What is Celiac disease? And what’s the difference between “Celiac” and “gluten free”?
Celiac disease is an autoimmune disease for which the only effective treatment is a strict gluten free diet. 1% percent of Americans have Celiac disease, and awareness and diagnosis of the disease are on the rise, so you’re increasingly likely to encounter people with Celiac disease in your social circles.
It has also become common for people without Celiac disease to follow a gluten free diet, for a variety of reasons. Non-Celiac gluten-avoiders generally do not worry about cross-contamination or rogue breadcrumbs here and there. Some will even “cheat” and enjoy a slice of pizza from time to time. However, for those with Celiac, the diet must be completely gluten free: no cheating, no cross-contamination, and no mistakes. It is a lifelong commitment and the strict gluten-free diet is the only effective treatment for Celiac disease!
If someone with Celiac disease accidentally ingests gluten, what are the consequences?
Ingesting even a very small amount of gluten will cause an autoimmune response. This can result in a host of different agonizing symptoms that can last a week or more. It’s not uncommon to be sidelined from work, school, and social events because of being ‘glutened’. However, these unpleasant short term consequences aren’t even the full story: people with Celiac disease who repeatedly ingest gluten risk long term irreversible damage to internal organs, increased the risk of some cancers and other autoimmune disorders, and many other possible complications. This combination of short term unpleasant episodes and serious long term health risks makes people with Celiac disease very cautious about what they eat.
Can I cook for a friend with Celiac disease?
Absolutely! Cooking for people with Celiac isn’t as daunting as you might think but you’ll need to be communicative, thoughtful, collaborative, and very careful. Your friend will appreciate you for it!
Crash course: What is gluten and what foods is it in?
Gluten is a composite protein found in wheat, barley, and rye. It is made up of the proteins gliadin and glutenin and is what makes bread and pizza dough stretchy, chewy, and fluffy.
In nature, gluten is only found in wheat, barley, and rye. What makes life difficult for Celiacs is that gluten is often a hidden ingredient with cryptic or generic names. Gluten is used as an additive and as a stabilizing agent. Most people know intuitively that beers, breads, and doughs contain gluten because we know they are made from wheat or barley. But who would guess that gluten is in most soy sauces, and often found in salad dressings, ice cream, sour cream, ketchup, pre-shredded cheese and even nuts?
The Ground Rules
Because gluten is often hidden in packaged ingredients, it is understandable that friends and family may be overwhelmed by the thought of taking on the task of cooking for someone with Celiac. And someone with Celiac is likely to be very hesitant about eating food prepared by someone who is new at it. There are a few ground rules to be prepared for:
- Communication is key. Keep in touch with your Celiac friend. Have their phone number on hand and don’t hesitate to contact while shopping or cooking. They are the expert and will feel better if you ask questions. Not sure about a label, certain brand, or ingredient list? Take a picture and text/email to it to them.
- Avoid already-open items in your refrigerator or cupboard–these are likely to have been contaminated. For example, if you have a half-empty jar of peanut butter, it has almost certainly been contaminated through double-dipping or contact with bread crumbs or crackers, or other sources of gluten. Open a fresh package, or pick up some sample packs if you only need a small amount.
- Skip the “bulk section.” Most people with Celiac disease avoid ingredients from the bulk section of the grocery store because scoopers often travel between bins and ingredients are likely contaminated with gluten.
- Almost anything that comes in a bag, box, bottle, or can is processed and may have gluten in the ingredients. Check every label very carefully. This includes nuts, seasoning mixes, soup stocks, and everything else. (See the “Guide to reading nutrition labels” below.)
- Beware of your spice collection. Read labels of spices and spice mixes–both are potentially unsafe.
- Oats are a grey area. You’ll need to communicate with your Celiac friend to find out if they eat oats. Even if they do, however, oats must specifically be marked as “Gluten free.” They must be grown and processed in special gluten free facilities because they are so likely to be contaminated with gluten.
- Avoid porous or non-washable cooking surfaces such as the toaster, wooden spoons, wood cutting boards, pizza stones, cast-iron pots, basting brushes, colanders (unless dishwasher safe), or your grill. Because these are porous and cannot survive the dishwasher, unless they have never been used, are likely contaminated with gluten. If you insist on grilling, use clean aluminum foil so the food won’t touch the grill. If you’re worried about a baking sheet, use parchment paper.
- If you’re hosting, keep any packaging from ingredients you have used. Your Celiac friend may want to inspect these when they arrive.
Packaged products: How to read labels
- Don’t be shy! Email pictures of labels to have them OK-ed or vetoed by your Celiac guest, especially if there is any question, whatsoever, about any ingredient. Keep your eyes open for ingredients you aren’t sure about. Check out this list for an introduction.
- Read beyond the list of ingredients. There is usually important information below the list.
- Regardless of ingredients, if a label says: “May contain wheat” or “May contain traces of what” it is not gluten free
- If a label says: “Packaged on the same equipment as items containing wheat,” they are likely not gluten free. Some people with Celiac feel comfortable with these items depending on the company, so ask them.
- If an item has no gluten-containing ingredients but the label says: “Packaged in the same facility as items containing wheat” they are safe.
- Some packaged items say: “Gluten Free” on them. These are most likely safe, but you still must check the labels because, although there are new laws around gluten free labelling, they are still young and may not be completely trustworthy or enforced. But, in general, if made in the U.S., a gluten free label is likely a safe bet.
- Look for allergen warnings or “Allergy information:” They are usually found under an ingredient list. Here is an example of an allergy warning: CONTAINS MILK AND SOY. MAY CONTAIN WHEAT
- How to interpret Allergy information on nutrition labels:
- If wheat is listed, even under the “may contain …” section, the item is not gluten free and should not be used.
- If an item has allergy information listed and wheat is not listed, it is likely gluten free but still check the full ingredient list.
- If an item does not have allergy information, inspect the ingredient list even more carefully and if you aren’t absolutely sure about all listed ingredients, do a quick Google search: “[brand name item name] gluten free” to look into it. Or have your Celiac guest do this investigation for you.
- How to interpret Allergy information on nutrition labels:
Cooking & Serving
- Be diligent about cooking with clean utensils and cooking surfaces.
- Corral all of your gluten free and safe ingredients in one area to keep yourself from accidentally grabbing something from your cupboard or refrigerator that isn’t safe (including spices, vinegars etc … ).
- If you will be storing the food before serving, use clean dishes or storage containers and store GF items on a higher shelf than the other non-GF items in your refrigerator. Label GF and non-GF items clearly.
- If possible, try not to serve both gluten free and non-gluten free options. This complicated how you serve the food as you’ll need to be extremely careful not to transfer serving utensils between them, and you will have to warn all guests to do the same (which can get socially awkward). If you must serve both options, serve the person with Celiac first to minimize the chances of exposing them to cross-contamination.
It’s worth the effort!
This may seem like a lot to take in at first glance, but once you get the hang of it, you’ll realize that it isn’t so difficult. And, your friend with Celiac will truly appreciate your effort, your diligence, and the great care that you’ll take in keeping them healthy, well fed, and having fun together!