Posts Tagged ‘Ask Shelley Case’

Ask Shelley Case: Anemia & Celiac Disease – Causes & Treatment

Tuesday, August 10th, 2010

Question: After years of being anemic, I just found out I have celiac disease. Do you have any advice on maximizing iron absorption?

Anemia is a concern for many folks that have been diagnosed with 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. As the disease progresses, villous atrophy in the lower part of the small intestine (terminal ileum), resulting in vitamin B12 malabsorption, can also occur in some individuals. Other reasons for inadequate absorption of B12 may be due to small intestinal bacterial overgrowth, low stomach acid levels (caused by the long-term use of gastric acid blocking agents for the treatment of reflux or ulcers) or pernicious anemia (an autoimmune disease that produces antibodies that destroy specific cells in the stomach which contain the Intrinsic Factor (IF) that is necessary for the absorption of B12 from foods).

How Can You Treat Anemia?

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. In addition to a strict gluten-free diet, it is important to include foods high in iron, folate and vitamin B12. Nutrition supplements may be required if the deficiency is severe. In the case of pernicious anemia, life-long vitamin B12 supplementation (shots, intranasal or oral supplements) are necessary. Discuss with your physician and dietitian about supplementation.

There are two types of iron in foods, heme iron and non-heme iron:

Heme Iron:
•    Is more readily absorbed by the body (approximately 23% of heme iron consumed is absorbed).
•    Absorption is not changed by other foods in the diet.
•    Is found only in red meat, fish and poultry.

Non-Heme Iron:
•    Is not absorbed as well as heme iron (only 3-8% of non-heme iron consumed is absorbed).
•    Absorption can be increased or decreased by other foods in the diet.
•    Is found in fruits, vegetables, grains and eggs.

How Can You Maximize Iron Absorption?

1.    Choose foods with a higher iron content

2.    Eat a source of heme iron with non-heme iron at the same meal: An example is stir-fried beef, chicken, pork or fish with vegetables (e.g., broccoli) and rice and toasted almonds or sesame seeds; or Chili with meat and beans.

3.    Vitamin C increases absorption of non-heme iron so combine vitamin C-rich foods with non-heme iron foods at the same meal: An example of this includes Poached egg and glass of orange juice; Casserole with rice, beans, canned tomatoes or tomato sauce; or a Spinach salad with strawberries or orange segments.

4.    Avoid coffee or tea with meals rich in iron as these beverages contain tannins which interfere with iron absorption. It is better to drink these beverages between meals.

5.    If taking iron supplements, consume supplement with vitamin C-rich foods.

How Much Iron Do You Need?

For more than 50 years, nutrition experts have produced a set of nutrient and energy standards known as the Recommended Dietary Allowances (RDA’s). A new set of standards has been developed called the Dietary Reference Intakes (DRl’s) which reflect collaborative efforts of American and Canadian scientists, through a review process overseen by the National Academy of Science’s Food and Nutrition Board, Institute of Medicine, National Academies.
The newly established levels for vitamins, minerals, protein, fats, cholesterol, carbohydrate, fiber, and energy levels can be found at this Board’s website (please note that iron levels are listed on page 2).

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: Are there any alcoholic beverages that are gluten-free?

Monday, July 12th, 2010

Question: On hot summer days, many people like to enjoy a cool, refreshing alcoholic beverage. Are there any alcoholic beverages that are gluten-free?

Answer: There has been a lot of misinformation about the gluten-free status of alcohol. The good news is that many alcoholic beverages are gluten-free. So lift up your glass and let’s toast to this good news! Here is the scoop…

Distilled Alcoholic Beverages:

Rye whiskey, scotch whiskey, gin, vodka and bourbon are distilled from a mash of fermented grains. Even though these alcoholic beverages can be derived from a gluten-containing grain, the distillation process removes the gluten from the purified final product, so they are gluten-free. Rum (distilled from sugar cane) and brandy (distilled from wine) are also gluten-free.

However, be aware that some pre-made Bloody Mary and Caesar beverage mixes may contain barley malt flavoring or hydrolyzed wheat protein and are not gluten-free so check the label on these items.

Liqueurs (also known as cordials):

These are made from an infusion of a distilled alcoholic beverage with added sugar and flavoring agents such as nuts, fruits, seeds, flowers or cream. Liqueurs are gluten-free.

Wine (including vermouth, port and sherry):

Wines are made from fermented grapes or other fruits. There are also fortified wines such as vermouth; port and sherry which include an added brandy or another distilled alcohol. All these wines are gluten-free.

Wine Coolers:

Historically most wine coolers were gluten-free as they were made from wine, fruit juice, a carbonated beverage and sugar. However in 1991 the US Congress increased the excise tax on wine so many producers substituted malt (from barley) for the wine. Any malt-based coolers are not gluten-free.


Alcoholic and non-alcoholic ciders are made from apple juice. Sparkling cider is made with apple cider and a carbonated beverage. Most ciders are gluten-free but some brands may use barley in its production and are not gluten-free. The best bet is to check with the manufacturer to determine if they are gluten-free.

Beer, Ale and Lager:

The basic ingredients in beer, ale and lager include malted barley, hops (a type of flower), yeast and water. As this mixture is only fermented and not distilled, it contains varying levels of gluten and must be avoided. However, a variety of gluten-free specialty  beers are now on the market made from various gluten-free grains such as buckwheat, sorghum, millet and rice.

Note: Always remember that although certain alcoholic beverages can be included in a gluten-free diet, it must be consumed responsibly and in moderation!

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: Getting the Facts about Celiac Disease & the Gluten-Free Diet

Monday, May 10th, 2010

Question: Can you share a few quick facts about celiac disease and the gluten-free diet? I would love to pass this info along to family members & friends who want to learn more about my daughter’s diagnosis.

Answer: May is Celiac Awareness Month so it’s a great time to share many facts about the disease and its treatment – the gluten-free diet.

* Celiac disease (CD) is an inherited autoimmune disease that affects 1:100 people. The disease can develop at any age including the elderly. It is twice as common as Crohn’s, ulcerative colitis and cystic fibrosis combined. 

* Consumption of gluten, found in the grains wheat, rye and barley, damages the tiny finger-like projections called “villi” that line the small intestinal tract. As a result, nutrients from foods, especially iron, calcium, vitamin D and folate, cannot be absorbed through the villi and into the bloodstream. A variety of nutritional deficiencies can occur over time. Gluten not only affects the gastrointestinal system but many other organ systems in the body.  This can lead to a wide range of symptoms that vary from one person to another. Some individuals may only present with a few symptoms or have none at all, while others can have numerous symptoms.

* Symptoms can include nausea, bloating, gas, abdominal pain, diarrhea or constipation (or both), lactose intolerance, weight loss (note-CD can also occur in obese individuals), mouth ulcers, extreme fatigue, irritability, bone and joint pain, easy bruising of the skin, swelling of the ankles and hands, menstrual irregularities, elevated liver enzymes, migraine headaches, depression and ataxia (balance and coordination difficulties). Children may also have delayed growth, dental enamel defects and concentration and learning difficulties.

* Another presentation of CD is a skin condition called dermatitis herpetiformis (DH). It is characterized by an intense burning, itchy rash that is symmetrically distributed. Areas affected can include the elbows, knees, back of the neck and scalp, upper back and buttocks. Initially, groups of small blisters are formed that soon erupt into small erosions. Most people with DH will also have varying degree of small intestinal villous atrophy, although many will have no bowel complaints. For more information about DH check out this link.

* CD can also occur more frequently in other conditions such as type 1 diabetes, autoimmune thyroid disease, autoimmune liver disease, Down syndrome, Turner syndrome and selective IgA deficiency.

* Untreated CD can result in nutritional deficiencies; osteoporosis; reproductive complications such as infertility (in both men and women) and miscarriage; development of other autoimmune disorders and an increased risk of gastrointestinal cancers.

* 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.

* There are specific blood screening tests that can be used to screen for CD, however the only definitive test for diagnosis is a small intestinal biopsy. Diagnosis for DH is a skin biopsy from unaffected skin adjacent to the blisters or erosions. In DH, an intestinal biopsy is not essential if the skin biopsy is positive.

* First degree relatives (parents, siblings and children) of individuals with CD have a higher risk of developing the disease so they should be screened for CD. For more information check out this link.

* 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.

* 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.

* Gluten is found in a wide variety of foods such as breads and other baked products, cereals, pastas, soups, sauces such as soy sauce which is often made from wheat and soy, seasonings, salad dressings, snack foods, prepared meats (e.g., deli meats, hot dogs, hamburger patties, imitation seafood), beer, flavored coffees and teas, some candies (e.g., licorice), chocolates and chocolate bars, as well as some nutrition supplements and medications.

* 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 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 CD 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 check out this link.

* 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.

* Many gluten-free products are made with refined flours and starches such as white rice flour, tapioca starch, potato starch and/or cornstarch which are lower in iron, B vitamins and fiber. Choose more nutritious ingredients such as amaranth, brown rice flour, buckwheat, flax, Montina™, nut flours, quinoa, legume flours (e.g., garbanzo/chick pea, Garfava™, yellow or green pea, bean {black, cranberry, soy} and teff when preparing or purchasing gluten-free foods. In addition look for gluten-free products that are enriched with vitamins and minerals.

* It is recommended to consult with a registered dietitian with expertise in CD and the gluten-free diet. The dietitian will do a nutritional assessment, provide nutrition education and practical information to help you successfully manage the gluten-free diet.

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

* There are many excellent books, cookbooks, websites and other resources for those following a gluten-free diet. Check out Gluten-Free Diet: A Comprehensive Resource Guide-Revised and Expanded Edition 2010. It is filled with detailed information about the diet, foods and ingredients allowed and to avoid, meal plans, recipes, cooking hints, substitutions, label regulations, nutritional information and practical strategies for healthy gluten-free living, over 3100 gluten-free specialty foods, a directory of more than 270 American, Canadian and international companies, resources, websites and more!


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: Breakfast Ideas You Don’t Want to Skip!

Monday, April 12th, 2010

Q: I’m usually running late in the morning so I often skip breakfast. Can you give me some healthy and quick breakfast tips?

A: I’m sure you have heard that breakfast is the most important meal of the day. It literally means break the fast. In order to jump start your day both mentally and physically you need to fuel your body with food. Healthy breakfast foods provide 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 in the chart below.

The chart includes examples of products from various companies. There are many more products available, especially baked items from gluten-free specialty bakeries across North America. The Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD, features over 3100 gluten-free products listed by company name, product name and package size and a directory of more than 270 American, Canadian and international companies. The book has a chapter on gluten-free specialty bakeries in North America. It also contains detailed information about the gluten-free diet including safe foods/ingredients and those to avoid; meal plans; recipes; cooking hints; substitutions; nutrition information and practical strategies for healthy gluten-free living and resources. See

Breakfast Idea



Nutrition Facts, Quick Tips & Other Notes

GF cold cereal, milk or yogurt and fresh fruit

Puffed Amaranth

GoGo Quinoa, NuWorld Amaranth, Orgran

Learn more about amaranth at:

Buckwheat Flakes

Arrowhead Mills

For more information about buckwheat see:

GF Corn Flakes

Barbara’s, Barkat, El Peto, Erewhon, Nature’s Path

Regular corn flakes contain barley malt flavoring which is not gluten-free. It is important to purchase brands such as these ones listed that do not contain barley malt.

GF Rice Crisp Cereal

Arrowhead Mills, Barbara’s, Barkat, Erewhon, Kinnikinnick, Nature’s Path, Kellogg’s GLUTEN-FREE Rice Krispies

GF Granola

Bakery On Main, Enjoy Life*, Udi’s, NoNuttin’, Glutenfreeda Foods**

* Enriched with vitamins and minerals.

** Made with pure, uncontaminated GF oats.

Multigrain Cereal

Nature’s Path Mesa Sunrise

Cornmeal, buckwheat, flax and amaranth.

Puffed Quinoa

GoGo Quinoa

To learn more about quinoa and recipes see:

GF hot cereal, milk, dash of cinnamon, brown sugar and sliced fruit


Birkett Mills (Pocono), Cream of the Crop

Cook hot cereals in the microwave in a large bowl so it does not boil over. Add some ground flax to the hot cereal. Flax is an excellent source of fiber and other nutrients.

Cream of Rice

Amy’s Kitchen, Arrowhead Mills, Bob’s Red Mill, El Peto, Lundberg

Choose brown rice for more fiber.

GF Oatmeal

Avena Foods (Only Oats), Bob’s Red Mill, Cream Hill Estates (Lara’s), Gluten-Free Oats, Gifts of Nature, Glutenfreeda Foods, Holly’s Oatmeal, Bakery On Main

These companies produce or use pure, uncontaminated GF oats. For more information about the use of oats see:

Multigrain Cereal

Bob’s Red Mill Mighty Tasty GF Hot Cereal

Whole grain brown rice, corn, sorghum, buckwheat.

Quinoa Flakes

Ancient Harvest, GoGo Quinoa


Bob’s Red Mill, Teff Company

For more information about teff and how to use it see:

Toasted GF bagel, nut butter (e.g., almond, cashew, peanut) or GF low fat cheese spread or melted cheese and a glass of juice

GF Bagels

Udi’s, Gluten-Free Creations Bakery, Glutino, Kinnikinnick, Mariposa Baking Company

Some companies enrich their bagels with vitamins and minerals (e.g., Udi’s, Gluten-Free Creations Bakery, Glutino and Kinnikinnick).

GF muffin, milk or GF yogurt drink

GF Muffins

El Peto, Foods By George, Gluten-Free Creations Bakery, Kinnikinnick,

Make your own muffins from scratch ingredients or buy a GF mix. Freeze in individual plastic zipper bags so you always have one ready for breakfast or a snack.

GF toast with nut butter or GF cheese spread

GF Breads

Celiac Specialties Bakery, El Peto, Ener-G Foods, French Meadow Bakery, Food For Life, Glutino, Kinnikinnick, Mariposa Baking Company, Udi’s, Rudi’s

GF breads taste better toasted. Some breads are enriched with vitamins and minerals (e.g., Ener-G Foods, Gluten-Free Creations, Glutino, Kinnikinnick). Make your own bread from scratch ingredients or buy a GF mix. Here is a recipe for an ancient grains bread using a mixer or bread machine:

Scrambled eggs or an omelet with GF salsa and GF toast

Eggs (fresh or frozen or liquid egg products)

Some frozen or liquid egg products may contain seasonings with hydrolyzed wheat protein which must be avoided on a gluten-free diet. Several brands of salsa contain wheat flour, hydrolyzed wheat protein or barley malt flavoring.

Add chopped peppers (green, orange, red or yellow), green onions and/or broccoli to the scrambled egg or omelet for extra nutrition.

Fruit smoothie with fresh or frozen fruit (e.g., bananas, blueberries, peaches, strawberries), yogurt or milk or non-dairy substitute and honey or other sweetener.

Low or non-fat milk or yogurt

For those with lactose intolerance, a special type of milk that has been treated with lactase enzymes can be substituted for regular milk. Another option is to use a non-dairy substitutes (e.g., almond, potato, rice or soy beverages). Choose brands that do not contain barley malt flavoring. Also look for ones that are enriched with calcium, vitamin D and other nutrients.

For more information about lactose intolerance and suitable products see:

Here’s a recipe for Very Berry Breakfast Shake

Non-dairy beverage

Blue Diamond, Imagine, Pacific Foods, Silk, So Good, So Nice, Vances

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

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

Ask Shelley Case: The Scoop on Gluten-Free Oats

Monday, February 8th, 2010

Question: Are oats allowed on a gluten-free diet? 

Historically, oats were not allowed on a gluten-free diet for those with celiac disease. The avenin protein in oats was thought to cause the same reaction as the proteins in the gluten-containing grains wheat, rye and barley.  However, many studies over the past 15 years have revealed that moderate amounts of pure, uncontaminated oats are tolerated by the majority of individuals with celiac disease.  It should be noted that a small number of individuals with celiac disease may not tolerate pure, uncontaminated oats. The mechanism triggering this intolerance has not yet been identified. So it is important to check with your doctor and dietitian before adding pure, uncontaminated oats to your gluten-free diet.

To learn more about the safety of oats in celiac disease, read the extensive review by Health Canada.

Remember… Not all oats are gluten-free:
Many commercial oat products on the market are cross-contaminated with wheat, rye and/or barley during harvesting, transportation, storage, milling, processing and packaging. An American study by dietitian Tricia Thompson tested three brands of commercially available oats and found varying levels of gluten contamination. Similar results were reported in two other studies by Hernando and Gelinas. Cross contamination has been the major reason why most health professionals and celiac groups have not allowed oats on a gluten-free diet. Fortunately there are companies in the USA and Canada that produce pure, uncontaminated oats on dedicated fields with dedicated equipment and processed in dedicated gluten-free facilities. The major specialty gluten-free oat companies include:


In addition to the above producers, many companies are adding gluten-free oats to their products in items such as granola, snack bars, muffins and breads.  Look for the words on the package label – “gluten-free oats”, “pure, uncontaminated oats”, or “certified gluten-free oats”. Also, the Gluten-Free Certification Organization (GFCO) does certify a number of companies producing and/or including gluten-free oats in various products. The GFCO symbol will be located on the package. The Canadian Celiac Association will be launching a new certification program for pure, uncontaminated oats in early 2010. Products meeting the certification will have the trademark “PAVENA™” on the food label.

Authorities approve oats:
Many health professionals, celiac organizations, celiac research centers and other associations around the world allow consumption of moderate amounts of pure, uncontaminated oats. I have included a detailed listing of the position statements from these organizations in my book Gluten-Free Diet: A Comprehensive Resource Guide.

The Canadian Celiac Association Professional Advisory Board has developed guidelines for the introduction of pure, uncontaminated oats in the gluten-free diet for those with celiac disease.  

Oat’s nutritional value:
A nutritious whole grain, oats are a good source of protein, fiber, iron and B vitamins.  Oats contain two kinds of fiber- soluble and insoluble. The soluble fiber (ß-glucan) can help lower cholesterol and control blood glucose levels. Insoluble fiber promotes regular bowel movements and prevents constipation. As many gluten-free products are frequently made with refined flours and starches and are low in iron, B vitamins and dietary fiber, oats are a healthy addition to the diet.

Where to find Oat recipes:
Gluten-free oats are available as whole oat groats, oatmeal, oat flour and oat bran. They can be incorporated into many recipes. has many gluten-free oat recipes including Oatmeal M&M Cookies and Orange Oatmeal Granola Trail Mix. Cream Hill Estates also has a great recipe for Muesli Cereal.


Shelley Case, RD
Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide

Ask Shelley Case: Do Spices, Herbs & Seasonings Contain Gluten?

Monday, January 11th, 2010

Question: I love to use spices, herbs and various seasoning blends to spice up my food… but I heard they may contain gluten! Help!

Answer: A wide variety of spices and herbs are used in foods for flavoring purposes. American and Canadian food regulations differ in how they define the terms spices, herbs and seasonings. Here are some facts about the gluten-free status of these ingredients.

Spices, herbs and seeds do not contain gluten

Although anti-caking agents may sometimes be added to spices, it is often silicon dioxide, calcium silicate or sodium aluminum silica and NOT wheat flour or wheat starch. Some imitation black peppers contain other ingredients such as buckwheat hulls and ground rice in addition to black pepper. I have not found any companies using wheat as a filler in imitation pepper.

Seasonings may contain gluten

In general terms “seasonings” are a blend of flavoring agents (spices and/or herbs) which are often combined with a carrier agent such as salt, sugar, lactose, whey powder, starches or flours. The carrier agent in seasoning mixtures in gravy mixes, sauces and snack foods often contain wheat flour or wheat starch.

If a seasoning mixture/blend is sold separately as a bottled or packaged seasoning(e.g., Cajun Seasoning, Taco Seasoning Mix, etc.) the components of all the ingredients must be declared on the label. When a seasoning mixture is used in other foods it may only say “seasoning” on the label and not indicate its components. However in the USA, the FDA’s “Food Allergen Labeling and Consumer Protection Act” requires that all components of ingredients when used in other foods must be declared if they contain any of the top eight allergens (including wheat). So if wheat flour or wheat starch was used in a seasoning blend it would have to be listed as “seasoning (wheat flour or wheat starch)” or “seasoning” and at the end of the ingredient list “Contains Wheat”. Also, whenever the term “seasoning” is used in the ingredient statement of a meat or poultry product, its components must be identified as a sublist.

It should be noted that, in Canada, seasoning, spice or herb mixtures, when used as ingredients in other foods are exempt from a declaration of their components. Although it is not currently required by regulation, Health Canada strongly urges manufacturers to declare components of ingredients such as seasonings if they contain allergens or gluten sources. Fortunately many companies are voluntarily labeling the components of seasonings when used in other foods. Also, Health Canada has proposed new labeling regulations entitled “Schedule No 1220- Enhanced Labelling for Food Allergen and Gluten Sources and Added Sulphites” that would make it mandatory to declare allergen and gluten sources.

The Bottom Line

If gluten sources such as wheat flour or wheat starch are used in a seasoning mixture/blend, it must be declared on the label of products sold in the USA. Although it is not yet mandatory in Canada, most companies do declare the source of the seasoning blend if it contains an allergen or gluten source. However, if a food product in Canada lists “seasonings” on a food label it is recommended to contact the company to ask if wheat is used as the carrier agent.

The above information was adapted from Gluten-Free Diet: A Comprehensive Resource Guide, Revised and Expanded Edition by Shelley Case, RD. Case Nutrition Consulting Inc.

Ask Shelley Case: Gluten-free Baking Tips & Tricks

Monday, December 7th, 2009

Question: I love to bake! Can you give me any gluten-free baking tips and pointers for this upcoming holiday season?


Baking with gluten-free ingredients can be both challenging… and fun! In order to make tasty and satisfying gluten-free baked products it is essential to learn how to use different types and combinations of flours, starches and other ingredients, as well as specific baking techniques in order to compensate for the lack of gluten. Here are a few general gluten-free baking tips:

General Gluten-free Baking Tips:
Store gluten-free flours and starches in plastic airtight containers with wide and tightly fitting lids; and for optimum freshness keep them in the refrigerator or freezer. Allow the cold flour or starch to return to room temperature before using.

• Mark It: Label containers with the name of the item and date purchased.

• Measure it once… and twice: Measure flours and starches carefully. Inaccurate measurements can greatly affect the quality of gluten-free recipes because each flour and starch has very unique properties.

• Keep it loose: Loosely spoon the flour or starch into the measuring cup, leveling the top with the flat side of a knife. Never pack down the flour.

• Cook with sparkle: Use shiny, light-colored metal pans (gray not black). Products bake and brown more evenly in lighter colored pans than in dark pans, which can leave edges crisp and over-browned.

• Keep it low: When using glass baking pans and non-stick metal baking pans [gray not black), reduce oven temperature by 25 degrees F.

• Longer is better: Most gluten-free breads are better when baked at lower temperatures for longer periods of time. After the first 10- 15 minutes of baking, tent the bread with foil to prevent over –browning.

• Lows and highs: Baking is also affected by temperature and altitude. Slightly reduce the amount of liquid in recipe if baking at a higher altitude or on a very humid day. For baking at very low altitudes, slightly increase the amount of liquid.

• That’s the way the (gluten-free) bread crumbles: Gluten-free bread dough tends to be softer, stickier and more batter-like. If it is too heavy and dry, the bread tends to be too crumbly.

• Dust it with sweetness: When making a gluten-free chocolate cake or brownies, grease the pan and then “flour” the pan with cocoa.


Texture Tips:

• Double it up: A combination of gluten-free flours and starches makes a better product than single flours.

• Leave it to leavening: Gluten-free baked products often require more leavening than products made with wheat due to the lack of gluten which is necessary to form an elastic dough and enables the product to rise.

• Crumbler fixers: It is important to use xanthan gum or guar gum in baked products in order to prevent crumbling. Add the gum to the dry ingredients as it does not mix with water. For every cup of gluten-free flour, use 1 teaspoon of gum for breads and ½-3/4 teaspoon for other baked goods.

• Gelatin to the rescue: Unflavored powdered gelatin also works as a binding agent and can prevent crumbling. If substituting gelatin for xanthan or guar gum, use twice as much gelatin. Soften the gelatin in half the water called for in the recipe before adding.

• (Butter)Milking it: Substituting buttermilk for the milk or water in recipes results in a lighter, more finely textured product. Carbonated beverages [not diet soft drinks) in place of water or milk can also result in a lighter-textured product (e.g., pancakes, cakes).

• Take the time: Let gluten-free dough sit at least 30 minutes at room temperature to soften. This results in a better-textured product


Flavor Tips:

•  Spice it up: To improve the flavor of gluten-free baked products use more herbs, spices and flavorings (approximately 1/3 – ½ more than normal).

• Get cocoa, nutty & fruity too: Adding chocolate chips, nuts, fruits (e.g., applesauce, bananas) dried fruits (e.g., apricots, cranberries, raisins) can also improve the flavor.

• Hey Sweetie: Honey or molasses can provide more flavor than white sugar. You need to reduce the amount of liquid in the recipe if making this substitution. If a recipe calls for 1 cup of sugar, use 3/4 cup honey or molasses.

• Toast it: Most gluten-free breads taste better toasted or warm.


Storage Tips:

• Seal it:  Baked products made with gluten-free flours have no preservatives, become stale quickly and are quite perishable. Wrap them tightly in plastic wrap and store in airtight plastic containers or self-seal plastic bags. If the product will not be eaten within one or two days, freeze to ensure minimum loss of moisture and flavor. For breads, it is best to thoroughly cool, slice and separate each slice with wax paper before bagging and freezing.

• Keep it moist: Placing baked products such as muffins in plastic bags when still warm can preserve moisture.

• Thaw Tips: Thaw frozen baked goods at room temperature instead of microwaving at full power; microwaving causes them to become rubbery and tough.


Note: Thanks to the following gluten-free culinary experts for some of the background information on gluten-free flours and starches, substitutions and many of the above baking tips:

Carol Fenster, PhD, President and Founder of Savory Palate, Inc., gluten-free publishing and consulting firm. Author of:
1000 Gluten-Free Recipes; Gluten-Free 101: Easy Basic Dishes without Wheat; Wheat-Free Recipes and Menus: Delicious, Healthful Eating for People with Food Sensitivities; Cooking Free: 220 Flavorful Recipes for People with Food Allergies and Multiple Food Sensitivities

Connie Sarros, Author of gluten-free cookbooks and other resources:
Wheat-Free Gluten-Free Recipes for Special Diets; Wheat-Free Gluten-Free Cookbook for Kids and Busy Adults; Newly Diagnosed Survival Kit; Wheat-Free Gluten-Free Dessert Cookbook; Wheat-Free Gluten-Free Reduced Calorie Cookbook; All You Wanted to Know About Gluten-Free Cooking DVD

Donna Washburn, P.H.Ec. and Heather Butt, P.H.Ec., partners in Quality Professional Services, specializing in recipe development and bread machine baking. Authors of:
Complete Gluten-Free Cookbook; 125 Best Gluten-Free Recipes; The Best Gluten-Free Family Cookbook


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 more glute-free tips at:

Ask Shelley Case: My Child Was Diagnosed with Celiac Disease… Now What?

Monday, November 9th, 2009

Q. My child was just diagnosed with celiac disease and learning about the gluten-free diet is overwhelming. Where do I begin and what resources are available to help us?

A.  Learning about celiac disease and how to eliminate gluten can be very challenging for both the child and family, especially in the beginning. Start slow and take it one day at a time! “One of the most important and effective steps you can take to equip your child to live gluten-free is to empower them with good self-esteem and the skills needed to make independent gluten-free food choices in and out of the home” says dietitian Nancy Patin Falini. “Instill in your child the appeal of being unique while dispelling the myth of needing to be like everybody else.” Fortunately there are many resources and groups that can help you on this new gluten-free journey…

See a Registered Dietitian
The first essential step is to consult a registered dietitian with expertise in celiac disease. The dietitian will do a complete nutritional assessment, provide detailed information about celiac disease and the gluten-free diet, as well as develop an individualized meal plan. Practical information about label reading, shopping, recipes, substitutions, preventing cross contamination, eating away from home and traveling will also be covered in the initial and follow-up visits. To locate American dietitians specializing in celiac disease see The Canadian Celiac Association has a list of celiac chapters that have dietitian advisors. Contact the local celiac group at

Join a Celiac Support Group
A number of national celiac support groups and their local chapters offer information and have regular meetings to help individuals and family members. For links to the American and Canadian groups see
There is a special support group for parents, families and friends of kids with celiac disease or gluten intolerance called R.O.C.K. (Raising our celiac kids). It was founded by Danna Korn after her son was diagnosed with celiac disease in 1991. For more information or to locate a R.O.C.K. group near you, contact

Seek out Practical Resources
The Gluten-Free Diet: A Comprehensive Resource Guide by dietitian Shelley Case is a 368 page book filled with detailed information about the gluten-free diet. It includes a listing of foods and ingredients allowed, to avoid and question; gluten-free labeling regulations; as well as meal plans, recipes, cooking hints, substitutions, nutrition information, cross contamination, eating out, over 3100 gluten-free specialty products, a directory of more than 270 companies, listing of cookbooks, books, websites and other helpful resources. See

Kids with Celiac Disease: A Family Guide to Raising Happy, Healthy, Gluten-Free Children by Danna Korn provides parents with advice and specific strategies on how to deal with the diagnosis, cope with emotional challenges, and help their child develop a positive attitude. Includes practical information on menu planning, shopping, food preparation, recipes and eating outside the home (e.g., birthdays, restaurants, camps, vacations). Available from

Dietitian Nancy Patin Falini’s Gluten-Free Friends: An Activity Book for Kids is an illustrated book for children ages 4-11 years. The book features two friendly kids who explain what gluten is, describe how gluten makes them sick and which foods to avoid, and how to make healthy food choices. Easy-to-follow instructions for parents and caregivers help guide children through learning activities and explore their thoughts and feelings about gluten-free living.  Available from

Children’s Hospital Boston has developed a 2 hour DVD entitled Raising Your Celiac Child: Guidelines for a Gluten-Free Life. It includes 12 interactive modules with practical advice on celiac disease, lifestyle management and emotional support. See

Three other wonderful illustrated story books for children are:
• No More Cupcakes & Tummy Aches: A Story for Parents and Their Celiac Children to Share by Jax Peters Lowell
• Eating Gluten-Free with Emily: A Story for Children with Celiac Disease by Bonne Kruszka
• How I Eat Without Wheat by Karen Fine

Sheri Sanderson has written a cookbook for kids called Incredible Edible Gluten-Free Foods for Kids. Features 150 family-tested recipes, general food preparation tips, baking substitutes, as well as an overview of celiac disease and the gluten-free diet, tips for dealing with daycare and schools, and resources.
Wheat-free Gluten-Free Cookbook for Kids and Busy Adults by Connie Sarros has 198 easy recipes along with a chapter devoted to safe kitchen craft projects for kids of all ages. See

The American Celiac Disease Alliance has practical guidelines and resources to help families navigate the school lunch program. See

Food allergies, sensitivities and celiac disease can be tough on a kid. Childhood traditions like trading sandwiches in the lunchroom, celebrating classroom holidays with cookies and treats, and sharing birthday cake with friends are often off-limits or require diligent oversight in order to be safe. Whether managing their unique needs leaves kids feeling isolated or helps them build self-confidence has a lot to do with how they are taught to view their situation.

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 more glute-free tips at:

Ask Shelley Case: How to Make the Gluten-Free Diet More Nutritious!

Monday, October 12th, 2009

Q. I am eating a gluten-free diet, but also want to make sure that I am choosing the most nutritious food choices too. Can you help?

Answer: In the quest to eliminate gluten from the diet, many people forget about the importance of good nutrition! The United States Department of Agriculture (USDA) MyPyramid and Canada’s Food Guide to Healthy Eating are practical tools to help individuals make healthy food choices. These tools differ somewhat with regard to the types of foods that are in specific groups, their serving size and recommended number of servings per day for each food group. The total amount per day for each group is based on factors such as age, body size, activity level and sex. The following chart has incorporated many of the key components of these tools with adaptations for the gluten-free diet. The symbol GF denotes gluten-free.







Grain Products








GF grain alternatives [e.g., amaranth, buckwheat, cornmeal, millet, Montina ™, oats (GF pure, uncontaminated), quinoa, rice (black, brown, red, white, wild), sorghum, teff]


GF breads, rolls, bagels, muffins


GF ready-to-eat cold cereals


GF hot cereals – e.g., amaranth; cornmeal; cream of buckwheat or brown rice or white rice; rolled oats (GF pure, uncontaminated), hominy or soy grits; rice flakes; soy flakes)


GF pasta -e.g., bean, 100% buckwheat, corn, pea, potato, quinoa/corn, quinoa/rice, soy, rice (brown, white, wild)


GF corn or rice tortillas


GF pancake and waffles





1.        Choose GF whole grains* more often  e.g., amaranth, buckwheat, cornmeal (whole grain- not degermed), millet, oats (GF pure, uncontaminated), quinoa, rice (black, brown, red, wild), sorghum, teff


2.       Choose enriched GF products more often. Not all GF breads, flours, cereals and pastas are enriched with iron and B vitamins and are often lower in fiber as many are made from refined flours and starches.


3.       Choose breads, rolls, bagels, muffins, cereals and pastas from flours and starches that are higher in fiber, protein and vitamins and minerals  e.g., amaranth, buckwheat, flax, legumes, mesquite, millet, Montina™, oats (GF pure, uncontaminated), quinoa, rice (brown), sorghum, teff



* Whole grains contain the entire grain seed (usually called the kernel) and consist of three parts- the bran, germ and endosperm. Refined grains have most of the bran and some of the germ removed which results in the loss of dietary fiber, vitamins, minerals and other nutritional components.





















Fresh, frozen or canned fruits and fruit juices


Dried fruits



1.       To get more fiber, choose fruit instead of juice.


2.       Choose unsweetened frozen fruit or canned fruit in 100% fruit juice or water.


3.       Choose orange-colored fruits (e.g., apricot, cantaloupe, orange, mango, nectarine, peach, red or pink grapefruit) more often as they are high in vitamins, minerals and phytochemicals (naturally occurring health compounds)


4.       Choose 100% fruit juice rather than fruit beverages which contain less juice and more added sugar.


5.       Some juices (e.g., orange) are enriched with calcium and/or vitamin D.











Fresh, frozen or canned vegetables and vegetable juices


Dried fruits



1.       Choose dark green and yellow/orange vegetables (e.g., broccoli, carrot, pumpkin, romaine lettuce, squash, sweet potato) more often as they are high in vitamins, minerals and phytochemicals.




Milk Products








Milk (fluid and dried powdered)


Milk (lactose-free, lactose-reduced)




Yogurt and yogurt-based beverages


Milk-based desserts (e.g., puddings made with milk, ice cream, frozen yogurt, ice milk)



1.       Choose lower-fat milk products more often.


2.       Milk and some yogurt products are enriched with vitamin D which is a key nutrient that aids in the absorption of calcium. Cheese, ice cream, commercial pudding cups and some yogurts are not enriched with vitamin D)


3.       Many brands of non-dairy beverages (e.g., nut, potato, rice, soy) and some orange/other fruit juices may be enriched with calcium and/or vitamin D but may not provide the other nutrients found in milk products.


Meats, Beans and Alternatives








Meats, poultry, fish, shellfish, eggs


Legumes (dried beans, peas and lentils)


Nuts and seeds


GF tofu, GF tempeh, GF texturized vegetable protein, GF veggie burgers



1.       Choose leaner meats and poultry as well as legumes more often.


2.       Flax seeds and walnuts. Along with some fish (e.g., herring, salmon, trout) are high in omega-3 fatty acids which play a positive role in heart health.


3.       Some seeds and nuts (almonds, hazelnuts, sunflower) are good sources of vitamin E.






















* This group is in MyPyramid. Canada’s Food Guide does not specifically include this group.



Oils (e.g., canola, coconut, corn, cottonseed, olive, palm kernel, peanut, safflower, sesame seed, walnut)


Foods naturally high in oils (e.g., avocado, flax, nuts, olives, some fish)


Solid fat (butter, beef fat [tallow, suet], pork fat [lard], stick margarine, shortening)


Foods high in solid fats (e.g., many cheese, cream, well-marbled cuts of meat, regular ground beef, bacon, poultry skin)



1.        All oils and fats are a mixture of unsaturated and saturated fatty acids.


2.        Most oils( except coconut and palm kernel) contain more monounstarurated and polyunsaturated fatty acids.


3.        Solid fats and coconut and palm kernel oils contain more saturated fatty acids and/or trans fats than unsaturated oils.


4.        Limit solid fats and coconut and palm kernel oils as saturated fats and trans fats raise LDL (bad) cholesterol levels in the blood which are a factor in coronary heart disease.




From: Gluten-Free Diet: A Comprehensive Resource Guide 2008 by Shelley Case, RD. Case Nutrition Consulting Inc. Publisher.

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