<<Disclaimer:  Verify this information before applying it to your situation.>>
 
...............................................................
:  Pitfalls in the Nutritional Management of Celiac Disease   :
:  --------------------------------------------------------   :
: by Nancy Patin Falini, MA, RD     summarized by Kathy Davis :
:.............................................................:
 
Nancy Patin Falini is a consulting dietitian, and is the dietitian
advisor for the Greater Philadelphia Celiac Sprue Support Group, a
chapter of CSA/USA.
 
Don't use the phrase gluten-free (GF) diet, because the word "diet"
implies something temporary that could end.  Instead, think and refer
to it as a GF meal plan, a behavior change that lasts a lifetime.
 
Nebulous ingredients are one of the big pitfalls in processed foods
and pharmaceuticals.  By "nebulous" I mean ingredients that might or
might not contain gluten.  Examples include vegetable protein,
modified food starch, vegetable gum, soy sauce, and malt.
 
Incidental ingredients are used in 1% of food processing.  One example
is mono- and diglycerides which by themselves are fat but in
processing may bind with wheat starch.  The wheat starch would be
considered an incidental ingredient.  Another example is brown rice
syrup which may be processed with barley enzymes.
 
Some foods can be floured before packaging; an example is potato
chips.
 
Cross contamination can occur in food at home or in a restaurant.  For
example, consider the residue in a deep fat fryer that cooks both
breaded foods and french fries.  The french fries can be cross
contaminated by the residue from the breaded foods.
 
In medications the fillers can be labeled as plain "starch"; this is
an ingredient that should be checked.
 
Alcohol can be used in foods and medications.
 
Over-the-counter medications label their ingredients on the package
insert.  For prescription medications you must contact the
manufacturer.  One idea is to have your physician give you a sample of
any new medication (if available) with the package insert listing the
ingredients, so that you can check them out.
 
If you take a medication such as Cipro and find out that it is safe,
don't assume it will be again in the future.  You need to check it
each time it is ordered.
 
If you take vitamin and mineral supplements, be sure they are GF;
otherwise you are defeating the purpose of taking them.
 
When you have to be in the hospital you must be very verbal about the
need for a GF diet.  A clear liquid diet can contain barley in herbal
tea, or caramel coloring and vegetable protein in broth.  If possible
have family members or friends bring you GF food to eat from home.  If
your hospital stay is preplanned, call the dietary staff and let them
know your needs before you are admitted.
 
You must develop skills to abstain from gluten; be a detective, take
the time to research ingredients, and be proactive [cringe; I HATE
that word-ed.], speak up.  Celiacs need support from the medical
community, family and friends.  If possible, be involved in a support
group.  A person with CD must have the skills, knowledge, and desire
to remain GF.
 
In response to questions from the floor, the following points were
made:
 
  *  Caramel color usually comes from corn.
 
  *  Anatto color comes from the anatto seed.  The color is extracted
     from the seed using alcohol.
 
  *  Natural and artificial colors are not a concern.  [There is some
     disagreement on this point; if a grain alcohol is used to extract
     a natural color, some people feel it will contain a small amount
     of gluten-ed.]
 
  *  Intravenous (IV) solutions can contain soy.
 
  *  When you are in a hospital on a GF diet, check how old the
     hospital's information is.  Some hospitals believe that malt and
     wheat starch are allowed.