1. Avoiding Gluten and Cross Contamination www.calgaryceliac.com The Gluten-Free Diet and The Prevention of Cross-Contamination General Information Programs Celiac Disease

2. Avoiding Gluten and Cross Contamination www.calgaryceliac.com The Nature of Celiac Disease Celiac Disease is an autoimmune disease. It is one of the most common autoimmune diseases. The autoimmune response occurs in the gut. It is triggered by Gluten, a storage protein in wheat, barley and rye.

3. Avoiding Gluten and Cross Contamination www.calgaryceliac.com The onset of CD can occur at any age. All people diagnosed with CD will have intestinal damage. The villi become inflamed, flattened and disappear. Nutrients, including carbohydrates, proteins, fats, vitamins and minerals, can no longer be absorbed. This leads to malnutrition and other serious health problems. The Nature of Celiac Disease

4. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Frequency of Occurrence CD occurs in almost 1% of the population. CD occurs in 1 in 22 first degree relatives. CD occurs in 1 in 39 second degree relatives. CD occurs in 1 in 56 people with gastro- intestinal symptoms. CD occurs in 1 in 133 of the ‘not at risk population.

5. Avoiding Gluten and Cross Contamination www.calgaryceliac.com The only treatment for Celiac Disease is a STRICT GLUTEN-FREE DIET FOR LIFE Even small amounts of gluten can be harmful to people with Celiac Disease and can cause continued small bowel damage. Treatment of CD

6. Avoiding Gluten and Cross Contamination www.calgaryceliac.com What Happens When We’re Glutened? The accidental ingestion of gluten does not cause the profound anaphylactic response that is common with peanuts and other allergens.

7. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Many people with CD will have immediate intestinal symptoms. Many will have headaches or other non- intestinal symptoms. Many will have delayed symptoms. Many will have no symptoms but will still have intestinal damage which can lead to other illnesses. What Happens When We’re Glutened?

8. Avoiding Gluten and Cross Contamination www.calgaryceliac.com What Happens When We’re Glutened? The progression of damage to the villi

9. Avoiding Gluten and Cross Contamination www.calgaryceliac.com What Happens When We’re Glutened?

10. Avoiding Gluten and Cross Contamination www.calgaryceliac.com What Happens When We’re Glutened?

11. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Major Concerns Increase Awareness Safe Ingredients Hidden Sources of Gluten CROSS CONTAMINATION

12. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Gluten Containing Grains & Grain Products BarleyBulgar Cereal Binding CouscousDurum Einkorn EmmerFiller Farro Graham flourKamut Malt Oats*Roux Rye SemolinaSpelt(Dinkel) Triticale Wheat Oats are currently excluded from the gluten-free diet because of the high risk of contamination from gluten containing grains

13. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Gluten-Free Grains & Grain Substitutes AmaranthArrowrootBuckwheat CassavaCorn (Maize)Dahl FlaxLegumesMillet NutsPoiPolenta PotatoesQuinoaRice SagoSorghumSoy TapiocaTeffWild Rice

14. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Other Gluten-free Foods Fresh meat, poultry, fish and seafood Fresh vegetables and fruits Eggs Cheese and other dairy All products made with gluten-free ingredients

15. Avoiding Gluten and Cross Contamination www.calgaryceliac.com The Questionable Products Baking powder Beverage mixes Bouillon cubes Cheese spreads Condiments Dried fruit Dry roasted nuts Flavourings Herbal teas HPP/HVP Ice cream and yogurt Icing sugar products Imitation seafood Licorice and candies Marinades and sauces Modified food starch Pilaf mixes Processed meats Puddings Rice and soy beverages Salad dressing Seasonings Seasoned fries Self basting poultry Smarties* Soups and broths Soy sauce Worcestershire sauce

16. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Preventing Contamination & Cross-contamination When preparing a gluten-free meal, it is important to prevent contamination of the gluten-free foods with gluten- containing food particles and residues. Even small amounts of gluten can result in continued intestinal damage for people with CD and DH Care must be taken to ensure that gluten-free foods remain gluten-free.

17. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Preventing Contamination & Cross-contamination Select a preparation area that is separate from other food preparation areas. Air-borne flour and other gluten- containing particles can contaminate gluten-free foods. Ensure all preparation surfaces, cooking surfaces and cooking utensils have been thoroughly cleaned, including counter top, meat slicer, grill surface, cutting boards, bowls, knives, utensils, thermometers, cleaning cloths.

18. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Use dedicated pots, pans, utensils and cutting boards whenever possible. Rolled edge pans are easier to clean. Scrub with soap and water to ensure removal of gluten-containing particle. Disinfect according to current standards of practice. Preventing Contamination & Cross-contamination

19. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Follow impeccable hand washing practices. Use sanitary gloves for food preparation and change them before handling GF foods. Ensure the powder used is gluten-free. Even powder-free gloves can have trace amounts of powder. Become knowledgeable about special needs diets and menu selections. Educational programs are offered through many of the local chapters of the Canadian Celiac Association. Preventing Contamination & Cross-contamination

20. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Ensure all ingredients are gluten-free. Check product ingredients regularly. Manufacturers and suppliers can change ingredients without notice. Ensure that anti-caking and flow agents are GF. These agents may not be identified in the ingredient lists. Use boldly labeled, air tight containers for all products designated as GF. Prepare GF meals before other menu selections Preventing Contamination & Cross-contamination

21. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Preventing Contamination & Cross-contamination Clean utensils must be used for each condiment, butter, sauce and all other items. Use individual portions and/or squeeze bottles. Deep fryer oil previously used for gluten- containing foods is unsafe for gluten-free cooking. Fresh water must always be used for boiling, poaching or steaming.

22. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Preventing Contamination & Cross-contamination Use the top oven racks. Use caution with convection ovens. Use toaster bags to prevent contamination of GF bread products. Arrange buffet tables with gluten-free selections first and separated from the gluten-containing selections. Label them. Bulk bins can be a source for cross- contamination.

23. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Using Safe Alternatives Many common food products have safe alternatives: Eg. Soy sauce. Safe thickening agents can be used in place of flour: Eg. Potato starch, tapioca starch. Select pure spice blends rather than seasoning blends that may contain gluten-containing fillers.

24. Avoiding Gluten and Cross Contamination www.calgaryceliac.com Using Safe Alternatives Many foods start out gluten-free and are glutened in menu preparation: Eg. Salads Many food items have gluten-free alternatives: Eg. Pizza shells, pasta Develop clearly identified gluten-free alternatives as part of a standard menu.

25. Avoiding Gluten and Cross Contamination www.calgaryceliac.com For More Information Our website: www.calgaryceliac.comwww.calgaryceliac.com National website: www.celiac.cawww.celiac.ca Links to other chapter and resource websites Email: Jo Anne Murray murray2@telusplanet.net