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      Frequently Asked Questions About Celiac Disease   09/30/2015

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to FREE Celiac.com email alerts What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease? - list blood tests, endo with biopsy, genetic test and enterolab (not diagnostic) Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet Free recipes: Gluten-Free Recipes Where can I buy gluten-free stuff? Support this site by shopping at The Celiac.com Store.

Need Advice For How To Cater To Celiacs
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Hello, iv been a proffesional chef for around 5 years and have worked at some of the best hotels in England. Iv had to deal with alot of different alergies in the past celiac disease being probaly the most common, I recently started working In a old people's home and have 1 woman who is a celiac. I'm not sure if there's different levels of celiacs like with but allergies but the woman's daughter has kicked up a fuss to make us change many things for her mother. Her mother (the celiac I cook for) has been a resident here for 3 years and there was never a problem but because she has started to lose weight (due to Alzheimer's) the daughter is trying to associate that to the food. Getting to the point I just wanted to ask for tips on how to care for her mother the best way because being in a kitchen catering for 80 other residents its hard to use seperate cooking utensils and have a preparation area just for her, all of my spoons are metal as our my pans so I wondered are they a risk of cross-contamination? And if anyone has any other tips for me all help is very much appreciated.

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You know how I cater to the one celiac (me) in every dinner I host (up to 20 people, including toddlers)? I make the food naturally gluten free. After 10 years of doing this, I've had no complaints and rarely repeat what I'm serving. It's just easier, because there are a lot of healthy, easy to prepare foods that are gluten free.

But I realize that you aren't going to make the whole facility gluten free! Though having naturally gluten free meals a few times a week would make many things easier, you still are going to have times where you don't want to do that. So, yes, you need to deal with cross contamination.

You say "there have been no problems" and yet she's losing weight. You cannt know that the weight loss is from Alzheimer's, as it could be caused by her getting contaminated as well. Further, in the kitchen, you aren't likely to be privy to all the details of her physical complaints. She may well be having abdominal pain, bloating, or other symptoms (including a shift in her Alzheimer's symptoms faster than expected, which a non-Alzheimer's patient would describe as brain fog). Perhaps, in her state, she hasn't mentioned much - forgetting to or not waning to be a trouble. Perhaps she has mentioned it and it was ignored as insignificant or just old age. Perhaps she hasn't mentioned it and her daughter has had to figure it out. No matter, I encourage you to give her the grace to be as healthy as she can. This isn't being done to make your life harder, though it may well feel that way in the heat and stress of the pre-dinner rush. You would certainly do the same for any of your loved ones who were sick and couldn't advocate or care for themselves.

A "separate" preparation area is a must! I think the easiest way to think about it is a comparison to raw meats. You wouldn't share a cutting board for raw meats with fruits/veggies not being cooked. Not without thorough washing first. You wouldn't prepare food on the same counter that had chicken juice splattered on it without washing first. You wouldn't pass raw chicken over a salad about to be served.

Likewise, you need separate cutting boards for non-gluten and gluten foods. You need to make sure that counters that have had gluten containing ingredients on them are well cleaned before preparing gluten free foods. And you need to avoid passing gluten foods (particularly things like bread or breaded items) over gluten free foods.

Just like you wouldn't use the same spoon to stir a dish full of raw meat and then a cold soup, you need to use separate spoons for gluten containing and gluten free foods. In a busy kitchen, doing what many do here and having different colored tape or labels to note which is which may help, and it may be procedurally easier to keep them permanently separate, though a thorough washing on metal utensils should be sufficient. Same with pots and pans - you can mark dedicated ones, but a thorough cleaning is usually good for stainless cookware.

Some things, like collanders for pasta, scratched non-stick surfaces, toasters, and porous material like wood, simply can't be thoroughly cleaned and it really is vital to have separate, dedicated equipment in this case.

I'm sure others here will have more help. You might PM a user by the name of kenlove directly, as he's worked with a number of restaurants on the issue of serving gluten free food.

Good luck, and come back and let us know how it goes!!

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I wonder if the woman with celiac is getting regular bloodwork and what it says.

How have you been prepping food for her (and for the other residents) until now? How did your predecessor do it?

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You do realize that even the slightest bit of cross-contamination can cause damage? There are some of us who don't even get digestive symptoms, but if we eat something that was stirred with the wrong spoon, or something that was made in the same room where someone just made a cake (where the flour dust will remain in the air for hours), we will have damage to our small intestines. That damage makes is hard or even impossible to absorb nutrients from the food we eat. This will of course lead to weight loss, so the daughter's suspicion that her Mom is getting cross-contaminated is not unreasonable.

The bad thing is, weight loss is only one of the consequences of cross-contamination. There are a host of very nasty diseases that can come from continual low level exposure. Cancers, lupus, thyroid problems, and even dementia itself.

Cross-contamination is extremely serious and the extra precautions taken to avoid it are well worth it. If you learn how to do it in this setting you will be ahead of the game because I am sure you will have other celiac patients in the future.

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There is research to suggest that dementia and other related mental decline diseases are strongly linked to celiac. As already stated, the least bit of contamination could not only be causing her symptoms due simply to celiac, but could be making the condition she is there for worse. Either way, that would make her food responsible for what is happening to her. A lot of good points were brought up in how to make food safely for her. You wouldn't be blowing this off so simply if it were a life threatening allergy, and although it won't kill us immediately, gluten contamination can be equally deadly to us. It is very important that her food be prepared safely for her.

This will be good for you as well. As a chef you are already well familiar with cross contamination, now you just have to adjust to the idea that with gluten things can become permanently contaminated rather than having the option of a little hot water being able to clean up after everything. The idea mentioned of naturally gluten free meals is a good one also. This will almost certainly not work all of the time, but a few times a week no one will notice.

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    • Hello,  I am in a job that I travel every 3rd week...It gets challenging becuase many times I am doing audits of warehouses and they dont even have a cafeteria.  I usually bring gluten-free protein bars as a back up if I have to miss a meal and then eat when I get back to the hotel.  Just a suggestion because they certainly fill me up....Have a safe trip...Kelly  
    • Hello all, I'm a new member here but have lurked for a while. I'm looking for some advice regarding my medical history, possible symptoms of celiac and next steps. General info: female, low level smoker, drink alcohol, aged 32. I started having bad gastro issues when I was around 17. Since then I've consistently suffered from chronic diarrhoea, frequent discomfort in the tummy area, feelings of dehydration despite drinking at least eight glasses a day and frequent fatigue for no real reason.  In 2008/9 I visited the doctor as my diarrhoea was having an effect on my studies at the time. The doctor tested me for allergies; eggs, fish, gluten and lactose and did a "standard" blood test. Everything came back fine except my liver results, which were elevated to double (I did not the see the results for myself so can't say which enzymes etc). I was told to drink less and take Imodium. The doctor implied that perhaps I was stressed and / or anxious and, still being young plus a student who regularly went out drinking, I accepted this advice and carried on with my life.  I would here add that I am not an unusually stressed person - in fact, learning to deal with my unpredictable bowels has forced me to be quite a laid-back person!  Fast forward to 2016. I had been living with my partner for two years by this point who had noticed my bowel habits and informed me that this was definitely not normal. He encouraged me to try out a gluten free diet since I was apprehensive about visiting a doctor only to be fobbed off with Imodium again. I did the diet as strictly as a newbie can for around two months before we set off travelling. During the diet I noticed that after a couple of weeks of extreme tiredness I felt quite a lot better - I kept a food journal at the time which showed that I almost immediately had diarrhoea once after eating an ice-cream, i felt bloated and unwell after an attempt to make oat muffins (maybe i didn't cook them very well though!) and I felt bloated and had diarrhoea after eating some fish fried in flour (We made a mistake in ordering them but I didn't want to complain). My partner also reported that my mood swings (which I admit can be a little unpredictable) were much better.  Once we started travelling I gave up and ate what I was given as we were staying with friends etc much of the time. Toward the end of our trip I started to feel extremely tired, to the point of having to stay in for "rest" days, and my guts were very unhappy. I chalked it up to irregular eating patterns, too many beers and late nights in general. During the trip I also had an extreme hangover after drinking wheat beer. And, while of course I accept that any overindulgence can make you ill, I really felt that that level of hangover was quite out of the ordinary. Finally, I developed a strange lump under my armpit during this period. Now back at home, I decided to go to the doc and check out the odd lump under my armpit. The doctor was pretty confident that it was nothing to worry about cancer-wise but she ordered a battery of blood tests just to be sure. The lump is fine (good news) but the results showed elevated GGT, high-ish ALT and normal AST liver enzymes plus signs of dehydration in red bloods / higher (but not concerning) levels of white bloods. I'm scheduled to go back for another blood test to double-check liver function and discuss results - if it is again high she will send me for a ultrasound.  Does this history chime with anyone here? I know that the correct course in basic health terms is to stop drinking for some time (easily done) and stop smoking forever (easy to say...) but I cannot help but think that something else is going on here. I will discuss this with my doctor and make clear that my bowel issues have not been resolved and that the initial IBS diagnosis wasn't based on any thorough testing so to speak. In the meantime - does anyone have any advice for me in times of avenues to research or experience of similar symptoms? Gluten remains in my diet but in all other respects it could be regarded as very healthy, I think anyway... (pescatarian, plenty of fruit and veg, little to no sugar on a daily basis, not much dairy to speak of...) Thanks in advance and sorry for bending everyone's' ear about this... I guess it's just taken a long time for me to admit I might be sick and I need some help. Jen
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