Image credit: From The Intolerant Gourmet by Barbara Kafka (Artisan Books). Copyright 2011 Johnny Miller
I became seriously interested in the possibilities and restrictions of a gluten-free diet the way most people do—when someone in their family or they themselves need to go on one. Four years ago, Jess, my stepdaughter, was told to avoid gluten, a protein found in wheat and related species. And so began a voyage of discovery that took me through Brooklyn’s Park Slope, where Jess lives, and Manhattan’s East Village—both of which have no lack of shops that cater to the gluten-averse—and a thicket of books and Web sites, only to lead to an unlikely foreign revelation.
If gluten intolerance still smacks of the disease du jour, it is also redefining life for many Americans, prompting millions to revisit how they shop, cook, and eat. According to the Hartman Group, a market research company, about 40 million Americans are interested in gluten-free diets. Actual celiac disease, which hinders the digestive system’s ability to absorb essential nutrients, is rarer: about 3 million Americans have it. But it often goes undiagnosed—as long as 11 years from the first onset of symptoms—and is increasing: a study released last year by the Center for Celiac Research at the University of Maryland said that in the U.S. the incidence of celiac disease has doubled every 15 years since 1974.
Manufacturers have gotten the message. From 2004 to 2009, according to the Nielsen Company, gluten-free-product sales rose 74 percent, and supermarkets are muscling in on what has been health-food territory. At the Summer Fancy Food Show, in Washington, D.C., I saw dozens of gluten-free products, and heard the representative story of Lucy Gibney, an emergency-room physician who started a cookie business after her baby son was diagnosed with severe allergies. Since 2007, when she founded Lucy’s, she told me, sales had grown by 2,100 percent. (Her cookies, which are also lactose-free, are crisp, crumbly, a bit salty, and good.)
Many popular gluten-free cookbooks have gone straight for the forbidden baked foods like cupcakes, brownies, pies, and bread. But there’s much more that anyone considering a gluten-free diet should know how to cook, especially if you need to avoid lactose, too—as many as 30 million Americans are lactose-intolerant. My friend Barbara Kafka, the author of Microwave Gourmet, Roasting: A Simple Art, and other books, learned she was in that subset several years ago, and turned that news into a cooking encyclopedia, rethought for people who need to avoid a number of foods. Just her ratings of packaged gluten-free pasta in The Intolerant Gourmet: Glorious Food Without Gluten & Lactose will be worth the price of the book for many.
Yet my revelation in how a whole country can help gluten-free people eat well, and afford to do it, came, unexpectedly, in Italy—where food trends arrive late if at all, particularly if they interfere with sacred dining habits like, say, pasta. When Jess, her father, and I went to Rome, we went into a market looking for gluten-free snacks and were immediately redirected to a pharmacy. Every pharmacy, in fact, seemed to have some products available, and when we traveled to Bra, a small city that is the birthplace of Slow Food, we found out why: the government, a pharmacist explained as she brought us into a sizable room stocked with gluten-free food, pays a monthly stipend to everyone who is prescribed a gluten-free diet. The amount varies by region, but many adults get nearly $200 a month. That explained the widespread availability of gluten-free food. It also helped explain why the liveliest restaurant we visited in Rome was Il Viaggio, near the Villa Borghese, which offers extensive gluten-free menus.
In the United States, where gluten-free products can be twice as expensive as their glutinous counterparts, people can only hope their insurance flex plans will cover the excess cost; some do, and the IRS allows the difference in price for gluten-free foods to be included in deductible medical expenses. State or medical-insurance support could lead to the kind of universal availability we found in Italy—and the kind of creativity that changes every part of the menu, not just starches. In August, the Food and Drug Administration reopened public comments on its “gluten-free” labeling rules, slated to take effect next year. That could help insurers here put in place the kind of subsidies common in Italy. Heading off expensive treatment for the consequences of chronic disease always saves money. And in this case it can give millions of people a life that tastes better, too.
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