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					                             C eliac News
                       Thunder Bay Chapter of the Canadian Celiac Association
                                                                 August 2007

                                 2nd Annual Celiac Walk-a-thon
EXECUTIVE                        The 2nd Annual Walk-a-thon was held on Saturday, June 2 in
                                 conjunction with the Rainy River District Celiac Satellite
President                        Chapter. Ten people participated and $942 in pledges was
Cheryl Kibsey: 577-8752          raised. Congratulations to Deb Paris and Bob & Carolyn Christie
                                 for collecting the most pledges. The walk took place around
Vice President                   Chapples golf course. A special thank you to Judy Gardner for
Deb Paris: 767-1068              welcoming the group into her home and offering scrumptious
                                 GF Persians, donuts, and coffee. Let’s see if we can raise even
Treasurer                        more money next year!
Sonja Van Rooyen:475-3105

Kathleen Romano: 473-5123

Executive Advisors
Eileen Bottos: 767-4958
Maureen Hill: 623-0242

Sharon Whent: 475-3800

Alison Peat: 473-9832
Katherine Smith: 577-9224
Bonnie Knott: 768-4026
                                      Pictured from L to R: Melvin Niemi, Carolyn Christie, Bonnie Knott,
The Canadian Celiac                   Patricia Newman, Laine, Cain & Caitlyn Perron, Judy Gardner &
Association is a national             Sugar. Missing: Deb Paris, Alison Peat.
organization dedicated to
providing services and
support to persons with celiac          Our next meeting will be held on:
disease and dermatitis                  Wednesday, September 5
herpetiformis through
programs of awareness,
                                        at 7:00 P.M.
advocacy, education, and                Royal Canadian Branch Legion No. 5
research. Find us on the web            235 Van Norman Street
at                        Everyone Welcome!
 Celiac News                                                                                                       August 2007

 President’s Message
 Hello Celiac Friends:
 Hope everyone has survived the heat wave of the last little while, and is ready to help with up coming
 events. First I would like to thank Judy for her many years as our President, and hope I can lean on her
 for advice. Secondly, I would like to express the Chapter's appreciation to those who have served as
 volunteers over the past year and welcome those who are new. Everyone’s contribution is important and
 many hands make light work! I would like to mention a couple of up coming events. Maureen is working
 on a spaghetti dinner for October, which is Celiac month, and the Christmas Party at the Valhalla Inn on
 November 25. Details will be shared at the September 5 meeting. Hope to see everyone there!
 Cheryl Kibsey, President

New Look for Our Newsletter                                      Economic Burden of a
Our local chapter has been blessed with additional help in       Gluten-free Diet
publishing our newsletter. Bonnie Knott has expertise in         A.R. Lee, D.L. Ng, J. Zivin & P.H.R. Green.
Desktop Publishing and has, as you can see, made a               The British Dietetic Association Ltd. 2007/Hum.
                                                                 Nutr. Diet. 20. pp. 1-8.
wonderful contribution by designing a new look for this
issue. On behalf of the Executive, and our membership,        Abstract
we welcome Bonnie. We’re thrilled to have you on board!       Background Coeliac disease is a common, autoimmune
                                                              disorder, for which the only treatment is lifelong
                                                              adherence to a gluten-free diet. This study evaluated the
Baileys Irish Cream
                                                              economic burden of adhering to a gluten free diet.
As a Celiac who loves Bailey’s, I was
upset to hear that Crown Royal has                            Methods A market basket of products identified by
notified consumers that Bailey’s is                           name brand, weight or package size for both regular
not gluten free. There is nothing                             wheat-based products and gluten-free counterparts was
listed in the ingredients on the bottle                       developed. The differences in price between purchase
that would indicate gluten is present.                        venues, both type of store (general grocery store, an
Smart List at                            upscale grocery store, a health food store and four
had originally shown Bailey’s to be                           internet-based grocery sites) and region was also
gluten free, but unfortunately this is not                    analysed.
the case.                                                     Results Availability of gluten-free products varied
                                                              between the different venues, regular grocery stores
                                                              carried 36%, while upscale markets carried 41%, and
Travel Info                                                   health food stores 94%, compared with 100% availability
An article written by a member of the Victoria Chapter        on the internet. Overall, every gluten-free product was
who traveled to Europe is included in this issue. It is       more expensive than their wheat-based counterpart (by
reprinted from the Victoria Celiac News. If you are           more than 5%). Bread and pasta was twice as expensive
planning a gluten-free vacation, there is a new website       as their wheat-based counterparts. Cost was affected
called Tripmates. You can join for         more by shopping venue than geographic location.
free and search for places to eat around the world that       Conclusions This study demonstrated that gluten-free
feature a gluten free menu. Plus, there is a forum for        foods have poor availability and are more expensive than
gluten free travel. Visitors are encouraged to share reviews their gluten-containing counterparts. The impact of
of restaurants that cook for people with celiac disease.      these findings on dietary compliance and the quality of
Tripmates also offers a lot of additional valuable travel     life needs to be addressed.
info that is worth checking out, such as Celiac Vacations:               The full article can be obtained by emailing Cheryl at
                                                     or Alison Peat at
(Reprinted from the Calgary Celiac News, First Edition 2007).

 Celiac News                                                                                               August 2007

3rd Annual Come & Go Garden Party
Wednesday, August 15, 2007
6:00 P.M. to 9:00 P.M.
(Rain date Thursday, August 16)
Sleeping Giant Bed & Breakfast
532 Cambrian Crescent
(no pets)
                     Door Prize, Raffles, Refreshments
                     Proceeds to the Thunder Bay Celiac Association
                                  Tickets available from any member of the association
                                  or by calling Sonja @475-3105 or at the door

            If anyone is interested in bringing baking, they can drop it of at the B & B

Local Bits and Bites                       continued on page 5

Did you know…
Our Chapter has set up a lending library of resources            Gluten Free Meals Available
with several (cookbooks, videotapes, etc.) that would be         The Metropolitan Moose Beanery &
of interest to the newly diagnosed. These are available          Café, Kakabeka offers gluten free
for borrowing -- free of charge. If you would like to            sandwiches and pizza. Soon GF wraps
borrow anything, please contact Eileen Bottos @                  will also be available. or 767-4958.                                Offered by special order are GF
                                                                 muffins and cakes. Take a nice drive to
If you have any cookbooks or reference                           see the falls & stop in for a bite.
books you are no longer using and
would like to donate these items for                             Gluten Free Beer Available in Thunder
sharing with other members, please                               Bay
drop them off at any meeting.
                                                                 La Messagère is North America’s first gluten
                                                                 free beer, brewed from rice and buckwheat.
We want to hear from you…                                        Pick up a 6 pack for $17.75 including deposit
Do you have a GF recipe or GF tip you’d like to share            from the LCBO on Dawson Road (Landmark
with other celiacs? Perhaps you know of a new GF                 Inn), Fort William Road (Thunder Centre);
product available in the area, or a restaurant offering          and Arthur Street (Arthur & Mountdale). The
gluten free items. If so, we want to hear from you. Please       Royal Canadian Legion Branch #5, Van
email Bonnie at so we can share              Norman Street also sells gluten free beer.
your information in future issues of Celiac News.                Stop by for a cold one!

 Celiac News                                                                                                    August 2007

The Anxious Traveler
I’ll explain the above title by telling you that early last
summer, my husband and I decided that we would take               SOME HIGHLIGHTS
a four week trip to Europe; southern France, Italy, and a         We were on a riverboat cruise in Provence for the first
bit of Switzerland to be exact. By August, I was the              seven days of our trip. It was a Peter Deilmann Cruise
personification of the term “high anxiety”. Having lived,         [just voted the best small cruise line in Europe by Conde
worked, and traveled in Europe for a year, shortly                Nast…Jan/07]. I had sent them information regarding
before I moved to Victoria, and having traveled all over          GF food when I made the reservation. I mentioned GF
North America, I could not understand my stress level.            breads, pastas, etc. were commercially available. When I
I’m not the anxious type. It finally dawned on me that            checked in, everything was arranged. All staff spoke
my last romp in Europe had been before “gluten free”              English and I met the chef and the waiter who would be
entered my vocabulary. How would I communicate my                 looking after me. I was served beautiful breakfasts, 4
dietary needs knowing very little French, German, and             course lunches, 5-6 course dinners and GF bread. All
no Italian? I knew that I wouldn’t starve, but the idea of        sauces and dishes were modified to my needs. One of
not being able to enjoy fully the marvelous food in               our tale partners was a diabetic, and he received the
unique European cafes and restaurants was unsettling. I           same level of attention. Of course, I missed out on many
became determined not to have to compromise culinary              of the afternoon tea items and hot midnight snack treats
delights on our trip.                                             but I was pleasantly stuffed at the main meals.
I began by contacting our Celiac Association at the               The remainder of our trip was train travel. My husband
national and local levels. National sent me lists of people       and I decided our destinations on a day by day basis. We
to contact in various countries for assistance, if needed.        tended to stay in the smaller European style hotels/
Italy had a contact person in all of its major cities but         pensions, and we usually ate in small restaurants--not the
there was only one contact number for France—in                   typical tourist stops--as that was what we had always
Paris. Switzerland had four contact references. National          enjoyed in the past. Contrary to what one sometimes
also sent me Italian, French, and German translations of          hears and reads, we found the people extremely friendly
information similar to that on our restaurant card but            and helpful, especially in the restaurants.
they added a caveat indicating that they could not                On a train to Florence, Italy, we met an Italian
guarantee that the translations were correct. In                  businessman who owned three beautiful hotels in
contacting the Victoria Chapter, Christine Rushforth,             Florence. He was knowledgeable about celiac disease
our chapter president and newsletter editor immediately           and his restaurant served GF breads and pastas. He
sent me translations entitled “Language Help for the              arranged for us to stay in one of his lovely, old boutique
Holidays” along with lots of encouragement. Sandra                hotels for a few days, and I enjoyed delicious pasta at his
Fraser, our chapter treasurer, also passed along more             gourmet restaurant and a GF breakfast every morning.
tips and inspiration as she had recently made a similar
trip to Europe. With the above help and the Babel Fish            In a small hotel in Sorrento, the front desk manager had
website, I composed translation cards in French, Italian,         celiac disease. She recommended restaurants that served
and German that I hoped would work for me.                        GF dishes and pasta.
And, dear reader, the cards worked, and I had a                   In many smaller, family-owned restaurants, we often got
wonderful trip with excellent food. The only major                to meet the whole family. Everyone wanted to see my
hiccup was on our international Air Canada flight. Barley         GF translation card and to help me decide what to eat.
soup was a course in one of the GF meals that I was               Instead of just pointing to a menu item and to my card,
served. I spoke with the head flight attendant and                we got to interact with the local people. Having celiac
completed a report regarding the mix-up that                      disease actually enhanced the whole experience! Most of
presumably made it to the pertinent Air Canada office. I          my memories are of these unique personal exchanges
never got feedback from them. My return AC flight,                and of the delicious food that I was served. We were
starting in Frankfurt, had no mistakes. As well as the            often given free after dinner drinks and samples of
main courses, I had GF bread, crackers, and a muffin.             house wines.

 Celiac News                                                                                                    August 2007

GENERAL TIPS                                                       comfortable regarding the menu items on the few trains
In Italy, GF supplies are sold at all major pharmacies. If         that had a dining car but this might vary depending on
you give the smaller pharmacy outlets sufficient notice            the train and country.
[4-8 hours] they will order items for you. I found GF              Plan your traveling for less busy times. You’ll get more
items in all of the pharmacies at the major train stations.        attention in restaurants and a better selection of places
In France, Switzerland, and Germany, GF supplies are               to stay. We were told that in southern Europe, June
purchased at health food stores, not pharmacies.                   through mid October are the busiest months. Our trip
Pharmacy staff can usually direct you to the nearest               was Oct 21-Nov 21. We had mild, beautiful sunny
source.                                                            weather [cool in the evenings] however the rains were
                                                                   starting as we returned to Germany to fly home.
The word for celiac disease seemed widely recognized in
Italy [celiachia] but less in France [la maladie coeliaque].       IN SUMMARY
In speaking, I was advised to use the term allergy/                I can hardly wait to go back! We are already planning a
allergie, in France, by two hotel owners who said that it          return trip to Spain, Portugal, and the western regions of
would be more effective. I found that to be my                     France. I found it reassuring to have our association and
experience as well. I tended to say “Je suis allergique au         its members so supportive and knowledgeable. Thank
gluten” quickly followed by examples, “le pain, la farine          you for helping to make our trip a success.
de blé”, and my translation card.
                                                                   Sherri McIntyre
Many hotels include a continental breakfast in their               Canadian Celiac Association, Victoria Chapter
room rates and often there are GF items such as cheese,
fruit, yogurt, ham slices, juice, and coffee. Other
breakfasts may be just coffee, bread, jam, pastries, and
cereal. Ask for a reduction in room cost if you can’t eat          Local Bits and Bites                      cont’d from page 3
the breakfast. Most hotels will deduct a few Euros.
We often purchased our breakfasts and lunches at the               The Athletic Club on Arthur Street has a Nutrition
central, open markets. These were a feast for the eyes             Consultant who has a program available for those
and stomach…stalls with fresh and beautiful flowers,               individuals interested in following a gluten free diet to
fruits, vegetables, herbs, seafood, meats, cheeses, baked          lose weight. It is a little pricey to begin with, but the
goods [not for us], plain grilled items, olives, oils, etc .       information that you receive may be quite invaluable. I
Each market was a busy, bustling, colourful experience             know that many ‘new’ celiacs are usually quite thin, but
that we looked forward to each day. Markets tended to              once you have mastered the cooking/planning/eating
open at about eight in the morning and to close around             part of it, you may have discovered that things are just a
two in the afternoon.                                              little too snug. It is an option and quite amazing to
                                                                   discover that some diet organization actually recognizes
The French and Italians take their food and restaurants            those on a gluten free diet.
seriously, and they devote a lot of time for the
experience. Meals are not a rushed affair. Dishes are
prepared individually and ‘from scratch’. The chef and
owner are very much aware of the ingredients used.
We heard more English spoken this time than our
previous trips. In all of the countries that we visited, the       Gluten Free Cereal
people did appreciate our efforts to speak a few words             President’s Choice Organics
of their language even if we managed just a few basics.            Crunch Corn, a wheat and
                                                                   gluten free cereal is available
Familiarize yourself with the key ‘gluten words’ in                at the Real Canadian
Italian, French, etc. so that you’ll recognize them on             Superstore and sells for
food labels when you’re shopping in the grocery stores.            $3.89 for a 284 g box.
When traveling on the trains, I packed my meals—a can
of beans, some fruit, cheese, and GF bread/crackers.
Most trains offered snacks and sandwiches. I didn’t feel
 Celiac News                                                                                                      August 2007

Last Meeting Highlights
                                                         Granola Bars (Supplied by Sherry Loyst)
Thank you to Jesse Rollings of El Peto Products          Source: Food That Really Schmechs (Modified)
Ltd. (specializing in gluten-wheat-, yeast-, corn-,      2 c. Desiccated Coconut
milk-, and egg free products) for coming to our          1 1/2 c oats, rolled, old fashion
last membership meeting. Jesse had a number of           1 1/2 c raisins
samples for tasting and products to purchase.            2 c sunflower seeds
El Peto products may be purchased locally at             1/3 c sesame seeds
Kelly’s Nutrition Centre on Red River Road and           3/4 c peanuts or soy nuts
the Nutrition Corner in Centennial Square. If you        1/2 c dried fruit, apples, cranberries, apricots
would like to be on their mailing list and receive       1/2 tsp salt
information on monthly specials, send your               1 c liquid honey
email address to Jesse at               1 tsp vanilla
                                                         1/2 c peanut butter
                                                         Mix all ingredients together. Thoroughly blend the honey, vanilla,
Cookbooks available for Purchase
                                                         and peanut butter. You may need to mix with greased hands to
  • Gluten Free By The Sea                               ensure everything is mixed together. Line jelly roll pan (rimmed
  • Gluten Free By The Sea-Silver Anniversary            cookie sheet) with greased parchment paper. Pat mixture firmly
  • 25 Years and Growing (Together We Are                into pan with greased hands or heated spoon. If you want thinner
    Better For Life)                                     bars, use two jelly roll pans. Bake at 275 F until golden brown, 50
  • Entertaining Gluten Free                             to 60 mins. Remove from oven and once again, pat firmly to
  • Growing Up Celiac                                    ensure bars hold together. Cut into bars or squares.

A special thank you to all those members who bring baking/treats to the bi-monthly meetings.
Thanks for sharing.

Upcoming Events

Keep informed of upcoming events by
reading your Celiac News:
                                                               October is Celiac Awareness Month
                                                               A spaghetti dinner is being planned a
Christmas Dinner – Valhalla Inn                                Caesar’s Place on Syndicate Avenue. First
Date: November 25                                              come, first served.
More info available a the September Meeting                    More info to follow at the September
National Conference
May 9-11, 2008 in Victoria, BC
Information can be found at

                  Your email addresses, please
                  Sherry Loyst is the new email/communications person. She can be reached at 683-8752 or
         If you would like to receive this newsletter electronically please send a
                  message to Sherry. This would save the chapter a considerable amount of money each year.
                  We respect your privacy and do not share our membership lists or email addresses with anyone.

  Celiac News                                                                                                           August 2007

From the Gluten Free Press, Toronto Chapter, April 2007
Is My Gluten Free Diet Healthy?
By Suzanne Simpson, Clinical Dietitian
When I started the gluten-free diet, I did not think about whether or not it was healthy. I just wanted to survive! But
now that I am used to the diet, I think it is time to look at what I am eating and say is this healthy? Am I missing
something (other than gluten)?
Recent dietary surveys show that adults on a gluten free diet may not be eating the recommended amount of folate, B
vitamins, iron, calcium, fiber and total grain servings (4). Why aren’t we eating better?
Many gluten free products are not fortified. Gluten free cereals, baking mixes and prepared baking goods are often
made from a combination of cornstarch, potato, tapioca and white rice flours (3). These flours are not overly
nutritious (See table 1 for a list of gluten-free flours). The question is how do we make our diets healthier and more
in line with what is recommended?
There is a new food guide for Canadians which you can access from the Health Canada website. Here are some
highlights from it:

Eating Well with Canada’s Food Guide
                   Children         Teens                                     Adults
 Age (Years)       2-     4-  9-    14-18                                       19-50                         51+
                   3      8   13
 Sex               Boys and         Females                      Males        Females         Males           Females      Males
 Vegetables &      4      5   6     7                            8            7-8             8-10            7            7
 Grain Products    3      4   6     6                            7            6-7             8               6            7

 Milk and                 2       2      3-       3-4              3-4        2                 2              3           3
 Alternatives                            4
 Meat and                 1       1      1-       2                3          2                 3              2           3
 Alternatives                            2
Review your typical eating pattern and compare it to the food guide. For example here is a typical day for me:
Breakfast: 1-1.5 cups cereal (pure uncontaminated oats or sweetened rice crisps) with 1 cup skim milk.
Lunch: Veggies or salad (lots) with low cal dressing, chicken/low fat cheese/water packed tuna and crispy minis/rice
crackers/potato or white rice.
Snacks: (1-2 per day): Source yogurt or fruit or Enjoy life (caramel apple bar ) + 1 cup skim milk.
Dinner: Salad, fruit, 1-2 source yogurts, chicken/ham/soy protein/shrimps.
Am I getting what I should be? NO!! I am not taking in enough grains. This is typical of the gluten free diet and is
especially true for whole grains. Whole grain intake has been linked with reduced risk of chronic disease including
heart disease and type 2 diabetes.
What are whole grains?
Whole grains are cereal grains which retain the bran, germ and endosperm. Refined grains only contain the
endosperm. The bran is the outer protective layer and contains fiber as well as B vitamins. The germ contains
unsaturated fat, vitamin E, some protein, minerals and B vitamins. The endosperm contains carbohydrate, protein
and B vitamins. When grains are refined most of the bran and the germ are removed. This means that there is less
fiber, minerals and vitamins.
What is the bottom line? Whole grains have more nutrients. They should be included in the diet if you have celiac
disease (or if you don’t.)                                                                                  Cont’d

 Celiac News                                                                                                            August 2007


      Amaranth                                               Buckwheat
      Corn (whole grain)                                     Cornmeal (whole grains)
      Millett                                                Montina (Indian Rice Grass)
      Oats (make sure they are uncontaminated)
      Popcorn                                                 Quinoa
      Rice (brown, wild)                                      Rice bran
      Sorghum (whole grain)                                   Teff

Steps to make your gluten-free diet healthier:
1. Choose cereals that are made with whole grains (read the ingredients and look for “whole grains”). If you have a
    sweet tooth like I do mix whole grain cereals with a little of the sweetened ones or add some Splenda /sweetener.
    Add some fruit, ground flax or dried fruits. I make muesli by mixing pure uncontaminated oats with yogurt and
    fruit and letting it sit for an hour.
2. Look on the food label for information about fiber (see Table 2 for your goal for fiber) and sugar. I try to choose
    cereals and snacks that have less than 10 grams of sugar and more than 3 grams of fiber per serving.
3. Try to have a hot whole grain cereal once or twice a week – pure uncontaminated oats/groats, buckwheat groats,
    enriched cornmeal, quinoa flakes, soy flakes, brown rice flakes. You could even mix a bunch of these grains and
    add some ground flax and raisins.
4. Use amaranth in baking or as a thickener in gravies and sauces.
5. Add some alternative whole grain flours to baking (sorghum, amaranth, teff, etc.) Shelley Case’s book has some
    recipes. Google recipes using these ingredients. Bob’s Red Mill has some on-line recipes. Or modify your own
    recipes by making 1/3 (or more) of the flour whole grain flour.
6. Choose whole grain based snacks such as amaranth crunchers, quinoa crunchies, popcorn, homemade bars,
    muffins, etc.
7. Add buckwheat flour to pancake mixes.
8. Make side dishes count. I usually stick with white rice (which is refined) or whole potato when I could be going
    for brown/wild rice, millet, quinoa, yams or legumes.
9. Buy enriched or fortified grains- enriched white rice, enriched corn meal/corn flour, enriched cereals (Perky O’s),
    enriched pasta, enriched bars (Enjoy life) and enriched flours/baked goods (see Shelley Case’s book for a list).
10. Add fruit and veggies to ALL 3 meals and at least one snack.
11. Experiment with legumes in soups, casseroles, salads or as a flour for baking (dried beans, peas, lentils, soybeans,
    bean flours: chick pea flour, garfava flour, fava flour, low-fat soy flour).
12. Choose lean meats and don’t fry them… have them baked in the oven, grilled, BBQ’d or roasted. Use low-fat
13. Choose low fat milk & alternatives and take the amount recommended to get enough calcium and vitamin D.
    If you do all of these then you are way ahead of me. Even if you try some of these steps, you should be able to meet your goals for
    important nutrients such as calcium, fiber, B vitamins, folate.

 Celiac News                                                                             August 2007

Table 1 Gluten Free Flours and Their Nutrients

 Flours:         Serving   Fiber     Protein     Calcium   Iron    Thiamin   Riboflavi   Folate
                 size      (grams)               (mg)      (mg)    (mg)      n           (mcg)
 Amaranth        1 cup     18        28          298       14.8    .16       .41         96
                 195 g.
 Buckwheat       1 cup     12.0      15.1        49        4.87    .50       .23         .65
 flour, (whole   120 g.
 Corn bran       1 cup     64.2      6.3         33        2.1     0         .07         3
                 168 g.
 Corn flour      1 cup     8.5       8           8         2.78    .29       .09         29
 (whole grain-   117 g.
 Cornmeal        1 cup     8.9       9.9         7         4.21    .47       .25         31
 (whole          122 g.
 Cornstarch      1 cup     1.2       0           3         .6      0         0           0
                 128 g.
 Oats            1 cup     7.9       12.9        42        3.4     .6        .11         26
                 81 g.
 Potato          1 cup     9.4       11          104       2.2     .36       .08         40
 flour           160 g.
 Quinoa          1 cup     10.0      22.2        102       15.72   .33       .67         83
                 170 g.
 Rice flour,     1 cup
 Brown           158 g.    7.3       11          17        3.13    .7        .13         25
 white           163 g.    3.9       9.4         16        .55     .2        .03         6
 Sorghum         1 cup     12.1      21.6        54        8.45    .45       .27
 flour           192 g.
 Soy flour       1 cup     9.0       40.9        165       5.27    .33       .25         361
 Low fat         88 g.
 Teff            1 cup     11                    331       12      .7        .2          135
  Whole wheat 1 cup        14.6      16.4        41        4.66    .54       .26         53
  Wheat flour  120 g
Bowes and Church
USDA Nutrient database
Pagano (Teff)

 Celiac News                                                                                                 August 2007

Table 2 DRI’s For Fiber and Carbohydrates:
AGE            Gender      GRAMS OF FIBER           Grams of carbohydrates
                           RECOMMENDED                                       It is recommended that “Added sugars” be
                                                                             limited to no more than 25% of energy.
1-3 years      Both        19                       130
4-8 years                  25                       130                      References:
9-13 years     Male        31                       130                      Venn BJ, ManJL. Ceral grain, legumes and
14-18 years                38                       130                      diabetes. Eur. J Clin Nutr, 2004;58;1443-
19-30 years                38                       130                      1461.
31-50 years                38                       130                      Seal CJ. Whole grains and CVD risk. Proceed
51-70 years                30                       130                      Nutr Soc. 2006; 65:24-34
>70 years                  30                       130                      Pagano A. Whole Grains and the Gluten-Free
9-13 years     Female      26                       130                      Diet. Practical Gastroenterology. Oct. 2006.
14-18 years                26                       130                      66-78.
19-30 years                25                       130
                                                                             Raymond N, Heap J., Case S. The Gluten-
31-50 years                25                       130
51-70 years                21                       130
                                                                             Free Diet: an Update for Health Professionals.
>70 years                  21                       130                      Practical Gastro, Sept. 2006. 67-
Pregnancy                  28                       175
Lactation                  29                       210

Celiac Disease and Liver Problems
Celiac disease has traditionally been considered as a disease of the gut in which gluten causes damage to the small
intestine by an autoimmune mechanism in genetically susceptible individuals. However, it has now become clear that
celiac disease, in fact, is a multi-system disorder in which other organs of the body can also be affected directly or
indirectly. One such organ that may get affected is the liver.
A variety of liver problems have been associated with celiac disease. One of the most common liver problems seen
in celiac diseases is evaluation of liver transaminases in the blood. Transaminases are enzymes present in the liver
cells that leak out in large quantities into the blood stream with inflammation of the liver. The process of liver
inflammation is called hepatitis. This hepatitis can occur from a variety of reasons including viral infections and
toxicity from drugs. Alcohol consumption is an example of the latter and is a common cause of increased liver
Elevation of liver transaminases is common in celiac disease. In one study 42% of patients with celiac disease had
some degree of elevation of transaminases, which normalized in 95% of cases after one year of gluten-free diet.
Another study found abnormal liver enzymes in 19% of patients. The problem resolved in all patients who were
compliant with the diet
It is not clear how celiac disease causes inflammation of the liver and an increase in transaminases. The liver may be
affected in an autoimmune process (called autoimmune hepatitis). Patients with one autoimmune disorder are at risk
of developing other auto immune disorders. Celiac disease is an autoimmune disorder and some individuals may,
therefore, develop an autoimmune hepatitis. Another proposed mechanism is that there are toll-like receptors
(TLRs) present on the surface of many cells in the body that participate in the autoimmune system. These receptors
can sense molecules present in bacterial pathogens. When the autoimmune system senses these molecules, certain
chemicals are released which set off an inflammatory response to help control the pathogen. One class of molecules
recognized by TLRs and common to most pathogenic bacteria is lipopolysaccharides (LPSs). Intestinal permeability
is increased in celiac disease due to the damage caused by gluten. This disruption of the intestinal barrier permits
products like LPS from the gut bacteria to enter the blood stream and reach the liver. This can trigger a TLR
response from immune cells in the liver resulting in inflammation and damage. Gluten itself could directly trigger a
liver immune response just as it does in the small intestine. Another reason of liver inflammation in celiac disease

  Celiac News                                                                                                                             August 2007

could be deposition of fat in the liver. In cases of malnutrition an abnormal amount of fat can get deposited in the
liver cells. This can lead to swelling of the cells with resultant injury and inflammation, a process called liver hepatitis.
In cases of celiac disease the body is unable to absorb the nutrients because of damage to the small intestinal mucosa
(lining). Therefore, the individual can develop malnutrition and fatty liver hepatitis. This would reverse itself by proper
management of celiac disease with a gluten-free diet.
Just as individuals with known celiac disease can develop liver problems, those with liver problems may be suffering
from undiagnosed celiac disease. Celiac disease has been described in patients with chronic liver disorders such as
primary biliary cirrhosis, primary sclerosing cholangitis, and “cryptogenic” liver disease. Cryptogenic refers to
unknown or of obscure origin when no cause is apparent). The reason for the association between celiac disease and
these liver diseases is not well understood. Some of the above-mentioned disorders have similarities in genetic
patterns with celiac disease.
Celiac disease has also been found in patients undergoing liver transplantation for chronic liver failure. One study
found that 8 of 185 patients (4.3%) who received a liver transplant had celiac disease. These individuals had a variety
of liver diseases the most common being primary biliary cirrhosis.
Celiac disease should be considered in all cases of chronic “cryptogenic” liver disease. Elevated transaminase levels
may be the only manifestation of celiac disease in some individuals. There are cases of individuals undergoing a liver
biopsy trying to find a cause of elevated transaminases. Serological testing for celiac disease is now readily available
and is recommended in such cases before embarking on more intrusive diagnostic procedures. A gluten-free diet will
correct the elevated transaminase levels and may also help halt the progression of liver disease.
Submitted by : Dr. Mohsin Rashid, MBBS, MBed, FRCP (C).
               Pediatric Gastroenterologist, Faculty of Medicine, Dalhousie University.
               Member, Professional Advisory Board, Canadian Celiac Association.
                                                                                                          Events at The Royal
This article, is from the Nova Scotia Celiac News, Winter issue
                                                                                                          Canadian Legion Branch 5
                                                                                                          on Van Norman Street
                                                                                                          Friday Nights—Steak nite dinner ,
                                                                                                          dance and meat draw. The meat draw
                                                                                                          starts at 11 am and the draw is held at
                                                                                                          7 pm. You don’t have to be present.
                                                                                                          The meal starts at 5-7 (eat in or take
                                                                                                          out) upstairs in the club room and
                                                                                                          consists of 8oz rib eye steak, baked
                                                                                                          potato with all the trimmings, salad,
                                                                                                          bun & coffee all for only $10.00. It's a
                                                                                                          really great deal. Sit back after dinner
                                                                                                          and listen to the music. There will be
                                                                                                          either a DJ or a band. There is a cover
                                                                                                          charge of $2.00 for the dance only for
                                                                                                          non-members and members just show
                                                                                                          I.D. We also have dances every Sat
                                                                                                          afternoon at 3-6 with live bands. There
                                                                                                          is a cover of $3.00 for non-members
                                                                                                          and members show I.D. Don't forget
                                                                                                          we have Gluten free beer La
                                                                                                          Messagère. We have senior
                                                                                                          shuffleboard every Thursday afternoon
                                                                                                          at 1pm. There is also open pool and
                                                                                                          shuffleboard, darts and cards. Everyone
                                                                                                          is welcome. You don't have to be a
                                                                                                          member or affiliated with someone who
                                                                                                          is. For further information contact
                                                                                                          Bonnie at 472-2631.

    The Canadian Celiac Association, Thunder Bay Branch, endorses no products. Any mention of a product in these pages is for information only, and
    does not constitute approval of said product. Similarly, reports concerning medical or dietary research are intended to create awareness, and should
    not be interpreted as forming an official position of the Branch or of the Canadian Celiac Association. If in doubt, consult your physician.