Feel Fabulous with Fiber

                                                                    

Fiber is an important nutrient that many Americans fall short on. The recommended intake is 25 grams per day for women and 38 grams per day for men. Fiber is not only important to aid in a healthy GI system but also promotes fullness after meals, helps to promote a healthy weight, can help to lower cholesterol, and helps to maintain blood sugar levels within a healthy range.  

Fiber is found naturally in many food sources such as fruits, vegetables, beans, lentils, nuts, seeds and whole grains so before thinking you need a supplement to help meet your needs you may want to try incorporating some of the foods listed below: 

• 1 large pear with skin (7 grams) 
• 1 cup fresh raspberries (8 grams) 
• ½ medium avocado (5 grams) 
• 1 ounce almonds (3.5 grams) 
• ½ cup cooked black beans (7.5 grams) 
• 3 cups air-popped popcorn (3.6 grams) 
• 1 cup cooked pearled barley (6 grams) 

Meal ideas may entail oatmeal with nuts and berries for breakfast or for lunch a whole wheat wrap with added vegetables such as spinach and tomato. For healthy and fresh snack ideas try vegetables or whole wheat crackers with hummus.  

When eating fruits and vegetables, eating the skin or peel will help to increase fiber intake. Just be sure to always wash your fruits and vegetables prior to eating. Also, consuming products that have not been refined will have greater fiber content. For example, an apple will have more fiber than applesauce and applesauce will have more fiber than apple juice as apple juice has no fiber. So, the more refined the product is the less fiber it will have.  

It is important to increase your fiber intake slowly and to be sure to drink plenty of water. Increasing fiber too quickly can cause GI discomfort such as constipation, diarrhea, abdominal pain or bloating. Drinking plenty of water will also help reduce discomfort as the more fiber you have, the more water you will need.  

Larson, Holly. "Easy Ways to Boost Fiber in Your Daily Diet." Academy of Nutrition and Dietetics. Sept 2016. Web. 29 Sept. 2016.  

Back to School!

It is the time of the year when summer is wrapping up, everyone is getting back from vacations, and school supplies are on sale at every store. August and September are those months that both parents and children start to adjust back to the new school year. This means waking up earlier and schedules are busier with school time activities. It is important that families have a plan on how to manage school time meals because those meals are critical to those growing children. The following tips are ways to prepare ahead and think about meals for the school week.

-          Plan Ahead: No one wants come home from a long day at work on a Monday and have to think about what’s for dinner. The weekends are a great time, or even any down time, to plan and think about options for meals. When meal planning, it is best to try to give oneself a few options throughout the week, but try not to make it too overwhelming. It is also nice to have a few quick, ready prepared option such as crock pot recipes, deli meals, or frozen options as backups.  Thinking about what is in season is another a great way to get some ideas for meals. For example, as summer time ends, ideas that might involve grilling, cold salads, and fruit dishes may be shifting towards more fall and winter options such as casseroles, soups, stews and such.  Once the ideas and menus are planned for the week, it is time efficient to do as much meal prep in advance. Make and portion items out such as fruit, crackers, cheeses, vegetables and dip.  Sandwiches can always be premade even a few days in advance, but one may just hold the condiments till the day of. Freeze items like nut butter sandwiches, smoothies, or soups into portioned containers so that the night before or the morning of, one can take out and have ready to go. Let the kids get involved with meal planning and meal prep! As long as it is age appropriate and safe, being part of this process helps teach the kids important skills and behaviors with food.         

-          Breakfast: Do not skip! Children have been asleep all night and now have a busy day ahead of them. They need energy; however, as many parents know, getting kids up, moving and to school on time can be a challenge. Try to set food items out that could be ready to go such as cereals and certain fruits. The next morning all one has to do is add milk and you know they have a complete meal. If need be, have some grab and go options available like nut butter sandwiches, fruit, smoothies, and other similar items so that in worst case scenarios, the kids are not leaving the house on an empty stomach. 

-          Lunches: Pack and plan ahead. Strive for variety where one can! Like breakfast, preparing lunch ahead time can save time. Anything that one can do in advance will help. Many school age children often report they eat the same foods for lunch throughout the school year. Whether it is adding a new spread like avocado to a turkey sandwich, adding fruit to a nut butter sandwich, or trying a new vegetable dip, try new ideas slowly. 

-          Afternoon snacks:   Do not forget that afternoon fueling! It has usually been several hours since most children have eaten by the time they get home. Dinner can also be several hours away before the whole family is ready to eat. It is best for the parents to have some options for afternoon snacks available to help guide healthy eating. Combinations like cheese and crackers, fruit and nuts/nut butters, vegetables and dip like hummus, fruit and yogurt. It is also important to be mindful if there are afternoon activities like clubs or sports in which they may need an afternoon snack before or after. 

-          Family dinners:  So important!  Family dinners are so important for many reasons.  Research has shown how important it is for family bonding, communication and developmental skills.  Meals can be as elaborate as needed or as simple as a few items, but it is important to have balanced meals available.  Gathering the family for dinners can be hard, but if a family can strive for at least a few nights during the week, they can add more along the way.         

Raising Healthy Eaters from Preschool to High School. 

http://www.eatright.org/resource/food/nutrition/eating-as-a-family/raising-healthy-eaters-from-preschool-to-high-school. Website.  Accessed July 20, 2016. 

The Down Low on Food Safety and How to Protect Yourself

As children, we can all remember mom telling us “wash your hands!” Washing our hands not only helps in preventing us from getting sick with a cold but also plays a major role in food safety and in preventing foodborne illness. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 6 Americans gets sick from consuming contaminated foods each year. So, practicing a few food safety techniques can help save you from many hours groaning in pain. What can you do you ask? Well, good food safety involves using techniques that include proper handling, preparation, and storage to help prevent the contamination of foods. 

Using these 4 easy steps can keep you and your family safe at home:

1. Clean
• Prior to preparing any food or eating, hands should be washed for at least 20 seconds with soap and warm running water. All utensils, cutting boards and surfaces you will be using need to be washed thoroughly. Fruits and vegetables can also be rinsed with water to remove any dirt or unseen bacteria that can possibly contaminate the food. Many people think they should rinse meat and poultry; however, they should not! This is because rinsing raw meat only increases the risk of cross contamination. Above all, wash anything that has been in contact with raw meat or poultry. 
2. Separate 
• Make sure to separate cooked meat from raw meat. Put cooked meat on a clean platter or plate to avoid cross contamination. Even cooked meat, if in contact with other raw foods can become contaminated again. Use separate plates, cutting boards and utensils for produce, raw meat, poultry, seafood and eggs. Also you should keep raw items separated from others while shopping at the grocery store. 
• 
  
  
3. Cook
• Be sure to cook all meat, poultry, seafood and eggs thoroughly. A food thermometer should be used to measure the internal temperature of the meat to make sure it is cooked sufficiently to kill bacteria. Many people think they can tell if a food is done simply by looking at it but there is no way to be sure it is safe without abiding by the safe minimum cooking temperature by using a food thermometer. 

Food	Temperature (Fahrenheit)
Beef, pork, veal, lamb	160
Turkey, chicken	165
Steaks, roasts, chops	145
Fresh ham	145
Precooked ham	140
Eggs	Cooked until yolk and white are firm
Fin fish	145
Leftovers and casseroles	165

  

    4.  Chill

• After you are finished eating, items should be stored properly in air tight containers or bags and placed promptly in the refrigerator. Bacteria can grow quickly at room temperature, so refrigerate leftover foods if they are not going to be eaten within 4 hours. Frozen meats should be thawed in the refrigerator, never on the counter or in the sink. Foods that tend to spoil more quickly are fruits, vegetables, milk, eggs and meats and should be refrigerated within 2 hours. Be cautious of mixed dishes that have these food items in them such as chicken Alfredo. The milk from the Alfredo sauce is a food that spoils more quickly, so the 2-hour rule should be followed.

Bottom line

• Everybody is at risk to become infected with a foodborne illness- especially infants, young children, older adults and pregnant woman.
• Contaminated foods MAY NOT look, smell, or taste funny so be sure to follow the 4 food safety steps.
• Food poisoning symptoms can develop as quickly as 30 minutes or make take up to a few days before you notice any symptoms such as diarrhea, vomiting, nausea and abdominal cramping. 
• Remember 1 in 6 Americans get sick each year from consuming contaminated food. That means if we were able to reduce the incidence of foodborne illness by 10%, it would prevent 5 million Americans from getting sick each year. 
• Know when to throw food out!

References:

Home Food Safety. Available at: http://www.homefoodsafety.org/food-poisoning (Accessed: 2 Sept 2015).CDC and Food Safety. Centers of Disease Control and Prevention. Available at: http://www.cdc.gov/foodsafety/cdc-and-food-safety.html (Accessed: 2 Sept 2015). 

~Jason Klemka MS, RD, LD/N

Registered Dietitians Improve Childhood Obesity BMI Outcomes

The Centers for Disease Control and Prevention (CDC) estimates that obesity now affects 17% of all children and adolescents living in the United States. This percentage has tripled since just one generation ago. With all of the awareness and focus placed on Americans’ ever increasing rates of obesity it’s baffling to see that these numbers have yet to decrease.

A type of intervention that has been shown to work with obese children and adolescents are comprehensive weight management interventions. These include several components namely nutrition, physical activity and behavior modification strategies. One recent study examined two groups of children and adolescents in these programs with one group having a portion controlled diet and the other having a reduced glycemic load diet. Both groups were required to have at least one visit with a Registered Dietitian (RD), although some participants had more than just one visit.

The results from this study showed that the differences in diet between the two groups did not lead to any differences in their BMIs. However, what did make a difference for the participants was the number of visits that they had with a Registered Dietitian. With every additional visit with the RD the child’s odds of success increased by 28%. Furthermore, the probability of success was more than 78% with greater than 1 visit with a Registered Dietitian per month compared to 43% success rate in children who had minimal exposure to a Registered Dietitian.

Overall, this study showed that more frequent visits to see a Registered Dietitian improved BMI outcomes in obese children and adolescents regardless of the kind of dietary intervention they were on. Registered Dietitians are uniquely qualified to help combat these ever increasing rates of childhood obesity. If you or your child are struggling with obesity, get the help and support that an RD can provide today. You don’t have to do it alone, in fact you get better results with some help!

~Stefanie Rivera MS, RD, LD/N

Sources:

Center for Disease Control and Prevention. Childhood Overweight and Obesity. Accessed on 5/15/15. Available at: http://www.cdc.gov/obesity/childhood/index.html.

Kirk Shelley, Woo Jessica G., Jones Margaret N., and Siegel Robert M.. Childhood Obesity. April 2015, 11(2): 202-208. doi:10.1089/chi.2014.0079.

Energy drinks and health risks… what’s all the buzz about?

The popularity of energy drinks has grown tremendously in the past decade. In the U.S. alone, sales of energy drinks have increased 10% every year between 2008 and 2012, with US sales estimated to be over $12.5 billion in 2012 (about $40 per person). Additionally, nearly 500 new brands hit the market worldwide in 2006 alone. There are certain segments of the population that are more likely to drink energy drinks; It is estimated that 30% of adults, 68% of adolescents and 18% of children below the age of 10 consume energy drinks. 

With this dramatic increase in caffeine consumption worldwide, attention has been drawn to how these high levels of caffeine can affect public health. International health authorities from the World Health Organization (WHO) have completed a review of research to see if energy drink consumption should be a concern. 

Risks associated with energy drink consumption

According to the WHO paper published in the journal Frontiers in Public Health, they warn that caffeine intoxication (an actual diagnosis, according to the DSM-V) can lead to irregular heartbeat, Type 2 diabetes, high blood pressure, nausea/vomiting, convulsions, psychosis, miscarriages and even death. Specifically, caffeine consumption in children and adolescents has been proven to negatively affect the cardiovascular and neurological systems and may lead to physical dependence and addiction. In adolescence, energy drink consumption is associated with greater risk for depression, sensation seeking, tobacco, binge drinking, and use of other harmful substances. Energy drinks are also commonly mixed with alcohol (over 70% of young adults who consume them, mix them with alcohol). The act of mixing alcohol and energy drinks is risky in itself, due to the combination of a suppressant and stimulant on the nervous system. It is also positively associated with other high-risk behaviors, such as marijuana use, sexual risk taking, illicit drug use, etc. 

Energy drinks vs. coffee/tea

You may be asking yourself, “why are health authorities concerned now? People have been drinking caffeine in coffee and tea for hundreds of years… what is the big deal with energy drinks?” There are several reasons why energy drinks pose a greater health risk than coffee or tea. First, the caffeine found in coffee and tea is self-limiting in nature; one or two cups of coffee gives you a pleasant caffeine high, however, drink five cups and you will feel sick to your stomach. Because of this self-limiting factor, it is very hard to get severe caffeine intoxication from naturally-occurring caffeine sources. Energy drinks, on the other hand, can be quickly consumed in large amounts and may not upset your stomach if you drink too much. Secondly, energy drinks may contain vastly more caffeine than coffee per serving; 1 oz of coffee contains approximately 20 mg caffeine, whereas some energy drinks contain more than 434 mg/oz (Energy Catalyst)… that’s over 20X more caffeine than coffee! Another reason energy drinks are of concern is due to lack of research examining the acute and long-term effects of the other ingredients contained in these drinks, such as guarana, glucuronolactone, B-vitamins, ginseng and taurine. Further research is still needed to determine additional health consequences of heavy and long-term energy drink consumption. 

WHO Policy Recommendations

In response to their findings, the World Health Organization outlined specific policy recommendations that would limit the harmful effects of energy drink consumption.

1. Establish an Upper Limit (UL) for the amount of caffeine allowed in a single serving of any drink
2. Restrict sales of energy drinks to children and adolescents due to potentially harmful adverse and developmental effects of caffeine on children
3. Regulatory agencies (FDA) should enforce industry-wide standards for responsible marketing of energy drinks and ensure that the risks associated with energy drink consumption are well known

Bottom Line

If the U.S. is proactive on this issue, there will likely be an established UL for caffeine and there may even be age restrictions for purchasing energy drinks. For those of you who are coffee drinkers, you need not fear; while it is important to be aware of the negative health consequences of drinking too much caffeine, it’s also good to recognize that a moderate intake of caffeine can be healthy. Studies show that up to 400 mg (3-4 cups of coffee) of caffeine per day appears to be safe for most adults. And some studies show that a healthy level of caffeine may even provide additional health benefits, such as protecting against Parkinson's disease, type 2 diabetes and liver disease, including liver cancer. It also appears to improve cognitive function and decrease the risk of depression. So, as always, moderation is key!

- Ashley Hamm, MS, RD, LD/N

References:

Breda JJ, Whiting SH, Encarnação R, Norberg S, Jones R, Reinap M and Jewell J (2014) Energy drink consumption in Europe: a review of the risks, adverse health effects, and policy options to respond. Front. Public Health 2:134. doi: 10.3389/fpubh.2014.00134

Caffeine Content of Drinks. Caffeine Informer Website. Accessed November 7, 2014. Available at: http://www.caffeineinformer.com/the-caffeine-database

Hensrud, D. Is coffee good or bad for me? Mayo Clinic Website. March 13, 2014. Accessed November 7, 2014. Available at: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/expert-answers/coffee-and-health/faq-20058339

FDA Cracks Down on "Gluten-Free" Labeling

We are all familiar with the term “Gluten-free”. This term, which originally was used to describe foods that met the needs of those with Celiac disease and gluten sensitivity, has now become the foundation of one of the top trending diets of the decade... The “Gluten-Free Diet”. From 2011 to 2013 alone, the gluten-free craze has grown nearly 50% and is now a monstrous $10.5 billion industry. Everything from gluten-free flours and cereals to protein bars and frozen meals are taking up more and more shelf space each year. In fact, from 2012 to 2013 a whopping 1, 500 new gluten-free products hit the market. This is great for food manufacturers however, for people with Celiac disease or gluten sensitivity it has actually become quite a challenge.

A strict gluten-free diet can be a matter of life or death for those with Celiac disease. Even small amounts of gluten can have negative effects on the health of individuals with this condition. So what’s the big deal? Shouldn’t it be easier now for those with Celiac disease because there are so many more products on the market? Not necessarily… and here is why. Prior to 2013, the FDA had no official definition or labeling standards for gluten-free products. Because of this, food manufacturers could market their products as “gluten-free”, even if they did contain gluten. By lacking tight regulations for gluten-free products, it became extremely difficult for those with Celiac disease and gluten sensitivity to know which foods were safe for them to consume.

Thankfully, the FDA has recently taken action to address this issue. In a final ruling by the FDA, as of August 5^th of 2014, all food products that manufactures wish to label as gluten-free must abide by the FDA’s official definition of gluten-free.

The FDA has defined gluten-free foods as those that do not naturally contain gluten (such as water) or does not contain an ingredient that is:

• a gluten-containing grain (wheat, rye, barley, or crossbreeds of these grains)
• an ingredient derived from these grains and that has not been processed to remove gluten
• an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten 

In addition to this definition, the unavoidable presence of gluten in the food must be less than 20 ppm. This level is the lowest level that can be consistently detected in foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods with very small amounts of gluten without having adverse effects.

While it is huge step in the right direction for those with Celiac or gluten sensitivities, it is important to know that not ALL products on the market have to follow these regulations. The foods that must follow these rules include all FDA-regulated packaged food that are voluntarily labeled as “gluten-free”, “free of gluten” and “no gluten”. However, the rules do not apply to the following products:

• Products that do not wish to voluntarily include a claim regarding gluten content
• Products regulated by the USDA  - meats, poultry, and certain egg products  (FDA regulates the labeling of shell eggs)
• Products regulated by the Alcohol and Tobacco Tax and Trade Bureau (TTB) - distilled spirits, wines that contain 7 percent or more alcohol by volume, and malted beverages that are made with both malted barley and hops
• Non-packaged foods sold in restaurants

Although the FDA gluten-free labeling rules do not apply to non-packaged foods, such as most food from restaurants, the FDA does encourage restaurants that make a gluten-free claim on their menus to be consistent with the FDA’s definition. Given the public health significance of “gluten-free” labeling, restaurants would benefit greatly by adapting the FDA’s gluten-free definition. By serving truly gluten-free menu option, restaurants would gain the trust (and $) of many Americans. 

So what does this new gluten-free labeling rule mean for you? If you have Celiac disease or gluten sensitivity, you can take deep breath and relax; while you may still have to be careful when you eat out or purchase alcoholic beverages, you can trust that the packaged “gluten-free” products you’re purchasing are now guaranteed to be safe for you to eat!

Web Sources available at:

http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ucm362880.htm

http://www.foodtechconnect.com/2014/02/21/infographic-week-rise-gluten-free/

~Ashley Hamm, MS, RD 

Gluten-Free Diet: The Truth Behind the Trend

A diet void of wheat, rye, barley (and oats only occasionally)… The Gluten-Free Diet seems to be all the rage these days. What began as a simple treatment for an autoimmune disease has now become one of the most well-known diets in America. Not surprisingly, it has also become a food market goldmine, with GF sales expected to exceed over $5 billion by 2015. We’ve all heard the hype about how gluten-free foods are overall better for you, can help you lose weight, sleep better, give you more energy, clear up your acne and even improve medical conditions such as autism and rheumatoid arthritis. It can be difficult to sift through the mounds of messages that the media and food manufacturers have put forth touting the many health benefits of eliminating gluten from your diet. But is there any truth behind these claims? And if so, are they really worth eliminating some of the most delicious foods in your diet and dishing out extra money for gluten-free foods? Read on to discover the truth about gluten and whether or not you can benefit from a gluten-free diet.

What is gluten? 
It’s a protein composite of gliadin and glutenin found in wheat, rye, barley and triticale. Functionally, it helps food maintain its shape and gives dough elasticity and chewiness. It is also used as a thickener for many foods.

Who should avoid gluten?
In short, anyone who has been diagnosed with Celiac Disease (CD) or Non-Celiac Gluten Sensitivity (NCGS) should avoid gluten. CD is a genetic, autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. This causes malabsorption of almost all nutrients and can lead to very serious health consequences, such as weight loss, slowed growth and even death in severe cases. CD can be diagnosed by a combination of a blood test checking for antibodies to gluten and small bowel biopsy looking for damage to the intestinal cells. It is estimated that 1 in every 105 people in the US have CD.

A much less severe but more common condition related to gluten is Non-Celiac Gluten Sensitivity (NCGS). Current estimations indicate a 3-6% prevalence of NCGS in the US. While there is no definitive way of diagnosing NCGS, it is recognized by symptoms similar to those of celiac disease that improve when gluten is eliminated from the diet. Individuals with NCGS would not produce the same antibodies or have the intestinal damage as seen in CD. Some of the symptoms caused by NCGS include stomach pain, gas, diarrhea, extreme tiredness, “foggy mind” and bone/joint pain. Since there is no blood test for gluten sensitivity, the only way to be diagnosed is to undergo the screening and diagnostic tests required to confirm celiac disease. A diagnosis of gluten sensitivity is confirmed when/if the celiac disease or wheat allergy test are negative, and your symptoms diminish after starting a gluten-free diet, followed by a return of symptoms when gluten is reintroduced into your diet. There is no cure for gluten sensitivity or celiac disease, and the only treatment is to follow a gluten-free diet.

Those with a wheat allergy may also benefit from a gluten-free diet, because it is free of wheat. It is important to note, however, that this is an adverse immunologic reaction to wheat, NOT gluten. Wheat is the 8th most common food allergen in the US, and is more common among children than adults. Immediate symptoms of wheat allergy include: hives, airway obstruction, nausea, or gastrointestinal complaints. Delayed reaction may present 24 hours after ingestion with gastrointestinal complaints, itching and rash.

Gluten-Free for weight loss?
According to a reputable review article posted in the Journal of the Academy of Nutrition and Dietetics, there is no evidence suggesting that a gluten-free diet produces weight loss in people with or without CD or NCGS. In fact, for overweight or obese patients with CD, body weight may increase on a gluten-free diet. This is likely due to the fact that some gluten-free products have greater energy value than corresponding gluten-containing foods. Also, a gluten-free diet may lack whole grains and fiber, both of which have been shown to be associated with healthy weights.

Gluten-free for other health benefits? 
A commonly held belief among Americans is that gluten-free foods can improve gastrointestinal health. Data, however, suggest that this is not true. Naturally occurring starches in wheat, such as oligofructose and inulin, are beneficial for creating a healthy composition of gut bacteria. These “good” gut bacteria are known to have protective effects for some cancers, inflammatory conditions and cardiovascular disease. Recent evidence suggests that a gluten-free diet may lead to reductions in “good” gut bacteria and vice-versa… that increasing whole-grain wheat intake has been reported to increase “good” gut bacteria. This data supports the well-established, inverse relationship between whole-grain food intake and risk of cardiovascular diseases.

Additionally, a study published in the American Journal of Clinical Nutrition showed the potential benefits of gluten for improving blood lipid levels, and another article published in 2011 suggests that gluten may help control blood pressure. Other research studies indicate the potential role of gluten in boosting the immune system.

Bottom Line:
• GF diet is clearly indicated for CD and NCGS
• No evidence to suggest that following a GF diet has any significant benefits in the general population
• Going gluten-free for purposes of weight loss may have unintended consequences
• No data to support a weight loss claim for a gluten-free diet

~ Ashley Hamm, MS, RD


References:

Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Nutrients. 2013; 5(10):3839-53.

Glenn AG, Siddhartha SA. Gluten-Free Diet: Imprudent Dietary Advice for the General Population? Journal of the Academy of Nutrition and Dietetics. 2012;112(9):1330-1333 

Marcason, W. Is there evidence to support the claim that a gluten-free diet should be used for weight loss?. J Am Diet Assoc. 2011; 111: 1786

 Maureen ML, Brintha V. US perspective on gluten-related diseases. Clinical and Experimenal Gastroenterology. 2014(7):25-37. 

Rubino J. 7 gluten-free statistics you need to know. New Hope Website. Accessed Sept 15, 2014. Updated May 20, 2013. Available at: http://newhope360.com/managing-your-business/7-gluten-free-statistics-you-need-know.