Eating with celiac and diabetes – no piece of cake

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.

Published by Korim Publications, the NIS 98 medical-oriented kosher cookbook is published on glossy paper and includes beautiful, full-page photos of the appetizing dishes.

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 distress.

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 complications.

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 of cake.

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 system.

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 added.

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 bread).

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 flour.

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 powders.

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 above.

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 stevia powder.

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 35.

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 baking.

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 and basil.

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 bread.

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 meat.

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 inexpensive.

Glazer says she wrote her new cookbook in Hebrew, and has no plans at present to translate into English, but it is a possibility.

The potential cookbook market for celiac patients and diabetics in overweight and autoimmune America is huge.