Breaking Down Gluten: Understanding Intolerance & Celiac Disease

Summary

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Episode Overview

Episode Title: Breaking Down Gluten: Understanding Intolerance & Celiac Disease
Podcast: Taking Control Of Your Diabetes® – The Podcast!
Release Date: April 27, 2026
Host: Dr. Steve Edelman
Guest: EA Stewart (“The Spicy RD”), Registered Dietitian, Nutritionist, Autoimmune Warrior, Gluten-Free Recipe Creator

In this episode, Dr. Steve Edelman explores the complex world of gluten intolerance, celiac disease, and their connection to diabetes—especially type 1. Joined by “Spicy RD” EA Stewart, a dietitian and autoimmune advocate, they break down what it means to have celiac disease or gluten sensitivity, how to properly diagnose and manage these conditions, and how dietary changes can radically improve health. The discussion is lively, practical, and full of actionable advice for anyone living with diabetes, celiac disease, or other autoimmune issues.

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Key Discussion Points and Insights

EA Stewart’s Journey & Expertise ([01:55])

• EA’s entry into this field stems from her personal health journey: after her pregnancies, she developed neuropathy, fatigue, muscle aches, and was eventually diagnosed with the autoimmune disease Sjogren’s.
• She discovered a potential gluten-autoimmune link, got tested (negative for celiac but positive for the genetic marker), and upon removing gluten, "in about six months, basically all my symptoms went away" ([03:13] – EA Stewart).
• This inspired EA to focus her practice on people with celiac disease, autoimmune issues, and IBS, developing many gluten-free recipes along the way.

What is Celiac Disease? ([05:07])

• Celiac is an autoimmune—not allergic—condition: "You have to have the genetics for it, a trigger, and you have to be eating gluten" ([05:07] – EA Stewart).
• Gluten is found in wheat, rye, and barley; ingestion triggers an immune attack on the villi in the small intestine, leading to malabsorption and systemic issues.
• Celiac can develop at any age; most adults go undiagnosed due to a wide symptom range—"it can develop at any age" ([07:38] – EA Stewart).

Wheat Intolerance and FODMAPs ([08:18])

• FODMAPs are fermentable carbohydrates (not proteins like gluten) that can cause digestive symptoms similar to celiac, but are not autoimmune.
• Non-celiac gluten sensitivity is a diagnosis after celiac and wheat allergy are ruled out.

Celiac Prevalence and Diabetes ([09:17])

• General population prevalence: ~1%
• People with type 1 diabetes: 6–10%
• Both share similar genetic markers (DQ2 and DQ8).

Diagnosis: Who Should Be Tested and How? ([10:10])

• Type 1 diabetics are recommended for routine screening, but it is often forgotten.
• Testing involves bloodwork (TTG and IgA antibodies) and, if positive, small intestine biopsy.
  • "Do not start a gluten-free diet before testing—test results will be inaccurate" ([12:14] – Dr. Edelman & EA Stewart).
  • Must be eating gluten—“two slices of bread a day” for 6–8 weeks prior ([12:55] – EA Stewart).

Symptoms: The Broad Spectrum ([12:59])

• Symptoms can be GI (classic: diarrhea, weight loss) or non-GI: fatigue, iron deficiency anemia, osteoporosis, neuropathy, infertility, elevated liver tests, migraines, mood disorders, poor dental enamel.
  • "The most interesting case I saw was…their dentist diagnosed it because they had poor dental enamel" ([13:36] – EA Stewart).

Treatment: The Gluten-Free Diet ([15:04])

• Only true treatment for celiac is strict gluten avoidance.
• Emphasis on naturally gluten-free foods:
  • "…so many naturally gluten-free foods that you can eat…all your proteins…fruits and vegetables…nuts and seeds…gluten-free grains like corn, quinoa, buckwheat (which despite the name is gluten-free), teff, sorghum, nut flours." ([15:04] – EA Stewart)
• Gluten-free bread options have improved but tend to be lower in fiber and sometimes higher in simple carbs ([16:48]).
• Beware of hidden gluten in soy sauce, malt (barley), cross-contaminated products.

Cross-Contamination and Dining Out ([18:53])

• For celiac patients, even crumbs can cause a reaction: "A crouton might have roughly 500 mg of gluten…some people react to only 10 mg" ([20:22] – EA Stewart).
• Separate cookware, toasters, and cooking surfaces are important.
• In restaurants, cross-contamination is a big risk, especially in places like Italian restaurants with shared cooking water/surfaces ([21:07]).

Supplements and Nutritional Deficiencies ([22:18])

• Celiac can cause deficiencies in:
  • Iron, vitamin D, B12, folate, magnesium, zinc, and fat-soluble (A, D, E, K) vitamins.
• Gluten-free products are often not enriched like standard wheat products.
• "…a lot of gluten free products are not enriched with B vitamins, with iron like traditional wheat is. And so you might need an ongoing supplement…" ([23:33] – EA Stewart).

Carbs and Blood Sugar in Gluten-Free Products ([23:57])

• Gluten-free bread tends to have higher glycemic index and less fiber than whole-wheat bread, potentially spiking blood sugar more ([23:57] – EA Stewart).
• Labels should always be checked for carb content.

Reading Food Labels ([24:51])

• Wheat must be declared; rye and barley do not.
• Look for ‘malt’ as a barley source; oats are controversial due to cross-contamination.
• Products labeled "Gluten Free" by FDA should have <20ppm gluten—but some may be mislabeled. The site Gluten Free Watchdog is recommended ([25:31]).

Books and Resources ([26:34])

• EA contributed recipes to Plant Powered Plus (Dr. Will Bulsiewicz), focused on gut health, inflammation, and plant variety—all gluten-free and low-FODMAP ([27:09]).
• "…when it comes to gut health, variety is truly the spice of life" ([27:13] – EA Stewart).

Travel & Practical Strategies ([29:01])

• Use community networks and apps like "Find Me Gluten Free" for restaurant advice.
• Carry your own food, call restaurants ahead, use translation cards abroad.
• Mentioning the word “allergy” can get restaurants to take more care, even if technically celiac isn’t an allergy ([30:39] – EA Stewart).
• No, there isn’t an app that scans food for gluten…yet. ([30:39])

Final Takeaway ([31:04])

• "Focus on all the great gluten free foods that you can eat that are naturally gluten free and start there…variety, especially naturally gluten free plant foods, is key." ([31:04] – EA Stewart).

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Notable Quotes & Memorable Moments

• "You have to have the genetics for it, a trigger, and you have to be eating gluten [to get celiac]."
  – EA Stewart ([05:07])
• "The worst three hours of my life"
  – Dr. Edelman joking about his own gluten-free trial ([11:36])
• "Cross contamination is a big issue for people [with celiac]…crumbs can be enough."
  – EA Stewart ([20:22])
• "There are so many naturally gluten free foods you can eat—let’s not focus on what you can’t eat."
  – EA Stewart ([15:04])
• "If you never eat a speck of gluten in your life, you will not develop celiac disease."
  – EA Stewart ([06:01])
• "One autoimmune condition can beget another…when your immune system is already in overdrive."
  – EA Stewart ([09:43])
• "If you suspect your patient has it, please do not have them start a gluten free diet until they get tested."
  – Dr. Edelman ([12:13])
• "When it comes to gut health, variety is truly the spice of life."
  – EA Stewart ([27:13])

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Timestamps for Important Segments

• [01:55] – EA Stewart’s personal journey and becoming “The Spicy RD”
• [05:07] – What is celiac disease? Genetics, triggers, and gluten exposure
• [08:18] – FODMAPs vs. gluten; difference between sensitivity and celiac
• [09:17] – Prevalence in type 1 diabetes and why screening matters
• [10:30–12:14] – Diagnostic approach: screening, testing, when NOT to go gluten free
• [13:36] – Non-GI symptoms and the wide spectrum of celiac disease
• [15:04] – Mainstay of therapy: naturally gluten-free foods and substitutions
• [18:53] – Cross-contamination—why a crumb can matter
• [22:18] – Nutritional supplements and vitamin deficiencies in celiac
• [23:57] – Gluten-free carbs and glycemic index for diabetics
• [24:51] – Reading food labels: what to watch for, trusted resources
• [27:09] – EA’s book, “Plant Powered Plus,” and why plant variety matters
• [29:01] – Travel and restaurant tips for living gluten free
• [31:04] – Final advice: focus on variety and naturally gluten-free choices

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Resources & Further Reading

• EA Stewart’s site: eastewart.com (“The Spicy RD”)
• Book: Plant Powered Plus – Dr. Will Bulsiewicz, recipes by EA Stewart
• Community app: Find Me Gluten Free
• Food testing: Gluten Free Watchdog

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This episode provides a practical, hopeful, and medically sound guide for people with diabetes and anyone affected by celiac disease or gluten intolerance, emphasizing empowerment through knowledge—and a little humor.

Transcript

[A]

Are you gluten sensitive or do you have true self celiac disease? We'll discuss this very important topic on this episode of the Taking control of your diabetes podcast. I'm Dr. Steve Edelman. I'm an endocrinologist at UCSD, work at TCOID, and unfortunately I'm not here with my good buddy Jeremy Pettis, my co host. He's off eating wheat, barley and rye as we speak. But we are fortunate to have an expert in this area. And I want to introduce ea. Her name I won't even mention because she doesn't even like the true name. It's Edith. She is called the Spicy rd, a registered dietitian. I'm going to go through this list because I think it's an awesome list of things that she specializes in. Nutritionist, health and wellness coach, gluten free recipe creator. I love that. Digestive health expert, autoimmune warrior. And to me that's my favorite since I have type 1 diabetes, which is an autoimmune condition. Vibrant aging enthusiast. I also like that one. Should have been to my last 70th birthday party. And the dog of someone with type 1 diabetes who's also living with other autoimmune conditions happens to be my patient, Barbara. So with that, let's start. I think the first question is, ea, how did you get into this field of dealing with people with not only celiac or people that have quote unquote gluten sensitivity, but also other conditions that really affect what you eat?

[B]

Yeah. So thank you for having me here, first of all, and I try to make a long story short, but I so I've been a dietitian for over 30 years now and I have two kids who are 22 and 24. And after my daughter who's 24 was born three months after that, I started developing neuropathy in my big toe. Was really weird thing and went to see several doctors and they couldn't figure out what was going on. Got pregnant with my son and same thing. After I gave birth all my symptoms went away. Then after I gave birth I started having neuropathy again. Not just in my big toe, all over my body. I had really bad fatigue, muscle aches and pains. I constantly felt like I was on the verge of getting the flu and eventually was diagnosed with Sjogren's, which I know you're familiar with an autoimmune disease and was basically told, well, you know, you can go on this medication but there's not a whole lot we can do for it for You. So I decided to having my background in nutrition, decided to do research and I found this link between not only Sjogren's and gluten, but also all the other autoimmune diseases. Right. This link. And so I got tested, I asked to be tested for celiac disease. Blood test, my blood test came back negative. But I also did genetic testing and I do carry the genetic markers for celiac disease. But I thought, you know what, even though the test came back negative, I'm just going to take gluten out of my diet and see what happens. And within a period of time, it took about six months, but basically all my symptoms went away. So I became a true believer in gluten free diets. Certainly not for everyone. As we're going to talk, not everybody needs to be gluten free. That was probably 20 plus years ago when I took gluten out of my diet. I started my own nutrition practice at the same time and decided I really wanted to work with this population of people who either have celiac disease or have autoimmune disease. And so that's been a population I've worked with for a long time. I also working with celiac disease because of the GI symptoms. Right. I started working with a lot of patients who have been diagnosed with irritable bowel syndrome or ibs. And that's a big part of the population I work with. And then I developed all these gluten free recipes because I needed something to eat.

[A]

You created them. So why do they call you the spicy rd? Cause I didn't think people with celiac can eat spicy food. But that's probably my ignorance.

[B]

Yeah. I mean, yes, spices are gluten free. Right. Herbs and spices are gluten free. That name I pick for myself because I'm a firm believer in variety is the spice of life. And so when it comes to diet and everything. Plus I do like spicy food. So I like the name the spicy.

[A]

Yeah, I do. I do too. Well, let's talk about what is celiac true celiac disease and how does that compared to gluten sensitivity. So what is celiac disease?

[B]

Yeah. So celiac disease is an autoimmune disease. I like to tell people that there are three things that need to happen for celiac disease to occur. And one is you have to have the genetics for it. So if you don't have the genetics for it, you're 99% unlikely to develop celiac disease.

[A]

And you and I have those genetics. We do. We do.

[B]

Exactly. You have to have some sort of a trigger, which is common as, you know, with a lot of autoimmune diseases.

[A]

Right.

[B]

There's something, whether it is stress related, whether it is in a woman pregnancy or, I mean, there's some sort of environmental trigger. Right. That sets the stage. Right. And then the third thing is, and this is where celiac disease is actually kind of unique because you could never. You could be 100% sure you would never develop celiac disease if you didn't eat gluten. You have to be eating gluten. So that's the third thing.

[A]

You have to be exposed to it.

[B]

You have to be exposed to it. If you never eat a speck of gluten in your life, you will not develop celiac disease.

[A]

That's probably no one on this earth. So it is a chronic autoimmune condition. And the way you described how it occurs sounds like type 1 diabetes. Something happens and the immune system goes awry. So what are people allergic to? I shouldn't say allergic. That's a wheat allergy. What. What causes the autoimmune attack to start?

[B]

So it would be gluten, which is a protein, and it's found in wheat, rye and barley and derivatives of wheat. So that is again, you have to be eating that. Right. And then what happens is your small intestine is lined with finger like hair like projections called the villi. And basically the gluten, your immune system attacks when it sees the gluten and it attacks the villi and they become flattened. And once they're. You develop malnutrition and you can't because that's where you're absorbing all of your nutrients. Right?

[A]

Yeah. That's so important because in kids, which is common, they don't grow normally on the growth chart. And that's kind of a big red flag that goes up. But as I understand it, the range of symptoms can be absolutely no symptoms to stomach pain, weight loss, nausea, vomiting, and a whole list of things. So it probably goes around undiagnosed in people, I would say, I'm just guessing. Especially when you get it in adults. And you just told me before we did the podcast that people are getting it over the age of 60. So don't think that you didn't get it as a kid. You're not susceptible to it now.

[B]

Yeah, absolutely. Absolutely. Yeah. It can develop at any age. Right. When I was in school for nutrition a long time ago, I think we spent maybe 10 minutes talking about celiac disease. And it was classical symptoms. Failure to thrive, chronic Diarrhea, young children. That's all I learned about celiac disease. And now we know, as you said, there are so many other symptoms that can occur that have nothing to do with GI symptoms.

[A]

Now, the other thing that I want to just mention is this thing called wheat intolerance. And what is a food map spelled? F O, D. They left out O on the food maps.

[B]

Yeah, food map or fodmap. Right. So, yeah, they didn't leave it out. So fodmaps are carbohydrates. So gluten is a protein, and fodmaps are strictly carbohydrates. And it stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. So these are all short chain carbohydrates that are poorly digested sometimes. Right. And so they can ferment in the digestive tract and cause symptoms that you might. Same symptoms that you might see with celiac disease. Bloating, diarrhea, constipation, stomach pain. But it has nothing to do with gluten. It's not an autoimmune condition either. Right.

[A]

So we'll leave that on the side for now. But that's good to mention because it's in all the literature. Now. Why is it more common in people with type 1? Just because they're both autoimmune conditions. And how common is it in people with Type 1 compared to the general population?

[B]

So celiac in the general population here in the US is at about 1%. People are diagnosed with celiac disease within the type 1 diabetic population. It would be anywhere 6 to 10%, kind of on average, is what I see. And because, yes, there's the same genetics that are shared, as we mentioned, like the DQ2 and the DQ8 genotypes.

[A]

I'm impressed.

[B]

Got that.

[A]

E stands for Einstein.

[B]

Yes. And then, of course, as you know, like, one autoimmune condition can beget another autoimmune condition can beget another one when your immune system is already in overdrive. Right. It's it. You can have multiple autoimmune conditions.

[A]

You only have one autoimmune condition?

[B]

As far as I know. Yeah. I've only been wanting. Yeah, yeah, yeah. As far as I know. Just Sjogren's. Yeah.

[A]

Well, let's go on to how to make the diagnosis. And I guess the first question would be, if people can get it without any symptoms and you have type one, should everyone be screened? And we can talk about the screening tests which are fairly straightforward. Most primary care doctors can order the first screening test. It's a blood test.

[B]

Yeah, yeah. Yes. So recommendations are that type 1 diabetics get screened for celiac disease. That's kind of the general consensus. Is that what you're familiar with as well?

[A]

Yes, but I would say it's typically forgotten. Yeah, typically forgotten. And I have diagnosed people after they've developed symptoms like blood in their stool and things like that. But I do think that because it could be as high as 1 in 10, everyone should think about what type one should ask their doctor to get tested. Because first of all, if you have it, you don't want to chronic inflammation in your stomach, going untreated. And that leads to all kinds of issues including, you know, bone disease in women and fertility issues, just feeling bad, loss of energy, things like that. But. And if you don't have it, you don't want to be. You want to know that. So you don't have to be stuck with a gluten free diet. I shouldn't say it like that because it has changed your life a lot

[B]

better than you might think. I know you said you tried to go gluten free.

[A]

Yeah, it was the worst three hours of my life. But we're going to talk about that because I do know there's a lot more choices. There's whole choices in whole foods, gluten free. So in terms of making the diagnosis, it's a simple blood test, not to get too technical. TTG and IgA antibodies that they measure and then if they come back positive, they typically say you should get a biopsy of your small intestine. And it's very easy to make the diagnosis or not make the diagnosis. And one thing that they kept saying in the things that I was reading, that if you suspect your patient that have it, please do not have them start a gluten free diet until they get tested. Because if they start it right away, they may improve enough. You miss the diagnosis, then they say you don't have it.

[B]

I was just going to say that. Yeah, you have to be eating gluten for the blood test to be accurate. Right. So I get a lot of people and a lot of people, they do feel better. Maybe they've taken gluten out of their diet and they don't want to have to reintroduce it. But really that's the only way of knowing. And so I think the recommendations are two slices of bread over a six to eight week period or the equivalent of that. You need to be Eating that before doing the blood test for it to be accurate.

[A]

Two slices of bread a day.

[B]

A day. A day, Yeah. A day. Yeah. Yeah. Not over 68 weeks. A day.

[A]

Yes. So on the list of symptoms, I saw a list that said. And I want you to add to this because you're the expert, non gi and it says often overlooked. Fatigue. Of course, everyone's fatigued. Iron deficiency, anemia, osteopenia, osteoporosis. That's probably more important in women. Neuropathy.

[B]

Neuropathy. Yep.

[A]

Which you had. Infertility, you have two kids, so I know you don't have that. Elevated liver tests, and we talked about the classic pediatric appearance. But anything else that you want to add that your patients commonly complain of?

[B]

Yeah, I would say there's some link with migraine headaches. So increased incidence of migraines, mood disorders. Sometimes. Sometimes depression could be masquerading as celiac disease. Right. Because if you're not absorbing all the nutrients, that could show up as depression. One thing I remember that was the most interesting case I saw was a client of mine who was diagnosed, had no GI symptoms, no other symptoms, but their dentist diagnosed it because they had poor dental enamel.

[A]

It just sounds like your whole body's affected.

[B]

Your whole body's affected.

[A]

Yeah, it's inflammation. Autoimmune conditions, and if left untreated, could lead to some pretty severe signs and symptoms. Okay, well, let's talk about the mainstay of therapy. I don't think there's any disease I know of that I learned in medical school that you can completely turn around the symptoms 100% by changing your diet. And I know it's not easy, but I would definitely send every one of my patients to someone like you who knows a lot more about the gluten free diet. So I know there's some people take supplements. However, I know that people do pretty well these days just cutting out the gluten, which is difficult. So let's talk about that. Yeah, you have the floor to talk about. If I was someone come in and said, I just got diagnosed with celiac, I had a biopsy of my small intestine. What can I eat? What can I eat?

[B]

Right, Right. So I always like to start with, there are so many naturally gluten free foods that you can eat. So that's my biggest thing is let's not focus on. And of course it's natural to lament giving up gluten and bread. Everybody loves bread. Right. But I like to focus on all the naturally gluten free foods that you can still eat. So of course all your proteins, all of your whatever, it's your chicken, your fish, your meat, your eggs, your dairy products, those are all gluten free. Then certainly the fruits and vegetables which I'm always trying to get people to eat more of whole foods. So nuts and seeds are gluten free. Beans and legum a big one. And then the herbs and spices, we were talking about that. Right. And then all the gluten free grains. Right. So alternatives. Right. So instead of wheat, rye and barley again, which are the gluten containing grains, you can still have corn, you can still have quinoa is one of my favorite ones. Buckwheat, even though it has the name wheat in it, is actually gluten free. There's teff, there's sorghum, there's like almonds, nut flours which are actually can be a little more nutritious too, getting a little more fiber and healthy fats in the diet. So that's my biggest thing. I start by yes, it's going to be difficult, but there are so many things you still can eat.

[A]

You just named off a bunch of great foods. Now, since people love bread so much, what do they do to substitute bread? And I did try gluten free bread and the texture wasn't quite the same. But that was a couple years ago when I tried that and I know things have changed since then.

[B]

Yeah, bread is probably for me personally. I don't even miss it now because I've been gluten free for so long. I do eat gluten free bread occasionally, but if I go to a restaurant and there's the bread basket, I don't even miss it at all anymore. Even if they brought gluten free bread, I'd probably say no thanks. But so gluten free bread typically is less nourishing than regular bread. So whole wheat actually is a pretty good source of protein and fiber. So a lot of the gluten free breads are very low in fiber, so that's not so great. There are some decent ones like a nice fermented sourdough bread, just kind of a plain fermented sourdough bread made with gluten free grains like sorghum and rice flour. Again, it's going to be probably less have less fiber than a traditional bread. But there are alternatives out there. But things like corn tortillas, that's a good one. If you're used to having a quesadilla with a flour tortilla, have a corn Tortilla rice. A lot of people eat rice. And so rice is gluten free. Brown rice, white rice, wild rice, all those things.

[A]

But there's one thing you put on rice that is packed with gluten.

[B]

Oh, you're talking about soy sauce.

[A]

Yep, yep. And that's something that everyone's surprised about.

[B]

Yeah. Soy sauce is one of those kind of hidden sources of gluten. Right. Soy sauce has wheat in it. You can do tamari, but you have to look for gluten free tamari specifically. Yep. So there's pretty much an alternate for everything you want to eat. But again, we don't want. You know, my goal is not to get people to just start eating like low quality gluten free bread or cookies or crackers. Yes, those are all available. But what can we eat that's maybe a whole grain versus something like that, you know, can we do a whole grain buckwheat or oats? And oats are controversial with celiac community. Oats and other grains are typically grown near wheat. And so there's this thing called cross contamination that we have to watch out for.

[A]

Yeah, let's talk about that. Because I was about to ask, do most restaurants have gluten free options and how do you know it's really gluten free? But I think the bigger question to me is, so what if one piece of bread touches another piece of bread that's supposed to be gluten free? I mean, sometimes you hear these experts and that's like, terrible. You get a little bit of gluten. Talk about that a little bit. Because it sounds like if you're going to do it and you have true celiac disease, you better do it. Right?

[B]

Yes, 100%. Yeah. So, and we didn't really talk too much about gluten sensitivity or non celiac wheat sensitivity. That is another condition which I would consider myself to have. It's really a diagnosis of exclusion because there's no. Despite what you read on the Internet, there's really no testing for gluten sensitivity. Right. It's really, you take it out of your diet and you see if you do better.

[A]

And then theoretically, the other tests are negative for celiac.

[B]

Yeah, exactly. Exactly. Yeah. Rule out celiac first, then you can take gluten out of your diet. See if you do better ideally, then you reintroduce it into your diet and see if you have a reaction at that point.

[A]

Sure.

[B]

But yeah. So I'm sorry, what was the original question again?

[A]

Okay, sorry, I had three questions in one, how Bad is it with this cross contamination, this hidden gluten? I think that to me shocked me a little bit. You go to a restaurant, there's not much cross contamination. But what will that do to someone? It'll reignite the inflammation, I'd imagine.

[B]

Yes. So somebody with celiac disease can react to the most minute portion of gluten. Right. So for example, think of a crouton might have. Roughly one Crouton might have 500 milligrams of gluten in it. And some people might react to only 10 milligrams of gluten. So that's a huge difference. Right. So that we're talking crumbs. Right. You were talking about.

[A]

Right.

[B]

So yes, if a piece of bread, of gluten containing bread touches gluten free, you know, somebody with celiac can't eat that. Right. Or toaster like in the home. Right. If somebody has people who are eating gluten, not eating gluten.

[A]

Right.

[B]

You want to have separate toasters because the crumbs in the toaster. Right. If you go to a restaurant, a lot of times there's so much. Like Italian restaurants, for instance, will do gluten free pasta or they will do gluten free pizza crust now, which again, if you have gluten sensitivity, you might be fine if there's any cross contamination. But somebody with celiac disease, you want to make sure that the pasta is not cooked in the same water. Right. Because that could cross contaminate it.

[A]

This is amazing.

[B]

It's.

[A]

Eric, did you know that?

[B]

You didn't know that, right? Yeah. Or the pizza, the gluten free pizza, it's got to be cooked in a separate surface. Right. So it gets. Yeah. Cross contamination is a big issue for people.

[A]

I guess if you're really someone that's type A, you can drive yourself crazy and the staff at a restaurant crazy. But certain restaurants probably have better reputations than others. Well, so since you mentioned that the bread may not have as much fiber or other nutrients, are supplements recommended, like vitamin D for example? Not the crazy list of supplements that probably don't do anything. But what do you recommend?

[B]

Yeah. So certainly when somebody is first diagnosed with celiac disease, pretty much everybody I see is going to need supplementation of some sort. Right. Just because of that, again, the villi, you're not absorbing the nutrients. And so the common ones would be iron. We talked about iron deficienc deficiency anemia and testing and retesting that. Right. Vitamin D is another one. And sometimes initially large amounts of vitamin D might be needed to help bring the levels back up. The other ones would be some of the B vitamins like B12 and folate. Magnesium can be low as well as zinc and then sometimes the fat soluble vitamins. So A, D, E and K can also be deficient. So you're going to want to test first. Right. Test the level of nutrients and then treat with supplementation and then reassess. Right. Because it's not necessarily that you're going to need those supplements long term, but certainly initially. But the other thing to be cautious of is a lot of gluten free products are not enriched with B vitamins, with iron like traditional wheat is. And so you might need an ongoing supplement with some B vitamins and in iron, depending on your age group.

[A]

Yeah. And those vitamins can be measured in the blood. Well, when it comes to bread, us type ones, we love bread, we love carbs. Do these gluten free breads have more or less carbs? And I imagine if you have a continuous glucose monitor, you can observe how it affects your blood sugar based on a certain amount of insulin that you used to take for regular bread. Does it have more or less carbs in general?

[B]

So the carb content, they tend to be low fiber carbs. Right. Unless you're eating. We can talk about some of the more nutritious gluten free grains, but the typical bread you're going to buy in the grocery store is going to have rice flour. Right. White rice flour. It's going to also be enriched with tapioca and potato starch, and those are going to be a much higher glycemic index, carbohydrate. Right. And so we're going to see potentially higher spikes in blood sugar levels eating the gluten free products over the traditional gluten containing products.

[A]

Yeah. And once again, you know, everything comes down to see how it affects your blood sugars. Well, in terms of reading the label, it'll always have the number of carbs. So hopefully it mentions the true value. What else should people take a extra close look at on the food labels? If you have gluten free?

[B]

Yeah. So in terms of food labeling, it's interesting. So wheat must be declared on a label because it's one of the main food allergens. Right. Like milk must be declared on a label. Soy, other allergens. But rye and barley do not need to be declared on a food label. Right. So barley common one you might find would be malt. So if you see anything with malt on the label, know that that probably has barley in it. Rye is a pretty obvious one, but so if you see wheat on a label, you just want to avoid that, period. Right. But then beyond that, you've got to look for sources of barley or see if there's rye on there. And then you can choose gluten free products that are labeled gluten free. But know that you don't have to label things as gluten free. Right. It's not a requirement. A lot of food manufacturers are choosing to do that. So if it has gluten free on it, it should truly be gluten free or contain less than 20 parts per million of gluten. That's kind of the threshold for the FDA for the labeling laws. So looking for that. But unfortunately there's a good website I recommend. It's called Gluten Free Watchdog and it was developed by a dietitian who has celiac disease and she tests people can send in products. Will you test this to see if has gluten in it or not, even though it might say it's gluten free? I think at one point there was like 20% of products that were labeled gluten free actually contain gluten, which is kind of a scary thing. Right. So even you can do all the label reading. Right. And do all your homework and you might still be getting gluten.

[A]

Well, since you very politely introduced someone else's source, what about your book? Tell us about your book and how that could help some of our viewers. Listeners.

[B]

Yeah, so my book, I actually had the pleasure of writing the recipes for a new book. It's called Plant Powered plus, and it was written by a gastroenterologist, Dr. Will Bulsiewicz, and he also wrote Fiber Fueled, which was a New York Times bestseller. And this Plant Powered plus was released this January and it made the New York Times bestseller list. So I'm really proud of that.

[A]

So is it for people on plant based diets or gluten free? No.

[B]

So it's really for. The topic is using gut health. Excuse me, Gut health. To help with inflammation. To help tame inflammation. Right. And all the power of the gut microbiome. So we start with all the recipes are plant based, they are all gluten free and they're all low fodmaps. Because we were talking about fodmaps. Right. They start out that way, but then they can be adapted. So if somebody eats is a pescatarian or a vegetarian, they can add whatever proteins they want to the diet. But it's really about the whole point of the book is about variety and we talked about variety is the spice of life. But when it comes to gut health, variety is truly the spice of life. So research shows that eating more diversity in plants, foods, and again, we're not just talking about fruits and vegetables. We're talking about beans and legumes and nuts and seeds and herbs and spices. Coffee is actually good for gut health and good for overall health. Dark chocolate too. Right. So all these foods help feed our gut microbiome. And when you have more diversity in the gut microbiome, you have better overall health. Inflammation decreases and everything.

[A]

So yeah, the world is evolved around inflammation and the gut too. Most people don't realize the gut microbiome, all these microflora and the gut are so important in overall health. Well, I hope to get a signed copy one of these days.

[B]

Oh, I think so. Maybe if you're lucky.

[A]

Well, let's finish up with a few more practical tips. For someone that's on a strict gluten free diet that has celiac disease, what do they do when they travel internationally or they go to restaurants where they just are not convinced that they serve true gluten free foods?

[B]

Yeah. So traveling, one of the things, this is where I really recommend and I know you're very active on social media, but social media and finding people who have celiac disease, they're like the best community because they will tell you like, I ate at this restaurant. I really trust this restaurant. So reaching out to people who have celiac disease is like one of the biggest things I recommend. Beyond that, there are apps, there's Find me. Gluten Free is an app and people can report into the app and say, I ate at this restaurant. This was my experience. They're very strict with cross contamination or not. When you're traveling too, call ahead. Can you get try and bring your own food as much as possible, especially for breakfast or something like that? Can you get stay in a place that has a refrigerator and bring your own food? At least things like nuts and seeds and maybe some gluten free protein bars so you always have something to eat. Eating out at restaurants, calling ahead if possible is always a good strategy for eating out. And then there are especially traveling. If you're traveling overseas and you don't speak the language, there are cards that will translate that you can show to the waiter and the wait staff and explain the severity of the situation. Right. Sometimes I tell people too, you know, I don't like this, but if you mention you have an Allergy. Sometimes they're better, you know, because they hear the word allergy and they don't. Even though celiac disease is not a wheat allergy, it's something different. You know, they might, you know, be more cautious in the kitchen.

[A]

Have you heard about that new app? You hold it over your plate and if it detects gluten and it, it gives an alarm. Just kidding. No, there isn't.

[B]

I was gonna.

[A]

Wait. What? But we ought to think of that. Well, I would say that. God, I learned a lot from doing this topic with you, Ea. If you want to leave our listeners with one thing to remember about being able to stick to a gluten free diet, what would it be?

[B]

Yeah, I'd go back to variety and I'd go back to emphasizing, focusing on all the things, all the great gluten free foods that you can eat that are naturally gluten free and start there. Right. And again, that variety, you know, when we talk about eating more plant based foods into your diet, whether you know, you're eating other proteins or not, whether you're a vegetarian, vegan or you're an omnivore, eating a wide variety of plants, especially obviously those that are naturally gluten free. That's my recommendation.

[A]

That's awesome. Well, Jeremy Pettis, of course, the co host of this podcast, he always tells parents of kids with type one, what are the chances of their other kid having it? And he always starts off their chances of not having it like 90%, 95% plus. Gotta start with a positive. So I think that's important. Well, just tell us your website and the name of your book that you described. Written by the gastroenterologist. Didn't think they knew how to cook well, but I guess I do now and that way we can have that and people can get it on their own.

[B]

Yeah, awesome. So my website is EA Stewart S-T-E-W-A-R-T.com or you can just Google the spicy RD and I'll pop up. I'm on social media hespicyrd, so especially on Instagram. That's kind of my favorite place. And the book again is called Plant Powered plus by Dr. Will Bulsiewicz and

[A]

recipes by me, you're recipe creator. Well, ea, thank you so much for joining. I learned a ton. I know our listeners will, so. So I appreciate it.

[B]

Thank you so much for having me.

[A]

Okay.