Becoming gluten-free is not truly a transition. For recently diagnosed celiacs, a gluten-free lifestyle spells a cold hard stop to their former lifestyle. The potentially lethal effects of gluten within a celiac's system necessitate a "no leniency" policy where gluten-containing foods are concerned. Those with extreme external symptoms to gluten need to avoid any product that contains gluten, whether a food or cosmetic. This drastic lifestyle change poses many physical and emotional challenges, which is why support is vital for surviving such adjustments. Finding trustworthy and informative resources is a key step in managing your new life, rendering the knowledge of an experienced dietitian like Shelley Case of vital importance.
About Shelley Case, RD
Shelley Case is a registered dietitian and a flourishing resource for celiacs. She is currently lauded as the leading international expert regarding celiac disease, gluten-free diets, and lifestyle transitioning. Her book, Gluten-Free Diet, is a thorough resource that includes practically everything a new celiac needs to know about food products, restaurants, lifestyle adaptations, and current controversies within the gluten-free world. Shelley travels the world delivering lectures and gluten-free workshops. She has also made numerous television appearances on popular news stations and continues as an active member of several outstanding celiac organizations. Where becoming gluten-free is concerned, Shelley Case is the authority.
Interview With Shelley Case: Becoming Gluten-Free
The Starting Point
LovetoKnow: What do you feel represent the greatest difficulties for individuals transitioning into a gluten-free lifestyle?
Shelley Case: As a dietitian for the past 27 years, I have found the gluten-free diet to be one of the most difficult diets. Adapting to the gluten-free lifestyle can be extremely challenging for most individuals for many different reasons:
- Wheat-based products are major staples in the North American diet
- Gluten is found in a wide variety of food and beverages
- Understanding food labeling regulations and determining the gluten-free status of products
- Finding gluten-free specialty products
- Gluten-free products are often 2-3 times more expensive than regular products
- Busy lifestyles result in more meals eaten away from home and/or use of convenience, pre-packaged foods
- Finding suitable gluten-free foods when eating in social situations and traveling
- Cross-contamination issues at home and eating out
- Conflicting information about the gluten-free diet from health professionals, the media, internet and other resources.
Because of these challenges, I felt the need to write a book on the gluten-free diet that would provide accurate and practical information to help people successfully follow the diet and live a healthy life. My book Gluten-Free Diet: A Comprehensive Resource Guide came out in 2001 and is now in its 8th printing and 4th edition.
LTK: Label reading is very important for individuals who are gluten-intolerant. What are some common foods and ingredients that may contain gluten?
SC: Gluten (found in the grains wheat, rye and barley) can be found in a wide variety of foods such as baked products, cereals, pastas, soups, sauces, marinades, salad dressings, snack foods, prepared meats (e.g., deli meats, burgers, imitation seafood), beer, flavored coffees and teas, some candies (e.g., licorice), chocolates and chocolate bars, as well as some nutrition supplements and medications.
Other sources of gluten include brewer's yeast, malt, malt extract and malt flavoring which are derived from barley. Hydrolyzed wheat protein can be used in many different food products. Soy sauce is often made from wheat and soy. Wheat flour and wheat starch can be used as a carrier agent in seasoning blends. Canned baked beans can be thickened with wheat flour. Some cake frostings and icings contain wheat starch.
LTK: Your book addresses controversial food issues such as the consumption of oats on a gluten-free diet. Could you describe some of the controversy surrounding oats and oat-based foods?
SC: The protein in oats (called avenin) was originally thought to trigger the same toxic reaction as wheat, rye and barley. However, new research in Europe and the US over the past 15 years has revealed that consumption of moderate amounts of pure, uncontaminated oats is safe for the majority of children and adults with celiac disease. Based on this new research, a growing number of celiac organizations and health professionals around the world now allow consumption of moderate amounts of pure, uncontaminated oat products in the diet. An extensive technical review on the safety of oats is published on Health Canada's website.
It should be noted that the regular commercial oats in the marketplace are cross-contaminated with wheat, rye and/or barley. This occurs during harvesting, transportation, storage, milling, processing and packaging. Fortunately there are a number of companies who are now producing pure, uncontaminated oats in North America. These include:
- Bob's Red Mill
- Cream Hill Estates (Lara's brand)
- Avena Foods (Only Oats™)
- Gifts of Nature
- Gluten-Free Oats
- Montana Gluten-Free Processors
Before adding pure, uncontaminated oats to the gluten-free diet you should consult with your physician and dietitian because a small number of individuals with celiac disease may not tolerate pure oats. The mechanism causing this intolerance has yet to be established. For more information on oats and guidelines on using pure oats vist the Canadian Celiac Association.
LTK: As a leading expert in the world of gluten-free nutrition, do you feel that the majority of persons on a gluten-free diet are achieving adequate nutrition? And, if not, what are some reasons?
SC: Many people following a gluten-free diet are not getting enough fiber, iron, calcium, vitamin D, and other nutrients. There are several reasons for this. A lot of gluten-free specialty products on the market today are made with white rice flour, tapioca, corn and potato starch. These refined flours and starches are low in protein, iron, B vitamins and fiber. Also these products usually contain more carbohydrates (especially sugars), fats and calories. This often leads to unwanted, extra weight gain.
Another concern is that most gluten-free products are not enriched with iron and B vitamins like their gluten-containing counterparts. Fortunately some companies are now making healthier gluten-free options by adding vitamins and minerals, as well as using more nutritious gluten-free alternatives such as amaranth, buckwheat, flax, millet, quinoa, brown rice, sorghum and teff. I have included a listing in my book (www.glutenfreediet.ca) of companies and products that are enriching their products.
LTK: Do you have any other recommendations for individuals trying to follow a healthy gluten-free diet?
SC: It is important to eat a wide variety of naturally gluten-free foods such as meats, poultry, fish, eggs, nuts, seeds, legumes, fruit and vegetables. Choose nutritious gluten-free grain alternatives such as amaranth, buckwheat, flax, millet, Montina (Indian ricegrass), mesquite flour, oats (pure, uncontaminated), quinoa, colored rice (black, brown and red), sorghum and teff. Legume flours (e.g. chickpea and bean) and nut flours also add more fiber, protein, vitamins and minerals.
Incorporate low fat dairy products and other calcium and vitamin D rich foods. If you cannot tolerate milk products due to lactose intolerance see BeFreeForMe.com.
Limit gluten-free cookies, cakes, and other snack foods high in fat and sugars. Drink plenty of fluids, especially water. Take a gluten-free multi-vitamin and mineral supplement. Get more exercise.
Finally, consult with a registered dietitian who has expertise in the gluten-free diet for a nutritional assessment and education. A dietitian is the most qualified health care professional to provide nutrition therapy. Dietitians have extensive academic and practical experience including:
- In-depth knowledge about the role of food and nutrition in the prevention, treatment and progression of acute and chronic disease and how disease and treatment affect food and nutritional needs.
- Nutrition composition and food preparation information.
- Socioeconomic, psychological and educational factors that affect food and nutrition behavior of people across the lifespan.
- Skills to translate scientific information into laymen's terms and assist individuals in gaining knowledge, self understanding and improved decision making and behavioral changes.
Although other health care professionals can disseminate nutrition advice, they do not have the training in nutrition sciences and food composition to be able to translate complex medical nutrition concepts and issues into attainable dietary changes.
For more information about becoming gluten-free, be sure to visit Shelley's website, Gluten-Free Diet, where you can learn important up-to-date tips on mastering your new lifestyle. Moreover, please note that the advertisements placed within this interview, particularly those referencing gluten-containing products, are not representative of the author or interviewee's views.