GIG FAQ

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Whether you are new to the gluten-free lifestyle or are a seasoned pro, you are sure to have questions! Let our team tackle them for you. Simply submit your question here and we will be happy to respond to you.
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Inherently gluten-free and naturally gluten-free refer to the same quality: by nature, and if unchanged the food item is gluten-free. For example, raw fruits and vegetables are inherently gluten-free, although they could come into contact with gluten at any stage between growing, harvesting and storage, transporting, and manufacturing. See details about labeling naturally gluten-free products under GLUTEN-FREE LABELING & REGULATIONS in this FAQ. Check out our article 3 Tips for Reading Gluten-Free Labels. 

The Executive Council of the Society for the Study of Celiac Disease (SSCD) released a statement regarding vaccination for the COVID19 virus for people with celiac disease: “As the safety and efficacy data on Covid vaccination has emerged, there is no evidence to suggest that people with celiac disease would be more prone to an adverse effect of vaccination. Celiac disease is not considered an allergy, and by itself does not prompt additional precaution when proceeding with vaccination. Patients with concerns about vaccination and their particular circumstance should speak with their health care provider.” Read the entire statement from the SSCD. 

Unfortunately, there are no supplements or medications that “neutralize” or “de-activate” gluten. The scientific community is researching substances that could make consuming small amounts of gluten less problematic, such as what one might get through cross-contact. A gluten-free diet is currently the only treatment for gluten-related disorders. For more information on the topic, read Commercially available glutenases: a potential hazard in coeliac disease. 

 

Gluten cross-contact can take place when glutenfree foods are processed using the same equipment as gluten-containing products. Cross-contact can happen in manufacturing facilities; food service establishments including restaurants and especially at buffets; or even in your home kitchen. Cross-contamination refers to microorganisms, namely bacteria, that are transferred from one substance or object to another by accident that causes harm – like salmonella or E. coli. For more information, check out our article on cross-contact and agricultural commingling. 

Non-celiac gluten sensitivity or NCGS is a health condition characterized by intestinal and other reactions related to ingesting gluten not connected to a celiac disease diagnosis or a wheat allergy. 

Gluten intolerance broadly includes any inability to tolerate gluten that covers both celiac disease and NCGS. In the case of discussing gluten, the word “intolerance” is not commonly used as a medical term. The word “sensitivity,” as in “gluten sensitivity,” is the more common term. 

The term non-celiac wheat sensitivity or NCWS may also be used, but this is different from celiac disease and wheat allergy. Check out Celiac Disease, Non-Celiac Gluten Sensitivity or Wheat Allergy: What is the Difference? 

If you think you, or someone you love, is experiencing a gluten sensitivity, it is important to check for other conditions that might cause the same symptoms, including celiac disease or possible intolerances to other substances in gluten-containing foods, such as “FODMAPs” or fructans. There is no specific diagnostic test for NCGS.  

Celiac disease is a serious autoimmune disease where the ingestion of gluten leads to damage in the small intestine and other related health problemsCommon symptoms of celiac disease include diarrhea, abdominal pain, fatigue, migraines, and joint pain. 

The term “gluten-free” describes the elimination of gluten-containing grains – wheat, barley, and rye – in food, drinks, and other products that could be ingested or enter the body in some other manner. People living gluten-free have either been diagnosed with celiac disease or experience reactions to consuming gluten due to a non-celiac gluten sensitivity (NCGS) or have made the choice to eliminate gluten from their diets. The FDA dictates that any FDA-regulated food product labeled “gluten-free” should contain less than 20 ppm (parts per million) of gluten. The GFCO’s criteria for “gluten-free” certification is twice as strict as the FDAs, at 10 ppm of gluten or less. 

Someone with NCGS is reactive to gluten from wheat, barley, and rye. Individuals with NCGS may also be sensitive to fructans, a type of carbohydrate and one of various types of FODMAPs (FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides and Polyols or short chain carbs). In certain cases, a person may react to fructans or FODMAPs and not gluten. 

Generally, NCGS is diagnosed by first ruling out other conditions that may be causing the symptoms, and then eliminating gluten and watching for symptom improvement.  If you still experience symptoms after eliminating gluten from your diet, it could be a sign of an intolerance or sensitivity to components of gluten-containing foods other than the gluten itself. 

Some gluten-containing foods contain fructans, such as wheatNon-gluten-containing foods may also contain fructans, such as onion and watermelon. Going on a gluten-free diet could reduce fructan intake. Some research indicates that individuals who think they are gluten sensitive are actually reacting to fructansRead the study: Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity and our Educational Bulletin on Gluten Sensitivity and FODMAP. 

Individuals should work with a healthcare team, including a knowledgeable dietitian, if gluten sensitivity is suspected in order to explore and rule out other possible conditions. 

Theoretically, a tap line should be flushed and cleaned before a new item, such as a gluten-free beer or cider, is put into it. Unfortunately, there are no standards to follow for cleaning a tap line and no guarantee that the cleaning even happens.  

Before ordering and consuming a gluten-free drink from a tap, ask the establishment’s wait staff or manager questions about what was in the tap line previously and how it was cleaned before the gluten-free beverage was tappedAt that pointit boils down to your personal judgement as to the quality of the answers received from staffThe safer option is to order beer labeled gluten-free in accordance with FDA regulations or, for additional assurance, that is GFCO third-party certified as gluten-free. bottled drinks rather than those coming from a tap. 

It is possible for a certified gluten-free product to contain wheat, but the wheat would need to be processed to remove all protein. An ingredient like wheat starch would be the most common example, and the ingredient would need to be tested to ensure that it meets our 10 ppm threshold.

“May contain” or “shared equipment” statements are voluntarily included on some products to alert wheat allergic consumers of the presence of wheat in a manufacturing facility, because people with wheat allergies can have a reaction to wheat fractions other than gluten, and there is no test available to detect these other fractions. The presence of wheat starch as an ingredient would be an example of where you might see a “Contains: Wheat” statement alongside a gluten-free claim. For purposes of choosing gluten-free products, these types of statements are not relevant. If you see this type of statement on a product that is certified gluten-free, the gluten-free labeling/certification means that it is gluten-free regardless of any “may contain” type statements and contains 10 ppm gluten or less.

Unfortunately there are no supplements or medications which “neutralize” or “de-activate” gluten.  Research is going on in the scientific community on substances that may make it less problematic to consume very small amounts of gluten, such as what might be ingested due to cross-contamination.   A gluten-free diet is currently the only treatment for gluten-related disorders.

It is important if you think you have gluten sensitivity, that you are checked for other conditions that might cause your symptoms.  There is no specific diagnostic test for gluten sensitivity.  So, it is important that other possible causes of symptoms be looked into as well (including celiac disease, and possibly intolerance to other substances in gluten-containing foods, such as “FODMAPs”).

Most dried fruits are gluten-free. Some dried fruits, like dates, could be coated with oat flour to prevent sticking. Oats, and oat flour, should be avoided unless labeled* or certified gluten-free. Oat flour used to dust dried fruits is not likely to be gluten-free. For safe dried fruits, read labels and avoid bulk bins. Choose a product either labeled gluten-free in accordance with FDA regulations or, for additional assurance, that is GFCO third-party certified as gluten-free.

 

* The safest oat products are those that have been certified gluten-free. While products labeled gluten-free should comply with the FDA definition of containing no more than 20 ppm of gluten, this is not third-party verified. GFCO’s standard for gluten-free is 10 ppm of gluten or less.

The risk of cross-contact in a kitchen where both gluten-containing and gluten-free foods are stored and prepared is real. For instance, if a pot holder is being used on a gluten-containing fruit cobbler and the cobbler rises up to or over the top of the baking pan, there is a chance the pot holder may inadvertently come into contact with the food. If a bit of gluten is on the pot holder, and you later use it in the same way on your gluten-free cobbler, cross-contact could result.  

On the other hand, if sufficient care is taken to be sure that the pot holder does not come into contact with the food, there should be minimal to no riskUsing separate pot holders is a good idea and won’t break the bank. 

One should note the type and number of gluten-containing items being made in a home kitchen. Keep in mind that younger children, others in the household, or visitors who have less understanding of dietary needs may not be as vigilant about avoiding cross-contact as you are.  

Regarding dish towels, the same principles apply. If others in the household are using kitchen towels only on dishes or hands that have been thoroughly washed, the risk is minimal to none. Otherwise, using separate towels, or even paper towels, is a good idea.  

Welcome to the gluten-free culinary adventure! Luckily for gluten-free consumers these days, there are a number of excellent gluten-free flour blends on the market. Gone are the days when it was necessary to purchase multiple flours and mix up the right blend at home, leaving you with numerous partially used bags of gluten-free flours and nowhere to keep them 

While many of these new flour blends can be used as a direct substitution for wheat flour (sometimes requiring the addition of xanthan or guar gum), this doesn’t guarantee results will be identical to gluten baked goods. Gluten-free baked goods can, however, be absolutely delicious, but the flavor and texture may vary from their wheat flour-based versions.  

Choose a gluten-free flour blend (or make a custom blend) and start experimenting with recipes that contain smaller amounts of flours (e.g., nut tortes, fruit crisps). When flour isn’t the main component of a dessert, flavor and texture differences related to gluten-free substitutions will be less noticeable. As you get more comfortable with gluten-free baking, try recipes that rely more on flour.  

Another approach to gluten-free baking is to use recipes that don’t call for any flour, for example, flourless chocolate cake, French macarons, flourless peanut butter chocolate chip cookies, and meringues. Finally, don’t forget to explore the world of gluten-free baking that takes advantage of delicious and nutritious gluten-free flours such as teff, buckwheat, and sorghum.  

Check out our post “Gluten-Free Cooking & Baking Hacks” to get started. There is baking joy after making a gluten-free switch. Happy Baking! 

Some research has indicated that GERD (gastroesophogealreflux disease) symptoms may occur in individuals with untreated or newly diagnosed celiac disease. GERD occurs when a muscle at the end of the esophagus does not close properly and allows stomach content to go back up into the esophagus. This backwash – or reflux – irritates the lining of the esophagus, causing symptoms that include heartburn, a sour taste in the mouth, and nausea. Getting a proper diagnosis and controlling celiac disease through a gluten-free diet can minimize or eliminate GERD symptoms. GERD may exist as a separate condition, so always follow-up with your personal physician if symptoms exist. 

Yes, there is a genetic linkage between celiac disease and other associated autoimmune diseases. About 14% of people with celiac disease have an additional autoimmune condition, while only 3% of the general population do. Other autoimmune conditions most commonly associated with celiac disease are type 1 diabetes and autoimmune thyroid disease. Read more about Associated Auto-Immune Diseases. 

Flatbreads are a great place to start when you’re just beginning to bake gluten-free bread because they don’t depend on yeast and rising the way most traditional loaf breads do. As long as they are made from gluten-free grains, they are a great bread alternative. Flatbreads, crepes, and savory pancakes are regularly consumed in many parts of the world, even if not as common in the U.S 

Here are a few delicious options to try: 

Injera - A traditional flatbread in Ethiopia made from teff flour. Be aware that Ethiopian restaurants in the U.S. often make injera with a combination of teff and wheat. Take care to always confirm the gluten-free status of foods you get in a restaurant.  

Socca – A flatbread found in various parts of Europe made from chickpea flour.  

Dosa – An Indian crepe made with rice and lentil flour.  

And don’t forget about corn tortillas that are popular, gluten-free, and especially delicious when freshly made.  

Ice creams are generally gluten when they use basic ingredients like milk, cream, and sweetener(s)As you add flavors, including chocolate, vanilla and fruit, the risk of gluten exposure increasesFlavorings could contain gluten and need to be verified. Many popular ice creams add in obvious gluten-containing ingredients such as cookie or brownie pieces. If buying ice cream at a store, read ingredient labels on packaged ice cream carefully or choose products labeled gluten-free in accordance with FDA regulations or, for additional assurance, that are GFCO third-party certified as gluten-free. 

When ordering from any food business including ice cream shopsask questionsIf a business serves cones that are not gluten-free, simply requesting a scoop in a dish instead of a cone does not guarantee safety. When previous cone orders were filled, the same utensil used to serve your ice cream could have been used to push a scoop onto a cone, possibly resulting in cross-contact with the gluten-containing cone, transferring cone crumbs into the ice cream containerWhen in doubt, be vocal about a need for assurance of a totally gluten-free productAsk if there is an ice cream container that has not yet been opened that could be used, along with clean serving utensils, to guarantee that your scoop is free of cross-contact with gluten. 

If you use a shared kitchen or eating space at home, work, or school, you could inadvertently be ingesting gluten. Remember, even a crumb of gluten-containing bread can be enough to cause problems for people with celiac disease or gluten sensitivity.  

Consider washing table tops with soap and water or putting a barrier (e.g., paper towel) between food container and the table top to avoid picking up hard-to-see crumbs. Check out 7 Tips for Avoiding Cross-Contact at Home. 

Also, don’t forget that exchanging kisses with someone who eats gluten may require advanced teeth brushing on their part to get rid of gluten particlesSee our article 7 Things to Know About Kissing Gluten-Free.

Finally, washing hands with soap and water before preparing and eating any food can help prevent cross-contact to stay gluten-free and healthy. 

While many restaurants now offer gluten-free options, not all food establishment staff have enough awareness or training regarding gluten-free ingredients or how to strictly avoid cross-contact during food preparation. Some restaurants offering “gluten-free” menu options may not have necessary procedures set up to reliably produce gluten-free items.  

When possible, do some research in advance: call or visit the restaurant when the food establishment may be less busy. Ask how gluten-free items are prepared and what procedures are in place to avoid cross-contact between foods that contain gluten and those intended to be gluten-free. Make an informed decision as to the comfort level of dining in an establishment once you have the answers to your questions. 

The short answer is no. The FDA gluten-free regulation applies to food products, not to advertising. A separate government agency regulates truth in advertising: The Federal Trade Commission (FTC).  

The FTC website (www.FTC.gov) states: “When consumers see or hear an advertisement, whether it’s on the Internet, radio or television, or anywhere else, federal law says that ad must be truthful, not misleading, and, when appropriate, backed by scientific evidence.  

The Federal Trade Commission enforces these truth-in-advertising laws and applies the same standards no matter where an ad appears, including newspapers and magazines, online, in the mail, or on billboards or buses. If a consumer believes that an advertising claim is false or misleading, they can submit a report and the FTC may conduct an investigation.  

Although not specified, it is reasonable to expect that if the FTC were to investigate a “gluten-free” claim, the same standard for gluten-free used by the FDA (< 20 ppm) would also be used by the FTC as the FDA. 

Both xanthan gum and guar gum are commonly used in gluten-free baking to provide some of the properties otherwise delivered by gluten, such as improved texture and elasticity. Guar gum comes from the guar bean seed, originally of Asian origin. Xanthan gum is the result of bacterial fermentation of carbohydrates from various non-gluten sources. Alternative ingredients that offer some of the same characteristics are chia seeds and psyllium husk. More and more gluten-free recipes, as well as packaged foods, are now incorporating these ingredients. 

If a person eats products that contain gluten at some ppm level greater than zero, then the more of those products consumed, the more gluten would be ingestedThe amount of gluten ingested via products labeled gluten-free in accordance with FDA regulations, or that are GFCO third-party certified as gluten-free, would likely not be problematic given the normal amount of food consumed by a person in a day. Here’s why: 

Research has indicated that 10 mg per day of gluten is a safe level of consumption for individuals with celiac disease. Read the study here.

Using 10mg per day as a safe threshold, a person would have to eat half a kilogram (1.1 lbs.) of products containing 20 ppm of gluten to reach that 10 mg mark during the course of a day. If they were consuming a GFCO-certified product containing 10 ppm of gluten, that food volume goes up to a full kilogram (2.2 lbs.) to get to 10 mg of gluten 

Keep in mind that most gluten-free products don’t have gluten levels anywhere near either threshold. It would take quite a bit of eating to exceed 10 mg of gluten per day and cause a problem. 

Most natural flavors are safely gluten-free, but use cautionThe term “natural flavors” on a product that is not labeled or certified gluten-free means it could be made using a gluten-containing ingredient such as malt extract derived from barley. Unless you can confirm the product does not contain malt extract, it should be avoided. If a natural flavor in an FDA-regulated product contains wheat, it must be stated on the label. 

Yes, flour could be used in processing some chocolates, but FALCPA (the Food Allergen Labeling and Consumer Protection Act) says that all processing aids and ingredients that are allergens must be labeled. Manufacturers cannot use wheat flour on a candy line to prevent sticking without stating it as an ingredient. Be sure to read ingredient labels carefully or choose options that are labeled gluten-free in accordance with FDA regulations or, for additional assurance, that are GFCO third-party certified as gluten-free. 

The word “malt” in both of these ingredients can cause confusion since malt usually comes from barley, and barley is not gluten-free. However, both maltose and maltodextrin are gluten-free. Maltose is a type of sugar and is inherently gluten-free. Maltodextrin is a thickener, flavor enhancer, or filler that can be derived from a variety of starches including corn, potato, rice, or wheat. Even when derived from wheat, maltodextrin is so highly processed that it is gluten-free. 

No, bleach only sanitizes gluten. Sanitizing and cleaning are not the same thing. Sanitizing makes it “sterile.” Scrubbing with soap and water can remove gluten from surfaces such as your kitchen counter or cooking utensils. 

Wheat grass is a wheat product that comes from the stem of the plantnot the flower head where gluten is present. If wheat grass is harvested before the flower head builds, it is almost entirely carbohydrates and is theoretically gluten-free. However, when the wheat plant starts to mature, the possibility of gluten being present in wheat grass could be a problem. Avoid wheatgrass unless it is labeled gluten-free in accordance with FDA regulations or, for additional assurance, that is GFCO third-party certified as gluten-free. 

Here are some things to ask when eating out: 

  1. May I see a gluten-free menu or allergen list?  
  2. Is there a dedicated fryer for gluten-free foods? 
  3. Are these sauces certified gluten-free? If made in-house, do they know if they contain gluten? Worcestershire-type sauces and soy sauce could contain gluten. 
  4. Does this contain flour or roux? Roux is flour and fat cooked together to thicken soups. The flour used is often wheat flour. 
  5. Are your marinades and seasonings gluten-free? What is in your marinades and what seasonings are used in this dish? 
  6. Is the grill used to cook gluten-free foods separate or shared with gluten foods? If shared, how is it cleaned and how often? 
  7. Can my meal be cooked in a separate pan from gluten foods? 
  8. Can I have my egg soft-boiled? Soft-boiled eggs remain in their shell which limits the chance of cross-contact in a pan. 

More tips on eating out: Restaurant Dining: 7 Tips for Staying Gluten-Free.

In this case, parts per million means 20 weight units of gluten per million weight units of all components of the food or the product. 

Here are some comparisons to illustrate 20 ppm: 

  • 1 second in approximately 14 hours 
  • 1 penny in $500 
  • 1 teaspoon in approximately 65 gallons of water  

Recovery from exposure to gluten – being “glutened” – varies from person to person and also depends on how much gluten was ingested. Treat symptoms (e.g., diarrhea, headache, etc.) as you would if they were caused by anything else. Avoid dairy products as damaged intestinal villi (in the case of celiac disease) may have temporarily lost the ability to produce lactase needed for digesting the primary carbohydrate in dairy (lactose). While activated charcoal is effective at binding and removing some poisons from the system, there is no data to support that it binds gluten. Similarly, there is no data showing that glutenasetype products marketed as being able to “break down” gluten are effective(See above: Is there a supplement I can take so I can still eat foods that contain gluten?) 

Here are some tips for finding places to eat gluten-free and things to keep in mind: 

  1. Look for GFFS-validated restaurants. These locations have been reviewed by GIG’s Gluten-Free Food Services program (GFFS) and are properly equipped to provide safe, gluten-free menu options.   
  2. Search the GFFS database at gffs.org to identify food establishments already validated. This database currently includes several large chains and some smaller places. 
  3. Do an internet or map search for restaurants with gluten-free options. Be aware that even places that claim to offer gluten-free items may not be safe: ingredients used might be gluten-free, but there may not be precautions in place to prevent cross-contactetc. Call in advance and ask questions. 
  4. Find out if there is a GIG support group in or near your destination. If so, reach out in advance to get more localized information regarding gluten-free restaurants and other resources.   
  5. Keep a supply of non-perishable GF snacks handy to always be prepared, just in case you need backup food to eat.   
  6. Visit a local grocery store when you arrive to pick up more GF items rather than traveling with a large supply.  
  7. Do not rely on “glutenase”-type products that claim to break down gluten as data does not show them to be effective in addressing possible exposure due to gluten.  (See above: Is there a supplement I can take so I can still eat foods that contain gluten?) 

Vitamin E is gluten-free. Confusion can arise because vitamin E is sometimes derived from wheat germ oil. The wheat germ oil used to make vitamin # is highly processed and is free of gluten protein.  

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 amountsreducing – but not eliminating – the risk of potential exposure to glutenTo be safest, choose spices that are labeled gluten-free in accordance with FDA regulations or, for additional assurance, that are GFCO third-party certified as gluten-free. 

Personal care products are not part of the FDA gluten-free labeling regulation. Most individuals on a gluten-free diet don’t need to be concerned about gluten in products applied to the skin (e.g., lotion, shampoo). From a scientific standpoint, the gluten protein is too large to be absorbed through the skin. Anecdotally, some people report skin sensitivities that they attribute to gluten in products, although the reactions could also be attributed to other ingredients. If you prefer to use products that are gluten-free, look for GFCOcertified versions by searching the GFCO Product Finder. Read: 5 Facts About Gluten-Free Skin Care. 

Yes, the manufacturer must ensure that any potential cross-contact results in a product with less than 20 ppm of gluten. For GFCO certified products, the threshold is stricter and should contain no more than 10 ppm of gluten. 

Meats and eggs are naturally gluten-free and are safe to consume in their natural form, regardless of whether the source animal consumed gluten-containing grain. Gluten should not be present in properly handled meats. Processed meats such as deli meats could contain gluten, but it is not typical for gluten to be added. Meats marinated or injected with seasonings prior to packaging increases the risk of gluten being present. Check ingredients or buy products labeled gluten-free in accordance with FDA regulations or, for additional assurance, that are GFCO third-party certified as gluten-free. 

Due to a higher level of risk of cross-contact than with other legumes or beans, lentils should be either labeled gluten-free in accordance with FDA regulations or, for additional assurance, GFCO third-party certified as gluten-free. Organic status is unrelated to gluten-free status, so this recommendation also applies to organic lentils. 

Some yeast extracts may be grown in barley. Choose yeast extract that is labeled gluten-free in accordance with FDA regulations or, for additional assurance, that is GFCO third-party certified as gluten-free. If yeast or yeast-containing products are not labeled or certified gluten-free, they should be avoided. 

Yes, nutritional yeast is gluten-free, as is baking yeast. The only type of yeast to be concerned about is brewer’s yeast as it could be derived from beer which is usually made from wheat or barley and would not be gluten-free. 

Most vinegars are gluten-free. Most varieties are distilled and made from inherently gluten-free ingredients such as grapes. The only vinegar that needs to be avoided is malt vinegar. Malt vinegar is not distilled, and malt is derived from barley, a grain that is not gluten-free. The term “vinegar” in the ingredients list of a product that is certified by the GFCO or labeled gluten-free, in accordance with FDA regulations, means it is safe to consume for people with celiac disease. On products that are not certified or labeled gluten-free, the general term “vinegar” could refer to malt vinegar. In that case, the product should be avoided unless the manufacturer can confirm it is not malt vinegar.  

Glucose is a highly processed product, consisting of pure carbohydrates. Even when the source of the glucose is wheat, no protein of any sort – including gluten – remains in the final product.   

Some products that appear to be gluten-free based on ingredient labels have a higher risk of cross-contact with gluten and are best avoided unless certified or labeled gluten-free. Riskier products include oats, lentils, and milled products made from grains, beans, seeds or legumes (e.g., sorghum flour, garbanzo bean flour, ground flax). Otherwise, products containing ingredients that appear to be gluten-free should be safe to consume. Choose products labeled gluten-free in accordance with FDA regulations or, for additional assurance, that are GFCO third-party certified as gluten-free. 

May contain” or “shared equipment” statements are voluntarily included on some products to alert wheat allergic consumers of the presence of wheat in a manufacturing facility, because people with wheat allergies can have a reaction to wheat fractions other than gluten, and current testing cannot identify all non-gluten proteins in wheat. If you see this type of statement on a product that is certified gluten-free, the gluten-free certification means that it is gluten-free regardless of any “may contain” type statements and contains 10 ppm gluten or less. When present on a product labeled gluten-free in compliance with FDA regulations, the product should comply with the FDA standard of less than 20 ppm gluten and should also be safe to consume. On a product that is neither certified or labeled gluten-free, but appears to be gluten-free based on the ingredients list, this type of statement could indicate some risk, and it is safer to avoid the product.

When a family member has been diagnosed with celiac disease, first degree relatives of those who have been diagnosed (children, parents, siblings) have a significantly higher chance of developing the condition, with prevalence ranging from 4% to 16%. In second degree relatives (uncles, aunts, nephews, nieces, grandparents, grandchildren, half siblings), the prevalence is about 2.5%. 

Since these relatives have a higher chance of developing celiac disease, some may wish to find out whether they do carry the related genes. If so, then the results signal that celiac disease could potentially develop at some point in their lives. If an individual does not carry the genes, they know that it is virtually impossible for them to develop the condition in the future.  

Genetic testing is applicable to celiac disease since there is a genetic component to the condition. Non-celiac gluten sensitivity (NCGS), on the other hand, is not thought to have a genetic component, although it is a condition that warrants further research. Without having the genes associated with celiac disease, it is virtually impossible to develop the condition.  

Genetic testing can be especially useful to parents who have celiac disease and want to know whether their children have the potential to develop the condition. Positive genetic tests tell them that monitoring should be ongoing (see Celiac Disease Testing in Children). Negative tests would mean that no further screening is necessary. 

There are two main scenarios that could warrant screening for genes associated with celiac disease: 

1) If a person has stopped eating gluten before having the antibody screening tests for celiac disease. It is always advisable that testing for celiac disease be done before giving up gluten, but this does not always happen. Once a person feels better after becoming gluten-free, they are often reluctant to re-introduce gluten, so the diagnostic screening tests for celiac disease may not provide meaningful results. 

2) Undergoing genetic testing for celiac disease can tell these individuals the following: If the test is positive, they know that they could have celiac disease. Since about a third of the general population carries the genes, but only one percent develops celiac disease, having the genes does not mean that celiac disease will necessarily develop. The test is more informative if it is negative: negative results tell a person that it is virtually impossible that they have, or will develop, celiac disease. 

Note: The test doesn’t shed any light on whether or not a person has non-celiac gluten sensitivity (NCGS). The first step to diagnosing NCGS is generally to rule out other possible causes of symptoms, including celiac disease.

Glutinous ricealso known as sticky rice or sweet rice, is gluten-free despite its name. In fact, all varieties of rice are gluten-free. The term “glutinous,” in this case, means “sticky.” The proportion of starches in rice varies by rice typeIn the case of glutinous or sticky rice, the proportion of starches makes the cooked product stickier than standard riceSticky rice is commonly used in various Asian cuisines for both savory and sweet dishes. 

For individuals who need to be gluten-free, oat milk needs to be assessed the same way you assess whole oats. While oats are inherently gluten-free, there is a significant risk of cross-contact with gluten-containing grains during the growing, transporting, storing and/or processing of oatsOats and oat milk should not be consumed unless labeled gluten-free in accordance with FDA regulations or, for additional assurance, that is GFCO third-party certified as gluten-free. To be certified gluten-free, oat milk needs to be made with oats that meet our certification standard. “Oats can be tolerated by most, but not all, people who are intolerant to gluten. Consult with your physician or dietitian before including oats – or oat milk – in a gluten-free diet. Check out our article Are Oats and Oat Flour Gluten-Free? 

As a rule, anything that goes into the mouth should be evaluated for gluten content. Alternatives to plastic, like glass or stainless steel, are safely gluten-free. Some straws that are biodegradable, however, may include ingredients such as bamboo, corn starch, wheat straw, or sugar cane.  

Before placing your order for a drink that’s likely to come with a straw, ask the staff what their straws are made from and whether they are gluten-free. Many brands of straws made from wheat straw are gluten-free because straw is the stalk left over after the gluten-containing grain is harvestedSome straws sourced from wheat straw have tested at levels below the FDA’s 20 ppm cut-off. Even though the potential for cross-contact exists, it is unlikely, yet it makes sense to be cautious and ask questions. If in doubt, reject the straw and drink straight from the glass. 

Numerous research studies have found that the hepatitis B vaccine is less likely to be effective in individuals with celiac disease. * Some research shows that people with well-controlled celiac disease and compliant with a gluten-free diet do not have this issue 

No standard recommendation exists to address this situation. Each individual case can vary depending on when the vaccine was received relative to initiating a gluten-free diet and achieving good celiac disease control. The best course of action is to discuss the situation with a personal physician and healthcare team to determine whether re-vaccination is needed. 

*Note that this interference with the effectiveness of a vaccine due to celiac disease does not apply to other vaccines; only to the hepatitis B vaccine. 

References 

Anania C, Olivero F, Spagnolo A, Chiesa C, Pacifico L. Immune response to vaccines in children with celiac disease. World J Gastroenterol. 2017 May 14; 23(18): 3205–321. Published online 2017 May 14. doi: 10.3748/wjg.v23.i18.3205 www.ncbi.nlm.nih.gov/pmc/articles/PMC5434426/. Accessed July 25, 2018.
Ertekin V, Tosun MS, Selimoglu MA. Is There Need for a New Hepatitis B Vaccine Schedule for Children with Celiac Disease? Hepat Mon.2011 Aug 1; 11(8): 634–637. www.ncbi.nlm.nih.gov/pmc/articles/PMC3227494/. Accessed July 25, 2018.
Ertem D, et al.The response to hepatitis B vaccine: does it differ in celiac disease? Eur J Gastroenterol Hepatol. 2010 Jul;22(7):787-93. 2010 Jul;22(7):787-93. DOI:10.1097/MEG.0b013e32832e9d41. Accessed July 25, 2018.
Leonardi S, Spina M, Spicuzza L, Rotolo N, La Rosa M. Hepatitis B vaccination failure in celiac disease: Is there a need to reassess current immunization strategies? Vaccine.[12 Aug 2009, 27(43):6030-6033]DOI: 10.1016/j.vaccine.2009.07.099 . Accessed July 25, 2018.
Park SD, et al. Failure to respond to hepatitis B vaccine in children with celiac disease. J Pediatr Gstroenterol Nutr.2007 Apr;44(4):431-5.
www.ncbi.nlm.nih.gov/pubmed/17414139. Accessed July 25, 2018.
Rostami, Kamran; Nejad, Rostami M. Vaccinations in Celiac Disease. Journal of Pediatric Gastroenterology and Nutrition: April 2013 – Volume 56 – Issue 4 – p 341–342 doi: 10.1097/MPG.0b013e31827af217. journals.lww.com/jpgn/Fulltext/2013/04000/Vaccinations_in_Celiac_Disease.1.aspx. Accessed July 25, 2018.
Vitaliti G, et al. Hepatitis B vaccine in celiac disease: Yesterday, today and tomorrow. World J Gastroenterol.2013 Feb 14; 19(6): 838–845. Published online 2013 Feb 14. doi: 10.3748/wjg.v19.i6.838. Accessed July 25, 2018. 

During the first year after diagnosis, more frequent follow-ups are generally recommended. After that, speak with your healthcare team about annual followupsEach person’s physical and emotional health is unique, so the frequency of follow-ups should be discussed and determined with a personal physician and healthcare team 

The screening blood tests done as part of the celiac diagnosis are a primary component of follow-up visit since high antibody levels can indicate gluten exposure and incomplete healing. Seeking help from a dietitian knowledgeable about the gluten-free diet may also be advisable, especially if lab results indicate gluten exposure, and/or if there are particular nutritional deficiencies or concerns. 

References 

    • Academy of Nutrition and Dietetics, Evidence Analysis Library. Medical Nutrition Therapy Effectiveness (MNT) Systematic Review (2013-2015). Accessed July 16, 2018. 
    • Canadian Celiac Association. A Resource for Health Care Professionals: Follow-up Management of Patients with Celiac Disease. Prepared by the Professional Advisory Council, Canadian Celiac Association, March 16, 2016. www.celiac.ca/b/?page_id=3835. Accessed July 16, 2018. 
    • Rubio-Tapia A, et al. ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. Am J Gastroenterol 2013; 108:656–676; doi: 10.1038/ajg.2013.79. 
    • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706994/. Accessed July 16, 2018. 
    • Silvester JA, Rashid M. Long-term follow-up of individuals with celiac disease: An evaluation of current practice guidelines. Can J Gastroenterol. 2007 Sep; 21(9): 557–564. Accessed July 16, 2018. 
    • University of Chicago Medicine Celiac Disease Center. Follow-up Testing. https://www.cureceliacdisease.org/wp-content/uploads/341_CDCFactSheets7_PostDiagnosis.pdf. Accessed July 16, 2018. 
    • Welstead L. Guandalini S: Academic Editor. The Gluten-Free Diet in the 3rd Millennium: Rules, Risks and Opportunities. Diseases. 2015 Sep; 3(3): 136–149. Published online 2015 July 13. doi: 10.3390/diseases3030136. Accessed July 16, 2018. 

The first thing to know is that hay rides most likely use straw and not hay. 

“Hay” is dried grass used for animal feed and can come from various plants. The hay is usually harvested when a plant begins to bloom but before it has gone to seed. Since immature seeds can be present, hay from a gluten-containing grain could contain gluten. 

“Straw” is a by-product of cereal grains including wheat and barley. Straw consists of the stems or stalks of the plant after the seeds (where gluten would be found) have been harvestedEven with straw, there is still a chance that some seed, and therefore gluten, could remain. 

Bumping around on a rough “hay” or” straw” ride could cause particles to be propelled into the air. If the straw/hay from a gluten-containing grain did happen to contain some seed with gluten, it is possible that some air-borne gluten might be present. 

Gluten-free individuals and families should take these factors into consideration when evaluating potential exposure to gluten. 

Since either straw or hay can be sourced from wheat, it is understandable why this question comes up. The GIG stance is that a substrate is not a cause for concern.  

What exactly are straw and hay? Straw is an agricultural by-product that consists of the dry stalks of cereal plants. Hay is generally defined as the entire plant that has been dried. Both can come from various types of plants, including wheat. Either may be used as part of the substrate for growing plants. 

The two questions to answer are: 

1) When straw or hay come from wheator another gluten-containing plant, do they contain gluten? and 

2) If they do, does this gluten make it into the final plant that is grown on the substrate containing straw or hay? 

Since straw is the stalk of the plant, and gluten is found in the seed, straw technically does not contain gluten, although the possibility of cross-contact cannot be entirely ruled out. Hay is the whole dried plant, but it is generally harvested and dried before the seed develops, so again, it is unlikely to contain gluten. 

Even if a plant sprouts from a substrate that could potentially contain gluten – from straw or hay – the mature plant itself (i.e., the edible plant) would, for the most part, be physically removed and separated from the substrate/growing surface. The concern would be possible cross-contact due to gluten on surfaces the produce touches 

All produce should be washed before eating. Thorough cleaning can remove any potential residues of gluten that could even potentially result from cross-contact. Two specific types of produce we have received questions about in terms of straw or hay substrate are strawberries and mushrooms. We investigated and found these answers: 

Strawberries
According to the North American Strawberry Growers Association, hay is not used in strawberry production. Straw may be used as a winter cover in northern climates to protect against cold and keep the berries clean. It is very unlikely that there would be any gluten associated with the fruit at harvest time. 

Mushrooms
Hay or straw can be incorporated into a growing medium for mushrooms along with other substances that, together, form a compost. The compost is put into a bed on top of which goes the “mycelium” that functions like a root system that produces the spores responsible for a mushroom’s reproductive process. On top of the mycelium is a layer of peat moss that creates a physical barrier. The root system may come in contact with the hay or straw in the compost, but the mushrooms do not. The “dirt” we see on mushrooms is peat moss, which is pasteurized and is not a gluten-containing substance.