Gluten Free RN RN On Call’s, Nadine Grzeskowiak is a national speaker and expert for Gluten Intolerance and Celiac Disease from Corvallis, Oregon

Fun & profitable gluten free bakery, great location, cute store front, and off street parking with amazing customers and employees.

Below are some questions you may have, answered by the bakers themselves.

Why is the bakery for sale? Eric is doing consulting work to help others start their own bakeries in other towns and is hoping to get a development kitchen going soon. His passions are opening new businesses and creating new food products, he is hoping to spend more of his time doing that.

How much are you selling for? A reasonable price. Eric and Jenny want the new owners to be successful without a big debt load. There are different purchasing options available, depending on if the new owners would like to keep it just like it is now or if they would like Eric’s consulting services to expand the business (start a deli please!).

What is included in the price? All of the equipment, licensed rights to the recipes, training, their baking and operation manuals and all of the goodwill that they have developed in the last 3 ½ years.

Is it hard to keep great employees? No, their first bread baker stayed for most of the three years. Two of their other employees have been serving you for over a year.

Is the bakery doing well? Absolutely. They have been profitable since they opened and their sales are increasing every year. March and April were their third and fourth busiest months ever.

What are the terms? Cash only, no contracts.

Please call Eric if you are interested in more information at (541) 760-1050.

We will be teaching two more Saturday editions of the Introduction to Gluten Intolerance and Celiac Disease. Please join us on Saturday June 19th and July 24th as Nadine Grzeskowiak, RN, CEN discusses the basics of gluten intolerance and celiac disease and what it means to lead a gluten free lifestyle. Gluten free goodies will be provided! $25 per person please, no RSVP necessary.

This is a great article written by Talk About Curing Autism (TACA). The gluten free, casein free diet gets a bad reputation for being expensive. Cost is often a barrier we hear about from patients. However, TACA did an independent study to find out if it was possible to eat a gluten free, casein free, soy free diet while on food stamps. Not only were they able to stay under their allotted budget with money to spare, they were even able to plan their meals according to the Food Pyramid Guidelines, ensuring that they were not only eating foods that were GF/CF/SF, but that were nutritious too. Here is their summary of the study:

According to the USDA’s SNAP program, a family of four can get up to $588 per month of food subsidy funding. Of course, not every family gets that much so we aimed at the median family of four subsidy of $396 per month.  However, we did it in just $319!  (Technically, the food needed only cost $282.05 so the $319 includes the leftovers.)

We only included foods that were free of gluten, casein and soy.  We based the menu on the USDA’s Nutrition program for quantity and food groups to make sure the diet was healthy, not merely inexpensive. 

Once we had a monthly menu and a shopping list, we compared costs for the same products in three states to get a national average cost. 

Tip! Want to save a bundle?  Plant a garden!  Even a small patio can grow plenty of money-saving and healthy food, plus it’s great for the kids to learn!  If you have room for a tree, make it something that fruits and feeds your family. Also, buy food in season because it’s cheaper when it’s abundant.

Please note that the following menu, shopping list and recipes are for FOUR people for each meal and all four people are on the GFCFSF diet. It will be even CHEAPER if you use non-GFCF things like pasta, bread and pancake mix for those who don’t need it but we wanted to make sure that the diet COULD be done on this budget with the most ease when cooking for a whole family.  If you do this, you should cook the non-GFCF pasta or pancakes in a separate pot/pan.

To see a sample of their diet plan and for more helpful resources for living gluten, casein and/or soy free while on food stamps, visit their site here.

We received these recommendations from one of our readers who recently traveled throughout Europe. Her advice is useful to anyone with gluten intolerance traveling in Europe:

In France, Belgium and Germany I found gluten-free products fairly easy to source in the larger supermarkets and natural food/vitamin stores. The larger markets had entire end displays or aisle sections devoted to gluten free, natural and organic foods, sometimes mixed in with or located near the diet foods. The larger, newer, fancier supermarkets also offered deli-style, to-go foods like green salads, small cold cut plates, veggie plates, etc. which worked well for me. One large, multi-country market chain we found is Carrefour. The one we stopped in offered a wide variety of GF products.

Many of the processed, ready-to-eat gluten free products like cookies and crackers also indicated lactose free. In addition, they offered breads, snacks, baking mixes, pastas and more.

Look for “gluten frei” or “laktose frei” on German product labels or “sans gluten” or “sans lactose” on French labels. Travelers to Spain will want “sin gluten” and “sin lactosa” products.

Soy products abounded, including yogurts and puddings.

Whereas in Corvallis I see GF-friendly shelves with a variety of items from many different manufacturers, in France/Belgium/Germany there appeared to be products from one or two companies – an extensive, in-depth selection from each company. See the photos for better understanding.

Recommendations:

• I wish I would have taken some peanut butter for easy protein and GF salad dressing for restaurant use or to-go salads.
• I carried a small bottle of Lactaid pills, and they helped to bail me out of some tricky food situations.
• I carried Tums, gas pills and stool softeners – all of which I’d recommend to GF travelers.
• I packed some GF instant oatmeal packets which saved the day more than once when I couldn’t eat what was offered for breakfast (normally bread with butter, yogurt and coffee with milk) or was available in the dining car on the train. It was pretty easy to ask for a cup of hot water and a spoon.
• And, I carried some Lara and Kind bars, plus some protein packets to mix into juice.

In restaurants it was more challenging to find truly safe foods. Although I asked for salads with no dressing, requesting oil and vinegar to be separate, I usually ended up with vinaigrette dressing served separately in a small bowl. I couldn’t get them to understand the separate oil and vinegar option. In asking how meat was prepared, and requesting no butter or cream or sauce, my tummy often told me after the fact that instead of pure oil, there had been cross-contamination on the grill or perhaps the cook had used some sort of dairy product in the preparation.

I would recommend taking some note cards in different languages explaining GF/LF needs so the waitress and the cook can clearly understand what you can and cannot eat.

Generally safe foods I found readily available in restaurants were green salads, steak, and French fries in France and Belgium. In Germany I relied on sausages and pork, sauerkraut, boiled potatoes, green salad. Occasionally I found roast or grilled chicken.

Requesting meals

You can also request gluten free or special diet meals on the airplane if you do so at least 48-hours ahead of time. But, pack some safe food just in case! One flight worked well for me with veggies-rice-grilled chicken, fruit cup and green salad…and one didn’t work at all due to a lack of the online request form not getting processed – so they had no GF meal for me.

We stayed in two B&B’s in France which offered dinner made with local, garden-fresh ingredients. We made dinner reservations with them, and I let each hostess know about my GF/LF issues. I asked that they make their regular foods, saying I’d just eat what I could – not wanting to be a problem child… but also not wanting the hostess to think I didn’t like her meal if it was something I could not eat. BOTH hostesses made delicious dinners that were all or primarily all gluten and lactose free! J

German Bavarian Alps hotel

Our final destination was Garmish-Partenkirchen, Germany. Before we had finalized our lodging, I found a GF hotel there – but it is still under construction, slated to open August 2010. Rats! I exchanged emails with the owners, Darren and Michelle, and would recommend that you check out their Web site if you’re heading that direction! http://www.glutenfreehotel.co.uk/

Celiac disease is associated with over 300 signs and symptoms. The reason the problems are so diverse, is that complications are a manifestation of four causes. This is what makes celiac disease and gluten intolerance extremely tricky to recognize.

First of all, your body recognizes gluten as a pathogen or toxin and responds by inducing a state of inflammation. Anti-gliadin antibodies (AGA) are activated to attack the gliadin protein in gluten. Inflammation is actually a protective attempt by your body. In normal cases of infection it acts to remove the harmful pathogen and stimulate healing. However, when gluten is constantly present in the diet your body can become chronically inflamed. Chronic inflammation can lead to several complications, including allergies, heart disease, arthritis, interstitial cystitis, and even cancer (1).

Chronic inflammation can lead to down-regulation of the immune system by causing T cell dysfunction (2). This is why we often have patients with newly diagnosed celiac disease come in with candida overgrowth, recurrent strep infections and even hyposplenism (3).

Resulting from chronic inflammation, celiac disease is autoimmune in nature. Auto-antibodies attack our very own cells. Most are all too familiar with the common destruction of the intestinal lining in celiac disease leading to villous atrophy. However, autoimmune diseases tend to run together- once you have one, you are much more likely to have another. This is why we recommend that anyone with an autoimmune condition be tested for celiac disease. When your body attacks the beta cells in your pancreas it leads to type 1 diabetes. When it attacks your mucous membranes, the result is Sjogren’s disease. Attacking the thyroid can cause Graves’ disease or Hashimoto’s thyroiditis. Luckily, celiac disease is the only autoimmune disorder with a known cause. Cutting out that trigger (gluten) from the diet can lead to a full recovery.

Finally, symptoms in celiac disease can be the cause of malabsorption and malnutrition. In celiac disease there will be an increased level of intraepithelial lymphocytes (IELs) in the gut. This inflammation is what causes the destruction of the delicate villi and microvilli within the small intestine. Furthermore, the destruction leads to hyperplasia in the crypts between these villi, causing them to swell and thicken. The result is significantly decreased absorption by the small intestine. In severe cases fat absorption is severely inhibitied. Without absorbing fat, one cannot absorb the important fat soluble vitamins- A, D, E, and K- let alone the essential omega-3 and omega-6 fatty acids. Without vitamin D, calcium absorption is inhibited. Let’s not forget the other deficiency commonly seen in celiac disease including magnesium, copper, zinc, iron, vitamin C and all of your B-vitamins. Anemia is most often recognized with deficiency, but hair loss, eczema, depression, fatigue, rickets, “foggy” brain, impaired vision, infertility, osteoporosis and many more symptoms can result. It is not uncommon to have patients hungry and craving bizarre foods. These deficiencies are why we always suggest that patients take a liquid multi-vitamin along with their gluten free diet.

Celiac disease is a complex set up symptoms caused by the body’s recognition of a common food ingredient as toxic. The many signs of celiac disease are what can make it extremely difficult to diagnose and recognize in patients. With over 300 associated signs and symptoms, I encourage you to try and NOT relate something to celiac disease. It is nearly impossible to do and why we recommend that everyone be tested.

1. Schacter, E. Chronic Inflammation and Cancer. Oncology 16:217-232, 2002.
2. Ezernitchi A, Vaknin I, Cohen-Daniel L, Levy O, Manaster E, Halabi A, Pikarsky E, Shapira L, Baniyash M. TCR {zeta} down-regulation under chronic inflammation is mediated by myeloid suppressor cells differentially distributed between various lymphatic organs. J. Immunol. 2006;177;4763-4772. http://www.jimmunol.org/cgi/reprint/177/7/4763.
3. Walters J, Bamford K, Ghosh S. Coeliac disease and the risk of infections. Gut. Vol 57;No 8;1034-5. Aug 2008. http://gut.bmj.com/content/57/8/1034.full.pdf.

Depending on the study, the prevalence of celiac disease in children with Downs syndrome is estimated to be as high as 4-17%, compared with just 1% in the general population. Autoimmune conditions are much more common in DS, celiac disease included. However, the cause for this is still unknown. DS is caused by an extra chromosome 21. It is not a genetic disorder, but often the result of abnormal cell division. The DQ2 and DQ8 genes that are highly associated with CD are on the HLA markers on chromosome 6. Since these genes are present in 30-40% of the US population, the increased prevalence of CD in DS is probably not due to the genes, but to some other unknown trigger.

What we do know is that there is a link between the two. Children with DS are more likely to have “silent” CD than the general population, making it even more difficult to diagnose. Often there are symptoms that go away once on a gluten free diet that weren’t thought to be associated. Most studies suggest a mass screening for CD in children with DS, however, it is not being done. In particular, if your child has DS along with one of the following symptoms, you should get them tested:

• Any bowel disorder
• Failure to thrive in reference to Down’s syndrome specific reference charts
• Abdominal distension
• Depression or unhappiness
• Arthritis
• Rash
• Thyroid disease
• Any autoimmune condition
• Anemia

One negative test is not enough to rule your child for celiac disease, and annual tests are recommended. Finding out your child has celiac disease while they are still young can protect them from future health problems later in life including lymphoma, osteoporosis, and other autoimmune conditions.

The skin is highly affected by patients with untreated gluten intolerance. Dermatitis herpetiformis is widely recognized as being associated with CD/GI, however there are other skin issues that can result, but often go unnoticed.

Dermatitis herpetiformis is a skin condition affecting at least 25% of patients with celiac disease. It is caused by IgA deposits in the papillary dermis (right underneath the top layer of skin). These deposits are the result of epidermal tranglutaminase auto-antibodies. The rash is usually extremely itchy, and can be painful. The red skin eruptions are described as being on the limbs, trunk and scalp- that covers pretty much EVERYWHERE on your body. Like celiac disease, DH is often undiagnosed. In a study by Pfeiffer in 2006 says, “Suspecting and then searching for dermatitis herpetiformis is often clinically challenging, as the disease is a true chameleon with many clinical faces.”

Other skin issues in celiac disease can also be the result of multiple deficiencies. Zinc is essential for the repair and renewal of skin cells. Zinc deficiency can lead to eczema, psoriasis, acne, nasal polyps, and darkening skin. Zinc is also needed for the conversion of essential fatty acids into other compounds. Deficiency of omega-3 fatty acids can lead to dry skin and hair, which can be mistaken as eczema, as well as hard, dry, itchy papules called prurigo nodularis. Vitamin A deficiency can lead to pityriasis rubra pilaris, a type of dermatitis leading to thick, scaling skin and often associated with anemia. Iron deficiency can lead to a pruritic skin rash, a fancy term for “itchy skin”.

Still, untreated celiac disease can lead to even more skin issues not related to deficiencies. Scleroderma, causing hyperpigmented, taut shiny skin that looks like you had facial chemical peel gone wrong.  Seborrhea, a sebaceous gland disorder causing scaly patches and bumps on the skin. Vitiligo and the permanent loss of melanocytes. Erythema nodosum. Ichthyosis. Melanoma. Each of these skin disorders have a much higher prevalence rate in untreated celiac disease.

Skin conditions can be slow to heal on a gluten free diet, but strict adherence is successful in clearing up the painful and itchy issues in most cases. Skin conditions caused by deficiencies are the quickest to heal. The good news? A gluten free diet will, at the very least, halt the progression of the condition.

If you have an itchy rash, or unidentified skin condition anywhere on your body, we recommend getting tested for celiac disease and trying a gluten free diet.

May 22nd from 2pm to 6pm Midway Farms will be hosting live Bluegrass music along with wine, cheese and raw chocolate on the farm. Plus, they will be catering to those who are gluten free- sounds like a great time to me!

Live Bluegrass music will sweep you away in the garden at Midway Farms. Enjoy sipping amazing wines from Eola Hills Wine Cellars & savoring award winning cheeses of Willamette Valley Cheese, only to be topped off with decadent raw chocolate by Stirs The Soul Chocolates. Premium organic coffee, teas and hors d’oeuvres will be provided. Gluten Free Friendly! Tickets are available at Midway Farms in advance for $9.00 or at the door for $12.00. This is an adult event 21 & older please.

May is deemed National Foster Care Month by the Department of Human Services. The Gluten Free RN would like to say thank you to all of those families in Oregon who have welcomed children in need into their lives.

This month, we will be offering our Tuesday classes, Introduction to Gluten Intolerance and Celiac Disease, free to all foster families. Find out more about this commonly undiagnosed condition and how to lead a gluten free life. And don’t forget- if you have a group wanting to learn more about gluten intolerance who can’t come to us, we will travel.

Thank you foster parents!

I would like to explain some recent rumors about Bob’s Red Mill gluten free products being “tainted”.

Bob’s Red Mill produces a gluten free line with grains milled in a separate factory from the gluten containing grains. They are considered the “gold standard” as far as gluten free flours go, avoiding cross contamination at all possible avenues. Currently, the FDA recommends testing for gluten to 20 ppm in order to deem a product as “gluten free”. Bob’s Red Mill claims to test every batch of gluten free grains it sells to this level.

We test products ourselves using EZ Gluten test kits from ELISA Technologies, Inc. These test kits can detect gluten down to 10 ppm, making them highly sensitive. When yielding a positive test, we have worked with companies in the past to discover hidden sources of gluten. We recently received several concerns from clients mentioning that they were getting sick whenever they ate items made from Bob’s Red Mill products. In the past, we had tested two of Bob’s products and they had come back negative.

A client dropped off a bag of Bob’s gluten free flour that she was using. We tested the flour, and the results were positive. It is important to note that 10 ppm is an extremely small amount. This is equivalent to one drop in 50 liters of water, or 30 seconds out of one year. We DO NOT believe that Bob’s Red Mill was selling tainted gluten free flour in any way. If Bob’s tests their GF items to 20 ppm, it is possible that their test was negative and ours, at 10 ppm, could have been positive. Also a possibility is our source of flour. We received our sample from a client who does not have a designated gluten free kitchen. The flour could have been contaminated long after it left the mill.

As I mentioned, we have tested Bob’s products twice in the past, both times yielding negative results. So why are some people getting sick? In their gluten free facility Bob’s also mills corn, oats, soy and rice. People with multiple intolerances might have trouble with Bob’s products due to contamination with these other food items. Furthermore, the 20 ppm threshold that the FDA suggested is not based on any solid research. It is simply a threshold put in place because, at the time, it was the lowest amount of gluten that could be tested for in a product. This does not suggest that individuals who are gluten intolerant will not react if they ingest lower amounts of gluten in a food. There currently is not an established level of gluten that is considered “safe”. If you have food intolerances it is important to know your limitations when eating ANY packaged or processed food.  

We welcome all comments and concerns and are truly sorry for those we might have frightened with this rumor.

I would like to note, we have tested baked products at Living Earth Bakery several times with our EZ Gluten Test, and always received negative results for gluten. We continue to enjoy their delicious gluten free baked goods.