Gluten-Free Food Service - A Practical Guide
Many people with celiac disease have difficulty finding safe and palatable gluten-free meals and snacks in places like hospitals, long-term care facilities and retirement homes.
For those with celiac disease, eating gluten can negatively affect both mental and physical health, as well as quality of life. The longer the stay in a care facility, the greater the risk.
If you’re a Nutrition/Food Service manager, or work in the field, these guidelines are designed to help you and your staff improve safe and palatable gluten-free food service in these settings.
The guide includes comprehensive advice for leadership and teaching tools for front line staff.
Developed by dietitians with expertise in food service management at Celiac Canada, we hope this guide helps you improve the gluten-free food service you offer.
Please share this information with your peers.
We welcome your feedback. Please send comments to clientsupport@celiac.ca
Please download and print the full PDF of the Gluten-free Food Service: A Practical Guide which can be used as a training tool for staff.
You can use all the content or print specific sections for different food service workers.
Contents
- Gluten-free diet overview
- What is gluten?
- Who needs a gluten-free diet?
- Why do people need to follow a strict gluten-free diet?
- Food Service in health care settings.
- Gluten-free food service team.
- Planning
- Preparation
- Service & Delivery
APPENDICES
- Gluten-free foods to avoid
- Gluten-free diet
- Learn to read labels
- Unexpected sources of gluten
- Thickening agents
- Meal & snack suggestions
- Tips for cooks/chefs
- Tips for food service workers
- Tips for personal support workers & nursees
Gluten-free diet Overview
What is gluten?
Gluten is a protein found in wheat, rye and barley. When mixed with a liquid it creates the elastic texture of raw dough that causes baked products to rise. Regular oats (not labelled “gluten-free”) are frequently contaminated with gluten containing grains during the growing, harvesting, transportation and milling processes. Therefore wheat, barley, rye and regular oats, and the majority of ingredients/ foods made from these grains, are NOT ALLOWED on the gluten-free diet. See Appendix A for a list of gluten containing ingredients that should be avoided.
Who Needs the Gluten-Free Diet?
Individuals with celiac disease must follow a strict gluten-free diet for life. People with non-celiac gluten sensitivity also benefit from a gluten-free diet.
Why do people need to follow a strict gluten-free diet?
For people with non-celiac gluten sensitivity, gluten does not damage the small intestine. However, eating gluten can cause various negative health symptoms.
Food Service in Health Care and Congregate Settings
In a health care or other congregate setting, where people with a gluten-related disorder rely on others to provide food service, the patient or resident is vulnerable to exposure to gluten, and this risk increases with the longer the length of stay. This can negatively impact both mental and physical health and quality of life.
It’s very important that health care and congregate settings make every effort to provide safe and palatable gluten-free food service. This guide lays out all you need to know.
Gluten-free food service team
- Patient/Resident/Family or Substitute Decision Maker.
- Nutrition/Food Service Manager/Supervisor
- Registered dietitian/Diet technician
- Cook/Chef
- Food Service Worker
- Nursing Staff
- Personal Support Worker
Roles
Patient/Resident/Family or Substitute Decision Maker
- The patient/resident or close family are the best source of information regarding food preferences, foods they can and cannot tolerate and health conditions which impact food consumption; their input is critical to patient satisfaction and optimizing health.
- A new admission on a gluten-free diet should always be assessed by the Registered Dietitian as soon as possible.
- If the Registered Dietitian is not available on or shortly after admission, someone from Nutrition/ Food Services should visit the patient as soon as possible to obtain food preferences until the Registered Dietitian is available.
Nutrition/Food Service Manager with the Support of Supervisors
- Modify menus and utilize gluten-free products that are good tasting, nutritious and which provide variety.
- Create processes to monitor food service to ensure the medical and quality of life needs of gluten-free patients/residents are met.
- Put in place protocols for ingredient or product substitutions and ensure they are followed.
- Ensure all foodservice staff are trained in gluten-free food handling both in the kitchen and in dining rooms / service areas if applicable.
Registered Dietitian / Diet Technicians
- Meet with the patient/resident on admission to obtain a diet history to understand what food items they prefer and/or usually eat.
- Review gluten-free menu for nutritional adequacy and provide support for menu planning and staff education.
- Communicate patient/resident nutrition care plans with the diet office / food service staff as needed.
- Follow up to ensure patient/resident needs are being met and adjust care plan as necessary.
Cooks
- Follow best practice for storage and preparation to prevent cross-contamination and ensure menu items are truly gluten-free.
- Follow standard recipes and participate in recipe development to improve quality and variety where applicable.
Food Service Workers
- Learn how to identify gluten-containing foods and gluten-free foods correctly with the support of the Nutrition/Food Service leadership team and the Registered Dietitian.
- If in doubt always ask.
- Use best practice procedures to avoid cross-contamination.
- Report patient/resident comments and feedback about gluten-free service to Food Service leadership.
Nursing Staff
- Document the need for a gluten-free diet in the medical record and care plan.
- Do not provide gluten-containing foods e.g., regular cookies, other baked goods, snacks to patients requiring gluten-free food.
- Communicate feedback from the patient/resident/family to the Registered Dietitian / Diet Office or Nutrition/Food Service leadership team as appropriate.
Personal Support Worker
- Learn how to identify gluten-containing and gluten-free foods correctly with the support of the Nutrition/Food Service leadership team and the Registered Dietitian.
- If in doubt always ask.
- Share resident comments and feedback with the Nutrition/Food Service leadership team.
- Ensure patient/resident’s chart notes include any concerns regarding gluten-free meal service.
Planning
Developing or Customizing a Gluten-Free Menu
Eliminate all wheat, barley and rye and their derivatives i.e. an ingredient/food made from these sources. Identify sources of these gluten-containing grains in the table Appendix A.
- Regular oats are not allowed; however, specially produced oats labelled “gluten free” are allowed.
- Remember “wheat free” doesn’t always mean “gluten free” – the product could contain barley, rye or regular oats.
- See the table Appendix B for a detailed list of foods allowed / foods to question / foods to avoid by category.
- As much as possible use naturally gluten-free foods e.g. most fruit, vegetables, meats and alternatives, milk, cheese, rice and other gluten-free grains labelled “gluten free” etc.
- Wherever possible use products labelled “gluten free” to remove the guess work.
- Do not serve foods with “May Contain Gluten” statements unless the product also carries a “gluten- free” claim.
- For tips on How to Read a Food Label see table Appendix C.
- For more in-depth information on reading food labels see Celiac Canada’s Labelling Guide
- For tips on How to Avoid Unexpected Sources of Gluten see table Appendix D.
- There may be gluten-free alternatives available for many traditional gluten-containing foods. Check with your supplier. There are new products available frequently.
- Encourage the use of gluten-free items across the board where possible to maximize menu variety, for example, use gluten-free starches/flours to thicken gluten-free products (see table Appendix E), gluten-free soup and gravy bases; gluten-free soy sauce, and gluten-free salad dressings, etc.
- A “write-in list” or list of gluten-free items that are always available, outside of the menu served that day, can help to provide variety in what can be a very restrictive diet. These items are ideally non- perishable or frozen, and wrapped individually, to easily augment the patient’s menu, for example, individually wrapped frozen gluten-free muffins. Other good choices for “write ins” include cheese slices, fresh fruit, gluten-free yogurt and puddings, etc.
- If you really cannot control cross-contamination in your kitchen, consider using pre-packaged gluten-free meals which just need to be heated.
Nutritional Considerations
When planning a gluten-free menu, key nutrients of concern are fibre, iron, vitamin D and calcium. Ways to Improve Nutritional Content
- Choose products made from whole grains or pulses. Pulses include dried beans, peas and lentils. Use of these items increase fibre and nutrients e.g., bread products or pasta made from whole grains like brown rice, gluten-free oats, quinoa and sorghum or pulses (e.g. chickpeas, beans, lentils) rather than white rice-based items.
- Swap low fibre gluten-free cereals with higher fibre hot or cold cereals (e.g. gluten-free oatmeal).
- Use tips to increase fibre on the gluten-free diet to help your planning.
- Protein sources like meat, poultry and fish are good sources of iron and are gluten-free.
- Other sources of iron include leafy greens, pulses (dried beans, lentils and peas), nuts and seeds.
- Vitamin D and calcium is found in gluten-free dairy products (milk, cheese, gluten-free yogurt).
- Sometimes supplementation is necessary to meet nutrient needs (discuss with Registered Dietitian).
Budget-Friendly Tips
- Gluten-free corn tortillas served as a wrap are lower cost than most gluten-free bread products.
- Incorporate more plant sources of protein (e.g., pulses {dried beans, peas, lentils}, fruits, vegetables, nuts, seeds).
- If you prepare food in your facility, use base ingredients which are gluten-free if possible, reducing the need to buy specialty products.
- Where possible, buy individually wrapped gluten-free products, or individually wrap and freeze them in-house, reducing waste.
Food Quality
- If a gluten-free menu item is not good quality i.e., you wouldn’t want to eat it, find another alternative.
- If you can’t serve good quality safe gluten-free toast i.e., it won’t be good quality by the time it reaches the patient or you don’t have a dedicated toaster, serve gluten-free muffins, gluten-free pancakes or another alternative that is both gluten-free and of good quality.
- Gluten free bread served cold is generally not palatable – it tends to be dry and crumble. If you are going to serve gluten-free bread it should either be warmed e.g. place it under the lid on the hot side of re-thermalization systems, wrap it in heat resistant packaging like a wax paper bag while it is warmed, or toast it in a dedicated toaster. Re-usable toaster bags are generally not acceptable in institutional food service e.g., the same bag should not be re-used in a toaster used for multiple patients.
Variety
Especially for long stay patients, it is important to offer as much variety as possible. Consider bringing in some items you don’t normally serve, perhaps from the grocery or health food store, to augment variety. The family may also be able to bring in some favourite foods to increase variety. Make sure these are labelled “gluten free” with the client’s name and date.
Menu Ideas
Meal and snack suggestions can be found in Appendix F. There should be gluten-free snacks in emergency departments and on patient care units where possible.
Diet History
Consulting with the patient/resident on what they normally eat at home and what you can provide helps to reduce food waste and improve satisfaction. There is no point sourcing and serving items they don’t like or can’t eat.
Feedback
Ask patients and residents about the gluten-free meals you provide. Use feedback to help you continuously improve your menu. Maintain a quality improvement focus, consider feedback a gift to help you continually improve your service.
Procurement
It can be challenging to source gluten-free products in small quantities, of good quality, while at the same time providing variety. Below are some suggestions to make this easier and ways to help you ensure the product you serve is truly gluten-free.
Sourcing
- Where possible, use a distributor or vendor who makes it easy for you to identify gluten-free products e.g. Sysco allows you to sort the order guide by “gluten-free” and the symbol for gluten free can be shown beside the product.
- Make sure you understand how to search for gluten-free products on your distributor or supplier’s order guide. If you don’t know how, ask; if they don’t have this feature ask for it.
- Ideally choose foods with a gluten-free claim to remove the guess work.
- If the item does not have a “gluten-free” claim, and you think it may be gluten free, read the ingredient list and/or refer to the resources in the Appendices. When in doubt, do not serve!
- Food products may be reformulated and what was previously gluten-free can change. Keep an eye out for notifications from the vendor, and monitor which products currently have a gluten-free claim. If a patient/resident appears to be not tolerating a product you believe to be gluten-free follow up with the vendor.
Procuring gluten-free foods may be easier than you think!
- Procuring more naturally gluten-free foods (most protein, fruit, vegetables, dairy) is a cost-effective way to source menu items.
- There are a growing number of gluten-free products on the market every day. Purchase gluten-free building blocks to make more in-house menu items gluten free e.g., purchase gluten-free gravy and soup base, gluten-free soy sauce, thicken with gluten-free thickeners (see Appendix D), serve gluten-free salad dressings to everyone.
Receiving
- Check that items delivered are the correct products and have not been substituted – NEVER assume a replacement product or the same product in a different sized pack will have the same gluten-free status as the original.
- If you determine that a replacement product is not gluten-free, communicate this via communication tools at your site and choose a replacement product. Lack of clear communication for substitutions is a common way that a gluten-containing product may be served inadvertently.
- If ever in doubt about a product:
- Ask the supplier or Registered Dietitian;
- Contact the manufacturer;
- Or leave it off the menu for gluten-free diets.
Storage
- Gluten-free ingredients/foods are ideally stored in a segregated dedicated area. If this is not possible, then they need to be in well-labelled containers and stored on the highest shelves (to avoid gluten-containing foods from falling on them). Gluten-free flours keep best in a dark, cool area. For long-term storage, they can be placed in a refrigerator or freezer in well-sealed and labelled containers.
- Gluten-free meals, bread products and desserts may be individually frozen, in well-labelled and dated, air-tight packaging to make it easier to provide a small number of servings.
Preparation
Avoiding Cross-Contamination
During food preparation, cross-contamination can occur when gluten-free foods or ingredients come into contact with gluten-containing items. It is important to prevent cross-contamination as even small amounts of gluten can negatively affect the health of those requiring a gluten-free diet e.g., triggering a variety of symptoms and causing damage to the digestive system. Persons with gluten-related disorders who are admitted to health care and congregate facilities put the safety of their food, and therefore their health, in the hands of the Nutrition/Food Service and broader health care team.
Cross-contamination can be reduced by:
- Storing gluten-free foods separately from gluten-containing foods where possible.
- Labeling all containers of gluten-free products clearly.
- Cooking gluten-free foods separately from gluten-containing foods.
- When baking, ideally prepare gluten-free items on separate days from other products, or at least prior to gluten-containing.
- Using clean utensils and equipment for gluten-free food preparation.
- Using a separate toaster for gluten-free foods. Reusable toaster bags are not generally acceptable from a public health perspective.
- Using squeezable containers of condiments or individual condiments to eliminate the chance of double dipping.
- Wooden cutting boards and utensils are not recommended in institutional settings and they should not be used in gluten-free food preparation. If plastic cutting boards are badly scored they should be replaced or ground down so they can be cleaned properly.
- Using a separate pot and pasta strainer for gluten-free pasta.
- Tightly covering and labelling gluten-free products.
- Not using the same oil to fry gluten-containing and gluten-free food.
Meal Preparation
- Double check gluten-free ingredients to confirm they are still safe.
- Ensure meals/snacks are covered and labeled gluten-free once completed.
- Use standard recipes where possible.
Service and Delivery
It is important that prepared gluten-free food is delivered and served to the patient/resident without error or cross-contamination.
Tray Service
- Gluten-free meals should be checked by a Supervisor.
- The diet should be clearly visible on the tray ticket or menu.
- When staff provide the tray to the patient, they should state the tray is gluten-free to give the patient confidence the diet is accurate.
- Never add or change items on a gluten-free meal after it has been plated or left the kitchen unless you are absolutely sure the substitution or addition is also gluten-free.
Dining Room Service
There can be a greater chance for error in dining rooms as frontline staff interact with residents and may have to make decisions. The below are suggestions to minimize the chance of error.
- Staff should clean their hands with soap and water. Alcohol-based sanitizers are not recommended and do not eliminate gluten. Also the use of gloves is discouraged as they often gives staff a false sense of security.
- If residents can select from more than one menu item, ensure you offer only menu items that are gluten-free, if in doubt ask.
- Where possible serve gluten-free meals first using clean or designated utensils.
- Deliver meals directly to the individual and state the meal is gluten free.
- If there are self-service food bars, give the gluten-free resident the option of having their meal served to reduce cross-contamination.
- If the resident wishes to use the self-service, utilize squeeze containers for condiments or individual condiments.
- Clearly label the gluten-free items on the self-service food bar.
Foods from Home
- Foods brought from home should contain a label with the following information: gluten-free status, patient/resident name and the date.
- Ensure proper storage e.g. sealed packaging or containers and handling to minimize the risk of cross-contamination.
- Perishable food brought from home should be discarded within a specific timeframe e.g., three days to minimize the chance of food-borne illness.
Gluten-containing Foods to Avoid (Appendix A)
Gluten is found in grains like, wheat, barely, rye and triticale. These grains are also known by other names you need to know to avoid adding them to a menu. Also outlined below are gluten-containing derivatives to be avoided.
Wheat
- Atta
- Bulgur
- Couscous
- Dextrin
- Durum
- Einkorn
- Emmer
- Farina
- Farro
- Freekeh
- Fu
- Graham Flour
- Hydrolyzed wheat protein
- Kamut
- Matzoh/Matzah
- Seitan
- Semolina
- Spelt
- Triticale
- Wheat bran
- Wheat flour
- Wheat gluten
- Wheat starch
Barley
- Barley (flour, flakes, pearls)
- Brewers Yeast
- Malt
- Malted barley
- Malted barley flour
- Malted milk
- Malt extract
- Malt flavouring
- Malt vinegar
Rye
- Rye Flour
Oats*
*Only oats with a gluten-free claim are allowed.
- Oat bran
- Oat flour
- Oatmeal
- Oats
The Gluten-free Diet - Appendix B
Which gluten-free foods are ok, which should be avoided on a food service menu?
Adapted from Gluten Free: The Definitive Resource Guide – Revised Edition, 2022, by Shelley Case, Dietitian. www.shelleycase.com Used with Permission.
Food Category
Foods Allowed
Foods to question
Food Category
Foods to avoid
Dairy
Milk, buttercream, cream, sour cream, whipping cream, most ice creams, yogurts, frozen yogurts.
Malted milk, packaged granola-topped yogurt, ice cream and frozen yogurt made with gluten-filled ingredients like brownies, cookie dough or crumbs, ice cream cakes.
Cottage cheese, cream cheese (plain), hard cheese, (e.g cheddar, mozzarella, Parmesan, Swiss), soft cheese, (e.g brie, blue cheese, Gorgonzola, Roquefort, Stilton, processed cheese, processed cheese foods.
Dips with cream cheese or sour cream, cheese sauces, cheese spread, seasoned flavoured shredded cheese or cheese blends.
Malted milk, packaged granola-topped yogurt, ice cream and frozen yogurt made with gluten-filled ingredients like brownies, cookie dough or crumbs, ice cream cakes.
Non-diary, plant-based alternatives
Most non-diary beverages like coconut, flax, hemp, gluten-free oats, nuts, pea, potato, quinoa, rice and soy are ok.
Soy-based cheese and cream cheese, coconut or soy yogurt, ice cream made with no-dairy beverages like cashew, coconut, rice and soy.
Non-dairy beverages (e.g., coconut, flax, hemp, nuts, oats [NOT labeled “gluten-free”], potato, quinoa, rice, soy) made WITH barley malt, barley malt extract or barley malt flavouring
Non-dairy oat beverages [NOT labeled “gluten-free”] made WITHOUT barley malt, barley malt extract or barley malt flavouring.
Grains*
Buy grains, flours, legumes and seeds flax * hemp) with a gluten-fee claim.
Amaranth, buckwheat, corn, kañiwa, millet, gluten-free oats, quinoa, rice (black, brown, glutinous/sweet, green, purple, red, white), sorghum, teff, wild rice
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Grains flour, germ and meal*
Buy grains, flours, legumes and seeds flax * hemp) with a gluten-fee claim.
Amaranth flour, coconut flour, corn (bran, germ, flour),
Cornmeal, legume flours (bean, chickpea /garbanzo bean, Garfava™, lentil, pea, soy), mesquite flour, millet flour,
Nut flours (almond, cashew, chestnut, hazelnut, macadamia, peanut, pecan, walnut),
Gluten- free oat flour, potato flour, quinoa flour, rice flour (brown, glutinous/sweet, white), rice bran, rice polish, sorghum flour, sweet potato flour, teff flour, wild rice flour
Buckwheat flour
Items made with buckwheat flour
Wheat flours (atta, graham, white, whole wheat)
Wheat bran, wheat farina, wheat germ, wheat gluten
Flours made from barley, einkorn, emmer, kamut, rye, spelt, triticale
Oats (bran, flour, rolled oats / oatmeal) NOT labelled “gluten free”
Starches
Arrowroot, corn, potato, sago, tapioca (cassava/manioc), taro (dasheen/eddo)
Barley starch
Wheat starch****
Most wheat starches contain high levels of gluten protein. However, some gluten-free products may contain specially
Processed wheat starch
Grains and Grain-based foods*
Buy grains, flours, legumes and seeds (flax, hemp) with a “gluten-free” claim.
Hot Cereals (labeled “gluten free”)
Amaranth, buckwheat grits (cream of buckwheat), corn grits, cornmeal, cream of rice (brown, white), hominy grits, millet grits, gluten-free rolled oats / oatmeal and steel-cut oats, quinoa, quinoa flakes, rice flakes
Hot cereals and infant cereals made with wheat, einkorn, emmer, farro, kamut, spelt, rye, triticale, barley and/or regular oats (rolled oats/oatmeal, steel cut)
Cold Cereals (labeled “gluten free”)
Puffed gluten-free grains (e.g., amaranth, buckwheat, corn, millet, rice, sorghum), gluten- free cornflakes, gluten-free crisp rice, gluten-free granola (with or without gluten-free oats), rice flakes, soy-based cereals, other cereals with allowed ingredients
Cold cereals and infant cereals made with wheat, einkorn, emmer, farro, kamut, spelt, rye, triticale, barley and/or regular oats
Cereals made with added barley malt, barley malt extract or barley malt flavouring
Pastas (labeled “gluten free”)
Macaroni, noodles, spaghetti and other pasta shapes made from: corn; legumes (dried beans, chickpea/garbanzo beans, lentils, peas and soybeans); millet; potato; quinoa; rice; wild rice
Buckwheat pasta
Cold cereals and infant cereals made with wheat, einkorn, emmer, farro, kamut, spelt, rye, triticale, barley and/or regular oats
Cereals made with added barley malt, barley malt extract or barley malt flavouring
Rice
Plain rice (black, brown, glutinous/sweet, green, purple, red, white), wild rice
Seasoned (flavored) rice mixes, rice pilafs
Miscellaneous
Gluten-free tortillas/wraps, gluten-free pizza dough/crust
Corn tacos, corn tortillas/wraps, polenta
Wheat flour tacos and tortillas/ wraps, pizza dough and
crust made with not-allowed
ingredients; tabouli/tabbouleh
Gluten-free communion hosts/ wafers, gluten-free matzoh/ matzo/matzah
Low-gluten communion hosts/ wafers
Regular communion hosts/ wafers; matzoh/matzo/matzah made with wheat flour
Proteins & Alternatives
Deli/luncheon meats (e.g., bologna, ham, salami, turkey), frankfurters/wieners, sausages; meat and sandwich spreads; pâtés
Low-gluten communion hosts/ wafers
Meat, poultry, fish and seafood breaded in not-allowed ingredients; frozen chicken breasts injected with chicken broth (containing not-allowed ingredients); frozen turkey basted or injected with hydrolyzed wheat protein; frozen or fresh poultry with bread stuffing
Burgers (meat, fish, chicken, turkey), meat loaf, ham (ready- to-cook), dried meats (e.g., beef jerky)
Imitation bacon bits
Canned fish in vegetable broth containing hydrolyzed wheat protein
Eggs
Plain whole eggs (fresh, frozen, liquid, powder), plain omelets, scrambled eggs
Plain egg whites (frozen, liquid, powder)
Omelettes and scrambled eggs made with gluten-containing ingredients
Legumes
Beans (black, kidney, navy, pinto, white), chickpeas / garbanzo beans, lentils, peas, soybeans
* NOTE:
Purchase legumes with a “gluten-free” claim.
Canned beans in sauce
Omelettes and scrambled eggs made with gluten-containing ingredients
Nuts & Seeds
Plain or salted nuts and seeds (chia, poppy, pumpkin, sesame, sunflower)
* NOTE:
Purchase flax and hemp seeds with a “gluten-free” claim.
Seeds (flax, hemp)
Seasoned or dry-roasted nuts, chickpeas, pumpkin seeds and sunflower seeds
Meat Alternatives
Plain tofu
Flavoured tofu, tempeh, textured soy protein (TSP) / textured vegetable protein (TVP)
Plant-based meat substitutes (e.g., burgers, meatballs, sausages)
Fu, seitan
Plant-based meat substitutes made with wheat gluten and/or other not-allowed ingredients
Fruits
Plain fruits and juices (fresh, frozen, canned)
Dates, fruits with sauces, fruit juices and smoothies with barley grass or wheat grass
Dates, fruits with sauces, fruit juices and smoothies with barley grass or wheat grass
Vegetables
Plain vegetables and juices (fresh, frozen, canned)
French-fried potatoes, hash browns and potato wedges with seasonings or “fillers”
Vegetables in sauces
French-fried potatoes, hash browns and potato wedges cooked in oil also used for gluten-containing products (e.g., battered chicken and fish)
Scalloped potatoes containing wheat flour, battered deep-fried vegetables
Soups
Gluten-free bouillon cubes, dried soup bases, prepared broths, cream soups and stocks; homemade broth, soups and stocks made from allowed ingredients
Prepared broths, soups and stocks; dried soup bases, soup mixes, bouillon cubes
Broths, soups and stocks made with not-allowed ingredients; dried soup bases, soup mixes and bouillon cubes containing hydrolyzed wheat protein, wheat starch and/or wheat flour
Snack Foods
Plain crackers made with nuts, rice or other gluten-free grains; plain rice cakes; corn cakes; plain popcorn, potato chips, soy nuts, taco (corn) chips; gluten- free pretzels
Seasoned (flavoured) crackers, rice cakes, corn cakes, potato chips, soy nuts, taco (corn) chips; wasabi peas
Potato chips made with wheat flour, barley malt flour, wheat starch and/or malt vinegar; pretzels made with wheat flour
Desserts
Cakes, cookies, muffins, pies and pastries made with allowed ingredients; gluten-free bread pudding; gluten-free flourless cake; gluten-free ice cream cones, wafers and waffles
Custard, gelatin-desserts, milk puddings, sherbet, sorbet
Flourless cakes
Crème brûlée
Bread pudding, cakes, cookies, muffins, pies, pastries, ice cream cones, wafers and waffles made with not-allowed ingredients
Sugars, Candies and Other Sweets
Agave nectar/syrup, corn syrup, honey, jam, jelly, marmalade, maple syrup, molasses
Brown sugar, coconut sugar, confectioner’s/icing sugar, turbinado sugar, white sugar
Chocolates and chocolate bars made from allowed
ingredients; gluten-free licorice, marshmallows, whipped
toppings
Honey powder
Icings and frostings, sweet sauces/toppings
Chocolates, chocolate bars, hard candies, Smarties®
Licorice (usually contains wheat) and other candies made with not-allowed ingredients
Beverages
Cocoa, coffee (instant or ground; regular or
decaffeinated), flavored waters, soft drinks, tea
Coffee substitutes, flavoured coffees, flavored and herbal teas, hot chocolate mixes
Coffee substitutes made with not-allowed ingredients (e.g., Postum), malt-based beverages (e.g., Ovaltine [chocolate malt and malt flavors])
Fats
Butter, margarine, lard, shortening, vegetable oils, mayonnaise, salad dressings with allowed ingredients
Baking/cooking spray, salad dressings, suet
Salad dressings made with not- allowed ingredients
Condiments Sauces/Dips
Herbs, pepper, salt, spices
Ketchup, mustard (plain prepared), mustard flour (pure), olives, pickles (in clear brine), relish, tomato paste, vinegars (apple cider, balsamic, distilled white/spirit, pure rice, red wine, white wine)
Seasonings, seasoning blends/ mixes
Curry paste
Mustards (specialty prepared), mustard flour (prepared), mustard pickles, rice vinegar
Malt vinegar, miso (made with barley and/or wheat)
Gluten-free barbecue sauce, gluten-free miso, gluten-free soy sauce, gluten-free tamari soy sauce, gluten-free teriyaki sauce, other sauces and gravies made with allowed ingredients
Barbecue sauces, cooking sauces, Worcestershire sauce
Soy sauce, tamari soy sauce or shoyu soy sauce (made with wheat); teriyaki sauce (made with soy sauce containing wheat); other sauces and gravies made with hydrolyzed
wheat protein, wheat flour and/
or wheat starch
Miscellaneous
Baking chocolate (pure), carob chips and powder, chocolate chips, cocoa (plain), coconut
Seasoned (flavoured) crackers, rice cakes, corn cakes, potato chips, soy nuts, taco (corn) chips; wasabi peas
Potato chips made with wheat flour, barley malt flour, wheat starch and/or malt vinegar; pretzels made with wheat flour
Baking soda, cream of tartar, monosodium glutamate (MSG), vanilla (pure), vanilla extract (artificial/imitation), vanilla extract (pure), natural vanilla flavor
Baking powder, koji
Barley grass and wheat grass
Tempura (breaded with wheat flour)
Guar gum, xanthan gum, psyllium husks
Yeast (active dry, baker’s, nutritional, torula)
Autolyzed yeast, Autolyzed yeast extract
Brewer’s yeast
LEARN TO READ LABELS - APPENDIX C
Read every label, every time.
That’s the only way to be sure your ingredients and consumer packaged goods are safe for those with celiac disease and gluten intolerance.
Thickening Agents in Gluten-Free Cooking - APPENDIX E
Substitutions for 1 Tablespoon of Wheat Flour for Thickening
Thickener
Amount
Cooking Instructions
Suggested Use
Cornstarch
1 ½ tsp.
Mix with a cold liquid to create a smooth slurry before adding to other liquid. Bring to a gentle boil for a few minutes while stirring constantly.
Thickened liquid becomes translucent and shiny, thickens further when cooled.
Fruit and savoury sauces, fruit pies and cobbler, puddings, stir fries
Potato Starch
1 ½ tsp.
Mix with small amount of cold liquid then stir constantly (lumps easily) while adding to other liquid. Do not boil or overcook.
Yields a translucent thickened liquid.
Gravies, sauces, soups, stews.
Tapioca Starch
1 tbsp.
Mix with small amount of cold liquid and add to other liquid during last five minutes of cooking, stirring constantly.
Imparts a transparent and glossy appearance, produces a thick soft gel when cooled.
Pie filling, puddings, stir fries
Chickpea/ Garbanzo Bean Flour
1 tbsp.
Make a roux for thickening sauces and gravies by combining flour with butter or oil; add roux to soup or stew at the end of cooking time. Will thicken completely after 2-3 minutes of boiling.
Is yellow/tan in colour and produces cloudy appearance, smooth texture and slight bean-like taste.
Gravies, savoury sauces, soups, stews
Rice Flour (Brown)
1 tbsp.
Mix with small amount of cold liquid before using. Will thicken liquid after five or more minutes of boiling.
Gives a cloudy appearance and grainy texture.
Gravies, soups, stews
Sorghum Flour
1 tbsp.
Make a roux for thickening sauces and gravies by combining flour with butter and oil. Add roux to soup or stew at end of cooking time. Will thicken after 2-3 minutes of boiling.
Gravies, soups, stews
Gelatin (unflavoured)
1 ½ tsp.
Soften a small amount in cold water then heat until liquid is clear before using.
Thickness/firmness of final dish will range from semi- soft to extra firm depending on amount of gelatin used
Cheesecakes, puddings
Quick Cooking Tapioca
1 ½ tsp.
For fruit pies or cobblers/crisps, add dry tapioca granules to fruit and let stand for 10-20 minutes before baking.
Fruit crisps, pies, tapioca pudding
Adapted from Gluten Free: The Definitive Resource Guide – Revised Edition, 2022, by Shelley Case, Dietitian. www.shelleycase.com Used with Permission.
Meal and Snack Suggestions
Category
Suggestions
Breakfast
Cereals
- Gluten-free cold cereal e.g., gluten-free corn flakes with flax or granola served with milk or yogurt
- Gluten-free hot cereal e.g. single packets of gluten free oats with flax and fruit
Bagels, Breads, English Muffins and Muffins
- Gluten-free toast or muffin with yogurt and fruit
- Toasted gluten-free bagel or English muffin with peanut butter and banana
- Only use toast if you have access to a dedicated gluten-free toaster
- It is very difficult to provide palatable toast unless the patient/resident is consuming it immediately after toasting. If this is not possible utilize muffins or cereal to improve quality.
Eggs
- Scrambled, boiled, omelet, with toast and fruit
- Gluten-free breakfast wrap with eggs, or tofu scramble
- Western omelet (chopped peppers, onions and cheese) with potatoes
Pancakes and Waffles
- Gluten-free French toast (great way to use older bread)
- Gluten-free waffles with fruit salad
- Gluten free pancakes with peanut butter and banana or syrup and fruit salad
Miscellaneous
- Fruit smoothie
Lunch
Soups
- Gluten-free soup with gluten-free crackers and cheese
- Gluten-free soup with grilled cheese gluten-free sandwich
Salads
- Dark green leafy salad with vegetables and protein served with gluten-free crackers
- Gluten free pasta salad with beans (e.g., black, kidney, garbanzo), vegetables and protein
- Quinoa salad with vegetables and seeds or nuts
Pizzas and Pasta
- Gluten-free pasta and cheese with raw vegetables
- Gluten-free pasta with tomato-based sauce and cheese, served with salad
- Mini gluten free pizzas (English muffin with tomato sauce, toppings and cheese)
- Individual gluten-free pizza with toppings
Sandwiches, Rolls and Wraps
Gluten-free sandwich bread* or wraps/tortillas with:
- Chicken, egg salad, salmon, tuna with chopped celery, onion and spices
- Turkey, lettuce, tomato
- Hummus, spinach, cucumbers, tomato, red onion, peppers, shredded carrots
- Roast beef, lettuce and cheese
- Nut butter (e.g., almond, cashew, peanut) with jam or jelly
- Gluten-free ham and cheese
- Chicken, lettuce and gluten-free Caesar dressing
Tips about gluten-free bread
- Gluten-free breads tend to be dry unless toasted or warmed in a wax paper bag. If you don’t have a dedicated toaster or wax bags, offer alternatives e.g., muffins or wraps.
- Warm wraps slightly where possible to soften them.
- If you do serve gluten-free bread products that are somewhat dry, add moisture via avocado, salsa, mayonnaise, butter/margarine, mustard or other gluten-free spreads. *
Legumes
- Black bean chilli served over baked potato with grated cheese
- Lentil vegetable curry
- Fresh bean salad
Miscellaneous
- Baked stuffed potato with assorted toppings e.g., broccoli and cheese or ham and cheese
- Bowls with gluten-free whole grains, protein and salad
- Gluten-free crackers with cheese cubes, raw vegetables and fresh fruit plate
- Gluten-free corn tortilla chips with cooked vegetables and melted cheese
- Omelet with potato wedges
Dinner
Pasta Meals
- Gluten-free pasta with meat or tomato sauce with cheese
- Gluten-free fettuccini alfredo
- Gluten-free vegetable and beef lasagna
Meat, Poultry and Fish Meals
- Gluten-free barbeque chicken with vegetables and rice pilaf
- Gluten-free meatloaf with spaghetti squash and broccoli
- Grilled pork chops with roasted vegetables
- Salmon with rice and green beans
- Roast chicken or turkey with mashed potatoes and gluten-free gravy with glazed carrots
- Turkey meatballs with tomato sauce, rice and green peas and carrots
- Steak, baked potato and Greek salad
- Baked chicken or fish with roasted potatoes and coleslaw
- Roast pork, applesauce, baked sweet potato and steamed mixed vegetables
- Sweet and sour pork with rice and stir-fried vegetables
- Gluten-free chicken curry with rice and Greek yogurt
Casseroles, Stews and Miscellaneous
- Gluten-free corn tortillas or tacos with ground beef, cheese, chopped lettuce and tomatoes
- Chili with gluten-free cornbread and cheese
- Stir-fry beef, pork or chicken with vegetables with rice
- Beef stew thickened with gluten-free starch (see Appendix B)
- Gluten free burrito with mashed black beans, cheese, corn, lettuce and tomatoes
- Creamed salmon or tuna with green peas on rice
Snacks
Nuts, Seeds and Grains
- Gluten-free crackers made with legumes, nuts or other gluten-free grains
- Pumpkin or sunflower seeds
- Unsalted nuts
- Dried fruit and nut mixes
- Rice cakes, corn cakes
- Potato chips, corn chips
- Gluten-free pretzels
- Gluten-free granola and yogurt
- Gluten-free cereal and milk
- Gluten-free bagel with cream cheese with fruit
- Gluten-free muffins (or mini muffins)
Fruits/Vegetables
- Fresh fruits (e.g., pear, peach, apple, banana, orange, kiwi, melon)
- Canned fruit in water or juice (e.g. pears, peaches, pineapple, fruit cocktail)
- Dried fruits (e.g., raisins, apricots, cranberries, blueberries, mangoes)
- Applesauce (unsweetened)
- Sliced apple with peanut butter
- Baby carrots with hummus
- Celery with peanut butter and raisins
- Raw vegetables (e.g., green snap peas, sliced peppers, broccoli, cauliflower) and dip (yogurt and herbs or gluten-free salad dressing)
Protein
- Boiled eggs
- Cheese, (e.g., cottage cheese, string cheese, block cheese) with gluten-free crackers
- Peanut butter with banana or apple
- Yogurt with fruit
- Ice cream
- Roasted chickpeas or hummus
- Bean chips
Desserts
- Gluten-free cookies/brownies/cupcakes
- Gluten-free snack bar
- Custards/gluten-free puddings
- Sorbet/ice cream
- Gelatin desserts (jello)
Beverages
- Coffee
- Tea
- Juices
- Soft drinks
- Cocoa
- Flavoured waters
Adapted from Gluten Free: The Definitive Resource Guide – Revised Edition, 2022, by Shelley Case, Dietitian. www.shelleycase.com Used with Permission.
Gluten-Free Food Service: Tips for Cooks/Chefs
People with celiac disease or gluten sensitivity require a strict gluten-free diet for life to be healthy.
Research has found that many people with celiac disease have difficulty obtaining safe and palatable gluten-free meals and snacks in hospitals, retirement and long-term care facilities. For this reason, it is very important to carefully provide meals that are truly gluten-free to these patients to prevent serious symptoms and long-term complications.
Check the label
Gluten free food preparation
- Avoid BROW (Barley, rye, regular oats and wheat) ingredients and any ingredients made from these grains.
- Oats and oat-based products with a ‘Gluten-free’ claim are allowed.
- do not sue products that have a ‘May Contain’ statement for wheat, barley or rye unless the product also has a ‘gluten-free’ claim.
Follow standard recipes. If substitutions need to be made, check that the alternate item is ‘gluten-free’.
Try making existing menu items gluten-free (e.g use gluten-free soy sauce, gluten-free soup and gravy bases, thicken with gluten-free flours). See the table above for making gluten-free thickeners.
Look for designated gluten-free symbols which take the guesswork out of label-reading. Celiac Canada has its own trademark and certification program.
Cross contamination
A small amount of gluten can make someone with celiac disease or gluten sensitivity very sick.
Avoid cross contamination by:
- Storing gluten-free foods/ingredients separately from gluten-containing foods.
- Label all containers clearly ‘gluten-free’.
- Cook gluten-free foods separately from gluten-containing foods. Use a different surface for food preparation, different fryers, different sinks for cleaning etc.
- Use clean utensils and equipment for gluten-free food preparation.
- Use a separate toaster.
- Use squeezable condiment containers or individual portion condiments to eliminate the chance of double-dipping.
- Cook gluten-free pasta in a separate pot with clean water. Use a separate clean pasta strainer.
- Do not use the same oil to fry gluten-containing and gluten-free food.
- When baking, ideally prepare gluten-free food items on separate days from other products or at least before gluten-containing foods to avoid the risk or airborne contamination.
- Label and seal gluten-free products.
Gluten-Free Food Service: Tips for Food Service Workers
People with celiac disease or gluten sensitivity require a strict gluten-free diet for life to be healthy.
Research has found that many people with celiac disease have difficulty obtaining safe and palatable gluten-free meals and snacks in hospitals, retirement and long-term care facilities. For this reason, it is very important to carefully provide meals that are truly gluten-free to these patients to prevent serious symptoms and long-term complications.
Reading labels
Cross Contamination
- Use gluten-free ingredients when preparing foods. If in doubt ask your manager, supervisor or the dietitian in your facility.
- Avoid BROW (Barley, rye, regular oats and wheat) ingredients and any ingredients made from these grains.
- Oats and oat-based products with a ‘Gluten-free’ claim are allowed.
- Do not sue products that have a ‘May Contain’ statement for wheat, barley or rye unless the product also has a ‘gluten-free’ claim.
Look for designated gluten-free symbols which take the guesswork out of label-reading. Celiac Canada has its own trademark and certification program.
- A small amount of gluten can make someone with celiac disease or gluten-sensitivity very sick.
- Avoid cross contamination by:
- Ensuring all areas and equipment/utensils are clean.
- Using clean cloths to wipe counters and sanitize before you begin.
- Where possible prepare gluten-free foods in a separate area. If this is not possible, prepare gluten-free items BEFORE other foods.
- Use a sepearate strainer/colander for gluten-free foods.
- Cover and label all gluten-free foods.
- Store gluten-free foods above gluten-containing foods.
- Use a dedicated toaster for gluten-free toast.
- Use squeezable condiment bottles or individual packages to avoid double-dipping.
Service
- Gluten-free meal trays should be clearly labelled and checked by a supervisor.
- Never add or change items on a gluten-free tray after it has been checked unless you absolutely sure the substitution or addition is also gluten-free.
- In dining rooms understand which items are gluten-free, deliver the gluten-free meals first where possible and tell the resident that the patient or their family have provided these meals to add variety and satisfaction.
- Clearly label food items as gluten-free to avoid error.
Gluten-Free Food Service: Tips for Personal Support Workers and Nurses
People with celiac disease or gluten sensitivity require a strict gluten-free diet for life to be healthy.
Research has found that many people with celiac disease have difficulty obtaining safe and palatable gluten-free meals and snacks in hospitals, retirement and long-term care facilities. For this reason, it is very important to carefully provide meals that are truly gluten-free to these patients to prevent serious symptoms and long-term complications.
Communicating the gluten-free diet: Ordering, Service & Patient Monitoring.
- If the patient/resident has celiac disease or gluten sensitivity, a gluten-free diet must be ordered.
- Request a dietitian assess the patient. If that’s not timely ask a supervisor from Nutrition/Food Service to visit the patient/resident to confirm their preferences.
- Understand that patients/residents may be anxious about eating foods they have not prepared as they know and have likely experienced the risks of getting sick from eating even a small amount of gluten.
- If providing trays, check that the tray tickets clearly states a gluten-free diet.
- If providing service in a dining room where the residents have choice, explain which items are gluten-free. If in doubt, ask a supervisor or other food service staff member knowledgeable about the gluten-free status of each food item.
- Serve meals in dining room to gluten-free residents before others, as this minimises the risk of cross-contamination and running out of gluten-free options.
- If there are self-service food bars, give the resident the option of going through the line first or having their meal served to them.
- Don’t use bulk condiments. Use squeeze bottles instead or individual portion packs.
- Document relevant information related to the gluten-free diet and the patient’s health on the medical record.
Understanding what foods are gluten-free
Storing gluten-free food
- Serve appropriate gluten-free snacks or packaged snacks labeld gluten-free. (See tables above)
- Avoid BROW (Barley, rye, regular oats and wheat) ingredients and any ingredients made from these grains.
- Oats and oat-based products with a ‘Gluten-free’ claim are allowed.
- Do not serve products that have a ‘May Contain’ statement for wheat, barley or rye unless the product also has a ‘gluten-free’ claim.
- If unsure about a food product, ask the dietitian or the Nutrition/Food Service manager/supervisor to clarify.
- Gluten-free food and snacks (including those brought-in by families) must be covered and labelled to avoid error and cross contamination.
- Store gluten-free foods on the top shelf of the refrigerator or cupboard.
- Perishable food brought from home should be discarded within a specific time frame e.g three days.
Look for designated gluten-free symbols which take the guesswork out of label-reading. Celiac Canada has its own trademark and certification program.
