Friday, October 30, 2009

Friday Foto: Cilantro-Lime Grilled Shrimp


Whether you live in Colorado or not, you've probably heard about the monster snowstorm that just hammered us. Snowfall totals were approaching 40 inches in some locales (that's nearly 3.5 feet!). Here in Boulder, we officially clocked in with 20 inches of snow. Not a man to be separated from his grill, I shoveled a path from the backdoor of our house to the grill so that I could make this dish. As I prepared to step out the backdoor and do battle with Jack Frost, Kelli asked me, "Are you sure you don't mind grilling tonight?" Not in the least. I'm a passionate believer in year-round grilling.

If you're looking for a recipe with clean, bright flavors and a hint of smokiness, this is the one for you! The smoke from the grill, the brightness from the salt and lime, the edginess of raw garlic, and the herb goodness of cilantro make for a winning combination on the shrimp. It all starts with making a mojo-like concoction that doubles as both a marinade and a sauce:

1/3 bunch cilantro, chopped
6 garlic cloves, minced
1 lime, juiced (it should be a juicy lime that yields at least a 1/4 cup of fresh lime juice)
1/3 cup olive oil
1/2 tsp salt
1/2 tsp ground black pepper

Combine all the ingredients in a small bowl and mix well. Set aside half of the mix to use as a sauce later. You'll use the other half as a marinade for the shrimp...

20-30 shrimp, peeled, deveined, skewered (I used 31-40 count shrimp. You could go bigger or smaller - I wouldn't recommend smaller - but you may need to use more or less shrimp, or use more or less marinade...)

Place the shrimp skewers in a single layer on a large plate or tray. Then use a spoon to drizzle the marinade over them. (I marinade only one side, so don't worry about flipping them over.) While you're doing this, have your grill preheating to medium high.

With the grill up to temperature, place the shrimp skewers on the grill, marinade side up. It will only take a few minutes for the shrimp to cook through. You'll want to monitor them closely to make you don't overcook them. Toward the end, flip them once and grill briefly with marinade side down. Then remove from the grill.

To plate the dish, you can either leave the shrimp on the skewers, or remove them for yourself and your guests. If you leave the shrimp on the skewers, remember that the skewers (metal, in our case) will be very hot! Serve the shrimp over a bed of rice. For the finale, drizzle the sauce (which you set aside in the beginning) over the shrimp and rice. Lastly, enjoy! Serves 2.


Variation: If you don't have a grill, or don't feel like shoveling a path through deep snow in order to grill, you can also make this recipe by creating an open-top pocket of tinfoil, placing the shrimp and marinade inside, and sticking it under a broiler (similar to the way you might do a head of garlic with olive oil). However, this method of preparation will lack the added depth of smokiness imparted by the grill, and the shrimp will steam more so than they'll cook by direct heat.

Either way, though, this is still a winning dish. Happy Halloween!

- Pete

Thursday, October 29, 2009

Product Review: Two Moms in the Raw



Like Boulder Soup Works, Two Moms in the Raw is another joyous farmers market discovery. Based in Lafayette, Colorado, the company was founded by Shari, a mom who discovered that following a raw diet helped her body tackle a diagnosis with multiple sclerosis. To date, the company has come out with two product lines: granola, and sea crackers.

All the products are 100% raw, 100% organic, vegan certified, Kosher certified, and Colorado Proud (which means they're made with locally grown produce). At present, most - but not all - of the products are gluten-free. Three flavors of granola are off-limits to the GF folks. However, both the blueberry and the gojiberry granola come in GF versions, and all three flavors of the sea crackers (tomato basil, pesto, and garden herb) are gluten-free.

Two Moms triple washes the kitchen to minimize any potential for cross-contamination, and alternates production days, doing only gluten-free products on a designated day. (In addition, they'll be eliminating gluten from their other products. A staffer told me the gluten came from cross-contaminated oats, though I don't see oats listed in the ingredients for the products. Two Moms also plans to pursue GF certification in early 2010. Hooray!)

At present, TM is available in five states (CO, FL, KS, NM and TX), as well as online via their website.

But that's enough background... On with the review!

On the down side, this food is expensive: $10 for an 8oz bag of granola, and $7 for a 4oz bag of sea crackers. (You are - as cited by Two Mom's copious certifications - getting some high quality food, though.)

The Gluten-Free Granola

As I mentioned, the granola comes in two GF versions: blueberry and gojiberry. Both use the same base: millet, buckwheat, coconut, flaxseed, sunflower seeds, sesame seeds, pecans, almonds, pepitas, apples, agave, cinnamon, and sea salt. Presumably, the agave is the sticky binding agent that enables it all to hold together and not become a bag of glorified trail mix. For my taste, the combination of ingredients provides just the right amount of sweetness and whole grain nuttiness, and the cinnamon really comes through to pull the flavors all together.

In terms of comparing the blueberry and gojiberry...they are literally the only difference between the two granolas. For my money, I don't taste a significant difference from one to the other. The berries each bring similar qualities to the granola, enough so that they're largely interchangeable, and the resulting difference in flavors is subtle (almost to the point of being negligible).

Having said that, however, the bottom line is that the flavor is delicious. This is some good stuff. I could eat a bag full (oh wait... I HAVE eaten a bag full) and not get tired of the granola. I give the gluten-free granola an enthusiastic two thumbs up for flavor.


The gluten-free gojiberry granola


The Sea Crackers

The sea crackers - I also mentioned above - come in three flavors: tomato basil, pesto, and garden herb. The crackers are thin, with a slightly crunchy texture (in this sense, they're vaguely reminiscent of Mary's Gone Crackers). As with the granola, Two Moms here uses a common base, and the addition of certain ingredients shifts the flavor one way or the other. In the case of the sea crackers, that base is a pair of book ends, with flaxseed on one end, and kombu and sea salt on the other end.

In between, you'll find sun-dried tomatoes, garlic, and herbs for the tomato basil; pine nuts, herbs, spices and garlic for the pesto; and herbs, spices and garlic for the garden herb. What immediately struck me was how much each flavor tasted like what it said it was. This wasn't like sucking on a lime ice pop, where the lime flavor tastes clearly artificial and is a pale imitation of the real thing. I could taste the tomato and basil in the tomato basil sea cracker because...well...there's tomato and basil in there. Ditto for the pesto - the pine nuts plus the herbs (which I'm guessing includes basil, and maybe some parsley and/or cilantro) - makes for a very pesto-tasting pesto flavor. Nicely done.

What immediately struck me (and Kelli) next, though, was the taste of the kombu, which is an edible Japanese seaweed or kelp. That single ingredient overpowers and dominates the sea crackers. No matter which flavor I was eating, and no matter how much I tried to focus on the flavor, I couldn't get past the kombu. Now, this is strictly a flavor preference (or in my case, anti-preference). If you're someone who likes the flavor of kombu, I have no doubt you'll gobble these up. But if kombu is not your thing, move on.

The Bottom Line

From a quality of ingredients and an execution standpoint, Two Moms is a home run. Whether you're a raw foodie, or a foodie who eats raw food, there's much to love here. Two Moms does lose some points on price, because they're very expensive. And as you read, our reviews were mixed when it came to flavor. The granola was superb. The sea crackers - as much as I liked their intended flavors - were subverted by the overpowering kombu. Without the kombu, I suspect I'd enjoy the crackers as much as I did the granola.

The Deal for NGNP Readers

For those of you who've stuck in there through the full review, I've saved the best for last: Two Moms is generously offering to send a free sample package of their gluten-free products to two lucky No Gluten, No Problem readers. Email me at pete@peterbronski.com and include "Two Moms samples" in the subject line. Entries should be received by midnight, Thursday, November 5 (one week from today). On Friday, November 6, I'll randomly draw two names from among the entries, and you'll receive a sample package of Two Moms products in the mail.

- Pete

TMITR logo used with permission.

Monday, October 26, 2009

Product Review: Boulder Soup Works

We were recently strolling the aisles of our local farmers market when we came across a booth, prominently labeled "gluten-free," offering a variety of soups. Of course, we were instantly pulled in by its tractor beam and discovered Boulder Soup Works. BSW is an organic soup company whose entire line of 5 soups is gluten-free (prepared in a dedicated kitchen). Some of the soups are also dairy-free, vegan and/or vegetarian.

First, we love the philosophy behind the company and its soups. They use organic ingredients. The chicken stock base used in some soups is Certified Humane. They use fresh, hand-cut vegetables. And the soup containers are recyclable and reusable (one was recently found storing molasses cookies in our kitchen).

Second, there's the quality and taste of the soups. We sampled the Red Lentil Dahl and the White Bean with Tomato. The RLD was divine. We loved it enough to take home two 24-ounce containers (refrigerated, just heat to serve). We weren't quite as enamored with the WBT, but it was still quite good. The ingredients label on the RLD is a good example of the kind of familiar, natural ingredients you'll find in the soups: water, followed by an all-organic list - onions, red lentils, carrots, coconut milk, vegetable base, extra virgin olive oil, and curry spice blend. That's it. Which is just the way we like it. (Nutritionally, the RLD is a little high in sodium, but that's my only - and minor - criticism.)

The BSW soups are available at the Boulder Farmers Market, as well as Denver-Boulder area Whole Foods stores. You can also eat the soups at the Oliv You & Me cafe and ModMarket in Boulder.

For those of you in the Boulder area, the farmers market runs until November 7, and BSW is making a special offer to a select few NGNP readers. Stop by the BSW booth at the farmers market, tell them NGNP sent ya, and say the magic passphrase ("Soup to Live by"), and BSW will send the first 2 or 3 readers home with a free tub of soup! (Many thanks to Kate Carroll at BSW for offering this deal.)

In addition to enjoying the soups straight up, you can also use them as a base in slightly more elaborate recipes. Try these recipes submitted to us by BSW:

Potato Leek Soup it Up
Dice a quarter pound of pancetta and toss it in a pan with some onions on high heat. Slightly brown the onions and allow the pancetta to become a little crispy. Steam two cups of broccoli florettes. Cover the bottom of two large soup bowls with pancetta, onions and broccoli. Top with sharp cheddar cheese or a smokey Gouda. Pour hot Potato Leek soup over the top and enjoy. [NGNP: I'd recommend giving the pancetta a head start, and then adding the onions. This way some of the fat from the pancetta can help the onions to saute and caramelize.]

Roasted Tomato Basil Soup it Up
Pour a tub of a Tomato Basil soup into a saucepan and reduce, simmering for about twenty minutes. Add half a cup of dry red wine, one tablespoon of extra virgin olive oil, two cups of sliced mushrooms, and/or two cups of cooked Italian sausage. Serve over rice pasta with a fresh green salad and some vino.

Red Lentil Dahl Soup it Up
Cook a cup of white rice. In a soup bowl, cover some of the rice with pieces of grilled chicken or diced smoked turkey. Pour heated Red Lentil Dahl soup over the rice and chicken, and top with chopped fresh cilantro. This warm curry is greated with a marinated cucumber salad.

If you're looking for a great, flavorful soup made with familiar, healthy ingredients, then look no further. BSW is it.

- Pete

BSW logo used with permission.

Friday, October 23, 2009

Friday Foto: The Book Release

Marin modeling a copy of Artisanal Gluten-Free Cooking

I'm bucking the Friday Foto trend today and foregoing a pic of food with an accompanying recipe. Instead, I'm using this space to celebrate the release of our cookbook, Artisanal Gluten-Free Cooking. The book was hot off the presses just in time for us to receive our author copies to bring with us to the Gluten-Free Culinary Summit. Now, a few weeks later, the book is in stock online at places like Amazon, Borders, Barnes & Noble, and Target. Over the next few weeks, it'll populate brick and mortar bookstores nationwide.

You can check out this page to read more about the cookbook, and to see what some fellow GF bloggers and chefs have had to say about it! In the meantime, you can find us in the kitchen, continuing to develop new recipes that we'll be regularly posting here at NGNP. And, whether you're a long-time NGNP subscriber, or a first time visitor, consider also following us on Facebook and/or Twitter!

Have a great weekend.

- Pete

Thursday, October 22, 2009

A Pizza Pandemic

At times it feels like I do a lot of writing about gluten-free pizzas. I review GF pizza crusts, and review pizzerias offering GF pizzas, and write about the scratch pizzas we make for ourselves at home. Kelli is kind enough to point out when she thinks I've been covering pizza a bit too much. But now, it appears there's been a reason for it all: a growing pizza pandemic. Across the country, the demand for gluten-free pizzas is causing more and more pizzerias - from the national franchises to the independent pizza parlor down the street - to offer a GF pizza.

Just take a look at this article in yesterday's Bergen County Record in North Jersey. Whether it's because a pizzeria owner (or their spouse) was diagnosed with Celiac, customers asked for it, or a company offering GF pizza crust said "Hey, you should be offering this!" Pizzerias are taking note. In six short months, one pizzeria (A Mano in Ridgewood) went from not even offering a GF pizza, to selling 50 in one week!

Of course, one of the biggest concerns when it comes to GF pizzas at a pizzeria is the issue of cross-contamination. Wheat flour is everywhere - on hands, on shirts, on countertops, in the oven. Pizzeria's handle this risk in different ways. Some choose not to have the risk, and don't offer a GF pizza. Some bake their crusts on a pan, to avoid contact with floured surfaces. A Mano, to its credit, has a dedicated oven for GF pizzas. Most choose not to make their own crusts, instead sourcing par-baked GF pizza crusts from local vendors. Such is the case here in Boulder, Colorado, where the Gluten-free Bistro is supplying its GF par-baked pizza crust to a growing list of local restaurants.

And on that note, keep an eye out next week for our review of Gluten-free Bistro. After my negative experience with Abo's a few weeks ago, I contacted GFB to get samples of their pizza crust and flour blend to independently test and review. I've finished my review of the pizza crust, and will soon be finishing up my review of the flour blend as I use it to bake recipes. The results of that evaluation are forthcoming soon!

- Pete

Friday, October 16, 2009

Friday Foto: Barbacoa


After a week spent covering a serious and heavy topic, I'm happy to end the week on a much lighter note...with the Friday Foto! Back in August, the FF was of a carnitas-style pork. Today's FF is of its step-brother: a barbacoa-style beef. Barbacoa has its roots in Mexican cuisine, and today the term can generally be applied to tender, slow-cooked meats. I'll admit, our version is inspired by Chipotle (not that there's anything wrong with that!). The result is a moist, flavorful, well-seasoned beef that has a good amount of baseline heat that provides a "slow burn" over the course of the meal. (In other words, it's perfect in my book...) Here's how we make it:

1 medium sweet yellow onion, diced (a rough chop is fine)
1/2 jalapeno pepper, diced very small (membrane removed, half of seeds retained)
6 garlic cloves, minced
1 tbsp ground cumin
1/2 tsp ground cloves
1/2 tsp ground allspice
3 chipotles in adobo sauce, rough chopped
1 cup chicken stock
1/3 cup apple cider vinegar
salt and pepper
water
3 lbs beef roast, cut into 1 lb chunks

1. Add all ingredients through and including the cider vinegar to a slow cooker. Add a generous dash of salt and pepper, and stir to mix well.
2. Add the beef, and add just enough water until the meat is covered.
3. Cook covered in the slow cooker on low for 7 hours, or until the meat shreds easily.
4. Remove the meat and shred using two forks, discarding any large pieces of fat. (You can also allow the meat to cool and shred/pull using your hands.) Set the shredded beef aside.
5. Transfer the "broth" from the slow cooker to a pot, and blend (to smooth out any large pieces of onion, chipotle, etc.) using a handheld immersion blender.
6. Bring to a boil and reduce in volume by about 50%.
7. Add the meat back into the pot with the sauce/broth, and continue boiling and reducing (to allow the flavors to meld, for the broth to reduce just a little more, and for the meat to soak up some of the moisture).
8. Serve over cilantro-lime rice and with your favorite toppings (i.e. salsa, shredded lettuce, cheese, sour cream).

Enjoy!

- Pete

Thursday, October 15, 2009

Diagnosis: Celiac (Part 3 - The Case Study)

Earlier today, I was reminded once again why Celiac Disease and health care reform in the United States is such a timely topic. Sitting in my email inbox was the October newsletter of the National Foundation for Celiac Awareness, and the last article in the newsletter was a link to a Wall Street Journal Health Blog from mid-September.

The WSJ post of a 17-year old girl from the Chicago area who was dropped from her health plan after being diagnosed with Celiac. In a heavily criticized tactic known as recission, her health insurance provider - upon learning of her diagnosis - went back and reviewed three months worth of medical records. Then, looking solely at her symptomology prior to diagnosis, declared that if they had known about those symptoms, they would not have offered her coverage. Seriously? We all experience symptoms leading to the diagnosis of anything... that's how doctors do their job. The more I delve into this topic, the more disgusted I become with the health care system in the United States, and the more I feel like I come across questionable ethical practices on the part of insurance companies that appear to be motivated solely by corporate greed.

I feel like it's not that much a satirical leap of faith to foreshadow a time in the not too distant future when an unregulated health insurance company would turn to a patient and say: "We went back and reviewed your records, and we couldn't but notice that you were born. Your being born constitutes an implied acceptance of the terms of life. Unfortunately, those terms guarantee that you will get sick at some point over the course of your life. Based on those factors, we're declining coverage."

But again, I digress...

As I got my hands dirtier and dirtier with this topic, I wanted to do more than write about it. I didn't want to do a series of posts dealing only in hypotheticals, theories, anecdotal stories, and ideology. I wanted to do a concrete case study about the gauntlet of health insurance coverage faced by someone with Celiac, and who better to be the guinea pig than me?

And so I called four of the most prominent health insurance providers in Colorado (HumanaOne, Cigna, Aetna, and Anthem Blue Cross / Blue Shield), posing as a prospective customer. To each I gave the same set of circumstances: I was a self-employed sole proprietor exploring my options for health insurance coverage. Oh, and I had Celiac Disease. Was that considered a pre-existing condition that would exclude me from being able to obtain coverage? (These were all true statements.) Here's how each customer service department responded:

HumanaOne - Told me that I was not eligible for any of their plans, but recommended I look into Cover Colorado (a state-based health insurance plan offered specifically for people who've been turned away from other health insurance because of pre-existing conditions). The customer service rep also said that "not all companies are the same, and you might find another company that will offer a plan." And so I called other companies...

Aetna - The customer service rep was utterly unhelpful, and when she didn't find Celiac Disease in the underwriting guidelines, recommended I "apply online and see what they say." Basically, it was a crap shoot, and I wouldn't know the outcome unless I formally applied for acceptance to a health insurance plan.

Cigna - Here, too, the customer service rep didn't find any information about Celiac Disease in the underwriting guidelines. But this gentleman was more helpful, asking me to send him an email with my age, height, weight, and a description of the condition, and he'd pass it along to the underwriting team to get an answer.

Anthem BC/BS - The customer service rep told me, with regard to Celiac Disease, "I'm thinking it's not declinable." This was tentative good news. But I wanted a more definitive answer than that, I told him. And so he invited me to submit an application in order to get an official disposition from the underwriters.

In each of the cases where a company asked me to jump through an additional hoop in order to get a decision or answer, I began to follow those leads. But eventually, they all began asking for far more personal information than I was prepared to fork over. Instead, I switched gears and - wearing my investigative journalist hat - called the media relations rep for each company to get an official stance on the subject. Then the plot thickens...

I asked each media rep the same three questions: 1) Was Celiac Disease considered a pre-existing condition that would exclude someone from obtaining health insurance? 2) If so, what was the rationale behind the underwriters' disposition in that regard? And 3) Was that true across all insurance plans offered, or did it differ from plan to plan? (For example, would someone be excluded from one plan, but invited to join another that had higher rates?)

HumanaOne's media rep told me he'd have an answer for me in 1 to 2 days. 4 days later, not a word.

At Aetna, I left both a voicemail and sent an email. I just received word this afternoon that they're working on it.

Cigna was more helpful. The media rep there did some digging, and while she couldn't get an answer on the exclusion question, she was able to confirm that testing for Celiac Disease is covered under the company's insurance policies. (Which raises an interesting question - Do their insurance plans cover a test which, if it comes back positive, would then get you dropped from those plans?) She also recommended I call the Colorado Association of Health Plans to get an industry-wide sort of perspective. I have a message in to CAHP, but haven't yet received a response.

And lastly, there was Anthem BC/BS. Their media rep was by far the most knowledgeable, and the only one to point out several nuances of the health insurance structure in Colorado. (I'll get to that in a minute.)

Before I use Anthem BC/BS as a jumping off point, I wanted to share two other interesting tidbits related to the prior to companies (Cigna and Aetna):

First, when I did a search for "Aetna Celiac" on the Internet, Google returned four consecutive search results that seemed to offer conflicting information. #1 cited that Aetna deems a Celiac screen/test "medically necessary" for people suffering from symptoms of Celiac, and therefor covers the test under its insurance policies. #2 cites donations Aetna has made to the National Foundation for Celiac Awareness. #3 points to Intellihealth, an Aetna website with an extensive information page about Celiac Disease. All three seem to point to Aetna being kind toward people with Celiac. But then you come to #4 - the story of a parent whose 4-year old son was denied coverage by Aetna because he had Celiac Disease.

Second, when I did some digging on Cigna's website, I similarly found an extensive fact page about Celiac Disease. Couple this with the media rep's comment that they cover testing for Celiac, and you feel like you start to get a rosy picture. But then you hear Cigna's notorious reputation for denying coverage on the basis of pre-existing or diagnosed conditions. What does it all mean?

And so, returning to Anthem, the BC/BS media rep was the only one to point out the distinction between individual and group insurance options in Colorado. Here's where things really get interesting:

Colorado law stipulates that coverage cannot be denied to an employee (or their spouse or dependents) who is offered group health insurance through an employer. This is irrespective of pre-existing conditions. Further, Colorado law also ensures that group health insurance is "guaranteed renewable," which means your policy can't be cancelled if you're diagnosed with Celiac (or something else). (Colorado has also enacted other recent legislation, including the Health Insurance Portability and Accountability Act, which offers additional protections.) This is all good news for Celiacs in Colorado seeking to obtain health insurance, and many other states (though not all) have put in place similar legislation to varying degrees.

But what about the nearly 800,000 non-elderly adult individuals in Colorado (1 in 5 in the state for that age bracket!) who don't have health insurance, and who would need to obtain an individual policy? Well, I'm afraid they're largely out of luck. Individual health plans don't have the same state protections as group plans. As a result, a patient could be denied coverage on the basis of a pre-existing condition such as Celiac, which is why HumanaOne told me "no" when I called them.

However, there's even more to this story. The case isn't closed for individuals with pre-existing conditions in Colorado seeking health insurance. Certain self-employed people (such as me) would qualify for state status as a Business Group of One. Officially becoming a BGO in Colorado makes me a company from a health insurance standpoint. In essence, I'd be both the employer, and the only employee. And since I'd then be obtaining health insurance through my employer, I qualify for group health insurance plans, which are protected by state law, and under which I can't be denied coverage, even for a pre-existing condition like Celiac.

And wait...there's even more! Colorado law further states that group health insurance plans may not be underwritten. That's part of the reason why those plans are inclusive of people with pre-existing conditions. But, because they're not underwritten, and because they include all people, they inherently cost more... up to double or triple insurance plans that have underwriters. On the flip side of the coin, individual health plans with underwriters have lower costs, precisely because underwriters exclude people with pre-existing conditions whose heightened medical expenses would cause the overall costs of the plan to rise.

And so in the end, here is what the decision making process would look like for someone in my shoes pursuing health insurance coverage in Colorado, in light of a pre-existing diagnosis with Celiac Disease:

1. Am I employed, and is health insurance offered through my employer? If so, it's a group plan, and I can't be denied. I'll have health insurance, case closed.

2. If I am not employed, do any of the private health insurance companies offer individual plans, or am I excluded from them all on the basis of my pre-existing condition? If I'm excluded from all options, then I pursue Cover Colorado. (Other states have similar plans, such as the Oregon Medical Insurance Pool.) If I'm not excluded from all options, how do the individual plan costs compared to my only other option: Cover Colorado?

3. If I'm self-employed, do I qualify as a Business Group of One? If so, I qualify for group health plans, and I can't be denied. However, because group plans are significantly more expensive than individual plans, do I also qualify for individual plans, or would I be denied from them all? If some would accept me, how do their costs compare to a group plan, and how do either one of those costs compare to the state-based option?

It's enough to really get your head spinning. But as you can see, there are options. The private insurance companies, in my opinion, have some deplorable practices. But some do offer coverage to people with Celiac, and a combination of state-based legislation and a state-based health insurance option offer further protections and choice for consumers like you and me. But if I've made any case over the course of the three posts this week, it's that nationwide health care reform is badly needed.

I can't predict what that reform will look like in the end, but if we (people with Celiac Disease and gluten intolerance and wheat allergy and a long list of other pre-existing conditions) don't speak up and advocate, then that reform may not - or likely, will not - meet our needs. And that's who the reform is most meant to help...we the people. Not we the people without pre-existing conditions. All people. Ensuring health coverage for someone with Celiac Disease shouldn't be this difficult, or this labrynthine. And so raise your gluten-free voice, and be part of making that desperately needed reform happen.

- Pete

Wednesday, October 14, 2009

Diagnosis: Celiac (Part 2 - The Slippery Slope of Solutions)

It's one thing to criticize the health care system as being badly broken, but quite another to criticize it AND offer a suggestion for a viable solution. And yet, solutions are what is needed. You could look to yesterday's post for a reason why we need solutions. Or you could let statistics speak for themselves:

When the World Health Organization unveiled its World Health Rankings in 2000, the U.S. came in 37th, behind countries such as Costa Rica, Morocco, and Colombia. Admittedly, the task of ranking the world's health systems has become an incredibly complex one, and it is a process that has been criticized of having bias inherent in the formulas used to calculate the rankings. For that reason, the WHO has ceased publishing official rankings. But the WHO does continue to publish health statistics, which are free of bias, and which - I think - are even more telling (and more damning of the U.S. health care system) than the 2000 rankings.

I did a query of the WHO database, comparing the United States to other developed, Western countries such as Canada, Australia, Ireland, United Kingdom, Belgium, Norway, Germany, France, Switzerland, Spain and Portugal. And I looked at data for those countries that couldn't lie: adult mortality rate, infant mortality rate, life expectancy, healthy life expectancy, rate of obesity. The U.S. rated last in every statistic. We have the highest adult mortality rate, the lowest life expectancy and the lowest healthy life expectancy. Our infant mortality rate is the highest, too, roughly double that of many other countries in the comparison. And our obesity rate far exceeds any other country (we're nearly four times that of Italy, and more than five times that of Norway).

So even momentarily setting aside the issue of Celiac Disease, the health care system in our country is not working. Then we bring Celiac and its nuances back into the picture, and we have a heightened personal stake in the issue, coupled with a pretty compelling mandate for change.

But what would change look like? What would be an effective solution? On the surface, the solution seems obvious enough: ensure that all Americans have basic, essential health coverage (irrespective of age, race, gender, religion, sexuality, pre-existing conditions, etc.). But then the slippery slope comes into play...

First, should all Americans pay the same to be part of such a solution, or should some Americans pay more than others on the basis of pre-existing conditions, risk factors, and other considerations. The latter is already happening to a large degree. People with pre-existing conditions are paying more to join health insurance plans, or are being directed to individual and group plans that have inherently higher rates to cover the anticipated added medical expenses associated with caring for those individuals. We're also seeing an expanded role of "lifestyle taxes." There's the sin tax on tobacco and alcohol. There's a new debate about a possible sugar tax. And another new debate about a possible so-called fat tax (both charging obese people more to obtain health insurance, AND levying a tax of fattening foods).

On the one hand, it seems only sensible to pro-rate costs. Not all individuals will utilize the health care system equally. But on the other hand, deciding how much to pro-rate costs according to each person's unique profile is a near-impossible task (how do you weigh family history and genetics against environmental risk factors against personal lifestyle choices? how do you measure the risks of the cautious mountain climber against the careless driver who's texting?). Not to mention that pro-rating walks a very fine line that could easily tip over into discrimination. (And I can think of a hundred other examples where this slippery slope leads into murky waters, such as a sin tax on alcohol - too much alcohol is bad for you, but moderate consumption is actually good for you... so do we need a combined virtue payment and sin tax, depending on whether you drink a glass a day or a bottle a day? But I digress...)

Second, there's the seemingly obvious statement of providing "basic, essential health care" to all Americans. Well, what constitutes basic, essential health care? Making such a determination immediately sets us on a course of having to make value statements and tough decisions. Is a procedure essential or not? If a procedure is deemed elective, are all elective procedures voluntary? Or should some be deemed medically necessary? Again, we're walking down a path of subjectivity, which opens itself up to criticism.

Third, there's an issue of restructuring the payment system. Denver's 5280 magazine recently published an interview with an area doctor who made an interesting point - at present, doctors get paid by the insurance companies in part for ordering tests and procedures. To this degree, docs are incentivized to order more tests and procedures, which is not the same thing as helping a patient to get healthy. Instead, this doctor proposed an alternative in which doctors get paid for performance... in essence, they get paid for succeeding in helping patients to be healthy.

At first glance, it seems like a no brainer. I think such an approach would go a long way toward shifting our health care system away from sick care (which is what it really should be called) and wellness care (which is what we're striving for). But then that slippery slope creeps in again. If we financially reward doctors for the health of their patients, then what would stop them from skewing their patient loads toward healthy people and excluding unhealthy patients, in order to maximize the performance incentive? We'd need to regulate doctors the same way we're now trying to regulate insurance companies on the issue of excluding patients from insurance plans because of pre-existing conditions. Then there's the issue of exactly how we'd measure "healthy patients." Take their blood pressure? Cholesterol? Predict their lifespan? Ask them how happy they are? I have no idea...

The real struggle, I think, is that all parties involved - the patient, the health care provider, the health insurance company, and the government - need to have a stake in our well-being. Only then can they begin to make decisions that are in the best interest of the person. Allow me to share my landlord-tenant analogy to explain. I used this analogy a lot when talking about the environment, and energy conservation in particular, in my pre-writer days when I worked for an environmental non-profit. If a landlord includes all utilities in a renter's lease, the renter has no financial incentive to conserve energy, because they don't pay those costs. They crank the AC in the summer, and turn up the heat in the winter (maybe enough so that they then open a window to cool down an apartment!). They leave lights on, and electronics running. Conversely, if the renter pays all utilities, the landlord has no incentive to install energy efficient upgrades - better lightbulbs, better appliances, improved insulation, better windows. Only when landlord and tenant share the cost of utilities do both parties have an incentive to conserve.

I think a viable solution to the health care dilemma might take a similar approach. If all parties had a financial stake in promoting a healthy individual, they'd all take steps to make that happen. And if the patient's portion of the financial pie was some percentage of overall costs, they'd be financially motivated to make healthier choices, because their expenses would scale up or down with their medical costs. They'd be financially motivated to lose weight. Eat better food. To make the kind of lifestyle decisions that would decrease their medical expenses. And we wouldn't need sugar taxes and fat taxes and sin taxes to do it. (I'd like to think that our own health would be enough of an incentive, but that's clearly not enough to get Americans to make better choices based on the statistics and trends...) Of course, even that proposed scenario has its own challenges. Most notably, ensuring that a patient's share of the financial pie doesn't become a huge financial burden they're unable to pay. Somehow, a solution needs to remain affordable. Sigh...

What's more, I think we need a combination of regulation AND incentives. This perspective I also gleaned from my environmental days. We need regulation to set boundaries, to establish acceptable operating parameters. But we also need incentives to help push things further in a desirable direction. (For justification of this position, I think we could argue pretty strongly that given the current state of affairs, financial incentive alone hasn't worked...given the failure of a purely privatized, capitalist approach to health insurance that relies upon Adam Smith's Invisible Hand to guide us.)

In the end, I think it's important for all stakeholders to remember that life is a pre-existing condition. What I mean by that is that we all face risk factors. We're all going to be sick at some point in our lives. Sure, the details will differ from person to person. But inevitably, we'll all be in a similar boat at one point or another. Some of the factors are in our control. Some are not. But we all need health coverage, regardless of the nitty gritty details.

One of the justifications insurance companies have cited for keeping Celiacs in the "excluded due to pre-existing condition" category is that such patients can't be measured in their "compliance" with a gluten-free diet. This really irks me. In my experience, people with Celiac are actually some of the most likely patients to adhere to a diet prescribed by their doctor! This is no doubt due to the fact that we can almost immediately and very clearly see the improvement in our health, and we immediately feel the effects of a gluten contamination. We are fiercely incentivized to stay true to the diet. Compare this to, say, the person with high blood pressure or high cholesterol, and whose doctor tells them they need to shape up. How many don't follow those doctor's orders? Maybe that's because the blood pressure and cholesterol don't provide the kind of immediate feedback that gluten does to someone with Celiac, and the effects are longer-term, finally showing up years later as a heart attack, maybe.

My point, again, is that life is a pre-existing condition. There are a million tiny factors that influence each person's health profile. And it seems unfair to deny coverage to certain people with pre-existing conditions, while millions of other people may be just as burdened by health issues. Which brings me back to the beginning. We need basic, essential and affordable health care for all Americans. That much I know. What remains to be seen is how that can be achieved in light of the slippery slope of solutions.

Coming tomorrow: Part 3 - The Case Study. I've spent two days talking about ideas and hypotheticals and anecdotal stories. That's all well and good (and lengthy...looking how much I've been writing). But I decided to dive head first into the issue by using myself as a guinea pig and wearing my investigative journalist hat. I approached four health insurance companies with a scenario, and you'll be surprised to see how complicated the responses quickly got... This specific example will go a long way toward illustrating how someone with Celiac Disease can navigate the health insurance quagmire today, and hopefully how we can advocate for better health care reform tomorrow.

- Pete

Tuesday, October 13, 2009

Diagnosis: Celiac (Part 1 - The Problem)


With a current nationwide debate raging about much-needed health care reform in the United States, I thought it was timely to address the thorny topic of Celiac Disease and health insurance. For many, it's a sore subject, and understandably so. In fact, I was first inspired to tackle this slippery slope after reading the Facebook status update of a friend of a friend. She lived in Texas and had recently changed jobs. Applying for health insurance under her new employer, the woman was denied coverage because her Celiac Disease was considered a pre-existing condition that excluded her from eligibility. Could that happen to me? I wondered. You've probably wondered it, too, or maybe it has already happened to you.

If you do a basic Internet search for "Celiac Disease health insurance" you'll turn up hundreds of anecdotal stories from people who've all experienced the same outcome: denial of health insurance coverage. It makes it seem like a huge and prevalent problem, and it is. I think that many Americans are revolted by the idea of being denied health insurance, or dropped from coverage, on the basis of a pre-existing condition or new diagnosis (with Celiac or something else). Especially those people who have been on the unfortunate receiving end of such a scenario.

Much harder to find - but definitely out there - are the success stories of people with Celiac Disease who have obtained and retained health insurance. Given that plenty of these types of examples exist, how do we make sure we're in the latter population, and not the former?

Before we can answer that question, however, it's important to fundamentally understand the problem...simply, that millions of Americans are without health insurance, and can't afford the grossly inflated cost of health care in the United States. That's it, plain and simple.

The moral/ethical position of the General Public, I think, is also easy to state: I believe we have evolved as a society to a point where we generally agree that all people should have a fundamental right to basic, essential health care. That much is not in debate. It would be a rare and cold-hearted individual who would look at a fellow human being and say, "Deny them care. Let them die." Even so, I feel as though it's important to state this plainly. Over the years (and decades, and centuries, and millenia) those in power have had a need to state and assert the rights of those who are not in power; rights that seem self-evident, obvious, and not needing to be so plainly stated. The Declaration of Independence, U.S. Constitution and Bill of Rights (and subsequent amendments) did it (life, liberty, pursuit of happiness). The leaders of the women's suffrage and civil rights movements did it for women and minorities, respectively. The United Nations had to do it for access to clean drinking water. More recently, I think we could add "access to education" and "patient's bill of rights" to the list.

And so I say it again - people have a right to basic, essential health care. The devil's in the details, though, and that - I believe - is where the nation's debate resides. Namely, how much should health care cost? Who should pay for it? And how?

Of course, all three of those questions hit at the heart of the problem...that the health care system in the United States today is one centered not necessarily on health, but rather one centered on money. We have commoditized human health, and so instead of making health care a moral and ethical mandate, we've made it an economic argument, weighed in pros and cons, and costs and benefits. We look not at the value of a life, but at the cost to maintain that life. I hesitate to use these words, because they are so polarizing, but it partly comes down to the difference between a purely capitalist approach to health care, and a more socialist perspective.

In the U.S. today, it all comes down to risk pools. Any health insurance system is based on maintaining a workable risk pool, a balance of healthy and unhealthy individuals all enrolled in the same plan. We'll all be one of the "unhealthy" people at some point in our lives, but the idea is for the majority - the healthy folks, with their decreased medical expenses - to balance out the minority - the unhealthy folks, with their increased medical expenses. Again, we're back to the financial balance sheet.

People with pre-existing conditions get denied or dropped from coverage, then, because they're seen as being permanent residents of the "unhealthy" category of people, and insurance companies would then expect to have heightened ongoing costs associated with funding medical care for these persons. Viewed from a purely callous economic standpoint, this is a reasonable position. It'd be like insuring the Mona Lisa painting for $100 million, knowing it's going to get stolen next week. No underwriter would back that policy, and that's how insurance companies view pre-existing conditions.

There are just two big problems with that. Firstly, it violates my hypothesized generally agreed upon but not explicitly stated right of universal access to health care. Secondly, and very specifically to the case of those of us with Celiac Disease, it's an inaccurate perspective.

If you've lived with Celiac Disease, been diagnosed, and then been gluten-free for a period of time, you undoubtedly know that you're far healthier post-diagnosis than you were pre-diagnosis. If we think about it in terms of economics, undiagnosed Celiacs are a much greater financial burden on the system than Celiacs who are gluten-free. And there's the irony - our pre-existing condition actually makes us healthier than Celiacs who are undiagnosed (and hence who, in the eyes of insurance companies, have no pre-existing condition). We'll require less medical care over our lifetime, not more. What health insurance company wouldn't want to back that scenario?

Instead, we have the current dilemma. When we are sick, we turn to the health care system for help and answers, and to hopefully get better. But once we find those answers - in the form of a Celiac diagnosis and the instruction to follow a GF diet - we might suddenly find ourselves expelled from that health care system. For many people, being thrust into the GF lifestyle can be an initially isolating experience. Must we be isolated in our health care, too?

In response, some people with probable Celiac Disease shy away from pursuing a definitive diagnosis. For one, this skews the statistics, making the disease seem less prevalent than it actually is, and potentially impacting the amount of research funding that flows into the cause. But for another, it enables people to avoid a formal diagnosis so that they don't create a medical paper trail that leads back to Celiac (for fear of being denied or dropped from coverage). Either that, or it encourages some diagnosed Celiacs to lie and not claim or disclose Celiac Disease as a pre-existing condition when applying for or renewing health insurance. And that amounts to insurance fraud.

So what to do about it? Coming tomorrow...Part 2 - The Slippery Slope of Solutions.

- Pete

Friday, October 9, 2009

Friday Foto: Jambalaya

I've long been a fan of jambalaya. The blend of meat and seafood, rice and vegetables, and the way it all comes together in a heap on your plate just does it for me. In college, I'd frequent a place called Maxi's Supper Club in Ithaca, NY, largely because of their jambalaya. Lately, I've been talking to Kelli about making a jambalaya at home, and last we pulled the trigger.

Jambalaya is a dish with strong Louisiana roots, but there is some variability in its preparation, depending on whether your influence is Creole or Cajun. I'm calling this version our Crejun Jambalaya, because it blends the two styles. A strong tomato component is very much in line with the Creole style. But the sausage and spices speak to Cajun influence. Hence, Crejun.

First things first... preparing this dish starts with making a custom jambalaya spice mix:

1 tbsp onion powder
1 tbsp garlic powder
1 tbsp dried oregano
1 tbsp dried basil
2 tsp dried thyme
2 tsp ground black pepper
1 tsp cayenne pepper
5 tsp paprika
1 tbsp salt

Mix them together and store them in a spice jar or small, airtight container.


Then comes the recipe itself:

1 pound savory smoked/spicy sausage, cut into 1/2- to 1-inch thick discs
1 pound raw shrimp, peeled and deveined
1 1/2 green bell peppers, diced
1 onion, diced
5 garlic cloves, minced
1 14.5-oz can no-salt-added peeled and diced tomatoes
1 tbsp + 2 tsp jambalaya seasoning
5 shakes Frank's hot sauce
1 tsp Worcestershire sauce
1 cup uncooked long grain rice
water

1. In a large pot over medium-high heat cook the pepper, onion and garlic until the onions are translucent.
2. Add the sausage, 1/2 cup water, the tomatoes, jambalaya seasoning, hot sauce, and Worcestershire. Stir well, reduce the heat, and simmer for 10-15 minutes.
3. Add the uncooked rice and 1 cup water. Stir again, and continue simmering for another 15-20 minutes. (For this step, I like to simmer with the pot partially covered...I'll leave the lid slightly askew.)
4. Monitor the cooking. When the rice is al dente, add the shrimp. Again stir, and continue cooking just until the shrimp are done. Then remove from the heat and serve.

Enjoy!

* A note about the sausage. For the photos, we used a smoked turkey kielbasa, but you could substitute any savory smoked and/or spicy sausage, such as andouille.

- Pete

Thursday, October 8, 2009

Restaurant Non-Review: Abo's Pizza, Colorado

Earlier this week a friend had to cancel a dinner party because he was feeling sick and a co-worker had recently been diagnosed with H1N1. Kelli and I volunteered to host a change of venue so that the group could still get together. On such short notice, we weren't prepared (nor did we have the time) to prepare a scratch dinner. So we did the All-American thing...we ordered in pizza.

I first placed a call to Abo's Pizza, which has a location just a little more than a mile up the road from us. Originally founded in Boulder, there are now 18 locations throughout Colorado. Though the website didn't make any mention of a gluten-free pizza option, I figured it couldn't hurt to call and ask.

Much to my (initially) pleasant surprise, they did! But my joy was short lived. For starters, this sucker was expensive. The 12-inch GF pizza (plain) was available for the princely sum of $17.92. Add one topping, such as pepperoni, and jack it up to $19.81.

Then, as I always do, I started asking questions. "What's in your gluten-free crust?"

The guy on the phone dutifully grabbed one of the pre-made crusts and proceeded to read the nutrition information...calories, fat, carbs. etc.

"No," I corrected him. "Could you list the ingredients, please?"

He rattled off a straightforward list of ingredients (i.e. cheese, olive oil), with one glaring exception...something called the "Bistro gluten-free flour blend."

"What's in the Bistro flour blend?" I asked. "That's where the gluten would be."

"It's proprietary," was his response.

What? I couldn't help thinking. How could they not divulge the very ingredients that were meant to replace the gluten? (Never mind the questionable legality of this tactic.) In effect, they were forcing the customer to accept an implied "Just trust on this" with respect to the GF flour blend. And if I may speak on behalf of the GF community, we're not in the habit of "just trusting" anyone. We like to read the ingredients and make decisions for ourselves.

Meanwhile, the store manager was chiming in in the background, with the guy on the phone relaying the message.

"Umm, are you gluten intolerant or something?"

"Yeah, I have Celiac."

"Well, don't buy the gluten-free pizza if you're sensitive. My manager says it's better not to risk it."

End of conversation.

I ended up ordering other pizzas, and when I related this same story later that evening to our guests, one of them made a good point. "What if you hadn't asked those questions?" Indeed. What if I had simply asked if they had a GF pizza. They told me yes. And I said, "Great! Place me an order!"

This was a perfect example of when a little information (on the part of both the pizza parlor and the consumer) is more dangerous than no information at all. It hammers home a message I often try to share... be your own best advocate. Ask questions. Scrutinize ingredients. Experiences like these are what cause the GF community to so often be wary when dining out. We are sometimes forced to take a stance of Question Everything. Trust No One. (Sounds like a spy movie, doesn't it?)

But the story doesn't end there. As a follow up, I emailed Abo's corporate office with two basic questions: 1) What's in the Bistro gluten-free flour blend? And 2) What steps do you take to minimize the potential for gluten cross-contamination in your pizzerias? I pointed out that I wasn't asking for exact quantities or ratios on the flour blend, but that transparency in terms of the ingredients themselves was critical.

Founder Steve Abo replied: "...as of now only the Abos on [South Broadway] in Boulder has a gluten free crust that they purchase from one of our vendors. I don't produce a glutin [sic] free crust." In other words, only 1 of the 18 locations did a GF crust, basically flying solo in the effort. (Steve either ignored or was unable to answer my question about cross contamination.)

The GF pizza crust, meanwhile, is supplied by The Gluten Free Bistro in Boulder, Colorado. Julie McGinnis, one of the cofounders, kindly emailed me the ingredients of the Bistro flour blend: buckwheat flour, brown rice flour, tapioca flour, sorghum flour, coconut flour, xanthan gum, garlic salt, olive oil, and applesauce. Their premade pizza crusts are now being used by several area restaurants.

Stay tuned for an upcoming separate and independent review of the Gluten Free Bistro pizza crusts. I'll be getting my hands on some and making some pizzas at home to evaluate the crust. As for the Abo's in south Boulder...steer clear as far as GF pizza is concerned.

- Pete

Wednesday, October 7, 2009

Recipe: Garlic Shrimp

Up until recently, we had a massive bag of raw shrimp living in our freezer, and we've methodically been working our way through it, using the shrimp to make all sorts of dishes...from shrimp pad thai, to jambalaya (coming up in the Friday Foto), and in this garlic shrimp. This recipe is basically a quick and easy shrimp scampi, minus the chopped fresh parsley garnish.

I'll be honest with you. Either Kelli or I (probably me) accidentally threw away our recipe notes for this one. Thankfully, Kelli is a master at recalling her on-the-fly recipe creations, and we've done our best to recreate that which was lost. Admittedly, the exact measurements and ratios may be just slightly off, but probably not enough to impact the recipe. Though the photos and the recipe instructions make it sound simple and straightforward (which it is), the shrimp burst with flavor from the garlic, butter and white wine.


3 tbsp butter
3 cloves garlic, minced
Juice of one lemon
1/2 cup dry white wine
Salt and pepper to taste

Raw shrimp, peeled and deveined
GF pasta

1. Saute the butter and garlic until fragrant.
2. Add the shrimp and saute just until they're pink and cooked through. (Overcooking the shrimp will make them tough/chewy.) Remove and set aside.
3. Add the lemon juice and white wine, and simmer until the sauce is reduced by roughly half and slightly thickened. Season with salt and pepper.
4. Add the shrimp back in, toss to coat, and serve over your favorite GF pasta.

Enjoy!

- Pete

Tuesday, October 6, 2009

No Soup For You...Maybe

Yesterday I mentioned how both the attendees and the presenters at the GF Culinary Summit came from points near and far, and from equally diverse food backgrounds. We were all brought together, though, by one common thread: we're all gluten-free. But as the weekend moved along, I was continually reminded that for many, being gluten-free is just one component of a broader set of dietary restrictions. This is a topic I've addressed before, in a post titled Degrees of Free-dom from back in October 2008.

At the GF Culinary Summit in particular, I met folks who were not only gluten-free, but who were also... lactose-free, casein-free, dairy-free, soy-free, corn-free, and citrus-free. There were omnivores and vegetarians and vegans and adherents of the paleo diet. And surely there must have been others who I did not meet. As presenters were demonstrating a given dish, audience questions would inevitably pop up... Can I use Energ-G egg replacer? Can I substitute Smart Balance for butter? Can I use almond milk in place of cow's milk and cream?

Now that Kelli and I are gluten-free bloggers AND cookbook coauthors, I look at those degrees of free-dom through a slightly different lens than when I originally wrote about it in October. I've always had a level of understanding with and empathy for people with multiple degrees of free-dom because I'm one of them. Gluten is my dominant food no-no, but there are others, such as grapefruit. But now, the big question for us is: When developing new recipes, who are we developing them for, and how many dietary restrictions do we impose on ourselves in concocting recipes? The answer isn't quite as straightforward as I might like.

On one extreme end of the spectrum, we could take into account the full set of dietary restrictions I listed above, and create recipes and dishes that would be almost universally acceptable. This approach is hampered by two challenges: 1) It is almost unimaginably restrictive in the set of ingredients that would be permitted in our "toolbox," and 2) It would unfairly (or perhaps more accurately, unnecessarily) constrain people who don't have such an extreme level of dietary restriction. (And indeed, I don't know anyone who would be bound by ALL the restrictions I listed... each one of us is likely bound by a small subset of them...)

On the opposite end of the spectrum, we could cater to the lowest common denominator - gluten. We could develop recipes that are gluten-free, and in this sense, they would have a different kind of universal applicability since that is the dietary restriction shared by all of us. Of course, this approach has its own pitfalls. Most notably, if you have dietary restrictions beyond simply gluten, you're left to fend for yourself and modify the recipe in order to make it work with your particular diet.

Then there's what I call the selfish end of the spectrum. If Kelli and I were developing recipes only for ourselves, then this is the logical route to take. In essence, we'd create recipes that adhere to my particular set of dietary restrictions. They'd work for us, and since we're our own target audience, then it'd be a case of mission accomplished. But we don't create recipes only for ourselves, so the selfish approach wouldn't necessarily work because it's...self-serving.

Lastly, there's what I'd call the customization approach. In short, we'd customize our recipes based on the needs of the moment. We do this already when having friends over for dinner. We'll be making a gluten-free dinner for my sake. But sometimes we'll also have a vegetarian at the dinner table, or someone who can't do refined, processed sugars. And so we tailor the meal to meet the needs of everyone present. We can do this on the blog to a degree, answering questions and comments and offering suggestions for modifying a recipe to suit someone's particular needs. But a cookbook is a much more static thing, and we can't predict who might pick up a copy off the shelf at their local bookstore.

And therein lies the rub. So what do you think? If we assume that gluten is the most frequent, common denominator, what are the most prevalent secondary dietary restrictions? Lactose? Dairy in general? Something else? And when you build a recipe, do you do it for yourself? Or for a friend or family member who has a certain set of restrictions?

These are good questions to answer, I think. As gluten-free foodies, we're accustomed to asking others to accomodate our needs...whether a family member or friend, a restaurant, whatever. But it helps, at times, to think about the dietary needs and restrictions of others, which may be more restrictive - or simply different - than our own. And as people who do have a dietary restriction, we're in a unique position to understand how that feels.

- Pete

Monday, October 5, 2009

GF Culinary Summit, West Edition

Students from Johnson & Wales University who entered the GF Baking Competition pose for a snapshot with some of the event sponsors (including Expandex, Pamela's, Bob's Red Mill, Deby's Gluten-Free).


This past weekend was the Gluten-Free Culinary Summit, West Edition, held on the campus of Johnson & Wales University in Denver, Colorado. I'm going to put myself not too far out on a limb and say that if you weren't there, then you missed a spectacular event. It was two full days of fun, entertainment, inspiration, motivation, and camaraderie. Attendees and presenters alike traveled in from far and wide. There was a local Colorado contingent, of course, but they also came from places as distant as California, Minnesota, Connecticut, and Florida. They were chefs, bloggers, culinary students, company reps, cookbook authors, and passionate gluten-free foodies that made for a wonderfully diverse mix of people.

Kelli and I were there wearing many hats: as gluten-free bloggers, and as gluten-free cookbook coauthors, of course. But I also served as a judge for the GF Baking Invitational competition, and Kelli and I did a demo on Sunday afternoon showing how to make our pie dough/crust. (By the way, "we" did a demo means that I was the mouthpiece, telling our story, and Kelli was the talent, getting her hands dirty and making her as usual beautiful pie dough.)

The session topics covered some good ground. Day One featured a discussion of alternative grains and flours, insights into bread baking, breakfast porridges, cookies, imaginative desserts, and more. Day Two covered quickbreads, chocolates, Italian (bread and polenta), GF flour blends, savory dishes (including potato-based lasagna), and more. (Of course, in the interest of brevity, I've greatly abbreviated the topics here, and my one- or two-word topics don't nearly do each session and their presenters justice.) And, it must be said, we tasted lots of delicious samples. If I had one criticism (and this one that seemed to be generally shared by many who were there), it is that the sessions on the average trended toward sweet baked goods, and so by the end of the weekend many of us were overdosed on sugar and craving something wholly savory. But that's a minor quibble.

On the GF baking competition side of things, the judges' scores were tallied and counted along with a popular vote submitted by the attendees. We tackled foods entered in four categories: quick breads, cookies, yeast breads, and brownies. What I found most interesting, and inspiring, was not only the number of JWU students who entered the competition (kudos to them for tackling the challenge, and for perhaps becoming the next generation of GF bakers!), but also the sheer variety of entries within each category. The quick breads ranged from the relatively straightforward (lemon poppy seed muffins, pumpkin scones) to the imaginative and creative (Victorian sponge cake with rasberry filling). Other categories followed suit. For example, yeast breads ranged from a bagel to a kugelhopf to a rosemary focaccia.

I'll be completely honest. A select few entries left a lot to be desired. Many came in down the middle of the road - fair to average to good. But some were truly stunning. As the judges chatted in the back room after independently judging the entries and submitting our double blind evaluations (we didn't know the names of the entrants for each recipe, and our names were kept off our score sheets), most of us agreed that certain entries you couldn't tell were gluten-free, and that they could definitely find a place in a cookbook. Despite the fact that we were necessarily highly critical as judges, as a general rule we applauded the full spectrum of entries. As I said during my judge's comments at the event: Even if a recipe doesn't turn out quite as planned, or even if you deem it a failure, don't be discouraged. Kelli and I know from personal experience that you sometimes experience spectacular baking failures before you arrive at success. (Also, the winning submission in each category will have the recipe posted on the GF Culinary Productions website... keep an eye posted for that!)

I could go on and on about the finer details of the weekend, but I'm going to cut myself off here. If you have questions about a particular session, let me know. I'd be happy to answer it as best as I can. And I encourage you to browse the list of presenters...many of them came from restaurants with wonderful GF offerings, and you just might consider popping in to have a bite!

- Pete

Friday, October 2, 2009

Friday Foto: Pepper Sauce Steak

Most often when we're making a nice cut of steak for dinner, we'll keep the preparation pretty simple and let the flavor of the meat shine. Maybe a rub of salt on each side, and that's more or less it. But every now and again, I get a craving for something more...a red wine reduction, maybe, or in this case, a pepper sauce. As an added bonus, the pepper sauce goes great over mashed potatoes, so it's a double bonus. The pepper sauce is rich, with a complex layer of flavors, yet it's incredibly simple in its preparation. Here's how to make it:

3 tablespoons butter
1/4 cup onion, chopped
1 clove garlic, minced
1/2 teaspoon fresh cracked pepper
1 cup beef stock
1 tablespoon balsamic vinegar
1 tablespoon cognac

Saute the onion and garlic in the butter until the onions are translucent and the garlic is fragrant. Add the remaining ingredients, mix well, and cook over the stovetop until the sauce is reduced and thickened. Serve over beef/steak and mashed potatoes. Enjoy!

- Pete

Restaurant Review: Roosters Brewing Company and Restaurant, Ogden, UT

The night of the Xterra race in Utah, we went out to dinner on 25th Street, in historic downtown Ogden. The Mountain2Metro festival was in full swing, and after walking up and down the block evaluating our options, we settled on Roosters Brewing Company and Restaurant. To my pleasant surprise, they offered a gluten-free menu. Mind you, they had only a single copy, and it was rudimentary - someone from the kitchen had circled (in pen) menu items that were gluten-free, or could be prepared as such (handwritten notes indicated how to order an item in the latter case). But it was a GF menu none the less, and I felt good about that.

We started off with cocktails - gin and tonics with lime - to celebrate the race. The drinks were perfectly balanced. In my experience, this is not to be underestimated. Many a bartender, thinking they're doing me a favor, make a gin and tonic much too stiff. It completely throws off the balance of flavors. You need just the right amount of gin and tonic, and then a squeeze of lime, to pull it off with success. Roosters did.

Salads followed next. No surprises here. Just straightforward tasty goodness.

For dinner, I ordered an angus ribeye steak, cooked medium, with mashed potatoes and steamed veggies. Kelli had a baked chicken dish, which would have been ordered gluten-free if grilled (it also came with mashed potatoes and some veggies). The steak was delicious, though a portion of the cut was much too fatty/grizzly for my taste. Kelli had a mixed experience with her chicken - one breast was excellent, the other left something to be desired. We both agreed that the mashers were average. We've had much worse, but we've also had better.

So what does that make our final verdict? Roosters offers a middle of the road experience for the gluten-free diner. If you're in Ogden, it's worth a look, but 25th street offers much more that will surely catch your eye.

- Pete

Race Recap: The Championship

Team Bronski at the finish line after the 2009 Xterra U.S. National Championship

It was still dark when we drove up Ogden Canyon en route to Pineview Reservoir, the site of the swim portion of the 2009 Xterra U.S. National Championship. AC/DC and the soundtrack to Rocky IV played loudly through the car's speakers (sorry Marin, but Daddy needed to get psyched up...). Breakfast earlier that morning consisted of two yogurts and a banana, and as we arrived at Pineview, I noshed on a bit of gluten-free cereal (Nature's Path Organic Toasty O's). Because this was a point to point race, I had to set up two transitions - the swim-to-bike transition at Pineview, and the bike-to-run transition at the base of Snowbasin up in the gorgeous Wasatch Mountains.

We parked in a grassy field next to T1, and it was chilly before the sun crested the horizon. I did my usual pre-race routine - affixed my race number to the front of my bike, checked my tire pressure, taped packets of GU to my handlebars. Then I snagged a good spot in the transition area, and we cruised up to Snowbasin to get set there as well. Finally, it was back to T1 to prep for the race.

As usual, the energy on race morning was super positive, and in no short supply. In fact, it was heightened by the magnitude of the event. TV crews were getting pre-race footage for the syndicated one hour special that will air in early 2010, and as the 9am start time approached, athletes wiggled into their wetsuits and warmed up with a short swim in the reservoir. I took one last dose of ibuprofen, and waded into Pineview.

Because of how sick I'd been feeling right up until race start, I abandoned my original hope of pushing as hard as I could and seeing how I fared against the course and the field of elite competitors. Instead, I knew it would be important to set an alternate target... My biggest priority was simply to finish the race. Anything else was just gravy. To make sure I did that, I told myself two things - 1) meet the transition cutoff times, and 2) race within myself, taking a relatively modest pace so I wouldn't "blow up" somewhere on the course.

As 9am loomed, all the Championship athletes congregated at the water's edge. There were some 300 of us, plus the pros. People such as Conrad Stolz from South Africa, Nico Lebrun from France, Melanie McQuaid and Mike Vine from Canada, Josiah Middaugh and Shonny Vanlandingham and a long list of others from the U.S. These were people I'd seen race this event on TV just last year, and now I was lined up shoulder to shoulder with them. A helicopter hovered 200 feet over the race start, with a film crew dangling out the open door, catching all the action.

The cannon boomed, and we were off...everyone, all at once. No waves of swimmers sent out in groups separated by one or three minutes. Given that these were some of the best off-road triathletes in the country, it makes sense that they'd also be some of the most competitive, but for a moment I was startled at just how rough it actually was. Forget getting kicked or punched...there were full on strangle holds taking place out there! And there were other unexpected surprises as well - such as when I lifted my head up to sight the next buoy, and found myself staring straight into a video camera in a waterproof housing, held by another TV guy catching the action from out in the water.

I came out of Pineview feeling okay, took my time moving through transition, and then set out onto the mountain bike. That was going to be the make or break moment of the day. The mountain bike covered 30k (about 19 miles) and climbed more than 3,000 vertical feet. After a short stretch on the shoulder of a highway, it set off into Wheeler Canyon, and then ascended up into the Wasatch Mountains. It was liberating, in a way, to back off my race pace. I didn't obsess about checking my watch, I didn't worry about other racers passing me, I took the time to look up and admire the scenery (stunning...Utah fall foliage in full effect). I knew I had fallen well off the pace when the helicopter - following the race leaders - grew farther and farther away, until I couldn't even hear it anymore.

Around the 12.5 mile mark, I popped out of the woods and prepared to make the turn up into the final 6-plus miles of the bike, which included the steepest climbs of the day. By then I had written myself off, figuring I was bringing up the rear of the race. But then, to my amazement, I looked up and saw a string of racers climbing the next hill. More incredibly, as I ascended that hill as well, I looked back down and saw more people coming up behind me. By golly, I was still a part of this thing.

I came down into transition a little while later and tried to mentally prepare myself for the run. Kelli and Marin were there waiting for me, cheering louder than ever, and the boost to my morale was critical. As I tackled the 10k (6.3 mile trail run), my gas tank - which more or less started on empty - was running on fumes, despite sucking down a number of GUs over the course of the race. In order to survive this final leg of the race, I created a hierarchy of rules for myself. #1 - Run for 3 minutes, walk for 1 minute. #2 - If the 3 minutes ends, and I'm on a flat or a downhill, keep running until I hit an uphill. #3 - Always hydrate at the aid stations.

Incredibly, it worked. Not only did I survive the run portion. I also started passing other racers. Believe me, this was not part of the game plan. I was in no condition to be "reeling people in," as I normally might in a race. And yet it happened.

Then, some 4 hours and 18 minutes after the cannon first sounded at Pineview, I crossed the finish line. Kelli was there waiting for me (Marin was asleep in her stroller). We embraced in a tight hug, and then I started to cry simultaneous tears of joy and tears of agony. This goal - first set forth so long ago - had come to fruition. I was there, competing in the national championships, and I finished the course, despite my sickness. By that same token, it was the hardest race I'd ever done, and I was utterly spent.

I composed myself, and we sat in the shade as a family while I recovered. A long season of racing had come to a close. It had been one filled with many ups and downs, and ended - perhaps fittingly enough - on both a high and a low. I felt as though I had unfinished business. I had finished the course, but I hadn't been 100%, and I wondered just what I could do against the course and my fellow competitors if I had been at full strength. But for now, I'm relaxing. No training, no racing. I'm taking a few weeks off to let my body and my mind recover. And then, surely enough, I'll resume training, building a new foundation of endurance for next year. But that's putting the cart ahead of the horse. Neither Kelli nor I are ready to think about that just yet. For the moment, we're going to simply enjoy this moment...

- Pete