Frequently Asked Questions

Cross-Contamination

Can I cook my pasta in the same water I used for my boyfriend’s real pasta?

No. When you cook pasta, some of the starch separates from the pasta and becomes suspended in the water. You will probably notice that the pasta water becomes cloudy. You should boil your pasta in a separate pot in clean water. Don't use wheat pasta water to boil vegetables or to make rice.

Do I really need a new toaster? It seems like overkill.

We recommend that you get a new toaster for your GF bread. If you look in your toaster, you will probably see a number of crumbs. Those crumbs can be passed from gluten bread to regular bread and the slices bump in and out of the toaster. Unfortunately, just a few crumbs are enough to cause problems for someone with celiac disease.

Some people have two toasters in their kitchens, others reserve half of the toaster for GF bread and use the other half for regular bread.

An alternative is to purchase some toaster bags. You can put your gluten free bread inside the bag and then put the entire bag into the toaster. The bread toasts inside the bag, without coming into contact with crumbs.

Diagnosis

How long do I have to eat wheat before a biopsy and how much do I have to eat?

A biopsy for celiac disease looks for changes in the small intestine that happen when you eat gluten. If you have stopped eating gluten, your intestine may have begun to heal and that can lead to a false negative result (a negative biopsy even though you have celiac disease).

In general, the recommendation is that you eat the equivalent of 4 slices of wheat bread every day for at least 3 months before a biopsy. Your doctor may have different recommendations for you, based on your own medical condition.

We don't know a lot about how long it takes to redo damage after your gut heals, so this might not be enough time to re-introduce damage.

I’ve been gluten-free for years. Do I have to get tested for celiac disease?

For adults, this is personal choice. If you choose to assume you have celiac disease and eat gluten free, then you need to be as strict as someone with biopsy demonstrated celiac disease on your diet. Crumbs of gluten matter - the maximum safe amount of gluten is 10 milligrams per day (about 1.200th of a slice of bread).

The downsides of eating gluten free? This is an expensive and restrictive diet that you are committing to for the rest of your life. The food tends to have more carbohydrates and fat then their gluten-containing counterparts so you have to be careful of portion size.

GF foods are not fortified with iron and B vitamins like regular wheat flour is, so you need to make sure you are getting enough of those nutrients. GF foods are also usually lower in fibre than wheat-based foods so you need to make sure you get enough fibre as well.

If you are concerned about your relatives, they may be less willing to be screened for celiac disease if you don't have a confirmed diagnosis. In the future, doctors may not believe you either.

On the other hand, you have already discovered that you feel much better when you eat gluten free. That means a lot and can contribute greatly to your quality of life.

Some gastroenterologists will do a biopsy on someone in your situation even without a gluten challenge, because they know that damage can take a long time to heal. They need to be very aware of current research on celiac disease to understand what they are facing. Any damage on the biopsy represents celiac. If your biopsy turns out negative then you won't know if it is because you aren't celiac or because you have healed.

The CCA offers support to anyone who needs a gluten free diet, no matter what their diagnosis and we are very aware of the shortcomings of the current diagnosis process. Many people have been in the same situation yhou are in. Some choose the challenge, some just decide to be celiac.

What should I do about introducing gluten to my new baby?

According to the CCA position paper on reducing the risk of developing celiac disease in early childhood, gluten should be introduced into the infant's diet gradually in "small" amounts at age five to six months, while breast-feeding is continued. Breast-feeding for at least one month after the introduction of gluten may further reduce the risk of developing celiac disease in early childhood. It is not known if this will reduce lifetime risk or just delay the age of developing celiac disease. Additional genetic and environmental factors likely play a role in the development of celiac disease.

This position was based on research from a number of countries, but unfortunately the research does not really indicate what "small" amounts mean. Dr. Peter Green described small as "crumbs".

Can I get a test for celiac disease?

Depending on where you live, the answer is Yes or No or Maybe.

In most provinces in Canada, gene tests for celiac disease are not generally available. They are available from a number of private laboratories for those who are willing to pay. The labs generally charge between $300 and $500 depending on the exact tests they run.

Not everyone who has the markers for celiac disease (HLA-DQ2 and/or DQ8) will get celiac disease, but if you have these markers, you might develop celiac disease.

Is it worth getting a gene test? For people already diagnosed with celiac disease, knowing which genes you have is not going to change your treatment. It may be useful in two specific situations, however.

If you have an infant with a parent or sibling who is diagnosed with celiac disease, you may want to use a gene test to see if the child has the genes for celiac disease. If the test is negative, you no longer have to worry about the child developing celiac disease. If the test is positive, you know that you will want to watch the child so that if celiac disease develops, you will catch it early.

The second reason you might want to get a gene test is if you have been eating gluten free already for a period of time and do not want to eat gluten prior to a biopsy. A negative test will free you from the restrictions of a gluten-free diet. A positive test means that you might have celiac disease. If you have a positive gene test and decide that you do not want to undergo a gluten challenge and a biopsy to confirm your diagnosis, you should consider being a strict in your diet as someone with confirmed celiac disease must be.

How long do I have to eat wheat before a blood test and how much do I have to eat?

We don't have a good answer for this because there is little or no research on how long it takes for antibodies to develop once you have started eating gluten again.

The recommendations for a biopsy are the equivalent of 4 slices of bread for at least 12 weeks.

I had a positive blood test for celiac disease. What now?

The "gold standard" for a celiac diagnosis is a biopsy of the small bowel. This procedure demonstrates the damage of the villi and is done by a gastroenterologist. You need to be eating gluten until you have the test. It is a straightforward test - the only preparation is to not eat for 12 hours or so.

Some physicians are now diagnosing celiac disease based on symptoms, a family history, and high antibody levels and a good response to the gluten free diet. This is especially true if people also have some of the common deficiencies including iron, vitamin B12 and vitamin D or early onset osteoporosis.

Not all physicians are comfortable with that approach. The concern is that someone who does not have celiac disease will be falsely diagnosed as celiac when the problem is really something else.

Sometimes if people don't have a lot of symptoms they want the confirmation biopsy because they are not sure of the diagnosis. They don't want to adopt a gluten-free diet unless they must.

Do I have to have a biopsy?

The "gold standard" for a celiac diagnosis is a biopsy of the small bowel. This procedure demonstrates the damage of the villi and is done by a gastroenterologist. You need to be eating gluten until you have the test. It is a straightforward test - the only preparation is to not eat for 12 hours or so.

Some physicians are now diagnosing celiac disease based on symptoms, a family history, and high antibody levels and a good response to the gluten free diet. This is especially true if people also have some of the common deficiencies including iron, vitamin B12 and vitamin D or early onset osteoporosis.

Not all physicians are comfortable with that approach. The concern is that someone who does not have celiac disease will be falsely diagnosed as celiac when the problem is really something else.

Sometimes if people don't have a lot of symptoms they want the confirmation biopsy because they are not sure of the diagnosis. They don't want to adopt a gluten-free diet unless they must.

Ingredients

Is maltodextrin gluten free?

Yes. Maltodextrin is a highly processed starch product. Most maltodextrin is made from corn but it may also be made from tapioca or wheat. Even if the product is made from wheat, it is so highly processed that no wheat protein remains and it is considered safe for people with celiac disease and gluten sensitivity.

Can I eat meat and eggs from animals that ate grains?

Yes. Animals that eat grains break down the proteins and use the constituent amino acids for a variety of processes including creating other proteins and glucose. No gluten protein passes into the tissue or eggs intact.

Is modified corn starch really gluten free?

Modified starch, no matter what the source, is prepared by treating the starch physically, enzymatically, or chemically, changing the properties of the starch. Gluten ingredients are not used in the process, so if the starch was gluten free to begin with, it is gluten free after it is modified. Starches are used in food to make them thicker, stable, or to help the ingredients blend together. They are used in pharmaceuticals to make the active ingredients break apart during digestion. Starches are modified to make them work better under certain conditions. Starches may be modified make them more stable when they are heated or cooled or frozen or exposed to acid; to to change their texture; to make a substance thicker or thinner; or to make products gel faster or slower.

I was looking at a box of candy and it listed wheat glucose syrup. Does this mean it is not gluten free?

Glucose syrup is one of those ingredients that is considered gluten free even though it is derived from wheat. It is extensively processed and in that processing virtually all of the protein is removed, making it safe for people with celiac disease and gluten sensitivity. Wheat maltodextrin is another of those highly processed products that is acceptable for people with celiac disease and gluten sensitivity.

If an ingredient list just says “bran” how do I know what it is made from?

This problem should be improved when the new ingredient legislation takes effect in August 2012. For now, if it just says bran, assume it is wheat bran. Bran can be milled from rice, corn, and millet, and those products are gluten free.

Is maltitol gluten free?

Yes. Maltitol is a sugar alcohol used as a sugar substitute. Maltitol can act as a laxative if you consume it in large quantities.

I read that red fife wheat doesn’t have gluten in it. Can we eat it?

Red Fife is an older strain of wheat that was common in Canada in the late 1800's but fell out of favour in the early 1900's. It has recently become a specialty grain. It is still wheat and still contains more gluten than is acceptable for anyone with celiac disease or gluten sensitivity.

I need a fibre supplement. What can I take that is gluten free?

There are a variety of commercial products that are gluten free including Metamucil products (not the wafers) and Benefibre purchased in Canada. In the long term, we recommend that you look to food sources to increase your fibre intake. Check this article from Shelley Case for more information about getting fibre using gluten-free whole grains (http://www.glutenfreediet.ca/img/WholeGrains2.pdf) and this article from Allergic Living Canada that discusses gluten free sources of fibre include whole grains, fruits, vegetables, nuts, seeds and legumes (dried beans, peas and lentils).

Is freekeh gluten free?

Freekeh is wheat that is harvested and eaten before it fully ripens. It still contains gluten and is not acceptable for people with celiac disease and gluten sensitivity.

What is the current scoop on oats?

Most people with celiac disease can eat limited amounts of oats, as long as those oats are not contaminated with barley and wheat. This means you must purchase the brands of oats that are especially grown, processed, and packaged to avoid contamination, not just the standard store brands. As of October 2011, there are four brands of oats available in Canada that are safe for people with celiac disease: Lara's from Cream Hill Estate, OnlyOats from Avena Foods, Glutenfreeda, and Bob's Red Mill Oats (only the ones marked as gluten free or wheat free. Not all people with celiac disease can tolerate oats and we don't know why yet. If you try them, make sure you area feeling well and are not introducing other new foods at the same time so that you can be sure that any reaction is from the oats and not from some other food.

Is wheat grass okay?

Wheat grass doesn't contain any gluten protein and it is usually harvested before any seeds develop. The concern has always been that their might be seeds accidentally mixed in. Some manufacturers have started to test their products and can produce wheat or barley grass in a way that is not contaminated with gluten. Look for a product that is marked "gluten free" to be sure the manufacturer has considered the issue.

Is mustard gluten free? What about mustard powder/flour?

Mustard is gluten free. Most prepared mustards are gluten free. A few prepared mustards are made with either wheat flour or malt vinegar. Read the ingredient list to make sure your prepared mustard does not. Mustard powder or mustard flour is finely ground mustard seed and is gluten free. In Indian cooking, mustard seed is known as rai. This may account for some of the confusion.

Is peanut butter gluten free?

Generally yes, but you need to check the ingredient list to make sure that gluten ingredients have not been added.

I read that canola oil can be contaminated with wheat in the field. Is it OK?

It is true that canola is grown in the the Canadian and US prairies, and may even grow side by side with wheat, but the seeds are different sizes and shape and are easy to separate using screens. The situation is quite different with oat and barley or wheat seeds which are similar in size.

Is whey GF? What about whey powder?

Yes. Whey is the liquid left over after milk is curdled when making cheese. It is naturally gluten free.

Whey powder is dried whey, commonly used as a protein supplement. It might be mixed with something else that is not gluten free, so you need to read the ingredient list, but it is gluten free.

What brand of baking powder should I buy that is GF?

All baking powder contains a starch ingredient, but most baking powder products for sale in Canada use corn starch. Check the ingredient list to make sure your brand does not contain wheat starch.

Miscellaneous

I have been offered a job working in a bakery/commercial kitchen. Will it make me sick?

Some people with celiac disease or gluten sensitivity are able to work in regular bakeries and others find it intolerable. The primary concern is the amount of flour you might inhale. The amount of flour in the air can vary greatly depending on the equipment in use. If possible, visit the site to see the conditions you would be working in. Many commercial kitchens do little baking, reducing the amount of flour you might inhale. Again, you may have to visit the site to see what the situation is. In either case, it is important that you prepare food without tasting food that contains gluten. Even tasting amounts can contain enough gluten to cause intestinal damage. Any job that involves wheat, rye, or barley might cause problems, depending on how much gluten you inhale daily.

Is it okay for someone with celiac disease to visit a wheat farm?

You have to eat the wheat in order for it to cause a problem for you. Visiting a farm will not be a problem.

My family is planning a trip to Walt Disney World. Will my celiac child be able to eat there?

Disney seems to be a company that makes extra efforts to accommodate people with food allergies and gluten issues. The stories on this page describe how other families have handled Disney gluten free: http://orlandoglutenfree.com/gluten-free-walt-disney-world/ Here is the Disney World information page for guests with special dietary requests: http://disneyworld.disney.go.com/guest-services/special-dietary-requests/

Do you know of any scholarships available for people with celiac disease?

No, we have not found any. If you know of one, please send a message to the info@celiac.ca.

Symptoms

I don’t have any digestive problems. How can I have celiac disease?

In the past, we thought celiac disease only affected the digestive system. Today we know that the damage from celiac disease can affect any system in the body. Many people, for example, have anemia as their only symptom. Others only find out that they have celiac disease when they are diagnosed with osteoporosis and don't respond to the usual treatment. Some physicians believe that digestive symptoms may only appear after the disease has been present for a long time and significant damage has been done to the small intestine. Some people who didn't think they had digestive symptoms discover that they did have problems only after going gluten free and discovering how well they feel without gluten.