Gluten intolerance

[Jenise]

I just read an interview on Michael Ruhlman's website that made me realize that I have not properly understood gluten intolerance. I've never been close to anyone with this problem or had to cook for someone with this problem, so it's never been spelled out to me how little it would take to literally poison someone with celiac disease. After describing the multiday severe digestive disturbance that comes with gluten exposure, an interviewee says this, in answer to the question "why can't you just eat at restaurants after telling them you're gluten intolerant?"

Cross-contamination is probably the biggest risk: you can’t plate someone’s spaghetti à la nero and then plate my food without washing your hands in between. You can’t put a burger on a bun, re-check the ticket and see that I’m no-gluten, and just take the burger off the bun and serve it to me. I can’t eat fries that have been cooked in the same oil as anything battered. If an expediter wipes the rim of a plate with bread on it before serving it, then uses the same towel edge to wipe my plate, then they’ve essentially just wiped my plate with a piece of bread, and I’ll be sick.

I had no idea one could be THAT sensitive. If any of you know (Maria would, but she's rarely here), are there degrees of sensitivity? That is, do some have it worse than others or is every celiac as sensitive as she describes?

[Robin Garr]

Jenise, I know one guy who was recently diagnosed with celiac, and he's started being cautious about what he eats at home as well as dining out at places that promote gluten-free diets. For Sam, though, it's not pleasant but nothing like as awful as Ruhlman's article suggests.

A quick glance at the Mayo Clinic website suggests that Ruhlman may be picking the worst possible case to sensationalize the issue a bit.

Symptoms
By Mayo Clinic staff

There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as:

Intermittent diarrhea
Abdominal pain
Bloating

Sometimes people with celiac disease may have no gastrointestinal symptoms at all.

Lots more info here:

http://www.mayoclinic.com/health/celiac ... n=symptoms

[Jenise]

That answers the question, then: there ARE degrees. Probably helpful for most people to realize it. And unfortunate as her sensitivity is, probably not very reasonable for her to hold restaurant kitchens accountable for not being able to maintain the degree of gluten hygiene her version of the disease requires.

We have a good handful of gluten intolerant friends, and don't have any problem cooking for them even though there is a good chance in many case of the getting the cross contamination he is talking about. Our friends have never had any problems with what we make of them.

Gluten intolerance presents with a broad range of sensitivities, and the case described by Ruhlman seems to be at the extreme end of the sensitivity spectrum. We have a good friend with celiac, and one of my previous students has a child with celiac, and in both cases they are fine with minimal and reasonable precautions. This is a disease that must be managed on a case by case basis.

One thing I've recently learned from my wife's experiences is that there are facets of gluten intolerance that go beyond Celiac disease, too. Some people have gluten allergies, leading to typical allergic responses (sneezing, inflammation, hives and/or anaphylaxis). My wife has recently (last 5-10 years) an inflammatory responses that last year she identified as the result of gluten consumption. What she finds is that she doesn't have to be ultra-scrupulous about excluding gluten from her diet, but by avoiding the consumption of any significant quantity, she avoids the muscular pain and swelling that had plagued her for years.

Celiac disease is a miserable condition, though. It's caused by gluten-induced perforation of the gut, which in turn leads to bleeding, cramping and all the other symptoms. I've only known one person with it, but she had to avoid anything that had even the barest trace of gluten in it.

Mark Lipton