SNEAKY SOURCES OF GLUTEN And How to Spot Them

IF YOU HAVE CELIAC DISEASE, even traces of gluten (a protein found in wheat, , rye and sometimes ) can wreak havoc on your intestinal tract. When pain and distress persist despite remaining on guard against gluten in restaurants, con- sider these hidden sources. (And avoid any that aren’t labeled “gluten-free.”)

[Un]likely Suspects

MEDICATIONS & SUPPLEMENTS Gluten may be used to bind pills together. (Find gluten-free 1substitutes if you have celiac disease; research suggests a greater need for nutrients like B , D and iron.)

MEAT & POULTRY Watch for hydrolyzed wheat protein and soy sauce in 2 flavored, seasoned or marinated meats, and for gluten in self-basting poultry. Processed lunchmeats and deli meats may also contain gluten.

CHIPS & FRIES Potatoes and corn are gluten-free, but potato chip 3 seasoning may contain vinegar and wheat starch. Tortilla chips and French fries may be fried in the same oil used to fry breaded foods.

OATS Oats, sometimes grown next to wheat, are at high risk for 4 cross-contamination in processing. (And beware of oats in bulk bins.) Only choose oats “certified gluten-free.”

MEAT & FISH SUBSTITUTES Watch for gluten in veggie burgers, sausage, bacon and 5 crumbles, and in imitation seafood and seitan.

BEVERAGES & ALCOHOL Gluten may be lurking in flavored coffees and teas. Beer, 6 ale, lager and malt beverages may also contain gluten. (Wine and distilled alcohol are gluten-free.)

EGGS AT A RESTAURANT 7Omelets and eggs may be made with pancake batter.

“”GLUTEN-FREE” PIZZA & BAKED GOODS 8These may be contaminated by other grains.

SWEET TREATS & SNACKS Flavored ice creams (like cookie dough) and gelatos may 9 contain gluten. Look for gluten in candy (especially licorice), energy bars and granola bars, too.

SOY SAUCE & MISO Soy sauce (except for tamari) is made with wheat. 10 Miso, a soup base, may be made with barley.

SALAD FIXINGS Blue cheese may be made with wheat. Salad 11 dressings may contain gluten, too.

EZEKIAL This popular sprouted bread is made from wheat 12 and barley.

BROWN RICE SYRUP This syrup from gluten-free brown rice is made 13 using barley enzymes.

SOUPS & GRAVIES 14 Gluten may be used as a thickener, even in bouillon. Clues You Can Use

• KNOW WHEAT IN ALL ITS FORMS. Wheat berries, semolina, spelt, farina, graham, durum, emmer, farro, khorasan, udon and einkorn all contain gluten. (Watch for “modified” products, too.)

• DON’T BE FOOLED BY THE LATIN ON THE LABEL. Try memorizing Triticum vulgare (wheat), Hordeum vulgare (barley), Secale ceral (rye), Triticale (a wheat-rye hybrid) and Triticum spelta (spelt, a type of wheat).

• DON’T PUT A HALO OVER ALL GLUTEN-FREE FOODS. Gluten-free processed foods are often just as high in and just as unhealthy as other processed foods.

• WHEN IN DOUBT, PLAY IT SAFE. If you can’t confirm products are gluten-free, substitute fresh, naturally gluten-free, nutrient-rich whole foods without flavorings or additives. (Like fruits, vegetables, beans and raw nuts).

• LOOK FOR PHYTONUTRIENT-RICH FOODS. Berries, Brussels sprouts, summer squash, purple kale, quinoa and other nutrient-dense foods can help repair your intestinal lining. Eat a variety of colors every day to get more antioxidants.

• PREVENT KITCHEN CROSS-CONTAMINATION. Crumbs linger in shared toasters and community peanut butter, jam and cream cheese. Wipe counters regularly, and clean gluten-free dishes with a separate sponge. Line shared sifters and pans with parchment paper or foil, and wrap gluten-free bakery in foil.

SOURCES celiac.org/live-gluten-free/glutenfreediet/sources-of-gluten/ my.clevelandclinic.org/health/diseases_conditions/hic_celiac_disease/hic-following- a-gluten-free-diet-for-celiac-disease ncbi.nlm.nih.gov/pubmed/15825119 medicine.virginia.edu/clinical/departments/medicine/divisions/ digestive-health/nutrition-support-team/nutrition-articles/Sept0601.pdf

health.clevelandclinic.org

15-HHB-2110 © Cleveland Clinic 2015