Search the Community

Celiac.com 10/14/2019 - One of the big debates among people with celiac disease concerns how vigilant celiacs need to be to make sure they avoid gluten. What does science say about gluten contamination in three common scenarios? How careful do you need to be about gluten contamination? For example, how likely are you to get gluten over 20ppm if you share a toaster, pasta water, or slice a cupcake with the same knife used to cut a non-gluten-free cupcake? A team of researchers recently set out to assess three common scenarios where people with celiac disease might reasonably fear gluten contamination. How did the actual risk for each situation measure up? Scenario 1: Water used to cook regular pasta is reused to cook gluten-free penne and fusilli. The gluten-free pasta is then rinsed and served. Scenario 2: Toasting Gluten-Free Bread in an Uncleaned Shared Toaster Gluten-containing bread is toasted in a toaster. Immediately afterward, gluten-free bread is toasted in the same toaster. Scenario 3: Slicing a Gluten-Free and Regular Cupcake with Same Knife The research team included Vanessa M. Weisbrod, BA; Jocelyn A. Silvester, MD PhD; Catherine Raber, MA; Joyana McMahon, MS; Shayna S. Coburn, PhD; and Benny Kerzner, MD. They are variously affiliated with the Celiac Disease Program, Children’s National Health System, Washington, DC, USA; and the Harvard Celiac Disease Program, Boston Children’s Hospital, Boston, MA. Their paper titled, Preparation of Gluten-Free Foods Alongside Gluten-Containing Food May Not Always Be as Risky for Celiac Patients as Diet Guides Suggest, appears in Gasterojournal.org. Control samples of gluten-free pasta, bread, and cupcakes all tested below the limit of detection. Samples were individually packaged in plastic bags with randomized sample numbers. To avoid “hot spots” and ensure even analysis, all items were homogenized for analysis. Gluten content was measured with R5 sandwich ELISA (R7001, R-Biopharm, Darmstadt, Germany) which has a limit of detection of 5 ppm gluten by Bia Diagnostics (Colchester, Vermont). All control samples were similarly tested. The team then quantified gluten samples as under 5ppm, 5-10ppm, 10-20ppm, or over 20ppm, and based their confidence intervals upon binomial distribution. Boiling Gluten-Free Pasta in Regular Pasta Water In the first scenario, the team boiled sixteen-ounce packages of gluten-containing Barilla brand penne and fusilli separately in stainless steel pots in fresh tap water for 12 minutes, then removed with strainers. The water was reused to cook Dr. Schar gluten-free penne and fusilli. The team also tested the effect of rinsing some samples of the cooked and contaminated pasta under cold tap water for 30 seconds. The team found that Gluten was detected in all pasta samples cooked in water used for gluten-containing pasta, ranging from 33.9ppm to 115.7ppm. The rinsed gluten-free pasta samples tested at 5.1 ppm and 17.5 ppm detectable gluten. Interestingly, rinsing pots with water alone after cooking gluten-containing pasta was as effective as scrubbing with soap and water to prevent detectable gluten transfer. Toasting Gluten-Free Bread After Non-Gluten-Free Bread In the second scenario, the team toasted regular gluten-containing bread in two rolling toasters in a busy hospital cafeteria at 20-minute intervals, or in one of three shared pop-up toasters. Immediately after toasting the gluten-containing bread, they toasted Dr. Schar Artisan White Bread. Gluten-containing crumbs were visible in all toasters. They team did not clean the toasters. The team found that toasting in a shared toaster was not associated with gluten transfer above 20ppm; the four samples with detectable gluten had levels ranging only from 5.1 ppm to 8.3 ppm gluten. Slicing a Gluten-Free Cupcake with Knife Used on Gluten Cupcake In the third scenario, the team used a knife to slice frosted gluten-containing cupcakes. The knife was then reused to slice a frosted gluten-free Vanilla Cupcake from Whole Foods Gluten-Free Bake House. The knife was then washed in soap and water, rinsed in running water, or cleaned with an antibacterial hand wipe (Wet Ones) and a new gluten-free cupcake was sliced. Both gluten-free cupcakes were analyzed for gluten content. Although 28/30 cupcake samples had detectable gluten transfer, only 2/28 tested over 20ppm. The team found that cutting cupcakes with a knife used to cut frosted gluten-containing cupcakes was associated with low-level gluten transfer even when crumbs were visible on the icing adhered to the knife. All three knife washing methods tested were effective in removing gluten. The team acknowledges the limitations of their study, including small sample size, etc. They are calling for further study to assess best kitchen practices for people with celiac disease who are trying to avoid gluten contamination in shared kitchens. Main Takeaways 1) Some kitchen activities may pose less of a risk of cross-contact with gluten than is commonly believed. 2) Standard washing effectively removes gluten from shared utensils. 3) Cooking gluten-free pasta in the same water as regular gluten-containing pasta is likely okay, as long as the pasta gets rinsed well. 4) Sharing a toaster is unlikely to result in gluten contamination. Read more in Gastrojournal.org Conflict of Interest Declaration: JAS has served on an advisory board of Takeda Pharmaceuticals and received research support from Cour Pharma, Glutenostics, and the Celiac Disease Foundation. The other authors have no conflicts of interest to disclose. Funding Source: Supported by philanthropic gifts from the Celiac Disease Foundation, Dr. SCHAR USA, and Bia Diagnostics. JAS is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK119584.

Celiac.com 04/09/2020 - Anyone with celiac disease knows how hard it can be to follow a gluten-free diet. Some studies have shown that even celiacs who strive to stay gluten-free are commonly exposed to gluten. How common is gluten-exposure in celiacs who are following a gluten-free diet? A new study takes a deeper look at real world gluten exposure in celiac patients following a gluten-free diet. To do so, the research team set out to measure levels of gluten immunogenic peptides (GIP) in fecal and urine samples from celiac patients on a gluten-free diet. The research team included Juan Pablo Stefanolo, Martín Tálamo, Samanta Dodds, María de la Paz Temprano, Ana Florencia Costa, María Laura Moreno, María Inés Pinto-Sánchez, Edgardo Smecuol, Horacio Vázquez, Andrea Gonzalez, Sonia Isabel Niveloni, Eduardo Mauriño, Elena F. Verdu, Julio César Bai. They are variously affiliated with the Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina; the Farncombe Family Digestive Health Research Institute, McMaster University Medical Centre, Health Sciences, Hamilton, ON, Canada; and the Research Institutes of Health, Universidad del Salvador, Buenos Aires, Argentina. The team conducted a prospective study of 53 celiac adults in Argentina who had followed a gluten-free diet for more than two years, and an average of eight years. The team used a celiac symptom index questionnaire to assess celiac-related symptoms for each patient at the beginning of the study. Patients in the study collected stool each Friday and Saturday and urine samples each Sunday for one month. The team used a commercial ELISA to measure gluten immunogenic peptides in stool and point-of-care tests to measure gluten immunogenic peptides in urine samples. Among other revelations, the results showed that nearly 40% of stool and urine samples were positive for gluten immunogenic peptides. Nearly 90% patients had at least one fecal or urine sample that was positive for gluten immunogenic peptides (median, 3 excretions). Nearly 70% of urine samples were positive for gluten immunogenic peptides at least once. Positive gluten immunogenic peptides samples correlated with blood levels of deamidated gliadin peptide IgA, but not with levels of tissue transglutaminase. Interestingly, symptomatic patients had more weeks with detectable gluten immunogenic peptides in stool than patients without symptoms. Patients with celiac disease on a long-term gluten-free diet are still frequently exposed to gluten. Tests to measure gluten immunogenic peptides in stool and urine could help dietitians ensure gluten-free diet compliance. In their celiac patients. In this real world study, nearly nine out of ten celiacs who are following a gluten-free diet tested positive for gluten exposure at least once in this study, and nearly two out of five urine tests was positive for gluten exposure. Moreover, these exposures may not have symptoms. This is pretty alarming news, to be honest. People with celiac disease need to avoid gluten, and they need a reliable way to check and see if they need to adjust their diet. Do you have celiac disease? Are you on a gluten-free diet? Do you think you get exposed to gluten regularly? Do you think that regular testing might help you to avoid gluten? Comment below. Read more in the Clinical Gastroenterology and Hepatology