Archive for the ‘Health’ Category

Local Dairy – Good for our environment, health and economy

Wednesday, October 15th, 2014

It’s that time of year when the weather is perfect here in Boston. The air’s crisp, the sun’s warmth is worthy of extended smiles towards the sky and the colorful leaves provide the backdrop of color reminiscent of a photo in any old-time New Englander’s October calendar page.

But it comes as no surprise that sometimes in the hustle and bustle of daily life I often don’t stop, take the time for that deep breath of refreshing air, close my eyes, look-up and give an all-out ear-to-ear smile.

But this past week I was given that chance. I was able to break-out of my stuffy office and experience firsthand how a small local dairy farm, Hornstra Dairy Farm in Norwell, Massachusetts, contributes to New England’s economy, health, environment and community. Thanks to the New England Dairy Promotion Board, myself and several other Boston area bloggers & foodies (Kara from The Foodie Dietician; Julia from Juggling with Julia; Liz from Meal Makeover Moms; Jen from Edible Boston; Julia from The Department of Agriculture for the State of Massachusetts) were invited to tour Hornstra Dairy Farm, named Massachusetts 2013 Dairy Farm of the Year. Not only was it a welcoming break from the 9-to-5 in the office, but it was an inspirational and enlightening way to learn first-hand about local dairy farming, and most importantly why local dairy farming is an integral part of our lives.

The tour was guided by John Hornstra, proprietor of this farm that has been a family-owned and operated business for four generations. John walked us through the start (milking) to the finish of the dairy production at his farm. (Our end of the tour treat? An impromptu morning ice cream party… *cough* *cough* … a little ice cream in the morning never hurt anyone, right?)

Although I learned that each cow is named (Yes, I met a few new friends named Meredith, Kathy, and J. Low) and milked, loved and treated humanely 365 days a year and the farms milk processing, pasteurization process and final products are top-notch (the Vat Pasteurization method is used during the processing of their milk), the biggest impression that John had on me during the tour was the Hornstra Dairy Farm’s legacy to commitment, quality and the love of New England’s families, environment and economy.

And although I don’t consider myself a city-slicker, after my visit to Hornstra Dairy Farm I now truly appreciate local dairy farmers, the beauty of their open spaces, the local culture, and everything that my beloved New England dairy farmers offers to make my family’s lives, health and well-being, well … just a better place to live. And that’s another reason for us all to give an all-out ear-to-ear smile.

Looking for some delicious gluten-free recipes using fresh dairy products? Check out these recipes from myself and fellow bloggers:

Tomato Salsa with Sharp Cheddar & Black Olive Crostini from

Pear & Maple Yogurt Cups from Must Be The Milk

Salted Caramel Peanut Butter Apple Dip from Kara at the Foodie Dietician

Peach Berry Milkshakes from Julia at Juggling with Julia

Sunday Morning Frittata from Edible Boston

Autumn Apple Quinoa Salad from Liz at Meal Makeover Moms

Coming Clean: A Simple Guide to Get You on the Road to Gluten-Free Clean-Eating

Sunday, March 3rd, 2013

It seems that everyone you talk to is trying to eat less. Trying to eat less fatty foods. Trying to try to lose weight.

But instead of giving up the low-fat, low-calorie (and, as a result, low-flavor) foods I’ve chosen to become more aware of the foods that I am eating. To make my food choices simpler, and to really “get to know” my food – what is in it, where it came from, how it benefits and fuels my body.

Basically to clean-up my act when it comes to eating.

But I had questions about this buzzword “Clean Eating”. What does clean-eating really mean? Is it easy to follow? Is it expensive? Does clean eating fit into a gluten-free diet?

After a little research, I discovered that eating clean means eating foods that are whole and unprocessed. Foods like whole grains, lean meats, fruits, veggies and any food free of artificial ingredients, preservatives, sugars or trans and saturated fats. In other words – foods that are minimally processed.

Needless, I was thrilled to get an email from Attune Foods with link to their “Eat Clean: Gluten-Free Menu Guide” last month. This guide prepared by Alysa Bajenaru, RD is a great guideline and way to start off a gluten-free clean eating plan.

So… for the last few weeks I have been eating clean thanks to Attune Foods. They’ve come up with several clean eating diet plans specific to different dietary requirements:  A “basic” real food plan (for those with no allergies / intolerances), a vegetarian real food plan, and also a gluten-free real food plan (the plan that I followed).

I found the gluten-free clean eating diet easy to shop for, easy to prepare, and also easy to eat, thanks to the printable shopping list, recipes and tips to keep on track!  In fact I have found a few recipes (and the blogs that they came from!) that are now on my “keepers” list… recipes I will make over and over again.

“Eating clean” is also easier than expected, I think mostly because I am so use to reading labels and not being able to eat many processed foods due to celiac disease. I guess that celiacs are half-way there when it comes to following a clean eating lifestyle.

Some of my favorite recipes included the Colorful Stir Fry (my all-time favorite! ), Meyer Lemon Slow-Cooker Chicken with Sweet Potatoes, Maple Dijon Pork Tenderloin, and making up Breakfast Parfaits layered with Yogurt, Erewhon Buckwheat & Hemp cereal and Blackberries.

Come clean! Go ahead and give the Eat Clean Menu a try! Here are a few of my tips for those who want to follow this real food menu plan:
–    Consider shopping daily if only one or two people will be following the plan. You’ll find that you’ll have leftovers, and may not have to make a dinner each night.
–    Invest in a citrus press (see photo below).  This gadget is my new “must have” gadget! I love, love this thing! The best $10 I ever spent. =) It was a godsend when making the Meyer Lemon Slow Cooker Chick Dish, and came in quite handy for adding a citrus zip into the numerous glasses of water I drank while on the plan. Which leads me to the next tip…
–    Make sure you drink tons of water while on the plan. It helps flush any leftover toxins out of your body, and as an added bonus, it will make your skin glow!
–    As always, read the labels when buying items from the shopping list. Items, such as the almond milk, can contain gluten.
–    Definitely splurge and spend the extra when it comes to buying the grass-feed beef. It makes SUCH a difference in flavor, compared to “regular” beef. The grass-feed beef tastes like beef use to taste when I was younger. It makes such a difference!
–    Don’t feel that you have to buy everything on the shopping list. Improvise and make substitutions! I couldn’t bring myself to spend $11.99 for the hemp hearts, so I passed on them; I bought regular almond butter that cost $5.99, instead of the organic at $13.99; I don’t really like mushrooms, so the cremini mushrooms didn’t make the cut to get into my shopping cart; Use soy yogurt if you have dairy allergies. Feel free to get creative with the recipes and customize them to fit your tastes, budget & allergies.

NFCA Webinar: “Sex & the Celiac: A Focus on Reproductive Health” Wednesday 02/20/13

Tuesday, February 19th, 2013

It’s time again for another National Foundation for Celiac Awareness (NFCA) webinar!

Coming tomorrow, Wednesday, 02/20/13, at 8:30 PM EST (5:30PM PST) the webinar, “Sex and the Celiac: A Focus on Reproductive Health” will focus how celiac disease and reproductive health are commonly associated.

Let’s face it… when people think of celiac disease, they often just think of gastrointestinal health issues (aka: what goes on in the bathroom). But what many don’t know is that celiac disease can also impact what goes on in the bedroom too! Celiac disease can go hand-in-hand with reproductive system issues – complications such as infertility, miscarriages, stillbirths and adverse pregnancy outcomes. Plus, celiac disease can even have an impact on sexual libido.

Stephanie M. Moleski, MD, Assistant Professor of Medicine at Thomas Jefferson University Hospitals discusses this popular topic, along with questions direct from the attendees of the webinar.

This webinar is a must attend for anyone with celiac disease that is planning for a family now, or will be in the future.

Can’t attend? A recording of each webinar will be posted along with the webinar slides within 72 hours after the live event ends. Download recorded webinars and slides at:

As with all of the NFCA webinars it is FREE to attend! And registering is easy… Just click on the button below:

Ask Shelley Case: Healthy Gluten-Free Eating

Wednesday, March 14th, 2012

Shelley, can you give me some tips on how to eat healthy on a gluten-free diet?

March is national nutrition month so this is a perfect time to offer up some tips on eating nutritiously!  The American Academy of Nutrition and Dietetics and the Dietitians of Canada want to help consumers focus on the importance of making informed food choices and developing sound eating and physical activity habits not only in March but throughout the year.

Following a gluten-free diet can present certain challenges that arise when it comes to eating a balanced and nutritious diet due to the dietary limitations. Here are a few pointers and tips on eating nutritiously… and gluten-free:

Get your plate in shape everyday: When people first begin the gluten-free diet it is quite common to eat the same foods day after day such as rice crackers or rice cakes and white rice. This not only gets boring but can result in missing out on essential nutrients. To make sure you are eating adequate amounts from each food group use this food plate nutrition as a guide.  Also check out Canada’s Food Guide for more information, including tips for choosing and preparing foods from each group.

It’s about the whole grain: Many gluten-free baked products, cereals and pastas are made from refined flours and starches such as white rice flour, tapioca, corn and/or potato starch that are low in iron, B vitamins and fiber. When choosing gluten-free products, select ones that contain whole-grains, such as amaranth, brown rice, buckwheat, corn, millet, oats (pure, uncontaminated*), quinoa, sorghum, teff, and wild rice.  And to find out more read my blog post on whole grains and how to incorporate them into your gluten-free diet.

Start your day out right- eat breakfast: It’s true. Breakfast helps you jump start your day both mentally and physically. A healthy breakfast fuels your body with food and provides key nutrients such as protein, iron, B vitamins, carbohydrates and fiber. Many traditional breakfast items are made with gluten-containing grains, especially wheat and barley. But not to worry- there are plenty of great gluten-free breakfast options available. Check out my blog to find more nutritious gluten-free options.

Eat more veggies and fruits: Whether you are on a gluten-free diet or not, most people do not get enough fruit and veggies! With a little planning and creativity it’s possible to get more at snacks and meal times. I like adding blueberries, strawberries or sliced bananas on my gluten-free oatmeal or granola. How about apple or pear slices and nut butter on a gluten-free waffle or toast? Baby carrots, sliced peppers, cherry tomatoes and cucumbers make a great snack with hummus or low fat dip. Double up your portion of vegetables or serve a salad and a cooked vegetable for dinner. Need more ideas? Check out this link for tips on adding more fruit and vegetables to your diet.

Boost the nutritional content of sweet treats: For those with a  sweet tooth incorporate fruit and gluten-free flours from whole grains, nuts and pulses (aka legumes) when making cookies, muffins and cakes to make them more nutritious. Need some ideas? Check out these recipes: Oatmeal-Berry Bars, Anise-Apricot Biscotti, Strawberry Rhubarb Cobbler or Cranberry Pistachio Biscotti.

Remember quantity, as well as quality: Being overweight  or obese are at an all-time high in North America, so controlling the amount you eat can help prevent these two epidemics. Many gluten-free products are high in sugar, fat and calories and low in fiber so check the nutrition facts label and compare products for the healthier option. Also practice eating slowly, eating food from a plate or bowl… instead of eating out of a bag, and being conscious of portion sizes, especially while dining at restaurants, can all help in weight management, and ultimately better health.

Get more nutritional information:

Check out my website for more healthy tips on eating gluten-free at:

Also contact a registered dietitian in your area for personal assistance.
Registered dietitians are uniquely trained and qualified to translate the science of nutrition into practical advice for people of all ages, whether you have a health problem or just want to eat better. Here are links to find a dietitian in the USA and Canada.

Losing Weight & the Gluten-Free Diet: The Secrets We Already Know

Monday, January 2nd, 2012

The New Year is here and for many it’s the time to revisit the scale and devise ways to shed the extra weight we’ve gained over the holiday season, or have even been carrying around with us for the past year… or more.

Like many others, I too have gained weight since being gluten-free. Thankfully the days of having an insatiable appetite yet still being able to lose weight, because of undiagnosed celiac disease, are long gone. Also gone are the days of cramping, bouts with diarrhea, anemia and feeling like I was in a “mental fog” and out-of-sorts. Bye-bye to that all. Thank God.

I know that now my body is finally healthy. Finally. After years of eating gluten my body was not absorbing the basic nutrients needed to thrive –  including fats, vitamins, minerals, proteins and carbohydrates. Now, I am healthy and “normal” when it comes to gaining weight.

And what does a body behaving “normally” mean?  It means that now when I eat too much I gain weight. For the most part I eat healthy and well. But every so often, I enjoy all the gluten-free goodies, sweets, desserts and high-calorie things “I just have to try since it is gluten-free”. All things that don’t helping the waist line.

Through emails sent to BeFreeForMe from our members, comments on BeFreeForMe blog posts, and reading gluten-free forums and fellow gluten-free blogs, if seems that gaining unnecessary weight while on the gluten-free diet, and then trying to loose it, is a huge concern. It’s a hot topic. People are asking if there’s a trick? Any special ideas on losing this extra weight? Is there a special weight loss diet for those with celiac disease? And through it all I have learned that one thing is a fact: Losing that extra weight can be hard.

But why? Here we are a group of people, old-pros at restricted eating. We know what it takes to get into the mindset of eating for our health. Let’s face it, we are good at it. We’re proven pros. Which got me thinking… what if we simply take all we know about eating gluten-free successfully and apply it to eating to lose weight? Would we be on the right track to rid ourselves of any extra weight?

So after much thought I decided that instead of trying to find a magic trick or miracle diet, the secret is something we’ve been practicing all along… our gluten-free lifestyle.  Read on…

– Keep track of what you eat: We’ve all had it happen… The mistaken ingestion of gluten. This is where a food diary can help in determining where the gluten could have come from. By using the same “food tracking” concept when trying to loose weight, a food journal can help keep track of what you eat and assist in making better choices, as well as keep you accountable.

– Always have an emergency snack handy: Being gluten-free we know the scenario: You are stuck in an airplane on a snowy tarmac for hours or you are scheduled in back to back meetings and a gluten-free lunch option is nowhere in site… you get the picture. Any good dieter should also know that a healthy snack kept in your bag is a must to keep yourself in check calorie wise when hunger strikes. Some gluten-free options: fruit-based energy bars, nuts, or dried fruit.

– Plan ahead: We all know that the gluten-free lifestyle can require calling ahead to restaurants to find out what gluten-free options there are to eat.  When watching your weight the same due-diligence should be used. Check out restaurant menus online before getting to the restaurant to not only find the gluten-free options, but also the ones that are the healthiest and the best-bet calorie-wise. Do double due-diligence!

– Life beyond white bread: Being gluten-free we know that there are other options besides “white” (or refined grains) when it comes to bread. For those trying to lose weight, go for the gluten-free breads that contain whole grains that are higher in fiber and protein. Some grains to look for include: amaranth, brown rice, buckwheat, millet, oats (pure, uncontaminated), quinoa, sorghum, teff, and wild rice.

– You can do it: Being on a gluten-free diet, at least at first, takes some time and experience to get down pat. But over time, it comes more natural. The same holds free for eating to improve your health, and loose some weight. Renew that faith in yourself and remember that you can do what you put your mind to do!

– Life just isn’t about food: People that are trying to loose weight are often told to engage in activities that don’t focus around eating and food. If anyone knows the challenges of combining social situations and food, it’s a person on a gluten-free diet. Embrace activities that involve exercise, and bring along a light gluten-free snack to refuel!

– We know how to say “No thank you”: Being gluten-free we know how to say “no thank you” graciously and politely. Learn how to use these three little words when refusing high calorie foods that add to your waistline.

–  Respect your body: Often time, it takes awhile to get your body healthy. After I went gluten-free it took some time to heal – to feel better. The same holds true when it comes to weight loss. We can’t expect immediate results, but slow gradual ones. Be patient.

– Believe in yourself: Dig deep inside and dig up that “I can do it” attitude. You got through the ins-and-outs and the trials and tribulations of gluten-free living. Take that same attitude, motivate yourself, and set your mind to reducing your weight for your health!

What are your pointers for loosing weight on the gluten-free diet?

Do you have any New Year’s Resolutions when it comes to better health?

Discovered: CeliacSure – A Test to Diagnosis Celiac Disease at Home

Saturday, May 7th, 2011

This past weekend I got a chance to bond once again with everyone at my local Greater Boston celiac support group, the Healthy Villi, during our spring conference. Like many folks around the country I find that these local celiac support groups give me the chance to re-connect with like-minded people, as well as share and discover new ideas, concepts, and solutions for living the gluten-free life.

And at every one of these meetings I always take home such a wealth of knowledge & information from Dr. Daniel Leffler, the Director of Clinical Research at the Celiac Center at Beth Israel Deaconess Medical Center and Assistant Professor of Medicine at Harvard Medical School. Lucky for us at the Healthy Villi, Dr. Leffler (who is also  the co-editor of the book, “Real Life with Celiac Disease: Troubleshooting & Thriving Gluten-Free”) has become our “resident” go-to celiac expert –  always willing to help us,  give us answers, and most importantly support us.

But at this last meeting it was our time to give back… to support Dr. Leffler. The team at Beth Israel Deaconess Medical Center asked us to help with a research study. To potentially help celiacs everywhere. For once it was our chance to give back.

The research study we were asked to participate in involves having our first-degree relatives test themselves for celiac disease using a new “finger-stick” test kit. Research results of this testing will hopefully be beneficial in two ways: First, family members who tested positive for celiac disease will be assisted in arranging appropriate medical follow-up to lead to an earlier diagnosis & care of the disease; and second, this research will hopefully get these tests, which are currently approved in Canada, on the fast-track to get the final nod of approval by the USA so the medical community can more readily reach & treat more potential people with celiac disease, and allow these medical researchers the ability to conduct more efficient studies of the disease.

The test kit being used in Dr. Leffler’s test is distributed by GlutenPro and is called Biocard/CeliacSure. It is similar to the standard celiac blood test TTG used in doctor’s offices, but is super consumer-friendly. It involves using just a finger-stick and is able to be read directly by patients in less than 10-minutes right in their own homes. (Note: they can also be purchased on-line through the GlutenPro website).

My thoughts? The Biocard/CeliacSure tests will be a phenomenal help in getting more people diagnosed quickly & more efficiently with a celiac disease diagnosis. For years I have begged my Dad to go to the Doctors and get tested for celiac disease once I and other family members were diagnoses with the disease. He has every symptom in the book. But to get an old Italian guy, set in his bread-and-pasta-loving-ways to the doctor for this test is next to impossible. Begging, pleading and praying have yet to yield a trip to the doctor’s office to get the test and results of celiac disease that I suspect.

Maybe he is scared of going to the doctor? Maybe he is afraid of letting his traditional Italian bread and pasta recipes go? Maybe he is afraid of the change the disease demands? Maybe his positive diagnosis would be his way of feeling responsible for my, and other family members, celiac diagnosis?

Whatever the reason, I am going give my Dad one of these test kits so he can test himself – no doctor, no stress, no appointment needed. Then, regardless of the results, I’m going to treat him to a big delicious gluten-free Italian pasta dinner… and a great big thank you hug.

Just wondering… Your thoughts? Why won’t your relatives get diagnoses with celiac disease?

WIN-It-Wednesday: Hope Paige Design’s Medical Alert Bracelets

Tuesday, April 26th, 2011

I wear one. I wear it all the time. I never take it off. I’d never leave home without it.

What am I talking about? My medical alert bracelet.

I wear my medical alert bracelet because I am allergic to penicillin and sulfur drugs. My allergy is so bad that I become anaphylactic if I take even a small amount of either of these two drugs. I learned my lesson the hard way after having the scare of my life, and a trip to the emergency room that I, or my family, will never forget.

My anaphylactic reaction to these drugs is the same reactions many have that are allergic to various food allergies; nut allergies, peanut allergies, shellfish allergies – plus more. There are also other conditions where people should wear medical alert jewelry including: autism, diabetes, dementia, taking certain medicines like Coumadin or Warfarin, heart disease, arrhythmias, pacemakers, asthma, or children with special needs.

That’s why it astonishes me that so many adults and children with food allergies don’t wear medical alert bracelets.

Medical alert bracelets “talk” when you or your child can’t. “The mistakes that we see when there are reactions in school often have to do with dropping the guard because of lack of education…” said Dr. Scott Sicherer, a professor at pediatrics at Jaffe Food Allergy Institute at Mount Sinai Medical Center. “[Have] the child wear medical identification jewelry to keep that in mind.”

My thoughts? If you would tell an emergency room doctor about any condition you or your child have – a medical alert bracelet should be worn with that info on it.

Hope Paige Designs is a company that makes medical alert jewelry and medical identification bracelets that aren’t just functional, but fashionable too. After checking out the Hope Paige website you’ll see that medical alert bracelets have come a long, long way. Say goodbye to the ugly, super huge, cheapo, old-man looking, “one-style and size-fits-all” medical alert bracelets that have been worn for years and touted on flyers stuffed in a “take one” holder on every pharmacy counter in the country.

Hello Hope Paige! The company that makes medical alert bracelets fashionable and fun.

Hope Paige has medical alert bracelets that will appeal to kids, tweens, teens, 20-somethings, Moms, business-people and everyone in-between! I like the fact that Hope Paige designs “gets it”. No one wants to wear a gawd-awful looking piece of jewelry that draws unneeded attention to their condition.

This is especially true with children. It’s hard enough for kids having food allergies, diabetes, or other conditions that may make them feel different. Throwing a clunky medical bracelet on top of that doesn’t make things easier… but Hope Paige changes that. Their focus is on fashion and finding a way to add function without sacrificing the “hipness” and fashion of the bracelet. Hope Paige Designs provide a medical alert bracelet that’s stylish for kids and doesn’t even look medical –  so that kid’s can be more comfortable in their own skin.

Some of the most popular (and my favorite!) medical alert bracelets sold by Hope Paige include the thin and thick black rubber bands, thin pink rubber bracelets, Pandora style bracelets, rope knot bracelets and stainless steel heart link bracelet. Hope Paige Designs also offers free engraving with every bracelet ordered.

The next two (2) weeks WIN-It-Wednesday’s on is sponsored by Hope Paige Designs. They are offering two (Yes…2!) LUCKY BeFreeForMe members a chance to win the medical alert bracelet of your choice! One winner will be selected from all entries received before Tuesday, May 3, 2011 at 11:59PM EST. The second winner will be selected between all entries received between Wednesday, May 4 and Tuesday, May 10, 2011 at 11:59PM EST.

How can you win? Easy! Check out the Hope Paige Design’s website, reply to this blog and tell us what bracelet you would want to win!

Good luck, be safe…yet fashionable… and as always,

Be Free!

ASK Shelley Case: Dermatitis Herpetiformis – Find Out More!

Monday, October 11th, 2010

Question: My Aunt just got diagnosed with Dermatitis Herpetiformis. She said this is a type of celiac disease that affects the skin. Shelley, can you tell me more about this?

Dermatitis Herpetiformis (DH) is another form of celiac disease. This chronic skin condition is characterized by an intense burning, itchy and blistering rash. The rash is symmetrically distributed and commonly found on the elbows, knees and the buttocks, but can also occur on the back of the neck, upper back, scalp and hairline. Initially, groups of small blisters are formed that soon erupt into small erosions. Most people with DH will also have varying degrees of small intestinal villous atrophy although many will have no bowel complaints. A small percentage may present with bloating, abdominal pain and diarrhea, especially if the bowel involvement is severe, and some individuals may show evidence of malabsorption and malnutrition.

Approximately 10% of individuals with celiac disease have DH with a male to female ratio of 2: 1. The age of onset is typically between 25-45 but can also occur in children and older adults.

Individuals with DH are frequently misdiagnosed with other skin conditions such as eczema, contact dermatitis, allergies, hives, herpes or psoriasis and treated with a variety of topical creams. The only way to correctly diagnose DH is a skin biopsy from unaffected skin adjacent to blisters or erosions. A small intestinal biopsy is not essential if the skin biopsy is positive for DH.

Treatment for DH is a strict gluten-free diet for life. For some individuals, Dapsone, a drug from the “sulphone family,” may be prescribed to reduce the itching. Response to the medication can be dramatic (usually 48-72 hours). However, Dapsone has no effect on the ongoing immune response or intestinal atrophy. Following a strict gluten-free diet will result in:
•    Improvement in the skin lesions.
•    Major reduction in drug dosage for those people initially started on Dapsone. After a time, it is often possible to discontinue the drug to control the skin rash. Flare-ups due to inadvertent or intentional gluten consumption may require temporary use of Dapsone.
•    The gut function will return to normal.
For more information and photos about DH see the National Digestive Diseases Information Clearinghouse (NDDIC) website.

NOTE: Once a diagnosis of celiac disease or dermatitis herpetiformis is confirmed, it is essential to consult with a registered dietitian with expertise in celiac disease and the gluten-free diet for nutritional assessment, diet education, meal planning and assistance with social and emotional adaptation to the new gluten-free lifestyle. Also, joining a celiac support organization for further information and ongoing support is highly recommended.

ASK BeFreeForMe: What are Probiotics? Are they helpful for people with Celiac Disease?

Monday, May 3rd, 2010

Question: I’ve heard a lot lately about probiotics? What are they? Are they helpful for people with celiac disease?

When this question was asked by a BeFreeForMe member I decided to turn to one of my most reliable sources, Dr. Daniel Leffler, Instructor in Medicine at Harvard Medical School, and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston. During our conversations I was thrilled to learn that Dr. Leffler has recently launched his co-authored book, Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free (AGA Press, May 2010), which is available now at or your local bookstore. Check it out and get your copy now.

Do you have a question for Dr. Leffler? Do you have a question for Shelley Case? Is so, email me at Your question may be selected for our next column.

Be Free!

Kathleen Reale
Founder –


What exactly are probiotics?

The intestine is filled with countless microorganisms, mostly bacteria, but also yeasts and viruses among others.  Generally there are few bacteria in the top of the intestinal tract (stomach and beginning of the small intestine) and huge numbers in the colon. 

Probiotics, commonly referred to as “good bacteria,” are living microbial food ingredients that, when ingested in adequate amounts, are beneficial to health. Even though the science behind them is relatively new, their use goes back to ancient times when, in many areas of the Roman Empire, people used products fermented by bacteria with the assumption they would be beneficial to health.

Scientists had long considered probiotics to be a popular remedy devoid of any real effect. But in the last 15 years, they have been the focus of a great deal of laboratory and clinical research.  As a result, we now have identified a number of microorganisms that can improve health in a variety of ways.  We are just beginning to learn about the ways our body interacts with the microorganisms that live within us.  Although our understanding of this exciting area is primitive, it is clear that there is are many complicated relationships between intestinal microbes and health


What are the benefits of probiotics?

There are many suggested benefits of probiotics but only a few are supported by scientific data at this time.  While the following section focuses on an area we are most certain of, it is important to recognize that this is a young science.  Little is known about the types of probiotics that are best for specific problems.  On the other hand, with the exception of individuals who have significantly impaired immune systems, probiotics appear to be very safe.  For this reason, there is little reason, in consultation with your health care provider, not to consider a trial of at least one or two types of probiotics for a symptom or issue.

I have celiac disease, can probiotics help me?

One of the most important functions of the intestine is to prevent ingested toxins and antigens from getting into the blood. This barrier function is largely the job of the ‘tight junctions’ which connect adjacent cells in the intestinal lining. With injury to the intestine, as in untreated celiac disease, tight junctions do not function as well causing what is known commonly as ‘leaky gut’.  Probiotics may be beneficial by improving tight junctions and reducing inflammation.  There is also some laboratory evidence that certain types of probiotics can make gluten less toxic. 

It is important to note that probiotics cannot replace the gluten free diet or even allows one to be less strict with the gluten free diet; however they can be very helpful for individuals who are still having symptoms despite a strict gluten free diet.


What are some quick and easy ways to get probiotics into my diet?

There are many types and preparations of probiotics on the market. They can come in pills, powders, yogurts, snack bars and, drinks and candies.  This is important because not all preparations contain useful or even living microorganisms.   It is impossible to give a comprehensive listing of the probiotics available, although the nonprofit organizations USprobiotics, ( and The American Gastroenterological Association ( provide helpful information on probiotics.

Adapted from:  Guandalini S, Felipez L.  ‘Probiotics in Celiac Disease’ from: Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free by Melinda Dennis, MS, RD, LDN, and Daniel A. Leffler, MD, MS, published by AGA Press May 2010. Available at or your local bookstore.

This column is sponsored by Attune Foods (, a sponsor of the Celiac Disease Foundation. Attune makes gluten free chocolate probiotics bars that are a portable, easy way to get probiotics into your diet daily!

Ask Shelley Case: Does Celiac Disease & Lactose Intolerance Go Hand-in-Hand?

Monday, March 8th, 2010

Q. I have just been diagnosed with celiac disease. In addition to avoiding gluten do I need to avoid dairy products too? I hear that celiac disease and lactose intolerance can sometimes go hand-in-hand.

Celiac disease is an autoimmune disorder triggered by the consumption of gluten found in the grains wheat, rye and barley. The small intestinal villi (tiny finger-like projections) become inflamed and flattened (known as villous atrophy) due to the reaction to gluten. Malabsorption of various nutrients such as iron, folic acid, calcium and vitamin D can result. Fortunately, removing gluten from the diet will allow the villi to regenerate fairly quickly- often weeks to a few months. In some people with long-standing, undiagnosed celiac disease or in older individuals, it may take months to several years until the villi are completely healed. The most important factor is to follow a strict gluten-free diet for life.

The tips of the villi also contain enzymes such as lactase which is responsible for the digestion of lactose- a natural sugar found in milk and milk products. In some individuals with newly diagnosed celiac disease, especially those with major villous atrophy, the level of lactase is significantly reduced. This temporary lactose intolerance causes undigested lactose to pass through the intestinal tract, drawing fluid with it. It is then fermented by bacteria in the large intestine producing short-chain fatty acids and gases. Symptoms of lactose intolerance may include abdominal cramping, bloating, gas, nausea, headache and diarrhea. These symptoms can occur 15-30 minutes or as long as several hours after consuming foods with lactose.

The good news is that this temporary lactose intolerance often improves on the gluten-free diet alone. However, some people may also need to restrict or reduce lactose until the villi are completely healed and the lactase enzyme levels are restored to normal. This may take weeks to months depending on individual response. It should be noted that most individuals with lactose intolerance can digest small amounts of lactose.

Here are some options for those with lactose intolerance:

 Lactose-reduced milk contains added lactase enzymes and about 99% of the naturally occurring lactose has been converted to simple, easily digested sugars. Some brands such as Lactaid and Dairy-Ease are available in refrigerated forms and Lacteeze is in shelf-stable and refrigerated forms. Lactose-reduced milk is slightly sweeter than regular milk but it has the same nutritional value and can be used in cooking and baking as well.

 Lactase supplements can be taken just before meals or snacks that contain lactose. Lactaid makes caplets that can be swallowed or chewable tablets. Lacteeze brand has ultra-strength tablets.

 Lactase enzyme drops can be added to liquid dairy products. You need to pre-treat the milk at least 24 hours in advance to ensure the lactase breaks down the lactose. Lactaid and Lacteeze make these drops that are available in drug stores.

 Non-dairy beverages made from nuts, potatoes, rice or soy do not contain any lactose. Look for brands that are gluten-free (do not contain any barley malt flavoring) and are enriched with calcium, vitamin D and other nutrients.

 Yogurt is often tolerated by those with lactose intolerance. Although yogurt contains lactose, the lactase enzymes in the active cultures digest this lactose. Choose brands that contain “active” or “live” cultures.

 Cheese  especially aged, natural cheese such as Cheddar, Swiss, Parmesan and Mozzarella are low in lactose. In these cheeses most of the lactose is removed with the whey and the small amount remaining is broken down during the aging process, therefore, most aged cheese are well tolerated.  However, processed cheese food and processed cheese spreads often contain added modified milk solids, therefore their lactose content may be higher than plain processed cheese. Light cheese products also contain modified milk solids that replace milk fat. They tend to be high in lactose.

 Milk  taken in small amounts (1/4-1/2 cup) at a time may be tolerated. Avoid drinking large amounts at once. Consume milk with meals or snacks but avoid drinking on an empty stomach. The higher the fat content in the milk, the slower it is digested and more easily tolerated. Whole milk may be better tolerated than low-fat or non-fat milk.


The above information was excerpted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD. See

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