Everyone at the party is raving over the moist, exquisite Dutch chocolate triple-layer birthday cake. You're dying for a taste, but you just smile and nod politely, knowing a single bite could trigger a severe autoimmune reaction.
Registered nurse Michele Toye is no stranger to moments like this, ever since October 2009, when she was diagnosed with celiac disease. "I started having belly pain on and off, strange yellow stools, and I always felt bloated," says Toye, who initially dismissed her doctor's suspicion that she had celiac disease. Now, like other people with the disease, Toye adheres to a diet completely free of gluten, a protein found in wheat, oat, barley and derivatives of these grains.
"(Celiac disease) is an immune system response to ... gluten," says Dr. Sean Connolly, a gastroenterologist at Ochsner Medical Center. "It damages the small intestine, where the food is absorbed."
When the small intestine is incapable of absorbing nutrition, people may experience a variety of other disorders, including osteoporosis, and deficiences of vitamins like B12, folic acid and calcium. "The real problems are due to the malabsorption of vitamins and minerals," Connolly says.
Symptoms, if there are any, are fairly nonspecific (patients sometimes mistake their symptoms for irritable bowel syndrome), Connolly says and usually include diarrhea, gas and other abdominal discomfort, something else Toye experienced.
Even as a registered nurse, Toye didn't think of celiac disease when her symptoms began, although about one in every 100 to 200 people of northern European descent has the disease, according to Connolly. When she was diagnosed, however, she took it seriously and began a diet without bread, pasta and other beloved foods.
"The treatment for celiac (disease) is a lifelong abstinence from gluten," Connolly says. "We think (the disease) is probably related to an underlying genetic predisposition and environmental factors. Stress may trigger symptoms."
Connolly recommends individuals with a first- or second-degree relative diagnosed with celiac disease get tested for the disorder, as should people who have chronic diarrhea, malabsorptions or symptoms of irritable bowel syndrome. A knowledgeable dietitian and a celiac disease support group are invaluable aids in managing the disease, which can bring some emotional fallout.
"I went to Whole Foods to get a few gluten-free foods," Toye says. "I was standing in line and my eyes were welled up with tears. I was angry that everyone else there was able to get what they wanted to eat, and I remember thinking, 'This is bullshit!'"
Fortunately, more restaurants in the New Orleans area, including Naked Pizza, Casamento's Restaurant and Mark Twain's Pizza Landing, are offering gluten-free options.
"We're going through a case (of gluten-free pizza crust) every two weeks," says Jacques Broussard, owner of Mark Twain's Pizza Landing, which introduced gluten-free menu items in 2008. Connolly points out that there is no benefit to getting off gluten if you're not exhibiting symptoms of celiac disease, so most diners can feel free to enjoy pizza with a gluten crust.
Since diet is crucial in managing celiac disease, Toye cooks most of her own meals, sticking to fresh meats, fruits and vegetables. This cheesecake recipe is a treat Toye modified to be both gluten free and delicious.
Gluten-Free Cheesecake with White Chocolate Topping
1 box of Kinnikinnick Graham Style Crumbs
4 (8 oz.) packages cream cheese*
1 1/2 cups white sugar
3/4 cup milk
1 cup sour cream
1 tablespoon vanilla extract
*Make sure all ingredients are at room temperature before starting.
1. Preheat oven to 350 degrees. Grease a 9-inch springform pan.
2. Prepare Kinnikinnick Graham Style Crumbs per box directions, but do not refrigerate. Press crust into the pan, covering bottom and sides.
3. In a large bowl, mix cream cheese with sugar until smooth, being careful not to over beat. Using a wooden spoon, blend in the milk. Mix in the eggs one at a time. Mix in sour cream and vanilla until smooth. Pour filling into the prepared crust.
4. Wrap the bottom and sides of pan with two layers of foil. Place the springform pan inside another pan filled with 1/2 inch boiling water to make a water bath. Bake in preheated oven for 1 hour. Then, turn off the oven and let cake cool in oven with the door closed for 5 to 6 hours to prevent cracking. Chill in refrigerator until ready to serve.
White Chocolate & macademia nut Topping
1 1/2 cups heavy cream
4 oz. chopped white chocolate
3 oz. chopped macadamia nuts
1. Toast chopped macadamia nuts in oven or toaster oven until lightly golden. Be careful — nuts burn easily.
2. In a saucepan, heat cream over high heat until it simmers. Reduce heat to medium and whisk in chocolate until melted. Gently simmer sauce for 15 minutes, then cool to room temperature.