Cross-contamination is defined as the unintentional process by which gluten is transferred from one substance to another. Cross-contamination is a really big problem for those with celiac disease living a gluten free lifestyle. It is essential to learn the sources of cross-contamination as they often are not obvious. You can spend a lot of time planning and preparing gluten free food, but all of your efforts go to waste if your work is contaminated.

This is one of many examples to help you understand the concept:

For the sake of this example let's say that no one living in your home has celiac disease. Your good friend with celiac disease comes over for a Saturday morning visit. You have a supply of homemade strawberry jam you would like her to try. You have some gluten free bread you keep on hand in your freezer. You pull a piece out and throw it in your toaster. Next, you get out the strawberry jam to spread on her toast. You are sure this is gluten free because there is no gluten in her bread, nor is there gluten in the jam you made. . . WRONG! There is gluten everywhere in your toaster and there is no doubt her toast came into contact with those crumbs. There is also gluten sprinkled throughout your jam from the crumbs that have collected. You just glutened your guest! Of course, your intentions were good, but the outcome will not be so fun for your friend.

The example above illustrates some pretty obvious sources of cross-contamination. Many sources are not so obvious which you will learn as you continue reading.

First, read on to learn why preventing cross-contamination is important.

Cross-contamination causes an immune attack

Celiac disease is an auto-immune disease which means the immune system recognizes gluten as bad, in other words, your enemy. With auto-immune disease, your immune system is actually fighting against you instead of working for you. After gluten is ingested, antibodies are created to fight against gluten causing an immune reaction. This reaction occurs in the lining of the small intestine and results in severe inflammation and damage to the intestinal lining.

Antibody levels measure disease activity

As a physician assistant in family medicine, I see and treat people with celiac disease and we measure antibody levels to see how well the disease is controlled. The most useful and reliable antibody test is called tissue transglutaminase antibody. This blood test will tell you the amount of antibodies that are floating around in your blood stream. Normal antibody levels mean you are doing an excellent job of avoiding gluten and sources of cross-contamination.

High antibody levels mean your body is in a continuous state of fighting something bad; this immune reaction is not normal and leads to serious damage to your small intestine. You may not have any symptoms whatsoever, but if you were to look inside your intestine, you would see an angry mess.

Why is this important? Because your small intestine plays a major role in digesting and absorbing essential nutrients from your food. Poor intestinal function = poor nutrition = bad health consequences. These consequences include growth delay in children, anemia, osteoporosis, infertility, neuropathy, memory and psychological problems, even a rare type of cancer.

It takes just traces of gluten to cause this destructive immune reaction. Small amounts of exposure through cross-contamination are just enough to cause this negative chain of events. For many people, cross-contamination is the reason they are not getting better. Therefore, it is a very important subject.

Normal antibody levels should be your goal

It is important to have this blood test about six months after diagnosis, and again one year after diagnosis. If your levels are dropping down into a normal range - you are in great shape, and you are using good practices to prevent cross-contamination. If your levels remain above normal - and you feel you are doing everything right - you are likely experiencing a problem with cross-contamination.

Read more to discover where you can find those sneaky sources of cross-contamination.

Let's take a tour through the kitchen and talk about some sources of cross-contamination. As I mentioned in my introduction to our gluten free lifestyle: gluten hides and lingers on surfaces in small cracks, crevices, corners, scratches, holes, and pores.  

Here's where you will find it:

Certain foods are likely to be cross-contaminated with wheat. This usually happens during harvesting or at some point during the manufacturing process.  Refer to my spectrum of risk as a guide. Unfortunately, sources of cross-contamination do not have to be disclosed on your food labels.  Don’t hesitate to call the manufacturer of the product to ask about the possibility of cross-contamination. Items labeled gluten free should be safe and free of cross-contamination. 

Remember, you can never go wrong with fresh foods: fruits, vegetables, eggs, unprocessed meats. These are always the safest and healthiest choices.

Restaurants are notorious for cross-contamination. Unless the restaurant is 100% gluten free it is very difficult to follow strict protocols that will keep your food safe. Be very cautious, even if menu items are labeled gluten free. Learn more about restaurants in my article entitled How to Find Celiac Safe Restaurants.

Now you are able to identify sources of cross-contamination. You are doing great! Your next step is learning how to prevent exposure to these sneaky sources of gluten. Read on to learn more.

If you are living with someone with celiac disease, or responsible for preparing gluten-free food on a regular basis, you definitely need to invest in some new cookware. Make sure you keep it separate from other kitchen items. You can label your new gluten free items and store them in their own designated space. Gluten Free Labels is a company that makes dishwasher safe labels just for this purpose. They are so handy!

New purchases I would suggest include a toaster, frying pan, colander, cutting board, pizza cutter, a new rubber spatula, whisk, turner, and possibly a handheld mixer or KitchenAid (depending on how much you cook and bake). It's also a good idea to invest in some new plastic Rubbermaid storage containers. If you like to use a waffle iron or griddle you will need new ones that you can designate as gluten free. You can find my very favorite kitchen tools under my favorite products page.

In order to prevent cross-contamination, it is ideal to purchase new items, however, I realize this is not always feasible. If this is the case, do your best to clean up your old kitchen supplies as well as possible. You can’t beat a good scrubbing with warm soapy water followed by a hot cycle in the dishwasher. It may not completely remove the residue - but it certainly helps!

Items you can safely continue to use include glass plates, bowls, cups, and silverware. Also, stainless steel bowls, utensils, pots, and pans. Before you start your gluten free diet, wash everything up really well to remove any traces of gluten that may be present.

You may also continue to use your cookie sheets, muffin pans, pizza pans, and other baking pans - even if there are old baked-on stains. The easy solution is to use a protective sheet of parchment paper or tin foil and voilà - you’ve got yourself a clean surface. I personally love parchment paper. Nothing sticks to it and it is very affordable. I use it to cover my cookie sheets, pizza pans, cake pans - everything. Same concept when you use liners in your muffin pan. I continue to use the sturdy baking pans that I received for wedding gifts over 20 years ago. You can sure get new ones if you wish, but this method has not failed in our home.

I will add that you cannot cover your grill grates with parchment paper - but foil works great for the grill.

Next, you need to prepare a space for gluten free food products. I recommend a cupboard space, pantry shelf, or whatever works in your kitchen! You will definitely need separate supplies of peanut butter, butter, and jam. Be sure to label these things so they do not accidentally get contaminated. Since all four of our children have celiac disease, our kitchen is completely gluten free (well, 99.9% gluten free). My husband and I do not have the disease, but it works best for our family for everyone to eat the same. And it certainly reduces a lot of headaches in the kitchen!

The one thing my husband cannot give up is his peanut butter and jelly sandwiches and his chocolate-covered granola bars. We keep his stash of gluten in a little corner cupboard and the kids know this little area is off-limits. With the amount of food our kids eat (which is enormous), we ended up turning our broom closet into a gluten free pantry. Lee got this amazing wire shelving system on Amazon and it has been the best investment. If you need more storage space for kitchen items, I advise you to get creative and invent a space or rearrange a space to accommodate your needs.

The topic of safe restaurants has it's very own post with everything you need to know. Click here to learn more about how to choose celiac friendly restaurants.

You now know the importance of a kitchen makeover. Of equal importance is the process by which you prepare the food in your kitchen. Most of you will very likely be preparing foods with and without gluten at the very same time. It is SO incredibly easy to cross-contaminate as you prepare these things simultaneously. It is less likely if you have a separate space or area to prepare your gluten free food.

Another option is to prepare gluten free foods in advance so they are not handled at the same time as foods containing gluten. Remember SURFACES (including your hands) and UTENSILS are your major culprits for cross-contamination. Surfaces include countertops, cutting boards, utensils, pans, and your OWN HANDS. That’s right - you must remember to wash your hands as you go back and forth between foods as you prepare them. You have to clean up countertops, cutting boards, and surfaces that may be covered with crumbs or pieces of food containing gluten. Utensils including pizza cutters, turners, mixing spoons, whisks, and spatulas must not be shared between foods (unless they are washed very well in between).

I am going to give you an example that demonstrates incorrect and correct methods of gluten free food prep. This will give you a better understanding of the process of cross-contamination and how it can be prevented:

First, the INCORRECT example:
You are making a gluten-free grilled cheese sandwich for your child's friend with celiac disease. You have a loaf of gluten free bread in your freezer. You pull a few slices off the frozen loaf and place them in the microwave to thaw. You lay them on the microwave plate that is covered in crumbs. While the bread is defrosting you pull the tub of butter out of the refrigerator. You remove the bread slices from the microwave and butter them with your butter that is full of toast crumbs. You lay the buttered bread in your old, scratched-up, non-stick pan. At the same time, you decide to make your own child a grilled cheese in a separate pan using regular wheat bread. You butter your child's bread, place it in the other pan and get out the cheese slices. You place the cheese on each sandwich. You get out the turner and flip your child's grilled cheese then flip the gluten free grilled cheese. After a few minutes, they are nice and toasty and ready to eat. You use the turner to get them out of the pan and serve them up to the hungry kids.

Now, the CORRECT example:
You are making a gluten free grilled cheese sandwich for your child's friend with celiac disease. You start by washing your hands. You have a loaf of gluten free bread in your freezer. You pull a few slices off the frozen loaf and place them on a clean plate. You place them in the microwave to defrost and get out a new stick of butter to butter the gluten free bread. You lay the buttered bread in your stainless steel pan that you washed with warm soapy water. At the same time, you decide to make your own child's grilled cheese in a separate pan using regular wheat bread. You butter your child's bread and place it in the other pan. You wash your hands before getting cheese slices out of the refrigerator. You open up the cheese slices and place them on the gluten free sandwich first, then on the regular sandwich. You wash your hands again and find two clean turning tools and flip your child's grilled cheese with one and your gluten free grilled cheese with the other. After a few minutes, they are nice and toasty and ready to eat. You remove them from the pan with their designated turners and serve them up to the hungry kids.

The example above demonstrates many common cross-contamination mistakes. These are the mistakes listed in order (which are bolded in the paragraph above):

1. The crumbs on the microwave plate contaminated the gluten-free bread
2. The butter from the tub contaminated the gluten free bread
3. The scratched up non-stick pan contaminated your gluten free bread
4. Your hands contaminated the cheese after touching the wheat bread
5. The turner contaminated the gluten free sandwich after it was used to flip the wheat bread sandwich
6. The turner again contaminated the gluten-free sandwich when it was used to remove it from the pan and serve it

These are the correct steps listed in order (which are bolded in the paragraph above):

1. Hands were washed before any food prep took place - always a good habit in the kitchen
2. The gluten free bread was placed on a clean plate before being placed in the microwave
3. A fresh supply of butter was used to butter the gluten free bread
4. A steel pan without scratches was used and washed well before use
5. After touching the wheat bread you washed your hands before handling the cheese
6. Separate, clean turners were used for flipping and serving the sandwiches

Reading these steps may seem overwhelming, but with practice and repetition, the process becomes habit. I created a post summarizing the steps to take in the kitchen to keep your food safe. To go along with it, I created two printable graphics (see below) entitled CRUMBS and LAWS that illustrate and simplify this process. Now that you have a better understanding of how to prevent cross-contamination, take a look at these graphics. Print them off and post them in your kitchen to serve as a visual reminder of everything you have learned.

I created a step by step guide to follow as you read labels. This is your no-fail guide to choosing safe foods. It takes into account sources of cross-contamination. I suggest you print my label reading flow chart to go along with it.

Also, use this spectrum of risk as a general guide as you are choosing foods.

Remember, fresh foods (things without a label) are always your safest choices: fruits, vegetables, eggs, unprocessed meats, fish, poultry.

Ok, you've learned all about cross-contamination:

• What it is
• Why it's important
• Where it is found
• How to prevent it

Only one thing left:  When to start following a strict gluten free diet. Read more to learn. This is the final step.

You've Got This!

Use these resources as your guide

• Quick Guide to Safely Preparing Gluten Free Food
• Think CRUMBS To Prevent Gluten Cross Contamination
• Follow These LAWS To Prevent Gluten Exposure
• Identifying Gluten on Food Labels: Become a Master in Minutes!
• Flow Chart for Reading Labels
• Risk Of Containing Gluten Risk Chart

You might be asking yourself, When is the right time to implement my gluten free diet? The answer: when you receive the official diagnosis of celiac disease, it is time to get started. If you have elevated blood antibody levels, the diagnosis is quite likely, and most of the time your health care provider will recommend an endoscopy to prove the diagnosis. They will advise you to continue eating gluten leading up to the scope. Eliminating gluten before your scope could lead to healing that may make the diagnosis harder to confirm with the biopsy. Once your scope is completed, and your diagnosis is confirmed, you should not delay implementing a gluten free lifestyle. If we can manage this in our house, I know you can do it too! This website was created to help you!

Check out these articles to help kick-start your gluten free lifestyle:

• Identifying Gluten on Food Labels: Become a Master in Minutes
• Quick Guide to Safely Preparing Gluten Free Food.

You've completed the articles on cross-contamination. You are now are equipped with the knowledge you need to be successful on your journey. It is OK to feel overwhelmed at first. No fun, but perfectly normal to feel this way. It took us a lot of trial and error and a whole lot of practice. Nothing is perfected without practice. Don't give up.

You Can Do This!