Friday, January 19, 2007

Is it Gluten Free?

  • Foods made from grains (and grain like plants) that do not contain harmful gluten including: corn in all forms (corn flour, corn meal, grits etc..) Rice in all forms (white, brown, basmati and enriched rice etc..). Also amaranth, buckwheat (kasha) Montina, millet, quinoa, tef, sorghum, soy.
  • The followinig ingredients: Annatto, glucose syrup, lecithin, maltodextrin, plain spices, silicon dioxide, starch, food starch and vinegar (only malt vinegar might contain gluten). Also citric, lactic and malic acids as well as sucrose, dextrose, and lactose; and these baking products: arrowroot, cornstarch, guar and xanthum gus, manioc (tapioca flour) potato starch flour and potato starch, vanilla.
  • The following food: Milk, butter, margaine, real (not processed) cheese, plain yogurt, and vegetable oils inlcuing canola. Plan fruits, vegetables (fresh, frozen, canned) meat, seafood, eggs, nuts, beans, and legumes and flours made from them


  • Wheat in all forms including spelt, kamut, triticale (a combination of wheat and rye) durum, einkorn, farina, semolina, cake flour, matzo (or matzah) and couscou.
  • Ingredients with "wheat" in the name including wheat starch, modified wheat starch, hydrolyzed wheat protein, and pregelatinized wheat protein. Buckwheat, which is gluten free, is an exception.
  • Barley, Malt which is usually made from barley, and malt syrup, malt extract, malt flavoring and malt vinegar.
  • Meat, poultry, seafood, and vegetables that are breaded, floured, served with a sauce made from wheat, or marinated in a mixture that contains gluten such as soy and teriyaki sauces.
  • Licorice, imitation crab meat and nuts (if they are flavored iwth gluten-containing ingredients).
  • Commercial beer, which is made from barley (Gluten-free beer is available from several companies)


  • "Real" (not processed) cheese is gluten free; processed cheese (spray cheese for example) may contain gluten.
  • Dextrin- which is rarely used, can be made from wheat but that would be noted on the label. Plain maltodextrin, a more common ingredient is made from corn, potatoes or rice. When wheat is used, the label will say "maltodextrin (wheat)" or "wheat maltodextrin"
  • Distilled Alcoholic beverages- are gluten free because distillation effectively removes gluten from wheat. They are not gluten free if glute-containing ingredients are added after distillation, but this rarely if ever happens.
  • Flavorings- are often gluten free, but in rare instances can contain wheat or malt. By law, wheat would have to be labeled but malt would not.
  • Oats- used to be considered unsafe, but recent research has shown that a moderate amount of special pure oats is safe for most celiacs. Several companies produce oats specifically for the GF market
  • Pharmaceuticals- can contain gluten, although most are gluten free. Check with the pharmaceutical company.
  • Seasonings and seasoning mixes- have not been officially defined so they could contain gluten. By law, companies have to list wheat if it is found in any ingredient.
  • Spices- are gluten free. If there is no ingredient list on the container, it contains only the pure spice noted on the label
  • Soy sauces- is often (though not always) fermented from wheat. Read the label, front and back.

Special Cases

  • Caramel Color- can be made from malt syrup, but there is no known instance of a caramel color produced this way. Companies in North American use corn. You can consider caramel color gluten free.
  • Hydrolyzed Vegetable protein- is a phrase that cannot be used on a food label. Food processors have identify the "vegetable." So you might read "hydrolyzed wheat protein" which would not be gluten free or "hydrolyzed soy protein," which is gluten free.
  • Mono and Diglycerides- are fats and therefore gluten free. There had been unverified concern that wheat might be used with them as a carrier. Now, by law, a wheat carrier would have to be on the label.

Tuesday, January 16, 2007

Refractory Sprue

A small percentage of patients diagnosed with celiac disease fail to have a long-term favorable response to a strict gluten-free diet. These individuals continue to have symptoms and histologic abnormalities or have symptomatic relapse despite treatment with gluten-free diet and ultimately develop a potentially life-threatening disease known as refractory sprue. Based on data reported in recent studies, the majority of patients with refractory sprue have abnormal intraepithelial lymphocytes and a poor prognosis. The current hypothesis is that refractory sprue represents a transition state to intestinal lymphoma. The true prevalence of this disease entity is unknown. Future multicenter trials are therefore warranted to estimate its prevalence and establish clear therapeutic guidelines.

Celiac disease (CD) is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestations. Based on current knowledge, the initial step in disease pathogenesis is the deamidation of a toxic peptide fragment(s) from wheat, barley, and rye by tissue transglutaminase to form a complex. This peptide/HLA antigen complex triggers the immune response, which ultimately damages the small-intestinal mucosa. Clinically, the disease can be asymptomatic, and patients may have typical malabsorptive symptoms along with diarrhea, weight loss, and nutritional deficiencies.
The vast majority of patients diagnosed with CD respond to a gluten-free diet, with resolution of clinical symptoms and histologic and serologic recovery. Patients with malabsorption and histologic findings consistent with CD who are unable to achieve long-term remission on a gluten-free diet, and in whom other causes of flat mucosa have been excluded, are considered to suffer from unclassified or refractory sprue (RS). Prior to making the diagnosis of RS, all other causes of celiac-like enteropathy must be ruled out.
There are 3 discrete patterns of manifestations of RS. They are as follows: (1) only partial improvement on gluten-free diet; (2) no beneficial response to gluten-free diet; and (3) initial good response to gluten-free diet but relapse while still on this strict diet. Based on these manifestations, Ryan and colleagues defined 2 subgroups: primary RS and secondary RS. Patients with primary RS do not have full recovery on a gluten-free diet, whereas patients who have a full recovery and then relapse later have secondary RS. Ten of 21 patients with RS in a French multicenter study had initial clinical and histologic improvement on a gluten-free diet. All patients with RS have malabsorption and residual mucosal abnormalities of the small intestine.
There are no clear clinical or biological markers that predict the development of RS. The disorder manifests in adulthood and all reported cases have been in individuals over 20 years of age. Celiac serology tests were not performed in all of these reported cases. Ryan and colleagues reviewed the published reports and found that approximately only half of the patients had positive celiac serology tests. Cellier and associates reported that 17 (80%) of 21 patients with RS had antigliadin and/or antiendomysium antibodies prior to the gluten-free diet. With respect to the HLA-DQ2 association, 92% of the RS patients had this allele. The prevalence of the HLA-DQ2 association is similar to that found in uncomplicated celiac cases; however, this allele is known to be associated with many autoimmune diseases. Recent evidence suggests that RS comprises a heterogenous population of patients with diverse underlying causes. A small portion of these patients may have an adult form of autoimmune enteropathy, characterized by the presence of antienterocyte antibodies.
The primary clinical manifestations of RS are the absence of long-term beneficial response to a gluten-free diet and the worsening of symptoms that require therapeutic interventions. The presenting symptoms may be diarrhea, weight loss, abdominal pain, and refractory iron-deficiency anemia, or other nutritional deficiencies.
One of the endoscopic manifestations of RS is ulcerative jejunitis, which may progress to enteropathy-associated T-cell lymphoma (EATL). Both RS and EATL are characterized by the presence of a monoclonal T-cell population in the intestinal mucosa. In EATL, a similar monoclonal population that shows clonal identity with the lymphoma itself is also present in the enteropathic mucosa. Other patients have evident mucosal atrophy on endoscopy.
The histologic manifestations may include chronic mucosal atrophy, collagenous sprue, ulcerative jejunitis, subcryptal chronic inflammation, and mucosal thinning.
O'Mahony and coworkers estimated that 7% to 8% of adult celiac patients have RS. However, based on the sporadic reports, this appears to be an overestimation of the prevalence of RS. Table 1 summarizes the literature that has reported on more than single cases.

Meijer Brand list of Gluten Free Food

Meijer Brand list of Gluten Free Food

Gluten Free Online Stores/ Michigan Stores

Online Gluten Free Stores

Hiller's Markets

Ann Arbor, MI
Arbor Farms Market2103 W. Stadium Blvd734-996-8111

Hiller's Market3615 Washtenaw Ave734-677-2370People's Co-op (January 2005 update)

Trader Joe's (January 2005 update)2398 East Stadium Blvd. (In the Lampost Plaza)Ann Arbor, MI 48104 734-975-2455 Whole

Auburn, MI
Good For You! Health Products100 W. Midland RdAuburn, MI 48611989-662-4177

Berkley, MI
Hiller's Market3052 W. 12 Mile Road248-546-6599

Brighton, MI
Taorello's 1007 Grand River Avenue 810-225-8900
Healthy Exposure Nutrition**134 W. Main Street810-227-0690**Carries Kinnikinnick donuts, muffins, etc.

Canton, MI
Good Food

Clawson, MI
bel Cibo

Clinton Twp., MI
Life Smart ---- Sept. 2006 - Temporarily Closed due to a fire42359 Garfield Road586-627-0104

Commerce, MI
Hiller's Market39950 W. 14 Mile Road248-960-1990

Farmington Hills, MI
Trader Joe'

Flint, MI
Dale's Natural Foods4290 Miller Road810-230-8008

Fort Gratiot, MI
Honeycomb Natural Foods3900 Pine Grove Avenue810-984-1773

Frankenmuth, MI
Healthy Habitz545 South Main Street Frankenmuth, MI 48734989-652-0537

Gaylord, MI
JoJo's Natural Market1459 S. Otsego Avenue877-349-5656 or 989-705-8500

Grand Rapids, MI
Nutrition Plus3560 Alpine AvenueGrand Rapids, MI 49544616-785-1010

Harvest Health
1944 Eastern Ave SE, Grand Rapids, Michigan 616-245-6268

Apple Valley Natural Foods
6070 Kalamazoo Ave SE Grand Rapids, Michigan

Grosse Pointe Woods, MI
Healy's Health Hut (Natural Foods) (January 2005 update)Gluten-Free sectionCarries baked items from Celiac Specialties19850 Mack Ave.Grosse Pointe Woods, MI 48236 313-885-5000FAX: 313-885-1440

Livonia, MI

Milford, MI
The Health Mart115 W. Commerce248-684-6278Northville, MI Hiller's Market425 Center Street248-334-4001
Wildflours Bakery & Cafe43053 7 Mile Rd.Northville, MI 48167248-374-6244

Plymouth, MI

Rochester Hills, MI
Whole Foods Health Foods of Rochester2952 S. Rochester Road248-852-0336Holiday Market1203 South Main Street248-541-1414

Saginaw, MI
Discount Health Foods4575 Bay RoadSaginaw, MI 48604989-791-2010

Grains & Greens Inc 3641 Bay RoadSaginaw, MI 48603989-799-8171

Troy, MI
Good Food
Whole Foods

West Bloomfield, MI
Whole Foods

Hiller's Market6433 Orchard Lake Road248-851-7100

S' Betters

Wyandotte, MI
Celiac Products
May 2005 Heartland

July 2006Better Health

Celiac Specialties (exclusively gf)

The Breadwinner818 North Main StreetRochester, MI248-652-1280 A Piece O' Cake,


Shopping Outside Michigan

NW Healthy Alternative1636 Northwest Blvd.Columbus, OH 43212
The Gluten-Free Market

The Dietary Shoppe,

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