Cross Contamination and Celiac Disease

This is a bit of a controversial but very important topic to bring up in the celiac community and to the rest of the world. This is important because when I was first diagnosed I was not told of the possibilities of cross contamination and how it would effect my overall healing. 

It does not take very much gluten to make a celiac very sick, only one crumb to be in fact. One crumb will start an autoimmune response in the body, and the symptoms could or could not be present. Cross contamination could possibly be one of the hardest things to keeping a 100% gluten free diet for someone who has celiac disease as there are so many hidden places gluten can possibly be found.

I did not know of all the places that could be an issue and I am still learning over 3 years later. Places such as a cutting board, wooden spoons, or even kissing your boyfriend after he dinks a glass of beer or eats one of those massive kebabs he loves so much . Coming up next are all of the places I wish I knew to be careful of sooner, including some possible problems with the FDA (this will be a post all on it’s own, coming soon).

Where can hidden places of gluten be found?

  1. Kitchen:

Cutting Boards: Any cutting boards that have cuts in them could be hiding unknown gluten, especially wooden cutting boards. Replace these for a cutting board that does not produce deep cuts, like a wood fibre cutting board. I bought one of these a while back and love them because the cuts in them push out rather then in. This is not affiliated, but the cutting board I found is called a Epicurean and can be found here. But also, when you get new cutting boards – label them gluten free specific just like anything in the kitchen so it cannot and will not come into contact with gluten.

Wooden Spoons: Gluten can become stuck to porous products in the kitchen, one of which can be wooden spoons.

Pots and pans, colander, panini press, waffle maker, bread maker, BBQ racks, stovetop, tabletop, iron pans and pizza stones: This may seem over the top, however gluten is very good at hiding in equipment with any scratches, small holes or crevices. Therefore, scratches in non-stick pots or pans will be a perfect area for gluten to hang out, same with a porous rock pan or pot. Small crevices on a stove top or inside a panini press or a waffle maker along with a bread maker (ie. imagine a pot of pasta water over flowing onto the stove top – I know we have all been there). No you do not need to go buy a new oven, however I would scrub every inch of the top and inside of that oven before you use it again for a gluten free meal, and replace any other equipment you can that was originally used for gluten containing food. Use a designated countertop, and if this is not possible, then wipe down and clean the area of any flour or gluten containing left overs of another meal or food preparation.

Note: Although this doesn’t fall into the cross-contamination area, it is worth noting that celiacs should take precautions against breathing in flour dust when using flours with gluten. Flour dust in the nasal passages can be swallowed and end up being digested. So be careful walking into gluten containing bakeries.

Kitchen Wash cloths, sponges, rags, brushes and dish towels: HUGE spot for cross contamination, be sure to be using a gluten free only sponge or cleaning utensil for washing dishes in your sink. The gluten will soak and stick to the wash cloth, sponge, brush, towel or rag. Label one that is gluten free and keep it away from anything gluten.

Toaster and Convection Oven: This was one of the first things I replaced in my kitchen when I first learned of cross contamination. The gluten crumbs will sit on the side, top and bottom of the toaster and oven and will then make its way into your gluten free toast. Remember: it just takes one crumb to cause an autoimmune response in your body as a celiac, have a dedicated gluten free toaster and convection oven.

Utensils: For forks, knives and spoons – be sure to wash these in warm soapy water and scrub well to decease the chances of a gluten meal transferring to your gluten free meal by mistake. I’ve looked into getting a travel set of utensils for out at restaurants – may seem like a bit much, but sometimes I get a utensil with left over food on them.

Pantry and Fridge: Spills or damaged packaging can spread all over a pantry or fridge (ie. flour). Be sure that if you do not have a gluten free specific cupboard or fridge to put all gluten free products on the top shelf so nothing can spill or spread from above down into your food. Best practice is to have a separate pantry and fridge, if you can, that is a dedicated gluten free space. 

Spices, processed foods, teas, condiments: These are sneaky areas that can and usually do contain a hidden source of gluten. Always be sure that you read the label of any processed foods you buy and be sure to buy the ones that do not have any gluten containing ingredients, it can be hidden as an ingredient that does not necessarily say “gluten or wheat.”

My rule of thumb, if the package says “may contain gluten” “processed in the same facility as gluten” I stay away from them. Being 3 years into my diagnosis, my TTG levels are still higher then they should be, and I have recently just been able to get them down lower than I have been able to in the last 2 years. My secret? I have cut out processed foods, and if I need to use them, I will only buy them if they say or have a “certified gluten free” label on it. Do your research on the product you are going to buy, contact the seller and find out where that food is being processed, you are not being a pain for protecting your health and asking questions. I know for me, the reasons I could not lower my TTG levels is because I was going out to eat at restaurants and eating processed foods. Do what you feel is right, but be sure the food you are buying is certified gluten free or do your research into the company because not all good companies have the certified symbol on their product.

Butter, margarin, jam, condiments jars; Avoid ‘double dipping”: Another huge area of cross contamination, when one uses a knife or other utensil and spreads the jam or condiment on to a gluten containing piece of toast then puts that utensil back into the jar, there will be crumbs going into that same jar. As I have mentioned, it just takes one crumb to make someone violently ill with celiac disease. The crumbs that have now been transferred into that jar or onto the slab of butter, can now make its way onto a piece of gluten free toast later. Be sure to label all condiments gluten free, to avoid any crumbs from getting mixed into them.

Lentils: This one deserved a mention on it’s own because a can or bag of lentils is known for having kernels of wheat or oats (or pebbles) within the product. Be sure to buy certified gluten free lentils only.

2. Other:

Body products like soap, shampoo, conditioner, tooth paste, floss, mouth wash, face wash, makeup, hand lotion, lip stick and lip balm, sunscreen, moisturizers for face and body: First things first, there is not a lot of research showing that gluten is absorbed through the skin. HOWEVER, using gluten free body products can decrease the chances of gluten mistakenly getting into your body. Lip chaps, tooth paste, floss and mouthwash is not an area of argument – all of these products NEED to be gluten free as they go into the mouth and can be swallowed. Shampoo and conditioner is to your discretion, however, if a kid sucks on their hair, or you are sweating from a good workout and it makes its way into your mouth, there could be a reason for cross contamination. Same goes for face products, sunscreen, hand or body lotion, or nail polish, if it contains gluten and you eat with your hands, or rub the lotion on your lips and you lick them, or again, you are sweating and the sweat goes to your lips, there could be a chance of cross contamination.

Playdough: This was one that shocked me as I work as an athletic therapist and would use playdough for hand exercises and rehab all the time. This fun dough to play with contains gluten, be sure to look for ones that are labeled gluten free or make your own at home. Another option is if you work as a therapist, you could wear gloves to avoid it making contact with your hands.

Envelopes and stamps: “Web site after web site, story after story, and book after book about celiac disease, repeat the statement that gluten can be found in envelopes and stamps. But it’s not true. Tonya Muse, senior vice president of the Envelope Manufacturers Association, states that adhesives used on envelopes do not contain gluten.” -Gluten-Free Living. This is an ongoing debate and I think there needs to be more research done in this area to get a definitive answer.

Plastic in orthodontic retainers: This was another area that shocked me as I have a retainer I used every night (thankfully mine does not contain any gluten). There is a plastic called, “plasticized methacrylate polymer,” this is a plastic additive that is sometimes used in plastic and contains gluten. Be sure to check with your orthodontist that your retainer does not contain this plastic.

Friends and family in your kitchen: Even though they can mean well, they may not know the nitty gritty on exactly how to keep your food and kitchen gluten free. Just be sure to be there when they are preparing food to help them along the way if they need it.

Kisses from a loved one: Regardless if it is your other half, your parents, a sibling, an aunt or uncle or a friend, if they have just consumed gluten of any kind, there can be a chance that they will transfer it to you. Generally, I think if they brush their teeth and use mouthwash, it should get the gluten out of there and be safe to accept a kiss from them, but I think more research needs to be done in this area.

3. Cross contact away from home:

Bulk Bins: The utensils used in bulk bins can be transferred from bin to bin and with that gluten can be transferred as well. Gluten can be transferred also by hands if someone is not using the utensils and uses their hands to grab the food instead. I would recommend not eating or purchasing any foods out of a bulk bin, and be sure to only buy foods in a separate certified gluten free package.

Deli-counters: Because some processed meats can contain gluten, the equipment they use can also contain gluten when they slice the meat. Be sure that the processed meats you are buying are certified gluten free and sliced on dedicated gluten free equipment.

Buffet: Another great place for possible cross contamination due to the utensils used. There is always a chance that someone who doesn’t know any better, could have used the same spoon to pick up pasta then used that same spoon in the salad next to that pasta. Or someone is grabbing something that contains gluten and the crumbs of it falls into your gluten free food as it passes over it. If you are at a buffet, I would personally ask to talk with the chef about your options. When I went to Vegas, the chef at the buffet was absolutely amazing with me, he walked me around the whole buffet explaining what I could eat and at the end of it saw that I was still uncomfortable so he personally made me food in the back and served it to me. Always speak with the owners or chefs before you eat at a restaurant or buffet.

Gluten free products: Products that are labeled gluten free (without being certified) could possibly still contain gluten. The product itself could be gluten free, however if it is processed in the same facility as something with gluten, it can contaminate the food. If there is not a dedicated line or equipment that is 100% gluten free, the processed food can become contaminated with gluten. So be sure to contact the company to know more about how the food is processed and where it is processed. If they cannot 100% guarantee the food is gluten free, do not eat it or purchase it.

Fried foods: When ordering fried foods, such as French fries, out at a restaurant, be sure that they use a dedicated gluten free frier, as a frier that is used for gluten containing foods will contaminate your gluten free food if used in the same frier. Always be sure to talk with your server about how the food is prepared in the kitchen.

Airplanes and traveling: Always travel with your own food from home or certified gluten free bars or products that you can easily travel with. If this is not possible, be sure to contact the airline ahead of time to sort out gluten free meals for you on the plane. You do not want to be stuck on a plane without a meal for 11+ hours, believe me, I’ve been there.

FDA and Gluten Free Labeling

This is a controversial topic that needs a post on it’s own, which I will begin writing and get up on this blog very soon. The FDA (Food and Drug Administration) in the US states: “The rule specifies, among other criteria, that any foods that carry the label ‘gluten-free,’ ‘no gluten,’ ‘free of gluten,’ or ‘without gluten’ must contain less than 20 parts per million (ppm) of gluten. This level is the lowest that can be reliably detected in foods using scientifically validated analytical methods. Other countries and international bodies use these same criteria, as most people with celiac disease can tolerate foods with very small amounts of gluten.” They state that ‘most people’ with celiac disease can tolerate these levels which means not all can tolerate it. Also, not all countries use the same labeling criteria, take Australia and New Zealand for instance, they have a 0% tolerance of gluten found in gluten free foods, probably why I felt great while eating over there. I’m not trying to pick a fight with the FDA, I just believe more research needs to be done on this topic. Blog on this coming soon, I need to do more research into studies on this topic to give you the right information.

There are more and more studies coming out on the cross contamination of gluten with celiac disease. Some studies showing that cross contamination does or does not happen in the areas I mentioned above. However, I believe more studies need to be done to know for sure, so in the mean time, it doesn’t hurt to follow general rules and guidelines given to you by your dietician, nutritionist or doctor on what foods to avoid and where cross contamination can occur. 

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References: 

https://www.ncbi.nlm.nih.gov/pubmed/24137038

https://www.schaer.com/en-int/a/cross-contamination

https://celiac.org/gluten-free-living/global-associations-and-policies/policies-around-the-world/

https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling