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Avoiding Gluten and Cross Contamination www.calgaryceliac.com The Gluten-Free Diet and The Prevention of Cross-Contamination Medical Program Version Celiac.

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Presentation on theme: "Avoiding Gluten and Cross Contamination www.calgaryceliac.com The Gluten-Free Diet and The Prevention of Cross-Contamination Medical Program Version Celiac."— Presentation transcript:

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

2 Avoiding Gluten and Cross Contamination 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.

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

5 Avoiding Gluten and Cross Contamination 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 The Nature of Celiac Disease

6 Avoiding Gluten and Cross Contamination 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 The Nature of Celiac Disease

7 Avoiding Gluten and Cross Contamination 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 The Nature of Celiac Disease

8 Avoiding Gluten and Cross Contamination 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 Addisons disease Epilepsy Sarcoidosis Sjogrens disease Systemic lupus erythematosus Turners syndrome, Williams syndrome, Down syndrome The Nature of Celiac Disease

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

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

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

12 Avoiding Gluten and Cross Contamination 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.

13 Avoiding Gluten and Cross Contamination 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.

14 Avoiding Gluten and Cross Contamination 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.

15 Avoiding Gluten and Cross Contamination 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. Treatment of CD

16 Avoiding Gluten and Cross Contamination What Happens When Were 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.

17 Avoiding Gluten and Cross Contamination 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 Were Glutened?

18 Avoiding Gluten and Cross Contamination What Happens When Were Glutened? The progression of damage to the villi

19 Avoiding Gluten and Cross Contamination What Happens When Were Glutened?

20 Avoiding Gluten and Cross Contamination What Happens When Were Glutened? DH on the abdomen

21 Avoiding Gluten and Cross Contamination What Happens When Were Glutened? DH on the elbow DH on the knee

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

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

24 Avoiding Gluten and Cross Contamination 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

25 Avoiding Gluten and Cross Contamination Gluten-Free Grains & Grain Substitutes AmaranthArrowrootBuckwheat CassavaCorn (Maize)Dahl FlaxLegumesMillet NutsPoiPolenta PotatoesQuinoaRice SagoSorghumSoy TapiocaTeffWild Rice

26 Avoiding Gluten and Cross Contamination 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

27 Avoiding Gluten and Cross Contamination 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

28 Avoiding Gluten and Cross Contamination 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.

29 Avoiding Gluten and Cross Contamination 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.

30 Avoiding Gluten and 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. Preventing Contamination & Cross-contamination

31 Avoiding Gluten and 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. Preventing Contamination & Cross-contamination

32 Avoiding Gluten and 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 Preventing Contamination & Cross-contamination

33 Avoiding Gluten and Cross Contamination 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.

34 Avoiding Gluten and Cross Contamination 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.

35 Avoiding Gluten and Cross Contamination 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.

36 Avoiding Gluten and Cross Contamination 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.

37 Avoiding Gluten and Cross Contamination For More Information Our website: National website: Links to other chapter and resource websites Jo Anne Murray


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