Ask The Dietitian
Jodi Bloom Hadaway, of Central Baptist Hospital in Lexington, has been a Registered Dietitian since 1993 and has worked in a variety of patient settings, including eating disorder treatment, cardiac rehabilitation, and as a clinical dietitian. Jodi has counseled many patients with gluten-related disorders and is committed to helping them execute a healthy and satisfying gluten-free diet. Her brother was diagnosed with Celiac disease in 1988, and she has been involved with gluten-free diets ever since!
In the space below, we feature dietary questions that visitors to our site have submitted to Jodi, along with her answers. If you have a question that is not answered below, please click here to submit your question via email.
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Frequently Asked Questions
Q. Do the medicines I take need to be gluten free?
A. Yes, it is very important that all medicines you take by mouth (vs intravenously) be gluten-free. It can be difficult for consumers to determine whether or not medications (prescription or over-the-counter) contain gluten. The binders in drugs (called excipients) are often made from various types of starches, which could possibly include wheat starch (thus causing the product to then contain gluten). Sometimes contact information is available on the packaging so that the consumer can directly call the drug manufacturer in order to learn whether a drug is gluten-free (GF). Consumers can also enlist the help of a pharmacist when seeking information about GF drugs.
This month I talked with 5 different pharmacists locally/regionally in both retail and in-hospital settings, and each verified that the process of determining whether or not drugs contain gluten may take some extra effort, but that it IS possible to obtain the information needed. The process of determining whether a drug is gluten-free could be complicated because: 1) There are a large number of generic drugs on the market. The example one pharmacist gave me is that there may be 5 different companies making the same generic drug. So tracking down which company sent the drug for this particular shipment of the generic drug takes an eye for detail to assure that one is receiving the correct information for the product in hand. 2) It is necessary to obtain a list of each of the excipients, and then determine accurately if each of those excipients is GF.
So, just as you look at food labels every time you purchase and eat foods, you must take all the steps necessary (however difficult or easy) to assure that your medications are also GF. Pharmacists can provide you with assistance, and while it may take on-going effort to assure that your medications are GF, it is certainly WORTH the effort in order to maintain a gluten-free lifestyle!
*As an aside, if you are hospitalized I think it's a great idea to request a consult from both a Registered Dietitian and a Pharmacist to make sure that both of these experts can act as advocates for you during a hospital stay.
Q: I have been trying to find out if I can eat anything with the word 'modified' in it. I know I cannot have modified food starch but what about the others? I.e., Corn starch, potato starch, etc.
A: It is the food source that you need to be concerned about, not the word 'modified.' For example, modified corn starch is acceptable because the corn is an acceptable GF food. Modified 'food starch' is not acceptable for consumption unless you know WHICH food it is; if you learn from the company that the 'food' is corn (for example), then it is allowed.
Q: I was diagnosed with celiac disease last year. I have read that there might be gluten in foods that contain "artificial flavorings." Is this true?
A: The term "artificial flavorings" can refer to many different substances. According to the Celiac Sprue Association, the consumption of artificial flavorings as part of a gluten-free diet is "questionable," due to content, contact, or contamination with gluten. The specific type of artificial flavoring can possibly be researched further by calling the company to learn more about what specifically the company means by this term, and to learn which artificial flavoring is used in that particular food product. The artificial flavoring or binder may be from a grain source which is not allowed on a gluten-free diet (e.g., from a wheat source). Remember, "When in doubt, leave it out!"
Q: How can I help my family members understand that minimizing/eliminating cross-contamination of gluten at home is an important part of compliance with my gluten-free diet?
A: Perhaps emphasizing the idea that striving for a gluten-FREE (GF) diet, not a "gluten-REDUCED" diet is the goal. On a gluten-free diet, avoiding food sources with known gluten is essential. Additionally, to the best of your ability, you must also avoid gluten exposure ingested from food sources that have been cross-contaminated with gluten as well. A few examples of ways to minimize cross-contamination at home include:
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Designated GF toasters.
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Separate serving scoops in each canister ingredient (ie: so that a flour canister's scoop does not get used in the sugar canister and thus contaminate the sugar canister with gluten).
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Separate GF margarine/jelly/mayo containers (which could easily be contaminated with bread crumbs from spreaders used on regular breads, etc)
Q: I am confused about label reading. Does the “Food Allergen Labeling and Consumer Protection Act of 2004” (FALCPA) help me determine whether or not a product is gluten-free?
A: No, not necessarily. You must carefully read the full ingredient paragraph on packages to make sure that each of the ingredients listed is gluten-free. FALCPA applies to all packaged foods sold in the USA, and was designed only to address SOME of the major categories of food allergens: milk, egg, fish, crustacean shellfish, tree nuts, wheat, peanuts, and soybeans. FALCPA is NOT designed to address every food allergen possible! On a gluten-free diet where wheat, barley, oats and rye are avoided, only the “wheat” category is included in what FALCPA requires to be stated clearly on labels in a “Contains list” or in parenthesis in the ingredient paragraph. Note that barley, oats, and rye are not on the “big 8 list” above, so they will not be identified in the same manner. It should also be noted that companies are not required by FALCPA to include “advisory” information, ie: that the product may have been processed in a plant where allergens were present.
Bottom line: When label reading, don’t try to take shortcuts! At this time, we do not have labeling laws that tell you concisely whether a product contains gluten, so you must read EACH ingredient to determine whether or not the product is gluten-free. Please also remember that you must routinely read ingredient lists on all food products to assure that the food continues to be gluten-free, since product recipes/formulas could change at any time without notice.
*On a related note, currently the FDA is working towards defining clear standards/upper limits for what can be deemed/labeled as “gluten-free” in this country.
Note from GFL President Kevin Baker: For your own health and safety, Gluten Free Lexington strongly recommends that you read FALCPA yourself, to gain the fullest understanding of what the law requires. For example, FALCPA does not apply to the labeling of products regulated by the USDA, such as meat and poultry. It also does not apply to products regulated by the Alcohol Tobacco Tax and Trade Bureau (ATTB), such as distilled spirits, wine and beer. Surprised? All the more reason to read the law. To view the FDA's own Q&A on FALCPA - as well as read the law itself - click here.
Q: How Can I Increase Variety In My Diet?
A: The #1 principle for increasing variety is to PLAN WELL! For most people, variety does not “just happen,” but is the result of thought and time in planning meals and snacks. Here are a few tips to help you…
• Brainstorm. Take time to brainstorm gluten-free foods you like on paper (create the longest list you can think of!), and then post this list on your pantry or cupboard door for reference. Brainstorming a list of foods you like can also be helpful before creating a grocery list, to make sure you have a wide variety of items on hand when it's time to eat.
To continue to add to your master "go to" food list, wander the grocery store with pen and paper in hand. Preparing this “go to” list of healthy, gluten-free foods and pre-planned meal ideas can help give you the tools you need to increase variety.
• Be adventurous! Try new foods (to you) that are gluten free. You may see a new fruit or vegetable as you wander the grocery store, and if so, try that food and decide how you can incorporate the food into your weekly or monthly food choices.
• Consider the food groups. The good news is that there are not any entire FOOD GROUPS that are off limits on a gluten-free diet. Make sure you are consuming foods from all food groups each day, and be intentional about doing so! Include starches, fruits, vegetables, meats, milk, sweets/fats daily. Set a goal to consume foods from at least 3 food groups per meal. It may be helpful to use small, frequent meals and snacks if your schedule allows. The reason this may help increase variety is that it gives you more “chances” to eat different types of foods throughout any given day.
Q: I was recently diagnosed with Celiac disease. How long do I have to follow a gluten-free diet?
A: It is imperative that you are gluten-free for a lifetime! We are not talking about a “gluten-reduced” diet, but one where you strive (to the best of your ability) to be gluten-free for the rest of your life. Years after acute symptoms of celiac disease disappear , many people begin to question whether they really need to continue to follow the gluten-free diet. They may even begin to “test ” certain foods to see whether they have symptoms from eating food containing gluten. Please do not do this! You can KNOW that it is medically necessary for you to continue a gluten-free diet long-term whether you experience any symptoms from gluten-exposure or not! The gluten-free diet is THE treatment for celiac disease, and you must continue to treat your disease throughout your life.
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