If you're the parent of a child with coeliac disease and juggling two toasters and multiple cooking utensils to avoid cross-contamination, then you're not alone. It's common advice given to those who need to maintain a gluten-free diet.
According to a new study, however, gluten transfer in common cooking activities, such as toasting and making pasta, may be lower than once thought, with simple hygiene reducing or eliminating gluten transfer entirely.
"So many coeliac parents, including me, have taken every precaution to prevent a gluten exposure in our homes," says study co-author Vanessa Weisbrod, executive director of the Celiac Disease Program at Children's National Hospital. "In many cases that means having two of everything -- toasters, knives, and pasta pots, with little or no hard evidence showing we needed to."
That lack of evidence was something she and her team wanted to address, noting that fear of gluten exposure is common among those with coeliac disease and often leads to hypervigilance and decreased quality of life.
As part of the research published in the journal Gastroenterology the Children's National Hospital team assessed three scenarios; toasting bread, making cupcakes and cooking pasta, to determine whether gluten transfer could be high enough to pose a gluten exposure risk for someone with coeliac disease. In general, according to the authors, this is greater than 20 parts per million (ppm) or .002 per cent.
And here's what they found:
Toasting: When gluten-free bread was toasted in the same toaster as regular bread, gluten level levels remained at less than 20 ppm. This was even the case when regular bread crumbs were present at the bottom of the toaster.
Making cupcakes: Just like the toast, gluten levels remained below 20 ppm in most cases when a knife used to cut regular cupcakes was then used to cut the gluten-free variety. This was even the case when visible crumbs were stuck to icing on the knife.
Pasta: When it came to pasta, however, the story was a little different. Cooking gluten-free pasta in the same water as regular pasta caused "significant gluten transfer" up to 115 ppm. But it's not all bad news. If the gluten-free pasta was then rinsed under tap water after cooking, the transfer dropped to less than 20 ppm.
And here's where it gets even better: simply rinsing the pan before reusing meant gluten transfer was "undetectable".
While Weisbrod acknowledges that the sample was only small, the results gives her hope that, "someday soon we'll have empirical evidence to reassure the families we work with that their best defence is not two kitchens -- it's simply a good kitchen and personal hygiene. And, that we can travel to grandma's house or go on a vacation without worrying about a second toaster."
Dr Benny Kerzner, senior author and director of the Celiac Disease Program at Children's National, calls the findings "compelling".
"These are areas of the kitchen where today we coach families to exercise an abundance of caution," he says of the three scenarios tested, adding that the researchers still recommend following all guidelines from your coeliac care team to prevent cross-contamination until further study has been completed.
"The results are compelling enough that it's time for our larger coeliac community to look at the current recommendations with a critical eye and apply evidence-based approaches to pinpoint the true risks for families and eliminate some of the hypervigilant lifestyle changes that we sometimes see after a family receives a coeliac diagnosis," Dr Kerzner says.
According to the study authors, it's important for patients with coeliac disease to continue to ask questions about preparing gluten-free food, "while at the same time recognising that some practices may present a higher risk than others and vigilance must be directed appropriately."
The impact of that vigilance is not to be underestimated.
"The treatment burden of maintaining a strict gluten-free diet has been compared to that of end-stage renal disease, and the partner burden to that of caring for a cancer patient," says Marilyn G. Geller, chief executive officer of the Celiac Disease Foundation. "This preliminary study is encouraging that this burden may be reduced by scientifically evaluating best practices in avoiding cross-contact with gluten.
According to Coeliac Australia, coeliac disease affects on average approximately 1 in 70 Australians. It affects both males and females and people of all ages. They Sydney Children's Hospital notes that it rarely occurs before 12 months of age, but can affect children of any age after they start eating foods containing gluten.