Archive for the ‘Ask Shelley Case’ Category

Ask Shelley Case: Fresh Veggie Ideas for the Gluten-Free Diet

Monday, November 7th, 2011


Now that autumn is here do you have any ideas and gluten-free recipes to help me incorporate more vegetables into my diet?


Although summer is over and many of the plentiful vegetables of the season have dwindled in availability from your local farmer’s market and produce stands, fall is an opportunity to discover a whole new array of vegetables.

Three of the most popular vegetable categories of the autumn season include winter squashes, root vegetables and cruciferous vegetables. All three are excellent choices for making soups, stews, side dishes or even as the feature in vegetarian main dishes. Here is a quick primer on autumn vegetables and some gluten-free recipes. Enjoy!

Squash It! Winter squashes are the thick-skinned and bright colored cousins of the thin-skinned and lighter colored goose-necked squashes of summer past. Winter squashes are packed with nutrition, especially Vitamin A, potassium and dietary fiber. Besides the nutritional value of these squashes, winter squashes are a real “keeper” – meaning that they store well due to their thick, hearty skins and can keep fresh in a cool and dark storage location for several weeks.

Some popular varieties include butternut, pumpkin, acorn, and spaghetti squash.  Check out this link for more information about squash.

All these varieties are best prepared steamed or roasted, but they are also perfect additions to soups, stews and purees. A favorite of the holiday season, winter squash dishes are also fragrant while cooking since they pair well with nutmeg and cinnamon.  Some recipes using these squashes include:

Apple Cinnamon Stuffed Squash
Italian Herbed Sauce and Spaghetti Squash
Pureed Butternut Squash Soup

Take Root: Varieties of fall root vegetables include parsnips, beets, carrots, sweet potatoes turnips and rutabagas. These autumn root vegetables are often favored in soups and hearty stews.

Technically, root vegetables are the actual “root” of the vegetable plant that is enjoyed as the edible portion of the plant. Not all vegetables grown underground are root vegetables – many are tubers (potatoes or yams) or bulbs (garlic, onions and fennel).

Root vegetables are also sources of dietary fiber and other nutrients such as Vitamin A. Some recipes including root vegetables include these:

Sweet Buttered Parsnips
Sweet Balsamic Roasted Beets
Orange Sweet Potatoes

Cruciferous! Although the name sounds daunting, examples of some cruciferous vegetables include broccoli, Brussels sprouts, cabbage, cauliflower, bok choy and kale.  These nutritious vegetables contain disease-fighting phytochemicals (naturally occurring plant chemicals), dietary fiber, vitamins (especially vitamin C) and minerals. For more information about the nutritional composition check out this link.

Studies show consumption of cruciferous vegetables may lower your risk of various cancers.  So make sure to incorporate these healthy vegetables in soups, stews, salads or serve as a side dish. Check out these recipe ideas:

Brussels Sprouts Almondine
Roasted Cauliflower
Cream of Broccoli Soup

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: Gluten-Free Family Activities for the Fall

Monday, October 10th, 2011

Question: My child was diagnosed with celiac disease a year ago. Over the summer we found it easy to eat gluten-free with all the fresh fruits, vegetables, outdoor picnics & barbeques. Now that fall is here we are struggling to get into the swing of things, not to mention having to deal with Halloween. Any ideas?


Congratulations on the first year of gluten-free living! It has been said that the first year of being gluten-free can often be the toughest. With the change of seasons, there is always a learning curve, as well. Just when you seem to find seasonal gluten-free recipes and dishes that are both gluten-free and delicious – a whole new season of change occurs!

Autumn is a time to enjoy some great gluten-free recipes that hinge upon outdoor family activities & fun. So put on that extra sweater, get out for a walk and enjoy the changing colors of the season. Here are some family friendly activities & recipes to enjoy the autumn season gluten-free plus tips for a safe Halloween. Enjoy!

How ‘bout them apples? The fruit that is most associated with the fall and the change of seasons is the apple.  A portable, affordable and healthy snack, there are many different tasty varieties of apples. To find out more about different varieties of apples and their uses, check out this article. Apple picking is also a great family activity that is inexpensive, fun and yielding of fresh fruit. To find an apple orchard near you check out

And after you’ve picked your bag, basket or bushel of apples, make sure you check out these gluten-free apple recipes:

Spiced Apple Cake

Apple-Cinnamon Stuffed Squash

Sweet Onion, Cranberry & Apple Bake It’s the Great Pumpkin! Loaded with dietary fiber, Vitamin A and potassium, pumpkins make a healthy addition to your diet. For a great outdoor activity try pumpkin picking! Find your very own pumpkin patch close to your home on this website.

I love that pumpkin picking also leads into other family activities such as pumpkin carving and recipes such as these pumpkin seeds. No time to carve your own pumpkins? Use canned pumpkin for these Flax Pumpkin Squares and these Pumpkin Nut Muffins.

Tailgate Time! Tailgating is a time to cheer on the home team while enjoying time outside with family & friends. Preparing a gluten-free menu can be an easy game plan if you keep the menu options simple and prepare the foods ahead of time.  Some suggestions for gluten-free tailgating recipes that can be prepared ahead of time include: Sweet & Sticky Chicken Drumsticks, Sesame Chicken Skewers and Red Pepper Hummus.

Boo! Gluten-Free Treats for YOU! Halloween treats can often be laden with a lot of tricks when you are concerned with a gluten-free diet.  Make sure that you review all candy label ingredients prior to allowing your child (or you!) to eat. For those items that contain gluten offer to trade the unsafe candy for pennies, nickels or dimes.

Check out the article and links for safe candy lists at “Wish Craft: Keeping Halloween Gluten & Allergen-Free”.

When attending Halloween parties bring along non-food treats such as decorative pencils, markers, stickers, bouncy balls or other small toys – which are all are great alternatives to sweets.

Ask Shelley Case: Whole Grains and the Gluten-Free Diet

Monday, September 12th, 2011


I’ve heard that whole grains are important but I’m confused about gluten-free whole grains and how to incorporate them into my diet… Please help!


Why Whole Grains?

Individuals who regularly eat whole-grains have a lower risk of obesity, lower cholesterol levels and a reduced risk of heart disease, strokes, Type 2 diabetes and certain types of cancers. For those on a gluten-free diet, getting enough gluten-free whole grains can be a bit more challenging. But with a little insight, education, tips and recipe ideas gluten-free whole grains can easily be incorporated into a gluten-free diet and open up a whole new way of eating and good health!

What are Some Gluten-Free Whole Grains?

There are a wide variety of gluten-free whole grains…amaranth, brown rice, buckwheat, corn, Montina™ (Indiana ricegrass), millet, oats (pure, uncontaminated*), quinoa, sorghum, teff, and wild rice. A grain is considered “whole” when it is consumed in a form that includes the bran (or the outer layer and primary source of fiber), germ (or the part that sprouts into a new plant) and endosperm (or the bulk of the seed).

*The majority of commercial oat products on the market are cross-contaminated with wheat, rye or barley which occurs during harvesting, transporting, storing, milling, processing and packaging. The good news is that there are companies in the US, Canada and Europe who produce pure, uncontaminated specialty gluten-free oat products. The North American companies are Bob’s Red Mill, Cream Hill Estates, Avena Foods (Only Oats™), Gifts of Nature, GF Harvest (formerly Gluten Free Oats) and Legacy Valley (Montana Monster Munchies).

The Recommended Amounts of Whole Grains

The new 2010 Dietary Guidelines for Americans recommend that at least half of your grain servings per day should be whole grains.  The Guidelines and Whole Grains Council recommend at least 3 to 5 servings of whole grains per day. The average adult who consumes 2000 calories/day (the amount on the nutrition label), should eat 6 grain servings a day – making at least half of them whole grains. To make things simple and find smart choices, look for the yellow Whole Grains Stamps that have been developed by the Whole Grains Council.

An example of one serving of gluten-free whole grains include:

  • ½ cup cooked amaranth, brown rice, buckwheat groats, millet, oat groats, quinoa, sorghum, teff or wild rice
  • ½ cup cooked brown rice pasta

Tips for Adding Whole Grains to Your Gluten-Free Diet

The following tips are from the resource “Whole Grains and the Gluten-Free Diet” by Carol Fenster and Shelley Case.

  • Add cooked buckwheat, oat groats, steel-cut oats, quinoa, sorghum or wild rice to rice pilaf
  • Enrich soups with cooked brown rice, buckwheat, oat groats, quinoa, sorghum or wild rice
  • Boost nutritional content of brownies, cakes and cookies with ¼ cup cooked amaranth or teff
  • Sprinkle cooked whole grains over mixed green salads
  • Toss cooked whole grains with gluten-free pasta
  • Blend cooked oat groats or brown rice with black beans or pinto beans in Southwestern dishes
  • Extend hamburger patties or meat loaf with gluten-free rolled oats or cooked brown rice, quinoa, amaranth or teff
  • Replace ¼ of the cornmeal with teff grains for a cornmeal-teff polenta
  • Add cooked amaranth, quinoa or teff to puddings for interesting texture
  • Cook hot cereal for breakfast from Ancient Harvest quinoa flakes, Bob’s Red Mill Mighty Tasty GF Hot Cereal, The Birkett Mills’ buckwheat flakes or gluten-free rolled oats

  • Use quinoa flakes, gluten-free rolled oats or gluten-free cold cereals and granolas to top fruit crisps
  • Choose pasta that is made with quinoa (e.g., Ancient Harvest, GoGo Quinoa) or added  rice bran (e.g., Tinkyada, DeBoles GF Multi-Grain)
  • Choose baking flours such as amaranth, brown rice, buckwheat, Montina™, quinoa, sorghum, teff or wild rice because they are ground from the whole grain
  • Add cream of buckwheat cereal to homemade breads
  • Enjoy popcorn as a nutritious snack
  • Choose whole grain crackers (e.g., Mary’s Gone Crackers, Crunchmaster Multi-Grain Crackers)

More Information about Gluten-Free Whole Grains

To learn more about the nutritional composition, cooking tips, recipes, and companies who provide gluten-free whole grains, read Whole Grains and the Gluten-Free Diet by Carol Fenster, PhD and Shelley Case, RD.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: Picky-Eaters and the Gluten-Free Diet – How to Tackle Both!

Monday, August 8th, 2011

My 6 year old daughter just got diagnosed with celiac disease. She’s such a picky eater, I’m afraid she won’t eat anything! Please help!

Over the years I’ve heard this question many times – so rest assured that you are not the only parent with this concern. The key to making your child’s transition from “picky eater” to “gluten-free eater” effortlessly is to give your child a bit of control and decision making in her food choices and meal preparation. Here are a few suggestions on making this transition go from hassle-free to gluten-free in no time at all!

Help them understand the gluten-free diet: Age permitting, make sure that your child understands what the gluten-free diet is all about. Encourage them to ask questions. Introduce them to books that are geared towards children and address the gluten-free diet such as:

“Gluten-Free Friends: An Activity Book for Kids” by Nancy Patin Falini, RD

“Gluten-Free Kids: Raising Happy, Healthy Children with Celiac Disease, and Other Conditions” by Danna Korn

“Mommy, What is Celiac Disease?” by Katie Chalmers

Take your child grocery shopping with you: Letting your child have a say in their gluten-free food choices may take longer while you are in the market, but will avoid bad tempers and problems at mealtime. Get them to select a new fruit or vegetable each week to try, or pick a recipe beforehand and have your child help find the ingredients while in the grocery store with you.

Check out the many kid-friendly prepared gluten-free choices. Some manufacturers that cater to gluten-free kids are: Allergaroo, Enjoy Life FoodsEnviroKidz, GlutenFreedaGlutino, Ian’s Natural Foods, Kinnikinnick , Orgran and Pastariso.

Get them involved! Let your child help you in the kitchen while you are preparing meals with small, age-appropriate jobs. Some ideas are reading recipes and measuring or mixing ingredients. Engage your child!

Serve food that is fun for kids: Get creative with your menu options. Some ideas are:

  • Have the kids top it off! Try having your own gluten-free pizza night! Serve gluten-free pizza and let your children top their own personal pizza with a choice of fresh cut vegetables, lean cuts of meat and cheeses. Another idea is to cook-up some gluten-free burgers or hot dogs and serve them on a toasted gluten-free bun.  Let the kids make their own with fun and non-traditional out-of-the box toppings like salsa, chopped veggies, shredded cheeses and sauces.
  • Make a meal or snack item in a different shape. Try “Eggs in a Hole” by using a cookie cutter to cut out a small circle in the center of gluten free bread. Butter both sides of the bread, place in heated frying pan, crack an egg into the center, cook on one side and then flip to cook the other side. Or use a cookie cutter to make different shapes in a gluten-free grilled cheese sandwich, French toast or pancakes.
  • No bread needed. Breadless sandwich are fun to make! Take a large romaine or other lettuce leaf and place a slice of cheese and gluten-free turkey or ham and roll up secured with a toothpick.
  • Get creative! Try making “Ants on a Log” –   Spread peanut, almond or sunflower butter on a celery stick and decorate with raisins.

Encouraging children to build their own creative meals and snacks gives them ability to explore new food options that you may have thought they never would have tried!

Charm with condiments: So many parents tell me that their kids won’t eat vegetables. My solution? Serve them with a side, low-fat gluten-free ranch dressing, yogurt or hummus.  Suddenly broccoli, cauliflower, zucchini, peppers or baby carrots become fun.

Make meal time “family time”: Although schedules can be crazy and family-members can be running here and there, try to make as many meals as possible “family time”.  This will let your child know that you are all in this together. Things as simple as setting the table for the occasion, turning off the TV set and eating as a family can take the focus off the food, and onto the experience.

Travel the world! Try introducing new tastes and foods with a little international flair.  Have a taco night on Cinco de Mayo and serve gluten-free corn tacos with all the fixin’s. Make the dinner even more festive by wearing sombreros from the party store! Cook up some gluten-free Asian influenced foods on Chinese New Year, or traditional Irish foods on Saint Patrick’s Day. Food can be educational, fun and delicious!

Rock & Roll: Look for a “ROCK” (Raising our Celiac Kids) group. These celiac support groups are a great resource for parents and children. And they often have special events such as potlucks, parties or meeting at restaurants where your child can be encouraged to try new foods that other children are eating. For a R.O.C.K. Chapter near you check out this list of gluten-free support groups.

And finally, here is a helpful article from dietitians Mary K. Sharrett and Pam Cureton called “Kids with Celiac Disease” that has some other great ideas.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: A Behind the Scenes Look with Shelley Case – Gluten-Free Dietitian & Author

Monday, July 11th, 2011

Question: I really enjoy the Ask Shelley Case column on BeFreeForMe every month. Can you tell me a little bit more about Shelley?

When this question was asked by a BeFreeForMe member I decided it would be great to put on my best “Barbara Walters-esque reporting cap” and interview Shelley to find out more about her life outside of work; her education and background; and any future plans to help the celiac community. During my conversations with Shelley I was astounded by her enthusiasm, commitment, devotion, but most of all, the passion that she has for the celiac community.

Shelley’s book, Gluten-Free Diet: A Comprehensive Resource Guide, (which I affectionately call “My Gluten-Free Map”) is now in it’s recently released and wildly successful fourth edition, so I was thrilled to find out what Shelley has in store for us with her future endeavors.

Thanks to Shelley for sharing so much with me and I hope you all enjoy the compilation of my conversations with her.  Shelley ended our interview by commenting that she “looks forward to continuing on this gluten-free journey” with each and every one of us.

And with this I replied back, “I and the rest of the gluten-free community are looking forward to the rest of the ride, especially with you leading the way.”


Be Free!
Kathleen Reale
Founder /


Where do you live? Can you tell us something about it?

I live in Regina, Saskatchewan, Canada. Our province is north of Montana and North Dakota.  Regina’s population is about 250,000 people. We are the home of the Royal Canadian Mounted Police. Our provincial motto is “Land of the Living Skies”. You can see forever because the southern half of the province is flat and we have the most gorgeous sunsets. Because I love to take pictures, I am always getting great sunset shots right off of our deck. (BeFreeForMe Note: Check out the photograph below that Shelley took of one of these beautiful sunsets!)

Where did you go to school to train to become a dietitian and what degrees did you obtain?

I attended the University of Saskatchewan in Saskatoon, a city 150 miles north of Regina, and received my Bachelor of Science in Nutrition and Dietetics in 1980.  One year before I graduated I received my “Mrs.” degree! (I met my husband the very first day at U of S and 3 years later – between midterms and Christmas exams- got married in Regina. Two days after the wedding it was back to the books).  In the fall of 1980 my husband and I moved to Winnipeg where I did my 1 year dietetic internship at Health Sciences Centre in Winnipeg, Manitoba- the province east of Saskatchewan.

When did you decide / discover you wanted to help the gluten-free community and why?

As a new graduate dietitian in 1981, I was excited to finally enter the workforce after five challenging years of university and internship. My passion, which continues to this day, was to be able to help people eat nutritiously and improve their overall health and well-being. In my first job at a large outpatient diabetes and diet education center I was responsible for counseling children and adults with various conditions such as diabetes, heart disease, high blood pressure, cystic fibrosis, food allergies and gastrointestinal disorders, including celiac disease. I was well prepared to counsel individuals with many different problems, however celiac disease was definitely not one of them! Never having seen anyone with celiac disease during internship, and receiving only minimal information in one nutrition class at university, left me ill-prepared. The day I was to counsel my first patient with celiac disease, I remember scrambling to find any relevant information about the disease itself and especially about the gluten-free diet. The little information I did find was out of date and of little use. Realizing I needed help, I contacted the local celiac support group in Regina, Saskatchewan, which welcomed me and taught me so much about the disease and diet, and provided me with some basic materials for counseling future patients. After attending several meetings, I was asked to be their dietitian adviser. I accepted the position and, over time, my knowledge of the disease and diet grew. Ten years later I was invited to become a member of the Canadian Celiac Association Professional Advisory Board, a position I have held ever since. I find working in the gluten-free world so exciting and rewarding.

How did you come up with the idea of writing a book on the gluten-free diet?

Every patient that I saw with celiac disease always wanted very specific and practical information on food labeling and ingredients; names of  gluten-free companies/products and where to find them; recipes; meal planning suggestions; tips for eating out; how to prevent cross-contamination and other gluten-free diet resources. However, such information was usually only available from many different pamphlets, books, manuals and other sources, which meant that the patient had a pile of loose papers to take home after the counseling sessions! In addition to educating patients, I often got calls from other dietitians around the province, seeking information, as they too felt their knowledge of the disease and diet was inadequate. It soon became apparent that there was a real need for a more comprehensive resource, for both health professionals and patients, on celiac disease. This was the birth of the idea for the Gluten-Free Diet: A Comprehensive Resource Guide.

Tell us more about the book saga?

In 1997 I left a very rewarding career at the hospital to pursue a dream of starting nutrition consulting business. In 1999 I decided to get serious about turning this gluten-free resource idea into a reality and dedicated the next two years to researching and writing my first book – Gluten-Free Diet: A Comprehensive Resource Guide. It was self-published in May 2001. The next big hurdle was letting health professionals and individuals with celiac disease know about the resource. Without the backing of a large publishing house, it required creative promotional strategies on a shoestring budget. As the book became better known, positive feedback from individuals with celiac disease and from dietitians was very encouraging. News about the book continued to spread and more of my consulting time was being devoted to celiac disease. Being the marketing representative, shipper and accountant, as well as author and speaker has given me a new appreciation for the role of authors and publishers, and even more for the importance of accurate up-to-date resources for those with celiac disease.

The gluten-free world continues to grow in both the number of individuals being diagnosed and the products and resources available in the  marketplace. These changes have necessitated many revisions to the Gluten-Free Diet to include more information to meet this huge demand. I have now done 4 editions and 9 printings of the book.

On a completely different note, with the recent Royal visit by Will and Kate to Canada and the USA, I understand you have also have had a connection to the  British Royalty. Tell us more.

I received the Gold Duke of Edinburgh Award in 1976 from Prince Philip (Queen Elizabeth’s husband) at the Royal Military College in Kingston, Ontario. In addition to talking to Prince Philip, his son Andrew was also on the stage to see each of us get our award. The 1976 Olympics in Montreal also had the yachting competition in Kingston so security was very tight. Prior to getting to go to Kingston, my dad and I had to go to the RCMP in Regina and get our fingerprints taken and pass the security check!  One interesting side note- the award ceremony was originally supposed to be on the Royal Yacht but was changed at the last minute to the College because the politicians ending up having a dinner on the Yacht with the Royal couple.

I was also very honored to receive the Queen Elizabeth Golden Jubilee Medal from the Saskatchewan Lieutenant Governor at Government House in Regina. It was given in recognition for my contributions to the celiac community and dedication to educating health professionals and individuals with celiac disease in Canada and the USA.

When you are not busy speaking, writing, consulting, counseling clients and doing media interviews, what do you like to do in your spare time?

I love playing piano and keyboard. When I am not traveling, I play in our worship band at church. Taking photos is another hobby I enjoy, along with scrapbooking when I get a chance.

What final thoughts about your work in the gluten-free community would you like to leave our readers?

Thirty years ago I never would have dreamed that I would be a dietitian specializing in celiac disease and the gluten-free diet, let alone be the author of a national best-seller or being interviewed by Matt Lauer on the NBC Today Show. Rather ironic for a dietitian from Saskatchewan, the province known as the “bread basket of the world.” So, for everyone out there with an idea or dream – pursue it, work hard and never give up. Who knows where you may end up!

I’m amazed and truly blessed to have the opportunity to be involved in such an incredible field, meeting so many wonderful individuals with the  disease, along with health professionals and those in government and food industry from the USA, Canada and around the world, who are working so hard to improve the lives of people with gluten sensitivity. The Canadian Celiac Association’s motto “Together We’re Better” is a worthy ideal. I look forward to working together with you and continuing on this challenging gluten-free journey!

BeFreeForMe Note: Many thanks to Shelley for sharing these thoughts, views and inspiration to all of us in the gluten-free community! ~KR

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: The Difference Between Celiac Disease, Gluten Sensitivity and a Wheat Allergy

Monday, June 13th, 2011

I am confused about these 3 conditions. Can you tell me more?

What a great question and one that is confusing to many people! The following are some facts and pointers regarding each of these conditions to  help you understand the differences in these somewhat similar, yet very unique medical conditions:

Celiac Disease (CD)
This is one of the most common inherited disorders with an estimated prevalence rate of  1:100. Celiac disease is an autoimmune disorder in which the villi of the small intestine are damaged by specific proteins in the grains wheat, rye and barley (collectively called gluten). Symptoms of CD are highly variable, may occur at any age, including the elderly, and involve not only the gastrointestinal system but many other organ systems.  Gastrointestinal symptoms range from nausea, reflux, bloating, gas, diarrhea and/or constipation.  Other symptoms can include fatigue, weight loss (note CD can also occur in obese individuals), mouth ulcers, dental enamel defects, bone and joint pain, easy bruising of the skin, menstrual irregularities, miscarriage, infertility in both women and men, migraines, depression, ataxia, seizures, neuropathy, lactose intolerance and elevated liver enzymes.

Another presentation of CD is the skin condition dermatitis herpetiformis (DH) that is characterized by an intense burning, itchy rash that is symmetrically distributed.

Untreated celiac disease can result in nutritional deficiencies such as anemia and osteoporosis, as well as development of other autoimmune disorders (e.g., thyroid disease, arthritis, liver disease) and intestinal cancers.

There are specific blood tests (TTG and EMA) that can be used to screen for CD, however the only definitive test for diagnosis is the small intestinal biopsy. Diagnosis of DH is a skin biopsy from unaffected skin adjacent to the blisters or erosions. A gluten-free diet should never be started before the blood tests and biopsy are done as this can interfere with making an accurate diagnosis.

Once a diagnosis of CD is confirmed, the treatment is a strict gluten-free diet for life. For more information on the gluten-free diet see

Gluten Sensitivity (GS)
Recent research has revealed that it is possible to be sensitive to gluten and not have celiac disease or wheat allergy.  Although the exact mechanisms and prevalence of GS is not known at this time, Dr. Fasano from the Center for Celiac Research in Baltimore has recently published several papers on this topic. There appears to be differences in gut permeability and the immune system of those with CD compared to individuals with GS.  GS is not an autoimmune disease, is not accompanied by elevated tissue transglutaminase antibodies (TTG) and does not result in increased intestinal permeability or severe intestinal damage. However, it is interesting to note that IgA and IgG antigliadin antibodies (AGA) were elevated in almost 50% of the cases in the Fasano study.  Elevated AGA levels have also been seen in schizophrenia, ataxia (loss of muscle coordination) and other conditions.

Symptoms of GS can be similar to CD such as abdominal pain, bloating, gas, diarrhea, unexplained anemia, muscle cramps, leg numbness, and bone or joint pain.

Currently there are no specific tests for diagnosing GS. The only way to determine if someone has GS is by ruling out CD and wheat allergy, then seeing the response to a gluten-free diet and a gluten challenge. It is not known whether someone with GS must strictly avoid gluten for life like those with CD.

The Center for Celiac Research estimates that GS may affect 6-7% of the population compared to 1% for those with CD. Dr. Fasano will be speaking at the International celiac disease conference in Oslo, Norway June 19 at a session called Gluten Sensitivity: More Than Celiac Disease. So stay tuned for more information in my upcoming columns.

Wheat Allergy
A food allergy is an abnormal immune reaction to naturally occurring proteins. The most common food allergens are wheat, egg, peanut, tree nuts, fish, shellfish, soy and milk. Food allergies are estimated to affect approximately 5 to 6% of young children and 3 to 4 % of adults in westernized countries.

When someone with wheat allergy consumes foods made with wheat, it triggers the release of a specific antibody called Immunoglobulin E (IgE) from various cells in the body. This IgE circulates throughout the bloodstream and causes other cells to release inflammatory chemicals such as histamine. This immune response or allergic reaction may result in a variety of symptoms that can be mild to life threatening anaphylaxis that can occur within minutes to a few hours. It can affect the skin, gastrointestinal tract, respiratory system and/or cardiovascular system. Symptoms of wheat allergy can include swelling and itching in the mouth, hives, itchy rash, eczema, itchy and watery eyes, nasal congestion, abdominal cramps and pain, diarrhea, tightening of the throat and trouble breathing and swallowing, dizziness and a drop in blood pressure. Unlike CD, wheat allergy does not result in severe intestinal damage.

Wheat allergy is more common in infants and young children, and is frequently accompanied by other food allergies. Adolescents and adults can be allergic to wheat although it is not as common as in children. It is estimated that approximately 0.1% of the population has wheat allergies.

The only treatment for wheat allergy is to follow a strict wheat-free diet. But the good news is that the majority of children will outgrow their wheat allergy over time. Check out this link for more information about food allergies and food intolerances.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: Celiac Disease & the Gluten-Free Diet – 10 FACTS

Monday, May 9th, 2011

There is so much information on the internet regarding celiac disease and the gluten-free diet but it’s hard to distinguish fact from fiction. Shelley, please help me demystify and make sense of all this information!

Here are 10 Facts about celiac disease and the gluten-free diet, including links and resources that I have put together to help people learn more about the disease and its treatment:

1.    Celiac disease affects 1:100 people.

Celiac disease is one of the most common inherited disorders, with an estimated prevalence rate of 1:100.  It can develop at any age, even in the senior years. It is twice as common as Crohn’s, ulcerative colitis and cystic fibrosis combined. Click here for more information about celiac disease

2.    Diagnosis of celiac disease is often delayed.

Delay in diagnosis is common. Studies in the US and Canada have found that it can take over 10 years before an accurate diagnosis is made. Many individuals are frequently misdiagnosed with other conditions such as irritable bowel syndrome, ulcers, allergies, chronic fatigue syndrome and fibromyalgia prior to getting the correct diagnosis.

3.    Anemia is a common symptom of celiac disease.

Anemia is a condition that results from a deficiency in the size or number of red blood cells or the amount of hemoglobin in these cells. There are many causes of anemia; however, the most common is due to iron, folate or vitamin B12 deficiency. In celiac disease, damage to the intestinal villi in the area where iron and folate are absorbed, frequently results in a deficiency of these nutrients. Once a diagnosis of celiac disease is confirmed and the gluten-free diet is initiated, the villi begin to heal which allows for the absorption of nutrients. Response to the gluten-free diet varies from one individual to another and may take on average from 2-18 months until the nutritional deficiencies are corrected and symptoms resolve. For more information see Anemia and Celiac Disease – Causes and Treatment.

4.    Dermatitis Herpetiformis is related to celiac disease.

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. 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. See this article to find out more about DH.

5.    Some people with newly diagnosed celiac disease also have lactose intolerance.

In celiac disease the small intestinal villi (tiny finger-like projections) become inflamed and flattened (known as villous atrophy) due to the reaction to gluten. 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 tips to manage lactose intolerance.

6.    A strict gluten-free diet is the only treatment for celiac disease.

The only treatment for CD is a strict gluten-free diet for life. All forms of wheat, rye and barley must strictly be avoided, including spelt, kamut, einkorn, emmer, faro, durum, couscous, semolina, bulgur and triticale. Barley malt, barley malt extract, barley malt flavor, brewer’s yeast, malt vinegar, as well as barley-based ale, beer and lager must also be avoided. Here is a more detailed list of foods allowed, to avoid and to question.

7.    Pure uncontaminated oats are allowed on a gluten-free diet.

The protein in oats was originally thought to trigger the same toxic reaction as wheat and other gluten-containing grains. Research in Europe and the US over the past 15 years has revealed that consumption of moderate amounts of oats is safe for the majority of children and adults with celiac disease. Most of these studies used pure, uncontaminated oats, but it should be noted that a very small number of individuals with celiac disease may not tolerate pure oats. The mechanism causing this intolerance has yet to be established. Before adding pure, uncontaminated oats to your diet, talk to your doctor and dietitian. Most authorities recommend that individuals with celiac disease be well established on the gluten-free diet, the celiac antibodies have returned to normal and symptoms resolved. For more information about the safety of oats see this link.

8.    Many foods are gluten-free.

A wide variety of foods that are naturally gluten-free include plain meat, poultry, fish, eggs, legumes, nuts, seeds, milk, yogurt, cheese, fruits, vegetables, as well as many gluten-free flours, cereals and starches that can be substituted for wheat, barley and rye. Distilled alcoholic beverages, wine and gluten-free beer made from buckwheat, millet, rice or sorghum are also allowed.

Amaranth, buckwheat, corn, flax, Indian ricegrass (Montina), legume flours (bean, chickpea/garbanzo bean, pea, lentil), mesquite, millet, nut flours, potato flour, potato starch, quinoa, rice, sago, sorghum, soy, tapioca and teff are gluten-free options.

A growing number of gluten-free specialty products from companies in the USA, Canada and Europe are available in health food and grocery stores, as well as mail order companies. Examples include ready-to-eat baked products (e.g., breads, buns, bagels, muffins, cakes, cookies, pies, pizza crusts), baking mixes and specialty flours, hot and cold cereals, crackers, snack foods, entrees, pastas (corn, legumes, quinoa and rice), bread crumbs, coating mixes, gravy mixes, soups, sauces, communion wafers, ice cream cones, snack bars and gluten-free beers.

Check out Gluten-Free Diet: A Comprehensive Resource Guide for a detailed listing of foods allowed, over 3100 gluten-free specialty products from more than 270 companies, meal plans, recipes, nutrition guidelines and many other resources.

9.    Consulting a registered dietitian with expertise in celiac disease is good advice.

A dietitian will do a nutritional assessment, teach you about celiac disease and the gluten-free diet, and give you practical information to help you successfully manage the gluten-free diet.

10.    There are excellent celiac groups in North America.

Join a celiac group for additional support and encouragement. Here are links to celiac organizations in the US and Canada.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: The Facts on Flax – Incorporating Flax Into a Gluten-Free Diet

Monday, April 11th, 2011

I’ve heard a lot about flax and my doctor suggested I add some into my gluten-free diet. Can you tell me more about it, and how I can incorporate it into my diet?

Flax is a flat, oval seed with a pointed tip – about the size of a sesame seed. It is widely grown across the Canadian prairies and northern USA.  Some varieties of flax are grown for human food consumption while other varieties are used to produce fiber for industrial purposes (e.g., linoleum flooring, linen clothing). The brown and yellow flax seeds grown for human consumption are both very similar in their nutritional composition. Flax is available as an oil, whole seed or ground flax seed (also known as milled flax seed). Grinding ensures that all seeds are broken up, enabling the nutrients present to be absorbed by the body. Ground flax seed can be purchased in vacuum-sealed packages on store shelves or in plastic bags found in the refrigeration section. Whole flax seed can also be ground in a coffee grinder, food processor or blender to the consistency of finely ground coffee.

How to Incorporate Flax in Gluten-Free Cooking and Baking:

Time for an oil change: Flax oil is versatile and easy to use in gluten-free cooking. It is best used in cold foods such as fruit smoothies and salad dressings. It is not recommended for frying as it breaks down when exposed to high temperatures. The oil can also be drizzled over cooked gluten-free pasta!

Flax is a winner for breakfast, lunch or dinner: Whole flax seed and ground flax seed have a light, nutty flavor which becomes more robust if the flax is roasted. Whole and ground flax seed can be used in a wide variety of foods such as muffins, breads, pancakes, waffles, cookies, fruit cobblers, hot cereals, casseroles, meat loaf, burgers, stew, spaghetti sauce, rice dishes and salads. And don’t forget dessert! Mix ground flax in fruit smoothies, yogurt, pudding, cottage cheese, and even ice cream and frozen yogurt.

Got an Egg allergy? Take note! Flax can be used as an egg replacer. To replace 1 egg, soak 1 tsp. of ground flax in 1/4 cup boiling water for 5 minutes. Cool before using. Works best in cookie and snack bar recipes.

Cooking Tips When Using Flax:

Add the liquid: When adding ground flax to a recipe extra liquid must be added (e.g., for every 3 tbsp. of flax add 1 tbsp. liquid).

Lower the heat: Baked goods containing ground flax have a chewier texture and tend to brown more rapidly so the temperature may need to be reduced.

How to Store & Handle Flax:

Flax has got a good long life:
Whole flax seed can be stored at room temperature for up to one year.

Chilled & opaque:
Ground flax seed should be stored in a sealed opaque container in the refrigerator or freezer. For optimum freshness, it is best to grind flax seed as you need it, since the natural fats in flax seed go rancid if left exposed to heat or air. Flax oil is very perishable and should be kept refrigerated in an opaque container.

Nutritional Information About Flax:

Take heart – Flax is good for your overall health: Flax has been consumed throughout history for its nutritional and health benefits. It is rich in alpha-linolenic acid (an essential omega-3 fatty acid), fiber (soluble and insoluble) and plant lignans. These components play a role in the maintenance and improvement of general health. Flax helps promote bowel regularity due to its very high fiber content. It may also help protect against coronary heart disease, as well as breast and colon cancer. In addition, autoimmune diseases, like many other chronic diseases, are a disease of inflammation, and flax is being studied for its positive role in immune and inflammatory reactions.

High in fiber:
Whole flax seeds are an excellent source of fiber. In order to gain all the benefits of flax seed, including the omega-3 fatty acids, lignans, protein, vitamins and minerals, it is important to grind the whole flax seed. This improves the bioavailability of these components.

Vitamin and nutrient powerhouse: Flax is very high in iron, magnesium, zinc, calcium, phosphorus, potassium, thiamin, niacin, vitamin B6 and protein. It is a source of other B vitamins and other nutrients.

I highly suggest that anyone on a gluten-free diet give flax a try and incorporate it into their diets. Check out some of these recipes that include flax in the ingredients list:

Oven-Fried Chicken
High-Fiber Hot Cereal
Crunchy Granola

Check out Flackers®
While speaking on the gluten-free diet at the Natural Products Expo West conference in California in March, I had the chance to visit the exhibit hall and sample many new gluten-free products.  I enjoyed a unique product called Flackers® developed by Dr. Alison Levitt, MD. This large flax seed cracker is made of brown and golden flax seed and tasted great with hummus or peanut butter. Three crackers have 100 calories, 7 grams of fiber and 5 grams of protein and are available in three flavors- savory, dill and rosemary.

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case, RD is a Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Background information and excerpts taken from the following company publications and websites:
Flax Council of Canada
Saskatchewan Flax Development Commission

Ask Shelley Case: Pulses and the Gluten-Free Diet

Monday, March 7th, 2011

I’ve been told to incorporate more pulses into my diet for added fiber and nutrients.  What are pulses? Do you have any tips and recipes for using them in the gluten-free diet?

Pulses (aka legumes) include all types of dried peas & beans, lentils and chickpeas.  Frequently overlooked, pulses are one of the most nutritious and versatile foods. They are high in fiber, protein, B vitamins (especially folate), and a variety of minerals-plus they are low in fat and sodium.

Another benefit of pulses- they are readily available and low cost- a real bonus for those on a gluten-free diet. And the ways to use pulses are endless. They can be included in appetizers, soups, salads, main dishes, baked products and, believe it or not, even desserts!

Incorporating pulses in your gluten-free diet is easy. Here are a few suggestions…

–    Do the Salsa! Toss in ½ cup of black beans into gluten-free salsa. Add a splash of fresh chopped cilantro & a squeeze of lime juice for a quick and easy dip for fresh veggies or corn chips.

–    Humor them with Hummus! Hummus and fresh cut veggies sticks are a great snack or lunch option. The extra fiber and protein will boost your energy in the day.

–    Soup & Salad Time: Throw a handful of chickpeas or beans into your favorite family soup recipe or toss into a salad for a different twist.

–    Creative Sandwich: Mix ½ to 1 cup of cooked and mashed white beans into chicken, egg or tuna salad – The creaminess is surprising and a low fat alternative to mayonnaise!

–    Get Saucy: Add 1 cup of cooked whole or pureed chickpeas or lentils to your spaghetti sauce or chili, and reduce the amount of hamburger you use. Results- lower fat and added fiber!

In addition to adding cooked beans, chickpeas, lentils and peas into the diet, pulse flours such as yellow pea, chickpea, white bean or black bean flours can be used in a wide variety of gluten-free baked recipes.  They are healthy options for baking as many gluten-free flours and starches including white rice flour, tapioca flour, potato starch and corn starch are low in fiber, protein, iron, B vitamins and other nutrients. And gluten-free baked goods made with these refined grains and starches are not enriched with vitamins and minerals like most of the gluten-containing products. That’s why when I bake, I use pulse flours like Best Cooking Pulses yellow pea flour. Some delicious dessert recipes using this pea flour include Best Chocolate Brownies, Banana Chocolate Chip Muffins, and Apple Crisp. Note: To purchase this flour, check out this link on – Best Whole Yellow Pea Flour, 35-Ounces Pouches (Pack of 2)

I am also excited to share with you a wonderful new resource- hot off the press- called Pulses and the Gluten-Free Diet that culinary expert Carol Fenster and I developed for Pulse Canada. This FREE downloadable resource contains nutrition information; buying, storing and cooking pulses; creative ideas for using pulses including 26 delicious recipes using dried and canned pulses, as well as pulse flours.  Enjoy!

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

Ask Shelley Case: Using Almonds in Gluten-Free Baking & Cooking – A Healthy Addition!

Monday, February 7th, 2011

Question: I’ve been hearing so much about using almond flour, almond meal and almonds in gluten-free baking & cooking. Can you tell me more? It would be great if you could provide some recipes too!

Answer: Almond flour is made from blanched ground almonds. Almond meal is made from natural ground almonds with the skin on and has a coarser texture than almond flour.  Both are very nutritious and are high in fiber, protein, and other nutrients such as vitamin E, magnesium and manganese.  This is especially important because many of the gluten-free flours and starches such as white rice flour and starches (tapioca, potato and corn) are low in protein, iron, B vitamins and fiber.

Almond flour and almond meal can be found pre-packaged- available in grocery or natural food stores, from various gluten-free companies and internet stores. You can also grind your own in a small coffee grinder or food processor using blanched or natural almonds. Be sure to grind finely as possible but be careful not to over process or you will end up with almond butter! Due to its higher fat content remember to store almond flour or meal in a tightly sealed container in the refrigerator or freezer to keep it fresh.

Using almond flour/meal in baking adds a rich texture, nutty flavor and nice golden color to baked goods. But thinking beyond baking, almond flour/meal also makes a great gluten-free coating for chicken, meat, fish or seafood.

In addition to almond flour or meal – almond butter, almond milk and almonds (whole, sliced, slivered) are great additions to the gluten-free diet. There are many ways to enjoy the benefits of almonds, and numerous ways to incorporate them into your diet. And don’t forget… almonds are also a great way to boost your breakfast’s nutritional value!

I have been delighted to work with the Almond Board of California to develop these gluten-free resources for health professionals and consumers. Anyone concerned with the gluten-free diet will find them very informative and worth checking out.

Being February, the month designated for heart health, in both the United States and Canada, it is also important to note the benefits of almond in contributing to heart health.

Almonds are a smart choice for baking for Valentines Day. So makes sure you check out this delicious cake recipe – perfect for Valentine’s Day – from Carol Fenster:

Carol Fenster’s Flourless Chocolate Cake

Ask Shelley Case is a feature of It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at:

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