Cross Contamination: Drawing the Line

[Ginger Beard Man]

I was recently diagnosed with Celiac at age 23 and trying to get as educated as possible. I am the first of my family to be diagnosed, came from a family that is not a fan of doctors, most likely not the only one. Because of that, I don't really have anyone to ask judgment questions about. Following a gluten-free diet hasn't been difficult as my fiancee loves to cook and we mainly stick to a Keto diet for the past couple months before I was diagnosed anyway. The major issue I've found is eating out. I give the proper awareness to the server about being gluten-free but it seems like come items still cause systems. Not sure if this is because my sensitivities haven't completely gone away or not. Also I didn't have an issue in the past with gluten, it was that it was causing sensitivities to other foods. I could eat bread and drink beer and not have symptoms.

I was recently at a pizza place where you can see the kitchen through the window. They offered a gluten-free crust and I saw how the kitchen staff handled the food, no gloves, flower flying everywhere, and did not wash their hands before touching the gluten-free crust. Needless to say I didn't order the gluten-free crust. But after hearing how other places have a separate fryer for gluten-free items, like fries, it got me thinking where do others with Celiac draw the line with cross contamination? I've been to wing places and was told their bone in wings are gluten-free but the boneless are not, nothing was said about a separate fryer or anything.

When eating out, how far or detailed do you have to be to make sure cross contamination does not occur in the kitchen, or is it not worth the risk and get something you know will not come in contact with anything that could introduce cross contamination?

[Audra K]

I would love to hear others responses to this! Our 5 year old was diagnosed a little over a year ago. The only restaurant we go to is a dedicated gluten free restaurant. 

[cyclinglady]

I rarely eat out.  Seriously.  It is not worth the risk.  There are exceptions though.  We like to travel.  So what to do?  

We like using apps like “Find me Gluten Free”.  However, we read the reviews.  We find the restaurants critiqued by celiacs (those who did not report getting sick).  We prefer 100% dedicated restaurants.  We actually planned our last vacation around clusters of 100% gluten free restaurants and breweries (Washington and Oregon).   At nicer restaurants, I talk to the chef or manager.  Nothing against wait staff (I have been one), but if you want action, go to the top.  In a busy bar, I ask that my wine or drink be served in a to-go cup.  Why?  Busy bars will still use the dunk and rinse method.  Great for bacteria, but it does not always remove gluten.   

We normally try to eat before going out and bring snacks.  I listen to my gut.  Eating out is not worth getting sick.  Like you, I had no GI issues when diagnosed (anemia and osteoporosis).  But as the years have passed, gluten does affect my GI tract now. 

Thank goodness you have a great girlfriend!  Plan some picnics.   Invest in a good cooler.  That is what people did in the old days. Stopped at the picnic areas or tailgated.  Go camping.  Travel in an RV.    

With some planning, you do not have to miss out on anything!  

 

 

Edited October 30, 2018 by cyclinglady

[Ginger Beard Man]

  On 10/30/2018 at 2:41 PM, cyclinglady said:

I rarely eat out.  Seriously.  It is not worth the risk.  There are exceptions though.  We like to travel.  So what to do?  

We like using apps like “Find me Gluten Free”.  However, we read the reviews.  We find the restaurants critiqued by celiacs (those who did not report getting sick).  We prefer 100% dedicated restaurants.  At nicer restaurants, I talk to the chef or manager.  Nothing against wait staff (I have been one), but if you want action, go to the top.  In a busy bar, I ask that my wine or drink be served in a to-go cup.  Why?  Busy bars will still use the dunk and rinse method.  Great for bacteria, but it does not always remove gluten.   

I normally try to eat before going out and bring snacks.  I listen to my gut.  Eating out is not worth getting sick.  Like you, I had no GI issues when diagnosed (anemia and osteoporosis).  But as the years have passed, gluten does affect my GI tract now. 

Thank goodness you have a great girlfriend!  Plan some picnics.   Invest in a good cooler.  That is what people did in the old days.  Restaurants were not as plentiful or they were beyond our budget.  

 

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I honestly never would have thought about the glassware at bars. I have noticed a difference between places that are good about being gluten-free or having gluten-free options, as opposed to asking if an item is gluten-free or not. Have you been able to find a reliable app where you can scan the product bar code and will tell you if it is safe or not? I haven't found a good one with a wide database.

Her family is Italian so I mainly have to bring my own food to parties now. Since you also didn't have GI issues like I did, do you ever drink various types of whiskeys? I've read articles that say it is safe, and others that say it is not, or it is safe but some way avoid it and is up to the person's sensitivity since gluten is removed in the distillation process?

[cristiana]

Hi!

It has taken a looong time for my ttg blood results to come down. As the cut off point is 100 here in the UK I have no idea how high it was at diagnosis, but I was quite ill, so possibly it was stratospheric five years ago.  However,  last year I was getting a lot of pain again (felt like gastritis) and it was discovered that my ttg was in the 80s still.  ? 

I share a kitchen with my family who are gluten eaters so perhaps there was a bit of CC but I don't think it was that.  For a few weeks I had been taking Floradix instead of Floravital as an iron supplement by mistake, but was also eating out at restaurants which offered so called "Gluten Free Options".  

So with this pain, I was sent to see a nutritionalist and she advised me to stop eating out, as well to try to be more careful at home.  Obviously by then I wasn't taking Floradix anymore, either!

When I was tested again, six months later, my TTG had more than halved.  

So I would say, at least initally, try to only eat in gluten-free restaurants or take your own food.  

As my consultant said to me, at your average restaurant, if the chef is in a hurry, he might forget to change spoons to stir the gravy.  If there is student doing the washing up, don't expect it to be any better than the way your own children wash up at home! 

Mind you, I shouldn't be too down on my kids.  On one occasion I was given a gluten free salmon and scrambled egg dish, with glutenous bread on top.  Thankfully my daughter thought to ask the waitress if it was gluten free bread.  It wasn't!

[cyclinglady]

To be honest, I do not drink much anymore because I have more than just celiac disease (AI Gastritis).    Distilled alcohol is gluten free.   So, go ahead and try the whiskey.  Keep in mind that you might react because some celiacs are sensitive and can not even tolerate 20 ppm.   I would caution you to experiment once you have healed or whatever symptoms you have are resolved.  So, consider trying rum or vodka (potato sourced) before whiskey.  Remember damaged guts have issues digesting anything.  Flavorings added to distilled alcohol can be an issue.  Gluten-removed fermented drinks (beer) is an issue.  Stick with certified gluten-free beers (wait a while to forget good beer).  Better to be safe than sorry.  These gluten-removed beers are controversial in the celiac community.    I am conservative (like good health) so I avoid them (same with oats, only grown in dedicated fields and not mechanically sorted).  

I use no apps.  My hubby has been gluten-free for almost 20 years (me five).   I  use my brain to scan labels.  Consider a subscription to the Gluten Free Watchdog.  Trisha has celiac disease and is a dietitian and well respected in the celiac community.  She is like the Consumer Reports (small version) of gluten free products and advocates with the government.  

Bottom line is that every celiac is different. We all have different ranges of sensitivity.  The 20 ppm cut off was designed to cover most celiacs.  But honestly, not much long term research has been done (who wants to fund it...not the NHI).  

Best to play it conservative, heal and then experiment.  

Edited October 30, 2018 by cyclinglady
Whiskey comment updated.

[apprehensiveengineer]

  On 10/30/2018 at 2:52 PM, Ginger Beard Man said:

I honestly never would have thought about the glassware at bars. I have noticed a difference between places that are good about being gluten-free or having gluten-free options, as opposed to asking if an item is gluten-free or not. Have you been able to find a reliable app where you can scan the product bar code and will tell you if it is safe or not? I haven't found a good one with a wide database.

Her family is Italian so I mainly have to bring my own food to parties now. Since you also didn't have GI issues like I did, do you ever drink various types of whiskeys? I've read articles that say it is safe, and others that say it is not, or it is safe but some way avoid it and is up to the person's sensitivity since gluten is removed in the distillation process?

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I've had mega issues with glassware at bars as well. Part of it is that the glasses are sanitized (kills bacteria, viruses) but not cleaned (removes particulate matter, such as gluten residue). Another part of it is that bars with taps are very messy, and servers don't have time to wash their hands much. Beer is everywhere. Taps for non-gluten drinks can easily be contaminated, as can garnishes (limes, rim salt). 

Unless I am at a nicer place when it is slow, I opt to get a canned or bottled drink. Most places will have can/bottle of gluten-free beer or cider available. I always ask that they deliver it to me in the original container, unopened. If I am at a fancier place, I will explain my issue and ask for a wine glass that went through a real dishwasher.

As for distilled drinks, they are in fine in theory. Proteins are too heavy to make it into the final distilled product. However, many spirit-makers add ingredients post-distillation (flavourings, mash) that may not be gluten-free. Additionally, some manufacturers may not keep their distilled product away from potential contamination (shared equipment with gluten-containing alcohols, proximity to source grain/mash. Because alcohol does not have to have an ingredients list or allergen info, it is best to not assume anything and consult the manufacturer. Most have info on their websites. 

I know this is a lot right now... my tip is to keep a short list (perhaps on your phone) of commonly available brands of cider, spirits that are for sure safe as per the manufacturer. That way, you don't have to worry about getting caught out as much. Don't rely on apps/scanners as their info may not be updated or may not be vetted rigorously.

[RMJ]

It took me several years to get my DGP IgA level down to normal.  I only eat out at restaurants that are completely gluten free, or have procedures certified by the Gluten Intolerance Group.  I don’t even do that very often.  If necessary to be social I will go to a restaurant with coworkers and not eat.

[cristiana]

  On 11/1/2018 at 9:30 PM, RMJ said:

It took me several years to get my DGP IgA level down to normal.  I only eat out at restaurants that are completely gluten free, or have procedures certified by the Gluten Intolerance Group.  I don’t even do that very often.  If necessary to be social I will go to a restaurant with coworkers and not eat.

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Hi RMJ

So interesting to know this... I thought I was the only one taking a long time to get down to normal levels.   I don't know what my DGP IgA levels were though.

 

[cyclinglady]

  On 11/1/2018 at 8:41 PM, apprehensiveengineer said:

I've had mega issues with glassware at bars as well. Part of it is that the glasses are sanitized (kills bacteria, viruses) but not cleaned (removes particulate matter, such as gluten residue). Another part of it is that bars with taps are very messy, and servers don't have time to wash their hands much. Beer is everywhere. Taps for non-gluten drinks can easily be contaminated, as can garnishes (limes, rim salt). 

Unless I am at a nicer place when it is slow, I opt to get a canned or bottled drink. Most places will have can/bottle of gluten-free beer or cider available. I always ask that they deliver it to me in the original container, unopened. If I am at a fancier place, I will explain my issue and ask for a wine glass that went through a real dishwasher.

As for distilled drinks, they are in fine in theory. Proteins are too heavy to make it into the final distilled product. However, many spirit-makers add ingredients post-distillation (flavourings, mash) that may not be gluten-free. Additionally, some manufacturers may not keep their distilled product away from potential contamination (shared equipment with gluten-containing alcohols, proximity to source grain/mash. Because alcohol does not have to have an ingredients list or allergen info, it is best to not assume anything and consult the manufacturer. Most have info on their websites. 

I know this is a lot right now... my tip is to keep a short list (perhaps on your phone) of commonly available brands of cider, spirits that are for sure safe as per the manufacturer. That way, you don't have to worry about getting caught out as much. Don't rely on apps/scanners as their info may not be updated or may not be vetted rigorously.

Expand Quote  

Well written and so true!  

[Nikki2777]

I eat out all the time, but I'm lucky to live in a town where gluten-free awareness is very high.  While I prefer dedicated gluten-free restaurants, it's not always possible.  

There are only a few non-dedicated restaurants where I feel safe having the pizza.  One is known for its extensive gluten free offerings and procedures.

I always ask about a dedicated fryer for the fries or dedicated pot/pan for pasta or omelette.  If I can get a soft-boiled egg at a diner, that's breakfast.  I always emphasize that I have to be careful about cross-contamination.

Except for a few Asian places where, again, they're known for their gluten-free menu, I just eat rice at Asian restaurants, and maybe edamame if I'm feeling bold.  Some have gluten-free soy sauce and will bring it out.

Many of the local non-fast-food burger chains (5 Napkin, Bareburger) are known to have good practices and options.  I also ask if the meat at a steak or chicken place has been marinated in soy sauce.

I rarely go to true bars, but if I do, I just drink wine.  The barware issue never occurred to me.  Not sure if I will change my practices.

Good luck.

 

 

 

[apprehensiveengineer]

@Nikki2777

I wouldn't necessarily worry about it too much. For me, the issue was isolated to college-y type bars where everything is drenched with spilled beer. I make a bit of a snap judgement about a place by looking at the bar to see what's going on. If stuff looks clean, glasses are stored in a way that makes it unlikely for them to get contaminated, etc. then it may be fine.

I do the same with coffee places. Some places (ahem, Tim Hortons) store their cups, and other coffee-making stuff below their bread or on the same counter (often touching...). Some places use visibly breadcrumb-y cloths to wipe down spouts, carafes etc. Some even have their bakeries in the customer seating area... (wtf please stop this trend!). Never had an issue with Starbucks black coffee, however.