Last week, I had the honor of attending a National Foundation for Celiac Awareness fundraising (NFCA) dinner hosted by Chef David Bouley in his private test kitchen.

I’m a big fan of NFCA’s tireless efforts to raise awareness for gluten-related disorders, so this event could have taken place at a bowling alley and I would have been there in a second. The fact that the event was an eight-course, wine-paired, farm-to-table and, yes, gluten-free dinner prepared in Bouley’s very own test kitchen was a treat beyond belief.

Even though this was a private event, I share it with you to prove several points:

1. We’ve come a long way, but the best is yet to come in gluten-free dining. As part of the fundraising effort, Chef David Bouley’s team went through NFCA’s GREAT Kitchens Training Program.  I’ve eaten at several of Bouley’s restaurants and have had safe, memorable, gluten-free experiences, most recently at his divine Brushstroke (they catered to my every gluten-free need; it was a memorable evening).  To know that his team went through one of the best gluten-free foodservice training programs available is comforting.  Not just for eating at his restaurants, but because David Bouley is a thought-leader in the culinary world and I am confident that many other restaurants will follow his lead to have their foodservice associates trained.
2. Sublime gluten-free dining experiences are available now.  I find that the more a restaurant is dedicated to service, the more likely you’ll get a safe, gluten-free meal. It doesn’t matter if the restaurant advertises a gluten-free menu.  The gluten-free retail market has made huge advances in the last five years.  I’m confident that we’ll see a sea-change in gluten-free dining in the next five years.
3. We continue to learn more about gluten-related disorders every day.  Three physicians were in attendance and shared their thoughts about the direction medicine/research is going with respect to understanding gluten-related disorders.  I have followed the work of all of these physicians and they are without a doubt thought leaders.  It was a pleasure to get to speak with them in person:

• Dr. Mark Hyman, MD, Founder, The UltraWellness Center

• Dr. Gerard Mullins, MD, Associate Professor of Medicine, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital

• Dr. Keith Berkowitz, MD, Founder and Medical Director, Center for Balanced Health

Here’s a glimpse of the delicious evening…

Cocktail Hour: Elderberry Champagne with passed hors d’oeuvres of salmon blinis, kiwi and oysters, and more

Blood Orange Foam with Osetra Caviar

Forager’s Treasure of Wild Mushrooms
Sweet Garlic, Special Spices, Grilled Toro, Black Truffle Dressing

Spanish Sea Cucumber with Ocean Herbal Broth

Porcini Flan

Alaska Live Dungeness Crab and Black Truffle Dashi

Yellowtail with Coconut
Organic Connecticut Farm Egg
24 Month Comte Cloud and Iberico Ham

Organic Long Island Duck Puree
Hand-milled Polenta and Brooks Family Cherries from California

Santa Barbara Strawberries
Lychee Ice Cream

Flourless Chocolate Cake

While gluten-free dining can be frustrating, it is getting easier and more delicious every day.  Thanks to organizations like NFCA and chefs like David Bouley.

By Ashley Smith, MPH, RD, LD

A twenty-eight year old female lived a healthy lifestyle, frequently engaging in weight-bearing exercise and eating a well-balanced diet.  With no family history of osteoporosis, it was a surprise when she was diagnosed with a low bone mineral density (BMD).  Further testing determined she had celiac disease (CD), which was the cause of her osteoporosis.

What do we know about this relationship between CD and Osteoporosis, and what actions can be made to reduce its occurrence?

Celiac Disease and Osteoporosis
Studies show that children, adolescents, and adults with untreated CD may have reduced BMD. This is because the intestinal damage that occurs in untreated CD impairs the body’s ability to absorb nutrients, including those key to bone health. This makes it difficult to absorb enough calcium no matter how much of it you eat, drink, or take in the form of calcium supplements.

Thankfully, after removing gluten from the diet, the intestines start to heal.  As the intestines begin to heal, nutrients important to bone health can be absorbed into the blood and do the functions they are meant to do, including keeping our bones and teeth strong.  Usually within one year of starting the gluten-free (GF) diet, people with diagnosed CD are able to absorb calcium, vitamin D, and other nutrients they need to achieve normal bone density.

Screening
Upon being diagnosed, did your doctor test your BMD?  Also known as “DEXA scans” (dual-energy X-ray absorptiometry), BMD tests help to determine if you have or are at risk for osteoporosis or osteopenia.  Adults specifically are encouraged to have BMD tests done within one year of diagnosis.  This information allows doctors and dietitians to monitor your bone health and make more specific recommendations about your calcium and vitamin D needs.

Diet
People with CD have an increased risk for vitamin D deficiency and often follow GF diets that are too low in calcium.  For this reason, it is critical to seek out foods rich in calcium and vitamin D.  Some simple ways to consume calcium and/or vitamin D include:

• Substituting fat-free or low-fat milk for water when making certified GF oatmeal
• Having eggs or fortified GF cereal with fat-free or low-fat milk for breakfast
• Blending fat-free or low-fat yogurt or fortified tofu into your smoothies
• Drinking fat-free or low-fat milk as your beverage at each meal
• Making swordfish, salmon or tuna at lunch or dinner
• Eating cheese with fruit for a snack
• Topping toast, baked potatoes and salad with cheese
• Enjoying frozen yogurt topped with fruit for dessert

To further make sure you are meeting your nutritional needs:

• Determine your daily calcium and vitamin D needs
• Per MyPlate.gov, aim for an average of three servings of low-fat dairy per day
• Read nutrition facts labels for foods that provide a “good source of calcium” (provides > 10% of the recommended daily value of calcium in one serving)
• Look for front-of-package labeling that states, “calcium-rich” or “excellent source of calcium” (provides > 20% of the recommended daily value of calcium in one serving)
• Spread your calcium intake throughout the day to improve absorption.
• If your diet doesn’t provide enough calcium and vitamin D and you feel unable to improve your eating habits to eat more, consider a GF, age-appropriate multivitamin and mineral supplement.
• Work with a registered dietitian nutritionist to help you tailor a diet that meets your specific nutrition needs

Exercise
Exercise promotes bone development in children and young adults and prevents bone loss in older adults.  Some of the best exercises for bone health are “weight-bearing” activities, like:

• Walking
• Running
• Hiking
• Dancing
• Resistance training

Ashley Smith, MPH, RD, LD lives in Houston where she promotes health & wellness within food service systems. With a special interest in nutrition for the gluten-free diner, Ashley also provides gluten-free consulting for clients, consumers, companies and local cafes. To read more, visit Ashley at www.myGFdietitian.com.