January 08, 2009


The First Year: Celiac Disease and Living Gluten-Free—A Patient-Expert Walks You Through Everything You Need to Learn and Do. By Jules E. Dowler Shepard. Da Capo. $16.95.

     The latest entry in the well-thought-out The First Year series tackles one of the “popular” diseases of the moment. That does not mean that anyone with celiac disease considers it a good thing to have – it is life-changing, interfering to an extraordinary extent with everyday routines. And people with the condition often suffer considerable pain. But celiac disease is popular in the sense that more and more people, including doctors, are paying attention to it, and more and more products for people with the disease are being developed and sold.

     True celiac disease is an autoimmune disorder affecting three-quarters of one percent of Americans – a small percentage that nevertheless works out to more than two million people. People with the condition cannot digest gluten, a protein in wheat and other grains. When they consume anything containing gluten – which is in a very wide variety of foods – they develop mild to severe gastrointestinal symptoms that are often misdiagnosed. Misdiagnosis is exactly what happened to Jules E. Dowler Shepard, who is now spokeswoman for the University of Maryland’s Center for Celiac Research (and author of a cookbook for people with celiac disease). In The First Year: Celiac Disease and Living Gluten-Free, Shepard explains the difference between true celiac disease and other conditions requiring gluten-free living, such as gluten intolerance. She reviews what tests can and cannot determine, what testing and treatment insurance usually will and will not cover, and – most important and most useful – what to do after the diagnosis. Because this is a First Year book, its target audience is newly diagnosed people (who may find it frustrating to learn that no one really knows why celiac disease manifests at different times in people’s lives, or why its symptoms can differ significantly from individual to individual). The chapters are numbered as time periods – Day 1, Day 2, and so on – with Shepard mixing anecdotes, medical background and statistical data into this rather arbitrary arrangement. She also starts early to mix in recipes – which some readers will find the most valuable part of the book. Clearly, Shepard has worked hard to find substitutes for gluten that will allow people with celiac disease to eat well and enjoy their food without sacrificing taste or consistency. Thus, she provides a “nearly normal all-purpose flour mix” containing white rice flour, cornstarch and other ingredients; information on foods that are normally gluten-free (corn grits, for example); and suggestions for cooking meals that taste good while avoiding gluten (such as crab or shrimp quiche with vegetables).

     Because Shepard’s book is recipe-heavy, it will be especially appealing to people who are not time-pressed and who enjoy spending time in the kitchen. The lemon-oregano herb-rubbed chicken breasts, for example, must be rubbed at least two hours before cooking, while the nutty rice requires a slow cooker. The book will be less useful to people who want to prepare meals quickly and easily – indeed, Shepard seems to suggest that that is an unreasonable expectation for people with celiac disease. Of course, there are always restaurants, and Shepard has some useful thoughts on them in a helpful “dining and dating” section – for example, review the menu and ingredients online in advance, call ahead to speak with the chef or manager, focus on grilled or steamed food without sauces, and choose fresh fruit, sorbet or ice cream for dessert. Shepard’s thoughts on alcohol will also be useful for those who drink – she even provides a list of gluten-free alcoholic beverages. And her discussion of religious issues involving gluten will certainly be of interest to those affected (for example, the Catholic Church requires the Host used in Communion to contain wheat). There is, in fact, a lot of information here on a lot of subjects – potentially an overwhelming amount for someone newly diagnosed with celiac disease or another form of gluten intolerance. This book will be most useful to people who keep it handy for occasional consultation instead of trying to read it straight through – and who either love cooking or are willing, for the sake of their health, to come up with the time necessary to become adept in the kitchen.

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