Gluten in Immunoglobulin Therapy

Steve Plogsted, a pharmacist at Nationwide Children’s Hospital in Columbus, Ohio, is an expert on gluten in medications. His website, glutenfreedrugs.com, is widely recognized as the most reliable source of information on gluten-free prescription and over-the-counter drugs. Have a question about gluten and medications? Send it to glutenfreedrugs@gmail.com.

 

 

Q: I have celiac and am also being treated for myasthenia gravis. My physician wants to start me on immunoglobulin therapy and told me that it was “mostly gluten free.” Of course, I am concerned, and I can’t seem to find any answers.

A: Rest assured, this treatment is fine for people with celiac. There are numerous brands of immunoglobulin therapy currently on the market, but they share many of the same characteristics. There are two important issues to remember when using these products: none of them contain any gluten material, and for you to experience a gluten reaction, the gluten must first be absorbed through the gut. As a side note, no intravenous products currently only the market contain any form of gluten.

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2017 in Review: Gluten-Free News Roundup

We just had a banner year for gluten-free products and the gluten-free diet. Here are some of the most notable gluten-free news items and developments that occurred in 2017.

January

  • Shake Shack began offering Bellyrite Foods, Inc., hamburger buns for a $1 upcharge nationwide (except in stadiums) toward the end of December 2016. We include the news here because the buns were hard to find until 2017.
  • Cornell University formally launched a gluten-free dining hall, Risley Dining Room, in January. Cornell brought in alumna Amy Fothergill to train the kitchen staff and develop a grand-opening menu comprised of gluten-free recipes from her cookbook, The Warm Kitchen. Risley’s official changeover to its dedicated gluten-free status coincided with a formal certification from Kitchens With Confidence. The dining hall is also entirely peanut and tree-nut free.
  • Canyon Bakehouse introduced gluten-free Heritage loaves in two flavors (honey white and whole grain). These wide loaves are the width of an average hand, making them large enough to create a filling sandwich on their whole-grain goodness.

February

  • Nima Sensor’s portable gluten sensor became available for purchase at the end of January. The pocket-sized device allows people to test their food for gluten in a few minutes. Simply place the food into a one-time-use capsule and screw on the cap, insert the capsule into the device, and press the power button. In minutes, Nima will display the results—a wheat symbol if gluten is detected or a smile emoticon if the sample has fewer than 20 parts per million of gluten.
  • A University of Illinois study found people following a gluten-free diet had almost twice the concentration of arsenic in their urine and 70 percent higher mercury levels in their blood compared to people who were not gluten free. Unfortunately, the study size was small and did not address whether rice was the main source of the metals in people’s diets. There is no need to panic, however, because the amounts of arsenic and mercury found were much lower than those associated with arsenic toxicity or mercury poisoning. (For more on heavy metals and the gluten-free diet, see Study Sessions, page 60.)

March

  • Starbucks added gluten-free items to its menu. Goodie Girl Cookies’ mint slims in new grab-and-go packaging, Country Archer Jerky’s Hickory Smoke Turkey Jerky and Original Beef Jerky, and Bissinger’s Dark Chocolate Sea Salt Mini Chocolates became available at 7,900 stores nationwide. The coffee chain also added gluten-free smoked Canadian bacon breakfast sandwiches to its offerings nationwide on March 21. The sandwich features cherrywood-smoked Canadian bacon, a peppered egg patty and reduced-fat white cheddar cheese on a gluten-free roll. It is prepared in a certified gluten-free environment and
    sealed in an oven-safe parchment bag for heating.

April

  • The U.S. Food and Drug Administration (FDA) began allowing direct marketing of 23andMe Personal Genome Service Genetic Health Risk (GHR) tests to consumers. These are the first direct-to-consumer tests authorized by the FDA that provide information on an individual’s genetic predisposition to certain medical diseases. The 23andMe GHR tests work by isolating DNA from a saliva sample, which is then tested for more than 500,000 genetic variants. The presence or absence of some of these variants is associated with an increased risk for developing one of 10 diseases or conditions, including celiac.

May

  • Gluten Free, a documentary by Bailey Pryor, aired on Public Broadcasting System with the goal of changing public perception of those who need to omit gluten from their diet for the better. The documentary gives much-needed credibility to non-celiac gluten sensitivity, addresses the importance of preventing cross-contamination at home and in restaurants, discusses medical advances on the horizon and delves into some good old-fashioned myth-busting.
  • Julia König, PhD, a postdoctoral research fellow at the School of Medical Sciences at University of Örebro, Sweden, studied a gluten-destroying enzyme known as AN-PEP. In a study, 18 participants with gluten sensitivities ate a meal of porridge and other foods, including gluten-containing wheat cookies. Participants took either AN-PEP or a placebo. Researchers then examined the gluten levels in the participants’ bodies over a three-hour span. The enzyme broke down gluten in the stomach and the first section of the small intestine, known as the duodenum. Gluten levels in the stomachs of patients who took AN-PEP were 85 percent lower than in those who took a placebo. However, no research was done on patients with celiac.

June

  • After successful tests in Washington, Idaho and Mississippi in 2016, Chick-fil-A added gluten-free buns to its menu nationwide on June 19. Made with a blend of ancient grains like quinoa, sorghum, amaranth, millet and teff, the certified gluten-free bun costs an additional $1.15 and is enriched with vitamins and minerals. The buns are individually wrapped and stored frozen. Once thawed, each bun is served sealed alongside a container with grilled chicken and condiments for guests to assemble.
  • Delta Air Lines added three new gluten-free snack options: Squirrel Brand almonds, Pretzel Perfection olive oil and sea salt pretzels, and Kind Healthy Grains oats and honey with toasted coconut bars.
  • Pope Frances reminded bishops and priests that the wafers Catholics consume as the Body of Christ must contain at least some gluten. He added that low-gluten hosts can be used, “provided they contain a sufficient amount of gluten to obtain the confection of bread without the addition of foreign materials and without the use of procedures that would alter the nature of bread.” This thinking isn’t helpful for Catholics who follow a strict gluten-free diet and can’t tolerate even small amounts of gluten, nor is it the first time the pope has come down against low-gluten wafers.

July

  • Johnny Rockets started serving its certified Angus beef burgers on Udi’s Gluten Free hamburger buns.
  • Papa John’s added gluten-free crust made with ancient grains to its menu but warns it isn’t safe for those with celiac because of cross-contamination with wheat during preparation.
  • Subway added made-without-gluten bread to 12 pilot locations in the United States, Canada and the United Kingdom. The bread is roughly the size of a 6-inch sub, costs an extra $1 and tests below 20 parts per million of gluten. It arrives frozen, pre-sliced and individually wrapped. It goes into the freezer and is thawed in the cooler for 12 hours before serving. However, shared ingredients are used to prepare sandwiches, making cross-contamination a possibility.

August

  • Research to develop a gluten-free children’s snack made of sprouted millet and quinoa earned doctoral student Gabriela John Swamy the Gerber Endowment in Pediatric Nutrition Graduate Scholarship. Out of a group of 500 applicants, Swamy won by determining the optimum sprouting time for millet and quinoa. She then ground them into flour to produce a protein-rich and easier-to-digest puffed cereal without added sugar.
  • ImmusanT was nominated for a BIO Buzz award as a Late Stage Leader. It is developing a peptide-based vaccine for the treatment of celiac and the first personalized diagnostic toolkit for celiac. Clinical data in over 150 celiac patients have been positive—relevant bioactivity and target engagement was seen in three separate phase 1b studies. Its diagnostic/therapeutic platform is being leveraged for related autoimmune indications, such as type 1 diabetes.

September 

  • Canyon Bakehouse’s new blueberry and cinnamon raisin bagels rolled out to retailers nationwide. The blueberry bagel is a first for national distribution, making this gluten-free bakehouse’s second hit of notable developments for 2017.
  • Enjoy Life Foods announced a rebrand of its entire product portfolio to eye-catching teal, the color associated with food allergy awareness and free-from products.
  • The Institute for Sustainable Agriculture in Cordoba, Spain, began making genetically modified wheat sans 90 percent of the gliadins traditionally found in wheat. It is attempting to prevent the gliadin genes from reproducing, but because they remain intact, the wheat could start producing the proteins again. Small trials of the genetically modified wheat involving 10 and 20 people with celiac are being conducted in Mexico and Spain.

October

  • Actress Mandy Moore was diagnosed with celiac and shared her upper endoscopy journey on social media. “Just had an upper endoscopy to officially see whether or not I have celiac (only way to diagnose) …things are looking (good),” said Moore.

  • Enjoy Life Foods debuted mini versions of its vegan dark chocolate bars in Halloween-themed bags of rice milk minis, dark chocolate minis, rice milk crunch minis and a variety pack.
  • The scientific journal Gastroenterology published the results of an international study coordinated by the Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany. This study showed that more than 50 percent of affected children can be diagnosed with celiac without an endoscopy. This could mean that the risk and cost associated with an endoscopy aren’t necessary for an accurate diagnosis.
  • DoubleTree by Hilton hotels began offering Homefree Chocolate Chip Mini Cookies at guest check-in as a nut-free alternative to its iconic chocolate chip cookies. Homefree’s cookies are free from peanuts, tree nuts, eggs, dairy, wheat and gluten.

  • The Gluten Intolerance Group of North America sued celebrity chef Jamie Oliver for “federal certification mark infringement, counterfeiting and unfair competition under federal statutes, with pendent claims for trademark infringement and unfair competition” because of his use of a gluten-free symbol that is similar to the group’s signature gluten-free certification label (the letters “GF” in a circle with the phrase “Certified Gluten Free”).

November

  • Grain & Seed bars from Enjoy Life Foods debuted in stores in four sweet flavors: banana caramel, cranberry orange, chocolate marshmallow and maple sweet potato. Made with three types of sorghum, including popped, and gluten-free oats, the bars are free from 14 allergens and produced in a dedicated nut-free and gluten-free facility.
  • Canyon Bakehouse’s new stay-fresh packaging first appeared on three new products available at Walmart nationwide: Ancient Grain and Country White loaves as well as Deli White Bagels. The stay-fresh packaging is airtight and keeps goods fresh for up to 90 days. Once the package is opened, the bread needs to be consumed within five days.

December

  • After receiving encouraging reviews in test markets in California, Colorado and Florida, sandwich chain Jersey Mike’s Subs planned to introduce gluten-free sub rolls at all 1,300-plus U.S. locations beginning Dec. 4 (see page 9). The individually wrapped rolls arrive at each store fully baked. Employees use new gloves and clean utensils when assembling sandwiches on fresh parchment paper instead of the counter to avoid cross-contamination.

I wonder what 2018 holds for the gluten-free community…

 

News Editor Jennifer Harris is a gluten-free consultant and blogs at gfgotoguide.com.

Photos credits: Shake Shack: DW labs Incorporated / Shutterstock.com; Starbucks: Natee Meepian / Shutterstock.com; Pope Francis: giulio napolitano / Shutterstock.com; Subway: Jonathan Weiss / Shutterstock.com; Doubletree: 8th.creator / Shutterstock.com; Mandy Moore: Jamie Lamor Thompson / Shutterstock.com

 

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Fresh Fish Parcels With Cod and Veggies

These pouches of perfection are SO quick to make, easy to clean up and healthy! You literally could put almost any fish and veggie combo together in here and it would be delicious. I use fresh cod fillets, mostly because they are readily available and cheap, but use any white flaky fish you like or even salmon fillets. As for the veg, I used some fresh spinach, grape tomatoes for sweetness, and cremini mushrooms and fresh basil for a nice fragrant touch. If you like asparagus or green beans instead, try them! Have fun with these fresh fish parcels. They are gluten free, dairy free and nut free.

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Mango Rice

Gluten-free vegan desserts do not need to present a challenge. There are so many possibilities when using rice as the main element. Inspired by her love of Vietnamese and Filipino desserts, Laura Hahn Carroll’s Mango Rice is a favorite of her husband, as it reminds him of his childhood. This delectable dessert is also free of dairy, nuts and corn.

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8 Lip-Smacking Gluten-Free Beer Alternatives

GF beer alternatives featured image

Beer is the drink of choice for many football fans—but not everyone enjoys the taste. If you’re not a beer drinker, check out these gluten-free alternatives to savor during the Big Game on Sunday.

Hard sodas

The hottest area of growth at the moment is the rise of “hard” sodas. While many of the popular alcoholic root
beers include barley malt, there are several that pass muster for those on a gluten-free diet. Louisiana’s Abita
Brewing Company offers an alcoholic version of its famous root beer. It’s the first product in the brewery’s line
of Bayou Bootlegger hard sodas and can be found primarily east of the Mississippi River. The flavor profile
delivers aromas of wintergreen, vanilla and sassafras, with hints of clove and anise.

Root Sellers’ Row Hard Root Beer
root_sellers_ginger_beer-FRAME
Root Sellers’ Pedal Hard Ginger Beer

Root Sellers, based in Missouri with distribution
concentrated in the Midwest and New England,
brews its Row Hard Root Beer without grains.
Row Hard is made with pure cane sugar, molasses, spices and botanicals. The brewery
also produces gluten-free Pedal Hard Ginger
Beer, brewed with ginger root, molasses and
cane sugar.

Combining fruits and vegetables, the brewery’s Himmel & Erde Carrot Apple Ale presents another gluten-free beverage option. Based on a German dish with potatoes and applesauce, the ale is made from fermented carrot juice and added sweetener that is part apple juice.

Hard sparkling water

For a lighter fizz, look for gluten-free “hard” sparkling waters such as those from Truly Spiked & Sparkling
and SpikedSeltzer. Distribution for both brands is rapidly expanding beyond the companies’ New England
bases into the Midwest and Mid-Atlantic states.

TRULY_Bucket_FRAME

Boston Beer, the producer of gluten-free
Angry Orchard alcoholic ciders, introduced
its Truly brand in April 2016. This spiked
sparkling water with a hint of fruit is an
alternative to light beer, especially for
those seeking something refreshing
made with simple ingredients and no
artificial flavors or sweeteners. Truly’s
three flavors—Colima lime, grapefruit
and pomelo, and pomegranate—are
100 calories per 12-ounce serving and
have 2 grams of carbohydrates.

 

 

SpikedSeltzer's four varieties. Photo by Edward Garrity for SpikedSeltzer.
SpikedSeltzer’s four varieties. Photo by Edward Garrity for SpikedSeltzer.

The first hard seltzer brand, SpikedSeltzer
launched in 2013 and is available in four
flavors: West Indies Lime, Indian River
Grapefruit, Valencia Orange, and Cape Cod
Cranberry. The alcohol in SpikedSeltzer is
derived from cold-brewed sugar, resulting in
a low-carb, low-calorie drink. Even Oprah is
a fan, featuring it as The Find in the June 2016
issue of her O magazine on account of its
refreshing, fruity and just-sweet-enough taste.

 

 

 

 

 

Mead

While obscure, mead is one of the oldest alcoholic drinks in existence. Also known as honey wine, mead is
created by fermenting honey with water and, unless grains are added (a variety known as braggot), it is gluten
free. Like wine, mead can be dry or sweet, still or sparkling.

Photo by Kerry Trusewicz
B. Nektar Tuco-Style Freakout. Photo by Kerry Trusewicz.

Mead makers, which number fewer than
200 in the U.S. (compared to more than
6,000 wineries), tend to focus on local or
regional distribution given their size.
B. Nektar in Michigan, which opened its
doors on National Mead Day (who knew!)
in 2008, produces several varieties of mead
with fun labels and names, including Zombies
Take Manhattan, Kill All the Golfers and Dragons
Are Real. Give one a try for National Mead Day
on August 6!

 

 

 

 

Vodka

The producer of the famed Stolichnaya vodka released a completely new gluten-free recipe to meet the
needs of consumers. Made with 88% corn and 12% buckwheat, Stoli Gluten Free is available nationwide.
The vodka is labeled “gluten free” pursuant to the U.S. government’s labeling classification, which requires
alcoholic beverages to be made with naturally gluten-free ingredients.

Titos-FRAME

Tito’s vodka, produced at the oldest distillery
in Texas, is made with corn instead of potatoes
and certified gluten free by the Gluten
Intolerance Group. According to founder and
owner Tito Beveridge, “some producers add a
little bit of mash back into the spirit after
distillation, which would add gluten content into
an otherwise gluten-free distillate [if using wheat
as the base], but I don’t do that regardless.”
Made in batches using old-fashioned pot stills,
Tito’s has grown exponentially since the first
case was sold in 1997 and is now one of the
best-selling vodkas in the U.S.

 

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The Gluten Free Documentary

“Incurable,” “autoimmune,” “disease,” “genetic,” “treatment”—these are not the words the media or many consumers associate with a gluten-free diet, but they should. A documentary by Bailey Pryor that is airing on Public Broadcasting System over the next two years aims to change public perception for the better. With a long career producing award-winning long-form documentaries through Telemark Films, Pryor chose to tackle the misunderstood topic of gluten and gluten-related illnesses (celiac, non-celiac gluten sensitivity, wheat allergy). The Gluten Free documentary gives much-needed credibility to non-celiac gluten sensitivity, delves into the importance of preventing cross-contamination at home and in restaurants, highlights medical advances on the horizon, and provides some old-fashioned myth-busting.

Pryor interviews the food and medical industry’s top experts as well as people diagnosed with non-celiac gluten sensitivity, celiac and wheat allergy to uncover what mainstream media and fad dieters can’t seem to grasp: a gluten-free diet is the only treatment for these conditions. There is no medical cure—eliminating gluten from the diet is the only way to heal the body (and mind) after it has been ravaged by gluten.

While a gluten-free diet is being used as a fad diet trend by the misinformed, to the more than 3 million people diagnosed with celiac and 18 million diagnosed with gluten sensitivity, it is a lifelong commitment not to be taken lightly. Millions are needlessly suffering from undiagnosed gluten-related illnesses, taking an average of six to 10 years to receive a proper diagnosis.

Common questions (such as whether gluten is harmful or not, is it a fad diet or can gluten actually kill people, and why is everyone going gluten free) are answered with accuracy by industry experts in a relatable and understandable manner. I recently spoke with Pryor about the documentary and what he hopes it accomplishes for the gluten-free community.

Gluten-Free Living: What made you decide to tackle this topic?

Bailey Pryor: Gluten-related illnesses are widely misunderstood in the United States. My goal is to provide accurate information about these illnesses, allowing viewers to understand what they can do to help their friends and loved ones who suffer from gluten.

gluten-free-expertsGFL: How did you choose the experts interviewed in the film?

BP: Considerable research led me to the experts and individuals who appear in the film. I chose a wide range of individuals who had differing experiences with gluten, both personally and through scientific research. Their stories help to clarify the full spectrum of information relating to the current science and actual experiences that are common to people suffering from gluten sensitivity and celiac disease.

GFL: The research and production of the documentary took four years. Can you describe your creative process?

BP: I initially develop my films through actual comments from individuals who appear on camera. This means that once I complete the initial research required to identify the experts, I interview all the experts, then review the comments they made on camera. This stimulates additional research and more interviews as the process matures, often taking me several years to complete a film. This protracted timeline also allows for word to get out among my subject community, thus allowing people I didn’t find through my research to make themselves known to me. Having an unrestricted amount of time to produce my films is a luxury in the film industry, and in the end, I believe it results in a far superior film.

GFL: What do you hope viewers take away from the information on einkorn, beer and pizza in the documentary?

BP: The idea with all of them is to investigate how individuals who suffer from gluten have taken matters into their own hands and created steps to rectify the problem. One individual figured out how to implement a bulletproof gluten-free program in his small pizzeria, another individual produced a gluten-free beer from a radical new idea using sorghum extract and a small processed-food manufacturer turned to an ancient grain in hopes of finding a better form of wheat. All are interesting and innovative ways of dealing with a common problem.

GFL: What do you hope people will take away from this documentary:

BP: I hope people learn about the complexity of gluten-related illnesses, the misinformation about fad diets and how to care for your loved ones by preventing cross-contamination.

GFL: What did you learn about gluten that you didn’t know prior to starting your research?

BP: I didn’t realize the extent of damage the human body will inflict upon itself. Celiac disease is a serious illness that has eluded medical professionals for decades. I am hopeful that they can decode this illness soon and commence a more accurate form of detection, treatment and prevention.

GFL: Thank you for shining a light on cross-contamination, which is largely ignored by mainstream media. What made you zero in on this issue?

BP: It seemed to be the obvious discussion point for my film. Others are not discussing it, yet it is such a simple and empowering thing to have this knowledge and then be able to act to help friends who suffer from gluten-related illnesses.

GFL: What else would you like to add?

BP: I love that this disease is not solely subject to medical treatment, as in surgery or lifelong medicine dependence. As soon as you find out you have celiac disease, you can take action yourself to cure yourself…to help others. As difficult as celiac disease is, it allows for you to be in control.

PBS plans to stream Gluten Free over the next two years. Check your local listings.

News Editor Jennifer Harris is a gluten-free consultant.

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Top 5: Dining Out Gluten Free

What you should ask

Most people enjoy dining out without really having to think about it, but someone following a gluten-free diet has to research and ask many questions before ordering with any level of confidence.

Restaurants have clued in to the demand for gluten-free offerings by adding replacement products and taking steps to keep gluten out of their dishes. Some have even created gluten-free menus or indicated gluten-free items on their regular menus. Unfortunately, not all restaurants are created equally, so determining what is and isn’t safe to order still requires a bit of work.

Asking these five questions at the restaurant will help you figure out which items you can safely and confidently order.

Do you accommodate gluten-free diners? This is a great starting question because it forces the restaurant to define what “gluten free” means to the staff as it relates to safe handling. The restaurant will usually highlight popular gluten-free items, which tend to include replacement products, such as bread, pasta and pizza. Unless the kitchen handles only gluten-free products, cross-contamination is always a possibility, but probe further to learn how the servers and kitchen staff handle gluten-free orders.

Do you have a gluten-free menu? This is an easy question because the answer is either “yes” or “no,” but it also lets the diner know how experienced the restaurant is at serving gluten-free diners.

Do you treat all gluten-free orders the same? People who order gluten free are commonly asked whether they are doing it by choice or for an allergy, which usually means all gluten-free orders aren’t treated the same and cross-contamination can occur. Be sure to answer “allergy” when asked so the staff takes all necessary precautions when preparing your order. Of course, allergy is the wrong term, but this is how the restaurant industry perceives gluten free.

How do you handle gluten-free replacement
products?
Replacement products include bread, pasta and pizza. Find out how the breads are heated, the pasta is cooked and the pizza is made to learn whether it is safe to consume. Not all restaurants follow safe handling procedures to prevent cross-contamination, and often heat and cook gluten-free items with wheat-based ones, on the same surface, without using dedicated utensils and equipment.

Do you have a dedicated fryer? Many restaurants don’t understand that gluten-free items prepared in a shared fryer can become contaminated by the wheat-y bits left behind by gluten-containing food. Fried foods such as chips, fries and onion rings are often marked ‘gluten free’ on menus when they really aren’t. It takes more than just gluten-free ingredients to render prepared food gluten free. Safe handling procedures have to be followed to keep food gluten free from start to finish.

What you should do

You have your questions prepared for the restaurant staff once you arrive, but before you even leave home you can use these tips for a stress-free and satisfying gluten-free dining experience.

Plan ahead by calling the restaurant and making a reservation that specifies your dietary needs. It is also a good idea to check out the menu online, but keep in mind that not all restaurants have current menus available on their website.

Avoid dining during peak hours, which will allow the staff to pay more attention to your needs and answer any questions you may have regarding safe choices. This is especially true when visiting a restaurant for the first time.

Know what to avoid when dining at a restaurant. Suspect items include sauces and gravies, breaded and fried foods, soups and salad dressing. Eating foods as close to their natural, unaltered state as possible is the best way to keep gluten out of a meal. Highly processed foods are more likely to contain gluten.

Use gluten-free apps to read reviews of the cuisine and service. A number of free apps on the market can help you not only avoid an unpleasant or even dangerous experience but lead you to a fabulous one as well. The Find Me Gluten Free, Gluten Free Passport and YoDish apps contain reviews and photos from restaurants with gluten-free offerings.

Take a gluten-free dining card and present it to the server to ensure there is no miscommunication.

—Jennifer Harris

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