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Celiac disease: what you need to know

Reading a food label.

Are you hearing more about Celiac Disease (CD) but don’t quite know what it is? Celiac Disease is a lifelong inherited autoimmune condition affecting children and adults. When people with CD eat foods that contain gluten, it creates an immune-mediated toxic reaction that causes damage to the small intestine and does not allow food to be properly absorbed. Even small amounts of gluten in foods can affect those with CD and cause health problems. Damage can occur to the small bowel even when there are no symptoms present.

Celiac Disease is not a food allergy, it is an autoimmune disease. Food allergies, including wheat allergy, are conditions that people can sometimes outgrow. This is not the case with CD. The cause of CD, also known as celiac sprue or gluten sensitive enteropathy, is a mystery. One out of 100 people in the US is affected with it.

Gluten is the common name for the proteins in specific grains that are harmful to persons with celiac disease. These proteins are found in all forms of wheat including durum, semolina, spelt, kamut, einkorn, and faro, and related grains rye, barley, and triticale. All of these grains must be eliminated from the diet.

A word of caution: don’t be misled by products that are labeled wheat-free. They may still contain spelt, rye or barley-based ingredients that are not gluten-free (GF).

Prevent cross-contamination of gluten-free foods

The same attention and precautions need to be given to gluten-free food orders as for allergy-free food orders. When preparing gluten-free foods, they must not come in contact with food containing gluten. Contamination or cross-contact can occur if foods are prepared on common surfaces or with utensils that are not thoroughly cleaned and sanitized after preparing gluten-containing foods. It is critical that food handlers wash their hands before working with GF foods and while preparing orders.

Think about how easily cross-contamination occurs.

  • Start with the basic tools like knives and cutting boards; have dedicated equipment for GF food prep including clean pans and spatulas reserved for grilling and frying.
  • Deep fried foods should not be cooked in oil used in cooking breaded products.
  • Using a common toaster for GF bread and regular bread is a major source of contamination.
  • Spreadable condiments in shared containers may also be a source of contamination. When a person dips into a condiment a second time with the knife used for spreading, the condiment (e.g. mustard, mayonnaise, jam, peanut butter, butter) can be contaminated with crumbs.

If food items are prepared on site using wheat flour, sifters and all equipment used must be cleaned. Be aware the wheat flour can stay airborne for many hours and contaminate exposed preparation surfaces, utensils and uncovered gluten-free products. Likewise, foods not produced in a gluten-free environment have the potential to be contaminated with gluten. This may occur in manufacturing facilities when equipment is inadequately cleaned after producing gluten-containing foods. Food manufacturers are required to abide by Good Manufacturing Practices outlined in the FDA Code of Federal Regulations to reduce the risk of contamination in manufacturing.

Read the label

A label that declares a complete list of ingredients is safest for your customers. Labels must be read every time foods are purchased since manufacturers can change ingredients at any time. What was safe last month may have had an ingredient change and no longer be GF. Work with your suppliers or manufacturers to verify ingredients by the lot number for any food in question.

Frequently overlooked foods that may contain hidden gluten and need to be verified include:

  • Brown rice syrup
  • Breading and coating mixes
  • Croutons
  • Energy bars
  • Dlour or cereal products
  • Imitation bacon
  • Imitation seafood
  • Marinades
  • Panko (Japanese bread crumbs)
  • Pastas
  • Processed luncheon meats
  • Sauces and gravies
  • Self-basting poultry
  • Soy sauce or soy sauce solids
  • Soup bases
  • Stuffing
  • Dressings
  • Thickeners (roux)

Other items that may contain gluten are

  • Communion wafers
  • Herbal supplements
  • Drugs and over-the-counter medications
  • Nutritional supplements, vitamins and mineral supplements

You or your staff should never make the decision as to whether a customer should be served a questionable food. Provide the customer with ingredient information, train your staff with proper prep and serving techniques and let the customer decide what they will order and eat.

Celiac disease and gluten-free resource

The Celiac Disease Foundation is a non-profit, public benefit corporation dedicated to providing services and support regarding Celiac Disease, through awareness, education, advocacy and research. The site is geared to individuals but will provide good resources for the foodservice industry as well.

Kathy Brandt, Extension food safety educator and Suzanne Driessen, Extension food safety educator

Reviewed in 2021

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