Avoiding Gluten and Cross Contamination The Gluten-Free Diet and The Prevention of Cross-Contamination Medical Program Version Celiac.
Post on 26-Mar-2015
218 Views
Preview:
Transcript
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
The Gluten-Free Dietand
The Prevention of Cross-ContaminationMedical Program Version
Celiac Disease
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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 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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
The Nature of Celiac Disease
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
The Nature of Celiac Disease
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
The Nature of Celiac Disease
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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 www.calgaryceliac.com
Frequency of Occurrence
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 gastro-intestinal symptoms.
CD occurs in 1 in 133 of the ‘not at risk population.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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 www.calgaryceliac.com
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
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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 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?
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
What Happens When We’re Glutened?
The progression of damage to the
villi
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
What Happens When We’re Glutened?
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
What Happens When We’re Glutened?
DH on the abdomen
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
What Happens When We’re Glutened?
DH on the elbow DH on the knee
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
Major Concerns
Increase Awareness Safe Ingredients Hidden Sources of Gluten CROSS CONTAMINATION
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
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 www.calgaryceliac.com
Gluten Containing Grains & Grain Products
Barley Bulgar Cereal BindingCouscous Durum EinkornEmmer Filler FarroGraham flour Kamut MaltOats* Roux RyeSemolina 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 www.calgaryceliac.com
Gluten-Free Grains & Grain Substitutes
Amaranth Arrowroot BuckwheatCassava Corn (Maize) DahlFlax Legumes MilletNuts Poi PolentaPotatoes Quinoa RiceSago Sorghum SoyTapioca Teff Wild Rice
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
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
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.
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.
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
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
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
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.
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.
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.
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.
Avoiding Gluten and Cross Contamination www.calgaryceliac.com
For More Information
Our website: www.calgaryceliac.com National website: www.celiac.ca Links to other chapter and resource
websites Email: Jo Anne Murray
murray2@telusplanet.net
top related