Question:

How can I manage the gluten-free diet in a way that is heart healthy since I also have heart disease?

Answer:

This is a great question since many gluten-free products are filled with gums, fats and empty starches to help them mimic the properties of wheat. The best way to manage the gluten-free diet is to focus your shopping on the perimeter of the store, cooking naturally gluten-free meals made primarily from fresh fruits and vegetables, lean meats and fish, legumes and some limited whole grains. Bean flours can be nutritionally dense, so incorporate them into your baking if you have the opportunity.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Question:

I don't have symptoms, but I do have celiac disease. How closely do I need to follow the gluten-free diet?

Answer:

If you are diagnosed with celiac disease, you need to follow the gluten-free diet 100%...100% of the time. Research shows that even those who are asymptomatic do experience antibodies and intestinal damage when exposed to gluten. Long-term exposure can increase your risk of cancer and the onset of other autoimmune diseases.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Question:

What should I do if I suspect that a product labeled gluten-free is not truly gluten-free?

Answer:

If you suspect that a packaged product labeled gluten-free made you ill or is mislabeled, save the box. Contact the manufacturer using the phone number on the packaging or on the company’s website. Provide the manufacturer with the barcode number on the package, the “sell by” or “use by” date, the date and location of purchase and your reason for making the complaint. Then contact your FDA Consumer Complaint Coordinator and the store where you purchased the product.

If you believe a gluten-free menu item in a restaurant is not gluten-free, speak to the manager immediately. Provide written documentation, if possible. Contact your local or state health department if you believe that the restaurant is marketing a gluten-free menu without an understanding of gluten-free ingredients and processes.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Question:

I've heard people claim that gluten sensitivity isn't real. Is that true?

Answer:

While we know very little about non-celiac gluten sensitivity ('gluten sensitivity') at this point in time, most experts in gluten-related disorders do believe it is a real condition. However, there may be experts with differing opinions.

We don’t have a disease definition yet for gluten sensitivity, so right now it is what we call a diagnosis of exclusion.

A diagnosis of gluten sensitivity is given when people experience similar symptoms as those with celiac disease when eating gluten, but who test negative for celiac disease and wheat allergy. These individuals then undergo an elimination diet under the supervision of an expert healthcare team to determine if gluten is at the root of their symptoms.

People with celiac disease develop auto-antibodies to gluten and experience damage to their intestines. People with gluten sensitivity experience neither of these celiac disease markers, however their symptoms can be quite debilitating and affect quality of life.

A gluten-free diet is recommended for people with a gluten sensitivity diagnosis, however we don’t know if eating small quantities of gluten can potentially lead to long-term health consequences, as is the case for people with celiac disease.

Your question probably arises from a research study that was reported in the media showing that gluten may not necessarily be the issue for all people with self-diagnosed gluten sensitivity, and that other food components may be at play for some of these individuals. This is preliminary research and we need to learn more. However, the majority of gluten-related disorders experts believe that gluten sensitivity is a real condition. We just don’t know much about it yet.

It is extremely important that people not self-diagnose as being gluten sensitive. All individuals who believe gluten may be problematic for them should see a gluten-related disorders expert healthcare team. This team can test for celiac disease and wheat allergy first. If these conditions are ruled out, then they can conduct an elimination diet to see what the problematic foods might be. It is highly recommended not to do an elimination diet on your own, as components of food can overlap making it very difficult to tease out the real issue. A healthcare team experienced in gluten-related disorders and conducting an elimination diet is the best route to go so that the real issue is identified.

Be well,

Rachel Begun, MS, RDN

Question:

I’ve read that caramel coloring should be gluten-free in the US, but I sometimes have symptoms like I’ve been glutened when I drink soda. Could caramel coloring cause the same symptoms?

Answer:

Caramel coloring in the United States is usually derived from corn, so exposure to gluten shouldn’t be an issue. Caramel coloring in products manufactured in other countries may be derived from wheat, however, it is refined to the point where there is no gluten so imported products shouldn’t be an issue either.

If you are experiencing symptoms when drinking soda, other factors may be at play. Without knowing your personal medical history, though, I don’t want to speculate as to why you are having symptoms when drinking soda. It should not be a result of consuming gluten, though.

I recommend raising the issue with your healthcare team who knows your medical history and can address it and provide you with a personalized treatment plan.

Be well,

Rachel Begun, MS, RDN

Question:

I’m maintaining a strict gluten-free diet, but my follow up blood work is showing I’m somehow still being exposed. How can I figure out what the problem is?

Answer:

Learning to live strictly gluten-free does not happen overnight. It takes a lot of education and practice. So, do not be discouraged if you are still being exposed. However, knowing that you are still being exposed is a good motivator to continue learning how to avoid gluten.

I highly recommend seeing a registered dietitian nutritionist (RDN) that is knowledgeable in treating patients with celiac disease. Gluten is lurking in unexpected places in the food supply, and it can be particularly challenging to avoid gluten when eating out at restaurants, as we don’t know what is going on in the kitchen.

A knowledgeable RDN can review your current food purchasing and eating habits to identify where you may be getting exposed to gluten. She can also teach you about where gluten is hiding in our food supply and how to avoid it both inside the home and when eating outside the home.

It’s critically important to continue seeing your physician so they can do follow up testing to determine if you are still being exposed to gluten.

Best of luck to you in your gluten-free journey!

Be well,

Rachel Begun, MS, RDN

Question:

I read on the internet that ancient grains are ok for people with celiac disease, even if it’s a form of wheat. Is this true?

Answer:

Despite what you may have read, it is not okay for people with celiac disease to eat any form of wheat, even if it is an ancient form of wheat that hasn’t been hybridized. Even if you do experience fewer symptoms or none at all when eating ancient forms of wheat, the body still experiences the typical immune reaction when eating gluten, which causes damage to the intestines and sets off an inflammatory response in the body. The reports you have seen probably cited a piece of research in which people with celiac disease showed fewer symptoms when eating ancient forms of wheat versus modern forms. This is just one study and it was done in a small group of people. Previous studies do indicate that ancient forms of wheat are still toxic to people with celiac disease.

The good news is that there are many gluten-free ancient grains that people with celiac disease can enjoy, including teff, amaranth, millet and quinoa. So, feel free to enjoy these gluten-free ancient grains!

Be well,

Rachel Begun, MS, RDN

Question:

I know that cross-contact is a concern, but how careful should I be at home? I don’t want to replace all of my equipment because of the cost and storage concerns. What are the absolutely necessary essentials to replace and what can I skip?

Answer:

While avoiding cross contact inside the home is just as important as away from home, keeping a completely gluten-free household is not practical for all families. You do not have to expend the cost and effort to replace big, expensive equipment. However, your equipment should be fully cleaned and sterilized to accommodate gluten-free cooking and meal preparation moving forward.

For major pieces of equipment and appliances that can’t be replaced or another one purchased—such as your oven or refrigerator—its best to make a family plan for your approach. Will the oven be completely gluten-free? That is ideal, but may not be practical for your family. If gluten-containing foods will be allowed in your oven, it is always best to prepare and cook gluten-free items first before gluten-containing, and always clean and sterilize the oven immediately after preparing gluten-containing foods. It’s important to know that you can’t “burn off” gluten in the oven. Cleaning and sterilizing is necessary to remove the gluten.

If you must have gluten-containing foods in your refrigerator, make sure they are stored on the bottom shelf so that any crumbs or droppings don’t fall into gluten-free food. Labeling gluten-free items is also important so the entire family knows how and where to be careful.

In most homes, it’s not practical to have more than one of your medium-sized appliances—such as blenders and food processors—as they are expensive and take up a lot of storage space. Again, here you should have a family plan for these items to be thoroughly cleaned and sanitized before and after use and stored in place where there will be no contact with gluten.

It does, however, make sense to have two sets of certain small appliances, equipment and utensils that are likely to come into contact with gluten, such as cutting boards, knives and colanders. If toaster-ovens are commonly used in your home, and purchasing a second one is feasible, I recommend doing that. A second dedicated gluten-free toaster can sometimes offset the need to use the oven, and is much easier to handle and clean. If these smaller items can be stored in separate cabinets/drawers that is ideal, however, not always possible. If you do need to store these items close to one another, it is a good idea to put labels on them so all can decipher between the two sets.

For cleaning and sanitizing equipment, utensils and cleaning surfaces, it is best to follow these steps:

1. Dry wipe to remove all crumbs and bits and pieces of food residue before cleaning
2. Wash thoroughly with warm, soap water
3. Rinse
4. Where possible, sanitize by running through the dish washer. Or, use a home sanitizing solution for necessary equipment.
5. Either let air dry or wipe with a clean towel that hasn’t come into contact with gluten

Of all these considerations, the most important is creating a system that works for your home and making sure that all family members understand the system. Labeling and proper storage are key components to ensuring the plan works.

Every family is different, so how gluten-free food storage and meal preparation is handled will be different for every single household. I hope these tips are a good starting point for you.

Be well,

Rachel Begun, MS, RDN

Question:

I am diagnosed with celiac disease and have been strictly following my gluten-free diet for four months, but I was accidentally “glutened.” Does the healing process start all over when something like this happens? Is there something I should be eating/not eating to stop the symptoms sooner?

Answer:

I’m sorry to hear you were “glutened.” It’s common to get glutened when first going on a gluten-free diet, as it takes time, education and practice to really understand how much and where gluten is lurking in our food supply.

For people with celiac disease, every time gluten is ingested the immune system triggers an attack on the intestines. So, yes, being glutened does start the inflammatory process all over again and that is why it’s so important to avoid gluten at all costs. The good news is that you aren’t starting from ground zero, so to speak. By being gluten-free for the past four months you have made tremendous strides to heal your intestines, and you are certainly much better off than before going gluten-free.

When you have been glutened, there are no foods that will stop the symptoms sooner. I recommend eating mild, gluten-free foods that are easy to tolerate and will not further upset your gastrointestinal (GI) system. If you are sensitive to other foods/ingredients, you will want to avoid them. It’s best to focus the diet on wholesome, nutrient-dense foods that will provide your GI system with the nutrients it needs to heal. Drinking lots of water is also recommended.

I hope you feel better soon. Keep up the good work with your gluten-free diet. We all get glutened from time to time. Eating gluten-free and preventing gluten contact does get easier with time and practice.

Be well,

Rachel Begun, MS, RDN

Question:

Is it true that the protein in coffee is a cross reactor?

Answer:

Celiac disease expert Stefano Guandalini, MD addressed this very question at the International Celiac Disease Symposium back in September 2013. He confirmed that there is no evidence that coffee has a protein that cross-reacts with gluten antibodies.

You do, however, have to be careful with flavored coffees found either at the supermarket or your local coffee shop. It is possible for some flavored coffees to have gluten-containing ingredients.

Once you’ve confirmed gluten-free status, go ahead and enjoy that cup of java!

Be well,

Rachel Begun, MS, RDN