ST. LOUIS — Rabia Rahman is as much a detective as a dietitian when she works with her patients to help them avoid gluten.
“I had one patient who got really sick from licking an envelope,” says Rahman, who’s both a nutritional counselor and an instructor in the department of nutrition and dietetics at St. Louis University.
Ironically, gluten is used in the binders or coatings of some medications that patients may be taking to feel better. And many of Rahman’s female patients are surprised to find out that gluten is sometimes an ingredient in makeup and lipstick.
Helping patients eliminate gluten from their diets is easier than ferreting out some of these more obscure uses, but it still poses significant challenges.
“We’ll always go over food habits and cover the broad items like wheat, barley and rye, which means they shouldn’t eat regular cakes, breads and pastas,” Rahman says. “But then I work with them to go over ingredient lists on labels closely and avoid specific items — hydrolized wheat starch, or anything that says malt, graham or spelt.
The medical reasons for going gluten-free, says Rahman, range from mild gluten intolerance to wheat allergies and celiac disease, an autoimmune disease in which consumption of gluten damages the small intestine. Blood tests can diagnose allergies and celiac disease, and Rahman calls a small-intestine biopsy the “gold standard” for diagnosis of celiac.
But there aren’t any specific tests for gluten sensitivity.
“That diagnosis often comes after a patient has gone from doctor to doctor to find out why they just don’t feel well,” Rahman says. “Sometimes it’s (gastrointestinal) symptoms, but many times the symptoms are less obvious — tiredness, headache, or even sometimes depression.”
Rahman has her patients keep a log of both their food consumption and their symptoms and eventually may recommend that they eliminate gluten from their diets. Or, in some cases, she may work the other way by having the patients go gluten free to see if it makes their symptoms go away.
“Even in the past five years, there’s been a huge increase in cookbooks, in what’s available in stores and restaurants and in online support,” Rahman says.
However, she adds, part of the demand has been generated by a certain trendiness in gluten-free lifestyles that’s been aided by their adoption by various celebrities.
Artisan Gluten-Free Flour Blend
5 cups (625 grams) brown rice flour
3 cups (350 grams) sorghum flour
2 2/3 cups (360 grams) cornstarch
1 cup (148 grams) potato starch
1/3 cup (57 grams) potato flour
4 teaspoons xanthan gum
Combine all ingredients and store in an airtight container in the fridge. The authors recommend measuring by weight rather than by volume for a more accurate and consistent result.
Notes: If you have a sensitivity to a specific ingredient, use the following substitutions. For corn, replace the cornstarch with 1 3/4 cups arrowroot flour. For potatoes, omit the potato starch and potato flour and replace with 1 1/3 cups tapioca starch. For sorghum, omit the sorghum flour and replace with an additional 3 cups of brown rice flour for a total of 8 cups of brown rice flour.
The ingredients can frequently be found in the specialty-flour or health-foods aisle of the supermarket or in health food stores.
Quinoa Salad with Vinaigrette
1 cup quinoa, rinsed if necessary
1/4 cup red wine vinegar
1/4 cup olive oil
Freshly ground black pepper
1/2 red bell pepper, stemmed, cored, seeded and diced small
3 green onions, thinly sliced
1. Prepare the quinoa according to package directions. Refrigerate until cooled.
2. Combine the vinegar and olive oil in a small bowl and season to taste with salt and pepper. Mix together the quinoa, bell pepper, green onions and olive oil and toss with the vinaigrette. Serve chilled.
Yield: 4 servings
Analysis per serving: 290 calories; 17g fat; 2g saturated fat; no cholesterol; 6g protein; 29g carbohydrate; 1g sugar; 4g fiber; 5mg sodium; 29mg calcium.
Adapted from “Artisanal Gluten-Free Cooking,” by Kelli and Peter Bronski (second edition, The Experiment, 2012)