By Jim Duncan
The gluten-free (GF) diet began as a medical treatment for celiac disease, an autoimmune digestive disorder that damages the small intestine and interferes with absorption of nutrients from food. Not only is it more common than people realize, but it’s also a disease on the rise. According to the National Foundation for Celiac Awareness (NFCA), celiac now affects one out every 133 Americans. It’s a disease that can lead to a number of other disorders including infertility, reduced bone density, neurological disorders, some cancers and additional autoimmune diseases. There is no pharmaceutical cure. The only treatment is a gluten-free diet.
Obviously, a pure GF diet is essential to diagnosed celiac sufferers. Medicine, though, is a very soft science. The NFCA estimates that more than 80 percent of people with celiac disease are undiagnosed or misdiagnosed with some other malady. Mostly that’s because the disease carries 300 symptoms which vary considerably among different people. Diarrhea and abdominal pain are the most common symptoms but they don’t afflict all carriers. Others might demonstrate irritability, depression or some combination of 296 other symptoms. Some patients develop celiac symptoms early in life, while others feel healthy far into adulthood. Some notice no symptoms at all.
Such differences make celiac diagnosis extremely difficult. The NFCA and related agencies are pushing to increase the number of those correctly diagnosed to 50 percent by the end of this decade. In addition, the NFCA reports research estimating that 18 million Americans suffer from non-celiac gluten sensitivity (N-CGS). That’s six times the number of Americans with celiac disease. People with N-CGS experience symptoms similar to those with celiac disease without demonstrating the same antibodies and intestinal damage.
Cyd Koehn, of Catering by Cyd, understands this, having noticed a big jump in demand for that diet. So she specializes in GF menus.
“Gluten-free has totally exploded,” she said. “Two years ago, a typical party for 50 people would include maybe two GF menus. This year it’s up to nearly 10 out of 50, she said. The number of 100 percent gluten-free meals requested keeps increasing, too, particularly at hospitals.
“A lot of doctors are on GF diets. That tells me something.”
Clearly glutens are worth the attention of a broader audience. That’s why market research company Packaged Facts recently reported than GF food sales reached $2.6 billion in 2010 and also estimated that they would nearly double by 2015. It also helps explain why more restaurants identify “gluten-restricted” and “gluten-free” items on their menus. The growing number of people with N-CGS surely contributes to the popularity of similar diets, particularly the Paleo Diet (which recommends eating unprocessed foods that were available to Paleolithic Era people) and various low-carb diets.
What is gluten?
Gluten was discovered in the 17th century by vegetarian Buddhist monks looking for a protein substitute for meat. It’s defined as a protein composite (of gliaden and glutenin) bonded to starch in the endosperm of grass-related grains, particularly wheat, barley and rye. In other words, it’s a byproduct of a simple chemistry experiment.
When flour is kneaded, gluten gives elasticity to dough helping it rise, hold its shape and produce a chewy texture. Because it is insoluble in water, gluten can easily be purified and then added to other things such as soy sauce, ice cream and ketchup. It’s also popular in hair and skin products.
To simplify on the safe side, GF diets allow fresh fruits, vegetables, meats and many dairy products. They also accept rice, corn, soy, potatoes, tapioca, beans, sorghum, quinoa, millet, pure buckwheat, arrowroot, amaranth, teff and nut flours. Oats are allowed by some and forbidden by others. All prohibit wheat, barley, rye and related components, including durum, graham, kamut, semolina, spelt and malt. All warn about processed foods — soy is OK, but soy sauce is not. (Language isn’t always helpful: Glutinous rice, which is used in sushi, contains no gluten; buckwheat contains no wheat.)
Most beers and ales are made with prohibited substances. Sutliff Hard Cider and Somerset Winery’s mead are popular GF alternatives that are made in Iowa. Most whiskies, vodkas and gins are made with forbidden grains, although 100-percent corn versions of those liquors do exist. Iowa’s Mississippi River Distillery makes GF vodka. Most spirits made without such grains, such as brandy, wine, rum, tequila and vermouth, are usually GF, but users should beware of additives particularly in flavored spirits. Liqueurs and pre-mixed drink products require serious examination.
That’s not easy. The United States Food and Drug Administration (FDA) does not require gluten to be included on food labels, because it’s in the “generally recognized as safe” category. One out every 133 Americans strongly disagrees. In August, the FDA issued its first standards for voluntary labeling of “gluten-free” products, which allows them to contain up 20 parts of gluten per million.
Do I want gluten in my body?
Last year George Formaro became the first Iowan named a top 20 restaurateur in America by the James Beard Foundation. He is in charge of the kitchens at Gateway Market, Centro, South Union, Django, Zombie Burger and the soon-to-launch Malo. Formaro constantly experiments with new and improved products. He also believes he suffers from N-CGS.
“The last couple years I have been having severe reactions I associate with eating products made with white flour. My stomach feels like I swallowed a bag of marbles. I can’t sleep, and my gut aches for days. Rye flours don‘t bother me, but white (wheat) flours do,” he recalled.
As a result, Formaro says he’s developed a preemptive celiac disease scheme. What’s the hardest thing to resist?
“White burger buns — not eating those tortures me,” he admitted. He also believes personal awareness has made him more cautious about “gluten-free” labeling.
“The last thing I want to do is overreach with a GF claim. It’s nearly impossible to do 100 percent GF in our kitchens, where we cook almost everything from scratch. Cross-contamination can hardly be avoided when you work with flour,” he said.
Formaro won’t make any GF claims about pizza at Centro, because all pies are cooked on the same stones, for example.
Formaro says he developed more caution after installing black counter tops in his home kitchen. “After playing around with flour one day, I noticed flour dust continued to settle on the counter tops for days,” he recalled. As a result his restaurants don’t call anything “gluten free” but rather offer “gluten-restricted” foods. “Even our French fries are not GF, because they are cooked in the same fryers as our calamari.”
Formaro said he tries to compensate gluten-intolerant diners by offering free substitutions. “It drives my line cooks crazy, but we feel we need to do that. We will substitute a vegetable for pasta. We can make pasta from corn and rice and cook it in a separate pot, but I still worry about cross-contamination.”
At Café di Scala, Cityview Food Dude’s “chef of the year” Phil Shires echoed similar concerns. “We are famous for scratch-made pasta. We have a very compact kitchen. We buy some GF rice noodles and will cook them in a separate pot if someone asks, but we don’t put that on the menu,” he said.
Even at Noah’s, the pioneer in Des Moines for offering GF versions of floury foods, pizza-makers cautioned that their “gluten-free” pies are baked in the same oven as their scratch-made flour pies, which are tossed a few feet away. They said their GF pizza crusts and pasta are ordered pre-made from a gluten-free facility.
Still, GF labels are exploding on foods and menus. Koehn uses a lot of ancient GF grains, like amaranth and teff, as well as flours made with almonds and other nuts. She advises GF dieters to carefully read labels even for things that sound safe “like rice crackers.” Koehn recommends the same restaurants to GF dieters and that her GF clients recommend to her: “Alba, Table 128, Namaste, India Star, Wasabi Tao, Club Car, King and I — they are all accommodating,” she said.
Menus are now touting GF versions of foods, like pizza, bread and noodles that are usually made from forbidden wheat flours. Of course, the Internet is helpful here: Applebee’s is credited with 54 GF menu items at www.glutenguidehq.com; www.findmeglutenfree.com names 40 Des Moines restaurants — including some surprising suspects, such as Pizza Ranch (which is most famous for pizza and breaded fried chicken), Noodles and Company, Fong’s Pizza and Godfather’s Pizza; www.glutenfreeregistry.com includes more than 150 dining facilities registered in Iowa; www.urbanspoon.com lists 20 Des Moines restaurants that advertise GF or gluten-friendly on its website; www.ultimateglutenfree.com names 86 restaurants in Des Moines, including some of Formaro’s that actually make lesser claims.
There’s an important bottom line: GF foods of all kinds are becoming more and more available, while GF claims remain very loosely regulated. People should consider why they are on a GF diet before investing too much trust in what they read. Formaro puts it this way:
“For celiac sufferers, a gluten-free diet is a very serious, even life-threatening, business. Low-carb dieters and Paleo enthusiasts are jumping on the GF bandwagon now, but they can take considerably more risks,” he cautioned. RELISH