During the holidays, food traditions move front and center. But if you have celiac disease or gluten sensitivity, your favorite family dishes might be off-limits. However, with a little know-how from Jennifer Welper, executive chef for the Mayo Clinic Healthy Living Program, you can convert grandma's special casserole or dad's secret sauce into a just-as-delicious, gluten-free version. Stock up on Jen's recommended pantry alternatives for easy recipe substitutions.

Gluten-free flours

In recipes that call for all-purpose wheat flour (like that scrumptious topping on apple crumble or breading on chicken), use a gluten-free flour instead. Some common options are:

• Oat flour is made from oats and is available at many grocery stores. Or save yourself a trip and make it yourself. Just grind oats in a blender or food processor until you achieve a texture like flour. Be sure to use certified gluten-free oats. Regular oats are often processed in facilities that also process wheat, which can contaminate the oats with gluten.
• Almond flour is made by grinding almonds together. You can purchase it at the store or make it yourself. To make your own, grind raw or blanched almonds in a blender or food processor. Don't grind them for too long. Otherwise you'll end up with something more like almond butter than almond flour.
• Rice flour is made from white or brown rice. Rice flour is difficult to make at home. So it's probably best to purchase it at the grocery store.

Gluten-free gravy

Some recipes use wheat flour as a thickening agent (think gravy or white sauce). Try a gluten-free thickener instead:

• Cornstarch, tapioca flour or arrowroot powder. You only need one of these options to make a thickening agent. Tapioca flour and arrowroot powder are sometimes used in gluten-free baked goods and nice to have on hand, although they are a little harder to find than cornstarch.

Gluten-free bread crumbs

If your recipe calls for bread crumbs (like meatballs), panko (panko-crusted fish) or wheat crackers (casserole topped with crumbled crackers), try:

• Gluten-free cereals. You can find many gluten-free cereals at the grocery store. They're often made of oats, rice, corn or a mix of gluten-free grains. Just be sure to choose one that doesn't include sugar or other sweeteners. Add the desired amount to your blender or food processor and grind the cereal into a coarse bread-crumb texture.

Gluten-free glaze

In recipes that call for soy sauce in a meat glaze, marinade or other recipe, use:

• Tamari is a wheat-free version of soy sauce. You can find it at your grocery store on the same shelves as the soy sauce.

How to make a substitution

For most basic recipes, you can make a 1:1 substitution. For example, if the recipe calls for 1/2 cup of all-purpose flour, use 1/2 cup of gluten-free flour. All other ingredients in the recipe — given that they are gluten-free — stay the same.

Substituting gluten in baked goods

Substituting flours in baked goods is more complex. The 1:1 substitution ratio for cookies, cakes and breads — which need to rise in the oven — doesn't hold up. To achieve the correct texture in baked goods, you typically need to mix several gluten-free flours together. And it can take a lot of trial and error to find the right mixture. So instead of adapting your favorite baked recipe yourself, seek out a new-to-you gluten-free recipe to try. The hard work of figuring out the baking ratios will already be done for you.

Storage tips

If you don't use gluten-free flours very often, store them in the freezer. Many flours, wheat flour included, go bad when they sit on the shelf for a long time.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

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If one member of a family has celiac disease, there is a likelihood that other members will be affected, as well, says Dr. Joseph Murray, a Mayo Clinic gastroenterologist.

"Family members who have somebody in a family with celiac disease are much more likely to have celiac disease than the general population."

Gluten, a protein in wheat, barley and rye, can cause damage in the intestine for those with celiac disease. Common symptoms include abdominal pain, diarrhea, bloating, excess gas, fatigue, anemia and vitamin deficiencies.

Dr. Murray says because of the genetic component, family members should consider being screened. 

"You can do a blood test, and the blood test, if it's positive, indicates a likelihood of celiac disease," says Dr. Murray.

Avoiding gluten is the only treatment. It can be found in many products — obvious and not. 

"It's in the pastas, the bread, the pizza, but also sauces, marinades, flavor additives."

If you have symptoms and think you might have celiac disease, Dr. Murray says to get tested before changing your diet. 

Meet people living with or caring for someone with digestive health concerns.

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ROCHESTER, Minn. — Parents, siblings and children of people with celiac disease are at high risk of also having the disease, according to a Mayo Clinic study. This study calls for screening of all first-degree relatives of patients — not just those who show symptoms.

The retrospective study, to be published in Mayo Clinic Proceedings in September, found that 44% of screened first-degree relatives had celiac disease. Of those patients, 94% had symptoms that were not classic or had no symptoms at all.

"Research has shown that family members of celiac disease patients are at higher risk, and we used our Mayo Clinic data to show that proactive screening of first-degree relatives, regardless of whether they showed symptoms, resulted in diagnoses that would have been missed," says Imad Absah, M.D., a Mayo Clinic pediatric gastroenterologist and the study's lead author.

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, rye and barley, that can damage the lining of the small intestine over time. This can lead to malabsorption of nutrients, and cause diarrhea, fatigue, weight loss and other complications. There's no cure for celiac disease, but patients can manage symptoms with a strict gluten-free diet.

The study looked at a retrospective sample of 104 patients diagnosed with celiac disease between 1983 and 2017, based on Mayo Clinic records and celiac disease registry data. Researchers then identified 477 first-degree relatives, of whom 360 were screened for celiac disease. Of those, 160 were diagnosed with celiac disease. The median period between diagnosis of the initial patient and the relative was just under six months.

More screening for celiac disease among family members could prevent long-term complications, such as nutritional deficiencies, development of new autoimmune conditions, and small bowel malignancy, according to the Mayo Clinic study. Other studies also have shown higher prevalence of celiac disease in family members.

"Gastroenterologists and general practitioners should ask about any family history of celiac disease among their patients' parents, siblings and children. And if they're present during the clinic visit, they should offer screening," says Dr. Absah.

Regarding screening, Joseph Murray, M.D., a Mayo Clinic gastroenterologist and co-author, says that patients should not change their diet to avoid foods containing gluten before testing.

"This research illustrates why it is important for clinicians and patients to be vigilant for celiac disease, especially in those with a family history," Dr. Murray says.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews on clinical and laboratory medicine, clinical research and basic science research. Mayo Clinic Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. Visit the Mayo Clinic Proceedings website to view articles.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside Look at Mayo Clinic for more information about Mayo.

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• Joe Dangor, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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ROCHESTER, Minn. — Micronutrient deficiencies, including vitamins B12 and D, as well as folate, iron, zinc and copper, are common in adults at the time of diagnosis with celiac disease. These deficiencies should be addressed at that time, according to a study by Mayo Clinic researchers.

The retrospective study of 309 adults newly diagnosed with celiac disease at Mayo Clinic from 2000 to 2014 also found that low body weight and weight loss, which are commonly associated with celiac disease, were less common. Weight loss was seen in only 25.2% of patients, and the average body mass index was categorized as overweight. The study will appear in the July issue of Mayo Clinic Proceedings.

"It was somewhat surprising to see the frequency of micronutrient deficiencies in this group of newly diagnosed patients, given that they were presenting fewer symptoms of malabsorption," says Adam Bledsoe, M.D., a gastroenterology fellow at Mayo Clinic's Rochester campus.

Celiac disease is an immune reaction to consuming gluten, a protein found in wheat, barley and rye. Eating gluten triggers an immune response in the small intestine that over time damages the intestine's lining and prevents it from absorbing some nutrients, leading to diarrhea, fatigue, anemia, weight loss and other complications.

Based on recent data, the prevalence of celiac disease in the U.S. is 1 in 141 people, and its prevalence has increased over the past 50 years.

"Our study suggests that the presentation of celiac disease has changed from the classic weight loss, anemia and diarrhea, with increasing numbers of patients diagnosed with nonclassical symptoms," says Dr. Bledsoe, the study's primary author. "Micronutrient deficiencies remain common in adults, however, and should be assessed." Assessment should include vitamin D, iron, folic acid, vitamin B12, zinc and copper.

Zinc deficiency was observed most frequently at diagnosis, the study says, with 59.4% of patients having a deficiency. Other deficiencies included iron, vitamin D, copper, vitamin B12 and folate.

The nutritional deficiencies have potential health ramifications, though in this retrospective study the clinical implications remain unknown. "Further studies are needed to better define the implications of the deficiencies, optimal replacement strategies and follow-up," says Dr. Bledsoe.

Joseph Murray, M.D., a Mayo Clinic gastroenterologist and the study's senior author, receives grant support from Mayo Clinic, ImmusanT Inc., the National Institutes of Health, ImmunogenX LLC, Takeda Pharmaceutical Company Limited, Allakos Inc., Oberkotter Foundation, and Cour Pharmaceuticals Inc. He is a consultant to Bionix Medical Technologies, Lilly Research Laboratories, Johnson & Johnson, Dr. Schar USA Inc., UCB Biopharma, Innovate Biopharmaceuticals, Glenmark Pharmaceuticals, Celimmune LLC, Intrexon Corp., and Boehringer Ingelheim International GmbH. Dr. Murray holds patent license to Evelo Biosciences Inc. and receives royalties from Torax Medical Inc. Another author, Melissa Snyder, Ph.D., of Mayo Clinic's Division of Clinical Biochemistry, has served on the strategic advisory committee for Inova Diagnostics Inc. No other authors have conflicts to disclose.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. It publishes submissions from authors worldwide. The journal has been published for more than 80 years and has a circulation of 130,000. Visit the Mayo Clinic Proceedings website to view articles.

About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network. 

Media contact:

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A gluten-free diet excludes the protein gluten, which is found in grains such as wheat, barley and rye. Switching to a gluten-free diet is a big change and takes time to get used to. It can be frustrating at first, but you will find that many foods you already eat are gluten-free, and tasty substitutes for gluten-containing foods are available.

“People who follow a gluten-free diet may have low levels of certain vitamins or nutrients in their diet,” says Derrick Woodward, M.D., family physician at Mayo Clinic Health System in Sparta. “It’s important to make sure that you continue to get enough iron, calcium, fiber, thiamin, riboflavin, niacin and folate when you’re gluten-free.”

There are many foods that are naturally gluten-free, including beans, fresh eggs, fresh meat, poultry or fish (that has not been breaded, batter-coated or marinated), fruits and vegetables, and most dairy products. Grains such as corn, certain flours (rice, soy, corn, potato), sorghum and teff can be part of a gluten-free diet.

You should avoid these items unless they’re labeled “gluten-free”: breads, cakes and pies, cereal, cookies and crackers, gravies, pastas, salad dressings, sauces, seasoned rice mixes and soups.

Be aware that products labeled “wheat-free” may still contain gluten. Gluten can also be found in food additives like malt flavoring, modified food starch and others. Medications and vitamins may also use gluten as a binding agent.

It’s also important to watch out for cross-contamination. Cross-contamination occurs when gluten-free products come in contact with foods that contain gluten. It can happen during the manufacturing process, in a restaurant or while cooking at home. Using a common toaster for gluten-free bread and regular bread is a major source of cross-contamination, for example.

Dr. Woodward recommends consulting a dietitian to answer questions and offer advice on how to avoid gluten while eating a healthy, balanced diet. A gluten-free diet isn't for everyone.

The post Gluten-Free Diet Basics – It’s Not for Everyone appeared first on Mayo Clinic News Network.

May is Celiac Awareness Month and Saturday, May 31, Mayo Clinic expert Joseph Murray, M.D., will join us to discuss whether celiac disease really is becoming more prevalent. Plus, Dr. Murray will talk about other immune reactions people experience when eating foods with gluten and whether the general population should jump on the gluten-free fad. Join us!

Myth or Matter of Fact: Eating a gluten-free diet without being diagnosed with a gluten allergy is a bad idea.

To hear the program LIVE on Saturday, click here.
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Researchers have estimated the rate of diagnosed and undiagnosed celiac disease at similar levels prior to this study, but this is the most definitive study on the issue. "This provides proof that this disease is common in the United States," says co-author Joseph Murray, M.D., a Mayo Clinic gastroenterologist. "If you detect one person for every five or six (who have it), we aren't doing a very good job detecting celiac disease."

Celiac disease is a digestive disorder brought on when genetically susceptible people eat wheat, rye and barley. A gluten-free diet, which excludes the protein gluten, is used to treat celiac disease. Roughly 80 percent of the people on a gluten-free diet do so without a diagnosis of celiac disease.

There are a lot of people on a gluten-free diet, and it's not clear what the medical need for that is," Dr. Murray says. "It is important if someone thinks they might have celiac disease that they be tested first before they go on the diet.

To determine its prevalence, researchers combined blood tests confirming celiac disease with interviews from a Centers for Disease Control and Prevention (CDC) nationwide population sample survey called National Health and Nutrition Examination Survey. The survey, designed to assess the health and nutrition of U.S. adults and children, is unique in that it combines interviews and physical examinations.

Researchers found that celiac disease is much more common in Caucasians.

"In fact, virtually all the individuals we found were non-Hispanic Caucasians," says co-author Alberto Rubio-Tapia, M.D., a Mayo Clinic gastroenterologist. But previous research in Mexico has shown that celiac disease could be just as common as it is in the U.S.

"So that is something we don't fully understand," Dr. Rubio-Tapia says. The study found the rate of celiac disease in the U.S. is similar to that found in several European countries.

The research was funded in part by the National Institutes of Health and the CDC. Study authors include James Everhart, M.D., from the National Institute of Diabetes and Digestive and Kidney Disease; Jonas Ludvigsson, M.D., Ph.D., from Orebro University Hospital and the Karolinska Institutet; and Tricia Brantner from Mayo Clinic.

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About Mayo Clinic:

Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org.

Media Contact: Brian Kilen, 507-284-5005 (days), newsbureau@mayo.edu

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