1. Celiac Disease
The Gluten-Free Diet and The Prevention of Cross-Contamination Medical Program Version
Avoiding Gluten and Cross Contamination

2. The Nature of Celiac Disease
Celiac Disease (CD) 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.
Avoiding Gluten and Cross Contamination

3. The Nature of Celiac Disease
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.
Avoiding Gluten and Cross Contamination

4. The Nature of Celiac Disease
CD was formerly thought to be a disease of childhood.
It is now recognized as a disease that can occur at any age.
CD can be triggered in otherwise healthy people when additional stresses are placed on the body, including: childbirth, severe infections, surgery, food poisoning and emotional stress.
Avoiding Gluten and Cross Contamination

5. It was once thought that CD had classic symptoms only, including:
The Nature of Celiac Disease
It was once thought that CD had classic symptoms only, including:
Abdominal cramping and pain
Nausea and/or vomiting
Intestinal gas and bloating
Diarrhea, including steatorrhea
Weight loss
Anemia and other vitamin deficiencies – iron, folate, B12, A, D, E, K
Avoiding Gluten and Cross Contamination

6. The Nature of Celiac Disease
It is now recognized as a multi-system disease including such additional symptoms as:
Bone and joint pain, including arthritis
Depression
Nervous system disorders – central and peripheral
Extreme weakness and fatigue
Easy bruising of the skin
Osteoporosis
Edema of the hands and ankles
Fertility problems, amenorrhea, impotence
Mouth ulcers – canker sores
Weight gain
Constipation
Lactose intolerance
Other digestive system symptoms
Avoiding Gluten and Cross Contamination

7. There are additional symptoms in children, including:
The Nature of Celiac Disease
There are additional symptoms in children, including:
Dental enamel defects
Delayed puberty
Failure to thrive/delayed growth/short stature
Abdominal distension
Learning difficulties
Severe irritability/behavioural changes
Avoiding Gluten and Cross Contamination

8. The Nature of Celiac Disease
CD is often associated with some other diseases and conditions, including:
Intestinal lymphoma
Type I diabetes
Autoimmune thyroid disease
Liver enzyme elevations
IgA deficiency
Autoimmune hepatitis
Addison’s disease
Epilepsy
Sarcoidosis
Sjogren’s disease
Systemic lupus erythematosus
Turner’s syndrome, Williams syndrome, Down syndrome
Avoiding Gluten and Cross Contamination

9. The Nature of Celiac Disease
When left untreated, CD can result in other disorders, including:
Nervous system disorders
Internal hemorrhaging
Intestinal lymphoma (non-Hodgkin’s)
Anemia
Osteoporosis
Vitamin and mineral deficiencies
Pancreatitis
Tooth enamel defects
Avoiding Gluten and Cross Contamination

10. The Nature of Celiac Disease
Celiac Disease is often misdiagnosed as other common ailments, including:
Allergies
Anemia
Crohn’s disease/colitis
Diverticulosis/spastic colon
Gall bladder disease
Irritable bowel syndrome
Chronic fatigue syndrome
Lactose intolerance
Stress/depression/emotional disturbances
Viral gastroenteritis
Avoiding Gluten and Cross Contamination

11. The Nature of Celiac Disease
Dermatitis Herpetiformis (DH) is an intensely itchy skin rash.
It is a form of celiac disease and is often referred to as CD of the skin.
People diagnosed with DH will also have intestinal damage, with or without symptoms.
It is often treated with dapsone in addition to the GF diet.
Avoiding Gluten and Cross Contamination

12. Celiac Disease is a true autoimmune disease.
Genetic Properties
Celiac Disease is a true autoimmune disease.
The genetic predisposition (HLA), the exogenous trigger (Gluten) and the autoantigen (tTG) are all known.
CD is currently the only autoimmune disease for which all three factors are known.
Unlike many other autoimmune diseases, the cause of the disease has been identified.
Avoiding Gluten and Cross Contamination

13. Frequency of Occurrence
CD occurs in almost 1% of the population.
CD occurs in 1 in 22 first degree relatives. Canadian Research per cent
CD occurs in 1 in 39 second degree relatives. Canadian Research 5-12 per cent
CD occurs in 1 in 56 people with gastro-intestinal symptoms.
CD occurs in 1 in 133 of the ‘not at risk population.
Avoiding Gluten and Cross Contamination

14. Diagnosing Celiac Disease
A series of serologic tests can assist in the preliminary screening for CD.
Serum IgA-endomesial antibody testing (IgA-EMA) OR
Serum IgA-tissue transglutaminase testing (IgA-tTG) PLUS
Total serum IgA
An intestinal biopsy must be performed to confirm the diagnosis of CD.
Avoiding Gluten and Cross Contamination

15. STRICT GLUTEN-FREE DIET FOR LIFE
Treatment of CD
The only treatment for Celiac Disease is a
STRICT GLUTEN-FREE DIET FOR LIFE
The GF Diet should never be started without an accurate diagnosis of Celiac Disease.
Avoiding Gluten and Cross Contamination

16. What Happens When We’re Glutened?
Even small amounts of gluten can be harmful to people with celiac disease and can cause continued small bowel damage.
*******
The accidental ingestion of gluten does not cause the profound anaphylactic response that is common with peanuts and other allergens.
Avoiding Gluten and Cross Contamination

17. What Happens When We’re Glutened?
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.
Avoiding Gluten and Cross Contamination

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

19. What Happens When We’re Glutened?
Avoiding Gluten and Cross Contamination

20. What Happens When We’re Glutened?
DH on the abdomen
Avoiding Gluten and Cross Contamination

21. What Happens When We’re Glutened?
DH on the elbow DH on the knee
Avoiding Gluten and Cross Contamination

22. Hidden Sources of Gluten CROSS CONTAMINATION
Major Concerns
Increase Awareness
Safe Ingredients
Hidden Sources of Gluten
CROSS CONTAMINATION
Avoiding Gluten and Cross Contamination

23. What is Gluten ?
Gluten refers to several different cereal grain storage proteins, or prolamins.
Gliadin in wheat
Secalin in rye
Hordein in barley
Avoiding Gluten and Cross Contamination

24. Gluten Containing Grains & Grain Products
Barley Bulgar Cereal Binding
Couscous Durum Einkorn
Emmer Filler Farro
Graham flour Kamut Malt
Oats* Roux Rye
Semolina Spelt (Dinkel) Triticale
Wheat
Oats are currently excluded from the gluten-free diet because of the high risk of contamination from gluten containing grains
Avoiding Gluten and Cross Contamination

25. Gluten-Free Grains & Grain Substitutes
Amaranth Arrowroot Buckwheat
Cassava Corn (Maize) Dahl
Flax Legumes Millet
Nuts Poi Polenta
Potatoes Quinoa Rice
Sago Sorghum Soy
Tapioca Teff Wild Rice
Avoiding Gluten and Cross Contamination

26. 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
Avoiding Gluten and Cross Contamination

27. 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
Avoiding Gluten and Cross Contamination

28. 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.
Avoiding Gluten and Cross Contamination

29. 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.
Avoiding Gluten and Cross Contamination

30. Preventing Contamination & Cross-contamination
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.
Avoiding Gluten and Cross Contamination

31. Preventing Contamination & Cross-contamination
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.
Avoiding Gluten and Cross Contamination

32. Preventing Contamination & Cross-contamination
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
Avoiding Gluten and Cross Contamination

33. 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.
Avoiding Gluten and Cross Contamination

34. 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.
Avoiding Gluten and Cross Contamination

35. 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.
Avoiding Gluten and Cross Contamination

36. 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.
Avoiding Gluten and Cross Contamination

37. Our website: www.calgaryceliac.com National website: www.celiac.ca
For More Information
Our website:
National website:
Links to other chapter and resource websites
Jo Anne Murray
Avoiding Gluten and Cross Contamination