by Paul Graham
I had wondered how I’d know when I was cured. Not cured of celiac disease, but of the longing for wheat, and gluten, and the old ways at the table. Of the confusion, the despair. I wanted the kind of proof no doctor could provide.
It came without my noticing: when I remembered, and rediscovered, that extended evenings spent at the table—either the one in our own kitchen or at a favorite restaurant, or at the homes of good friends—are among my favorite parts of my marriage. I long for such evenings more than I get them and relish them when they come, as they often do in the winter, when the sky darkens at four o’clock and the air outside turns brittle, and there is nothing more desirable to do than cook, drink wine, listen to good music, and eat. Or in the summer, when the college campus and the town are quiet and our CSA explodes with produce both strange and familiar—fennel and fava beans, Romanesco cauliflower and snow peas—a challenge that renews weekly with a demand for attention, innovation, and, often, simplicity.
On those nights, weekends, invariably, I ditch the afternoon chores and start cooking hours before we eat, simmering a stock, crisping bacon, browning meat, chopping vegetables. Often I make dessert first, something with berries or other fruits, unless the dessert is a soufflé or a dish that will not wait. Mousse is good and gluten-free, as is sorbet, or a granita. Then I go back to the beginning of the meal, working off one of the ingredients, whether cabbage or lentils or lamb, and following its suggestions associatively to other dishes, as I figured out how to do years ago, and then relearned how to do. I do not think about cholesterol, or fat, or sugar. I make pan sauces, aiolis, gastriques. I prepare small bites out of something left over in the fridge—duxelles, risotto cakes, roulades of smoked salmon. I quick-pickle some of the more numerous vegetables. Shortly before we eat, we pull out one of our better wines. I attempt to plate each course—mine first, so I can learn from the mistakes, and then hers.
Then we sit, and we eat. We drink. Something about the pace of the meal combined with the wine unspools new strands in our conversation, and we find ourselves talking more deeply than at other meals. The food is not always as good as we could get if we went out to eat, but the talk is more intimate, more hopeful, more deliberate.
And the truth about these meals is that all the good in them, alimentary and otherwise, would not exist if my wife and I were eating different foods. If Bec were eating bread and I were eating rice crackers, if she were eating semolina pasta and I were eating GF, if her sauce were thickened with wheat flour and mine with arrowroot, if her breading came from an artisanal loaf and mine from a bag of rice-and-cornstarch dust imported from Italy, then the experience would be tilted, askew. Never mind the mountain of dishes from two meals cooked simultaneously. The act of sharing the meal, and its symbolism, would not be the same. It would not be sharing at all. We might hurry through instead of lingering. One of us might be embarrassed, the other longing. We would not be able to revel in our success—not only what’s on the plate, but what we’ve canned, what’s come out of the garden, the local soil, the nearby pastures. And we would not wonder out loud at how far we’ve come, together, from those early days when the pasta wasn’t pasta and the sauce wasn’t thick and the food tasted safe but never tasted familiar, or inspired.
To share three hours at a table with the one person you chose from many—there is no loaf, no noodle, no ale so good as that.
The list of people who have had a part in this book begins in the stacks of the Owen D. Young Library at St. Lawrence University: the authors in the bibliography, and others, are in some way behind every page I’ve written, and I appreciate the effort they have put into their books more than I can express. My thanks to Theresa Simoni for the translations, Dr. Karin Heckman for the assistance with immunology and nanoparticles, Dan Marenda for his cogent breakdown of genetics, and Joe Casey and Amy Jeuck for information on the ins and outs of Clarex and Omission beer. Dr. Gregory Healey and Dr. Xiaosong Song took time from their busy practices to speak with me in the early stages of researching this book, and the Rev. Joel Miller generously told me his story, providing context and corroboration at an important time. Karen M. Johnson-Weiner brought me into the Amish community to learn about their experience with celiac disease, and a certain Amish household in particular gave me their time and their trust. In the early stages of writing this book, I received huge support from a number of people, and even if their gestures looked small to them at the time, I saw nothing small about them: Stephanie Elizondo Griest, Kirsten Kaschock, Margaret Kent Bass, Mary Hussmann, Brian Walker, Sarah Gates, John Dermott-Woods, Bob Thacker, and Mark Sturges. I’m especially grateful for the grant-funding from the Office of the Associate Dean for Faculty Affairs at St. Lawrence University; many chapters simply would not exist without it. Every person who sent me a link to a story on celiac-disease research, or brought me a new GF product to try, has had a part in the making of this book: Howard Eissenstat, Matt Carotenuto, Jon Rosales, Daina Carvel, June Peoples, Amy Feiereisel, Tom and Naomi Wilder, and Erik Johnson. I’m indebted to those who took extended time to talk with me about their own projects, businesses, and research: Jack Bishop, Lynn McKay and Stephanie Angle, Nancy Cain, Mary Schluckebier, Eliza Chace Hale Kelman, Chris Durand, and Faye Ori. I’ve grounded this book in stories of good eating as much as in research about celiac disease. Many friends have adjusted their own cooking for a night or longer, providing gifts in taste and spirit, especially David and Meredith Kratzmann, Sarah Barber and Cory Vineyard, Sid Sondergard and Ramona Ralston, Jon Sklaroff and Jessica Prody, my parents, and Jennifer Cockerill. Dan and Megan Kent, Kassandra Barton, Sue Wilson, and Ellen Rocco and the Feathered Lovelies have a special place in my kitchen and in my heart: together, you almost—almost—render wheat irrelevant. This project began at Graze magazine, where Brian Solem and Cyndi Fecher first published an essay that was the seed of it all. Thanks also to Paulette Lucitra, Peter Selgin, and Holly Hughes for the support in the earliest stages of my career as a writer who focuses on food. I’m grateful for the hard work and fabulous results of the entire team at Potter: Ian Dingman, Mark Birkey, Phil Leung, Annie Nelson, Anna Mintz, and Carly Gorga. Doris Cooper offered keen insights at the end of the process and supported me from the very beginning. My agent, Richard Florest, has been an unfaltering advisor; from the start, he believed in this book more than I did, and his sure hand and encouraging refrain—Onward!—have been among the greatest gifts a writer can receive. My editor at Potter, Rica Allannic, coaxed out my best and saved me from myself on just about every page. And, most of all, to my wife, Becky, companion at the table and everywhere else, I give my deepest admiration and gratitude: you gave me so much more than I can express, though I have tried.
1. Last Meals
some anthropologists believe: Thomas and Carol Sinclair, Bread, Beer, and the Seeds of Change: Agriculture’s Imprint on World History (Oxford and Cambridge, UK: CABI, 2010), 11.
a share of 900 fine wheat breads: H. E. Jacob, Six Thousand Years of Bread: Its Holy and Unholy History, trans. Richard and Clara Winston (New York: Lyons Press, 1944), 32.
has for a long time been 20 PPM: The Prolamin Working Group (Working Group on Prolamin Analysis and Toxicity) established the toxicity threshold at 20 PPM because this was the lowest number gluten could be reliably tested down to, and it remains the limit as of the FDA’s 2014 ruling on the definition of “gluten-free foods.” More recently it has been determined that the LS3600 gluten test can measure the presence of reactive peptides down to 10 PPM. My thanks to Mary Schluckebier, of the Celiac Support Association, for the conversation on the history. A recent study explored levels of gluten toxicity: Gilbert Kruizinga et al., “Threshold for Gluten-Induced Mucosal Damage,” American Journal of Clinical Nutrition, November 28, 2012.
2. The Perfect Immunological Trojan Horse
Few foods can measure up: Rachel Laudan, Cuisine and Empire: Cooking in World History (Berkeley: University of California Press, 2015), 30.
Ceres…the Latinate r
oot: H. E. Jacob, Six Thousand Years of Bread: Its Holy and Unholy History (New York: Lyons Press, 1944), 81.
argued about which kinds: Anthony Bobrow-Strain, White Bread: A Social History of the Store-Bought Loaf (Boston: Beacon Press), 2012, 7.
unscrupulous millers and bakers: John Marchant et al., Bread: A Slice of History (Stroud, Gloucester, UK: The History Press, 2007), 74–76.
Widespread “panophobia” does not appear: Darline Gay Levi, The Ideas and Careers of Simon-Nicolas-Henri Linguet (Carbondale: University of Illinois Press, 1980), 100–103, 130–31.
can be found in the history of ergotism: Mary Kilbourne Matossian, Poisons of the Past: Molds, Epidemics, and History (New Haven: Yale University Press, 1989), 12–14.
In Limoges in 857: Jacob, Six Thousand Years of Bread, 121–23.
Suspicion of demonic possession: Matossian, Poisons of the Past, 12–14, 56–57, 60–61.
The first known description: Aretaeus, The Extant Works of Aretaeus the Cappadocian, ed. and trans. Francis Adams (London, 1856).
after the Greek word for “belly”: Alberto Tommasini et al., “Ages of Celiac Disease: From Changing Environment to Improved Diagnostics,” World Journal of Gastroenterology 17 (32), 2011: 3665–71.
consistent with malabsorption: Tommasini et al., “Ages of Celiac Disease.”
Aretaeus also appears to have noted: Aretaeus, Extant Works.
blaming, instead of wheat or barley: Ibid.
diet was the most important factor: See, for example, Tommasini et al., “Ages of Celiac Disease,” and Hugh J. Freeman, “Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and New Potential Treatment Paradigms,” Gut and Liver 9 (1), January 2015: 28–37. In the research, there is disagreement over whether Samuel Gee accurately identified wheat as the cause of celiac disease; some scholars point to Dicke, and others note that Gee indeed, in his 1888 monograph, “states that the allowance of farinaceous foods must be small,” which they point to as proof of wheat being known to cause celiac symptoms since at least 1888. (“Letter: Samuel Gee, Aretaeus, and the Coeliac Affection,” British Medical Journal 2 (5916), May 25, 1974: 442.) Notably, a “small” amount of wheaten foods is not the same thing as eliminating wheaten foods.
He paid close attention to a child: Tommasini et al., “Ages of Celiac Disease.”
“could not be prevailed upon”: A. Fasano et al., eds., Frontiers in Celiac Disease (Basel: Karger, 2008), 5.
effects of a banana diet: G. P. van Berge-Henegouwen and C. J. Mulder, “Pioneer in the Gluten-Free Diet: Willem-Karel Dicke 1905–1962, Over 50 Years of Gluten-Free Diet,” Gut 34, 1993: 1473–75.
It is estimated that 4.5 million people: Henri A. van der Zee, The Hunger Winter: Occupied Holland 1944–1945 (Lincoln University of Nebraska Press, 1998), 304–5.
Those caught in the famine: van der Zee, Hunger Winter.
claim that he had suspected: “Pioneer in the Gluten-Free Diet.”
four to ten years in the United States: University of Chicago Celiac Disease Center, “Celiac Disease Facts and Figures,” http://www.uchospitals.edu/pdf/uch_007937.pdf.
only recently learned to screen: Celiac Central, “Celiac Disease Featured in Peer-Reviewed Medical Journal for Primary Care and Family Physicians,” http://www.celiaccentral.org/research-news/Celiac-Disease-Research/134/researchers—gluten-challenge—modified/vobid—9037/.
more than three hundred symptoms: University of Chicago Celiac Disease Center, “Celiac Disease Facts and Figures.”
average around four thousand dollars: Ibid.
The biopsies of my intestinal tissue: Cleo Libonati, Recognizing Celiac Disease: Signs, Symptoms, and Associated Disorders and Complications (Fort Washington, PA: Gluten-Free Works Publishing, 2007), 14, 31.
“breads of poverty”: William Rubel, Bread: A Global History (London: Reaktion Books, 2011).
3. Wheat Exile
about half the American population: http://www.cureceliacdisease.org/living-with-celiac/guide/fact-sheets.
one-in-twenty chance: http://www.cureceliacdisease.org/living-with-celiac/guide/fact-sheets.
most common autoimmune disorder in the world: http://www.cureceliacdisease.org/faqs.
A recent study by the Mayo Clinic: “Celiac Disease: On the Rise,” July 2010, http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise.
For decades: A. Fasano et al., “Prevalence of Celiac Disease in At-Risk and Not-at-Risk Groups”; Carlos Catassi, “Why Is Celiac Disease Endemic in People of the Sahara?” Letter. Lancet 354, 1999; L. Gandolfi et al., “Prevalence of Celiac Disease Among Blood Donors in Brazil,” American Journal of Gastroenterology, 2000: 95689–92.
more than half (58 percent): http://www.celiaccentral.org/celiac-disease/facts-and-figures/.
most likely to be a carrier: http://www.celiaccentral.org/riskfactors/. According to the National Foundation for Celiac Awareness, “About 95% of people with celiac disease have the HLA-DQ2 gene and most of the remaining 5% have the HLA-DQ8 gene.” Not everyone with the gene develops the disease.
a first-degree blood relative: The estimates for the potential for developing the disease vary. According to the National Foundation for Celiac Awareness (www.celiaccentral.org/riskfactors/ “Celiac Disease: Who Is At Risk?”), the risk factor is a conservative 5–10 percent.
unchecked, celiac disease can lead: In recent years, the chances of undiagnosed celiacs developing intestinal cancers have been revised down. According to the National Foundation for Celiac Awareness, “Those with celiac disease are especially more likely to develop lymphomas in the small intestine because of their compromised immune system. In the past the increased risk of celiacs developing lymphomas was quite high, 40–100% more likely. However, more recent studies have shown that the risk of lymphoma is slightly higher than the normal population—much less than previously believed—and that this risk reaches unity with the normal population after a gluten-free diet has been maintained for several years.”
400-percent greater chance: Rubio-Tapia et al., “Increased Prevalence and Mortality in Undiagnosed Celiac Disease,” Gastroenterology 137 (1), July 2009: 88–93.
Other complications: University of Celiac Disease Center.
some recent investigations: http://www.sciencedaily.com/releases/2014/12/141202093805.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily+%28Latest+Science+News+—+ScienceDaily%29.
90 percent of people with celiac: Carol Semrad, “Refractory Celiac Disease: What Is It? What to Do?” University of Chicago Celiac Disease Center, Impact 1 (3), 2008: 1.
“Tell me what you eat”: Jean Anthelme Brillat-Savarin, The Physiology of Taste, trans. Anne Drayton (New York: Penguin Books, 1970), 13.
4. Cleaning House
This was why the Chinese: Harold McGee, On Food and Cooking: The Science and Lore of the Kitchen (New York: Scribner, 2004), 468.
Marcel Proust’s “madeleine moment”: Marcel Proust, In Search of Lost Time: Volume 1: Swann’s Way, trans. C. K. Scott Moncrief (New York: Modern Library, 2003), 58–64.
5. Guy Fieri and Me
It might be more accurate: Thomas and Carol Sinclair, Bread, Beer, and the Seeds of Change: Agriculture’s Imprint on World History (Oxford and Cambridge, UK: CABI, 2010), 11. Sinclair and Sinclair use the phrase “genetic nudge” to describe the inherent appeal of grains. Rachel Laudan writes, “Throughout history, most societies have selected a few staple grains and have depended upon them for the entirety of history since. Only sugarcane has emerged to join those grains as an important source of food” (Cuisine and Empire: Cooking in World History [Berkeley: University of California Press, 2015], 31).
one that is around 10,000 to 12,000 years old: Joan P. Alcock, Food in the Ancient World (London: Greenwood Press
, 2006), xvii–xviii, 31–34.
which includes modern-day Iraq, Turkey, and Syria: See, for example, Patrick McGovern, Uncorking the Past: The Quest for Wine, Beer, and Other Alcoholic Beverages (Berkeley: University of California Press, 2009), 85; and Reay Tannahill, Food in History (New York: Broadway Books, 1995), 32. It should be pointed out that the birthplace of the earliest forerunners to bread, as well as the locations of the earliest gathering and cultivation of wheat, is a subject of lively debate that changes as archaeologists uncover remains of ancient settlements. For instance, compared to mid-twentieth-century research that surveyed grain-finds and fixed the dates at about 7500 BC, Joan Alcock writes that einkorn was gathered in Syria around 12,000 BC, and was later supplanted by emmer, which grew wild, by 9000 BC. Alcock notes that wild barley appeared throughout the Jordan Valley and the Levant, and by 11,000 BC had made its way to modern Greece (Food in the Ancient World, xvii). Meanwhile, Michael Symons has written that the Natufians, who were established in modern-day Palestine by 10,000 BC, were cultivating wheat by about that date, qualifying them as “incipient agriculturalists” (Michael Symons, A History of Cooks and Cooking [Urbana: University of Illinois Press, 1998], 226). Most recently, in 2015, Rachel Laudan wrote that gathering and cooking of the seeds of herbaceous plants—which would include wheat and barley—began as long as 19,000 years ago, nearly 10,000 years before the Neolithic Revolution (Cuisine and Empire, 13). Recent finds on grindstones in Europe suggest that primitive flours may have been ground from wild grains (not wheat) some 25,000 years BP (Anna Revedin et al., “Thirty-Thousand-Year Old Evidence of Plant Food Processing,” Proceedings of the National Academy of Sciences of the United States 107 [44], November 2, 2010: 18815–19).