and the Environment. Molecular, Clinical and Environmental Toxicology. Volume 101 of the series Experientia Supplementum pp 133-164, 24 April 2012. −− U.S. Food & Drug Administration. Arsenic in Rice and Rice Products. 2016. https://www.fda.gov/food/ foodborneillnesscontaminants/metals/ucm319870. htm. −− Wu, Hongyu; Grandjean, Philippe; Hu, Frank B.; Sun, Qi. Consumption of White Rice and Brown Rice and Urinary Inorganic Arsenic Concentration. Epidemiology: November 2015 - Volume 26 - Issue 6 - p e65–e67 doi: 10.1097/EDE.0000000000000369

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Research Update Screening at-risk children for celiac disease This study was undertaken to assess whether children at risk for celiac disease should be systematically screened. The researchers’ approach was to compare characteristics of at-risk children who were diagnosed through screening, to patients who were diagnosed because of clinical symptoms. 504 children with celiac disease were divided into two groups: screen-detected and clinically detected. No differences were found in serology (blood tests for antibodies) or histology (endoscopy results) between the two groups. More than half of the screen-detected patients had symptoms which were unrecognized at diagnosis. These results support active screening among children who are genetically at risk of developing celiac disease.

Adolescents with celiac disease: risk of other diseases This study looked at comprehensive medical data on a large group of Israeli adolescents: 7,145 with celiac disease, and 1,580,896 controls. Data analyses showed that autoimmune diseases, as well as some other conditions, were significantly more common in teenagers who had celiac disease. These conditions included insulin dependent diabetes, inflammatory bowel diseases, arthritis, thyroid diseases, psoriatic skin disorders, asthma, migraines and menstrual abnormalities. Bone fractures, on the other hand, were not found to be more common among those with celiac disease. These data indicate that even as early as adolescence, celiac disease is associated with other diseases and conditions, and that these are not limited to auto-immune disease.

Kivelä L, Laukinen K, Huhtala H, Lähdeaho ML, Mäki M, Kurppa K. “At Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study.” J Pediatr 2017 Apr;183:115-121.e2. doi: 10.1016/j.jpeds.2016.12.077. Epub 2017 Jan 30.

Assa A, Frenkel-Nir Y, Tzur D, Katz LH, Shamir R. “Large population study shows that adolescents with celiac disease have an increased risk of multiple autoimmune and nonautoimmune comorbidities.” Acta Paediatr. 2017 Mar 1. doi: 10.1111/apa.13808. [Epub ahead of print]

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Better Bread

Better You

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any (1) SCHäR BREAD

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CELIAC AWARENESS MONTH Celiac Awareness Month is just around the corner and GIG has plans for spreading awareness on social media throughout the month of May. But we need your help! On April 27th, GIG will be starting a fundraising campaign for Celiac Awareness Month using the hashtag, “Show Us Your GF Logo”, or #ShowUsYourGFLogo. We’re asking people to snap pictures of themselves holding up products with the GFCO label and share on social media tagging Gluten Intolerance Group (GIG) and the hashtag #ShowUsYourGFLogo. Copy and paste the following information to encourage others to donate to GIG and, share your selfie. Feel free to get creative and tell us why Celiac Awareness Month is important to you.

Social media post

#ShowUsYourGFLogo Here's mine. Now I'm inviting 5 of my friends to show me their GF Logos. If you don't have a GF logo in your house, give a donation to the @GlutenIntoleranceGroup @glutendotorg for continued education and outreach this Celiac Awareness Month. https://donorlynk.com/gluten/giving-form/ #glutenfree #celiac

Donating to GIG during Celiac Awareness Month is a great way to support advocacy, education, awareness, and food safety for those living gluten-free. If you’re unable to donate, you can still participate in our awareness campaign on social media. Have fun and happy Celiac Awareness Month! Thank you for your support and participation! 24

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The Facts Behind Celiac Disease There is no medication to treat celiac disease. The gluten-free diet is the only treatment.

1 in 100 people has celiac disease

Celiac disease can affect people of all ages, from infants to the elderly.

of people with type 1 diabetes

Symptoms have been associated with celiac disease. Some people have no symptoms at all.

Celiac disease occurs in

Celiac disease occurs in

3 - 16%

83% of people with celiac disease are undiagnosed or misdiagnosed

The first step to testing for celiac disease is a simple blood test.

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5%

of first degree relatives of people with celiac