Eating with celiac and diabetes – no piece of cake
A beautiful Hebrew-language cookbook for patients who have to avoid gluten and sugar has just been produced in Tel Aviv.
Lelo Gluten, Lelo Sukar Photo: Courtesy
Suddenly being diagnosed with celiac disease or type II diabetes, and realizing
one’s eating habits have now changed for life, can be a great shock. For some,
this prospect is devastating. In addition to sympathetic physicians, nurses and
the advice of clinical dietitians, a well-written and authoritative cookbook can
also provide some answers and emotional relief.
US-born Tel Avivian
Phyllis Glazer’s new 134-page hardcover Hebrew-language volume Lelo Gluten, Lelo
Sukar (Without Gluten, Without Sugar) is just such a book.
Korim Publications, the NIS 98 medical-oriented kosher cookbook is published on
glossy paper and includes beautiful, full-page photos of the appetizing
It’s a boon not only to people who have to avoid gluten or
control their sugar intake but to anyone who wants to eat nutritious food with a
minimum of artificial ingredients and processing.
While many of the
ingredients can be purchased in health food stores, others can be obtained at
ordinary supermarkets’ expanding gluten-free and sugar-free sections, or via
more do-it-yourself methods, such as grinding chickpeas into a flour substitute.
Lelo Gluten’s numerous recipes are mainly vegetarian, but also include some
fish, poultry and meat dishes. Some require many ingredients, but are relatively
simple to make.
CELIAC DISEASE is an autoimmune digestive disease that
can affect people of any age, and can appear suddenly. It can be triggered by
pregnancy, childbirth, surgery, viral infection or even severe emotional
But in other cases, there is no obvious explanation for why the
body’s immune system suddenly cannot tolerate gluten – a protein found in wheat,
barley, rye and other grains, as well in some more surprising places such as
vitamin pills, medications and even lip balms.
When people with celiac
disease eat foods or use products containing gluten, their immune system
responds by damaging or destroying villi, the tiny, finger-like projections that
line the small intestine. Villi normally allow nutrients from food to be
absorbed through the walls of the small intestine into the bloodstream, but if
they are not healthy, a person can suffer from malnutrition no matte how much
food is consumed.
When a celiac sufferer is exposed to gluten, the villi
atrophy as the result of an inflammatory response. A gluten-free diet helps
people with celiac disease control the symptoms and prevent
As soon as an individual has been diagnosed with blood
tests and a positive biopsy of the small intestine, his doctor will tell him to
go on a permanent gluten-free diet. Those used to consuming anything they like
are suddenly confronted with the tedious task of scrutinizing labels,
questioning storekeepers, food companies, bakery personnel, restaurant waiters
and kiosk owners.
Transitioning to a gluten-free diet is a big change,
and requires getting used to.
Until they get the hang of it, celiac
patients may feel very deprived as they watch others casually buy a sandwich or
a piece of cake. Strictly observing the diet is – literally – not a piece
Having to follow a gluten-free diet may cause deficiencies in
certain vitamins and minerals, making it necessary to take supplements of iron,
fiber, thiamin, niacin, folate, calcium or riboflavin. In some serious cases,
even a gluten-free diet doesn’t halt the symptoms and complications of celiac,
and the patient may need special medications to suppress the immune
If a celiac patient occasionally “sins” and eats a doughnut or
accidentally consumes something with “hidden” gluten, they may suffer diarrhea
and stomach pain, but even without suffering symptoms, even small amounts of
gluten can harm the small intestine.
So what foods can celiac patients
depend on to be naturally gluten free? This group includes beans, seeds and nuts
in their natural, unprocessed form; fresh meat, fish and poultry; fresh eggs;
fresh fruits and vegetables and most milk, cheese and other dairy products to
which gluten-containing grains or preservatives have not been
Glazer, in her introduction, lists grains or grain-like products
that are gluten free. These include (in alphabetical order) amaranth;
arrowroot; buckwheat; corn and cornmeal; flax; flours ground from rice, soy,
corn, potato, beans and chickpeas; millet; quinoa (really a tiny fruit); rice;
sorghum; soy; tapioca and teff (which is a basic ingredient for Ethiopian
As for foods that celiac sufferers have to avoid, the list is
also long: wheat; durum flour; barley (malt, malt flavoring and malt vinegar are
usually made from barley); rye; bulgur; farina; semolina; spelt; and graham
Unless the following products are labeled “gluten free,” beware:
beer, breads; cakes and pies; candies; cereals; cookies and crackers; croutons;
french fries; packaged gravies; matza that is not specially made for celiac
patients; pastas; pastrami; salad dressings; prepared sauces, seasoned rice
mixes; seasoned snack foods such as potato and tortilla chips; and soup
Certain grains, such as oats, can be contaminated with wheat and
other gluten grains during growing and processing stages of
production. So experts advise avoiding oats unless they are specifically
labeled gluten-free. People with celiac need to avoid contact even with
“Play-Doh,” as it is based on flour.
AS FOR type II diabetes, which is
largely a lifestyle metabolic disease resulting from overweight, poor diet and
lack of exercise, patients to need to minimize the amount of sugar in their
diet. Glazer explains the glycemic index (GI) – the measurement of how much
one’s glucose (sugar) level in the blood increases from consuming carbohydrates:
Pure glucose has a glycemic index of 100, so all other foods have a lower
GI. Every type of food has its own GI number. Thus it is
considered low under 55, moderate between 56 and 69, and high if it’s 70 or
The author’s recipes use natural sweeteners such as agave sugar
(20 GI), silan (from dates, 42 GI), honey, real maple syrup (very expensive, but
54 GI), carob syrup and artificial sweeteners such as sucralose and natural
But she prefers a natural sweetener called coconut sap
sugar (also known as coconut palm sugar), which is produced from the sap of cut
flower buds of the coconut palm.
Coconut sugar has been used as a
traditional sweetener for thousands of years in southern and southeastern Asia
countries such as Philippines and Indonesia, and is sold in health food stores.
Glazer says it has a “deep” taste and is very rich in vitamins (especially from
the B vitamin family), iron, potassium and zinc. It is suitable, within limits,
for people who have to control their blood sugar levels as its GI is only
Not all the sweeteners are suitable for baking. Artificial
sweeteners like stevia and sucralose (both hundreds of times as sweet as table
sugar) come in powdered form. But other artificial sweeteners lack the bulk that
white sugar provides to baked products.
Glazer also recommends canola and
olive oils, coconut oil and avocado oil for salads, cooking and
THE RECIPES are divided among six chapters that include breakfast
foods, breads and salty baked goods, first courses and appetizers, schnitzels
and meats, vegetarian dishes and sweet dishes.
“Silver dollar pancakes”
is the first item. They are made with coconut sap sugar, eggs, agava or
honey, vanilla, yogurt, oil, almond flour, tapioca, salt, bicarbonate of soda,
lemon juice and strawberries. As in many other sweet recipes, Glazer suggests
that diabetics use sucralose instead of the honey or agava. Other breakfast
dishes are mini-muffins with dried blueberries and bananas; Florentine eggs;
cooked cereal with quinoa and rice flour; sunflower seed bread made with olive
oil and raw tehina; dried-tomato bread with yogurt, tapioca and almond flour;
and thin pizza from chickpea flour, thyme, olive oil, tomatoes, cheese
First courses and appetizers include rice sheets filled with
goat-milk cream and smoked salmon; tofu snacks with Korean sauce; blini with
salmon caviar; smoked fish salad; stuffed mushrooms with pistachios; felafel,
and smorgasbord sandwiches made from dried-tomato or sunflower flour
Schnitzel – that all-time Israeli favorite – is coated before
frying or baking by dipping chicken breast into ground almonds, cornmeal or
chickpea flour. Not an ordinary breadcrumb in sight. Among the other poultry
recipes are turkey and rice meatballs; chicken and vegetable roll; stir-fried
noodles with chicken and vegetables; and corn tortillas with chili and
Vegetarian main courses include a rich corn quiche, corn gnocci;
Parmesan eggplant; cauliflower or broccoli quiches; rootvegetable curry; and
Korean Bin Dae Duk.
The desserts range from fruit panna cotta and
marzipan cake with nuts and raisins to peanut butter cookies (without eggs),
carrot cake, and chocolate cupcakes.
These dishes certainly aren’t
boring, even if they take time to shop for and prepare, and many are not
Glazer says she wrote her new cookbook in Hebrew, and has no
plans at present to translate into English, but it is a possibility.
potential cookbook market for celiac patients and diabetics in overweight and
autoimmune America is huge.