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Oct/Nov 2013 Issue
A special diet in war-torn Afghanistan
On March 24, 2012, five soldiers gathered in a dimly lit wooden shed in Kandahar, Afghanistan. Dust poured through cracks in the plank walls, blanketing the gluten-free snacks laid out only moments earlier. The servicemen were there for the first-ever gluten-free support meeting in Afghanistan—“or so we suspected,” says Captain B. Donald Andrasik, the national guardsman who led the group.
The idea for such a gathering didn’t occur to Andrasik until he was nearing the end of a year-long deployment in Afghanistan. By accident, he stumbled upon a few boxes of gluten-free food and a toaster left behind by another gluten-free soldier, whom he was unable to track down despite his best efforts.
“I was dumbfounded,” he recalls. “In this most remote part of the world, someone else had dealt with the same struggles and food challenges that I had.” Soon he was wondering—were there others?
In 2012, Kandahar Airfield (KAF), as the base was known, was a North Atlantic Treaty Organization (NATO) post, home to an international contingency of some 30,000 soldiers. Andrasik attempted to post fliers about a gluten-free meet-up at dining facilities and other gathering spots. However, most were promptly taken down, even after securing permissions. He also purchased a website, glutenfreeinafghanistan.com, and asked people to e-mail him if they were gluten-free.
In a matter of days, he had located 12 gluten-free service members, of whom four made it to that first meeting in the dusty shed. Most agreed they were managing their diet reasonably well, considering the circumstances. However, they were on their own. No one had told their chain of command, or the Army, about their special diet. Worse yet, all of them accepted getting sick—glutened—as part of deployment lifestyle.
“Being gluten-free can be a dicey prospect for a soldier,” says Andrasik.
Early on in his deployment, he ate a meal that appeared safe—plain turkey, sliced cucumbers and rice—but within an hour, he was hit by the unmistakable abdominal discomfort of gluten ingestion. (There was wheat in a marinade on the turkey.) As it happened, the base was under rocket attack and Andrasik was forced to take shelter in a crowded, bathroom-less bunker. To leave the bunker meant risking his life—the thin plastic walls of the nearby portable toilets offered no protection from the incoming shrapnel, which can tear through cars at close enough range. It was a situation he swore never to find himself in again.ý
Andrasik joined the Maryland Army National Guard in January 2001 when he was 19 years old. Before enlisting, he talked to other service members about what they ate (he was assured, lots of plain rice) and met with a dietitian, as well as civilian and Army doctors. None seem alarmed by his dietary needs. Most just shrugged their shoulders, he recalls, although in hindsight he points out knowledge of the rigors of the gluten-free diet wasn’t as widespread as it is today.
Andrasik began the diet in his early teens after his mother was diagnosed with celiac disease, an autoimmune disorder set off by the ingestion of gluten. Classic symptoms include diarrhea, bloating and abdominal discomfort. Although Andrasik himself had experienced celiac-like symptoms, the diet was largely forced upon him by his mother, who purged the household of gluten following her long-overdue diagnosis. By the time he enlisted, he felt better and more fit than ever—and was fully committed to the diet.
As he’d hoped, Andrasik found avoiding gluten to be doable, apart from his six-week stint in basic training, otherwise known as boot camp. There, he “laid low and kept quiet,” doing his best to seek out plain rice, salad and other foods that looked safe. Of course, the strategy wasn’t foolproof and Andrasik paid the price more than once. However, he survived and returned to Maryland to an easier pace of life, drilling on the weekends as a combat engineer with the 121st Engineer Battalion.
Although it wasn’t easy or without mishaps, Andrasik learned to ask questions, locate naturally gluten-free foods as they were offered and tote along enough gluten-free food to fill in the gaps. Things were going well enough that, a few years later, he completed the Reserve Officers Training Corps and was commissioned as a second lieutenant.
When he learned he’d be deploying to Afghanistan, he’d been in the service ten years and spent considerable time on U.S. bases, including Air Force and Navy posts.
“I was relatively confident I could manage,” he says. Still, he tried to learn as much as he could to prepare for deployment, even arranging a meeting with the chief of nutrition service at Carl R. Darnall Army Medical Center in Ft. Hood, Texas. At their meeting, it was made clear: deployment was going to be the ultimate gluten-free challenge. Food in the dining facilities on KAF would be a combination of food shipped from the United States, as well as food purchased from nearby countries, like Pakistan. In either case, little information about gluten or potential cross contamination would be readily available. The Army focused on the health and sanitation of its food but gluten was not tracked by anyone.ý
The Army can accommodate hospital inpatients who require a gluten-free diet but little else is promised when it comes to avoiding gluten. According to Army Regulation 40-501 (Standards of Medical Fitness), “intestinal malabsorption syndromes” disqualify one from enlisting. Although celiac disease isn’t directly addressed by 40-501, the condition can lead to malabsorptive symptoms, explains Col. Stephen A. Harrison, MD, director of medical education at San Antonio Military Medical Center and gastroenterology consultant to the Office of the Surgeon General.
“Celiac sprue can be a severe disorder, even life-threatening in some patients,” Harrison says. “Because of the extreme challenges of deploying to austere environments, where it cannot be ensured that soldiers will be able to adhere faithfully to a gluten-free diet, causing symptoms to flare, it should be a bar to accession.”
Soldiers diagnosed with celiac disease while on active duty are referred to a Medical Evaluation Board (MEB), where their condition is documented and any duty limitations, like deployment, are identified. Entering an MEB doesn’t mean automatic discharge, however.
While it may not be in the best interest of celiacs to routinely deploy, the gluten-free diet is no longer bound so exclusively to celiac disease as it was once. Not every person on the gluten-free diet has celiac disease. Aside from Andrasik, there was at least one soldier at the first gluten-free meeting on KAF who didn’t have an official diagnosis.
A newly recognized condition that’s gained traction among celiac experts—non-celiac gluten sensitivity—can cause similar and just-as-debilitating symptoms as celiac disease, although the condition isn’t believed to carry the same long-term health risks as untreated celiac disease. Others use the gluten-free diet to help ease symptoms related to ADHD, migraines, irritable bowel syndrome and even Lyme disease.ý
Andrasik arrived in Afghanistan after multiple stopovers, including ones in Ireland and Asia, just in time for the midnight meal. (Some chow halls serve a midnight meal in addition to breakfast, lunch and dinner.) Tub after tub in the assembly line of food—meals were cafeteria style—was either breaded or covered in sauce. Andrasik tried to talk to the staff (and later, when he wasn’t rushed, to the kitchen manager), but there was little understanding of gluten and all the food packages were written in Arabic. That first night, he settled for an orange and a salad.
Breakfast was better. In fact, breakfast was consistently the easiest gluten-free meal of the day for Andrasik. He’d load up on hard-boiled eggs, milk and fresh fruit—apples, oranges, grapes, watermelon and kiwi were all remarkably plentiful.
Most of the meat continued to be fried or swimming in gravy. After his misstep with the turkey, Andrasik decided to forgo all meat and follow a vegetarian diet during his deployment. The strategy worked fairly well—when the Army serves green beans or corn or rice, it is what it says it is (i.e., plain). Cross contamination is typically minimal—the bread tong never mixes with the corn tong, for example.
Andrasik was making it work well enough until the Pakistani border temporarily closed and shipments of fresh fruit and vegetables were stymied. Although some service members barely noted the disruption, Andrasik was forced to rely almost exclusively on his own stash of gluten-free food. Replenishing his fast-dwindling supply wasn’t easy, however. About a third of what he ordered (via the Internet) never arrived or showed up weeks late, speckled with mold.
Still, Andrasik considered himself lucky. He had regular Internet access for ordering gluten-free food and he had space to store it. He also had seniority. Now captain, he wasn’t as likely to be harassed about his special diet.
“The military can be a brutal environment if you have any perceived ‘weakness,’” he says.
Although Andrasik was mostly left alone about his diet, there was one unfortunate incident when a higher ranking officer found his stash of gluten-free food, including pizza crusts he was planning to use for an upcoming support group meeting, and threw all of it into the dumpster.
“It was a lot of food,” recalls Andrasik, still fuming over the prank. “I doubt he knew what gluten-free was or how important the food was to me—but I don’t think it would’ve mattered.”
Andrasik rummaged through the dumpster but there was no salvaging anything.
“With the temperature over 100 degrees, the flies were swarming everywhere,” he says.ý
Andrasik led three more support group meetings before deploying home. One topic the group discussed at length was the MRE: Why couldn’t there be a gluten-free option?
Meals Ready to Eat (MRE) are individually packaged, high-calorie field rations used by all branches of the military. A typical MRE consists of an entrée, like breaded chicken or beef teriyaki, a powdered milk shake (to be mixed with water), crackers or bread, fruit, and dessert or an energy bar (plus condiments, utensils, napkins and a heating device).
Some components of the MREs are already gluten-free, like the powdered shake, says Andrasik. He would cobble together an MRE by swapping things like breaded chicken for the shake. (Trading is common practice, he says. Soldiers have been doing it since the first World War.)
Unlike food in the dining facilities, ingredients in the MRE come from known sources and their gluten-free status can be ascertained. Ingredients are actually listed on the individual components of most MREs, says Andrasik. In his research, he found that the factories that process MREs clean their equipment between runs, reducing the risk of cross contamination. What’s more, he adds, kosher, Halal and vegetarian MREs have been available for several years now.
“Producing a gluten-free MRE would just be a matter of fine-turning what they already do,” he contends.
But when Andrasik asked some of his fellow gluten-free soldiers if they’d be willing to talk “on the record” to push for changes like the gluten-free MRE, no one was interested. How will the Army know, if there’s not a demand for it, he implored.
“I had their anonymous support but no one wanted to publicly declare they were gluten-free, or even worse, had celiac disease,” he says. “A soldier’s worst fear is becoming a target for discharge, that the Army would rather cut its losses than have to make special accommodations.”
“Deployment, particularly to a desolate place like Afghanistan, is certainly not an ideal scenario to have to deal with the gluten-free diet,” Andrasik concedes. “It can be challenging under the best of circumstances.”
However, out of an estimated 1,095 meals he ate during deployment, just eight of them contained enough gluten to make him feel noticeably ill.
“That’s an accuracy rate of about 99.3 percent,” Andrasik calculates. More importantly, he never missed duty and remained otherwise healthy, albeit almost 40 pounds lighter. (Walking several miles daily while carrying heavy equipment played a role in his weight loss, he points out.)
“With dedication, the gluten-free diet can be done anywhere by anyone,” Andrasik says. “I’m no one special and I made it work.”