UNDERSTANDING COELIAC DISEASE

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UNDERSTANDING COELIAC DISEASE COELIAC DISEASE Coeliac Disease (CD) is an immune-mediated systemic disorder generated by gluten intake in genetically susceptible individuals.

2 UNDERSTANDING COELIAC DISEASE COELIAC DISEASE Coeliac Disease (CD) is an immune-mediated systemic disorder generated by gluten intake in genetically susceptible individuals. When someone with coeliac disease eats gluten, their immune system reacts by damaging the lining of the small intestine. CD is characterized by the presence of a variable combination of gluten dependent clinical manifestations, CD specific antibodies, HLA-DQ2 and/or HLA-DQ8 haplotypes and enteropathy. Once diagnosed, the only treatment for coeliac disease is a gluten-free diet. GLUTEN Gluten means a combination of proteins (90%), lipids (8%) and carbohydrates (2%) contained in the endosperm of some cereals, which can easily form a mass. The capacity of forming a mass is due to the carbohydrates which tie water but also proteins and lipids which join together and give the dough its viscoelastic and cohesive properties. Those rheological properties give the dough the capacity of retaining the gas generated on the fermentation and its expansion.

3 After baking the dough, the final product presents a porous and spongy inside structure and a crisp crust outside. Cereals which contain gluten are wheat, rye, barley, spelt, Kamut and triticale. Some people are also sensitive to oats. Gluten can be found in obvious foods such as cake, bread, pasta and biscuits but also in less obvious items such as sauces, cold meats, chocolates, yogurts and cheese by-products. It is very often used as a thickener but also as a fixer of additives, flavourings and colorants. Coeliacs cannot eat any foods made from cereals, or containing gluten as an ingredient derived from the manufacturing of cereals such as flour, starch etc but also foods in which it is included as an additive or coadjuvant. CROSS CONTAMINATION A gluten-free food can easily add gluten to its composition in different ways: - Direct contact coming from another food that has it in its composition or - by contact with a kitchen utensil or - with a surface which has traces leftovers When this happens, we say that a food has been contaminated with gluten. It is also important that cooks, kitchen helpers, waiters... check the cleanliness of hands and clothes. It is very important that all staff involved clean their hands before handling any glutenfree food and it may even be necessary to change their clothes if they could be contaminated. This process is known as Cross Contamination and together with the gluten-free ingredients, are the most important things that have to be controlled to ensure Good Handling Procedures. Coeliacs cannot eat gluten or traces of gluten. Any quantity, even if it is small can develop manifestations in some coeliac people. The response will vary from person to person, but usually being glutened means diarrhoea, vomiting, stomach pain, headaches, lethargy which can last several days. Other can be asymptomatic. In both cases, any intake of gluten damages their intestine.

4 PREVALENCE 1 in 100 people have coeliac disease. Although many are still not diagnosed it is improving rapidly because of the checks in first-degree relatives and other related diseases such as Down Syndrome, Diabetes Mellitus! LEGISLATION If you are thinking about offering gluten-free dishes, you need to understand the law to make sure you are compliant. - Regulation EC/41/2009 defines the labelling of gluten-free food and has been in force since 1 st January This law specifies the use of the gluten-free and involves the food industry, but also caterings and pre-packaged food. o o Gluten Free applies to food which has 20 parts per million (ppm) or less of gluten Very low gluten applies to special products in which gluten has been especially processed to reduce its content to less than 100ppm in the final product. Even though, Codex Alimentarius does not allow these foods for Coeliacs. If you are labelling gluten-free, you need to ensure that your dish contains 20ppm of gluten or less. - EU Regulation 1169/2011 law which defines food information to customers and has been in force since 13rd December. This law involves informing end customers or mass caterers about food information, including allergen ingredients when providing packaged and unpackaged foodstuff and also food packaged by retailer at the request of the customer.

GLUTEN FREE BURGER RESTAURANTS REASONS TO ACCREDIT YOUR ESTABLISHMENT Gluten-free is a widely recognized term and it is worth getting some of your dishes to this level and publicising this to your

5 GLUTEN FREE BURGER RESTAURANTS REASONS TO ACCREDIT YOUR ESTABLISHMENT Gluten-free is a widely recognized term and it is worth getting some of your dishes to this level and publicising this to your costumers. Eating out of the house is one of the biggest handicaps coeliac people find when they go out. Eating and drinking on the go is very difficult because only 3% of establishments (in Catalonia) can assure you of their food preparation procedures. If you can cater to their diet you will ensure your business gives confidence and reassurance to coeliac people and also to the friends and family they eat out with. Moreover, if you can provide gluten-free options you will gain a loyal customer who is likely to eat with you regularly. PROVIDING GLUTEN-FREE HAMBURGERS TO YOUR COSTUMERS GOODS IN, BUYING and STORAGE The first step in offering a proper GF Service is to be sure about the gluten content of the products you using. It is essential to review the Gluten Free Check List to ensure what kind of foods we are going to buy (annex 1). However it is very important to read the composition and also look for the International Crossed Grain Symbol. Ask for the following documents from your provider: Technical sheet in order to have complete information (composition, allergen information ) Gluten-free certification This guide has been designed taking into account that your principal ingredients are: bread, hamburgers, hot dogs, etc... Gluten-free products (GFP) must be stored in a different cupboard so as to avoid cross contamination with other products or if it is not possible to have different places, you can store them together but GFP must be in the upper part of the cupboard. In general, it is very important that gluten-free products are stored in specific containers; labelled with a visual system that makes it easy to identify them. Gluten-free products (GFP) must be stored in a different cupboard so as to avoid cross contamination with other products or if it is not possible to have different places, you can store them together but GFP must be in the upper part of the cupboard.

In general, it is very important that gluten-free products are stored in specific containers; labelled with a visual system that makes it easy to identify them.

It is very useful to have a GF Utensil Kit because it allows you work more quickly and assure there is no cross contamination.

Never put the bread directly on the griddle unless it is only used to grill Gluten Free Products.

6 In general, it is very important that gluten-free products are stored in specific containers; labelled with a visual system that makes it easy to identify them. PREPARATION AND COOKING You don t need to have a special area but it is essential that the working area is clean and glutenfree. If it is necessary, you may clean it just before the preparation. It is very useful to have a GF Utensil Kit because it allows you work more quickly and assure there is no cross contamination. Bread: Cut it in the specific area, where there are no gluten products and is clean. Bread can be grilled, baked or heated. Never put the bread directly on the griddle unless it is only used to grill Gluten Free Products. Packaged bread is very useful for baking, the package allows it to be baked in a common oven and avoids cross contamination. It is also possible to heat it in a clean microwave. Special papers or packagings are sold to improve this task. Hamburgers: You can buy hamburgers or prepare them from minced meat. In both cases, you need to make sure that they are Gluten Free. If it is possible, it would be better to buy GF hamburgers or GF minced meat so that all products can be cooked on the griddle at the same time. If you have more than one kind of hamburger, and some of them are gluten-free and others are not, you need to have two griddles in order to avoid cross contamination. Other ingredients o Hot Dogs need the same procedure as hamburgers. And if they have to be boiled before, make sure the pot is clean and use clean water. o Fried potatoes need to be fried in a separate pan or also in a separate electric-fryer for Gluten Free Products.

7 o o o o Sauces such as ketchup, mustard, mayonnaise... need to be transferred to new bottles which will be exclusively reserved for coeliac clients. These new bottles also have to be labelled and stored in specific places. It is also possible to have individual GF sachets. Toppings such as tomatoes, pickles, lettuce, bacon, caramelized onion... may be stored in specific containers kept separate until their use when you should use them with specific utensils. If one topping needs to be cooked, follow the same process as for hamburgers. Salt is GF. It is necessary to use a handheld salt-cellar. Drinks, remember that soft drinks are GF but beer contains gluten so you have to look for a GF brand. If necessary, you can use the Catalonian Coeliac Food Guide or Directory to find specific celiac products and suitable brands. GOOD HYGIENE PRACTICES The first step must always be to verify that the working area is clean and ready to use, but also the utensils. After this, all the staff involved (cooks, waiters ) have to wash their hands before starting to prepare GF Products. It may also be necessary to change the apron before food preparation if the person has previously been working with gluten products. THE FOOD SERVICE It is recommendable that all staff know about Coeliac Disease in order to give proper information to the coeliac customer and to provide reassurance if the client asks for information about food composition or kitchen procedures etc... Important points that you may take into account in order to avoid confusion or mistakes are: Identify the coeliac s place at the table by a decorative element to avoid mistakes during the service

TRAINING It is recommendable that all staff are aware of the procedures of offering a GF service, including the ingredients contained in each dish and which changes may be possible in its composition

8 Identify on your menu which products are available to coeliacs with a visible logo The plate could also be different (colour, shape ) The waiter must take note of and identify which plates are for the coeliac person and communicate this to the kitchen staff In take away establishments you may need to have suitable containers that can be stored separately so as to avoid cross contamination TRAINING It is recommendable that all staff are aware of the procedures of offering a GF service, including the ingredients contained in each dish and which changes may be possible in its composition to make it Gluten Free. All staff should receive training in handling GF ingredients, procedures to store and cook them and also procedures to avoid cross contamination and allergen composition. COMMUNICATION: LABELLING INFORMATION As mentioned before, EU law 1169/2011 says that 14 allergens need to be identified if they are used as ingredients in a dish.

9 All businesses have to provide information about allergenic ingredients used in their food preparation, so as a business offering loose food you will have to supply information for every item on your menu containing each of the 14 allergens. As you are offering products without gluten, you can also take advantage of this and identify those items which are Gluten Free. Catalonia Coeliacs Association offers you catering training in which we share our knowledge and experience of Gluten Free establishments and inform you about all the options available. If you are interested in offering Gluten Free Services, you may contact with the Catalonian Coeliacs Association.

10 ANNEX 1: GLUTEN CHECK LIST Gluten Free Cereals: rice, corn, sesame seeds, Fresh fruit and juice Vegetables, raw legumes or packaged legumes, eggs Dried fruits and nuts (toasted and dried), with or without the shell Fresh or frozen meat, fresh fish and shellfish, powdered milk (whole, semi-skimmed or skimmed, natural yogurt or flavoured yogurts Butter, vegetable or flaxseed oil Cheese White or brown sugar, honey and molasses Packages spices not ground Soft drinks, distilled alcoholic drinks, wine, cava Salt and vinegar Need to check Cereal by-products from GF cereals: pasta, flour, semolina Fruit juices with other ingredients Meat products, cold meats and patés Ready meals; Food in batter... including meat and fish powdered eggs Margarine Powdered milk, fruit yogurts, cheese byproducts (spreadable, grated...) Stock, vegetable soups, industrial sauces canned legumes Cocoa powder, cocoa butter and byproducts (Chocolate bars...) Beer Not Gluten Free Cereals: Wheat, Rye, Barley, Spelt, Oats, Kamut and Triticale

www.celiacscatalunya.org Associació Celíacs de Catalunya C.

11 Associació Celíacs de Catalunya C. Independència, 257 bxs Barcelona info@celiacscatalunya.org

Coeliac disease catering gluten-free

Coeliac disease catering gluten-free About Coeliac UK National Charity for people with coeliac disease and dermatitis herpetiformis Founded in 1968 and is the largest coeliac charity in the world Mission: