What is cross-contact in gluten-free diets. How does cross-contact differ from cross-contamination. Where are hidden sources of gluten commonly found. Can the same toaster be used for gluten-free and gluten-containing items. How to safely prepare gluten-free foods in shared kitchen environments. What precautions should be taken when cleaning gluten-free cookware.

The Importance of Understanding Cross-Contact for Gluten-Free Living

For individuals diagnosed with celiac disease or other gluten-related disorders, maintaining a strict gluten-free diet is crucial. While avoiding wheat, rye, barley, and their derivatives is a well-known necessity, the concept of cross-contact poses a significant challenge that many may overlook. Cross-contact occurs when gluten-free foods come into contact with gluten-containing items, rendering them unsafe for consumption by those with gluten sensitivities.

Even minute amounts of gluten, as little as a crumb, can trigger an autoimmune response in individuals with celiac disease, regardless of whether symptoms are immediately apparent. This makes understanding and managing cross-contact one of the most critical aspects of adhering to a gluten-free lifestyle.

Cross-Contact vs. Cross-Contamination: Understanding the Difference

It’s essential to distinguish between cross-contact and cross-contamination, as these terms are often used interchangeably but have distinct meanings in food safety contexts.

What is cross-contamination?

Cross-contamination typically refers to the transfer of harmful bacteria or microorganisms between foods, which can lead to foodborne illnesses. This term is commonly used in food service industries and implies that contamination can be eliminated through proper cooking or sanitization methods.

Why is cross-contact the correct term for gluten exposure?

Cross-contact is the more accurate term when discussing gluten exposure because:

• Gluten is a protein, not a microorganism
• Proteins cannot be “killed off” by heat or disinfectants
• The term better reflects the physical transfer of gluten particles between foods

Using the correct terminology is crucial when communicating with food service professionals, as it helps ensure proper understanding and implementation of gluten-free safety measures.

Hidden Sources of Gluten: Identifying Potential Cross-Contact Risks

Gluten can lurk in unexpected places, making it essential for those following a gluten-free diet to be vigilant about potential sources of cross-contact. While some individuals opt for entirely gluten-free households, this isn’t always feasible due to space limitations, budget constraints, or living with family members who consume gluten.

Common hidden sources of gluten in the kitchen:

1. Shared cooking utensils and cutting boards
2. Toasters and toaster ovens
3. Convection ovens
4. Shared condiment jars (due to double-dipping)
5. Dish sponges and cleaning rags
6. Wooden utensils and cutting boards (which can harbor gluten in their porous surfaces)
7. Flour residue on surfaces and in the air

Being aware of these potential sources of cross-contact is the first step in creating a safe gluten-free environment. It’s crucial to develop strategies to mitigate these risks, which may involve designating separate areas, utensils, and appliances for gluten-free food preparation.

Toaster Troubles: Navigating Gluten-Free Toasting in a Mixed Household

One of the most common questions among those new to gluten-free living is whether they can share a toaster with gluten-containing items. The short answer is no, but let’s delve deeper into why this is the case and explore potential solutions.

Why can’t gluten-free and gluten-containing items share a toaster?

Toasters are notorious for trapping crumbs and food particles in their heating elements and crevices. When gluten-containing bread is toasted, these particles can easily transfer to gluten-free bread, causing cross-contact. Even a few crumbs can be enough to trigger a reaction in sensitive individuals.

What are the alternatives for gluten-free toasting?

• Dedicated gluten-free toaster: The safest option is to have a separate toaster exclusively for gluten-free items.
• Toaster bags: Reusable, heat-resistant bags can create a barrier between gluten-free bread and a shared toaster. However, these require careful handling to prevent cross-contact.
• Toaster oven with foil: Using a clean piece of foil on the rack of a toaster oven can provide a safe surface for toasting gluten-free items.

When using toaster bags or a toaster oven, it’s crucial to handle the gluten-free items with clean utensils and avoid placing them on surfaces that may have come into contact with gluten-containing crumbs.

Oven Safety: Preparing Gluten-Free Foods in Shared Ovens

While ovens present less risk of cross-contact than toasters, there are still precautions to take when preparing gluten-free foods in an oven that’s also used for gluten-containing items.

Can convection ovens be used safely for gluten-free cooking?

Convection ovens pose a higher risk of cross-contact due to their fan-driven air circulation, which can blow gluten particles onto gluten-free foods. However, they can still be used with proper precautions:

• Cover gluten-free foods tightly with foil or a lid
• Clean the oven thoroughly before preparing gluten-free items
• Consider using a separate baking sheet or oven-safe dish for gluten-free foods

How to use a shared toaster oven for gluten-free cooking:

1. Clean the toaster oven thoroughly, paying special attention to crumb trays and heating elements
2. Use a clean baking sheet or create a barrier with foil on the rack
3. Avoid placing gluten-free foods directly on racks or surfaces that have touched gluten-containing items
4. Consider using the toaster oven when it’s coolest (i.e., first thing in the morning) to minimize the risk of airborne particles

By following these guidelines, it’s possible to safely prepare gluten-free foods in shared ovens, reducing the risk of cross-contact while maintaining a flexible kitchen environment.

Cleaning Conundrums: Proper Sanitization to Prevent Cross-Contact

Maintaining a clean kitchen is crucial for preventing cross-contact, but it’s not just about cleanliness—it’s about using the right tools and methods to ensure gluten particles are not transferred between surfaces and utensils.

Should separate cleaning tools be used for gluten-free items?

Yes, it’s highly recommended to use separate sponges, dishcloths, and cleaning rags for gluten-free cookware and surfaces. This prevents the transfer of gluten particles that may remain on cleaning tools even after washing.

Best practices for cleaning in a mixed gluten/gluten-free kitchen:

• Use color-coded cleaning tools to easily distinguish between gluten-free and gluten-containing areas
• Opt for disposable paper towels when cleaning surfaces that have been exposed to gluten
• Change dishwater frequently when hand-washing dishes to prevent gluten transfer
• Consider using a separate dish rack or drying area for gluten-free items
• Regularly clean and sanitize shared appliances, such as microwaves and refrigerators

Remember, while thorough cleaning is essential, it’s not foolproof. Gluten proteins cannot be “killed” by heat or sanitizers, so physical removal of all particles is necessary to prevent cross-contact.

Beyond the Kitchen: Cross-Contact Risks in Food Production and Dining Out

While managing cross-contact at home is challenging enough, the risks extend far beyond your kitchen. Understanding potential sources of gluten exposure throughout the food production chain and when dining out is crucial for maintaining a strictly gluten-free diet.

Cross-contact risks in food production:

Gluten can find its way into otherwise gluten-free foods at various stages of production:

• Growing: Crop rotation practices may lead to gluten-containing grains growing in fields previously used for gluten-free crops
• Harvesting: Shared equipment used for both gluten-containing and gluten-free grains
• Processing: Facilities that process both gluten-containing and gluten-free products on the same lines
• Packaging: Cross-contact during the packaging process or from shared storage facilities

These risks underscore the importance of choosing products from manufacturers who follow strict gluten-free protocols and regularly test their products for gluten content.

Navigating cross-contact when dining out:

Eating at restaurants presents unique challenges for those following a gluten-free diet. Here are some strategies to minimize risk:

1. Research restaurants in advance, looking for those with gluten-free menus or protocols
2. Call ahead to discuss your needs with the chef or manager
3. Communicate clearly with your server about the severity of your gluten intolerance
4. Ask about food preparation methods and potential sources of cross-contact
5. Be cautious of high-risk items like fried foods (which may share oil with breaded items) and salad bars
6. Consider bringing your own condiments or salad dressings to avoid shared containers

While these precautions may seem daunting at first, they become second nature with practice and can significantly reduce the risk of accidental gluten exposure when eating away from home.

Educating Others: Spreading Awareness About Cross-Contact

One of the most challenging aspects of managing a gluten-free diet is educating friends, family, and food service professionals about the importance of preventing cross-contact. Many people are unaware of how easily gluten can transfer between foods and surfaces, making it crucial to spread awareness.

Tips for educating others about cross-contact:

• Be patient and explain the concept of cross-contact in simple terms
• Use visual aids or demonstrations to illustrate how easily gluten can spread
• Share personal experiences to help others understand the impact of accidental gluten exposure
• Offer resources from reputable organizations like Beyond Celiac for further information
• Lead by example, demonstrating proper handling and preparation of gluten-free foods

By raising awareness about cross-contact, you not only protect yourself but also contribute to creating a safer environment for all individuals with gluten-related disorders.

The role of labeling in preventing cross-contact:

Understanding food labels is crucial for those following a gluten-free diet. While “gluten-free” labels are helpful, they don’t always tell the whole story when it comes to cross-contact risks. Educate yourself and others about:

• The difference between “gluten-free” and “certified gluten-free” labels
• Precautionary statements like “may contain traces of wheat” or “processed in a facility that also processes wheat”
• The importance of contacting manufacturers for more information about their production processes

By fostering a better understanding of these issues, we can work towards creating a more inclusive and safe environment for individuals with gluten sensitivities.

Embracing a Proactive Approach to Gluten-Free Living

Managing cross-contact risks is an ongoing process that requires vigilance and dedication. While it may seem overwhelming at first, adopting a proactive approach to gluten-free living can lead to improved health outcomes and peace of mind.

Key takeaways for preventing cross-contact:

• Educate yourself and others about the dangers of even small amounts of gluten exposure
• Implement strict kitchen protocols, including separate utensils and appliances when possible
• Be cautious when dining out and communicate your needs clearly
• Stay informed about food production processes and labeling practices
• Advocate for better awareness and accommodation of gluten-free needs in various settings

Remember, while managing cross-contact can be challenging, the benefits of maintaining a strict gluten-free diet for those with celiac disease or gluten sensitivities are substantial. By taking control of your environment and educating those around you, you can significantly reduce the risk of accidental gluten exposure and enjoy a healthier, more comfortable life.

As research in the field of gluten-related disorders continues to advance, stay connected with reputable organizations and healthcare providers to remain informed about the latest recommendations and best practices for managing cross-contact and maintaining a gluten-free lifestyle. Your diligence in this area is not just about avoiding symptoms—it’s about protecting your long-term health and well-being.

Cross-Contact | BeyondCeliac.org

You’ve been diagnosed with celiac disease or another gluten-related disorder. You know you have to avoid wheat, rye, barley and ingredients and products derived from them. But are you aware of the dangers of cross-contact?

Before you begin your own gluten-free adventures at home, or decide to try eating out, you’ll need to be aware of all of the places in a kitchen where gluten may lurk. It doesn’t take very much gluten to make you sick! Even just a crumb of gluten is enough to start the autoimmune response in people with celiac disease, even if symptoms are not present. Many people find cross-contact to be one of the most difficult parts of the gluten-free diet to manage.

What is cross-contact?

Cross-contact is when a gluten-free food or food product is exposed to a gluten-containing ingredient or food – making it unsafe for people with celiac disease to eat. There are many obvious (and not-so-obvious) sources of cross-contact at home and in restaurants and other foodservice locations. There is even a risk of cross-contact before ingredients make it to the kitchen, such as during the growing, processing, and manufacturing processes.

While it may seem like a challenge to remember and be proactive about all of the possible sources of cross-contact at first, your improved health will make the effort worth it. Read on to better understand some of these sources and what you can do to prevent cross-contact.

What is cross-contamination?

Cross-contamination is a term that implies that a food has been exposed to bacteria or a microrganism, which could result in a foodborne illness like salmonella. By definition, it can lead foodservice and other industry professionals to believe that if a food is “contaminated” by gluten, they can simply “kill off” the contaminant. However, gluten is a protein (not a type of bacteria) and proteins cannot be “killed off” using heat or disinfecting agents like most bacteria can be.

The term “cross-contact” more accurately reflects that a gluten-containing food cannot come into contact with a gluten-free food. If we speak the same language as chefs and foodservice professionals, we are more likely to have a better experience when dining away from home.

What are hidden sources of gluten?

Gluten can hide in lots of places, even in your home. Some people opt to maintain an entirely gluten-free household, but for many, that’s not possible, especially because cabinet space and budget concerns can play into the decision.

Download:
Infographic: Hot Spots at Home

Can I use the same toaster for gluten-free and gluten-containing items?

The short answer : No, you cannot use the same toaster for both gluten-free and gluten-containing items.

An explanation: Celiac disease experts strongly recommend that you buy a separate toaster for gluten-free items to avoid cross-contact with gluten-containing foods. However, there are reusable “toaster bags” on the market which can be used in a pinch to prevent cross-contact. These can be useful for travel and eating at a friend or relative’s house. Toaster bags are not foolproof, and caution must be used to ensure that crumbs from gluten-containing items do not fall into the bag. It is also important to remember to never place the bag itself on gluten-free plates of food, as the outside of the bags will expose the other foods to any gluten it came into contact with in the toaster. Similar caution should be used when preparing gluten-free foods in toaster or convection ovens.

Can I prepare gluten-free foods in toaster or convection ovens that have been used to make gluten-containing food?

The short answer: There is a high risk for cross-contact.

An explanation: Convection ovens use a fan to circulate air around food. This process can cause cross-contact because gluten particles can be blown by the fan. You can still use a convection oven that has been used to prepare gluten-containing foods, but only as long as you keep gluten-free foods tightly covered when cooking. Toaster ovens are acceptable to use too, and using foil or a clean tray on the rack helps create a barrier from any crumbs. Also, be sure to thoroughly clean the oven in between uses, even if there are no visible crumbs.

Can I use the same sponges and dish rags to clean gluten-free cookware as I use for cookware that has been used to make gluten-containing items?

The short answer: No, you should have separate sponges and dishrags to clean gluten-free cookware. Paper towels may not be “green” but you can clean up and toss the gluten-containing crumbs.

An explanation: Gluten cannot be sanitized away, so any gluten that remains on sponges or dishrags can be transferred to otherwise clean plates. Make sure to also use fresh dish water if you hand wash your dishes, as particles of gluten in the water can also be transferred to otherwise clean dishes when rinsing. Save dishes that held gluten-containing foods for last when hand-washing dishes.

While gluten cannot be “killed off,” dishes must still be washed thoroughly to eliminate any remaining particles on them. Dish soap combined with warm water accomplishes this much more effectively than simply running dishes under water. Beyond Celiac Scientific/Medical Advisory Council member Rachel Begun, MS, RDN, highlights these steps for cleaning dishes in shared kitchens:

1. Dry wipe to remove all crumbs and bits and pieces of food residue before cleaning
2. Wash thoroughly with warm, soapy water
3. Rinse
4. Where possible, clean by running through the dish washer. Or, use a home sanitizing solution for necessary equipment.
5. Either let air dry or wipe with a clean towel that hasn’t come into contact with gluten

Can I use condiments from the same containers that have been used to prepare gluten-containing foods?

The short answer: No!

An explanation: Utensils that are used to spread butter, peanut butter, jelly, mayonnaise, cream cheese and other condiments will expose the product to gluten which can then be spread onto your gluten-free breads, bagels, etc. As a solution, you may find condiments in squirt bottles useful as long as those using the condiments are well aware that they cannot wipe the tip of the squirt bottle on their gluten-containing foods. It is safest to have separate condiments, and to clearly label the condiments that are dedicated gluten-free.

Families (or roommates) may find it helpful to discuss gluten-free kitchen dos and don’ts and should express the importance of confessing mistakes. If someone accidentally dips his or her knife in the gluten-free jar, it is his or her responsibility to make sure family members or roommates are well aware. A similar situation can happen with dips. If someone dunks a gluten-containing pretzel into the vegetable dip, it is no longer safe for someone with celiac disease to consume.

Can I use the same water for boiling gluten-free pasta, steaming vegetables, and thickening gluten-free sauces that was used to boil gluten-containing pasta?

The short answer: No, you must use clean water.

An explanation: This remains a very common misconception when the term “cross-contamination” is used. Some believe that boiling water after making gluten-containing pasta or other gluten-containing foods will “sanitize” the water, and make it safe to prepare gluten-free foods. Gluten cannot be “killed off” or “disinfected,” so it is not safe to use the same water to make gluten-free foods that was also used to make gluten-containing foods. This is a practice called comingling. This should also be kept in mind when using colanders to strain pasta. Gluten-free pasta should always be strained in a clean, preferably dedicated, colander.

Can I use the same oil for frying gluten-free items that was used to make gluten-containing fried foods?

The short answer: No, a separate fryer must be used for gluten-free items to avoid cross-contact.

An explanation: Similar to the misconception about using the same water to boil both gluten-containing foods and gluten-free foods, it is also not safe to use the same oil to fry these items. High heat will not eliminate gluten in the oil, so fryers used to make breaded or battered items would not be safe to use for gluten-free French fries, corn tortilla chips or other gluten-free items.

Are cutting boards a source of cross-contact?

The short answer: Yes, cutting boards can be a hot spot for sources of gluten.

An explanation: Knives can cause cuts on the surface of cutting boards, and these are hard to clean out completely. If a cutting board is used to slice, cut or dice gluten-containing items – like bread or dough – gluten can get stuck in these crevices and transfer the gluten to your food. Make sure to purchase a cutting board that is only used to cut gluten-free foods. Color-coding is an effective way to differentiate between the gluten-free cutting board and the cutting board that can be used for gluten-containing items.

Can I safely prepare gluten-free foods on the same grill or griddle that was used to prepare gluten-containing foods?

The short answer: No, it is not recommended that you use the same grill or griddle to prepare gluten-free foods that is used to make gluten-containing foods.

An explanation: Crumbs from toasting hamburger buns or sticky marinade residue can easily be left on the grate of the grill, and it is difficult to properly clean after it has charred on. Also, it’s common for restaurants and other foodservice establishments to cook both naturally gluten-free foods like omelettes and breakfast potatoes and gluten-containing foods like pancakes and French toast on the same surface such as a griddle or flat grill. We recommend that you ask questions and assess your risk for cross-contact. If the char grill never sees bread – and many restaurant grills do not – and only raw meats and vegetables with no marinades are used, a char grill is a safe choice. Assess your risk by asking the chef or manager if they toast bread products on the grill. Also ask if the grill or griddle is used to cook marinated foods and gluten-conataining foods like pancakes. If the grill has been exposed to gluten, heavy, sturdy foil can be put on the grill or a sauté pan should be used instead. If there is a great risk of gluten exposure at home, you may choose to purchase a small grill that can be dedicated to only preparing gluten-free foods.

Can I make gluten-free waffles using the same waffle iron that was used to make gluten-containing waffles?

The short answer: It is not safe to use a waffle iron to prepare both gluten-containing and gluten-free waffles.

An explanation: Waffle irons are incredibly difficult to clean thoroughly, and residual gluten may be left on the iron even after cleaning. You should buy separate waffle irons (and other similar appliances) to prepare gluten-containing and gluten-free waffles to avoid any chances for cross-contact.

Can the refrigerator door handle really expose me to gluten?

The short answer: Yes! All handles in the kitchen can expose you to gluten.

An explanation: Although not the most common source of gluten, the refrigerator door handle can contain sticky gluten residue. For example, a chef is preparing cookies or has flour-dusted hands and suddenly realizes they’re missing an important ingredient. They then may hastily wipe them on the dish towel or apron (which are now also sources of unwanted gluten!) and open the fridge. Any residual gluten that was on their hands is now on the refrigerator door handle and may be a source of cross-contact later on. If you do not have a dedicated gluten-free kitchen at home, make sure to regularly clean your refrigerator door and other handles in the kitchen to ensure that you will not accidentally be exposed to gluten when you’re grabbing a quick bite to eat from the fridge!

Should I store my gluten-free items on the bottom or top shelf of my pantry and refrigerator?

The short answer: Store your gluten-free items on the top shelf in a dedicated area.

An explanation: We recommend that you keep gluten-free items on the top shelf of your pantry, refrigerator and freezer to prevent crumbs of gluten-containing items from falling into gluten-free foods. Make sure to also have a dedicated gluten-free shelf of foods, as it can be easy to mistakenly grab the gluten-containing bread crumbs because they were right next to the gluten-free ones. Label your gluten-free foods with colored tape or stickers to ensure that the whole family can recognize their status confidently.

Do I need to worry about airborne flour?

The short answer: Yes.

An Explanation: Most people will be surprised to know that flour can stay airborne for 12-24 hours depending on ventilation and quantity of flour. If there is a risk of any flour or particles of gluten in the air, it is safest to avoid those areas for the next 24 hours. While simply touching gluten will not harm an individual with celiac disease, there can be a risk of ingesting airborne gluten, which is usually caused by flour. It is also important to remember not to prepare gluten-free foods in spaces where there is a risk of airborne gluten, as particles will settle on the food, making it unsafe for those with celiac disease to eat. Some of the most common places where this type of cross-contact can occur include pizzerias and bakeries.

Can I safely eat at a buffet that has both gluten-free and gluten-filled foods?

The short answer: Sometimes.

An explanation: While there may be gluten-free options on a buffet, there is no guarantee that they have not come into contact with gluten. Even when those making the food claim to be very aware of their preparation methods, other people eating at the buffet may not be. Spoons may be set back in the wrong dish, and tongs may be used to pick up several different foods before being put back in the right spot. Gluten-filled foods could spill into the gluten-free foods. Thermometers that are used to check if food is safe to consume may be used in gluten-filled and gluten-free foods without proper cleaning between checks. These are just a few examples of the potential for cross-contact in buffets. As a solution, you can ask to speak to the chef to see if they can bring out a freshly made plate of gluten-free foods directly from the kitchen. Or, you can work with the chef and catering company to make sure that you are able to serve yourself first, before cross-contact can occur.

Should I be concerned about cross-contact during the growing and manufacturing processes?

The short answer: Yes, absolutely!

An explanation: It is important to know how your food is made, from farm to table, in order to avoid possible gluten exposure. To voluntarily label a product gluten-free in the U.S., it must contain less than 20 ppm gluten, as mandated by the FDA. However, if a product is NOT labeled gluten-free, but you do not see any gluten-containing ingredients listed, this does not mean that it is under the same 20 ppm threshold. This is because manufacturers are manufacturers are not required to call out “gluten” in food products; the FDA gluten-free labeling rule is voluntary for food manufacturers. To determine whether there was a risk of cross-contact during the growing and/or manufacturing processes, it is best to call the manufacturer and inquire whether they batch test their product for gluten, if they know how their raw materials were sourced and produced, and what procedures they go through to prevent cross-contact in the factory.

Rethinking Cross Contamination – No Need to Be So Careful?

A new, preliminary study from Children’s National Hospital published in the journal Gastroenterology found no significant gluten transfer when tools like the same toaster or knives are used for both gluten-free and gluten-containing foods.

• Children’s National Medical Center, medicalxpress.com ¹

Preliminary study suggests that risk of gluten transfer in common-cooking activities may be lower than previously thought. Parents using multiple kitchen appliances and utensils to prevent their child with celiac disease from being exposed to gluten may be able to eliminate some cumbersome steps.

For the Canadian Celiac Association’s recommendations for preventing cross contamination, please scroll down to bottom of page.

The study authors found that performing these types of kitchen activities using the same kitchen equipment may not pose a high risk of gluten exposure for people with celiac disease. Additionally, basic kitchen hygiene, including routine washing of utensils and equipment with soap and water and hand washing, can further reduce or eliminate gluten transfer.

The authors tested three scenarios where it was thought that gluten transfer could be high enough to pose a gluten exposure risk for someone with celiac disease—in general, greater than 20 parts per million (ppm) or .002%. However, the study found less gluten transfer than expected in the following scenarios:

Toasting bread: Gluten levels remained at less than 20 ppm when gluten-free bread was toasted in the same toaster as regular bread, across repeated tests and even when gluten-containing crumbs were present at the bottom of the toaster.

Cupcakes: Gluten levels also remained below 20 ppm in most cases when a knife used to cut frosted gluten-containing cupcakes was then used to cut gluten-free cupcakes, even when visible crumbs were stuck to the icing on the knife.

Pasta: Cooking gluten-free pasta in the same water as regular pasta did cause significant gluten transfer, sometimes as high as 115 ppm. However, if the gluten-free pasta was rinsed under running tap water after cooking, the gluten transfer dropped to less than 20 ppm. If the pasta pot was simply rinsed with fresh water before being reused, then gluten transfer was undetectable.

“So many celiac parents, including me, have taken every precaution to prevent a gluten exposure in our homes. In many cases that means having two of everything—toasters, knives, and pasta pots, with little or no hard evidence showing we needed to,” says Vanessa Weisbrod, executive director of the Celiac Disease Program at Children’s National Hospital, who conceived and led the study.

“Though the sample is small, this study gives me hope that someday soon we’ll have empirical evidence to reassure the families we work with that their best defense is not two kitchens—it’s simply a good kitchen and personal hygiene. And, that we can travel to grandma’s house or go on a vacation without worrying about a second toaster.”

“These are areas of the kitchen where today we coach families to exercise an abundance of caution. We still recommend following all guidelines from your celiac care team to prevent cross contamination while we do further study,” adds Benny Kerzner, M.D., the study’s senior author and director of the Celiac Disease Program at Children’s National.

“But the results are compelling enough that it’s time for our larger celiac community to look at the current recommendations with a critical eye and apply evidence-based approaches to pinpoint the true risks for families and eliminate some of the hypervigilant lifestyle changes that we sometimes see after a family receives a celiac diagnosis.”

“This study provides novel data that quantifies the risk of gluten exposure when preparing gluten-free food alongside gluten-containing foods and highlights the need for further study in this area so that recommendations can be evidence-based,” notes Jocelyn Silvester, M. D., Ph.D. FRCPC, director of Research for the Celiac Disease Program at Boston Children’s Hospital who led the study’s biostatistical analysis.

The authors maintain that the most important thing families can do to prevent gluten reaction is practicing simple hygiene steps that include washing pots, pans and kitchen utensils with soap and water after each use (and before using them to prepare gluten-free food) and for all family members to wash their hands with soap and water before preparing gluten-free food.

“The treatment burden of maintaining a strict gluten-free diet has been compared to that of end-stage renal disease, and the partner burden to that of caring for a cancer patient,” says Marilyn G. Geller, chief executive officer of the Celiac Disease Foundation.

“This preliminary study is encouraging that this burden may be reduced by scientifically evaluating best practices in avoiding cross-contact with gluten. We congratulate the Children’s National Celiac Disease Program team in taking this important first step in bettering the lives of celiac disease patients and their loved ones. ”

• SEE link to ‘A Quantitative Assessment of Gluten Cross-Contact in the School Environment for Children with Celiac Disease’
• SEE LINK to ‘Preparation of Gluten-Free Foods Alongside Gluten-Containing Food May Not Always Be as Risky for Celiac Patients as Diet Guides Suggest’

DISCUSSION:

• More information: Vanessa M. Weisbrod et al, Preparation of Gluten-Free Foods Alongside Gluten-Containing Food May Not Always Be as Risky for Celiac Patients as Diet Guides Suggest, Gastroenterology (2019). DOI: 10.1053/j.gastro.2019.09.007
• https://linkinghub.elsevier.com/retrieve/pii/S0016508519413401
• https://medicalxpress.com/journals/gastroenterology/

Preventing Cross Contamination

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People who need to eat gluten free need to check both the ingredients in food and any cross-contamination with gluten-containing ingredients that might happen when the food is manufactured, packaged and prepared for eating.

When you think about avoiding cross-contamination, you need to realize that crumbs matter. Look around your kitchen to see where there are crumbs – on the counter top, in the microwave, on the cutting board or in the corners of your metal baking dishes? Anywhere you see crumbs is a potential place for cross-contamination.

At home the following practices will go a long way toward avoiding cross contamination:

• A celiac should have their own butter dish and a cutting board that is used for gluten free foods only.
• A celiac should have their own toaster. A toaster oven, where the rack can be removed and washed if others have used it may be a good alternative. If you do not have access to a separate toaster, try a toaster bag, a silicon bag that holds the bread while it is toasted. The bread toasts right through the bag.
• If it is not practical to have a section of the counter top set aside for preparing gluten free food only, always make sure that the counter space you are using to prepare gluten free food is freshly washed to ensure it is free from crumbs or flour dust.
• Do gluten free baking first, and have it well wrapped and stored before doing anything with regular flours. Flour dust (in the air) from regular flours could settle on the gluten free products, thus contaminating them.
• Note: Although this doesn’t fall into the cross contamination area, it is worth noting that a Celiac should take precautions against breathing in flour dust when using other than gluten free flours. Flour dust that settles on the nasal passages may eventually get swallowed and end up being digested.
• When making sandwiches, do the gluten free ones first – otherwise be sure to wash your hands after touching regular bread and before touching gluten free supplies.
• Use clean utensils and avoid “double dipping” – knives or spoons are OK the first time, but once they have touched food with gluten, they can contaminate the food in the container if used again. If it is too difficult to train other family members in this regard, it would be wise for the celiac to have their own jar of jam, peanut butter, mustard, etc.
• Be especially alert and cautious when you have guests helping in the kitchen – they will not have your gluten awareness. Also, it is when you are otherwise distracted that you are more likely to make a gluten error.
• Make sure any pots, utensils, etc. that are used for other foods are thoroughly scrubbed before using for gluten free foods. In the case of something like muffin tins, paper liners may be a worthwhile consideration.
• It is best to have a separate set of utensils with porous surfaces, such as wooden spoons, for your gluten free baking. These utensils might retain some gluten particles after cleaning.
• If using lentils, be sure to meticulously pick them over before putting in the pot to cook. Even if you buy them packaged, it is not uncommon to find kernels of wheat or oats (or pebbles) in with the lentils.

Away from home, be aware of sources of cross contamination:

• Products in bulk bins can become contaminated by using the scoops in more than one bin. There is no assurance that the other customers will be as cautious as you. Also, flour dust in the air around these bins can cause a problem.
• At the deli counter, where gluten free meats are being cut using the same utensils without cleaning in between or where cut meats often overlap on the counter.
• Buffet lunches, where the chef tests the temperatures in all the dishes using one thermometer, or spoons are used for more than one dish.
• French fries cooked in oil where battered foods have been fried.
• Meat cooked on a grill which hasn’t been cleaned after cooking regular food with gluten.
• Gluten-free pasta may be cooked in water used for regular pasta and rice may be cooked in broth containing gluten.
• Milling of gluten free grains on equipment that has been used for regular grains.
• In product production where a gluten free product is not produced on a dedicated line. Cereals and candy bars that have gluten free ingredients may be produced after a non GF item without having the equipment cleaned thoroughly in between.

¹ https://medicalxpress.com/news/2019-09-preliminary-gluten-common-cooking-previously.html
² https://www.celiac.ca/living-gluten-free/newly-diagnosed as adapted from an article prepared by the CCA Calgary Chapter http://www.calgaryceliac.ca/wp-content/uploads/2012/03/Contamination.pdf

Myths about celiac disease – Life without gluten

Myth #1: Celiac disease is an easy disease to diagnose .

TRUE: Diagnosing celiac disease is often difficult because the symptoms are usually unclear, and their presence does not always indicate an abdominal health problem . Symptoms can vary greatly from person to person.

Myth #2: Celiac disease is a childhood disease

TRUE: Celiac disease is a genetically inherited disease, and its symptoms can appear at any age when foods containing gluten are eaten. According to the results of studies in foreign countries, most often celiac disease is diagnosed in people aged 40-60 years. Most diagnoses are delayed because the median time to detect celiac disease is 13 years.

Myth #3: Celiac disease is a food allergy

TRUE: Celiac disease is not an allergy, but a disease of genetic origin in which gluten (gluten) causes the patient’s immune system to attack their own body. The difference between celiac disease and allergies is that the symptoms of allergic origin disappear over time, while autoimmune diseases do not disappear from the genes. In the case of an allergy, allergic reactions such as swelling, hives or, in more serious cases, anaphylactic shock appear immediately or within a few hours after ingestion of a gluten-containing product.

Myth #4: There is no link between celiac disease and dermatitis herpetiformis.

TRUE: Dermatitis herpetiformis (an itchy, blistering skin rash that most commonly occurs on the elbows, knees, buttocks, and back) is a skin manifestation of celiac disease. People with dermatitis herpetiformis may or may not have the typical intestinal problems of celiac disease, and only a biopsy will show damaged intestinal villi.

A gluten-free diet and medication is needed to prevent rash and itching.

Myth #5: Trying a gluten-free diet is a good way to tell if you have celiac disease.

TRUE: A gluten-free diet should not be started until a diagnosis has been made. Blood tests, a biopsy of the small intestine and a DNA test are required. The HLA DQ2 and DQ8 genes can be present in anyone, but this does not mean that these genes are activated during life. By starting an unreasonable gluten-free diet, damaged intestinal mucosa can begin the healing process, which can lead to false analysis and diagnosis. In turn, the only way to completely exclude the diagnosis of celiac disease is a negative gene test. In addition, there are several diseases that respond to the removal of gluten from the diet.

Myth #6: Once diagnosed and on a consistent gluten-free diet, a patient diagnosed with celiac disease is considered “HEALTHY” and no longer needs further medical attention.

TRUE: The patient must be under medical supervision to prevent complications caused by celiac disease such as anemia, osteoporosis. And also the doctor must make sure that the patient, following a diet, receives enough nutrients in your diet. In addition, the doctor should be able to diagnose the first signs of other diseases often associated with celiac disease, such as diabetes mellitus, thyroid disease, and some others.

Myth #7: Nothing bad will happen if you eat small amounts of gluten from time to time.

TRUE: There are patients with celiac disease who do not show any obvious reaction of the body when eating foods containing gluten, but damage to the intestinal villi occurs. Each person’s body reacts differently. Long-term exposure of gluten to the intestinal villi can cause very serious health problems, including cancer of the gastrointestinal tract.

Myth #8: To be diagnosed with celiac disease, symptoms such as diarrhea or vomiting must be present.

TRUTH: Any organ in the body can suffer from exposure to gluten. Each person’s symptoms are different, depending on their location, frequency and degree of intensity. Celiac disease is a whole body disease, when exposed to gluten, immune cells can program themselves to leave the intestinal tract and start fighting the body elsewhere. This causes symptoms such as fatigue, anemia, headache, joint pain, weight loss, itchy skin, infertility and so on.

Myth #9: Celiac disease is a disease of people who are underweight.

TRUE: Research has shown that most patients with celiac disease were of normal weight at diagnosis, or even slightly overweight. Thus, it should not be assumed that weight alone can determine who needs to be tested for celiac disease.

Myth #10: You Can “Grow Out of Celiac”

TRUTH: Celiac disease is a lifelong disease if diagnosed correctly. There are cases when a person lived for several years with a diagnosis of celiac disease, but later it turned out that he was allergic to wheat, since genes for celiac disease were not found. For patients with celiac disease, adherence to a gluten-free diet is currently the only “cure” and provides a full and quality life. If gluten-containing foods are reintroduced into the diet later on, the immune system will react and eventually the villi in the gastrointestinal tract will be damaged again. In a person who follows a gluten-free diet, tests should be negative on repeat tests and biopsies. In repeated tests, antibodies should not be present in the blood, since the immune system does not respond to “poisonous” gluten. However, this does not mean that the disease no longer exists.

Myth #11: Celiac disease is only a disease in Europe

TRUTH: Celiac disease affects all ethnic groups. This disease is common not only in Europe and North America, but also in South Asia, the Middle East, North Africa and South America. The increase in the number of celiac patients in North Africa and Asia, especially in India, is a big surprise in recent years. It can be observed that even within the same country, if we consider India, the incidence of celiac disease among the population varies, with a higher percentage of people with celiac disease in the north of the country, where wheat is consumed more, and lower in the southern part, where the main food is rice.

Myth #12: “Gluten-free” means that the gluten content of foods is zero mg of gluten per kilogram of product. The label on the package: “Gluten Free” is a legal term that certifies that a safe amount of gluten is used in this product. This means that not all gluten-free products are completely gluten-free. Some more sensitive people react even to this slight tolerance level of gluten.

Myth #13: Patients diagnosed with celiac disease should use gluten-free shampoos, soaps, lotions, and other cosmetics.

TRUE: Scientists note that gluten in shampoos and cleansers is not harmful because gluten cannot be absorbed through the skin. The only way gluten enters the body is by eating it. However, care must be taken in cases where the cosmetic product can enter the body during the adoption of water procedures, washing, etc. Children are recommended gluten-free detergents and shampoos, as they may ingest contaminated water while bathing. Be careful with hand creams and lotions – it is recommended to wash your hands thoroughly before eating. Toothpastes and lipsticks must be labeled “gluten-free”. Special care should be taken in patients with atopic dermatitis, and in these cases, such patients who are more sensitive to gluten are advised to use gluten-free cosmetics. And these patients should definitely consult with their doctor!

Myth #14: Products labeled “Gluten Free” cannot contain ingredients derived from wheat, barley, or rye containing wheat, rye or barley, if they are gluten-free to an acceptable level of <20 mg gluten per kilogram of product. These product ingredients can be wheat starch, ethanol or maltodextrin. Ethanol is an alcohol derived from gluten-containing grains. Ethanol is one of the components of food flavorings. Maltodextrin is also obtained from gluten-containing grains. Use maltodextrin as a thickener, filler or preservative, as well as a sugar substitute. Most commonly used in Europe. These foods are considered gluten-free, but some sensitive people have reactions to these foods as well.

Myth #15: “Gluten Free” means that the product is not manufactured in an industry or facility that was also used to make products containing gluten.

TRUE: It is possible that a business manufactures both gluten-free and gluten-containing products, but in order to be labeled “gluten-free” on the packaging, it is necessary to ensure that the amount of gluten in the product does not exceed 20 mg per kilogram of product, and there was no risk of cross-contamination.

Myth #16: “Wheat Free” = “Gluten Free”

TRUE: Foods labeled “wheat free” do not contain wheat but are very likely to contain barley or rye and are not allowed in a gluten free diet . In turn, those who do not eat wheat should also be careful with gluten-free products, as wheat starch is sometimes used in gluten-free products.

Information sources:

• https://www.celiac.ca/pdfs/celiac%20disease%20myths%20&%20facts.pdf
• https://health. usnews.com/wellness/articles/2016-05-18/5-myths-about-celiac-disease
• https://www.verywellfit.com/what-does-no-gluten-ingredients-mean-562781
• https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/myths-about-coeliac-disease/

Frequently Asked Questions – Gluten Free Life

What is the difference between celiac disease and gluten allergy?

Indeed, people often get confused about the various terms associated with gluten. There is a huge difference between a wheat protein allergy (not gluten) and gluten intolerance, including celiac disease. In case of allergy to wheat protein, the patient cannot eat anything that contains wheat, but can eat gluten-containing rye, barley, oats, if there is no allergic reaction to one of these foods. In the case of gluten intolerance (sensitivity and celiac disease), nothing containing gluten should be consumed, but you can, for example, gluten-free wheat starch. About terminology.

Can a simple blood test show if I have celiac disease? Which?

Routine blood test shows no reaction to gluten. A specific diagnosis is required.

Advise pediatric/adult doctors experienced in diagnosing celiac disease.

You can find a list of doctors recommended by members of our society in the “Diagnostics” section.

Is there gluten in oats?

Oat protein – avenin – is not dangerous for people with celiac disease, and yet ONLY oatmeal labeled “Gluten-Free” should be used in the diet, as ordinary cereals that can be bought in the store can contain significant impurities of wheat and barley. More about oats.

If the packaging says a product may contain gluten, can it be eaten?

Each person reacts differently to gluten and may not even feel bad, but in the case of celiac disease, damage to the intestinal villi is imperceptible. If you eat foods that may contain gluten every day, health problems will appear over time. Myths and reality.

Are buckwheat, lentils and split peas grown in Latvia safe?

Although buckwheat does not contain gluten, special attention should be paid to this product. Buckwheat is often harvested from the field with the same harvester as other cereals and stored next to other grains, so there is a risk of cross-contamination. Very often in buckwheat bought in stores, we noticed wheat grains. Therefore, we recommend buying buckwheat with the inscription “Gluten-Free” or pour it on baking paper and carefully sort it out, and then rinse thoroughly. The same situation can arise with lentils and split peas. For safety reasons, always sort them out and rinse them thoroughly.

Under no circumstances should buckwheat, pea flour be eaten unless it says “Gluten Free”, as these products have a high risk of cross-contamination!

I/my child has been diagnosed with celiac disease. So what’s now?

The most important thing is to change your diet, apply for benefits (if you have not already done so), read the list of allowed and prohibited foods, inform the educational institution and provide the school/kindergarten with information materials prepared by the society, as well as to educate close people who are responsible for the diet and nutrition of the child. Discuss the situation with the child, you can watch the video on Youtube, a thinking child himself realizes the importance of dieting. Older children will be interested in reading the book “Secrets of the Planet Celiac”. During the first year it is necessary to closely monitor the state of health. Become a member of the society, and you will be able to learn the news, as well as receive useful materials.

Do I need to take any medication in addition to my diet?

Consult your family doctor or gastroenterologist about the need to take medication. There is a possibility that celiac disease due to nutritional deficiencies resulting from villous atrophy will need to take iron supplements, vitamin B, joint strengthening drugs, or medications for advanced diseases. Choose your medicines carefully! Medications may also contain gluten, so it is best to choose products labeled “Gluten Free” or consult your pharmacist and, if in doubt, contact the manufacturer.