Celiac Disease

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March 21, 2014

Why Aren’t My Symptoms Getting Better?

By Margaret Shepard, Communications Specialist

Are you on a gluten-free diet and wondering why your symptoms aren't getting better? Jacalyn See, a registered clinical dietitian, discusses the risks of hidden gluten and provides tips to help patients with celiac disease maintain a gluten-free diet.

There are many places where hidden gluten can arise. It can occur in the home, restaurants, in other people's homes, fields or factories, and from unclear labeling on food products.

Hidden gluten may occur in your own kitchen, especially if some family members are maintaining a regular diet. Here are some examples of where hidden gluten may arise due to the accumulation of crumbs:

  • Toasters used for regular bread
  • Cutting boards
  • Rolling pins
  • Counter tops
  • Silverware trays
  • Knife blocks
  • Condiment jars

How can you reduce this problem? This is a personal choice. One way to reduce the risk of hidden gluten is to have a gluten-free kitchen or a gluten-free household. Another way is having a separate area for gluten-free items such as a separate toaster, condiment jars, or drawers.

Restaurants are another place where hidden gluten may occur. This happens through cross contamination between gluten and gluten-free items in deep fryers, grills, soups and dishes with multiple ingredients, and salad bars. Kitchens play a larger role in cross contamination through lack of proper food handling and poor employee education. Here are some tips to protect yourself from hidden gluten while eating in a restaurant:

  • Try to eat at celiac friendly restaurants
  • Try dining at non peak times
  • Observe food handling procedures
  • Avoid high risks foods
  • Look over your meal after it's served to you
  • Ask questions about how your food was prepared

Eating at someone's home can also be challenging when trying to maintain a gluten-free diet. To prepare, call the host or hostess and find out what is being served.

  • Offer to bring something to pass
  • Bring your own breads and go-withs
  • Eat before hand
  • Replicate an item with gluten-free ingredients

Contamination in the field or factory is another source of hidden gluten. This can occur in fields where gluten-free grains are adjacent to wheat fields. It can also occur in shipping, storage, and processing. To avoid this situation, avoid foods labeled "made in a facility with," "made with shared equipment," and buy grains labeled gluten-free.

The Food Allergy Labeling and Consumer Protection Act requires that wheat be labeled clearly on all items containing wheat. However, manufactures are not required to label malt or barley. Medications and vitamins can also be a source of hidden gluten. It's best to buy items labeled gluten-free, contact the manufacturer, or ask a pharmacist if you have questions.

For more information on celiac disease, visit mayoclinic.org/celiacdisease.

Tags: celiac disease, gluten, gluten free, gluten free diet, Jacalyn See, symptoms, Tips from Clinicians


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