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

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

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

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

Happy Gluten-Free Halloween

I have a special attachment to Halloween.

Nearly 20 years ago, we celebrated this crazy day of costumes and candy with tremendous relief. My then 2-year-old daughter had just been diagnosed with celiac disease after a scary -- much scarier than any dressed-up ghoul -- rapid decline from a healthy toddler to one who couldn't walk and could barely hold up her head.

But by Halloween she was on a gluten-free diet, nearly back to herself and so excited to wear her unicorn costume and go out collecting candy. I think of that every year when pumpkins and ghosts start appearing.

Certainly we were a little afraid of what to do about Halloween candy given that we were so new to the diet and there was so little gluten-free information available then. But my daughter was so happy about the holiday we were determined to find a way to keep her safe while not ruining it for her.

In the pictures we have from that year, she looks a little gaunt because of all the weight she had lost while sick, but there's huge smile on her face as she sits surrounded by all her candy spread on the floor.

From that first year until the last she trick-or-treated we used a trading system -- for every piece of candy she had to give up because it contained cookies or wafers or rice crispy pieces or any kind of gluten, she could choose one from our stash of gluten-free Halloween treats.
 
So she grew up loving Halloween and had more gusto for it, from picking and planning a costume to hiking the length and breadth of our neighborhood, than our other two children. The year she was Cinderella, it poured. But she was not deterred and came home soaking wet but happily clutching a pillow case loaded with candy.

This year I found the perfect card to send her at college. It had a drawing of many streets and homes with a little ghost making its way through them. "So little time, so many houses," it said, capturing her Halloween philosophy.

So I hope all the children who follow a gluten-free diet have a happy and memorable Halloween. For their parents, I would advise using the trade system, as well as emphasizing all the fun of carving a pumpkin, making pumpkin seeds, decorating the porch, dressing in costume and then combing  the streets when it's dark. The candy is important too, I know that. But don't let worry about it cast a pall on Halloween

Here's a candy list to help you out. (Make sure you always read package labels as these are the most up-to-date sources of information. For example, Nestle now includes a label statement on several Wonka brand products that says they are made in a facility that also processes wheat. This includes Bottle Caps, Gobstoppers, Nerds, Runts, Spree and Sweet Tarts.)

Happy Halloween and Best Witches,

Amy Ratner

What I am working on for the next issue...

Last Thursday I attended a taping of The View in preparation for an interview of Elizabeth Hasselbeck for our next issue. I have to say watching a taping of a live show is an amazing experience, the production crew is flying all over the place making sure things work out perfectly.

I woke up in the middle of the night because it occurred to me that the ABC Studios were just about as far west as they could possibly be on the island of Manhattan. My plan of a train to Grand Central station and walking up was not going to work.

Plan B of taking train to subways and walking west was not going to work either. Plan C of driving in is always fraught with the “what if” there is an accident, or construction on the bridge, or a dead dog slowing traffic to one lane on the West Side Highway (it happened once).

Plan D was train to taxi from 42nd street to West 66th. I knew I had plenty of time even with the morning rush.

New Yorkers have a habit of telling their taxi drivers the route to go, but this time I bit my tongue and just sat back after I said “320 West 66th.” He started off in a boneheaded direction, but I didn’t say anything.

Somehow my taxi driver heard me say “50th and 6th” and that is where he was taking me. He started to turn east on 50th street and I yelled out, and I admit I did holler, “No, No, No…I’m going to 66th and West End, way, way west of here.”

Sadly, he did not stop his turn in time and we were heading east. I was due at the studio in ten minutes. Instead of freaking out, I just said, “I’m going to put my head down and you are going to get me there as fast as you can please.”

It is just too terrifying to look up when your taxi driver is trying to get from point A to point B in a ridiculous hurry. We lurched and screeched our way to 66th and West End.

He dropped me at a corner and there was a huge throng of people, which looked like kids. I actually wondered if it was an American Idol tryout…but remembered that I was looking for ABC, not Fox.

Actually, I was just looking for someone with a clip board, interns always have clipboards. I found a kid with a clip board, who started laughing at my question of where the lineup was for ABC’s The View. She told me I was in the middle of a New York City public school fire drill!

I jogged the block and found another young person with a clipboard, and this time she really was an intern and I found my way in.

At this point in time, I was sorry that I hadn’t taken a piece of advice from Elizabeth’s first book to carry a snack in my purse…I think the adrenaline kicked my stomach into high gear!

As I said it was very interesting and fun to watch the show happen. Look for the interview in Vol 11, #4!
Kendall Egan

Gluten-Free Favorites

If you follow the gluten-free diet, the Natural Products Expo East was pay back for all the times you went somewhere and there was nothing gluten-free to eat.

So many of the 1,400 exhibitors whose booths packed the Baltimore Convention Center had gluten-free foods to sample it was easy get to the point where you could not take one more bite.

In the interest of spreading the word about good, new gluten-free products I did my best to taste as many products as possible. Here's info on some of my personal favorites.

Star Fish Panko breaded shrimp. The breading on the shrimp is made by Aleia's and both it and the finished shrimp are certified by the Celiac Sprue Association. The sample I tasted had a terrific crispy crust on a plump tasty shrimp.This product is not yet available on the Starfish website but it is offered at the Gluten-Free Mall, where it is currently on sale.

"home free" crunch mini vanilla cookies were selected as a finalist in the Expo best foods category, which included all products, not just those that were gluten free. They combine a nice light taste with healthy ingredients, including 13 grams or more of whole grains per 6 cookie serving. Certified gluten-free oats are the main ingredient in the cookies. They are made on equipment that is also used to make products with barley flour, but Jill Robbins, company president, said gluten-free ingredients are segregated, gluten-free baking is done on separate days and thorough cleaning procedures are used. In addition, the company tests for gluten in the finished cookies, which are certified gluten-free by the Gluten Intolerance Group.

Udi's frozen pizza, in three cheese, margherita and pepperoni flavors, had a nice thin crust. The pizza is made in a dedicated gluten-free plant and is certified by GIG. Udi's also introduced  Chocolate Chia and Blueberry Nutri- tops, which are like muffin tops. Blueberry has 8 grams of whole grains and 5 grams of fiber. Both are fortified and should be available soon.

feel good foods will be selling its new gluten-free egg rolls in stores by the end of the year. They come in chicken, vegetable and shrimp flavors and were flying off the plate as quickly as company reps could cook them up at Expo. Most importantly the wrapper was nice and crispy. In fact it was so good I did not pay much attention to the filling. I think that means I need another sample! I also tasted the company's Asian style dumplings which I had trouble making when I tried them at home. I honestly thought this was one of those good ideas that just did not work. But they were being prepared at the show and turned out fine, so maybe it was just me. Feel good foods products are made in a facility that also processes wheat, but the company says strict safety measured are followed to prevent cross-contamination.

Canyon Bakehouse Rosemary and Thyme Focaccia might not be new to everyone, especially those lucky folks in the company's home state of Colorado, but this was the first time I had a chance to taste it. Both it and the 7-grain bread had great texture. The company, which uses a dedicated gluten-free bakery, is transitioning to use of all whole grains in all of its products. The hamburger buns already 100 percent whole grain, and brown rice is the main ingredient in the focaccia.

Kinnikinnick frozen, ready to fill  pie crusts. My grandmother was a master of the flaky pie crust, a skill I did not inherit even in the wheat-flour form. So I've always been intimidated by gluten-free pies that were not of the crushed-cookie crust variety. For anyone who has longed for gluten-free pie but has similar crust insecurity, these might be the easiest answer. The pie crusts are available in stores now and come two in a package. They are made in dedicated gluten-free facility.

Eco Planet Gluten-Free Toaster Pastries. For kids of all ages who miss the indulgence of  Pop Tart-like treat, these will be a welcome addition to the gluten-free line up. They contain seven whole grains, but the first two ingredients are rice flour and tapioca flour, which means these less nutritious flours are used in greater quantity than the healthier whole grain mix. Still, it's a toaster pastry so the stab at a healthier mix is a good start. They are certified by GIG, made in a dedicated facility and expected to be in stores soon.

Medora Snacks Popcorner. These triangle chips are made from air-popped popcorn and come in five flavors. The most exciting news about this product is that it is handed out as a snack on Jet Blue flights. When I fly, the snack is usually pretzels or honey peanuts that contain wheat starch. I love the idea that gluten-free travelers don't have to refuse the snack. The main ingredient is yellow corn enriched with iron, thiamin, riboflavin, niacin and folate.

Jovial brown rice pasta. This rivals some of the best gluten-free pasta already on the market. It cooks evenly and does not have that tale tell mushy gluten-free consistency. The pasta comes in five shapes and is made in a dedicated gluten-free facility. I also liked the Jovial cookies, which come in fig, and vanilla and chocolate cream filled. I love figs so these cookies, which Jovial says are the first fig-filled gluten-free cookies, really appealed to me. They are made in small patches and mixed by hand in a family-owned bakery in Italy. The bakery is not totally gluten-free but dedicated equipment is used and production is done on separate days. Each batch is tested to less than 10 ppm of gluten. Both the pasta and cookies are certified by GIG.  

Snikiddy "eat your vegetables" chips. There's been explosion of gluten-free chips, but what I like about these is they contain one full serving of vegetables in a one-ounce one- serving bag. They also provide 35 percent of your daily requirement of Vitamin A. Snikiddy usually targets its products for children, but these are being pushed for adults. The chips are made in a facility that also processes wheat, but the company says good manufacturing practices are used to segregate ingredients.

Selina Naturally Celtic Sea Salt Toasted Sesame with Garlic. This simple blend of sesame seeds, garlic and sea salt perks up any plain dish easily. It comes in its own grinder. At Expo it was sprinkled over grape tomatoes, which were delicious. When I brought some home I ground a little over penna pasta mixed with olive oil for a really tasty and easy side dish. Some seasonings contain gluten so it's nice to find a brand that is gluten free. It also comes in toasted sesame and toasted sesame with flax.

Solterra Bake in Bag Pizza caused a buzz at Expo. The concept of baking a gluten-free pizza right in the bag to eliminate cross contamination has a lot of appeal to those who take their own pizza to their local pizza shop and have it heated in the oven there. It also makes things easier if you take your pizza over to a friend's house. After the pizza is baked you tear open the bag and serve. The pizza comes in margherita and vegan cheese flavors.

Pamela's, a leader in the gluten-free market, introduced Whenever bars in four flavors. The Whenever name alludes to the fact that the bars make a good on-the-go snack.  They are made on dedicated gluten-free machinery with nine grams of whole grains, including gluten-free oats. I tried and liked the Oat Blueberry Lemon bar.

Simply Sprouted Way Better Snacks have such interesting ingredients lists I had to try them. The six flavors are made with things like flax, chia, radish and broccoli seeds, quinoa, and black beans. Eleven chips equals one serving of vegetables. They are made on dedicated gluten-free machinery and certified gluten free by GIG.

Namaste Foods featured its easy to make pasta meals. I liked the idea of a convenience pasta that comes with seasoning. The Say Cheese meal comes with pasta and a shake-on cheese pack, while the Pasta Pisavera includes veggie brown rice pasta and an Italian seasoning packet. Taco Pasta has the seasoning blended right into the pasta shells. Namaste products are made in a dedicated gluten-free facility.

Roland Quinoa. I love quinoa as much as I love figs so the five easy-to-make flavors appealed to me. All you have to do is add water and heat them for 15 minutes. Each serving of the toasted sesame ginger, Mediterranean, Black Bean, Garden Vegetable and Roasted Garlic quinoa provides at least 40 grams of whole grains.

Mini Pops Air Popped Sorghum. Sorghum is a tiny grain so it pops up in what looks like miniature popcorn. In fact popped sorghum has no hulls, is corn free and has less saturated fat and calories than popcorn. It also requires 50 percent less water to grow. But what caught my attention was the novelty of this pre-popped snack. You just can resist trying those little tiny pops. Made in a gluten-free facility and certified by GIG, the pops come in eight flavors.

As you can see there was an abundance of gluten-free options at Expo. While reading about them is a nibble of information, the only way to know which ones you'll really like is to give them a try. If you do, let me know what you think.

Amy Ratner