Transcript Avoiding Gluten and Cross Contamination

Celiac Disease
The Gluten-Free Diet
and
The Prevention of Cross-Contamination
Medical Program Version
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The Nature of Celiac Disease
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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.
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The Nature of Celiac Disease
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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.
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The Nature of Celiac Disease
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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.
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The Nature of Celiac Disease
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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
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The Nature of Celiac Disease
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It is now recognized as a multi-system disease including
such additional symptoms as:
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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
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The Nature of Celiac Disease
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There are additional symptoms in
children, including:
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Dental enamel defects
Delayed puberty
Failure to thrive/delayed growth/short stature
Abdominal distension
Learning difficulties
Severe irritability/behavioural changes
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The Nature of Celiac Disease
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CD is often associated with some other diseases and
conditions, including:
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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
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The Nature of Celiac Disease
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When left untreated, CD can result in
other disorders, including:
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Nervous system disorders
Internal hemorrhaging
Intestinal lymphoma (non-Hodgkin’s)
Anemia
Osteoporosis
Vitamin and mineral deficiencies
Pancreatitis
Tooth enamel defects
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The Nature of Celiac Disease
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Celiac Disease is often misdiagnosed as other
common ailments, including:
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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
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The Nature of Celiac Disease
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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.
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Genetic Properties
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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.
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Frequency of Occurrence
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CD occurs in almost 1% of the
population.
CD occurs in 1 in 22 first degree
relatives. Canadian Research 12-15 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 gastrointestinal symptoms.
CD occurs in 1 in 133 of the ‘not at risk
population.
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Diagnosing Celiac Disease
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A series of serologic tests can assist in
the preliminary screening for CD.
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Serum IgA-endomesial antibody testing (IgAEMA) OR
Serum IgA-tissue transglutaminase testing
(IgA-tTG) PLUS
Total serum IgA
An intestinal biopsy must be performed
to confirm the diagnosis of CD.
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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.
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What Happens When We’re
Glutened?
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Even small amounts of gluten can be
harmful to people with celiac disease and
can cause continued small bowel damage.
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The accidental ingestion of gluten does
not cause the profound anaphylactic
response that is common with peanuts
and other allergens.
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What Happens When We’re
Glutened?
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Many people with CD will have
immediate intestinal symptoms.
Many will have headaches or other nonintestinal symptoms.
Many will have delayed symptoms.
Many will have no symptoms but will
still have intestinal damage which can
lead to other illnesses.
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What Happens When We’re
Glutened?
The progression of
damage to the
villi
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What Happens When We’re
Glutened?
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What Happens When We’re
Glutened?
DH on the abdomen
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What Happens When We’re
Glutened?
DH on the elbow
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DH on the knee
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Major Concerns
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Increase Awareness
Safe Ingredients
Hidden Sources of Gluten
CROSS CONTAMINATION
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What is Gluten ?
Gluten refers to several different
cereal grain storage proteins, or
prolamins.
 Gliadin in wheat
 Secalin in rye
 Hordein in barley
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Gluten Containing Grains &
Grain Products
Barley
Couscous
Emmer
Graham flour
Oats*
Semolina
Wheat
Bulgar
Durum
Filler
Kamut
Roux
Spelt (Dinkel)
Cereal Binding
Einkorn
Farro
Malt
Rye
Triticale
Oats are currently excluded from the gluten-free diet because of the high risk of contamination from gluten
containing grains
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Gluten-Free Grains &
Grain Substitutes
Amaranth
Cassava
Flax
Nuts
Potatoes
Sago
Tapioca
Arrowroot
Corn (Maize)
Legumes
Poi
Quinoa
Sorghum
Teff
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Buckwheat
Dahl
Millet
Polenta
Rice
Soy
Wild Rice
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Other Gluten-free Foods
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Fresh meat, poultry, fish and seafood
Fresh vegetables and fruits
Eggs
Cheese and other dairy
All products made with gluten-free
ingredients
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The Questionable Products
Baking powder
Bouillon cubes
Condiments
Dry roasted nuts
Herbal teas
Ice cream and yogurt
Imitation seafood
Marinades and sauces
Pilaf mixes
Puddings
Salad dressing
Seasoned fries
Smarties*
Soy sauce
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Beverage mixes
Cheese spreads
Dried fruit
Flavourings
HPP/HVP
Icing sugar products
Licorice and candies
Modified food starch
Processed meats
Rice and soy beverages
Seasonings
Self basting poultry
Soups and broths
Worcestershire sauce
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Preventing Contamination &
Cross-contamination
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When preparing a gluten-free meal, it is
important to prevent contamination of
the gluten-free foods with glutencontaining 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.
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Preventing Contamination &
Cross-contamination
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Select a preparation area that is
separate from other food preparation
areas.
Air-borne flour and other glutencontaining 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.
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Preventing Contamination &
Cross-contamination
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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.
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Preventing Contamination &
Cross-contamination
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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.
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Preventing Contamination &
Cross-contamination
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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
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Preventing Contamination &
Cross-contamination
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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 glutencontaining foods is unsafe for gluten-free
cooking.
Fresh water must always be used for
boiling, poaching or steaming.
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Preventing Contamination &
Cross-contamination
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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 crosscontamination.
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Using Safe Alternatives
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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.
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Using Safe Alternatives
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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.
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For More Information
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Our website: www.calgaryceliac.com
National website: www.celiac.ca
Links to other chapter and resource
websites
Email: Jo Anne Murray
[email protected]
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