Searching for Substitutes: A Celiac’s Guide to Going Gluten-Free
This piece originally appeared in the Fall/Winter 2017 issue of USA TODAY Best Years.
I was diagnosed with celiac disease in April 2012, and the nutritional journey that ensued was nothing short of Odyssean. I pored over books, downloaded apps that help to weed out ingredients with gluten, avoided dining out and spent hours searching for gluten-free recipes.
Th serious autoimmune disorder—estimated to affect 1 in 100 Americans—causes people’s immune systems to act up whenever they eat gluten, a protein found predominantly in wheat, barley, rye, oat and even in surprising foods, like soy sauce. When someone with celiac disease ingests food with gluten, it causes damage to the small intestine, preventing the absorption of nutrients. According to the nonprofit Celiac Support Association, common symptoms include joint pain, anemia, diarrhea, constipation, fatigue and irritability. Over time, if a gluten-free diet isn’t adhered to, additional health issues can occur, making it important for someone with celiac disease to maintain a lifelong and strict diet.
Thankfully, it’s become a different world for gluten-free diners. In 2015, Vox.com’s Julia Belluz offered a fascinating glimpse into diet trends with heat maps of Google searches for diet terms, including “gluten-free diet,” between 2006 and 2015. The increase is visually staggering. Represented by the color purple, gluten-free searches merely freckle the 2006 map, but dominate more than 80 percent of the 2015 map. Restaurants around the world reflect this skyrocketing trend by readily offering gluten-free dishes on their regular menus, or by warning patrons about possible cross-contamination in the kitchen. Today, it seems easier than ever to avoid wheat’s infamous protein.
But it’s important to separate fact from urban legend, especially when it comes to nutrition. And while celiac disease specialist agree a biological difference exists between celiac disease and non-celiac wheat sensitivity—namely, patients with the latter react only to wheat and not to all gluten-containing grains—the specifics surrounding this non-celiac reaction to wheat remains an elusive mystery to researchers.
“There are two things about being on a gluten-free diet,” says Dr. Peter H.R. Green, director of Columbia University’s renowned Celiac Disease Center. The easiest part is knowing what to avoid, he says. “The most difficult thing is knowing what to eat.”
Dr. Amy Burkhart, a Napa, Calif.-based medical doctor and registered dietician who specializes in celiac disease and non-wheat gluten sensitivity, recommends eating gluten-free substitutes made with nutrient-rich ingredients.
“Many manufacturers are now using products containing more nutrient dense gluten-free grains—such as quinoa, amaranth, millet, buckwheat or fonio—to increase nutrient density of gluten-free products,” says Dr. Burkhart. She and her child both have celiac disease.
Going gluten-free still remains no easy task. In my experience, the mere act of finding a suitable sliced-bread substitute has been costly and elusive—I tried over half a dozen brands before I found my favorite, Pure Knead, carried in Kroger stores in parts of the South. I like it, even though it doesn’t quite replicate wheat bread’s airy texture and elasticity, and costs twice as much as a loaf of regular bread. I still haven’t found a suitable substitute for New York-style pizza.
And don’t even get me started on baking your own loaf. For that, I consulted two experts to help me navigate the complexities of gluten-free baking.
Gerard Nudo and his husband Gary McElroy own Mediterranea, a gluten-free restaurant in Atlanta’s Grant Park neighborhood. The restaurant opened earlier this year, and offers a decadent menu brimming with focaccia, orzo, flatbread pizza and a score of other gluten-substituting delights. The restaurant also features a completely gluten-free bakery helmed by Nudo, who studied pastry making at the Institute of Culinary Education (ICE) in New York City.
When McElroy was diagnosed with celiac disease 13 years ago, Nudo decided to study the fundamentals of baking at ICE so he could create gluten-free alternatives of his favorite baked goods.
“That foundation, learning how to do things with wheat flour, helped to lay the groundwork—to know this is how you do things with this kind of dough, and now this is how you make it with this kind of flour,” Nudo says.
Even for an expert like Nudo, whose gluten-free cranberry scones and cheddar biscuits leave me hungry for more, trial and error are the norm. That’s because the number of gluten-free flour options is astounding. Oat, almond, tapioca, coconut, millet and quinoa flours are just a few of the go-tos for gluten-free bakers. Having so many options makes the process extremely complex and results in a lot of experimentation before you find the right mix for your recipe. Some of the flours don’t even work in particular recipes; the more bitter-tasting ones shouldn’t be used for baking, for example.
To further complicate things, the simplicity of using wheat flour as a multipurpose ingredient doesn’t apply when it comes to baking with gluten-free flours. Instead, flours must be combined and then complemented by binders, which add the volume and texture that wheat flour creates naturally. They also come in a multitude of forms—egg, flax seed, xantham gum, and others.
“A lot of my baking ends up being a chemistry experiment,” says Rucha Purohit, an avid gluten-free baker who sells her home-baked goods to family, friends and word-of-mouth fans she meets through online groups. “I try to avoid any flour blends that are mostly white rice flour, (which is naturally gluten-free) because it creates such a dense product that you can tell is gluten-free the moment you try it,” she says.
Instead, Purohit recommends baking cakes and cookies with a one-to-one mixture of oat flour, for sturdiness, and almond flour, for moistness.
However, unless you have the patience of a saint and the curiosity of a chemist, I recommend skipping the at-home gluten-free baking and opting for one of the brands recommended experts. A team at Columbia University’s Celiac Disease Center, led by nutritionist Anne Lee, recently conducted a study that shows gluten-free products are 130 percent to 200 percent more expensive than their gluten-containing counterparts. With that kind of price tag, you may as well pay for someone else to get it right.