Shelley Case, BSc., RD
"North America’s Celiac Nutrition Expert"
Consulting Dietitian, Speaker and Author of
Gluten-Free Diet: A Comprehensive
Meal Chart (PDF)
Interview with Marlisa Brown MS RD CDE CDN Creator of Gluten Free Easy and Author of Gluten-Free Hassle Free,
Shelley Case, BSc., RD,
"North America’s Celiac Nutrition Expert",
Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide
Question: Why did you first take an interest in celiac disease?
Answer: In my first job at a large outpatient diabetes and diet education center where I worked for 12 years, I was responsible for counseling individuals and their families with diabetes, heart disease, food allergies, celiac disease and other conditions. Never having seen anyone with celiac disease during my internship and receiving only limited information during undergraduate nutrition classes, I was ill-prepared to counsel my first client with the disease. I began searching for relevant information about the disease and the gluten-free diet but found very little practical information that would be beneficial for my clients. Realizing I needed help, I contacted the Regina chapter of the Canadian Celiac Association (CCA) who gave me some basic information for counseling clients. I continued to attend their regular meetings to learn more about the disease and diet. Not long after attending, I was asked to be their nutrition advisor which I accepted. Ten years later I was invited to become a member of the CCA Professional Advisory Board, a position I have been actively involved in for over 13 years.
Question: What was the main reason you wrote the Gluten-Free Diet book?
Answer: Every client I saw with celiac disease always wanted very specific and practical information on food labeling and ingredients; names of gluten-free companies/products and where to find them: meal planning suggestions; recipes; how to deal with various nutritional concerns; how to prevent cross-contamination; recipes; tips for eating out and other gluten-free resources. Unfortunately there was limited information and most of it was found in many different pamphlets, books, manuals and other sources, which meant that the client had a pile of loose papers to take home after the counseling sessions! In addition to educating clients, I often got calls from other dietitians seeking information about celiac disease and the GF diet, as they too felt their knowledge of the disease was inadequate. It soon became apparent that there was a real need for a more comprehensive resource for both health professionals and their clients. This was the birth of the idea for my book Gluten-Free Diet: A Comprehensive Resource Guide (www.glutenfreediet.ca) which took 2 years to research, write and publish. The first edition was published in 2001 and I have done 3 other editions since then. The most recent “Revised and Expanded Edition” was October 2008. Each edition gets larger with more new information, products, companies and resources, as research concerning celiac disease and the gluten-free diet is exploding at a rapid pace.
Question: What do you think some of the biggest challenges are for those following a gluten-free diet?
Answer: Changing life-long eating habits and adapting to the GF lifestyle is a huge challenge because wheat-based products are major staples in the North American diet. Also hectic lifestyles result in more meals eaten away from home and reliance on packaged, convenience foods which frequently contain wheat. Eating in restaurants is also difficult because many menu items are wheat based, there is a great potential for cross-contamination and foodservice staff often have a limited knowledge of the gluten-free diet.
Another concern is that gluten is often a hidden ingredient or component of an ingredient that may not always be declared on the food label. Different countries have different regulations for the labeling of ingredients and the terminology and symbols used for the term gluten-free. Fortunately in the US, the Food Allergen Labeling Consumer Protection Act that came into effective January 1, 2006 requires manufacturers to declare on the label the major 8 food allergens, which includes wheat, however, barley is not one of the ingredients that must be declared. The FDA also has a proposed new gluten-free regulation that would require companies to declare all sources of gluten but the regulation has been delayed. It is not known when this voluntary gluten-free regulation will be finalized and become law.
Canada does have a regulation for foods that make a gluten-free claim that has been in effect for a number of years. However, there are some ingredients (e.g., hydrolyzed vegetable protein, modified food starch, seasonings) that are exempt from declaration of its components that may contain wheat or barley on labels of food products not making a gluten-free claim. In July 2008, Health Canada released a proposed regulation entitled “Enhanced Labelling for Food Allergen and Gluten Sources and Added Sulphites”. This would tighten the loopholes for foods that currently do not require a declaration of all the allergen, gluten and sulphites on the label.
Another challenge in following a gluten-free diet is cost. Most GF specialty products such as breads, cereals, crackers, cookies, baking mixes and pasta are often double or triple the cost of their gluten-containing counterparts.
Question: Do you see the future becoming easier for those on a gluten free diet?
Answer: Yes! Fortunately the gluten-free market is growing rapidly with a larger variety of GF products today that are not only available in health food stores but grocery stores and other locations. In addition to specialty companies producing GF products, more mainstream companies are developing or reformulating their products for the GF market (e.g., General Mills Chex cereals, Anheuser Busch Redbridge Beer). Also the texture and taste of the GF products have improved dramatically.
Another positive note is that more restaurants are offering gluten-free items on the menu (including pizza chains) and are recognizing the importance of preventing cross contamination. A growing number of restaurant chains, as well as small and medium sized family restaurants are catering to the growing gluten-free market. The Gluten Intolerance Group (GIG) has the Gluten-Free Restaurant Awareness Program (GFRAP) that provides educational and training materials for restaurants. They have also recently launched the “Chef- to-Plate” national awareness program. For more information see www.gluten.net
The international Codex Alimentarius has recently agreed upon a single definition of the term gluten-free (less than 20 ppm), although each country can decide whether to adopt this new standard. More countries including the US and Canada are improving their food labeling regulations that will make it easier for those with celiac disease to identify safe foods.
The volume of information about celiac disease and the gluten-free diet continues to grow daily which is good news. It is available from so many sources such as books, journals, magazines, brochures and on the internet. However, just because someone has written information does not mean it is always accurate or based on solid science. One of the main reasons why I wrote my book was to combat the misinformation and provide accurate, evidence-based materials for consumers and health professionals. At the National Institutes of Health Consensus Development Conference on Celiac Disease, I presented a session entitled “How to provide effective education and resources on the gluten-free diet”. I reminded the panel that it is essential everyone involved in celiac disease needs to be “singing from the same song sheet” using accurate information. I also stressed the importance of individuals being referred to a registered dietitian with expertise in celiac disease and the need for insurance coverage for these services. To read more about my presentation and other speakers see www.glutenfreediet.ca/about_celiac.php
Question: What are your favorite gluten-free foods?
Answer: I have so many ones in different categories but here are a few below. I could list lots more bunt this would take up a lot of space!
- Bob’s Red Mill Mighty Tasty GF Hot Cereal (I add ground flax to it for extra fiber)
- Bakery on Main GF Granola
- Cream Hill Estates Lara’s Old Fashioned Rolled Oats
- Nature’s Path Mesa Sunrise Multigrain Cereal
Breads, Rolls and other baked items:
- Glutino Premium Brown Rice & Mesquite
- Kinnikinnick True Fibre Multigrain Rice and Robin’s Honey Brown Rice Bread, Tapioca Rice English Muffins
- French Meadow Bakery’s new line of gluten-free breads coming out in late spring
- Schar Multigrain Bread
- Bumble Bars
- Enjoy Life Sunbutter Crunch
- Mrs. May’s Naturals
- Blue Diamond Nut Thins
- Crunchmaster Multigrain Crackers
- Edward & Son’s Exotic Rice Toast
- Mary’s Gone Crackers
- Schar Italian Breadsticks
Cookies and Cakes:
- All of them. My motto is “Life is short - eat dessert first!”
- Kettle Cuisine
- Pacific Foods
Question: What would you say to someone who was just diagnosed with celiac disease?
Answer: Take it one step and one day at a time. Shopping will take longer and it may seem overwhelming at first but it will get easier. I tell them there are many foods that are naturally gluten-free such as plain meats, poultry, fish, eggs, nuts, seeds, legumes, fruits, vegetables, cheese, milk, yogurt, potatoes, rice, corn, as well as lots of alternative gluten-free grains, flours and starches. See a registered dietitian with expertise in celiac disease and join a celiac support group. As celiac disease is hereditary, I encourage them to get their relatives tested for the disease.
Question: What would you like to see in the future?
Answer: More education about celiac disease and the gluten-free diet for physicians, dietitians and other health professionals so people would get diagnosed earlier and be given correct information! As a co-author of the largest celiac health survey in the world (2681 adults and 168 children in Canada) that was published in Digestive Disease and Sciences April 2007, we found the delay in diagnosis from the time the person went to see a physician until they were finally diagnosed was 11.7 years for adults and 1 year for children. A similar study was done in the US by Dr. Peter Green and the delay was almost 10 years. So we have lots of work to do here in North America to raise the level of awareness of the disease and management.
There is an excellent network of dietitians called “Dietitians in Gluten Intolerance Diseases” (DIGID) that is part of the American Dietetic Association’s Medical Nutrition Dietetic Practice Group. I am one of a number of dietitians from the US and Canada who are working very hard to educate our colleagues about celiac disease and the gluten-free diet. We publish articles, provide resources and educational sessions for dietitians so they will be armed with the most accurate and practical information. We have come a long way but are job is not finished yet!
March 23, 2009
Copyright by Shelley Case, RD and approved for use by Marlissa Brown at www.glutenfreeeasy.com
Shelley Case, BSc., RD
North America’s Celiac Nutrition Expert
Consulting Dietitian, Speaker and Author of
Gluten-Free Diet: A Comprehensive Resource Guide
A registered dietitian, Shelley Case is a leading international nutrition expert on celiac disease and the gluten-free diet. She is a member of the Medical Advisory Boards of the Celiac Disease Foundation and Gluten Intolerance Group in the United States and the Professional Advisory Board of the Canadian Celiac Association.
Shelley is a frequent guest on television and radio, including the NBC Today Show and CBC Newsworld. A popular speaker, she has delivered numerous lectures and workshops at national and regional medical, dietetic, celiac and food industry conferences throughout the USA and Canada, including the National Institutes of Health Consensus Development Conference on Celiac Disease, American Dietetic Association and Dietitians of Canada annual conferences and Natural Products Food Expo conferences.
She is the author of many articles on celiac disease and the gluten-free diet in leading publications such as Gastroenterology, Digestive Disease Sciences, Pediatrics, Journal of Human Nutrition and Dietetics, Topics in Clinical Nutrition, and Today’s Dietitian. In addition, she co-authored the celiac section in the Manual of Clinical Dietetics (6th ed.) by the American Dietetic Associationand Dietitians of Canada, and has contributed to many other publications including textbooks, magazines,and other patient education resources. Shelley writes "Ask the Celiac Expert" column for Allergic Living Magazine.
In recognition of Shelley’s major contributions to the celiac community and dedication to educating health professionals and individuals with celiac disease in Canada and the United States, she was awarded the Queen Elizabeth Golden Jubilee Medal. Shelley also recently received the Canadian Celiac Association’s Honourary Life MemberAward.
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