Wednesday, November 30, 2011

First scientific research into gluten in drugs

Do you spend a lot of time worrying about gluten in your prescription and over-the-counter medicine?

It's a topic I've researched and written about many times. The general conclusion is that gluten does not turn up in drugs that often.  But because it sometimes does and is not clearly labeled, we are left looking through everything from common pain relievers to prescriptions used for rare ailments to find that oddball medicine that might contain some form of gluten.

Now there is word that the National Foundation for Celiac Awareness has received a grant to conduct the first scientific research into the use of gluten in drugs. This is good news for everyone who is gluten free.

The $50,000 grant from the Food and Drug Administration will fund preliminary research that the NFCA says "aims to validate or nullify" anecdotal reports of gluten reactions to drugs from those who have celiac disease or gluten intolerance.

The research project goes by the rather cumbersome title, "Gluten in Medication: Qualifying the extent of exposure to people with celiac disease and identifying a hidden and preventable cause of an adverse drug event." The NFCA says the project will "characterize the problem of unlabeled gluten in medication and raise awareness of the potential harm that can occur to patients who ingest medications that they do not recognize as containing gluten."

My hope is that the research will mainly concentrate on objectively determining the extent to which gluten is found in the vast array of drugs available and in what amounts. We need to have that information to determine what kind of risk actually exists and how to proceed with steps for better labeling.

The NFCA is the leading advocate for better labeling of gluten in drugs, something that would surely be helpful to those with celiac disease or gluten intolerance. The group says the research will a first step in providing a foundation for further investigation within the FDA and scientific communities.

"To date, there has been no scientific research conducted to determine if the amount of gluten that is in medication results in harm to people with celiac disease or gluten sensitivity, although there are reports of significant patient reactions to gluten in medication," the NFCA says in a press release announcing the study.

Since we know that reactions to gluten are not a reliable way to determine the gluten-free status of a food or, in this case, a drug, scientific evidence is very important.

A drug's active ingredients, which actually treat an illness or condition, are gluten free. But inactive ingredients,  which make up the bulk of most medications, occasionally contain gluten, mainly in the form of wheat starch.

Everyone, including the NFCA, agrees that relatively few medications contain gluten, but poor labeling requirements make it difficult to identify them. As a result every drug becomes suspect.

Further complicating matters is the fact that prescription drugs don't have to list inactive ingredients on the label. The only way to find out what's in them is to ask the pharmacist or call the drug company.

While over-the-counter medications do detail inactive ingredients,  unlike food, the FDA does not require that the use of wheat be clearly spelled out on a label.

Loretta Jay, an NFCA consultant, and Dr. Robert Mangione, dean and professor of pharmacy at St. John's University, are leading the research team doing the NFCA study.  A survey of celiac disease patients will help the researchers select types of drugs reported to have caused reactions. The drugs will  tested to determine how many parts per million and milligrams per dose of gluten they might contain.

Currently, the best source of information about gluten in drugs can be found on a website run by Steven Plogsted, a pharmacist at Columbia Children's Hospital who regularly researches gluten in specific medications. Also, some over-the-counter products are now labeled gluten free.

Otherwise, determining a drug's gluten-free status can be an arduous and frustrating process for gluten-free consumers. Drug companies can be reluctant to give out information and often simply say none of their drugs have been tested to be gluten free. Other times they give conflicting and confusing answers to questions about ingredients and gluten content.

The valuable research being done by the NFCA could eventually lead to clear labeling of gluten in prescription and over-the-counter drugs. And that would make any pill easier to swallow for everyone who is gluten free.

Amy Ratner

Tuesday, November 22, 2011

Thankful for Mainstream Media November Love Fest on All Things Gluten Free

We are only 22 days into the month, but every time I open a mainstream publication I find another article on something gluten free.

Let’s start with the free publication, Natural Awakenings. The November 2011 Westchester/Putnam NY issue includes an article on Gluten-Free Baking, written by Claire O’Neil. It has a review of different types of flours and some lovely sounding recipes.

The second article I found was in the November 2011 issue of Health magazine. This was a really good article entitled, “Is going gluten-free the secret to weight loss?” by Kate Lowenstein. Spoiler alert…they got the answer right, if you just swap out one type of carb for another type of carb, you are not going to lose weight. There is still a lot of gluten free “junk food,” that has calories in it! You can lose weight if you cut out the pasta, pizza and breads altogether but that is not “going gluten-free,” that is just cutting back on carbohydrates. Thanks so much for getting it right.

The third article was in Sports Illustrated, November 7, 2011, entitled “The New Training Table” by Alexander Wolff. This article was fascinating and it really was more about diet and “performance, wellness and recovery.” Athletes are “eating to win.” This really talks about reducing inflammation to speed recovery, which is another facet of a gluten-free diet. Some of the athletes in the article actually eat gluten-free food because they have to due to a diagnosis, but others are not. We have a major article on athletes & CD in Gluten-Free Living Vol 11, #4…shipping November 28th!

The New York Times has taken a particular interest in a gluten-free diet. The New York Times Magazine that centered on food back in October, had three mentions of a gluten-free diet or gluten-free food in that issue…including a coast to coast GF quote! But, the one that really caught my eye was the New York Times Magazine on November 13, 2011 in the Diagnosis article. The minute I read the symptoms, I knew what the mystery ailment was…celiac disease. What was really great about this presentation of symptoms is that the patient experienced muscle or joint pain for 10 years, anemia, depression, IBS, fibromyalgia, endometriosis, had periods of terrible weakness and had been through many different doctors. That is the reality with diagnosing CD, it doesn’t always present with straight gastrological symptoms!

Then last Sunday, the Wall Street Journal weekend edition, November 19-20, 2011, featured an article about Alice Medrich, an award winning cookbook author, and her latest dessert project. She is developing gluten-free baked good recipes. Right now she is experimenting with all types of gluten-free flour and I’m sure this will be very interesting when it is finished!

Fifteen years ago when I was diagnosed, I was told celiac disease was a “very rare” condition. From the coverage I’m seeing about a gluten-free diet, I hope that original doctor is now telling his patients about a “very common” condition that strikes 1 in 133 Americans. Thanks to everyone this year who has helped grow the awareness for celiac disease and gluten intolerance.

Kendall Egan

Wednesday, November 9, 2011

My CSA Experience

Last spring I joined an organic CSA (community supported agriculture) by purchasing a full vegetable share. Vegetables are gluten-free, and these were organic and local so what could have been better?

The farm delivered a bountiful selection of greens, herbs, cucumbers and zucchini in June and July. I learned what a garlic scape was and discovered that they were excellent grilled or sautéed and thrown into a pasta sauce. Part of the fun was chatting with other people at vege pick up to find out how they were going to use some of the more esoteric greens, or the four pounds of cucumbers.

I was eagerly anticipating the deliveries slated from late August through November. I knew I would be receiving lots of tomatoes, kale and a huge selection of root vegetables.

My last delivery in August included these sweet little yellow tomatoes and some baby kale. I grilled up the tomatoes that were left, but most of them were eaten straight from the basket. I made kale chips and they were a huge hit. Have you ever tried kale chips? Honestly, they are addicting. Plus,they are so easy to prepare...a little toss with some olive oil, salt and your choice of spices and bake them on a cookie sheet until crispy.

I was getting ready to receive potatoes, turnips, parsnips, butternut and acorn squash. I think these make the best side dishes for weekday dinners and I had been clipping recipes using purple potatoes, red potatoes and butternut squash!

Tropical Storm Irene changed all of that in a week of disastrous flooding in upstate New York. Almost every sleepy, winding, pokey, little brook became a raging river full of class three rapids! My organic farm in New York was totally flooded and destroyed by the storm. Once the waters subsided, the rivers left behind a sludgy layer of “yuck.” The FDA said this produce could not be harvested and sold, it must be destroyed.

For the farmers of this CSA, that news was devastating in more ways than one. The investment of a share in a CSA is plowed into that year’s harvest, so the money was spent. It’s also fairly complex to get organic certification, and I do not know what that layer of muck does to the future of that farm.

I certainly did not expect a refund for any unfulfilled portion of my share, nor did anyone in my community. Weather and bugs and all sorts of risk are part of farming and I knowingly took on that risk when I purchased a share. Who would have thought a costal event, like a hurricane, would wreak havoc all the way up through Vermont as it waned to a tropical storm? Who could have predicted a huge snow storm two days before Halloween? Wacky stuff.

I am sorry not to receive this produce, I had a lot of gluten-free side dishes planned! For now I shop the farmer’s market and enjoy their fall produce. I feel so sad for the owners of that farm, but I look forward to trying a share in a CSA again next year. I have to hope the weather won’t be so weird.

Kendall Egan

Wednesday, November 2, 2011

The Brioche

It is true the food evokes memories from meals and events, family celebrations, weddings, break ups and travels around the world. Recently, I have had brioche swirl up into my consciousness.

When I was a junior at Boston College, I spent a semester in Strasbourg, France. I lived with a family and the “mom” was a classically trained chef who taught French cuisine at the university. How does a kid get so lucky to stay with a family like that? I had fresh pastries for breakfast every single day…the real blessing is that I had to walk 45 minutes to school and I was still healthy, but not yet diagnosed with celiac disease. I took a particular liking to the brioche.

Recently, I traveled to Las Vegas and stayed where Thomas Keller’s Bouchon Bistro was a quick elevator ride away from my hotel room. I had brunch there before flying back to New York. The “Breakfast Americaine” comes with pastry and brioche, but I asked the server to hold those. I did not explain why, I just said to hold those items.

I had been in touch with the communications team from TKRG about their new gluten free flour, C4C (cup for cup) gluten free flour, after I read about it in the New York Times. I followed up with my contact after I ate at Bouchon and received an invitation to the launch of the flour at Per Se in New York City.

I met Thomas Keller and Lena Kwak, the research and development chef, and told her my story about my love of brioche and how sad I was not to eat the gorgeous looking pastry at my breakfast at Bouchon. She pointed me in the direction of a gluten-free platter of brioche and Danish.

They were so delicious! The fact that I was nibbling a gluten-free brioche, to me, was just astounding. The last time I had a good brioche was in Strasbourg, France, a waaaaaay long ago…1988. Maybe I have eaten a brioche since 1988, I have only been diagnosed a celiac for fifteen years.

No other brioche eating experience evokes the memory of sitting in that tiny kitchen in Strasbourg with a warm “bowl” of café au lait and a perfect brioche on my plate, eating that brioche at Per Se really brought back a lovely memory of France through my taste buds. Thank you!

Kendall Egan