Dr. Alessio Faisano, Director of the Center for Celiac Research at the University of Maryland, in his new article: Surprises from Celiac Disease in the August issue of Scientific American,  states that “gluten causes this inflammation and intestinal damage by eliciting activity by various cells of the immune system.”  Dr. Faisano’s acknowledgment that gluten is an inflammatory agent is an important connection.  As many know the prevailing professional wisdom is that there is a relationship between Diabetes and Celiac Disease.  It is highly likely that we will see more dual diagnoses of Diabetes and Celiac Disease, so understanding how the Glycemic index works is going to be increasingly important.

My life-long journey with Celiac Disease led me to the Glycemic Index through Anti-Inflammation diets some years ago and I have been waiting for this book or one like it to reach me.  Although published in 2007, I just discovered it while in Portland, OR.  I mention Portland, OR because that was the place I first became aware of the problem with the Celiac Disease diet and recipes and diabetes.

Last year, my friend’s husband was diagnosed as gluten intolerant and pre-diabetic.  Handed the GF diet what he and his wife soon discovered was that his insulin spiked when he ate the “traditional” CD diet of rice, potato starch, tapioca and the like: all those staples in most of our recipes. Insulin spiking is not a good thing when you are pre-diabetic. Shortly after he was diagnosed, I met an Irish MD who was doing her internship at one of the hospitals in Portland, OR.  Her sister, who had Downs syndrome, is an insulin dependent diabetic and was recently diagnosed with Celiac Disease, was adamant that the “Celiac Disease” diet “needed major revision”…actually what she really said was that the CD diet was “just plain rubbish” in this very thick Irish accent.  Her sister couldn’t eat any of the recommended bread and certainly the rice was also major issue.  So, if there are friends of yours who are already dually diagnosed, the “Low GI Gluten Free Eating Made Easy” will be an important resource.

In addition to understanding the Glycemic Index, the authors make another important distinction.  They delineate 5 categories related to Celiac Disease.  Celiac Disease itself, Dermatitis Herpetiformis, Gluten Intolerance, Wheat Intolerance and Wheat Allergy.  Diagnosed as an infant in 1945 with Celiac Disease, I currently do not test positive for the changed classification of Celiac Disease. Not only are there people like myself, there are also many people who do not currently test positive for Celiac Disease for whatever reason.  Here in the US the prevailing allopathic medical view is that those of us who do not test positive for Celiac Disease do not need medical attention or are not as important. I have been told several times by allopathic doctors that it was fashionable to diagnose Celiac Disease in the 1940s and ‘50s and that my diagnosis is not a valid diagnosis. I am relieved to finally see that there is a book written with everyone in mind.

The recipes in “Low GI Gluten Free Eating Made Easy” are quite interesting and weekly food plans are certainly a good place to start. There is one suggestion I have when making wraps these days…Either use Vietnamese Rice wrappers or Iceberg or Romaine lettuce leaves as wraps.  The book refers to some gluten free wraps…but I suspect they are Australian and not a common item here in the US….yet.  The most important thing tho’ is that finally there is a book that connects the first set of dots between diabetes and celiac disease.

My Dad was the one who taught me to cook and also the parent who gave me my first cookbook:  “The Settlement Cook Book.”  It’s still a staple on my cookbook shelf.  And, I think I really got to cook with my Dad because he enlisted me as his sous chef after he had a massive coronary and majorly revamped our eating habits when I was about 12 years old, which would have been around 1957.

Dad was a health educator and a do it yourself-er, so, after his heart attack he took over lots of the cooking and kitchen experiences.  Although my Mom continued to cook, Dad was clearly in charge.  Mostly, he was a super cook, but there were some activities that he never did very well, like mince and fine chop.  He mostly did rough chop.  So, I think I got recruited as sous chef because he thought I could do better mincing and also because I did the dishes.  Now I can safely say, I still detest mincing and still do dishes.  Nonetheless, we managed to create wonderful dishes despite the “larger” chunks of ingredients. No one ever complained about the food and the plates were always clean.

Although his emphasis was on healthy food and lifestyle because of his heart attack, his specialty eventually became Chinese cuisine …and he really did make a mean steamed Chinese sea bass.   Although I now wonder what we did about Soy Sauce/sodium issues, all the food we made was pretty darn good and tasted Chinese-ee.  I still use many of his and my Mom’s recipes.  Eventually, she handled the hot and sour soup we made at home.

We spent MANY Saturdays making Egg Rolls…and we didn’t just make a dozen we made easily 3 dozen or so…usually the number of wrappers in a package I imagine. Then we froze them.  I was the only kid in school who brought egg rolls for lunch…and if the truth be told, my friends were always eager to trade some “cafeteria” food for home made egg rolls.  I could count on getting some great Mac and Cheese or Chicken Chow Mein for an egg roll or two.  We never ate Mac and Cheese after my Dad had his heart attack and although I do like cafeteria food, I don’t eat it anymore….well, mostly.

Because my Dad had to watch his sodium intake, to this day I have trouble remembering to use salt in my cooking, although It’s always on the table for guests to use.

My Dad was an inspiration in my life in many domains and most especially when I am in the kitchen.  Every time I pick up an onion to cut it, I still make sure to tuck my fingers back, just like my Dad taught me.

Happy Fathers Day, Dad!

I can say that the diet referred to in this accounting as the “Hass diet” is what I lived on as a child. I ate lots of ripe bananas, rice and cottage cheese.

History of the Coeliac Condition
By: Dr James S. Steward, Consultant Physician, West Middlesex University Hospital, Isleworth, Middlesex.

About 10,000 years ago, after the end of the last Ice Age, people learnt that hunting animals and gathering wild berries and other fruits were not the only ways of supporting life. They discovered that if they settled in one place for long enough they could sow and then harvest crops of cereals like wheat. This was the neolithic revolution. One of its consequences was civilization. Another was that people who could not tolerate wheat in their diet became ill with the coeliac condition.

The first description of childhood and adult coeliac disease was written in the second half of the second century A.D. by a contemporary of the ancient Roman Physician, Galen. He is known as Aretaeus of Cappadocia and his writings which have survived to more recent times were edited and translated by Francis Adams and printed for the Sydenham Society in 1856. The original Greek Text of the sections on “The Coeliac Affection” suggests that Aretaeus may possibly have understood a remarkable amount about the coeliac condition.

The chapter on “The Coeliac Diathesis” describes fatty diarrhoea (steatorrhoea) for the first time in European literature and then proceeds to give an account of several other features of the condition including loss of weight, pallor, chronic relapsing and the way in which it affects children as well as adults. The chapter on “The Cure of Coeliacs” opens with the first passage in which these patients are specifically called coeliacs: “If the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs”. While some people with disorders which may mimic the coeliac condition were doubtless unwittingly included in this description, the same is true for subsequent descriptions until the second half of this present century. The Greek work “koiliakos” used by Aretaeus had originally meant “suffering in the bowels” when used to describe people. Passing through Latin, ‘k’ became ‘c’ and ‘oi’ became ‘oe’. Dropping the Greek adjectival ending ‘os’ gave us the word coeliac.

It was not until seventeen centuries after Aretaeus that there follows the next clear clinical account of childhood and adult coeliac condition. In 1888 Samuel Gee, using an identical title to Francis Adams’ translation, “The Coeliac Affection”, gave the second classic description of the condition. Several passages from Gee’s account have often been quoted as prophetic, particularly “to regulate the food is the main part of treatment … The allowance of farinaceous foods must be small … but if the patient can be cured at all, it must be by means of diet.” During the early part of this century the doctors most responsible for increasing the understanding of the coeliac condition were looking after children. This may well have been because coeliac children tend to respond more rapidly and more dramatically than adult coeliacs to successful dietary treatment. Whatever the reason, children’s physicians (pediatricians) continued to lead the advance in the treatment of this disease, leaving the main discoveries on diagnosis to physicians caring for adults.

In 1908 there appeared a book in coeliac children by Herter, a paediatrician accepted as such an authority on this subject that the condition was often referred to as Gee-Herter’s disease. His most important contribution was his statement that fats are better tolerated than carbohydrates. This original observation was later supported by Sir Frederick Still, another famous paediatrician who, in a memorial lecture to the Royal College of Physicians in 1918, first drew attention to the specifically harmful effects of bread in coeliac disease. “Unfortunately one form of starch which seems particularly liable to aggravate the symptoms is bread. I know of no adequate substitute.”

This theme was developed further by Howland in a farsighted presidential address to the American Pediatric Society in 1921 on “Prolonged Intolerance to Carbohydrates” describing the treatment of children with coeliac disease. “From clinical experience it has been found that, of all the elements of food, carbohydrate is the one which must be excluded rigorously; that with this greatly reduced the other elements are almost always well adjusted even though the absorption of fat may not be so satisfactory as in health.” His three-stage diet allowed carbohydrates only in the last stage, when they had to be added, “very gradually with the most careful observation of the digestive capacity … Bread, cereals and potatoes are the last articles which can be allowed. The treatment is time consuming but these patients will repay the effort expended on them.”

Three years later came the banana diet advocated by Haas, which was essentially a diet low in carbohydrate except for ripe bananas. In a later paper, in 1938, Haas noted that a minute amount of some foods containing carbohydates will produce fatty diarrhoea even when the patient is taking hardly any fat in the diet, but a high carbohydrate intake in the form of banana will be well tolerated even though a much larger amount of fat is eaten.

After the 1939-45 war came a fundamental discovery, which proved to be the main advance in the treatment of coeliac children and adults alike. This discovery was made and described in detail by a Dutch paediatrician, Professor Dicke, in his doctoral thesis for the University of Utrecht in 1950. He showed how coeliac children benefited dramatically when wheat, rye and oats flour were excluded from the diet. As soon as these were replaced by wheat starch, maize flour, maize starch or rice flour the children’s appetite returned and their absorption of fat improved so that the fatty diarrhoea disappeared.

This work was confirmed and extended by Charlotte (now Professor) Anderson and her colleagues in Birmingham, who extracted the starch and some other constituents of wheat flour and found that “the resulting gluten mass” was the harmful part. Since 1950, therefore, the basis of treatment of coeliac patients has been the gluten-free diet.

The original observation which, together with Processor Dicke’s discovery, led to our present understanding of the nature of the coeliac condition was made by Dr. J. W. Paulley, a physician in Ipswich, and reported to the British Society of Gastroenology in Birmingham in the same year as Professor Dicke’s discovery. Dr. Paulley described an abnormality of the lining of the small intestine found at the operation in an adult coeliac patient. This abnormality consisted of an inflammation, the exact nature of which is still being investigated. The existence of this inflammatory change was confirmed in several patients by Dr. Paulley and was then found by many doctors in this country, the United States and elsewhere to be the most essential single feature on which the diagnosis of the coeliac condition could be based. Its importance to the patient is that it results in a loss of the microscopic projections or villi, which are partly responsible for providing the lining membrane of the small intestine with a large surface area. It is from this mucous membrane lining that the absorption of food into the bloodstream takes place.

It is encouraging to note that treatment with a strict gluten- free diet usually leads to a return of the “flat” lining of the coeliac small intestine to the normal stage. On the whole, the younger the patient, the more dramatic the improvement tends to be, but the most important single point is the strictness of the diet.

Within three years of Dr Paulley’s discovery an American physician, Colonel Eddy Palmer, used a tube which had been designed to take a tiny piece of the lining of the stomach to help find the cause of a different disorder, changed it slightly and slipped it into the small intestine of patients who had part of their stomach removed at a previous operation for something which had nothing to do with the coeliac condition. His paper (1953) includes an excellent photograph of normal intestinal lining obtained by this technique.

Two years later some doctors in Argentina made the biopsy tube more flexible so that it could pass through the intact stomach into the small intestine. In 1956 Dr Margo Shiner introduced further changes so that intestinal biopsy became the standard technique for diagnosis of the coeliac condition. Dr (later Professor) Israel Doniach, with whom the young Dr Shiner did this work at the Hammersmith Hospital in London, interpreted the changes in the intestinal lining of the coeliac patients.

Next year a completely flexible biopsy tube was designed by another American army officer, Colonel Crosby, working with an engineer, Kugler. Their instrument, known as the Crosby capsule, soon became the most widely used biopsy instrument throughout the world.

In the 1960s Physicians caring for disorders of the skin (dermatologists) discovered that a particular type of itchy rash call dermatitis herpetiformis may also be associated with atrophy of the villi and usually responds to a strict gluten-free diet.

To see the complete request please go to: The Federal Register

If you think that your words don’t count, think again. My experience is that when it comes to making sure that people in government have all the correct information, I found that if I didn’t tell them what I thought they needed to know, often they never got the correct information. It’s important that we all voice our thoughts and opinions.

Here’s some of what I learned in the beginning:

From June 28 to 30, 2004, The National Institute of Health convened a Consensus Conference to look at the prevalence of Celiac Disease in the United States. Having some previous experience in health related Government activities. I was in awe at the list of people who came together for the Consensus Conference. Clearly, this was a serious undertaking. Click here to go to the NIH Awareness Campaign

The NIH was interested in knowing:

• How is celiac disease diagnosed?
• How prevalent is celiac disease?
• What are the manifestations and long-term consequences of celiac disease?
• Who should be tested for celiac disease?
• How is celiac disease managed?
• What are recommendations for future research on celiac disease and related conditions?

There was one recommendation.

To educate physicians, dietitians, nurses, and the public about celiac disease by a trans-NIH initiative, to be led by the NIDDK*, in association with the Centers for Disease Control and Prevention. The first CD Awareness Campaign newsletter came out in the Fall of 2005.

*The National Digestive Diseases Information Clearinghouse (NDDIC) was given responsibility for developing the Celiac Disease Awareness Campaign. NDDIC is an information dissemination service of the NIDDK. The NDDIC was established in 1980 to increase knowledge and understanding about digestive diseases among people with these conditions and their families, health care professionals, and the general public. To carry out this mission, NDDIC works closely with a coordinating panel of representatives from Federal agencies, voluntary organizations on the national level, and professional groups to identify and respond to informational needs about digestive diseases.

I can tell that the awareness campaign is working. My friends send me articles, recipes from the news, or they ask me if I’ve seen this or that book, tv show or news item. Recently, a classmate of mine was diagnosed with Celiac Disease. She tested positive for CD and was clearly not prepared for the diagnosis. In fact, I don’t know that she was informed that she was being tested for CD. In addition to being told she tested postivie for CD, she was also told that she is a-symptomatic. That means she has “no symptoms.” I don’t know what her Dr. told her, but in my conversations with her it certainly didn’t sound complete. But at least she knows.

Remember, as of this date (July 14th, 2008) 95% of people with CD are undiagnosed.