Category Archives: Osteomalacia

Good gluten-free bread machine results

(As usual, you can click through for a larger version of any photo.)

I was reminded again today, baking another loaf of bread, that I hadn’t yet gotten this posted. I’m still having problems with the osteomalacia, and have been running into some symptoms of the vitamin D deficiency (and hypocalcemia) again this winter in spite of supplementation, including the low energy and fatigue. So I haven’t been able to post as much lately as I’d like. There are a lot of step-by-step recipe photos waiting for writeups. *wry smile*

But, it took me a while to figure out a consistently good bread machine recipe and techniques for basic sandwich-type bread, and I thought I should share what’s been working well here.

I lost the first recipe I was getting consistently good results from, and haven’t been able to find it again online. But, I was glad to try this one: Finally, Really Good Sandwich Bread: Our Favorite Gluten Free Bread Recipe, from Gluten Free Cooking School.

That looks to be a good basic recipe (with no dairy, and the option of egg replacement), but of course I had to fiddle with it. 😉 Here’s the version I’ve been using:

  • 1.5 packages of fast-acting yeast, or roughly 1 tablespoon
  • 1 tablespoon sugar
  • 0.5 c./about 125mL water a bit over body temperature. As long as it’s not hot enough to burn your skin, it’s OK.

Mix that up in a coffee mug, and set it aside for the yeast to proof while you get everything else ready.

In another bowl (I just use a handy British pint measuring cup), mix the dry ingredients together:

  • 2.5 cups/British pint/roughly 600mL flour blend (I’ve been using roughly a third each of chickpea flour/besan, brown rice or sorghum flour, and finely ground white rice flour)
  • 2 teaspoons xanthan gum
  • 1 teaspoon salt, or more to taste, since this makes a fairly hefty loaf and I like salt 😉

In the bread machine loaf pan, combine:

  • 2-3 lightly beaten eggs, preferably at room temperature
  • 1 c./250mL kefir, buttermilk, or yogurt warmed to about body temperature (a good use for any that’s gone very sour!)
  • 2 tablespoons oil or melted butter

By this time, the yeast should be threatening to foam out of the cup, and we’re ready to go. 🙂

As with most baking, the behavior here will vary depending on your ingredients, the weather, and especially your particular bread machine. But, this is what works best with mine: a circa 2004-vintage Kenwood model, which helpfully came with a GF cycle I didn’t even know I needed then! If yours doesn’t have that, the cake setting is supposed to work pretty well. A GF dough doesn’t want more than one rising period, so the regular bread cycles don’t work as well.

I didn’t think to get photos before everything was mixed up in the pan, either when I took these photos or today.

But, add the proofed yeast into the pan with the other liquid ingredients. I have found that it works best to start the cycle before beginning to add the dry ingredients gradually and carefully, so it doesn’t throw flour all over the place. Especially with the xanthan gum in there, it tends to glump up and need more stirring to mix up properly if you just dump all the flour in there before turning the machine on.

It still takes more attention during the mixing and kneading stage than a wheat flour bread would, because the dough needs to be wetter and doesn’t move around the pan as freely. A rubber spatula is your friend, with a table knife to scrape the sticky dough off it back into the pan. 🙂 You’ll need to scrape the sides of the pan down, and make sure it all gets properly mixed. I usually fold the dough over with a spatula a few times later on during the mixing/kneading process, just to make sure it’s uniform.

The dough consistency should be kind of like a thick br0wnie batter starting out; it also takes a while for rice and bean flours to absorb liquid, so hold off on adjusting the consistency for at least five minutes after it’s thoroughly mixed up.

It’s hard to get decent photos inside a working bread machine, so this is what we end up with instead. 😉

Dough near the end of the kneading time. This loaf still turned out a little moist and dense, but that’s better than dry and sandy end results!

At the end of the kneading cycle. As you can see, it tends to get a big air bubble around the paddle, at the bottom of the pan. I’m knocking that out with the spatula, and about to smooth the top of the loaf.

As smooth as it’s going to get! It’s hard to get all the gooey dough scraped down off the sides, but that’s good enough.

Even starting out with warm liquid ingredients, the rising time on my machine is still not long enough. I usually have to switch the machine off and let it sit for an extra hour or so, then use the “bake only” cycle.

I was afraid this would collapse if I let it go much longer. You can see how the top is starting to crack, with bubbles visible. That’s a better indication that it’s risen enough than the common “doubled in the pan” standard, in my experience.

And, finally, a finished loaf of bread! This one did turn out a bit denser than I’d wanted, from slightly too-moist dough, but it was still delicious.

Carefully pulling the very hot paddle out of the bottom of the very hot bread with a chopstick! It tends to stick.

This basic dough has also worked well for pizza crust, BTW. You can make the dough a bit stiffer, but this still won’t roll out well. Best just to plonk it onto a well-oiled pan with a good sprinkling of corn meal, and spread it out with your hands. Smoothing it down with slightly wet hands works better for a xanthan gum dough than flouring it for ease of handling, IME.

Advertisements

This post has enough to do with the long-term effects of celiac and gluten sensitivity that I am reblogging it here.

Urocyon's Meanderings

Content note: Discussion of dental fear, with descriptions of bad experiences with dental treatment.

One of my personal worst fears seems to have come true: it looks like I probably have an abscessed molar, and can’t keep putting off having some dental work done. Last night, I went ahead and e-mailed a nearby dental anesthetic clinic to try to set an appointment (yes, luckily there is one!), and have been spending the morning so far avoiding my e-mail and having anxiety attacks thinking about it.

I have never had an abscess before, myself, but seem to have pretty much all the symptoms, including a migraine-level headache and earache and other nerve weirdness on that side of my face. I’ve always been afraid of them, though, because my mom had a serious problem with them, and got very sick a lot and ended up losing a lot of teeth from…

View original post 5,211 more words

QOTD (and PSA): Adult-diagnosed celiac disease and osteomalacia

This is something I posted recently on my main blog, and it seemed very, very relevant here, so I am crossposting.

Not surprisingly, I haven’t been posting here lately after the premature “I’m back” post, because I underestimated how much extra supplementation was needed over the winter–and have been having fresh problems with things like stress fractures and hypocalcemia symptoms again. And, I just noticed that those include steatorrhea, and no doubt other digestive problems. 😐

Other posts under the vitamin D tag on my main blog.

____________

From a text I ran across, Metabolic bone disease and clinically related disorders (edited by Louis V. Avioli, Stephen M. Krane), discussing health problems which cause malabsorption:

The potential risk of osteomalacia is greatest in adult celiac disease because the mucosal defect impairs absorption of vitamin D and calcium directly and may also reduce local calcitriol synthesis. Patients with mild subclinical celiac disease may manifest all the symptoms of HVOi[*], which improve with a gluten-free diet. In patients untreated for many years, osteomalacia develops in more than half, but can be forestalled by timely diagnosis. Osteomalacia can occur even without steatorrhea and may be the presenting manifestation…[T]here is no response to ultraviolet irradiation or to moderate doses of vitamin D in the absence of a gluten-free diet.

Emphasis added, and citations omitted (you can click through to the book preview if you want to see that). As the local calcitriol synthesis and lack of response to UV exposure would suggest, just what I have been able to skim so far has been very interesting in terms of complexity; I’d suspected as much, but the usual models presented are way oversimplified.

One interesting bit that seems very relevant: what sounds like another vicious cycle, in which calcium can’t be used properly without enough vitamin D (the bit that gets the most attention)–but, also, depleted calcium levels will keep your body from using the D properly. The roles of a lot of other minerals involved in bone modeling, and how they interact, are poorly understood.

There is also discussion of how multiple factors tend to be involved, if things get to the point of serious bone demineralization and/or hypocalcemia symptoms. Including that people with disabilities that keep them from getting out much tend not to get much UV exposure; I’d add that this can also snowball, as you feel worse and worse from deficiency problems.

An excellent point from Osteoporosis and Osteomalacia in Patients with Celiac Disease:

Although it may be asymptomatic, Celiac Disease is a lifelong disease. If there is lifelong impairment in calcium absorption, bone density will be compromised.

This is too often overlooked by clinicians, when dealing with people diagnosed as adults, often because the symptoms have changed. While I did have digestive problems my whole life that got put off on all kinds of things–because celiac was still considered so rare–it suddenly got a lot worse as an adult, after I moved somewhere that wheat is cheap and gets used in absolutely everything like corn is in the US. Some people don’t even have the obvious if lower-level digestive symptoms. And, as mentioned in the main quote, just because you haven’t been spending half your time with the runs like you’ve been eating Olestra over the longer term, that doesn’t mean you’ve been absorbing nutrients properly.

I honestly think there is too often also the perception, including among medical professionals, that if an adult had really been suffering from celiac disease (and I use “suffering” advisedly here) for a lifetime, they’d be dead or at least severely impaired in readily visible ways. Leading to the idea that even though celiac is, by definition, a lifelong condition, the onset must have been recent–or it must have been a mild enough case not to have done any real damage. Bzzt, it doesn’t work that way.

It doesn’t help that both celiac and vitamin D deficiency are still considered rarer than they are, to the point of their just not thinking to look for it. Osteomalacia among people who are not elderly, even more so.

Another often overlooked point, from Osteomalacia in Adult Celiac Disease:

Mineralization defect and osteomalacic changes are common later on, irrespective of whether patients are in remission or not. Changes may not respond to a gluten-free diet alone but may require supplementation.

Emphasis in the original, this time. That one also includes pretty good descriptions** of some of the signs to watch out for. (Even if it gives bad off-the-cuff advice about how much sun exposure is needed.)

That is what seems to have happened to me, not helped at all by lack of UV exposure at the latitude where I am living. (On a GF diet for better than five years now, and I seem to be able to synthesize and use D from sunlight when it’s available.) But, there is a pretty common idea that a GF diet will fix everything, and quickly. When you’re almost certainly dealing with multiple longterm deficiencies, that ain’t necessarily so–which should be obvious. One good analogy I saw, though I can’t remember where, in the context of just a vitamin D deficiency and low-level supplementation: it’s like trying to treat dehydration with a shot glass full of water. All the while, you’re getting more and more dehydrated.

And that’s even without some professionals not even sending people for nutrient testing and bone scans–and brushing off classic vitamin/mineral deficiency and osteomalacia symptoms. Because a GF diet fixes everything instantly, right? (Yeah, it’s hard not to sound bitter sometimes. But, there’s just no excuse.)

Another factor that may be relevant, and I suspect is one reason why I’ve been needing to take so much vitamin D and Osteocare (with other minerals besides calcium, which has made a difference): the relationship between vitamin D and some continuing IBS symptoms.

The relationship with vitamin D and IBS is cyclic. Autoimmune disorders are associated with vitamin D deficiency, but then can also cause vitamin D deficiency. The malabsorption caused by IBS results in deficiency of vitamins absorbed in the intestines, which includes vitamin D.

Sounds like a ball that (autoimmune) celiac could easily get rolling, yeah. More vicious cycles.

But, I was shocked enough by the “more than half” prevalence that I had to post the original quote; then it mushroomed. 🙂

_____________

* Explanation from Lessons for nutritional science from vitamin D:

Parfitt (3), building on the expansion of knowledge in bone biology in the past 40 y, has characterized the disorder due to insufficient vitamin D as “hypovitaminosis D osteopathy” (HVO) (3). He divides HVO into 3 stages along a scale of increasing severity. In HVOi there is malabsorption of calcium accompanied by physiologic evidence of an attempt to compensate (eg, elevated parathyroid hormone production and high bone remodeling); the result is bone loss, ie, osteoporosis. In HVOii, bone mass is also low, calcium malabsorption continues, and bone remodeling is either high or drops back into the normal range; now, histologic examination of bone reveals subclinical, early osteomalacia. In HVOiii, clinical rickets or osteomalacia is present and bone remodeling is reduced or absent entirely (partly because of the dependence of bone resorption on 1,25-dihydroxyvitamin D [1,25(OH)2D] and partly because bony surfaces covered with unmineralized osteoid serve as barriers to osteoclastic erosion). The prevalence of each degree of HVO is unknown but environmental vitamin D availability seems sufficient to prevent HOViii in most North Americans. Therefore, most vitamin D deficiency does not manifest itself as clinical rickets or osteomalacia.

** I would add: the pain can also be in long bones in your arms– and especially the ribcage and sternum, too. They underemphasize the kind of pain levels it can cause. And it does more than ache once the insufficiency/stress fractures start, so if this might be a problem for you, I hope you can get it managed before it reaches that point!