Written by Corlyn Voorhees and Brittany Durgin · 06/26/2014 · 5:00 am
It's not every day that a dietary condition leads to a new diet fad that ends up sweeping the nation. Allergies and intolerances to certain foods have been around for years with little attention being paid by those unaffected, but the diet designed primarily for those with a gluten-intolerance or celiac disease has gone mainstream. With 'gluten-free' menu items and products taking over the market, the diet seemingly has become less about those who suffer from a gluten condition and more about a chance to lose weight.
Maria Newman, an Uxbridge native recently diagnosed with celiac disease, says the gluten-free fad 'makes it harder on the people who really have a problem.' While the number of gluten-free products has increased, certain people with gluten conditions, such as Newman, worry that the increase in popularity will lead to foods being incorrectly labeled 'gluten-free' in an effort to keep up with the demand. There is also the concern that gluten conditions will not be treated as seriously as they should be.
Dani LeBlanc, a Fitchburg resident also diagnosed with celiac disease, agrees, saying that while she does appreciate the influx of gluten-free products, she wishes 'there were more awareness for [gluten-free dieting] as a treatment.'
DIAGNOSED
Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a genetic autoimmune disorder in which consuming gluten, a type of protein found in grain-products, triggers an immune response that damages the small intestine. Due to the damage, the small intestine has trouble absorbing nutrients, which can lead to malnutrition and a plethora of health complications.
LeBlanc first started noticing symptoms of celiac disease during her sophomore year at Assumption College. 'I was having a lot of diarrhea and I dropped 20 pounds in two months, so I had been following up with a gastroenterologist for almost nine years and had been diagnosed with irritable bowel syndrome,' she says. 'My symptoms kept persisting over the years and my doctor suggested that I do an actual biopsy on my small intestine. It was a lot of misdiagnoses over the years. I had low levels of vitamin B12 and iron. I was anemic because my intestines weren't able to absorb a lot of nutrients from my food. I was on two different kinds of medication, one to slow digestion and the other for heartburn.'
After being diagnosed with celiac disease through a biopsy in February of this year, LeBlanc went gluten-free in March. 'I'm not on any more medication for all the symptoms I was having,' she says, explaining a gluten-free diet is the only treatment for celiac disease. 'I don't have to take any more medications, I can just treat it with what I eat.'
According to Sarah LeBlanc, no relation to Dani LeBlanc, a registered dietician at St. Vincent's Hospital in Worcester, more people today are being diagnosed with celiac disease than ever before, stating that one in 133 people (or about 1 percent of the population) have been diagnosed with celiac disease. 'It could be higher for all we know,' she says. 'The symptoms range all over the place.'
Newman, who was diagnosed with celiac disease just last month, started experiencing symptoms about four years ago. 'They didn't know what was wrong with me for three and a half years,' she says. In addition to IgA-based blood tests to test for gluten antibodies, such as anti-tissue transglutaminase (tTG), Newman was also tested for the celiac disease gene. 'Both kids have to get tested because it looks like I had celiac disease on both sides of the family,' she says.
Celiac disease is passed genetically; people with celiac disease carry one or multiple Human Leukocyte Antigens (HLAs) that are linked to the disease, including DR3, DQ2, DQ8 and others. While carrying the gene does not necessarily mean someone has celiac disease, it is a strong indicator that the disease can either be passed down to offspring or could appear at any age if triggered.
For those diagnosed with celiac disease like Newman, whose symptoms include diarrhea, vomiting, hives, rashes, severe headaches, joints swelling up and inflammation, a mislabeled product or restaurant menu item can mean misery. If Newman accidentally consumes gluten, she is sick for almost an entire week.
ON THE MENU
As more people are diagnosed with celiac disease, more restaurants, including several in Central Massachusetts, have made changes to their kitchens, adding gluten-free ingredients and cooking utensils dedicated to gluten-free foods, giving customers the option to order meals that are free of gluten.
Ignatius Chang, owner of Nancy Chang restaurant on Chandler Street in Worcester, first added gluten-free options to his food menu eight years ago, in 2006. At the time, gluten-free was not frequently found on restaurant menus or in news headlines. 'I have a good friend with a daughter who has celiac disease,' says Chang, 'and she wanted to come down to the restaurant, but there was nothing she could eat.'
Now, eight years since Chang first gave customers the option to eat gluten-free, the lunch and dinner food menu at Nancy Chang lists more than 40 gluten-free entrees. 'If you're going to do something, you should do it right,' he says.
Chang says customers travel from as far away as Cape Cod and Rhode Island to dine at his restaurant. The reason, he says, '[is] because we have a menu with very speciality items.'
EVO Dining, located just down the road, across Park Ave. on Chandler Street, has also attracted diners seeking speciality diet options. Since opening its doors in December of 2008, EVO has offered vegetarian, vegan, gluten-free options, as well as meals suitable for diabetic customers.
When crafting EVO's menu, Executive Chef Al Maykel III recalls, 'I wanted to offer to the largest demographic as possible ... so gluten was always in that mix with what I wanted to offer to people because I didn't see a lot of [gluten-free options at restaurants] in the area.'
By offering gluten-free options, restaurants are faced with additional precautions and costs.
'We have to be very cautious of cross-contamination,' says Maykel, and 'our kitchen and staff have to be trained.'
At Nancy Chang, 'You have to make sure the wok is not contaminated with gluten,' says Chang, explaining that the restaurant uses two woks: one specifically for cooking food with gluten and the other used for cooking gluten-free meals.
With the amount of Asian cuisine ingredients that are naturally gluten-free and are staples of many plates, like rice noodles, Chang says he does not know why more Chinese restaurants do not offer gluten-free food options. Corn starch can be used in place of flour and gluten-free soy sauce is a key ingredient in the kitchen at Nancy Chang.
While some restaurants have had both service and kitchen staff trained on how to best serve customers with celiac disease, and have taken steps to ensure there is no risk of cross contamination, others have not. This, Dani LeBlanc says, is due to a lack of knowledge about the disease.
'I think that I would trust that they label [gluten-free] on the menu, but I've gone places where the waiter looks at me like I have three heads because they don't know what celiac is. A lot of people don't. I didn't until I was diagnosed with it,' she says.
Newman says that because eating gluten-free has become trendy, she is concerned service and kitchen staff at restaurants will not take her request seriously. 'Before [it became popular to order gluten-free], you could just go in [a restaurant] and say I have a problem with gluten. Now, I have to go in and say I have celiac disease and talk to the manager so they can assure me. I don't trust [restaurants] now,' she says. 'Going to friends' and family's houses, they're very supportive. You're kind of uncomfortable going to people's houses because you don't want to insult them because you don't know how they cook it. I tend to eat more at home now and I have one restaurant where the owner has celiac in his family.'
Patricia Iorio, executive director at Health Span Solutions in Clinton, Mass. and a registered dietitian and nutritionist, has seen a growing number of people diagnosed with celiac disease, along with an increasing number of people who are choosing a gluten-free diet in hopes of losing weight and feeling better.
THE GLUTEN-FREE TREND
According to a report by Nielsen, the US sale of products that carry a gluten-free label increased 16.4 percent from 2013 to 2014, making it a $23.3 billion industry.
'So many people do not really have to be removing gluten. It also has to do with misunderstanding,' says Iorio. 'Bread is very easy to overeat, so when you remove that, you are going to feel better.'
Worcester-area restaurants have seen an increase in demand for gluten-free meals, not just by customers with a serious diagnosis, but also by many who simply choose to not eat gluten. 'The majority of customers (requesting gluten-free meals) say it's a dietary choice, rather than because they are celiac,' says Alec Lopez, owner of Armsby Abbey, CRUST Bakeshop and the Dive Bar.
Other restaurants have also felt the demand. Eighty percent of EVO's menu can be made gluten-free. Out of all the orders placed, Maykel estimates 25 percent are specifically requested to be prepared as gluten-free, and of those, 'probably 3 percent of those customers actually have an [intolerance] to gluten,' he says. 'For the rest, it's personal preference.'
At Nancy Chang, the amount of gluten-free speciality menu items ordered on an average Friday or Saturday night in 2006 was roughly 2-3 percent of all dine-in and takeout business. Today, Chang estimates that amount has risen to 15 percent.
'Part of it is a trend,' says Chang. Of all the gluten-free orders placed in his restaurant today, he suspects that 35-40 percent are based on the popularity of the diet and not a doctor's note. 'People order the gluten-free because they think, 'I will lose weight,' 'I will feel better,'' he says.
'I definitely see a lot of that trend going on, when in actuality the majority of studies show [eating gluten-free when you're not diagnosed with celiac disease] is not that healthy for you,' says Maykel. 'The things they have to use to make food gluten-free and to make it tasty, it's a lot of starches, it's a lot of sugars.'
According to Sarah LeBlanc, gluten-free products tend to be lower in fiber, iron and B vitamins because of the ingredients used. 'They aren't based on whole-grain products,' she says. 'Hopefully that's changing.'
Iorio says it's hard to pinpoint exactly why the diet has become popular among those who have not been diagnosed with celiac disease. 'It's relatively new in the media, so I think that's one thing that could play on this, and people are always looking for ways to lose weight and feel better.'
Sarah LeBlanc agrees. 'It's definitely a big fad. It's not something that people have to do unless they've been diagnosed with celiac disease. It's become a big mainstream thing.' While it's becoming easier to go gluten-free with more products and dining-out options available, Sarah LeBlanc says a gluten-free diet is not, and should not be for everyone. 'It's not an easy diet to follow and that's one of the reasons I wouldn't suggest going gluten-free unless [someone has] been diagnosed with celiac disease or they're a firm believer that they're sensitive to gluten.'
A COSTLY DISEASE
There is no doubt that there is an added cost to eating gluten-free.
'It's awful,' says Newman. 'My grocery bills are ridiculous. It's triple the price. I go to a Swiss bakery out in Millis and it costs me $13 for one loaf of bread. I only allow myself two pieces of bread a week to make it last a month. I could get a loaf of bread for $2.'
'I think in general, [gluten-free products are] just a little pricier because they're not readily available ingredients,' says Dani LeBlanc. 'For the most part, I've just switched to eating more fruits and vegetables and focusing more on whole foods. There are plenty of things out there you can buy that are naturally gluten-free.'
For restaurants, purchasing gluten-free ingredients usually means higher menu prices for customers.
To purchase in bulk, Maykel says a bag of bread costs roughly $2, while a loaf of gluten-free bread costs upwards of $6-$8. 'Some dishes are naturally gluten-free,' says Maykel. 'But if you're using a different bread or substitute, unfortunately we do have to pass that cost along to our customers.'
To purchase five gallons of soy sauce, Chang says the price is between $20-$30. In comparison, to purchase five gallons of gluten-free soy sauce, he pays between $150-$175. Gluten-free chicken served at Nancy Chang comes frozen by way of air cargo from Taiwan. 'It's expensive,' says Chang. But, he believes, 'Customers don't mind that it's expensive because that's what they want.'
In recent years, the US government has stepped up to the plate with legislation aimed at supporting those who have been diagnosed with celiac disease. On Aug. 2, 2013, the US Food and Drug Administration (FDA) defined gluten-free foods as being those containing less than 20 parts per million of gluten. This final rule will restrict manufacturers from labeling products as 'gluten-free' if they do not meet this definition. According to the FDA, the term 'gluten' refers to 'proteins that occur naturally in wheat, rye, barley and cross-bred hybrids of these grains.'
Iorio, who works to educate individuals and families on best nutritional practices, says that 'so much today depends on being able to read the label and understand what it's telling us and what it isn't telling us ... any time you can clarify label requirements, it makes it easier for the consumer.'
Though it is expected that many manufacturers will take advantage of current trends and place a gluten-free notice on products, the rule does not require gluten-free products be labeled as such. In addition to the labeling of products, the FDA states: 'We expect that restaurants' use of 'gluten-free' labeling will be consistent with the federal definition.' The deadline for compliance is August of this year.
According to the Celiac Disease Foundation (CDF), Argentina, Australia and New Zealand, Canada, the European Union, Ireland, Italy and the UK have adopted similar policies. The Australian and New Zealand bi-national government agency Food Standard's Code requires that only foods with no detectable gluten be labeled 'gluten free'; ingredients derived from gluten containing grains, no matter how small the amount, must be declared on food labels; and only foods with less than 200 parts per million of gluten can be labeled as 'low gluten.' Like the US, Health Canada (the country's Federal health department), rather than requiring the labeling of foods as gluten-free versus low gluten, simply restricts foods exceeding 20 parts per million of gluten from being labeled 'gluten-free.'
When comparing the US to the rest of the world, Newman says, 'We are behind in diagnosing this disease in our country. In Italy, they are far ahead in diagnosing children and adults. Here, it seems to be the last thing they think about, although it's changing in the last several years which may be why we are hearing so much about it. The amount of people with [celiac disease] was equal to other countries, but they were just undiagnosed or misdiagnosed with other diseases here.'
In Italy, all citizens are tested for celiac disease by the age of 6. Those diagnosed with celiac disease receive several forms of support: beginning at age 10, citizens are given a monthly stipend of 140 euros to be spent specifically on gluten-free foods, monitored by the Ministry of Health; extra vacation time is given to shop and prepare gluten-free foods; and gluten-free meals are offered in schools, hospitals and all other public eating establishments, according to the CDF. In Ireland, citizens can claim tax deductions on the additional amount of money spent on gluten-free food versus non-gluten free foods, providing a doctor's note has been issued.
Similarly, citizens of the US are able to deduct costs incurred by celiac disease. The United States' Internal Revenue Service (IRS), in Publication 502, defines medical expenses as 'the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body.' According to the CDF, deductible expenses for those who have been diagnosed with celiac disease include the additional cost of gluten-free foods to their counterparts (if a loaf of bread made with gluten costs $2 and a loaf of gluten-free bread costs $5, the excess $3 cost can be included as a medical expense), the cost of special items needed for a gluten-free diet, the cost of transportation to a store to purchase gluten-free foods (for those who used their own vehicle for these trips, they may deduct 24 cents per mile), and the full cost of postage or other delivery expenses for gluten-free foods made by mail order.
FOR SOME, THERE IS NO CHOICE
There continues to be debate over whether or not eating a gluten-free diet is healthy for individuals who have not been diagnosed with celiac disease.
According to Sarah LeBlanc, there are really no benefits to going gluten-free.
'[People who go gluten-free] could be drastically reducing fiber if they rely on specialty products,' she says, adding that going gluten-free 'requires special planning.' As for celiac disease itself, she says, 'People don't take it as seriously as they should, where it's so mainstream.'
Iorio, however, says the choice to exclude gluten from one's diet can be a healthy one, providing adequate substitutions are worked into the diet.
'I don't really think it's harmful in any way,' says Iorio. 'The only thing that they're missing is the fiber that you would get in the wheat products. So obviously then you would want to make that up in other products such as fruits and vegetables. There are other grains you can use, such as quinoa.'
For Dani LeBlanc and Newman, there is no choice. Like others diagnosed with celiac disease, the women will forever be met with fewer options when dining out, additional costs at grocery stores and potential criticism of their diet due to it once being trendy.
Dani LeBlanc admits that she wouldn't give up gluten if she didn't have to because of her condition.
'I've run into a lot more people that are trying the gluten-free diet and I usually tell them they shouldn't go gluten-free,' says Dani LeBlanc. 'I have to be gluten-free for the rest of my life. I can't cheat, I can't snag a doughnut, I have to be this way to stay healthy. I think it's a trend that will go away in mainstream, but there will still be the rest of us who have to be gluten-free. We don't have a choice in the matter.'
Entities 0 Name: Newman Count: 9 1 Name: Dani LeBlanc Count: 8 2 Name: Nancy Chang Count: 8 3 Name: Chang Count: 8 4 Name: Iorio Count: 5 5 Name: Sarah LeBlanc Count: 5 6 Name: US Count: 5 7 Name: Maykel Count: 5 8 Name: EVO Count: 4 9 Name: Italy Count: 3 10 Name: Chandler Street Count: 2 11 Name: New Zealand Count: 2 12 Name: Mass. Count: 2 13 Name: Ireland Count: 2 14 Name: Health Span Solutions Count: 2 15 Name: Patricia Iorio Count: 2 16 Name: LeBlanc Count: 2 17 Name: Fitchburg Count: 2 18 Name: CDF Count: 2 19 Name: Clinton Count: 2 20 Name: Al Maykel III Count: 2 21 Name: FDA Count: 2 22 Name: Worcester Count: 2 23 Name: Assumption College Count: 1 24 Name: Park Ave. Count: 1 25 Name: Steven King\/Worcester Magazine Count: 1 26 Name: Food Standard Count: 1 27 Name: Canada Count: 1 28 Name: Ignatius Chang Count: 1 29 Name: Millis Count: 1 30 Name: Armsby Abbey Count: 1 31 Name: Central Massachusetts Count: 1 32 Name: Argentina Count: 1 33 Name: St. Vincent 's Hospital Count: 1 34 Name: Nielsen Count: 1 35 Name: Corlyn Voorhees Count: 1 36 Name: Alec Lopez Count: 1 37 Name: Steven King\/Worcester Magazine Chang Count: 1 38 Name: United States ' Internal Revenue Service Count: 1 39 Name: Health Canada Count: 1 40 Name: Ministry of Health Count: 1 41 Name: Steven Count: 1 42 Name: Celiac Disease Foundation Count: 1 43 Name: Steven King\/Worcester Magazine Worcester-area Count: 1 44 Name: Australia Count: 1 45 Name: Cape Cod Count: 1 46 Name: Swiss Count: 1 47 Name: European Union Count: 1 48 Name: Ignatious Chang Count: 1 49 Name: US Food and Drug Administration Count: 1 50 Name: Maria Newman Count: 1 51 Name: Brittany Durgin Count: 1 52 Name: Steven King\/Worcester Magazine At Nancy Chang Count: 1 53 Name: Asian Count: 1 54 Name: UK Count: 1 55 Name: Uxbridge Count: 1 56 Name: Taiwan Count: 1 57 Name: Rhode Island Count: 1 Related 0 Url: http://ift.tt/U3l0qR Title: Gluten-Free Eating Appears to Be Here to Stay Description: In the luxe dining room of Del Posto, one of New York's most heralded and expensive Italian restaurants, one-third of the tables on any given night will have at least one gluten-free diner. Mark Ladner, the restaurant's chef and widely considered to be one of the best pasta cooks in the nation, knows it is a remarkable number.
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