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AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET TO THE NATIONAL POST

No.2/October 2011

FOOD ALLERGIES AND CELIAC

3 TIPS

FOR STAYING SAFE WITH DIETARY NEEDS

PHOTO: LESLIE BARTON

BAKING FOR EVERYONE Allergies in schools What you need to know to keep your kids safe

Author Cybele Pascal discusses treats that everyone can enjoy Bruce Croxon How he addresses his kids' food allergies

2 · OCTOBER 2011

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CHALLENGES

1 TIP

REACH OUT TO A LOCAL ASSOCIATION TO LEARN MORE

WE RECOMMEND Clear labels, safer choices Why food labels matter.

PAGE 7

“There’s no cure for food allergies, so allergic consumers need to rely on safe, accurate, clear labelling when purchasing a product for themselves or for their child." Panel of experts

p. 6

Knowledge is power

p. 7

Find out what food manufacturers are doing for dietary needs.

Food allergies and intolerances are increasingly affecting Canadians—children and adults alike. As there is no cure, the fight is to improve awareness and fight complacency.

Learn the importance of getting diagnosed and the problems involved with diagnosing yourself.

Manage allergies through education, understanding

F

ood allergy is a growing public health issue in Canada. Recent research estimates that food allergies affect more than 1.3 million people, of which over 300,000 are children. Medically described as an overreaction of the body’s immune system to a triggering agent (an allergen),an allergic reaction is a serious condition that requires prompt medical treatment. In its most severe form, anaphylaxis, it can be life-threatening. Reactions can range from mild—such as a rash or hives—to the most serious, including difficulty breathing and a sudden drop in blood pressure. The common food allergens, as identified by Health Canada, include peanuts, tree nuts, fish, shellfish, egg, milk, sesame, soy, wheat and mustard (as of August 2012). Insect stings, medicine, latex and exercise can also cause a reaction.

Avoidance is the only way As there is no known cure for food

allergies, avoidance of allergens is the only sure way people at risk can prevent a reaction and stay safe. This can be difficult when food is part of our every day lives and can sometimes be hard to avoid. From home to school to restaurants, allergic individuals must be vigilant when managing their allergies. However, with some careful planning and preparedness, allergic individuals can stay safe while enjoying the same experiences as others. When dealing with food allergies, it’s important to be careful–but not fearful.

of food allergies helps family members, friends, educators and others in the community participate in efforts to protect those at risk. Policy measures are also an important contributor to keeping people with food allergies safe.

Rising from a tragic precedent

Beatrice Povolo Director, Marketing and Communications, Anaphylaxis Canada

MY BEST TIPS

Knowledge can be a life saver

Always:

Anaphylaxis Canada, the national advocacy organization for people with food allergies, promotes education and understanding as the means of avoiding a potentially life-threatening allergic reaction. The more credible information a person or parent of a child with food allergies has about how to stay safe, the more likely they will stay safe. As well, understanding the seriousness and unpredictability

■ Carry an epinephrine autoinjector (e.g.EpiPen® or Twinject®) and wear MedicAlert® identification. ■ Read ingredient lists to ensure food does not contain their allergens. ■ Ask about ingredients and food preparation whenever eating away from home. ■ Let others know about your allergies.

One such effort was Sabrina’s Law (named for teenager Sabrina Shannon who died after an allergic reaction), legislation effective from 2006 to ensure public schools in Ontario have plans in place to safeguard students at risk of anaphylaxis. Another was the recent food labelling regulatory changes passed this earlier year by Health Canada that will ensure all pre-packaged food products in Canada have clearer ingredient lists, making it easier to identify common allergens. For more information, please visit www.anaphylaxis.ca

Opening the door on Hallowe’en night and being surprised by all the scary little ones has always been a favourite of mine. Until I became involved with the Canadian Celiac Association, I had never realized that some of those little kids (but mostly their parents!) had a whole different idea about ‘scary little ones’—in this case it’s those tasty little treats we drop into those loot bags! Behind that mask a child might be wondering if ‘this one’ is one I can have.

Jim McCarthy Executive Director, Canadian Celiac Association

Clear labels, safe food Back home most of us sort through the treats to check for treats we’ll sneak from the kids! CCA’s members begin the tireless task of checking labels, checking their list of treats that are supposed to be OK, discarding the delicious homemade stuff a thoughtful homemaker created but probably didn’t check his ingredients. Kind of takes a little of the shine off what should have been a really fun night and a chocolate high for a seven year old!

Responsible for this issue: Publisher: Pat Craven [email protected] Designer: Penelope Graham [email protected] Mariel Fitzgerald Contributors: Jeannie Armstrong; Elaine Cadrin; Tonya Facey; Mike Irwin; Scott Mahon; Jim McCarthy; Beatrice Povolo; Michael Smulders; Professional Advisory Board, Canadian Celiac Association Managing Director: Gustav Aspegren [email protected] Production Coordinator: Jemima Codrington [email protected] Business Developer: Chris Vassallo [email protected] Photo Credit: All images are from iStock.com unless otherwise accredited. Distributed within: National Post, October 2011 This section was created by Mediaplanet and did not involve the National Post or its Editorial Departments.

BEATRICE POVOLO [email protected] FOLLOW US ON FACEBOOK & TWITTER! www.facebook.com/MediaplanetCA www.twitter.com/MediaplanetCA

The right to safe food Isn’t fall just the best time of year? Family walks in the parks along trails admiring the fall colours! The freshening air and the anticipation of Hallowe’en filling the kids’ heads with excitement!

FOOD ALLERGIES AND CELIAC 2ND EDITION, OCTOBER 2011

Most of us expect our food to be safe—especially those prepackaged goodies you get on Hallowe’en.Celiacs, and many others with serious allergies, have a different perspective. At the same time, we at the CCA believe we also have a ‘Right to Safe Food’. More than 300,000 Canadians have celiac disease, and another 1.5 million are likely gluten intolerant. Accurate and informative food labels are compulsory reading for us.That’s why the recent changes in Allergen labelling have been so important. We have to read every label, every time – and that’s just to make sure it’s safe for our families.

Safety starts with you This issue of Food Allergies and Celiac is a great step to raise awareness about

Mediaplanet’s business is to create new customers for our advertisers by providing readers with high quality editorial content that motivates them to act.

the safety of food—and beverages and supplements and therapeutics and cosmetics—with a focus on people with allergies or affected by gluten! Health Canada and the Canadian Food Inspection Agency set and enforce rules for food manufacturers such as the need to identify that allergens, gluten and sulphites may be in a product, or when you can call a product ‘gluten free’. This certainly helps but the ultimate responsibility for your food safety rests with you! And when you think something is not quite right—you need to take action—call the company, expect clear answers—they should know what’s in those tiny little treats! Help us make sure that the only scary things on Hallowe’en night are the costumes!

TIPS 1. Find a doctor you trust, follow his or her medical advice, and stop worrying. 2. Read labels on all processed food you may decide to try. 3. Join a support group and go to meetings. Virtually all support groups need more help than they get. Pitch in. 4. Focus on the benefits of the GF diet, not the burdens. It’s a very healthy diet. COURTESY OF CANADIAN CELIAC ASSOCIATION

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OCTOBER 2011 · 3

INSPIRATION

On race day, I was so excited that I barely slept. I got up before 5:30 a.m., hugged my parents and headed out the door in the dark. There were already a lot of people there, warming up. Start time came and we were off. The sun was really bright, even with sunglasses, but I got to the 10k mark in 56 minutes and thought “so far, so good.” I had to expect the second half to be tougher and it was, though remembering why I was there helped to keep the pain away. I thought of my friends and family, my doctors and everyone who had offered a kind word or encouraged me along the way. After giving my parents the biggest hugs I could manage, all I could think was, “Wow, I did it.” To my fellow celiac, this marathon was for you too. Celiac disease will not hold us back. MIKE IRWIN, FORT NELSON / CALGARY, AB PHOTOS: CANADIAN CELIAC ASSOCIATION

Trim: 10.8” Live: 10.55”

When food allergies strike, will you be prepared?

Severe Allergy Risk Test Nearly 600,000 Canadians are at risk of a severe allergic reaction. Are you one of them?

In the event of a severe allergic reaction, every second counts. However, many people at risk of a severe allergic reaction do not carry an emergency treatment, such as an EpiPen® Auto-Injector. If you’ve ever had a reaction, even a mild one, to food products or insect stings, it could be a sign of dangers to come. You can’t always avoid your allergy triggers, but you can be prepared.

Should you be carrying an EpiPen Auto-Injector? Take the test now! ®

EpiPen® and EpiPen® Jr Auto-Injectors are indicated for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis. After administration, patients should seek medical attention immediately or go to the emergency room. For the next 48 hours, patients must stay within close proximity to a healthcare facility or where they can call 911. To ensure this product is right for you, always read and follow the label.

To help determine your risk of a severe allergic reaction, check all the boxes that apply to you. I had a reaction shortly after exposure to even a small amount of: ❒ Peanuts ❒ Shellfish ❒ Soya ❒ Tree nuts ❒ Sesame ❒ Egg ❒ Fish ❒ Milk ❒ Wheat It included the following symptoms:

❒ Insect stings ❒ Medications

❒ MOUTH: itching, swelling of the lips and/or tongue ❒ GUT: vomiting, diarrhea, cramps ❒ THROAT *: itching, tightness, closure, hoarseness

❒ LUNG*: shortness of breath, cough, wheeze

❒ SKIN: itching, hives, redness, swelling

❒ HEART *: weak pulse, dizziness, passing out (due to low blood pressure)

*Some symptoms can be life threatening.

If you checked at least 1 box in each section, you could be at risk for a severe allergic reaction. Your risk is even higher if you: ❒ Have asthma ❒ Have had a previous reaction (even if mild) Your reaction could be more severe if you: ❒ Have asthma ❒ Have cardiovascular problems

Take this test to your doctor to find out if you should be carrying an EpiPen® Auto-Injector. Additional Resources:

© 2011 Pfizer Canada Inc. Kirkland, Quebec H9J 2M5 • Toll free: 1-877-EPIPEN1 (1-877-374-7361) EpiPen, EpiPen Jr are registered trademarks of Mylan Inc. licensed exclusively to its wholly-owned affiliate, Dey Pharma, LP. of Napa, California USA.

4 · OCTOBER 2011

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INSPIRATION

LIVE TO EAT Cybele maintains that you don’t have to cut out your favourite foods—simply find a sweet substitute. PHOTO: LESLIE BARTON

When her newborn son inexplicably broke out in hives and rashes, author Cybele Pascal knew changes were needed in her kitchen and diet. Little did she realize how much her culinary care was needed nation-wide.

Fear not your favourite foods: Simply be smart Los Angeles-based cookbook author Cybele Pascal is out to eliminate the stigma around allergen-free cooking and find a way to make any dish hypoallergenic. Beginning the journey Shortly after giving birth to her first son, Pascal knew that something wasn’t right. Early on, her son was plagued with hives, rashes and projectile vomiting. Repeated trips to the doctor and rounds of antibiotics didn’t help.A few long months later, her son was diagnosed with food allergies. Despite the fact that her son was being nursed, Pascal had to switch up her diet by eliminating the top allergens to ensure that she wasn’t transferring any allergens to her son through her milk.

A new way to cook When she first got the news, Pascal wasn’t sure what to eat. “I was eating chicken and

rice and I didn’t know what to do and I wasn’t getting enough calories,” says Pascal. “So basically I decided to take it upon myself as this challenge to completely revamp my favourite foods and make them hypoallergenic.” This meant learning to cook with a new set of ingredients. Gone were the days of wheat, eggs, dairy and nuts. Luckily, after 15 years spent working in restaurants, Pascal knew her way around the kitchen.

Beyond the home kitchen After success in her kitchen, Pascal turned her passion for producing hypoallergenic meals for her food-allergic family into a career. “I began to reach out to other people on the Internet and I discovered that there were thousands of other people dealing with the same issue who were having a very hard time feeding themselves and their children,” explains Pascal. “Then I realized there was no cookbook that met

PROFILE

their needs.” Pascal is now an award-winning author of two books and has been featured in numerous publications and appeared on The Martha Stewart Show to promote allergen-free cooking.

Cooking with allergens in mind

Cybele Pascal ■ Occupation: Food allergy cookbook author and lifestyle expert. ■ Published work: Author of “The Whole Foods Allergy Cookbook” and “The AllergenFree Baker’s Handbook.”

In Canada, food allergies affect five to six percent of young children and three to four percent of adults. The most common allergens are wheat, soy, eggs, dairy, peanuts, tree nuts, sesame, fish and shellfish. Luckily there are a number of substitutes that Pascal recommends integrating into a hypoallergenic pantry. Instead of traditional wheat flour, Pascal uses a mix of superfine brown rice flour, potato and tapioca starches. There are a number of dairy substitutes including rice and oat milks. For eggs, Pascal recommends a mix of flax meal (ground flax seeds) and water which works well in baking. For those craving nut butters,

a great substitute is a “butter” made from sunflower seeds. Many people assume that eating an allergen-free diet means giving up their favourite foods, but Pascal stresses that on an allergen-free diet “You can have anything you want, just an allergen-free version.” As proof to that statement, Pascal has created allergen-free recipes for everything from cakes to gnocchi to crème brûlée. On The Martha Stewart Show, her allergen-free cookies were preferred over traditional cookies, a testament to the versatility of allergen-free cooking and baking. Pascal is currently working on her third book,which focuses on quick and easy dinners and will be released in November 2012.

TONYA FACEY [email protected]

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INSPIRATION

OCTOBER 2011 · 5

2 TIP

PREPARE AHEAD TO ENJOY DELICIOUS MEALS

BRUCE CROXON explains that his family’s diet is not only safe for their children but also a lot healthier due to the subtraction of many processed and fast foods. PHOTO: CHRISTOPHER WAHL

Learning to manage a food-allergic family Bruce Croxon and his wife Debra Thier were surprised when they received the diagnosis about seven years ago that their son Lucas suffered from food allergies. After having milk for the first time Lucas broke out into hives. Another bad experience with milk followed, and after some testing Lucas was diagnosed with food allergies. Croxon’s family now has to be vigilant about a number of allergens. Eight year-old Lucas is allergic to dairy, eggs, peanuts, tree nuts, fish, lentils, sesame, while his sister, six year-old Addy, is allergic to eggs.

A new way of living After being sent home from the doctor with some Internet printouts, the family immediately felt the impact of the diagnosis as they began to research and navigate how to manage food allergies, eventually getting support from Anaphylaxis Canada. “All of a sudden the trust became a big component in the way we shop. We could no longer take it for granted what was in something,” explains Thier. “All of a sudden the grocery store felt like a landmine.” Out of necessity their family developed a system of labelling new products in their home to indicate that the product’s safety has to be verified by the manufacturer. If the grocery store felt like a landmine, travel was mostly off the table. Croxon and Thier don’t travel as much

“All of a sudden the trust became a big component in the way we shop. We could no longer take it for granted what was in something. All of a sudden the grocery store felt like a landmine.”

as they would like to as there are potential dangers. “It’s taken us a while to get comfortable getting on a plane for any long period of time,” explains Croxon. “As you can imagine when you’re 30,000 feet in the air and if something were to happen it’s not a quick trip to the hospital. “ On a day-to-day basis one of the biggest adjustments for Thier, an avid food lover, has been the loss of spontaneity when it comes to food as every meal has to be pre-planned. “What you take for granted is just dropping into Starbucks and grabbing a muffin and a coffee, those things aren’t part of our repertoire,” explains Thier. “We can do it, but it has to be planned.”

A positive light While many may see a food allergy as challenging, Croxon is able to put a positive spin on things. “We eat very well,” says Croxon. “We don’t eat a lot of processed foods, there’s not a lot of fast foods and there are a surprising number of things you can eat that are good for you and that are safe for them.”

While it’s important for children to understand the severity of their allergies it’s also important for them not to live in constant fear. “You don’t want to raise anxious kids, but they need to be aware that as much as it’s something that nourishes you, food can also be life-threatening, it’s a fine line,” says Croxon.

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Bruce Croxon ■ Occupation: Entrepreneur and Dragon on CBC’s “Dragons' Den” ■ Parent to: Two food-allergic children ■ Allergies represented: Dairy, eggs, peanuts, tree nuts, fish, lentils and sesame

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Raising vigilant kids With young children it’s important that they understand what their allergies mean and how to react in different situations. Croxon and Thier roleplay different scenarios with their children to coach them on how to react when they are offered food out side of their home.

STOP GUESSING

START LIVING

TONYA FACEY [email protected]

www.glutenpro.com

6 · OCTOBER 2011

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PANEL OF EXPERTS Elaine Cadrin President, Cadcan Marketing and Sales

Scott Mahon Owner, Hilton Soy Foods

Michael Smulders Founder and President, Bakery on Main

Question 1: When developing a new product with a dietary specialty in mind, what aspect do you focus on most?

That new product ingredients must meet food safety guidelines and dietary restricted guidelines.We tend to stick with our known suppliers because we are confident they are following all the food safety guidelines.They also know us well and know which ingredients we will not use in our CheeCha Puffs. It is very important that our customers can rely on our dedication to making safe foods that meet the allergen claims that are on our packaging. Their health and peace of mind depend on them making wise choices in their food consumption and we want to be known as a company that they can trust with satisfying both those needs.

We focus on providing a product that meets the needs of the particular dietary condition, yet would be accepted by the entire family as a nutritious, great tasting food item. It is important that the person with a particular dietary need doesn’t have to eat separately or have a special meal prepared to meet their needs. Many people view food as a social event and one that brings people together—foods that meet special dietary needs and are well received by everyone are good choices.

Once the particular dietary specialty and nutritional features have been established, the focus then becomes making the product taste as good, if not better than, the traditional lesshealthy version. I founded Bakery On Main with that philosophy in mind: making food that’s good for you but tastes like it isn’t. No one should have to sacrifice taste due to an allergy, intolerance or other special dietary need.

Question 2: What is most challenging about being a manufacturer of a special dietary product?

Meeting our customers’ requests for flavours that are difficult to develop because of restricted ingredients is a real challenge for us. We are often asked to make flavours that match other snack foods on the shelf. However, when we check out the list of ingredients of those flavours they may contain ingredients that we can never use. For instance, we work to keep all artificial flavour enhancers such as monosodium glutamate out of CheeCha Puffs. We also keep our gluten free line dairy and soya free because many consumers who have gluten allergies also have allergies related to other products—so when someone asks for a flavour that they may find on the shelf in the regular chip section, we often find it impossible to match that flavour and be true to our mandate of natural healthy ingredients.

We must take extra caution and care with who we select as suppliers for our ingredient and packaging needs—ones that respect our special allergen sensitive requirements. Also, consumers with special dietary needs often have multiple requirements and it is hard to list on the packaging all of the suitable applications of a product. Many food companies don’t realize that many consumers have multiple allergies with various allergen combinations and it becomes more difficult to develop foods to meet their needs.

The biggest challenge is in dealing with retailers who expect the niche product to perform as a mainstream product would. In addition, the slotting fees, advertising and promotion requests from the retailer are often unrealistic, too expensive and do not yield enough the sales lift to make the investment worthwhile for the manufacturer. These are costs larger more traditional manufacturers can afford easily, but smaller specialty manufacturers such as Bakery On Main and many other gluten free companies aren’t working with the same kind of budget.

Question 3: What advice would you give to someone recently diagnosed, or who has family with a recently diagnosed allergy/intolerance/celiac?

The first thing they can do to receive excellent advice is contact their local organizations, such as their local celiac association, to gain help in understanding their situation and locating foods that they will be able to eat. It will be very beneficial in many ways to communicate through these organizations with other people that are facing the same problems and challenges. Today, there is so much more information out there to help overcome dietary challenges and the individual organizations are often the best starting point. Following up with questions to food manufacturers can also provide invaluable information.

Closely read and inspect all food labels and if there is any question regarding the food contents of an item, further investigation is required.Good reputable food companies respect the need for proper food labelling. I personally have strong confidence in Canadian produced foods as we have some of the highest food safety and labelling standards in the world. Our company advocates food labelling at all levels including school lunch items made from home, especially those containing our WOWBUTTER. Any labels on imported foods that look questionable or do not meet our Canadian labelling standards are products to avoid.

I would encourage them by saying that so many resources and products now exist for people with celiac disease that it is much easier than it used to be. There are Celiac support groups, gluten free vendor fairs, and gluten free sections in conventional supermarkets. I would point them to many of the resources, websites, and product lines that are available.

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NEWS

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Question: How can people with food allergies, sensitivities and celiac disease make smart decisions and avoid potentially risky situations? Answer: By having clear, accurate, and easyto-understand labelling on all food items.

PAY CAREFUL ATTENTION TO INGREDIENTS IN GROCERIES

For the over 1.75 million Canadians with food allergies, celiac disease and/or sulphite sensitivities, making smart food choices by reading labels carefully is critical. While consumers have to be diligent about reading labels, the labels themselves also have to be clear and easy to understand.

into place to keep his family safe. “Simple and clear labels are a key part of our defense, so anything that can be done to make it even clearer and more consistent is highly useful and highly valuable,” says Smith. “Health Canada has taken steps in the right direction, but there is still room for improvement.”

Additional challenges

Changes to how foods are labelled Earlier this year Health Canada amended their current labelling laws to make them easier for the average consumer to understand when new packaging is rolled out by August 2012. One of the biggest changes includes listing the most common allergens (peanuts, tree nuts, sesame, dairy, eggs, soy, fish and shellfish) as well as gluten and sulphites by their more common names instead of using scientific or derivative names. For example, a product containing soy may list soy as the ingredient or hydrolyzed vegetable protein (soy). The new labelling requirements

will also expose hidden ingredients in products such as components of margarine, seasonings and flour that were previously exempt from declaration in the ingredient list. Jim McCarthy,Executive Director of the Canadian Celiac Association, is a strong believer in the need for clearer labelling. “Labelling on package is ultimately what helps ensure people that what they put in their mouth is safe, it’s that simple” explains McCarthy. “It’s vital that ingredient lists are complete and it’s vital and that the language on the lists is in plain English.” As a parent, Smith appreciates the measures that Health Canada has put

Despite the changes, one area that is still a cause for concern are “precautionary statements” which are words on packaging such as “may contain” or any of the other 30 to 40 statements that manufacturers voluntarily put on products to caution consumers that the food may have come in contact with certain allergens or gluten. These precautionary statements are often a source of confusion to consumers as they try to evaluate what their level of risk would be if they tried the product. “What we recommend to people is that if there’s any kind of precautionary labelling, such as ‘may contain’, that’s telling you that this product may have the allergen that you’re allergic to and you should not purchase or consume it,” explains Povolo. Both Anaphylaxis Canada and the Canadian Celiac Association encourage consumers to contact manufacturers directly if they have any questions around the safety of a particular product. TONYA FACEY [email protected]

The power of diagnosing celiac When it comes to your health, individuals should be aware and proactive; this is no different when it comes to celiac disease. Eating gluten free before being diagnosed with celiac disease can leave you with an uncertain or inaccurate diagnosis. Serological (blood) testing for celiac disease is a useful screening tool for your doctor. This test is normally performed by a laboratory but an overthe-counter test kit is also available. This kit is based on similar principles to one of the laboratory tests and is available at some pharmacies. Whichever test you are using, you must remember the following things: ■ You must be eating a regular diet that contains gluten at the time of the test. The test may not be valid if you are already eating gluten free or have cut back on the amount of gluten you are eating. ■ A normal (negative) test does not

DON’T MISS!

School policy triggers adverse reaction School administrators have to “err on the side of caution” to ensure students with allergies have safe learning environments, says Catherine Fife, president of the Ontario Public School Board Association.

Clear labels, safer choices: Why food labels matter Beatrice Povolo, Director of Marketing and Communications for Anaphylaxis Canada, stresses the importance of food labelling as it’s a lifeline for allergic consumers. “There’s no cure for food allergies, so allergic consumers need to rely on safe, accurate, clear labelling when purchasing a product for themselves or for their child,” explains Povolo. “They need to know that products have all of the ingredients listed, especially the allergens, and that the labels are complete and accurate.” As a parent of a food-allergic child, Jeff Smith knows first-hand the complexities of reading food labels. When his daughter Madeleine, now 6, was first diagnosed, grocery shopping became an increasingly difficult and time-consuming task. “It was really challenging to get in step with reading labels and being super diligent every single time,” says Smith. “I think it took us almost three months until we had the system down.”

OCTOBER 2011 · 7

rule out celiac disease. ■ An abnormal (positive) test does not confirm celiac disease. A small intestinal biopsy is required to confirm the diagnosis. ■ While you are waiting for your biopsy, continue eating a regular diet that contains gluten. Do NOT start a gluten-free diet before the biopsy because this may hinder the proper evaluation and interpretation of the biopsy, delaying your diagnosis. ■ You may need further tests to make sure that any problems associated with celiac disease, such as anemia (low blood) and osteoporosis (weak bones), are properly identified and treated. ■ Blood screening tests for celiac disease are less reliable for children younger than three years. ■ A negative result at a given time does not guarantee that an individual will not develop celiac disease in the future. If you use the at home test, take the results to your doctor to discuss the

next steps to confirm your diagnosis. If you are already on a gluten-free or gluten-reduced diet, you may get an invalid negative test result, confusing the situation and delaying the diagnosis. When someone with celiac disease eats a gluten-free diet, the intestinal mucosa (lining) heals and the serological results become normal, usually about six months after starting a strict gluten-free diet. If your blood test results are normal and a small intestinal biopsy is negative, there is no way to diagnose celiac disease. To confirm a celiac disease diagnosis in this case, you must begin eating gluten again (an oral gluten challenge) to induce changes to the intestinal mucosa before an intestinal biopsy is valid. How long you have to eat gluten before a biopsy varies from individual to individual; some will relapse in a few weeks while others may take months or even years. Serologic tests are also helpful in screening people who are at-risk for

celiac disease, including first- and second-degree relatives of patients with celiac disease, those with type 1 diabetes mellitus and other autoimmune conditions, and those with atypical symptoms. Currently, serological blood tests are available to the physicians with no charge to the patients through provincial health care in all provinces except Ontario. Just because treatment for celiac disease involves dietary changes and not prescription medications does not mean the same amount of seriousness should not be taken for diagnosis, like any other disease. Knowledge is power when dealing with your own health. If you feel you might be suffering from celiac disease, getting tested is the first step to finding this out and subsequently living a healthy and normal life.

Controversy has erupted between parents and school officials in London, Ontario over the Thames Valley District School Board’s decision to ban peanut butter substitutes,“because of the difficulty in being able to distinguish alternatives from the real thing.” Four additional Ontario school districts have now issued similar cautions: Trillium Lakelands, Rainbow, Upper Grand and Grand Erie. Sabrina’s Law, a bill passed in 2005, requires Ontario school boards to establish and maintain an anaphylaxis policy to protect the estimated 42,000 students across the province considered at risk from allergies. “We have a communication plan in place to ensure that parents understand what is safe to bring and what is not. That varies from school to school, except for nuts. Every school board in the province has a plan in place around nut allergies,” says Fife. During her years as a trustee, Fife has seen school boards restrict a variety of foods because of allergies, including dairy products and seeds. “We have to create learning environments that are safe for all students. School boards have been dealing with emerging allergies in our student population for many years, but that conversation has been accelerated because of the risks involved,” says Fife. Before determining policy,school boards consult with experts at regional public health units, says Fife. “The most up-to-date medical advice should be what guides school boards.” Thames Valley parent Jeanette Turnbull is raising concerns about the ban to her Member of Parliament. “I understand the dangers of nut allergies. But it has to stop at some point. School boards have gone overboard,” says Turnbull. Turnbull’s children are enrolled in the Thames Valley School District. “My oldest daughter has taken (a peanut butter replacement spread) for three years to a school that bans peanuts. No one has ever reacted to it.” Her daughters, Skylar and Naomi, ages seven and four,are very allergic to chocolate. The girls take chocolate-free lunches to school, “and know not to eat out of other kids’ lunch pails.” Turnbull feels the ban on peanut butter substitutes denies her children a safe, nutritious lunch option. “We’re not supposed to send cold meats to school because of bacteria. You can’t use cheese or butter because of dairy allergies. All that leaves us is jam, which is full of sugar. At some point this has to stop.” Fife says, “The starting point of the conversation has to be, ‘what is in the child’s best interest?’ We as school boards promise parents that we are providing safe and healthy learning environments.We are talking about one meal a day— lunch—and at the end of the day,we have to err on the side of caution.”

PROFESSIONAL ADVISORY BOARD

JEANNIE ARMSTRONG

CANADIAN CELIAC ASSOCIATION

[email protected]

[email protected]

8 · OCTOBER 2011

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET TO THE NATIONAL POST

RECIPE SHOWCASE Basic Gluten-Free Flour Mix (makes 6 cups) Chocolate Chunk Blondie Bars (makes 16 bars) 2 ½ cups plus 2 tablespoons Basic Gluten-Free Flour Mix ½ teaspoon plus 1/8 teaspoon xanthan gum 1 ½ teaspoons double-acting baking powder ¼ teaspoon salt ¾ cup dairy-free, soy-free vegetable shortening ¾ cup granulated sugar ¼ cup plus 2 tablespoons firmly packed light brown sugar 2 teaspoons pure vanilla extract 1 ½ teaspoons Ener-G egg replacer mixed with 2 tablespoons rice milk ¼ cup plus 1 teaspoon rice milk 6 ounces (about 4 bars) Enjoy Life Rice Milk bars or Dark Chocolate Boom Choco Boom bars, chopped into centimeter-size chunks

4 cups superfine brown rice flour 11/3 cups potato starch (not potato flour) 2/3 cup tapioca flour (also called tapioca starch) 1. To measure flour, use a large spoon to scoop flour into the measuring cup, then level it off with the back of a knife or straightedge. Do not use the measuring cup itself to scoop your flour when measuring! It will compact the flour and you will wind up with too much for the recipe. 2. Combine all ingredients in a gallon-size zipper-top bag. Shake until well blended. Store in the refrigerator until ready to use.

1. Preheat the oven to 350°F. Grease a 9 by 9-inch pan. 2. Whisk together the flour mix, xanthan gum, baking powder, and salt. Set aside. 3. In the bowl of a stand mixer fitted with the paddle attachment, combine the shortening, granulated sugar, and brown sugar, beating on medium speed until light and fluffy, about 2 minutes. 4. Add the vanilla and egg replacer and mix for 20 seconds. 5. Add the flour mix in three batches, mixing on low speed, alternating with the rice milk, and beginning and ending with the flour mix. 6. Fold in the chocolate chunks. 7. Spread the batter evenly across the bottom of the baking pan. 8. Bake in the center of the oven for 35 minutes, or until lightly golden, rotating the pan halfway through. 9. Remove from the oven and let cool in the pan on a cooling rack for about 15 minutes. Cut into 16 squares. Let cool.

Velvet Frosting (makes enough to frost 1 8-inch layer cake) 1 cup dairy-free, soy-free vegetable shortening Pinch of salt 3 cups confectioners’ sugar 3 tablespoons rice milk 1 tablespoon freshly squeezed lemon juice 1 teaspoon pure vanilla extract 1. In the bowl of a stand mixer fitted with the paddle attachment, cream the shortening and salt on medium speed for 1 minute. 2. Add the confectioners’ sugar in three batches, beating after each addition. 3. Add the rice milk, lemon juice, and vanilla. Beat on medium speed until smooth, creamy, and fluffy, about 5 minutes.

Red Velvet Cake with Velvet Frosting (makes 1 8-inch layer cake) 2 ¾ cups Basic Gluten-Free Flour Mix ¼ cup unsweetened cocoa powder ¾ teaspoon xanthan gum 1 ½ teaspoons double-acting baking powder 1 ½ teaspoons baking soda 1 ½ teaspoons salt 1 ½ cups rice milk 1 ½ teaspoons cider vinegar ¾ cup dairy-free, soy-free vegetable shortening 1 ½ cups granulated sugar 4 ½ teaspoons Ener-G egg replacer mixed with 6 tablespoons rice milk 1 teaspoon pure vanilla extract 1 (1-ounce) bottle red food coloring 1 recipe Velvet Frosting (recipe follows) 1. Preheat the oven to 350°F. Grease two 8-inch round cake pans, line with cutout parchment paper, grease again, and dust with a little cocoa powder. 2. Whisk together the flour mix, cocoa powder, xanthan gum, baking powder, baking soda, and salt. Set aside. 3. Combine the rice milk and cider vinegar. Set aside. 4. In the bowl of a stand mixer fitted with the paddle attachment, combine the shortening, sugar, egg replacer, and vanilla. Beat on medium speed until light and fluffy, about 2 minutes. Add the food coloring and mix until combined, scraping down the sides of the bowl as necessary. Sift in the flour mixture in three batches, alternating with the rice milk mixture, and beginning and ending with the flour mixture. Beat until smooth, about 30 seconds, scraping down the sides of the bowl as necessary. 5. Divide the batter between the two pans, and smooth down the surface using a frosting spatula. 6. Bake in the center of the oven for about 35 minutes, or until the cake is beginning to pull away from the sides of the pan and a skewer inserted into the center comes out clean. Rotate the pans halfway through the baking time. 7. Let cool in the pans on a cooling rack for 30 minutes. Cover the cake pan with a large plate, flip, peel off the parchment paper, and flip the cake back onto the rack, right side up, to cool completely. Repeat with the other cake. 8. Once the cakes have cooled completely, you may use a serrated knife to trim the tops to make them level. Frost with Velvet Frosting. Once the frosting has set, store covered at room temperature. This cake is even better on days two and three!

THESE RECIPES AND MORE IN

Cherry Oat Scones (makes 12 scones) 1 cup plus 2 tablespoons rice milk 1 tablespoon cider vinegar 2 cups Basic Gluten-Free Flour Mix (page 19) ¾ teaspoon xanthan gum 2 tablespoons double-acting baking powder 1/3 cup granulated sugar ¼ teaspoon salt ¼ teaspoon ground cinnamon 1 ¼ cups gluten-free old-fashioned oats 1/3 cup dairy-free, soy-free vegetable shortening ½ cup dried cherries Sanding sugar (optional) 1. Preheat the oven to 400°F. Line a baking sheet with parchment paper. 2. Whisk together 1 cup of the rice milk and the cider vinegar. Set aside. 3. In a large bowl, whisk together the flour mix, xanthan gum, baking powder, granulated sugar, salt, and cinnamon. 4. Add the oats and toss. Add the shortening in pieces, and work in with a pastry blender or two knives until you have a pea-sized crumb. 5. Add the cherries, tossing until combined. 6. Add the rice milk mixture and stir with a wooden spoon until combined but still clumpy. 7. Flour a work surface lightly with a little gluten-free flour mix, and turn out the dough. Lightly flour your hands. Sprinkle the dough with a little flour mix. 8. Divide the dough in half. The dough will be sticky. Shape into two 6-inch disks. Cut the disks into 6 pie-shaped wedges. Transfer the scones to the baking sheet. Brush with the remaining 2 tablespoons rice milk, then sprinkle with sanding sugar. 9. Bake in the center of the oven for 17 minutes, or until lightly golden. 10. Serve warm from the oven, or let cool on a cooling rack.

Reprinted with permission from The Allergen-Free Baker’s Handbook: How to Bake Without Gluten, Wheat, Dairy, Eggs, Soy, Peanuts, Tree Nuts, and Sesame. Copyright © 2009 by Cybele Pascal. Published by Celestial Arts, an imprint of Ten Speed Press and the Crown Publishing Group, Berkeley, CA. PHOTOS: CHUGRAD MCANDREWS