March is National Nutrition Month, when the Academy of Nutrition and Dietetics reminds everyone to return to the basics of healthy eating. It is also the time of year when the Academy celebrates expertise of registered dietitian nutritionists as the food and nutrition experts.
You might not think twice about the pot you use to boil water, the plate you put your food on or even the shelf where you got your grocery item, but for people with celiac disease, these every day considerations can be a virtual mine field. That's because gluten (a protein in grains such as wheat, rye and barley) can show up just about anywhere in our food supply chain — even if it's not intended — from growing to processing to preparation and consumption. When a person with celiac disease eats foods or products that contain gluten, it triggers an autoimmune reaction in which the intestines are damaged and nutrients cannot be absorbed for use by the body.
"For people with celiac disease, even just a microscopic amount of gluten can cause a reaction and damage to the intestines, such as a single bread crumb on a plate or speck of wheat flour on manufacturing equipment," says Rachel Begun, MS, RDN.
Cross-contamination — when a gluten-free food comes into contact with gluten — is a common concern for those with celiac disease or gluten sensitivity. But there are ways to reduce the risk.
Keep it Clean and Separate at Home
Begun says that the easiest way to prevent cross-contamination at home is to make it 100-percent gluten-free. But that's not always practical, especially for a shared kitchen. The key is to keep things clean and separated. That means crumb-free food preparation surfaces, separate or carefully cleaned cooking and serving equipment for gluten-free foods, strategic food storage and good dishwashing skills.
Begun offers some at-home tips:
- Place gluten-free items above gluten-containing items in the pantry and refrigerator, so gluten particles don't fall or settle into gluten-free foods.
- Identify gluten-free foods with an indelible pen or stickers.
- Thoroughly clean all dishes, pots, pans and utensils between uses.
- Purchase a second, gluten-free toaster.
- Use a separate set of cutting boards for gluten-free food prep.
- Have two sets of condiment jars or a squeezable condiment container, reducing the risk of contaminated spoons getting dipped into your mustard or peanut butter.
Ask Questions When You're Dining Out
Keeping your own kitchen gluten-free is one thing, but you don't have control over the kitchen in a restaurant. You might order what you think is a gluten-free item, but once that dish arrives at your table, it could have been contaminated in any number of ways. For example, egg dishes can be prepared on the same grill as pancakes, fried items are often put in the same fryer as breaded items, or the same pot of water might be used to cook all of the pasta. "It's not enough to ask about ingredients. It's just as important to ask how a meal is being prepared and to ask questions about all utensils, equipment and surfaces coming into contact with your dish," says Begun.
Always ask that your meal be prepared:
- In its own separate and thoroughly washed pot or pan.
- Using separate and thoroughly cleaned cutting boards and utensils.
- With care by the food handlers to avoid cross-contamination of foods.
Consult Your Host at Social Gatherings
Social gatherings can be tricky. Commingling of people and utensils and serving dishes create the perfect environment for gluten to sneak onto your plate. But this doesn't mean you need to skip the party. First, let your host know ahead of time about your gluten-free needs. It's best to do this before your host starts planning the menu. A better idea is to offer to make a couple dishes of your own to share. "This ensures there are at least a couple of items you can eat safely and takes some of the burden off of your host," says Begun.
Go ahead and ask the host if you can serve yourself first, before dishes become contaminated. "It may seem like bad manners, but it has the exact opposite effect. Serving yourself first allows you to participate in the meal rather than feeling awkward for having an empty plate because the dishes aren't safe to eat," says Begun.
Pay Attention at the Grocery Store
According to Begun, just because a product has a gluten-free label doesn't mean it's safe for celiacs to eat. "Always read all ingredient statements to ensure there are no gluten-containing ingredients in a product and that the product has a low risk for cross-contamination."
Gluten-containing ingredients can show up as additives or appear under different names, so it's important to learn how to read labels. When in doubt, call the manufacturer.
Additionally, a food might not contain gluten, but it could have been harvested, transported or processed on equipment or in a facility that has also been in contact with gluten. One example of this is oats. "Even though oats do not inherently contain gluten, cross-contamination can easily occur in the food supply chain and, therefore, are off limits to people with celiac disease," says Begun. Some people can, however, tolerate moderate amounts of gluten-free oats. Look for "certified gluten-free" or "pure, uncontaminated."
Grocery aisles themselves can even be a site of cross-contamination. For example, a gluten-free product placed on a shelf underneath flours or fresh baked goods in loose packaging, or bulk bins with scoops that might be shared or containers that allow ingredients to leak through. Begun says it's best to avoid these items.
In addition to bringing your friends and family on board with your gluten-free lifestyle, Begun recommends seeking the advice of a registered dietitian nutritionist and joining a support group to help navigate the ins and outs of gluten cross-contamination.
"[A dietitian] is a great resource for learning how to read food labels and understanding cross-contamination pitfalls when eating outside the home," says Begun. Look for an RDN who is knowledgeable about celiac disease, gluten-related disorders and the gluten-free diet.
A support group can also be an invaluable resource, she adds, that can help with anything from learning which packaged foods are safe to eat, identifying gluten-free friendly restaurants and knowing which resources are reliable and credible.