Wednesday, July 16, 2014

Celiac Disease: Gluten Cross-Contact

This is the fourth post in my series about celiac disease.

One of the most significant issues for people with celiac disease is cross-contact of gluten into or onto gluten-free foods. As a reminder, gluten is: protein found in wheat, barley, and rye. It is made up of two other proteins known as gliadin and glutenin. It's the combination of those two proteins that are responsible for the elastic texture of dough, helping it to rise and keep its shape. Gliadin is what enables bread to rise properly, while glutenin is the major protein in wheat flour, making up 47% of the total protein content. (I created this definition of gluten from three different websites...sadly, I can't remember which ones!)

I used to refer to cross-contact as cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect), but after researching celiac disease further, I feel cross-contact is the proper terminology. Cross-contact occurs when an allergen is inadvertently transferred from a food containing an allergen to a food that does not contain the allergen. Cooking does not reduce or eliminate the chances of a person with a food allergy having a reaction to the food eaten. *Definition taken from the FARE (Food Allergy Research and Education) website.

I feel the need to point out the seriousness of gluten cross-contact. Gluten is a very sticky protein that clings to pretty much everything. Thus, a person with celiac disease must be very careful that anything they eat hasn't been touched by gluten. If celiacs want to ensure their food is truly gluten free, they also have to make sure the foods they buy have been manufactured in true gluten-free processing facilities. *Later, I'll explain the precautions that must be taken to avoid cross-contact during food preparation. (Several paragraphs below.)

Gluten cross-contact used to be a much bigger problem in the US. Thankfully, cross-contact occurring in manufactured/processed/packaged foods is something celiacs don't have to worry quite so much about. On August 2nd, 2013, the FDA gave a press release that included their new regulations, i.e., a standard definition as to what constitutes a food or product being gluten free. The FDA also stated on their page, "What is Gluten-Free? FDA Has an Answer":
"As one of the criteria for using the claim 'gluten-free,' FDA is setting a gluten limit of less than 20 ppm (parts per million) in foods that carry this label. This is the lowest level that can be consistently detected in foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods with very small amounts of gluten. This level is consistent with those set by other countries and international bodies that set food safety standards. 
"In addition to limiting the unavoidable presence of gluten to less than 20 ppm, FDA will allow manufacturers to label a food "gluten-free" if the food does not contain any of the following:
  • an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
  • an ingredient derived from these grains and that has not been processed to remove gluten
  • an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten
"Foods such as bottled spring water, fruits and vegetables, and eggs can also be labeled 'gluten-free' if they inherently don't have any gluten."
While I applaud the FDA's efforts, and I am truly grateful for their updated regulations, it doesn't take away every cross-contact issue for celiacs. I still have to frequently and consistently check manufacturers' websites, or call them directly to find out if a product is truly gluten free, i.e., no cross-contact has occurred. Sometimes when I call some manufacturers, I'll find out they indeed have gluten-free products, but for whatever reason, those manufacturers chose not to label their product "gluten free". While I'm happy for the gluten-free good news (!), it's a bit annoying that they didn't just label it "gluten free" in the first place!

I would love nothing more than if every manufacturer would clearly and honestly label their product one of two ways, "Gluten Free" or "NOT Gluten Free". See how simple that would be? It would literally save me hours every week in my search for gluten-free products! :)

*Now, onto gluten cross-contact during food preparation. Celiacs must make sure all items in their kitchen haven't been used for gluten-containing foods without thoroughly washing everything first, or they will have problems with cross-contact. I researched this topic thoroughly, and after avoiding gluten cross-contact for the past three-and-a-half years, here are my recommendations :

1. Cooking or baking with stainless steel, glass, thick non-scratched aluminum, or porcelain kitchen wares are the best options for keeping your foods gluten free.

2. Don't use plastic, wood, silicon, or non-stick-coated cooking/baking dishes/utensils that have previously had gluten in/on them. The gluten is nearly impossible to clean off, especially if there are scratches in the dishes/utensils, and you know how easy it is for plastic or non-stick coatings to have scratches! It's impossible to remove gluten from wood, so don't even try. ;) That said, if you have personally bought completely new kitchen wares—i.e., they haven't been used for cooking/baking by anyone—and have dedicated them to only gluten-free cooking/baking, you can feel safe in continuing to use them.

I gave away my non-stick kitchen items, which included: one sandwich maker; two waffle makers; one large griddle (I really miss it!); two muffin tins; three cake pans. I gave away my aluminum baking sheets, as they had multiple scratches that gluten could hide in. Years ago, I had given away my plastic kitchen items (you know, when we found out about the dangers of BPA in plastics) which included lidded plastic storage containers, cups, plates, bowls, utensils, etc., but I ended up giving away my large cutting board just recently. I also gave away two silicon heart-shaped cake molds; several wooden spoons; one wooden rolling pin; and several pairs of bamboo chopsticks.

3. Don't use toasters that have had gluten-containing breads in them at all, for you will encounter cross-contact. Either buy a new toaster specifically and only for gluten-free bread, or use baking sheets in the oven and broil your bread until it's nice and toasty on both sides. Plus, it smells really yummy! :)

I gave away my darling 1950s-looking toaster and didn't buy a new one. Instead, I toast all of my family's bread in the oven—it's quick and works perfectly every long as I don't forget to flip the bread!

4. Don't use strainers, sifters, or slotted spoons that have had gluten in/on them, as you can't fully clean out the gluten in their tiny spaces.

I bought a new strainer for our gluten-free pastas, kept our old strainer for our gluten-containing pastas, and keep those strainers separate from each other. I only use our slotted spoons for gluten-containing pastas, and use solid stainless steel spoons for our gluten-free pastas. I never previously used our sifter for anything with gluten in it, so I happily kept it! :)

To update the rest of my gluten-free kitchen (which already included stainless steel pots/pans/bowls, porcelain/ceramic bowls and platters, and glassware baking dishes), I bought the following: two thick aluminum muffin pans, cake pans and baking sheets; two thin stainless steel baking sheets and pizza pans; one stainless steel stove-top griddle (cooks four standard pancakes at one time); one large stainless steel frying pan (doubles as another griddle when I want to cook more pancakes at the same time); two new cutting boards (one large, one small); one stainless steel rolling pin (I SO love it!).

5. Be certain not to use any condiments/toppings/spreads that have been previously used on gluten-containing foods, as they could have easily touched gluten, or a utensil could have touched gluten and then dipped back into the jar.

I bought all new condiments/toppings/spreads and labeled them "GF". I'm so strict when it comes to keeping our condiments/toppings/spreads gluten free. We never double-dip from a gluten-containing food back into a gluten-free jar of anything. I wash off every utensil I think might have been contaminated with gluten. We also have two sets of butter: one gluten free, one regular.

6. Keep all food preparation surfaces, i.e., counters and tables, clean.

I constantly wipe down our counters, unless I'm certain they don't have any gluten on it...which is hard to ensure! I also change our table cloth every two to three days (I have three that I wash and rotate through), depending on how messy/crumby it is.

7. When making a gluten-free meal and a gluten-containing meal simultaneously (we do this frequently because of the high cost of gluten-free foods), it's absolutely essential to prepare all gluten-free foods first. If, while making the gluten-free portion of the meal, your hands accidentally touch gluten, make sure you rewash your hands before touching the gluten-free foods again.

I'm constantly washing my hands to make sure I haven't transferred gluten. My hands are frequently dry (There is even gluten in lotions!), but the dryness is 100% worth my peace of mind. :) My youngest son who doesn't have celiac disease, always has to wait for his gluten-containing food—you know, because I have to prepare the gluten-free foods first. I'm sure this is quite trying for my darling son's soul. That said, my baby boy is one of the most patient, understanding, and strongest souls that I've ever met. Because of his strong soul, it's like my youngest son was specifically saved to be the last child of our family. Still, I'm constantly looking for ways to make sure my non-celiac-disease baby feels appreciated, loved and special. :)

8. Separate your gluten-free foods from gluten-containing foods to the best of your ability. If you can't separate your foods, put the gluten-free foods on the upper shelves so no gluten crumbs/dust fall onto or into the gluten-free packages.

I have a separate corner cupboard where I keep the majority of our gluten-free foods. Sadly, it's not large enough to keep everything separated. Thus, Ziploc plastic bags are some of my best friends! ;) I literally Ziploc bag every gluten-free item that doesn't fit into my gluten-free cupboard. And I wash my hands before I even touch a gluten-free-food-containing bag. The same applies for fridge items. Although, most of the time, I use plastic wrap to cover dishes. It's not a perfect system, but it's the best I can do without remodeling my entire kitchen!

9. If you're going out of your house for an extended period of time, i.e., school, or family/friend activities, make and take food with you. Trust me, it's worth the time you spend making gluten-free food. Then you won't have to worry about the effects of gluten cross-contact.

10. Don't use gluten-containing flours at all. I used to keep a "mixed" kitchen (e.g., gluten-containing and gluten-free foods) that included regular flours, but then I read that regular gluten-containing flour can float around in the air—contaminating everything in the kitchen—for up to two hours after you've finished baking! Thus, now I only bake with gluten-free flours. Gluten-free flours are more expensive, but again, healthy children and my sanity are worth it! :)

11. In my church, we partake of the sacrament in sacrament meeting. This is traditionally done with bread and water. Obviously, we don't have to worry about the water, but we do have to worry about the bread. Thus, my husband and I send two Chex cereal pieces in a plastic baggie that the Aaronic Priesthood holders place on the sacrament tray. The Chex pieces are blessed (by holders of the Aaronic Priesthood) on the sacrament table exactly like the rest of the bread and water, but then we are ensured that no gluten cross-contact occurs. Whew! I remember the day my Texas bishop showed me the letter from our church's headquarters, stating it was acceptable to use a bread substitution for those church members with food issues/allergies—it totally made me smile! :)

12. When saving left-overs, be sure to use approved/safe containers that can't transfer gluten onto your food, i.e., glass/porcelain dishes with new/unused plastic wrap, or a stainless steel pot with a lid, or a new/unused plastic Ziploc baggie, or wrap it in new/unused foil, etc.

Honestly, keeping my celiac-diseased children free from gluten cross-contact feels like a part-time job. And I have the gluten-free shopping/organizing/cleaning hours to prove it! ;) Preventing gluten cross-contact is on my mind from the minute I wake up in the morning, until my children are tucked safely into their beds at night. At first, this way of thinking really wore me out. I frequently felt overwhelmed and tired from constantly worrying about my babies' safety. Yet, it only took me about a year-and-a-half to really internalize all of my above suggestions and turn them into daily habits. Now, my gluten-cross-contact prevention is second nature! :) The only time I really start worrying, is when I have to think about my children eating somewhere other than our house.

My family's gluten-free reality has definitely taught me a lot of patience.

At the end of the day, I'm grateful for all the knowledge I've gained to keep my children healthy. I'm beyond grateful for my wonderful husband who works tirelessly alongside me to ensure our children's physical safety. Greg is 100% as dedicated as I am in our family's gluten-free quest! Also, we have been blessed with extended family members, friends, and church members, who are also concerned with the well-being of our children. Their genuine caring and support means more to me than they'll ever know.

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