Let's say you've been diagnosed with Celiac Disease, gluten intolerance, or a wheat allergy. While the prospect of life without wheat was a hard pill to swallow at first, the bright side was that at least—finally—you'd start feeling better. Now it's been weeks since you tossed out your pretzels, said goodbye to your morning bagel, and bid adieu to those flaky croissants.
So why aren't you feeling better?
Most likely, there's still some gluten lurking in your diet somewhere under the radar. If you've reviewed all of the usual suspects—salad dressings, condiments, energy bars, restaurant meals—and are still coming up empty, here are a few more places to check for hidden gluten:
Your toaster: It may seem obvious, but when you switched from regular bread to gluten-free bread, did you switch to a brand new toaster as well? If not, your old pop-up toaster has got to go. If you have a toaster oven that can be cleaned and de-crumbed thoroughly, it may be salvageable. But if you're sharing it with others in the house, be sure to designate the top shelf as gluten-free only. By reserving the top shelf for gluten-free use, you're preventing the possibility of any wheat-containing crumbs falling onto your food or shelf surface.
The peanut butter jar: If you share living quarters with others, chances are you may also be sharing a jar of peanut butter, sticks of butter, or a tub of cream cheese. This also means your knives are all double-dipping into the same common spreads—and depositing crumbs from your respective breads in their wake. If you can't maintain separate condiments, you may need to institute a "no double dipping" policy to prevent cross-contamination: only clean knives can enter shared condiment jars, and each person should portion out what they need onto their plate before spreading it onto their food.
Your medicine cabinet: We tend not to think of vitamins, supplements, and medicines as food, so these items often get overlooked when doing a household gluten purge. But almost all pills contain inactive filler ingredients or coatings in addition to their active ingredients, and some of these are wheat derived. Since a pill travels through your digestive tract just like food does, it can easily be a source of gluten exposure. Whereas a common ingredient called "modified food starch" is virtually always corn-derived (gluten-free) when used in food, it's usually wheat-derived (not gluten-free) when it's used in medicine. To complicate matters further, many products do not even list inactive ingredients on their labels, making it impossible to assess their safety without more research. More and more pharmaceutical and supplement manufacturers have voluntarily begun printing allergen statements on their labels; but when in doubt, ask your pharmacist or call the product's manufacturer directly to verify whether your brand is gluten-free.
A co-worker's candy jar: You probably know to avoid chocolate bars with wafers, cookies, or pretzels in them, but perhaps you hadn't realized that gluten appears in a variety of other candies as well. Licorice (including Twizzlers) contains wheat flour, as do Jordan almonds. Barley malt, which contains gluten, is an ingredient in malt balls (e.g., Whoppers), and some candy bars that use crisped rice pieces, such as Nestle Crunch and 100 Grand bars. In some cases, a candy bar that is gluten-free (e.g., Butterfinger) may have a spin-off version that contains gluten (e.g., Butterfinger Crisp), so it's important to read labels for each individual product you buy. If you're a gluten-free Christmas cookie enthusiast, be aware that those decorative, edible, metal balls—called dragées—often contain gluten as well.
The Chinese takeout container: Even if you're avoiding the obvious flour-containing dishes like lo mein noodles, wonton soup, moo shu pancakes, egg rolls and General Tso's Chicken, if you're eating restaurant Chinese food, you're almost guaranteed to be eating gluten as well. Virtually all Chinese condiments—including soy, oyster, hoisin, and bean sauces, contain wheat. And these ingredients touch almost everything on a Chinese menu. If there's a group dinner being planned, and Chinese food is under consideration, try steering the festivities to a gluten-free-friendlier venue, such as a Mexican or Indian restaurant. But if its got to be Chinese, seek out a national chain that offers a dedicated gluten-free menu, such as P.F. Chang's. (I can't vouch for the healthfulness of their food or the appropriateness of their portion sizes, but at least it will be safe to eat there!) Alternatively, try bringing your own wheat-free tamari to flavor an order of steamed chicken or fish with steamed veggies and rice—and hold the sauce.
If you're still having symptoms and are stumped as to why, it may be time to visit your dietitian for a second pair of eyes on your diet. Then, check in with your gastroenterologist; she may want to evaluate you for other possible conditions that could be causing you trouble.
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Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.