Staying Safely Gluten-Free: At Home and Beyond

We held another GIG Educational Event for Celiac Disease Awareness Month, this one titled Staying Safely Gluten-Free: At Home and Beyond. Our guest experts for the evening’s discussion were Dr. Joe Murray, a gastroenterologist from the Mayo Clinic; Laura Allred, Ph.D., GFCO’s regulatory expert; and Ronni Alicea, GFCO’s manager of quality control, who is also a registered dietitian.

Here are some of the most-asked questions from the event with answers and related resources.

FOOD & DRINK 

Q: How do we know which oats are safe? People say to use certified gluten-free oats, but are those even safe? My dietitian told me that I may be able to eat the Purity Protocol oats later.

A: Oats are a hot-button topic within the celiac and gluten-free communities. Oats are not considered a top allergen, and in their pure form, oats are safe for most people with celiac disease. Unlike wheat, barley, and rye, oats are not considered a source of gluten in many countries.

The concern with oats is that they may come into contact with gluten grains from the field or at any point from storing and processing through manufacturing. Therefore, it is recommended that individuals with celiac disease consume only oats that are certified, or at the least labeled, gluten-free and generally only in small amounts. Individuals with celiac disease should consult their physician or dietitian before introducing oats into their diet. 

For more details, read: Are Oats and Oat Flour Gluten-Free?

Q: Are regular milk and cheese safe to drink if they do not say gluten-free?

A: Most milk and cheese products found at the grocery store are safe to consume, even if they are not labeled gluten-free. However, there are two considerations:

1) Just as with any non-labeled or non-certified product, the ingredient list must be read carefully to confirm there are no gluten-containing ingredients added as flavorings.

2) Cultured dairy products could, in some cases, contain gluten since cultures can be grown on gluten-containing grains.

The amount of gluten that could potentially make its way into finished food products made with cultures is small, but some of these products have been found – on occasion – to exceed the 10-ppm cut-off for GIG’s GFCO certification program.

Cultures and enzymes used to produce cheese and other fermented dairy products can sometimes be grown on media that contains wheat derivatives or ingredients, like yeast extract, which could contain gluten. As mentioned during the panel event, dairy products, including cultured dairy products, are generally safe.

Any potential gluten introduced through cultures and enzymes is typically well below the GFCO threshold of 10 ppm. Keep in mind that GFCO uses a lower threshold than the FDA or products simply labeled gluten-free. You may wish to contact the manufacturer to find out the source of the culture on products that are not certified gluten-free or choose an alternate certified gluten-free version of the product.

Q: Are spices gluten-free?  Do spices label if they are? Do they need to be labeled?

Spices could contain both gluten and allergens, but the American Spice Trade Association is working hard to clean up the spice industry with a focus on allergens and gluten. Spices are typically used in very small amounts, reducing—but not eliminating—the risk of potential exposure to gluten.

To be safest, choose spices that are labeled gluten-free following FDA regulations, or for additional assurance, spices that are GFCO third-party certified as gluten-free. As is the case with all food products, gluten-free labeling is voluntary.

Read more about spices and their gluten-free status here: https://gluten.org/faq/what-about-spices/

Q: What about Kombucha? Is Kombucha safely gluten-free?

A: As with other fermented products, this would depend on the ingredients. Kombucha also uses a starter culture, so GFCO would check to ensure that the culture was not grown on a medium that contained gluten, or that the use of the culture could not result in a gluten level that exceeds the GFCO threshold. A lot of dried culture materials are gluten-free, so it is possible to make a truly gluten-free kombucha.

Q: Are distilled spirits and wines safe for consumption?

A: Distilled spirits and wine are usually gluten-free. Learn more about wine in our article Is Wine Gluten-Free? and more about spirits in our article Fermentation Versus Distillation.

HOME, PERSONAL CARE, SOCIAL LIFE

Q: How clean do your kitchen, dishes, utensils, and surfaces need to be if you are living gluten-free in the same house as a non-gluten-free person? How do you clean them? Do we need to change pots and pans if they get gluten on them?

1. You do need to be careful to avoid cross-contact if you are living in a household with individuals who consume gluten. Thorough cleaning of cooking equipment and utensils with soap and water is sufficient for most items. Some items that are difficult to thoroughly clean – such as colanders, sifters, and waffle irons – should not be shared between gluten-free and non-gluten-free use. For more information, read our article 7 Tips for Avoiding Gluten Cross-Contact at Home.

Q: What about gluten in lotions and things you apply to the skin? Are those safe for someone with celiac disease?

A: To date, medical research does not show that the topical application of gluten to the skin causes a reaction related to celiac disease. Dermatitis herpetiformis (DH), the skin rash that is seen in some people diagnosed with celiac disease, is a reaction to ingested gluten. Often skin reactions to topicals are related to ingredients other than gluten. The main concern is when a topical gets into the mouth and is ingested. For more information about skincare products, read our article “Gluten-Free Skin Care.”

Q: How can I be certain that prescription meds are gluten-free? Can “gluten-free” enzyme supplements potentially contain gluten?

A: There is currently no regulation regarding gluten-free labeling of prescription medications. While most medications are gluten-free, it is important to confirm that any excipients (inactive ingredients) they contain are gluten-free, particularly regarding a medication you take regularly. Ask your pharmacist to confirm gluten-free status, and/or check with the manufacturer yourself. Check out our article “Are Your Medications and Supplements Gluten-Free?” for more information.

Q: Can I eat at someone else’s home without bringing my own food?

A: The way you prepare, or respond to, eating at someone else’s home will vary, depending on the situation and your relationship with the host. If you are eating at the home of someone who is unfamiliar with your requirement for gluten-free food, it is important to communicate about your needs in advance—if the situation is such that you feel comfortable doing so.

If the host is someone you do not know well and do not expect to interact with much in the future, you may wish to simply bring your own gluten-free food. On the other hand, if you believe the host would be receptive—and especially if it is someone you expect to interact with in the future—graciously inform them of your gluten-free needs, and about the importance of avoiding cross-contact of gluten-free foods they may be offering with any that do contain gluten.

Offering to contribute one of your own delicious gluten-free dishes is a wonderful way to start a discussion and provide education about gluten-free eating.

Q: What about restaurants that advertise gluten-free items but in discussing their gluten-free menu items, many of them risk cross-contamination such as a fryer used for multiple things. Of the items listed as gluten-free on their menu, maybe only one or two items are. What can I do?

A: To be safely gluten-free restaurants need to have an area dedicated to preparing gluten-free food apart from any gluten-containing food. It is essential to ask questions at restaurants, even when a restaurant advertises “gluten-free” items. A GFFS-validated Gluten Free Safe Spot is a food service establishment where staff is trained in safely preparing gluten-free food. Read more about questions to ask and things to watch out for in our article Restaurant Dining: 7 Tips for Staying Gluten-Free.

REGULATIONS AND PRODUCT TESTING

Q: Do the foods that are labeled gluten-free meet the FDA gluten-free requirements? Is gluten testing ever done on gluten-free labeled foods to see if gluten level requirements are being met? And is the safe threshold for gluten 20 ppm or 10 ppm?

A: The FDA’s gluten-free labeling regulation states that foods under their purview that are labeled “gluten-free” must meet the definition laid out in FDA guidelines. The FDA does not do routine testing of these products.

The FDA standard for gluten-free is less than 20 ppm of gluten. This level has been found to be safe for most individuals with celiac disease and is a standard that is accepted in many parts of the world.

The GFCO cut-off is 10 ppm, which is an even safer level. In addition, GFCO-certified products go through a rigorous review and testing process to assure compliance.

Q. What about fermented and hydrolyzed foods and ingredients?

A. The concern with these items is that the gluten proteins in hydrolyzed and fermented foods are no longer intact and cannot be adequately detected and quantified with currently available testing methods. These gluten proteins that are no longer intact, however, can still be problematic for individuals with celiac disease.

Therefore, the FDA released a rule stating that any foods labeled gluten-free that contain fermented or hydrolyzed ingredients must demonstrate compliance based on records kept by the manufacturer to show that the foods were gluten-free before fermentation or hydrolysis.

Watch the video recording of Staying Safely Gluten-Free: At Home and Beyond for additional information.