Many people today are talking about diets that are “gluten-free.” Restaurants are offering “gluten-free” menus. There are websites, chiropractors, and others proclaiming that going on a gluten-free diet will provide improved health. But lets be clear- unless you have an allergy to gluten, removing gluten from your diet will not provide better health, weight loss, but eliminating gluten will dramatically limit what you can eat.

But there are some people who are “allergic” to gluten- and for them having a gluten free diet is the difference between health and illness – between a risk of some rare cancers for which we don’t have great treatment for. We call that condition celiac disease – for those who have celiac disease, being gluten free is critical. Other names for this disease include celiac sprue, gluten sensitive enteropathy, non-tropical sprue, and a few other names.

Gluten is a protein that is found in wheat, barley, rye, and oats. Gluten is a protein that allows wheat to have “elasticity” – meaning you can roll out the dough- or toss it in the air and make a great pizza crust. You can’t do that with non-gluten grains—no one can make a pizza or great bread from corn alone. Gluten is also used to thicken soups, ketchup, soy sauce, and is found in almost every processed food out there. Take gluten out of the American diet and you will be challenged to find good alternatives.

When a person is allergic to gluten their symptoms include malnutrition, anemia, osteoporosis, infertility, short stature, and inability to thrive. However, the “classic” symptoms are not necessarily common. There are a number of patients who have silent celiac disease, where they will be discovered to have atrophy of their absorptive surface of the small bowel without any symptoms, or just mild symptoms such as an iron deficiency anemia. There are a number of forms of celiac disease that respond well to a gluten free diet – and remain normal after introduction of gluten into the diet.

Celiac disease is best diagnosed with a biopsy of the small intestine. Most often the biopsy is performed endoscopically from the first part of the small bowel, the duodenum. However, those biopsies can be negative, and more distal small bowel may show the classic pathologic appearance. Those biopsies most often have to be done surgically, or with advanced endoscopic equipment.

The small bowel, under a microscope, has many small finger-like projections called villi. These serve to increase the surface area of the small bowel to allow for maximum absorption of nutrients. In celiac disease, there is atrophy of these villi – seen microscopically- and this improves when gluten is removed from the diet.

Above normal villi, below- atrophied

While celiac disease is classically called an “allergy” to gluten – it does promote some antibodies against the connective tissue elements – leading some to call this an auto-immune disease. However, when the foreign protein is withdrawn, there is no residual auto-immune function. The “auto-antibodies” may simply reflect the gluten protein unfolded – and having a similar structure to the bodies own endomysium protein.

There have been various reports about the prevalence of celiac disease – ranging from 1:300 among Northern Europeans (Celtic) to 1:122. There is a large genetic distribution of the disease – with a high concordance among identical twins of up to 70 per cent. There are some genetic markers that have a high association with celiac disease, but the expression of the disease is variable – meaning that the genetic marker is a tendency but not a certainty of celiac disease. If everyone who had the genetic markers were to develop the disease, it would be estimated that 1 in 22 people would have this. However, this is not the case.

Diagnosis of celiac disease is made based on clinical suspicion of the classical presentation (iron deficiency, osteoporosis, with abdominal complaints) followed by some tests. A biopsy is the most reliable test, however there are blood tests ( IgA anti-gliadin and IgA anti-endomysial and anti-tissue transglutaminase) that are over 90 per cent accurate. Even with a negative blood test but a high enough suspicion, duodenal biopsy or even surgical biopsy is warranted.

There are plenty of questions about celiac disease- we don’t know the actual prevalence in the population, we don’t know if being gluten free as demonstrated by follow up biopsy has a lower incidence of lymphoma.

What we do know is that gluten is not a health issue in people who do not have celiac disease. Gluten-free will not cure autism. Gluten free will not facilitate weight  loss. There are, however,  groups who will claim that gluten is a health issue- there is no basis for this claim. If someone has told you to remove gluten from your diet, and you do not have a test showing celiac disease (one of the tests listed above)- please see a physician to resolve this.

For people who have celiac disease- there is a bit of culinary hope. Thomas Keller, one of the world’s greatest chefs and owner of Ad Hoc, French Laundry, Per Se, and Bouchon- has developed a flour that works well. You can purchase it from Williams-Sonoma.

Thomas Keller has come up with a great flour, gluten Free.

The results, as they were with President Eisenhower- are not likely to be different.  Eisenhower ended up eating almost nothing but Melba toast and grapefruit, obsessed with his cholesterol level, and having more heart attacks until the last one killed him.

What is the evidence that a vegan diet is healthier for a person than a diet with animal proteins? None. There is no evidence that a diet that is based around plants or a diet with low animal fat does little.

Some will cite epidemiologic data- a poor source for data less than a level one.  If you cite epidemiologic data you have to explain all the data—and often they ignore the “French Paradox.”  Or ignore that while the Japanese eat little meat and have few heart attacks – their average consumption has increased over 22 percent with no increase in heart attacks (often people cite data from post World War 2 Japan, and not current Japan – and then ignore the data about stroke rate). When all epidemiologic studies are examined – one cannot justify a plant based diet on those.

Some cite the Journal of the American Medical Association (JAMA) study claiming that an animal based diet had more mortality than a plant based diet – but few have read the study.  While Dr. Ornish jumped on this study, saying it justified what he has been telling people- apparently he didn’t read the study either.

This study divided people into two groups- the low-carb group received 37 to 60 percent of their calories from carbohydrates (that isn’t low carbohydrate by any standard). The meat group was not divided out for those who smoked and were overweight (a higher portion of the meat group smoked and were obese). The vegetable group had 30 per cent of their calories from animals, as opposed to 45% for the meat group (so not really a vegetable group).  Once again, an epidemiologic study  and it is flawed.

What we do know from science about low-density-lipoproteins is that they fall into two groups- one group is far more deadly than the other, causing the majority of atherosclerotic plaques.  That is the group with the high tri-glyceride levels is the one that is deadly. Of this there is no doubt in the scientific community.  When the Very Low Density Lipoprotein and apo B – leading to high low density lipoprotein – leads the the increased in artery plaque leading to heart attacks and strokes.  The lower the triglyceride levels then the lipoproteins secreted by the liver become the subspecies of intermediate-density lipoproteins, which are far less cause of atherosclerosis than the others.  Where does the triglycerides come from? Not animal proteins, but primarily carbohydrates.

Bottom line from science – the more triglycerides – result in atherogenic small, dense LDL proteins – and this happens from carbohydrate rich foods.

What about Greece, and Southeast Asia, and Japan(after world war 2) . These populations barely had enough food to survive.  They didn’t use refined carbohydrates – and ate whatever they could. It was not the low-intake of saturated fat that protected them, rather the relative lack of a refined carbohydrate leading to low triglyceride levels. Still, those studies, championed by the late Ancel Keys, are still cited.  This in spite of overwhelming evidence to the contrary.

Back to President Clinton – a vegan diet will not save his heart. Saturated fat is not what led to the atherosclerotic plaques – rather, it was the abundance of triglycerides from highly processed and abundant carbohydrates. What he has done that will help him is, lose weight, have heart surgery, take medication –but  in terms of diet, President Clinton falls into what Eisenhower did, as well as every anorectic—when the only thing they can control is diet, they will fall victim to fads that sound healthy, are promoted by TV MD’s – but have no science to back them up.

If you want to be a vegan for health, there is no data to support that. In fact, vegans have a life expectancy that is less than pescetarians (fish eaters) and omnivores.President Clinton – a Vegan

I’m always looking for new ingredients to cook with that make an impact on flavor and calories. Spaghetti Squash is a great substitute for pasta. It has more flavor, fewer calories, more nutrients – and is just as easy to cook as pasta.

Making this is pretty easy. The hardest part is cutting the squash. There are two ways to do it: brute force, or heat. If you’re feeling really strong, you can use a serrated knife- cut off both ends and cut from the inside out. Or with a very sharp knife, pierce the skin with the tip- and pull toward you. All of which require being careful or you will need my surgical services to sew you up.

Not liking brute force when it comes to knives (we surgeons like a delicate touch) – I prefer this method: With a fork, pierce the skin of the squash. Pretend the squash is a rectangle and pierce it twice per side with the fork. Place in a microwave on high for two minutes. This will allow the squash skin to soften then you can cut it with minimal force.

Once it is cut in half- scoop out the seeds with a spoon. You can roast the seeds if you like. I like to drizzle olive oil over the squash as well as some Sea salt and pepper. Bake at 350 degrees for 30-45 minutes (its done when you can easily pierce the skin with a fork). Take it out of the oven- let it sit for ten minutes- then pull the pulp away from the skin and it will naturally form into noodles.

I like to use tongs to separate the squash from the skin. You can season the squash after you separate it from the skin. This can be used as the basis for its own dish- a much healthier and less fattening dish than any pasta.

My Favorite, And the Easiest Method

You can do it all in the microwave. Pierce the skin of the squash with the fork and place it into the microwave for 10 to 12 minutes. Once it is cooked let it rest for about five minutes. Cut the squash and scoop out the seeds (you can roast the seeds for a healthy snack). Drizzle on olive oil (with some a touch of truffle) and salt and pepper to taste (I like sea salt).

(Watch Dr. Terry Simpson and Jineane Ford cook up a healthy, low calorie halibut dish. It’s fast, healthy, and delicious!)

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My good friend Jineane Ford stopped by and we decided to make a simple Halibut dish that anyone can make.  Here are the ingredients:

Halibut fillets, or Halibut cheeks if you can get them.  About 4 inches of soda or Ritz crackers,  salt and pepper,  and one stick of butter.

To make it:

• Pre heat the oven to 400 degrees
• Melt one stick of butter
• Crunch up the crackers
• Cut the fillets into 1-2 inch pieces
• Dip them in butter
• Cover them in the crunched up crackers
• Then put remaining crackers over them and some butter

Into the oven it goes for just 10 minutes or so, or until the halibut is flaky. That’s It!

This is best with fresh halibut– but you could use any flaky white fish.  A two inch piece has about 225 calories.

I am proud of Jineane – four years ago she had lap band surgery and now is the weight she was when she won Ms. USA in 1989.  Now she is able to eat great food- like halibut- and keep her weight off.

The average person will pack on 5 pounds this Holiday season. But you don’t have to! Check out Dr. Simpson and the lovely Jineane Ford as they discuss how to avoid Holiday weight gain.

In terms of the Swine flu — that vaccine is specific for that flu. So if you had the Swine flu vaccine last year, or if you had the swine flu- you don’t to be re-vaccinated against the swine flu, but you DO need this year’s flu vaccine.

(Watch as Dr. Terry Simpson talks one-on-one with Daytime’s Cyndi Edwards about the cold and flu season and how to fight it!)

Who Should Get the Flu Vaccine?

We break it down into those people who cannot afford to get sick — the elderly, people who have transplants, people who work in the health care industry (yes, I’m getting the vaccine), and anyone who’s immune system is compromised.  If you have any questions, check with your physician.

A few simple myths about the flu:

Antibiotics don’t help it get better faster.  Patients call me wanting a Z-pack, or some antibiotic because they have the flu.  Antibiotics don’t make the flu go away any sooner. The flu is caused by a virus– and antibiotics are meant for bacteria.

Those surgical masks people wear — most of them won’t protect you against the flu. First, the flu virus is very small, and it can get through that mask.  Second, if you shake someone’s hand, who has the flu – well, that mask didn’t help did it?

Soap and water are the best thing you can use– and the new special soaps, that are alcohol based, do help prevent the spread of  the virus.

So, this year — get the vaccine.  If you don’t and you get the flu, do your co-workers a favor and stay home.  If you cannot afford to stay home with the flu, it’s simple:  Get the Vaccine!

One of my favorite kitchen tools is the Wok. It is easy to use, versatile and inexpensive. If you don’t have one, purchase a simple Wok, non electric, that you can use on the stove top. My Wok was just $12 at Tuesday Morning.

Here is what you will need for this recipe:
1 1/2 lb of Broccoli
1 lb of cut beef (flank steak, sirloin, whatever the grocery store has cut for stir fry)
Soy sauce
Minced garlic (comes in a jar – great stuff)
Stir Fry sauce (lots of varieties out there)
Pepper
Vegetable oil

First- take your steak out and put it in a shallow pan and cover it with soy sauce and some vegetable oil (3 parts soy sauce, 1 part oil) – some people prefer to toss in a teaspoon of corn starch to bind it all together. Add some pepper to taste. This is just a marinade that will put some nice flavor in the beef. You can even do this the night before. Put all those ingredients together and store in the refrigerator – the longer that you marinade the beef, the more tender it becomes, but don’t marinade for longer than a day.

Cooking vegetables in a Wok is easy. For this recipe, you’ll need broccoli. Like most vegetables, broccoli has few calories — about 27 calories for 1/2 cup of chopped broccoli.

Put about 1 1/2 inches of water in the Wok and cover it. You won’t find a Wok cover – so use any pan cover you have. Crank up the heat. Once the water comes to a boil, add the broccoli.

In 3 minutes your broccoli is ready — easier than using a steamer because it’s faster, and tastes fresh.

I then toss the broccoli into a colander and leave it there. Dry it with a quick wipe of a towel – don’t get burned! Your Wok is now hot, so add about a tablespoon of vegetable oil to coat the bottom of the Wok (ok, here is confession number one: I don’t measure much) – just be sure to coat the bottom.

Add the minced garlic and stir. Once you can smell it (in about half a minute), you are ready to add your beef.

Take the marinated beef and toss it in the wok. The Wok has a large surface area – and you want each strip of beef to have contact with the Wok. In 30 seconds the beef will be done on that side, and then flip them with a kitchen tool, like a wooden spoon or even a large metal one. Stir the beef so it gets done on all sides, this will take one or two minutes.

Now, pour in the stir-fry sauce and simmer for 30 seconds. Put the broccoli back in and stir it so the sauce coats everything. You are ready to serve! (Recipe serves 4 people).

Calorie Count — 200 calories for the beef, 27 calories for the broccoli, 10 calories for the stir fry sauce, and maybe 5 calories for the oil. Dinner for less than 300 calories and done in five minutes!

You can get more complicated with your sauces and your beef marinade. So try this first, and as you get to where you want to do more I suggest you buy a copy of my friend Jaden Hair’s Cookbook – The Steamy Kitchen

When it comes to finding simple things to lose ten pounds in a year, often the answer is easy.  It means changing your tastes – and finding something that is a lower calorie alternative or substitution for what you normally drink.

Soda pop is nothing but pure liquid calories – and often I see people walk around with a huge container filled with soda from some convenience store.  Did you know that a can of soda is about 100 calories for 8 ounces? There it is– a simple way to save ten pounds in a year.

I don’t think that even diet soda is a great thing for the health-conscious consumer- but it is a step to better health.

Still, be on the look out for liquid calories that add up quickly for your weight gain.

The 20 ounces bottle of Sunkist soda is 325 calories! That isn’t “natural goodness” in there– that is the same amount of calories as over a dozen chocolate chip cookies.

Snapple 20 ounces is 250 calories. Drink one of those a day above what you burn for calories and at the end of the year you will have gained 25 pounds!

And don’t forget that cup of latte you get – well, the Starbucks Frappuccino (13.7 ounce bottle) is 290 calories! A simple cup of coffee with a teaspoon of sugar and creamer is 25 calories (add ice in the summer to make a cold coffee drink).

So, when it comes to liquid calories- water is best, calorie free, and will quench your thirst. If you “must” drink soda– don’t drink the kind with sugar or high fructose corn syrup – instead, drink zero calorie soda.

Other healthy alternatives include Propel Fit Lemon, only 25 calories, or Desani Plus Pomegranate Blackberry, zero calories. Sobe Lean Mango Melon is 12.5 calories.  And for your water you can always purchase packages of Crystal Lite to place in the water– zero calories!

Remember, changing 100 calories a day is 10 pounds in a year. So think about those liquid calories – and try some new ones.

Tempted to go to the fast food counter for some quick dinner? Many people are.

Recently on Daytime Television I was in the kitchen with co-host Lindsay MacDonald and we put together a simple recipe for Halibut that will take you less than 15 minutes to make.

Here it is:

1 cup dried apricots
1 cup dried cranberries
1 cup dried bing cherries
1 and 1 / 2 cups white wine
3 tablespoons minced ginger
1 cup slightly chopped mint leaves
4, 6-ounce pieces fresh halibut fillets (or seabass or salmon fillets)
salt and crushed red pepper (or black pepper)
1 lemon
In a microwave-safe container, combine the dried fruit, 1 cup wine, ginger, and half the mint.  Cover and cook at full power in the microwave oven for 2 minutes.  Can be done 8 hours before cooking with all food refrigerated.  Preheat oven to 350 degrees. Place fish flat side down on a baking pan, then sprinkle with salt and red pepper or ground black pepper.  Add all the fruit both around and on top of the fish.  Add the remaining wine around the sides of the fish.  Place in the oven, and roast uncovered until the fish just begins to flake, about 12 minutes.  Transfer to dinner plates.  Squeeze lemon juice on fish.  Garnish with remaining mint.  Serve.

This dish is around 400 calories per serving. Compare with a 1/4 pound hamburger with cheese (about 410 calories) add the medium french fries (another 400 calories) and a coke (200 calories) and you can see the difference.

So next time you think you don’t have time to cook– and want to go out to dinner instead- try this recipe. If you don’t have fresh Halibut fillets available you can try any fresh white fish.