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gluten free

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Roses are Red, Violets are Blue, Sugar is Sweet, and Food Allergies Can Be Sweet Too

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Ah, Valentine’s Day. For some, this day provides a great excuse to press pause on the stressors of life and take time to celebrate the ones you love. For those with food allergies and intolerances, however, this day can bring about a lot of anxiety. 

If you’re a food allergy parent like me, here’s what probably goes through your head: Will my child be given a valentine that contains their allergen? What will be served at school? Will they feel comfortable speaking up to ensure the treat is safe? Why does this holiday have to center around food?!

If you are celebrating Valentine’s Day as a food-allergic adult, it can be just as stressful. Valentine’s Day often comes in the form of chocolates, or a splurge on a nice dinner and dessert (in our house that means sushi)!

We get it guys. This holiday can be hard. That’s why we’ve teamed up with our friend chef Ming Tsai to bring you a homemade sweet treat this Valentine’s Day. 

Easy? Check. Healthy? Check. Top eight allergen free AND gluten free AND sesame free? Check check check. 

Here’s Chef Tsai’s recipe for Strawberry Coconut Sorbet (note: this recipe contains coconut). 

Strawberry Coconut Sorbet (serves 2)

- 1/2 cup frozen strawberries

- 1/2 cup coconut milk

- 1/4 teaspoon lemon zest

- 2 tablespoons unsweetened coconut flakes

Add strawberries, coconut milk, and zest to a blender and blend until just smooth. Serve immediately and garnish with coconut flakes or cacao nibs (or whatever your heart desires 😍).  

Enjoy friends!

XOXO, 

Meg and the Allergy Amulet Team 

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Breaking Bread

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This past Christmas Eve, I listened to the soft sounds of Ave Maria and Silent Night waft through candlelit pews. My father has sung in a church choir ever since I was a child, like his father before him, so from a young age I was instilled with an appreciation for robed singers harmonizing centuries-old Latin hymns. I’m also a sucker for Christmas carols. 😉

As the communion bread was passed around among the pews, I thought about people who could not eat the bread—not because they weren’t baptized, but because they were allergic or intolerant.

Growing up, our family belonged to a small stone Episcopalian church on a grassy hill that could have been pulled out of the Scottish Highlands or a child’s storybook. At one point, we had a female priest, which was something of a rarity back then. Sermons routinely invoked global current affairs and the common values shared across religions, and everyone, regardless of creed, was welcome. We were a progressive church. The communion bread was also baked in the church kitchen and tasted heavenly. I’d walk up to the altar, cup my hands, and receive a hunk of doughy bread, which I’d dip into a chalice of wine. I can’t remember ever worrying about my food allergies during Sunday communion growing up. Plain bread as a kid was always considered safe. That has since changed. 

Today, 1 in 13 kids has a food allergy, and millions more have a gluten intolerance. We live in a different world from a couple decades back. The communion bread I ate growing up definitely contained wheat, although I never knew anyone that had a problem with gluten back then. These days, however, it seems as though at least one person at every dinner party is gluten-free. To accommodate, many churches now offer gluten-free bread with communion.

The rise of gluten-free products has been a double-edged sword for the nut-allergic like me: on the one hand, it has helped increase awareness and accommodations for those with food allergies and intolerances; on the other hand, nut substitutes (like almond flour) for wheat have become increasingly common. 

Years ago, I admittedly thought the spike in gluten-free products was more fad than the result of a growing severe medical condition. That all changed when I spoke to a woman at a food allergy conference years back who relayed the harrowing experience of her young son and how their family discovered his gluten intolerance. On Sundays, her son would develop debilitating migraines that would keep him bed ridden for days. As she described her experience, and his symptoms, I was horrified. Her family connected the dots back to the communion bread. “Gluten did that to your son!?” I thought. Unfortunately, their church wasn’t able to accommodate his gluten intolerance, and her family was forced to join another parish. 

At the Scottish storybook church, if you declined the bread or wine, you could fold your arms across your chest and receive a blessing from the priest. At the church I attended this Christmas Eve, communion bread was passed between parishioners in pews on trays, and wine (which turned out to be grape juice), was served in small plastic cups. Surprisingly, an individual blessing did not appear to be an alternative option. You’d think a simple blessing like this would be an option at all churches, allowing everyone to partake in communion and ensuring that the food allergic and intolerant aren’t left out.

Religion, like food, should bring people together. Breaking bread has long been a symbol of community and peace. That community piece is lost, however, if everyone isn’t afforded a seat at the table. 

- Abi & the Allergy Amulet Team

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Best Practices for Kids + Epinephrine

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I’m not quite sure how summer passed by so quickly. Is it really back-to-school season already?! As families gear up for the school year ahead, we thought it would be a great time to review current best practices for kids and epinephrine—something every parent should know even if your child has no food allergies! 

Here are a few things to remember as you prepare for your child’s fun (and safe!) return to school.

Educating Your School Tribe

It’s a good idea to get your child’s food allergies on the radar of their school caretakers before the year begins—especially if your child is changing schools. Contact their school nurse and teacher to plan for where the epinephrine will be stored and how it will be used in case of an emergency. You may also want to discuss how snacks and treats are handled in the classroom. Many schools have food allergy policies in place, but some protocols are at the teacher’s discretion. 

It doesn’t hurt to schedule a face-to-face with your child, teachers, and caregivers before school starts to talk through your food allergy game plan. As a bonus, this gives your child an opportunity to meet their teacher before the year begins and help them tackle some of those first-day jitters! 

Epi Dosing Options

There are currently three different epinephrine dosages available. For adults and kids who weigh more than 30 kilograms (~66 pounds), the recommended dose is 0.3 milligrams. For smaller kids weighing between 15 and 30 kilograms (~33-66 pounds), the recommended dose is 0.15 milligrams. Several brands offer both dosing options, including EpiPen, Adrenaclick, and Auvi-Q.  

For infants and toddlers who weigh between 7.5 and 15 kilograms (~16.5-33 pounds), Auvi-Q makes an auto-injector with a lower dosage (0.1 milligrams), which also features a smaller needle. 

Make sure to check with your doctor to determine the best option for your child! 

Safe Storage

Remember that epinephrine is temperature sensitive. The medication should be stored at room temperature and never in extreme hot or cold climates (e.g., car glove compartments). Some brands also recommend that users periodically check to ensure the liquid has not changed color. If the solution assumes a pinkish or brownish hue, this can indicate decreased effectiveness. Epinephrine is light sensitive too—so store your auto-injectors in cases!  

Parents should work with their child’s school or daycare provider to map out a plan for both on-site and off-site storage (e.g., field trips), to ensure availability and maximum effectiveness. 

Using Your Epinephrine

As explained in one of our earlier blog posts, the outer thigh is the best place to administer the injection, even through clothing if necessary. Most manufacturers offer videos on their websites to demonstrate how to use their product. These can be a great resource for new caregivers and anyone that should be prepared for an allergic emergency. Like CPR, administering epinephrine is a good skill for any parent to have in their arsenal.

Replacing Your Supply

Currently, most auto-injectors expire within 12 to 18 months. Make sure to check your epinephrine expiration dates and mark them in your calendar. A good rule of thumb is to always have two auto-injectors in close proximity to any food-allergic child in case one is defunct (and in some cases, two injections may be required!). 

As you replace old auto-injectors, remember that some manufacturers offer coupons or other financial assistance, especially for lower income families.  

While we hope you never have to use an epinephrine auto-injector, we share these reminders to keep all of our children safe as we send them off to the classroom! 

- Susannah and the Allergy Amulet Team  

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FOMO: Fear of Missing Out… On Nutrients

Part II: Wheat, Soy, Peanuts, and Tree Nuts

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Welcome to Part II of our FOMO series! Here we’re discussing how to replace nutrients lost from eliminating wheat, soy, peanuts, or tree nuts from your diet. You can find Part I here covering dairy, eggs, fish, and shellfish.

If you’re used to eating toast, cereal, pancakes, or other baked goods for breakfast, avoiding foods that contain wheat will likely be a hard adjustment. Or maybe you fed peanut butter and jelly sandwiches to your first child with no issue and your second child cannot eat peanut butter. It is an adjustment, to say the least! 

As a pediatric nutritionist, my work focuses on making sure kids with special dietary needs are getting the nutrients their growing bodies need. As you can imagine, many of my patients have multiple food allergies and have a fairly limited diet. The silver lining for these patients is that these children tend to have healthier diets because they’re avoiding lots of processed foods! 

I like to start by looking at each food that’s avoided and its corresponding nutrients side by side. As we discussed in Part I, this approach can make it less intimidating to identify other food sources for those lost nutrients.  

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Let’s take a closer look at a few of the nutrients needed when avoiding wheat, soy, peanuts, and tree nuts.

Wheat products in America are fortified with B vitamins, thiamin, riboflavin, and niacin. 

Thiamin is important for maintaining a healthy metabolism and key function of cells. The major thiamin food sources are whole grains, meat, and fish. In the US, breads, cereals, and infant formulas are enriched with thiamin as well as other B vitamins. If you’re avoiding wheat and most breads and cereals, you may want to ensure your wheat-free products are enriched with these key nutrients as well!

Niacin is another B vitamin—B3 to be specific. Niacin helps our bodies use fat, protein, and carbohydrates to create energy. This vitamin is also enriched in processed wheat products and can be found naturally in most meats as well as mushrooms, avocados, and sunflower seeds, to name a few. 

If you’re a meat eater and wheat-avoider, I’m not typically concerned that you’re missing out on B vitamins (thiamin, riboflavin, and niacin) or iron. However, you may want to think about how much fiber is in your diet. Many people substitute rice, potatoes, and corn-based products for wheat. However, these are mostly low in fiber.

Fiber is a carbohydrate that your body does not digest. There are two types of fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and helps to regulate blood cholesterol and glucose levels. Insoluble fiber does not dissolve in water and works to move food through the digestive tract. Many people experience symptoms like constipation after making a change in their diet. In these cases, I tell my patients to increase their fiber intake and add fruits, vegetables, legumes, brown rice, and other whole grains like oatmeal and quinoa. 

If you are not a meat eater, and you’ve eliminated wheat or soy, this next one is for you.

Iron is found in red meat, fish, and poultry, but there are many plant-based sources of iron outside of wheat and soy, including spinach, beans, lentils, nuts, seeds (e.g., pumpkin, chia, sunflower, and hemp), dried fruits, quinoa, and some fortified breakfast cereals. Iron is better absorbed with vitamin C, so I recommend adding an orange alongside your trail mix for your next snack. Calcium inhibits iron absorption, so whether you get your calcium from dairy or a dairy substitute, try to avoid eating them together. 

Avoiding soy is not easy because it is in so many foods. Both peanuts and soy belong to the legume family and contain many of the same nutrients such as B vitamins, protein, magnesium, and phosphorus. 

Magnesium helps normalize blood pressure and keeps our bones strong. Phosphorus also helps to keep our bones strong and helps our bodies make energy and move our muscles. Both of these minerals are found in abundance in beans, seeds, and tree nuts. Phosphorus is also found in dairy, eggs, in meat products, whole grains, potatoes, and dried fruit.

The goal for everyone should be to expand their diet and add more variety! A more diverse diet will lead to greater nutrient intake, and hopefully more delicious meals. If you feel like you’re in a food rut, take a chance and add something new to your routine. Your body (and likely your taste buds) will thank you!   

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

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Should I Go Gluten-Free? Break it Down for Me

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Google “gluten free” and you get roughly 150,000,000 results.

Clearly, the topic of gluten is trending.  You probably know at least one person that has cut gluten from their diet.  This begs the question: Is eating gluten-free a fad?  Will it pass by us eventually à la fat-free diets?  And what about the choice of whether or not you should go gluten-free?  Friends, that question is one we hear a lot.  And we want to help you find the answer.

Without having a severe gluten intolerance or celiac disease, it can be tough to know if it’s worth it, right?  How do you know if you have a gluten intolerance, celiac disease, or a sensitivity?  Well, while there is a test that can identify whether or not you have celiac disease, the only surefire way to know if you have a sensitivity is by eliminating gluten from your diet and seeing how your body responds after gradually reintroducing it thereafter.

To start, it’s important to understand the different types of gluten sensitivities.  These varying sensitivities can have different OR similar symptoms—and it’s often much more than just a bad stomachache.  Here’s a deeper look at the different sensitivities so you can better identify how gluten may be impacting you:

1. Gluten is a BIG problem for you (e.g., celiac disease)

Celiac disease is on the rise.  The condition, also called celiac sprue, coeliac, and gluten-sensitive enteropathy, once considered rare now affects more people than ever: 1 in 100.  Many physicians believe it is a grossly undiagnosed disease, and some doctors now regularly screen anyone with severe digestive complaints for the troubling illness.  The reality is that celiac is more than an uncomfortable condition—it can be life threatening, and is characterized by autoimmune antibodies.  It’s important to understand that celiac CANNOT cause anaphylaxis—a severe and potentially life-threatening allergic reaction—unlike a wheat allergy, for example.  Most people will not die from the immediate symptoms of celiac disease. However, left untreated, it can lead to several other conditions, some of which can be fatal.

●      Common symptoms: Stomach pain, chronic diarrhea, bloating, fatigue, floating or foul smelling stool, depression, fatigue, infertility, and weight loss.

●      Associated symptoms & conditions: Itchy rash, peripheral neuropathy, ataxia, osteoporosis, behavioral changes, irregular menstrual cycle, infertility, Addison’s disease, fibromyalgia, autism, anxiety/depression, chronic fatigue syndrome, inflammatory bowel disease, irritable bowel syndrome, severe headaches/migraines, rheumatoid arthritis, Hashimoto’s thyroiditis, Graves disease, type 1 diabetes, pancreatic disorders, and multiple sclerosis.

●      Diagnosis: To diagnose celiac disease, your doctor will administer a blood test called a Tissue Transglutaminase Antibodies (tTG-IgA), and you must have gluten in your system at the time of the test—if you’re on a gluten-free diet the test may produce false negative results.  This test is 98% accurate in patients with celiac disease.

2. You don’t have celiac disease, but something is way off (e.g., gluten intolerance/sensitivity)

Many people experience symptoms like those of celiac disease, despite negative tTG-IgA test results and intestinal biopsies revealing no tissue damage. It is unclear what the underlying cause is for a gluten intolerance or sensitivity, and is often diagnosed based on a patient’s response to a gluten-free diet.

●      Common symptoms: Often the same as celiac, and primarily digestive distress.

●      Dietary Recommendations: Having a severe gluten intolerance is becoming increasingly common, and it can be very frustrating because it’s difficult to obtain a clear diagnosis.  Gluten sensitivity can manifest in the same way as celiac disease, but with greater variability in severity and duration.  Your best bet may be to try an elimination diet, which you can find in many of our programs!  We recommend eliminating for two months for best results.  Determining if you’re gluten sensitive is just as important as determining if you have celiac disease, because over time, the integrity of your gut health can be compromised.  Gastrointestinal health is the cornerstone of optimal health—it plays a major role in the balance of hormones, mood, cognitive function, and other aspects of overall health and well-being.

3.  Gluten doesn’t make you feel too sexy

For those that don’t have celiac disease or a diagnosed intolerance, you may just not feel so hot after you eat gluten-containing foods.  Low energy, less endurance, and overall “slowness” are common words used to describe these feelings.  By removing gluten from your diet, many in this category see a positive change in their appearance, and many professional athletes have gone gluten-free to improve athletic performance!

●      Common symptoms: Digestive distress, fatigue, energy loss, and overall blah.

●      Dietary Recommendations: We recommend eliminating gluten from your diet for two months.  Why?  Gluten is pesky and can linger in the blood stream for a long time.  Add it back into your diet gradually over time and see you how feel.

4.  Gluten ain’t no thang

You feel absolutely fine with gluten.  No cramping or chronic side effects.  Perhaps you have headaches, digestive issues, or some joint pain.  You’ve tried going gluten-free for two months and noticed zero difference.  You’re realizing maybe something else is to blame.

Our feelings?  Being gluten-free is not a fad.  We have worked with too many people who notice legitimate improvements by removing it from their diet.  With that said, it’s important to consider a few things—when you cut out gluten, you are often cutting out a lot of unhealthy food too.  You will not be able to eat most fast food, many packaged items, and other foods that simply aren’t healthy.  So you have to ask yourself, was it the gluten or was it the crummy food?  One way to determine the difference is to eat healthy sources of gluten as a trial: wheat berries, farro, and couscous are just a handful of naturally gluten-filled whole grains.  On the flip side, going gluten-free and replacing those packaged foods with gluten-free versions may not necessarily improve your health, as they’re often laden with added sugars and fats to improve flavor.  The ticket is to try removing it from your diet and trying a healthy whole foods diet (with gluten grains) to see if gluten is the cause!

SO, what do you think? 

We hope this information helps guide you in making the decision of whether to go gluten-free.  Ultimately, the best way to find out whether a gluten-free diet is right for you is to remove it from your diet, then gauge how your body responds upon reintroduction.  We help people explore this in our 20-day nutrition program: Prescribe 20.  Because going at these things alone is never easy, and rarely successful, we believe that community is the key to success.  With our programs, we’re with you every step of the way, offering recipes, educational materials, and professional guidance.  With this support system in place, the process of discovering how to feed YOUR body isn’t so bad. Not one bit.

 Megan Morris is a certified nutritionist, Co-Founder & CEO of Prescribe Nutrition, and Founder of The Root of Health: an online digestive health resource. 

 

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