Gluten-Free Dietetic Internship

Today I was able to realize a dream that I have had for years.  This dream is to work in a kitchen where I am not afraid of getting sick.  Where I don’t have to be careful about what I touch, or worry about breathing in and swallowing glutenous flour.  A place where I can learn the skills and techniques I need to know for my career as a Dietitian, and also be healthy.

This dream was realized through the cooperation of Sea Mar Community Health Center’s Dietetic Internship (Seattle) and Flying Apron, a GIG certified gluten-free retail/wholesale bakery in Seattle.

Background: Before someone can become a Dietitian, they have to get a degree in nutrition with an emphasis on dietetics.  They must apply for and be accepted to an internship program, then complete a series of competencies that cover the basis of Dietetics: working with the community to do nutrition education, working in a clinical setting (eg. hospital, long-term care), and working in a food service establishment to learn how to run a kitchen. (The final step is to past the licensing exam.)

As a person with severe reaction to gluten, and a hopeful future Dietitian, I was terrified of the food service portion of the Dietetic Internship (DI) because when I work in regular kitchens for many days, I get sick from exposure to gluten, no matter what I do to try to prevent it.  So how in the world could I reach my goal of becoming a Dietitian AND not expose myself to ill health?  Fortunately, after I was accepted to the Sea Mar DI, I did a lot of research about where I could work, and what I needed to do to ensure I learned and had the experiences I needed.

Today, as I prepared to leave my house, I was able to leave one thing behind, my lunch.  For the first time in almost 7 years, I didn’t have to take my lunch to work.  I was worry-free knowing that I would be able to buy my lunch at Flying Apron, and I would have no fear of getting sick or being stuck without food.  I cannot express with words what an amazing feeling that was and how grateful I am to have this opportunity.

Thank you so much to Sea Mar Community Health Center’s Dietetic Internship and Flying Apron in Seattle!!!!

P.S. Here’s a shout out to Bastyr University, today I became thankful for the 100+ hours of community service in a kitchen that you required for me to graduate with an MS.

Learn More:

http://www.seamarchc.org

http://www.flyingapron.com

 

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“Gluten-Free” means nothing to me, yet

As of today, August 15, 2013, the phrase “gluten-free” has no binding legal meaning.  (“Certified gluten-free,” usually means 10ppm, but always check with the certifying agency). At best, “gluten-free” really does signify that there is less than 20ppm (parts per million) of gluten per serving.  At worst, it means no gluten was intentionally added to the food. “Naturally gluten-free” has no legal meaning.

So what’s the problem? 

In food manufacturing plants, wheat and other glutinous flours can be used to coat the production lines (so things don’t stick), or can simply be processed in the same facility as items that don’t contain gluten in their natural state.  When the production facility changes from slicing barley to chopping dill for spice (for example), they are required to clean the lines for sanitization that destroys pathogens, but those cleaners do not necessarily affect any gluten proteins that are stuck in grooves, nooks, crevices, or corners of the equipment.  Then when the dill is processed on the equipment, it can pick up some of those gluten proteins.  Once the item is packaged, the ingredient list says “dill” because that’s the only intentional thing that went into the bottle, but the dill itself could have parts per million of gluten.

But I don’t have celiac disease, so why should parts per million matter to me?

Many people I have met try to eat gluten free food because they have noticed that gluten makes them feel bad (in the stomach, head, joints, anywhere).  But to maintain socialization, and continue finding food wherever they go, they eat anywhere that says “gluten-free” without asking any questions.  Some people say “as long as I don’t have a reaction that is too bad, than it’s fine for me.”  Let me stop right here.  I get it.  Having to think about the safety of your food at every meal, snack, tasting, etc is tiring.  The problem is that not thinking about it is damaging your health and possibly making you sick, really sick, in the long-run, like when your 60; I’m talking about osteoporosis, depression, skin diseases, and cancer as some of the biggies.  Studies are mostly conducted on people with celiac disease because that is relatively easy to identify, where as non-celiac gluten sensitivity (NCGS) isn’t so easy, but can have the same adverse affects when untreated.

Then what do I need to do?

In a little over a year “gluten-free” on a label or menu will legally mean “less than 20ppm” as designated by the FDA (link below).  Start talking to the owners of your favorite restaurants, and encourage them to join a program like the Chef to Plate Gluten-Free Restaurant Awareness Program offered by the Gluten Intolerance Group (link below).  Chefs and restaurant owners have no intention of making people sick, they just want their business to thrive.  By talking with them you are making the food safe for you, helping your favorite restaurant stay in business because they will be abiding by the new labeling laws, and their profits will grow with repeat customers that don’t get sick at all.

By 2015, hopefully, I won’t have to quiz every chef or kitchen manager about ingredients, food preparation methods, and gluten-free awareness.  Until then, I encourage everyone to join me to help the FDA regulation of “gluten-free” have real meaning, for our health and our peace of mind.

http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm362880.htm  (specifically #9 relates to restaurants)

http://www.gluten.net/chef-to-plate-gluten-free-restaurant-awareness-program

You are perfect as you are

Today, flipping through one of my favorite magazines, I came across an ad that stopped me in my tracks.  The first thing I saw was an overweight man in the foreground, posing with flexed muscles as though he was a pin-up model.  Then my eye followed his shadow to see the outline of an extremely muscular and slim man in the background.  Finally, my eye traveled to the top of the page to read the advertisement that this supplement promotes healthy weight loss.  Now, I want to be clear, I really like the company that this ad was for, and I am making no judgments about the validity of the claim of the supplement.  (And good job marketers, you got my attention.)

 

There are thousands of these ads on TV, in magazines, on every social media site and every talk show.  All advertise that you’ll be that much more attractive, that much of a better person, that much happier, if only you use this product and lose weight.  All of this leads to one thing: we are a society of people overweight condemning ourselves hundreds of times a day, stating to ourselves and each other that we aren’t good enough unless we are thin.  The problem is that even if you did lose weight, that doesn’t necessarily mean you have health.  Health comes from exercising, eating foods that nourish your body, and feeling confidant in yourself.

 

What I noticed was that this ad made me feel sad.  It says “this overweight man isn’t good enough as he is, but if he uses this product he will become good enough.”  And for a moment, that sentiment was reflected in my own head.  But the reality is that what this advertisement implies is FALSE.   I am here to tell you that right now, in this exact moment, you are good enough, in fact, you are perfect.  You are strong enough, you are smart enough and you are the right size for you, right now.  Now is the time you can take to be as healthy as you can be, for your own situation, your own lifestyle and your own peace of mind.

 

Many people assume that eating a gluten-free diet will make them healthier.  This may or may not be true, it is entirely individual.  But if you have decided to try eating gluten-free, especially if you find it difficult sometimes, and you decide to eat gluten, that is perfect.  If you are overweight or underweight and struggle to change that, embrace the difficulty, because it is perfect.    You are on your own path, your own journey and it is unlike anyone else’s, and that makes it the perfect journey for you.   If you are ready, than I free you from listening to the media that says you need to do something else because you aren’t good enough.  You are your best right now.  You are perfect right now.  You will be your best tomorrow, because all we can do in each moment is to be our best at that moment, and our best changes with situations and feelings.  So I ask you to throw out the diet books, stop listening to people who “offer” another miracle way to lose weight fast, and start believing in the power of how wonderful you are right now when you take a moment to love your self and treat yourself to a healthful lifestyle, what ever that means for you.  There is no other way to be healthy, there is no other way to be happy, there is no other way to fulfill your goals than to embrace and love yourself right now, because in this moment, you are perfect.

Gluten-Free Dentistry

Going to the dentist for your semi-annual cleaning can seem like a semi-anal inconvenience.  But it is especially tough for the 1 in 133 people with Celiac disease and the 6-7% of people who have non-celiac gluten sensitivity, according to the Gluten Intolerance Group.  We have to call the dentist ahead of time, check on their knowledge level surrounding gluten intolerance, and if they have any products that are safe for us.  Then, when in the office we have to double check the products, and sometimes call the manufacturers ourselves.

Yet I am so excited to tell you that I have found a dentist who knows about gluten intolerance and celiac disease.  In light of this knowledge, she has flour of pumice, which is gluten free. Not only did my teeth become shiny and clean, but I also had no reaction to the pumice!  Proper and regular dental cleaning is imperative to good health.  It may take some searching and several phone calls to dentists in your area to find a clinic that meets your needs, but I wanted you to know that there are dentists out there who are aware of gluten intolerance and stock items just for us!  I have added a live link here to a great article in Living Without magazine titled Avoiding Common Dental Allergens.

http://www.livingwithout.com/issues/2_4/dental_details-1180-1.html

Happy smiles, everyone!

This post is not intended to (and cannot) advise, diagnose, or treat any syndrome, disease or treatment, neither is it a recommendation for any particular dentist or dentistry tactic.  Talk with your healthcare professional to determine what is best for you.

Fear of Gluten

I live a life in fear.  Fear that the person serving me food will unintentionally be handing me a plate of poison. Fear that the grocery store clerk was handling a bread sandwich just before bagging my groceries, and neglected to wash his hands.  Fear that the plate my friend served me food on has had bread on it.  Fear that the kitchen I am working in has flour in the air which will settle in my hair and on my clothes causing me to become contaminated for days.  Fear that a loved one or friend will hand me a piece of food saying, “I made it gluten-free for you” with the look of sincere love that breaks my heart, because I have to quiz them about what ingredients were used, how the food was prepared and possibly decide that it is not, in fact, safe for me to eat.  Fear that the next bite will cause me to be in physical, emotional and psychological pain for the next 2 weeks.  And this fear causes isolation.

I always want to present the best face.  I want to be positive, a role model to look to, an example of how wonderful life can be when one lives a gluten-free life.  Because it is a wonderful life, free from pain, hurt, and psychological issues.  But there is another side to this face.  The other side is the one that has fear before every meal that is not within my control.  The underlying concern that I will get cross-contamination, or actual contamination from gluten, because this causes hurt, pain, and psychological issues.  It is a life lived in fear.  I am constantly afraid that the food I will be served by the waitress, or my friend, or my family, or that I bought which says “gluten-free” but is not certified, will have some gluten in it and cause me to be sick.

Here is the real issue: many thousands of people are somewhat sensitive to gluten.  Thousands more are sensitive to minute amounts of gluten, amounts so small that the single visible crumb you see from a piece of bread can cause pain and agony for days, or in my case, weeks.  Although that speck of gluten doesn’t cause anaphylaxis (a life-threatening, sudden closing of the airways) it does cause: gas, bloating, constipation, diarrhea, stomach cramps, muscle fatigue, tiredness, crankiness, sensitivity to light and sound, depression, sadness, difficulty with vision and hundreds of other symptoms. (There are 625 documented symptoms that can occur due to gluten intolerance, some are listed here: http://glutenfreeworks.com/gluten-disorders/celiac-disease/symptom-guide/#.UN5VX7Y1bQw)  Additionally, many people who have some sort of sensitivity to gluten also have some other health issue(s) that is exacerbated by any exposure to gluten.  Not only does this make them more sick, it means that health is that much harder to regain.

Some people tell me I shouldn’t go out to eat at a restaurant or friends house if the problem is that severe.  I have one challenge to those people: You try for 30 days to live a normal life, go out with friends, socialize, go to restaurants and bars like normal, only don’t ever eat anything that you didn’t prepare with your own two hands.  That will give you a small peak into what my life is like.  So when I have the opportunity, I do like to go out to a restaurant once or twice a month, and if the restaurant advertises serving “gluten-free” meals, I need to be able to trust that.

I am glad I have extreme gluten intolerance, I am so luck to know exactly what I need to feel healthy and be happy.  There is almost no other illness or disease like it on the planet, where a strict adherence to a diet means no pills, no injections, no illness and no pain.  What it requires from me, however, can be more difficult, I have to have an iron will and vigilance to make sure I avoid any level of contamination with gluten.  This has become easier because of more places testing and being certified gluten-free (by companies like the Gluten Intolerance Group), and more difficult by the thousands of food manufacturers and restaurants that advertise “gluten-free” but have no education and pay no attention to direct or cross contamination of food.  The United States of America is one of the last industrialized nations to NOT have any regulation in place regarding gluten testing and labeling in food.  The Food and Drug Association has been dragging their heals since 2004 when the “big 8” allergens were identified; gluten was included in the FDA proposal and put on hold 4 times since then.  (http://www.fda.gov/food/labelingnutrition/FoodAllergensLabeling/GuidanceComplianceRegulatoryInformation/ucm106187.htm  see SEC. 206. GLUTEN LABELING).  Thousands of people just like me live their lives in social exile for fear of getting contaminated.  And then if we do get gluten we live with the days or weeks of repercussion.

I have written this blog because I don’t really tell my friends how scary it is to eat, I just laugh, smile, remind myself and them that my life is sooooo much better than when I was consuming gluten on a regular basis and always sick (tho I didn’t know it then).  But I want you to know.  If you are struggling with standing up to others to protect your health, that’s OK, it is tough and you can do it.  If you have a family member or friend you just don’t understand, try to hear what their world is like.  If you run a restaurant and want to make food that your gluten sensitive customers can enjoy without fear, I encourage you to learn all you can about making food truly free from cross-contamination. (Visit the GIG at http://www.gluten.net/).  No person is an island, we all rely on each other and we all need to clearly communicate.  This is my way.  I really believe that some day gluten sensitivity will be understood by everyone and treated with the deference it deserves.  Until then, those of us that can speak up, must.  I am trying to do my part.

Thank you for reading.

 

The Dreaded Constipation Problem

A lot of people don’t like to talk about or even think about their bathroom habits, but they can tell you a great deal about your current health.  It is for that reason that I am discussing constipation today.

Constipation is when part or all of a bowel movement cannot be completed.  Often it is accompanied by an uncomfortable “full” feeling in the lower abdomen, gas, cramps, and other discomfort.  According to the National Digestive Diseases Information Clearing House, “More than 4 million Americans have frequent constipation” (1).  What is so interesting about this is that the amount we each go to the bathroom is highly individual and can be considered “normal” to have a movement anywhere from 3 times a day to 3 times a week.  What isn’t “normal” is if the movement is difficult to pass, hard, unformed or pebble-like.  Constipation affects us all from time to time. But if you have chronic constipation you should know there are lots of ways to treat it, because there are many reasons that it could be happening. It can be due to diet, medications, stress, illness, diseases and or lack of physical exercise.  Some methods to treat constipation include:

1. See a Registered Dietitian* who can help you identify things in your personal diet that may make constipation worse and better.

2. See a Physical Therapist* who is trained in pelvic floor and gastrointestinal issues, they can help you learn how to properly sit on the toilet, what a healthy movement feels like, ways to relax the muscles and more.

3. Talk to your doctor to determine if it could be due to medications and if there are any alternatives.

4. See a practitioner* for Visceral Manipulation to help your intestines and other organs move like they are supposed to.

5. Attend a session on meditation and relaxation to reduce your reaction to stressful situations.

6. Visit an Acupuncturist* and, or Doctor of Oriental Medicine* / Doctor of Traditional Chinese Medicine for herbal remedies.

 

7.  Talk to your doctor about increasing your physical exercise; even walking an additional 30 minutes a day can offer dramatic reduction in some forms of constipation and improvements to your over-all health.

8. Talk to your family and friends about it, we have a world of help around us if we ask. The biggest thing to know is that there are things you can do to reduce or alleviate chronic constipation so that you can be your healthiest and happiest self, and leave the rest behind.

*As always, please be sure the people you are consulting are professionals, properly trained and licensed by a reputable state or national organization to practice their medicinal art.  It is always worth inquiring where the professional went to school, what licensure they have, and how long they have been practicing.  If they are reputable, they will have no trouble answering these questions.
If you have other ideas of how to treat constipation, leave a comment!!!  Also check out the NIDDK (sited above as source 1) at http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/  for a trust-worthy, good and scientific source of information about what can cause constipation.

Gluten cross-contamination avoidance tactics.

What is cross-contamination, and how does it happen in packaging? 

Cross-contamination can occur when any product, like black beans for example, is processed on equipment that either is dusted with glutinous flour to prevent the items from sticking, or equipment that also processes items that contain gluten.  When the equipment is not cleaned between glutinous and non-glutinous items are processed, they can have over 20 parts per million of gluten, enough to make a very sensitive person or Celiac sick.

Companies can use the same equipment, but clean it in between gluten and non-gluten containing items, then do “batch testing” to determine if the non-gluten product contains more than 20 parts per million of gluten.  Look for labels that tell you how products are tested.  If a product isn’t labeled to your satisfaction, you can look at a manufacturers website to see if there is any information there about their processing facilities.  You can bet that if they don’t say anything under the FAQ section, the food could come with a dose of gluten.  If you really want a food, call the manufacturer directly and ask if they have any standards for gluten-free processing, and if so, what they are.  Manufacturers who do have standards have always been very helpful and kind to me, and in return I give them my business and recommendation.

In the end, my rule is: when in doubt, leave it out.

What about gluten hiding in my kitchen?

In a kitchen, cross-contamination can occur when any food item comes into contact with any food preparation item that has gluten stuck in it’s scratches.  This can be as simple as gluten sticking to a pan inside the scratches, and as complex as gluten sticking in a wood cutting board, then being extracted from the cuts on the board and transferred to the food when chopping, even veggies.  This is why it is very important for people who are very sensitive to gluten to have their own cooking equipment.  I know it seems like a lot, but it can be done.  My parents, who have always been very supportive of my gluten free journey, finally gave in two years ago and purchased a separate pan, sauce pot and dishes for me to use when at their home.  Now, when I go over to have dinner at their house, we use the gluten-free cutting board, dishes and utensils and we never have to worry that I will get sick from eating at their house.  It’s a small investment with a big return, your good health!

Hunting for Gluten-Free Food in Vancouver WA

Last weekend I was at a conference in Vancouver, WA.  As usual, I had inquired with the people in charge of making lunch for the conference to determine if the food was really gluten-free.  Although they had “gluten-free” options, the food manager was kind enough to tell me that they do not have any policies in place to prevent cross-contamination.  This means that if someone cuts a loaf a bread on a cutting board, washes the board, then prepares the veggies for the salad on it, it is cross-contaminated.  With Celiac level sensitivity to gluten, that just isn’t good enough for me and is a potential place where I could easily get a little gluten and become sick.  So I packed my lunch for both days of the conference.

Here’s where it gets fun.  On the second day, when I was sitting down with my friends, ready to pull out my lunch and eat it while they were being served a beautiful salmon salad, I smelled a foul odor.  In preparing the guacamole for my lettuce sandwich a day early, it had gone bad.  I was devastated.  I sat at the table wondering why life was so unfair.  Here I was, doing my best to protect myself and take care of my health, going out of my way to always have food that promotes my health, and it had gone wrong.  I had other snack-y foods on me, so I wasn’t completely bereft, but that just didn’t seem filling enough.  So I said chao to my friends and left the conference in search of a restaurant.  As I walked across the park, I realized that I could dwell in how unfair my life was, or I could turn it around and see this as an unexpected adventure.  If my sandwich hadn’t gone bad, I wouldn’t have left the conference at all during the day. Instead, I got a beautiful walk through the park on a lovely sunny day.  Across the way there was a Thai food restaurant.  I’ve often had good luck encountering people who work in Thai restaurants who really understand what it means to be gluten-free.  The waitress was very sympathetic and sat me at a table.  I ate an amazing curry dish and enjoyed a quiet lunch to myself.

After lunch I returned to the conference full of good food, content and happy.  It reminded me that the challenges I face daily in having to be so careful about my food, are only difficult challenges when I approach them with that attitude.  When I approach them as a challenge to love myself, and take care of myself, I am always able to succeed and feel good about my choices.  It was a simple chance to remember why I’ve dedicated my life to learning more about food intolerances, so that I can the go out and educate others with science and personal experience, hopefully helping people to see that it is worth it to cherish your health.

Air New Zealand Gluten-Intolerant Meal

I arrived in Auckland yesterday after flying 13 hours from San Francisco on Air New Zealand. Here is the cool thing and part of the big reason I chose to come to New Zealand among all of the places in the world I’d like to travel: they have a high rate and general understanding of Celiac (Coeliac) Gluten-Intolerance. When booking my flight I checked that they had a GF meal (they call them Gluten-Intolerance meals instead of Gluten-Free). Quantas also has Gluten-Intolerant meals available.

Upon boarding the plane I made sure the Flight Attendant knew I was the GF person and being in Premium Economy, the meal was fantastic, GF heaven. The flight attendants were very nice to be careful that when serving bread to my neighbor across from me, so that no bread crumbs spilled on my tray (I also always covered it with my napkin). For dinner, the first course was a salad with chicken strips, fresh fruit, and a rice cake; the second course was a delicious salmon fillet in lemon with potatoes, tomato, and steamed broccoli. No desert for me, but that was fine because I had Skittles in my bag. For breakfast I was served another fruit plate and rice cake, then I got a mushroom omelet with steamed spinach and tomato.

I was able to get off the plane in New Zealand feeling ready to begin my adventure happy and healthy. No worries about if the food would make me sick or if I would become ill in a few days. What a wonderful way to start a trip.

Gluten-Free Breast Cancer 3-Day Walk

Yes, on Sunday I completed the Breast Cancer 3-Day Walk benefiting Susan G. Komen for the Cure, and I did the whole thing Gluten-Free!  To do this, I made sure there was a allergy alert in the system with my name (by calling the 3 Day coaches and “double” checking about eight times).  I also re-affirmed again and again that I could bring my own cooler with all my meals, that my lunch would be brought to me, and that I could have dinner heated up.  There was a bit of confusion, so it took a lot of persistence for me to call and get a straight answer.  Most of the time the coaches were nice on the phone and as helpful as they knew how to be, but every time I called, I got a slightly different answer, a little different bit of information, and the occasional attitude from someone who didn’t understand how diet could be as important as I was making it.

This merry-go-round of attitude is something I experience quite a lot when checking on food in a restaurant or outing: one person totally gets the GF needs and will do everything to accommodate me; another person has half the answer because they were trained by the person who is totally committed but they themselves don’t fully understand; and the final person thinks I’m just being a little too picky.  To me, the truth is that it just comes down to education.  People think I’m picky because they don’t understand that ANY cross-contamination can make me very sick.  Sometimes it’s flat out disbelief, sometimes it’s that I’m making it up, sometimes I’m just too picky; no matter what I persevere in making myself understood and trying to educate people so they can understand that a little poison is still poison.  It may not kill me, but it is painful.

In the end, I packed all my food in different bags according to the day and meal, and put them in my cooler.  I was able to retrieve them myself for breakfast and dinner and got my lunch bag from the cooler trailer.  The cooks were very nice about listening to me, changing their gloves, and keeping my Gluten-Free Deli Frozen Meal cross-contamination free!  On day 3 I met a nice couple and she was also GF and they had brought all her food too!

I had my GF food which kept me going and healthy for the 3-Day 60 mile walk and I’m so glad that I figured out how to eat, without letting it interrupt what I wanted to do.