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Yes, You Can Eat! When Gluten Isn’t the Only Ingredient to Avoid with Melinda Dennis, MS, RD, LDN Beth Israel Deaconess Medical Center

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① Continuing Education Credit: • Registered Dietitians (RD) and Dietetic Technicians, Registered (DTR) are able to participate in this live 60-minute webinar to obtain continuing education credits regardless of this program's approval status as long as the webinar is professional in nature. NFCA will provide a certificate as proof of participation for each webinar. Attendees must complete the program evaluation/follow-up survey in order to access this certificate. Program participants will receive a link to complete the program evaluation/follow-up survey 24 hours after the close of the webinar through an email from GoToWebinar.

• Please note that RDs and DTRs are not permitted to claim credits by viewing archived webinars. Only those who register and attend live webinars will receive the opportunity to obtain continuing education credits.

③ In early July, NFCA community members can look for a review of the presentation in the form of a printable guide featuring major highlights from this educational session. Please check back at CeliacCentral.org

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Watch & Win!! A total of 3 webinar participants will each win a special prize pack from Lucy’s!

• Each prize pack includes a 5.5 oz. box of Lucy's newest flavors of gluten-free, vegan cookies (made without milk, eggs, peanuts, or tree nuts!) Ginger Snap: These snaps are made with real ginger, lemon and a tiny tad of chipotle spice. Kids love them as much as grown-ups do. Maple Bliss: These are crispy, crunchy, delicate, Maple Bliss. You'll think organic maple syrup dripped right from the tree into our batter. Not too sweet. Just right! Chocolate: These chocolate cookies have a delicate, crisp flavor. Eat them, crumble them over frozen treats, make a pie crust with them. Have you had your chocolate today?

Also up for grabs! Three more participants will win a copy of Melinda and Dr. Daniel A. Leffler's book: Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free, which was published by the AGA Press in May 2010.

Melinda Dennis, MS, RD, LDN

• Diagnosed with celiac more than 20 years ago • Nutrition Coordinator and Research Investigator at Celiac Center at BIDMC of Beth Israel Deaconess Medical Center, Boston • Former Task Group Member: Academy of Nutrition and Dietetics’s Evidence Analysis Library for Celiac Disease •Coauthor: Real Life with Celiac Disease www.RealLifewithCeliacDisease.com •Founder and owner of www.DeleteTheWheat.com •Founder of Healthy Villi Celiac Support Group, New England’s largest support group

• Differentiate between celiac disease, food allergies and food intolerances

• Review FDA and USDA food labeling laws

• Review key nutrients and recommended labs

• Discuss healthy alternative foods when gluten and other food groups are removed

• Recognize conditions such as Fructose Malabsorption and Small Intestinal Bacterial Overgrowth

• Gather tips and resources for dining out allergen-free

• A chronic small intestinal immune-mediated enteropathy triggered by exposure to dietary gluten in genetically predisposed individuals.

• 1% of the population • 3 million Americans • Lifelong avoidance of gluten • Genetic

Ludvigsson, et al. 2012

• Adverse reaction(s) involving IgE antibodies to one or more proteins found in the suspect food

• 3-4% of adult population

• 8% of the pediatric population

• Strict avoidance of the offending food(s)

• Runs in families

• Symptoms related to exposure to a particular food without an immune response (enzyme deficiency, food effect) • Unknown % of people with food intolerances

• Non-celiac gluten sensitivity • 16 million Americans • Suggested: 1 in every 4 people New Kid on the block

Ludvigsson, et al. 2012

• History of food intake

• Allergy skin tests and/or allergy blood testing

• Removal of the allergen

• An oral challenge under direct supervision of an allergist may be necessary.

• Rule out allergy.

• Do controlled food elimination trials or blood testing.

Why do late-onset food allergies and intolerances develop after going gluten-free?

• Pre-existing problems

• Injured gut lining

• Injury to immune system

<1 mg of gluten (1/50th of a slice of bread) can cause significant, sustained mucosal inflammation

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. How do we educate our patients on how to avoid gluten and other allergens?

Applies to FDA Regulated Foods • If a food or an ingredient in a food is or contains protein from 1 of the 8 major allergens, it must be listed: •Contains: Wheat, Soy, Egg, Peanut, Tree nuts, Milk, Fish, Shellfish •OR in the ingredient list: Modified food starch (wheat) • Includes packaged foods, prepackaged foods for retail sale, dietary supplements, infant formula, and medical foods

Proposed FDA Ruling: <20ppm = gluten-free

Food Allergen Labeling Consumer Protection Act, 2004:http://www.fda.gov/Food/LabelingNutrition/FoodAllergensLabeling GuidanceComplianceRegulatoryInformation/ucm106187.htm.

• The FDA does not mandate allergen labeling for oat, rye, barley, malt, and brewer’s yeast.

• “Under the proposed FDA rule, labeling foods with the term ‘gluten-free’ continues to be voluntary.”

• Allergen advisory statements related to food processing are voluntary and unregulated.

• i.e.: “processed in a facility that also processes wheat”

Applies to ingredients, NOT cross-contamination!

Recommendations Summary. Evidence Analysis Library. American Dietetic Association. http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key=2376. Accessed October 21, 2010.

United States Department of Agriculture (USDA) Regulated Foods

• Allergen labeling of USDA- regulated foods (processed Common Names: AVOID meat, poultry, eggs and mixed food products) is voluntary. Modified food Dextrin Maltodextrin starch

• USDA declares that all Caramel Glucose Starch ingredients be listed in the ingredient list by their common or usual name which Durum flour Enriched Farina does not always indicate flour ingredient source. Graham flour Plain flour Self-rising flour • USDA will likely follow FDA labeling once final definition Bulgur Spelt Semolina of “gluten free” is released. White flour Brewer’s Triticale yeast (from barley)

Thompson. Food Labeling in the US and Canada. In Real Life with Celiac Disease. Dennis, Leffler, Eds. AGA Press, Bethesda, MD, 2010. :Labeling of USDA- Regulated Foods. Available at http://www.glutenfreedietitian.com/articles/BLOGUSDALabelingBlog.30.pdf. Accessed October 21, 2010.

Checklist for Gluten Exposure and Cross-Contamination

Understand food labeling laws in their Kitchen free of cross-contamination country Medications & Supplements Educated family, roommate, guests, friends, schools, camps, nursing homes Pets and Pet Food Partner/Spouse/Kids: cross-contamination

Religious Practices/Holidays: Bulk bins •Communion wafer/matzo Contaminated Grains: Dining Out: • In the Field • Safe/Unsafe Ingredient Cards • • Transport Detailed Questions • Assertiveness • Milling/Processing • Location Selection • Repackaged Grains, Flours Body Care Products: Nose & Mouth Salad bars

Newly introduced foods Bakeries, Pizza Parlors

Gum, mints, candy

Frequently Overlooked Sources of Gluten

“Wheat-free” does not necessarily mean “gluten-free.

Beer/Ale/Lager Croutons Dressing Breading Croutons Broth/Bouillon Flour or cereal products Gravies Dressing Candy Flour or cereal products Coating/Drink Imitation bacon Gravies mixes Malt Imitation seafood Imitation bacon Communion wafers Marinades Imitation seafood Contaminated Matzo Sauces Grains Medications Seasonings Oats* Self-basting poultry Panko Soup bases Pasta Stuffing Play-Doh Supplements Processed Thickeners (Roux) Luncheon meats

Murray, Am J Clin Nutr, 1999; Jamatiomem, et al N Engl J Med, 1995; Miletic et al, J Pediatr Gastroenterol Nutr, 1994

• Medication ingredient lists are divided into: • Active= Safe, no gluten • Inactive= May contain gluten • Medications are NOT required to declare ◦ “wheat” or other allergens.

• Supplement ingredient lists are divided into: • Supplement facts • Ingredients

• The starch source in medicine, vitamin/mineral and herbal supplements can be made from any number of starches, including WHEAT.

• Supplements are required to declare “wheat” other allergens if an ingredient. • Supplements are NOT required to list barley, etc.

Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health Syst Pharm. 2001;58:396-401.

Drug/Supplement Ingredient Possible Botanical Source *This list is not comprehensive • Unspecified starch, modified starch • May be derived from wheat starch, etc. • Pregelatinized starch • Dusting powder, Flour, Gluten You need to clarify the • Dextrin, cyclodextrin source of the ingredients. • Dextrates • Maltodextrin • Dextri-maltose •Barley malt may be used in manufacturing • Caramel coloring • Sodium starch glycolate •Usually from potato starch; may be derived from other starches.

Adapted from Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology 2005;128:S121-S127. Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health-Syst Pharm; 2001;58:396-401. US Pharmacopeia 28th, National Formulary 23rd ed, 2005. Handbook of Pharmaceutical Excipients, 4th ed, 2003.

What if our patients are avoiding more than gluten? How does that impact their nutrition?

• CBC • Iron and Ferritin • 25 OH Vitamin D • Lipids • B12 • TSH (thyroid) • Folate • IgA-tTG

• Osteoporosis occurs in >25% of all patients with celiac disease

• High incidence of iron deficiency anemia in patients with newly diagnosed celiac disease in the U.S.

Needed to deliver oxygen to blood and muscles. Deficiency can lead to Iron fatigue and decreased immunity. Produces many important neurotransmitters.

Works with Vitamin B12 to make and maintain cells, and to make DNA Folate and RNA, the genetic material of cells.

Needed to help make nerve cells, red blood cells, and DNA, the genetic Vitamin B12 material of cells.

Needed to build and breakdown proteins, to build red blood cells, Vitamin B6 maintain brain function, and for the immune system.

Helps the body absorb calcium, which is needed for the normal development and maintenance of healthy teeth and bones. It also helps Vitamin D maintain proper blood levels of calcium and phosphorus. Offers anti- cancer benefits, helps reduce inflammation, influences hormones.

Barton, et al. Gastroenterol Clin N Am 2007;36:93-108

Calcium Needed for bone health and many other processes throughout the body. Aids in blood clotting, nerve function, and muscle contraction. Maintains normal levels of blood pressure and stomach acid. Needed for normal muscle and nerve function, to keep heart rhythm steady, Magnesium to support the immune system, and for bone health. Also used in the proper functioning of over 300 enzymes in the body.

Zinc Needed for immune function, improving of brain function (including memory), in the synthesis of insulin, growth and development, and wound healing.

Vitamin K Necessary for blood clotting. Some studies suggest that it helps promote strong bones. Vitamin A Needed for vision, bone growth, cell division, reproduction, and the immune system. Necessary to protect cells from damaging effects of free radicals that can Vitamin E contribute to cardiovascular disease and cancer; supports immune function.

Barton, et al. Gastroenterol Clin N Am 2007;36:93-108

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Food Nutrients Alternatives • Protein, healthy fat (vitamin E), folate, • Other tree nuts, sunflower seed niacin, fiber, copper. butter Peanut • Calcium, vitamin D, protein, phosphorus. • Soy milk, hemp milk, almond milk, rice milk, potato milk, hazelnut, coconut, flax milk, sunflower milk (all labeled gluten-free)*

Milk/Dairy • Protein, iron, B vitamins, fiber, • Amaranth, brown rice, buckwheat, antioxidants, calcium, phosphorus, zinc. millet, quinoa, sorghum, wild rice, black rice, oats (all labeled gluten free)

Wheat • Nutritionally complete protein, fiber, iron, • Gluten-free vegetarian burgers, dried naturally-occurring ALA omega-3 fatty beans, peas, lentils, dairy products, acids. seeds (flax), nuts

Soy

* Low/no protein in most

• Annual herb/broad leafed plant

• “Super food” for warriors 8,000 years ago

• More iron than most grains

• Combine with other gluten-free flours to make pancakes, flatbreads

• Very good in dark colored baked products, such as: • Dark bread, chocolate cake and with spices

• Toasted bran flour: •Cookies, quick breads

• Blend with almond flour in light colored mild flavored baked goods

• Honorable Mention:

• Protein, fiber, calcium, iron, magnesium • Phosphorus, potassium, zinc, lysine (amino acid), B vitamins

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Buckwheat • Is a fruit and is related to rhubarb • Groats: • Kernels stripped of outer coating, crushed • Kasha: • Roasted groats • Unroasted: • Poultry stuffing, cream of buckwheat • Flour: • Pancake mix, bread, muffins, “soba” noodles • Cook with: • Onions, chicken broth, maple syrup, egg, milk • Use for: • pie crusts, breakfast bars, side dish, pilaf, casseroles, thickener • Honorable Mention: • Protein, magnesium, zinc, phosphorus, potassium, niacin, riboflavin • B6, fiber, iron, cholesterol and blood pressure lowering properties www.birkettmills.com

• Is a cereal grass • Native to Ethiopia • 100 grains = 1 wheat kernel • Nutty, molasses-like flavor • Combine 25-50% teff with other flours • Use as: • Hot cereal, scones, pancakes, pie crust • Veggie burger (seeds, beans, tofu, garlic, herbs, onions) • porridge, polenta, thickener, enjera • Honorable Mention: • Fiber, protein • CALCIUM, IRON • Magnesium, thiamin, zinc

www.teffco.com www.Bob’s Red Mill

chickpea flour pea bran meal whole green pea flour

split green pea flour pea fiber whole yellow pea flour

Slide courtesy of Shelley Case; www.glutenfreediet.ca www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Pulse Power (1cup) Chickpea Yellow Pea White Rice Tapioca Cornstarch Potato (Garbanzo Flour Flour Starch Starch Bean) Flour Protein (g) 25.7 24.7 9.4 0 0.3 0.2

Fiber (g) 20.9 20.6 3.8 0 1.2 0

Carbohydrate (g) 73 71 127 119 117 158

Iron (mg) 6.8 5.4 0.6 0 0.6 2.9

Calcium (mg) 92 90 16 0 3 19

Zinc (mg) 3.5 3.9 1.3 0 0.1 N/A

Magnesium (mg) 169 144 55 0 4 N/A

Thiamin (mg) 0.70 0.73 0.22 0 0 0

Riboflavin (mg) 0.16 0.15 0.03 0 0 0

Folate (mcg) 334 15 55 0 0 N/A

* Chart excerpted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD ** Pulse flours analyzed by Silliker Canada June 2010

• Naturally gluten-free grains, flours, and products made from them may be contaminated with wheat, barley or rye.

• Whenever possible it is best to choose labeled gluten-free versions of these products.

Celiac Disease Toolkit. American Dietetic Association. Chicago, IL, 2011; 7. Thompson T, Lee AR, Grace T. J Am Diet Assoc. 2010;110:937-940.

Individuals with egg allergy should also avoid eggs from duck, turkey, goose, quail, etc., as these are known to be cross-reactive with chicken egg.

Avoid foods that contain eggs Egg is sometimes found in or any of these ingredients: the following:

•Albumin (also spelled albumen) • Baked goods •Egg (dried, powdered, solids, white, yolk) • Egg substitutes •Eggnog • Lecithin •Lysozyme • Macaroni •Mayonnaise • Marzipan •Meringue (meringue powder) • Marshmallows •Ovalbumin • Nougat •Surimi • Pasta

http://www.foodallergy.org/page/egg1

• 1 tsp. baking powder, 1 T. liquid, 1 T. vinegar.

• 1 tsp. yeast dissolved in 1/4 cup warm water.

• 1 1/2 T. water, 1 1/2 T. oil, 1 tsp. baking powder.

• 1 packet gelatin, 2 T. warm water. Do not mix until ready to use. These substitutes work well when baking • 1 T. ground flax seed in 3 T. water; from scratch and substituting 1 to 3 whisk; wait 3 minutes. eggs.

• Know the gluten-free diet • Know the restaurant • Identify yourself to the wait staff • Ask specific questions (and ask again!) • When in doubt, go simple • Do not accept mistakes • Do your homework before you go • Try to go early or late • Say thank you! • Tip well

Real Life with Celiac Disease, AGA Press, 2010.

• Cooler with milk & juice • Picnic supplies for lunches: • Gluten-free deli meat • Cheese or rice cheese sticks • Carrot sticks • Plain chips • Lunch in restaurants: • Salads - question salad dressings or bring your own! • Dinner in restaurants: • Ask for manager • Use restaurant cards • Remember to use: • GPS portable systems, AAA maps & itineraries • Mapquest.com or Google maps

Rinehart, Janet Y. Traveling the World Gluten Free.

•Call ahead to check on nearby eateries

•Check with local support groups

•Book a room with a kitchenette

•Reserve a mini-fridge

•Ask the hotel to hold food for you

• Less food available onboard or at pit stops • Pre-order gluten-free meal in advance • Check and double check • Think airport security:

•No knives

•No liquids or peanut butter, yogurt

• Prepare for delays and layovers • Pack non-smelly, easy to carry food:

•Alpine Aire: freeze dried

•Thai Kitchen

•Go Picnic

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Gluten-Free (and Allergy-Friendly) Food to Go: Choose Labeled Gluten-Free Products

 Dried fruit/trail mix  Pre-toasted bread  Fresh fruit, veggies  Pretzels  Plain nuts  Chips  Dried cereal in bags  Cookies, muffins  Tuna fish in pouch  Crackers, rice/corn cakes  Freeze-dried food  Soups  Energy bars  Packaged entrees  Oral supplements (Ensure®,  Peanut butter Boost®)  Dried pasta  Candy (in moderation)  Soy sauce, condiments  Yogurt smoothies with ice

*Don’t forget: Can opener, extra baggies, ice packs, containers

FAAN.org

AAAAI.org

GREAT Kitchens Training: CeliacLearning.com

GIG Gluten Free Food Service: Gluten.net

Indana-Allergynetwork.org

“My 3-year old has gluten and milk sensitivity.”

• Negative for celiac; negative for allergies • Rash, vomiting, diarrhea with gluten • Diarrhea, rectal sores with dairy • Doctor says, despite tests, still allergic to gluten and milk • Assuming the testing was reliable…what are the possibilities?

Assuming the testing was reliable…what are the possibilities?

① Intolerance with/without allergy

② Dermatitis Herpetiformis

③ Eosinophilic esophagitis

“I have wheat/gluten/various food allergies.”

• No money for doctor’s visit • Multiple loose bowels, painful gas, bloated and huge, bubbling stomach • Tried over the counter gas relief • What foods should I eliminate? • Testing is needed.

• What is it? • Poor digestion of a large sugar molecule found in some fruits, honey, high fructose corn syrup, etc. • Fermented by bacteria in the colon • What are the symptoms? • Excess gas/bloating, cramping, diarrhea • Who gets it? • Common in IBS, increasingly seen in celiac disease

• Testing with the Hydrogen Breath Test: • Tests ability to digest fructose • Baseline breath (hydrogen and methane) • Measurements every 30 mins x 2.5 hours • Watch for strong rise in either gas • Nothing by mouth midnight before test

Shepherd S, Gibson P. Fructose malabsorption and symptoms of IBS: guidelines for effective dietary management. J Am Diet Assoc. 2006;106:1631-1639

Fermentable oligo-, di-, and monosaccharides & polyols

• Fructose: Honey, certain fruits, high fructose corn syrup • Lactose: Milk products • Fructans: Wheat, onion family, artichoke • Galactans: Peas, soybeans, lentils, dried beans • Sugar Alcohols: Artificial sweeteners, sorbitol, xylitol, isomalt, prunes, cherries

CHOOSE AVOID

• Pineapple, strawberry •Prunes, pear, cherry, peach, plum • Blueberry, raspberry, lemon, lime • Apple, applesauce, apple juice, pear juice • Honeydew melon • Grapes, mango, date, figs, apricot • Banana, rhubarb, orange, kiwi, • Nectarine, dried fruit grapes, grapefruit, cranberry, tangelo

CHOOSE AVOID • Sucrose (table sugar), corn syrup • Agave, honey • Evaporated cane juice, jam or jelly • High Fructose Corn Syrup

• Maple syrup, syrup, stevia • Sugar alcohols

www.CeliacCentral.org Restoring Health … Reclaiming Lives. National Foundation for Celiac Awareness 2012. All rights reserved. Small Intestinal Bacterial Overgrowth (SIBO) • What is it? • Abnormally high bacterial populations in the UPPER bowel

• What are the symptoms?

• Gas, bloating, cramps, weight loss, diarrhea, nausea

• Who gets it? • Seen in celiac disease (in absence of obvious gluten exposure) • Diabetes, Crohn’s, IBS, scleroderma, diverticula, gastroparesis or any intestinal dysmotility syndrome • Fistulas, chronic pancreatitis, abdominal pain, diarrhea, weight loss, macrocytic anemia, etc.

• What are the implications? • Can lead to carbohydrate, protein and fat malabsorption, inflammation and toxin production • Can cause persistent damage to villi, vitamin deficiencies and increase in tTG levels

Ghousal et al, 2004 Tursi et al, 2003 Leffler et al, 2007

• Get a clinical evaluation and testing!

• Treatment: Antibiotics

• Consult a dietitian:

•Balanced, healthy diet; limit FODMAPs

•Vitamins/minerals

•Probiotics •Modest fiber and adequate fluid •Spacing meals through the day

Diet for IBS and SIBO. Specialists in Gastroenterology. www.gidoctor.net/diet-ibs-sibo.php; Scarlata K. Today’s Dietitian, April 2011,13(4):46.

• Most people with Oral Allergy Syndrome are allergic to one or more pollens

• What is it? • Body mistakes one protein for another • Local and mild reaction in general • Heat destroys the proteins (except NUTS)

• What to do: • See an allergist. • Solution: Cook/Avoid/Get allergy shots.

*If allergic to one of the pollens, avoid the related fruits and vegetables IF symptoms arise from eating them.

POLLENS CROSS- REACTIVE FRUITS/ VEGETABLES

Birch Pollen • Peach, Apple, Plum, Cherry, Apricot, Strawberry, Pear • Almond, Hazelnut, Potato, Carrot, Celery

Grass Pollen •Tomato, Melon, Watermelon Mugwort (weeds) •Apple, Celery, Carrot, Peanut, Kiwi

Ragweed Pollen • Banana, Melon, Honey, Cucumber, Zucchini • Watermelon, Chamomile

• Select some celiac-friendly restaurants in advance of your trip: • www.Allergyeats.com • www.CeliacCentral.org/Kitchens • Pack foods that travel well. • www.glutenfreerestaurants.org • [email protected] (archives) • www.celiacchicks.com • Carry a doctor’s note for • www.glutenfreepassport.com overseas trips • www.gluten.net • www.glutenfreemenus.net • www.gfregistry.com • Accept that travel is more costly and not as healthy. • Copy restaurant cards in different languages: • www.celiactravel.com/restaurant-cards.html • www.livingwithout.com • www.csaceliacs.org • www.triumphdining.com

• American Celiac Disease Alliance: www.americanceliac.org • Canadian Celiac Association: www.celiac.ca • Celiac Disease Foundation: www.celiac.org • Celiac Sprue Association: www.csaceliacs.org • Evidence Analysis Library Celiac Toolkit (for dietitians): www.adaevidencelibrary.com • Gluten Intolerance Group of North America: www.gluten.net • IBS – Free at Last!: www.ibsfree.net • National Foundation for Celiac Awareness: • CeliacCentral.org • CeliacCentral.org/Kids • CeliacCentral.org/Gluten-Free-Food • National Institutes of Health: http//:digestive.niddk.nih.gov/ddiseases/pubs/celiac • Other websites: • www.glutenfreedietitian.com • www.celiac.com

www.CeliacNow.org

Coming Summer 2012

From:

 More organic food  More home grown food  Less processed food  Less label reading  Advocacy  Social events are also about people

•Gluten Free •Vegan •No Peanuts, No Tree Nuts •Dedicated Bakery •Ingredients Tested •Og Trans Fat •Omg Cholesterol •Non-GMO •All Natural

Thursday, July 26th at 8:30pm Eastern/5:30pm Pacific

"Setting the Record Straight: Dispelling Gluten-Free Manufacturing and Production Myths” Tricia Thompson, MS, RD; The Gluten-Free Dietitian, Nutrition Consultant Celiac Disease, Founder Gluten Free Watchdog, LLC

CeliacCentral.org/webinars/schedule/