ADA: Celiac & Gluten

What is the ADA?
“The Americans with Disabilities Act (ADA) is a federal civil rights law that gives protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications.”

Essentially the ADA provides the public with protection against discrimination, and provides equal employment opportunities.

How does the ADA define a disability?
Under the ADA a person with a disability is described as someone who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment.

2011 – New Regulations:
In the past it has been questionable if celiac disease, gluten intolerance and other disorders were considered disabilities under the ADA. In March of 2011 a new set of guidelines were put in place that expanded the definition of disability:

The ADAAA expanded the definition of disability by introducing a new, non-exhaustive list of major life activities that include: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working. Also, for the first time, the ADAAA has stated that major life activities will include the operation of major bodily functions, including but not limited to functions of the immune system; normal cell growth; and digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine and reproductive functions.”

Invisible disabilities:
Celiac disease is also considered an “invisible disability” under the ADA. “Invisible disabilities” is an umbrella term that captures a whole spectrum of hidden disabilities or challenges. Celiac Disease, Food allergies, and other intolerances are all considered invisible disabilities.

Family Medical Leave Act:
Celiac disease is considered a “chronic and serious” health condition, and therefore it is covered under the family medical leave act. What does this mean? Essentially this means that with a doctors note there are a specific set of rules that prevent a celiac patient from losing their job if an extended period of time is need off for celiac related reasons. If you live in Oregon, click this link for more information:

Students With Celiac Disease:
School can be especially difficult for anyone with celiac disease. Luckily, students with disabilities are covered under Section 504 of the Rehabilitation act of 1973.

What is Section 504?
“Section 504 of the rehabilitation act of 1973, a federal civil rights statute, is designed to prohibit discrimination on the basis of a disability in an educational program or institution. This prohibition extends to any educational institution accepting federal funds. Students with disabilities under this act are afforded accommodations and modifications to their educational program to ensure equal access.”

Essentially all public schools and any federally funded programs must provide equal access to all programs and services as those who are not disabled.

What about colleges?
Colleges are required to abide by section 504. The section states that if a school accepts federal funding then they must abide by the 504 act, and therefore must make any necessary accommodations. Which in turn means that schools (even colleges) must provide equal programs and services to all students.

Currently there are colleges across the nation that have began to accommodate gluten free needs. Here in the Willamette Valley both Oregon State and the University of Oregon have implemented gluten free menus.

How do I file for a 504 plan?
Documentation requirements vary by state however usually school officials will require proof of diagnosis, explanation of how celiac disease affects diet, and how it may adversely affect a person in an educational setting.

There are several resources on the web that give detailed instructions on developing a 504 plan that works for you or your child:…a%20Student%20with%20Celiac%20Disease%20-%202011.pdf

Further Assistance?
If further assistance or information is needed on this topic you can contact the Americans With Disabilities Act for more information. The ADA may provide you with a caseworker that can help you with your specific situation.




Wheat Germ Oil

Gluten Free but not Wheat Free?
It is well known in the gluten free community that wheat free does not always mean gluten free. However, it is not as well known that gluten free does not always mean wheat free. Recently, we have discovered several products labeled gluten free that contain wheat. After finding these products, our office decided to investigate further. We found that in almost all of these “gluten free” products wheat germ oil was listed in the ingredients. We wanted to know more; what was wheat germ oil, how could it be labeled gluten free, and was it harmful to celiacs and gluten sensitive individuals?

What is Wheat Germ Oil?
Most frequently used in cosmetics due to its high vitamin E content, wheat germ oil is known scientifically as triticum vulgare. The only oil that is derived from a gluten containing source; wheat germ oil is a fatty acid found in very small quantities within the small embryo of the wheat plant.

Is Wheat Germ oil Gluten Free?
Typically, when wheat germ oil is used it has been refined. The refining process in theory removes all gluten proteins, and therefore would make wheat germ oil free of any gluten proteins. Although it is likely to be a small amount it is possible for refined oils to contain trace amounts of gluten. These trace amounts may be left over from a poor refining method or from cross contamination that may occur during the process. We essentially relate this to a product that is labeled “gluten free” yet made in a manufacturing plant that also process wheat. These are products that we believe should not be labeled gluten free and most often do contain gluten.

Can Wheat Germ oil be Labeled as Gluten Free? 
There are no gluten free labeling laws in the United States. There are a set of “proposed laws” that state products under 20ppm gluten may be labeled as gluten free. Due to the low amount of gluten, these proposed laws would make wheat germ oil a “gluten free” product in the United States. Furthermore, the FDA states, “highly refined oils and ingredients made from highly refined oils are exempt from allergen labeling.” The US Department of Agriculture states “A benefit of refining oils is that the refining process renders them virtually free of allergenic protein”. This would then imply that wheat germ oil is an allergen free product, and exempt from all labeling laws.

Is Wheat Germ oil Safe for Celiacs?
According to celiac centers in the United States and Canada wheat germ oil is not a safe product for celiacs and gluten intolerant individuals. Here at the Gluten Free RN we are in agreement that wheat germ oil is not a safe product to use. We believe that using a product derived from wheat is too big of a risk to take. It is still possible that this product may contain a small amount of gluten, and we believe that any amount of gluten is too much for a gluten free diet. It is also important to remember that there are subsets of people who are both intolerant to gluten and allergic to wheat. These individuals would have a definite reaction to any products containing wheat germ oil.

 Identifying Wheat Germ oil in Products: 
Wheat germ oil is often found in beauty products and may be labeled as tocopherol (vitamin E). Although the amount of wheat germ oil found in tocopheral may be low, it is important to always contact the manufacture to insure their vitamin E is derived from a different source. If the manufacture does not know where their tocopherol is derived from we recommend finding an alternative beauty product. Remember any amount of gluten is too much!

 Wheat germ oil can also be found in edible products including chocolate, and other processed products. Our office has found that these products are labeled gluten free but not wheat free and do include “wheat germ oil” on the ingredient list. Currently we recommend keeping these products out of your gluten free diet. The manufactures may insist that the gluten protein has been completely removed from their wheat germ oil but we believe that is too bold of a statement to make. There are just too many unknowns about wheat, gluten intolerance, and the affects of wheat germ oil on a gluten free diet to allow it to be part of our diets.When it comes to wheat germ oil we will use our golden rule; when in doubt, go with out!


Where is Gluten Hiding in Your Life

We live in America and gluten is everywhere!

Below are just a few of the places gluten can hide…

Your Significant Other:
Can you get gluten contaminated from kissing someone?

The answer is yes.

When my husband reaches over for a kiss… I always have to stop and ask him; do you have gluten mouth? Although this might not seem very romantic, either is the horrible aftermath that will occur if he kisses me with a mouth full of gluten.

Update: Shortly after this post my husband went 100% gluten free. Our entire house is now gluten free including the pet food 🙂 

Gluten CAN be transferred from one mouth to the next! If your significant partner is not ready to make the switch to a gluten free lifestyle they can take a few precautions, to ensure they do not poison you.

We keep mouthwash in almost every room of the house, that way my husband can be lazy, and wash out his mouth no matter where he is. We also tote around a travel size mouthwash, and toothbrush. We also take other precautions in our home. My husband has his own gluten everything! He has his own cupboard, cabinet, pans, utensils, and plates. He also washes his hands after touching anything that has gluten in it.  We also keep gluten free sanitizer wipes in every room in case of any over spills.

Beauty products:
Gluten is hidden a lot of beauty, and cosmetic products. See our cosmetic blog:

Beer and distilled liquor:
Beverages can be tricky. Many people make the mistake of thinking their beverages must be gluten free when in fact they are not. This includes juices, smoothies, milkshakes, and any other beverages. Always make sure you know how your product is made and all the ingredients that go into that product. Some red flag ingredients in beverages are; natural flavors, caramel coloring, added preservative and manufactured in a facility with wheat.

Almost all beer does contain gluten. Luckily, there are now a large number of quality gluten free beers on the market, and the number of safe options is growing. It is also an option to try hard ciders. However, it is important to make sure the cider is labeled gluten free. Not all hard ciders are free of gluten, and wheat!

Most distilled liquors are considered “gluten free”. It is said that the gluten protein is “washed” out of the alcohol through the distillation process. However, not only have we found that many celiacs cannot tolerate grain alcohol, it is also important to be aware of cheap liquor. Several of the cheap liquors do not use a thorough distillation process, and some of the gluten proteins may still be present.

It is also important to be aware of any alcohol with coloring or flavors as these may contain some source of gluten. If you do decide to drink distilled liquor then we suggest sticking to alcohol that is not derived from a grain. Some suggestions are; rice or potato vodka, tequila, and light rum.

Gluten is used in candy to give it those stretchy elastic properties. All big name brand licorice has gluten in it. This includes; Twizzlers, Good & Plenty, and any other big name brands. There are some brands that make “gluten free” licorice, however it is important to read the label every time, and be aware of cross contamination.

Gum is one of those products that fall into the grey category. It is quite possible that most gum does contain some form of gluten. Trident is one company that is listed as being gluten free.

Soy sauce:
Almost all soy sauce has wheat in it.

San-J and Kikkoman are both companies that do make a line of gluten free soy sauces. Their products can usually be purchased at local grocery stores or through online gluten free stores.

Wheat is used as a thickening agent in almost all soups and sauces. Always read the label, and when in doubt go without. Some companies that offer gluten free soups are: Pacific Natural Foods, and The Gluten Free Café.

Salad dressing:
Salad dressing can often have a hidden source of wheat that is not displayed on the label; many companies will use wheat to help thicken the dressing. Some options for salad dressing are: Olive oil, and lemon juice, balsamic vinegar, purchase a “certified” gluten free option or make a different variety at home.

Tea and coffee:
Many people often make the mistake that all tea, and coffee is gluten free. All plain coffee grounds should be gluten free. The problem arises when flavors are added into the coffee grounds or espresso drinks. Often these flavors will have additional ingredients that may contain gluten. If you choose to drink coffee from places other than home, we suggest finding a place that you trust and knowing all the ingredients that go into your drink.

An example of this is Toroni syrup, Toroni is often used in espresso drinks and other flavored beverages. If you look at Toroni’s ingredient list it states that all their drinks are wheat free. However if you dig a little deeper you will find that five of their syrups do contain gluten. Here are the ingredients for their caramel flavored syrup: Pure cane sugar, water, natural flavors, citric acid, sodium benzoate, and potassium sorbate. Most would look at these ingredients and assume this was gluten free. Unfortunately this is one of the syrups that do contain gluten. The other syrups that contain gluten are; Bacon, SF Caramel, Marshmellow, and SF French Vanilla.

There are two issues that come into play when dealing with tea. The first is the packaging. Many companies will use gluten to help the tea bag stay closed, and this gluten can contaminate your tea bag. The other issue is that many companies often put barley into their herbal teas. There are some great options for gluten free tea; Tazo* and Celestial Seasons both have gluten free options.

*Not all Tazo Teas are gluten free. The following teas do contain gluten: Green Ginger, Honeybush, Lemon Ginger and Tea Lemonade.

Deli meat:
Almost all processed meat has some source of hidden gluten in it. When I buy lunchmeat or any other processed meat I always make sure it says gluten free on the label. If you prefer to purchase deli lunch meat, I suggest going to the supermarket when it first opens so all the counters, cutters, and knifes are clean. Then ask the deli person to help you check ingredients. Make sure that they understand that all surfaces need to be cleaned, and that they will need to change their gloves before helping you with your purchase.

Farmland Foods provides a great example of a lunch meat that may have hidden gluten. When looking at the ingredients on their deli meats you will not find any mention of gluten.

Here are the ingredients from one of their deli meats: Pork liver, pork, bacon (cured with: water, salt, sugar, sodium phosphate, sodium erythorbate, sodium nitrite), water, salt, dextrose, flavorings, sodium nitrite.

With a closer look we found this information under their FAQ section on their website we found the following information: Spice formulations from our suppliers and secondary suppliers can change from time to time and still be correct under USDA labeling requirements. Because of this, along with the possibility of cross-contamination from the secondary suppliers to our own main ingredients, we cannot absolutely guarantee that any of our products will be gluten-free.

Wheat free products
When buying processed products it is important to always read the label. If a product claims it is “wheat free” that does not mean it is gluten free. Remember gluten is not just wheat and can come from several other sources. Only buy products that are; wheat free, gluten free and manufactured in a dedicated or clean facility. Always be cautious of products that claim they are gluten free but are also made in a facility with wheat.

All medicine has the potential to contain gluten.

For prescription medicine:
We recommend always checking with your pharmacist, and doctor before talking any medicine. The Gluten Free RN office can also test any medication for $10. If your pharmacist or doctor refuses to help you find the ingredients in your medicine please let us know.

Over the counter medicine:
Did you know that beano contains gluten? It is essential to always read the label on your medicines! However, some medicines will not list all of their ingredients on the label, it might be necessary to call the manufacture to make sure it is safe.  There are also websites that provide extensive lists of gluten free medication. If you chose to use these lists make sure that all the information is up to date.

All play-doh has gluten in it! Here is a recipe to make your own play-doh at home:

French fries:
French fries from fast food restaurants are NOT gluten free. Nine times out of ten these restaurants will use a common fryer for their fries, chicken nuggets, tater tots, ect. That common fryer WILL contaminated your fries with gluten. We recommend staying away from all fast food. We believe that the risk of cross contamination is just too high. If you are craving burgers and fries it is always an option to make your own at home or find a local restaurant that can adjust to your needs.

*Be aware that not only are McDonalds Fries made in a common fryer. They are also coated with wheat and milk.

Processed food:
To be on a completely 100% gluten free diet taking out processed food may be essential. It is important to remember that even a bread crumb can trigger the same autoimmune reaction as a piece of bread.  Here is a link to an excellent resource on processed food containing gluten:

Cleaning products:
It is important to make sure that all of your cleaning products are gluten free. There are several natural cleaning products out there. Both apple cider vinegar and baking soda make great safe cleaning products.


Lapid, Nancy. “N/A.” Celiac Disease – Gluten-Free Diet. 26 Jan. 2008. Web. 09 Apr. 2011. <>.

Sarros, Connie. “Hidden Sources of Gluten.” Celiac Solution. Web. 09 Apr. 2011. <>.


Gluten Free Primer

The gluten free diet can seem overwhelming at first, but with some practice and some simple first steps, you will be on your way to a healthier life. As you start to feel better with your new lifestyle, you will see that the gluten free diet really does become easier with time.

Avoid all gluten containing foods.

This includes, but is not limited to wheat, rye, barley, malt, spelt, kamut, triticale, couscous, wheat starch, beer, oats, pasta, breads, and sweets.

Beware of hidden sources.

Gluten can be found lurking in candies, soy sauce, deli meats, cheeses, envelopes, stamps, chapstick, cosmetics, play dough, toothpaste, mouthwash, medications, vitamins and more.

Check all labels, often.

Many processed foods purchase their ingredients from the cheapest source. That means those chips you love with corn starch in them one month, may contain wheat starch the next. Make sure you check labels every time you purchase packaged food and call the manufacturer if you are unsure about an ingredient. Packaged items claiming to be “gluten free”, but processed in facilities that contain wheat should be avoided.

Check your personal hygiene products.

This is a controversial issue and many healthcare professionals will tell you that your personal hygiene products don’t matter. The Gluten Free RN disagrees. If you have dermatitis herpetiformis, there are small tears in your skin. Putting gluten containing lotions on your skin is like pouring gluten directly into your blood stream.

Check out Dessert Essence and Gluten Free Savonnerie for gluten free brands.

Clean out your kitchen.

Empty your cupboards and give the gluten containing products away. Clean out the utensil drawer. Replace your wooden cutting boards and spoons, your toaster, sponge, and bread machine. If you MUST keep gluten containing food in your house, put it in a separate cupboard on a different counter and away from the rest of the food.

Be aware of cross contamination.

This is especially important if you share the house with gluten-consuming family members. We had a patient once complain that her peanut butter was making her sick. No, it was the breadcrumbs in the peanut butter from her son double dipping his knife while making sandwiches. Ideally, you will have a gluten free kitchen. If that is just not possible, have clearly labeled separate containers for butter, mayonnaise, peanut butter, jelly, honey and anything else that you may need to spread on bread. Separate utensils and sponges and a different toaster are also important.

Furthermore, flour is airborne. If anyone is baking in your house, it is very likely that the flour has gotten onto your gluten free area. You will need to re-sanitize before eating.

Be careful eating out, even at restaurants that have gluten free menus. If they do not have a separate kitchen and are preparing gluten containing items as well, it is very likely that your dish has been contaminated. Avoid anything fried, as they probably fried croutons, onion rings or breaded items in the same oil. Bread may have been grilled in the same area that your chicken breast is on, cut with the same utensils or placed on the same counter.


Myths and Misconceptions

Myth: Children “grow out” of celiac disease.

Fact: Celiac disease is chronic. If you have ever been diagnosed with celiac disease, you will need to avoid all gluten for life.

Myth: You can be “cured” of celiac disease and eat gluten again.

Fact: Celiac disease is chronic and cannot be cured, despite what a physician, chiropractor or alternative health doc may tell you. If they tell you that you will be able to eat “a little bit every once in awhile” after their treatment- they are lying. Turn around and run.

Myth: Only really skinny people have celiac disease.

Fact: Patients with celiac disease come in all shapes and sizes. Damage to the small intestine causes deficiencies and malnutrition. Malabsorption of fat in celiac disease is especially common leading to inadequate amounts of the fat soluble vitamins A, D, E, and K. Calcium and magnesium absorption are also hindered along with essential fatty acids- linoleic and linolenic acid. These deficiencies lead to a feeling of starvation, stimulating appetite. Furthermore, low energy and fatigue, two common symptoms of celiac disease, inhibit motivation to exercise. A gluten free diet in obese individuals with celiac disease commonly leads to a 5 to 8 pound weight loss within the first week! So ditch your notion that going gluten free doesn’t apply to you and your spare tire.

Myth: In order to have celiac disease, you must have diarrhea.

Fact: Have you heard of the “iceberg of celiac disease” yet? The basic premises is the classical symptoms of celiac disease, diarrhea, bloating, and weight loss make up that tiny tip of the iceberg above the water. However, we now know that celiac disease has over 300 associated symptoms and conditions, making it particularly difficult to recognize. Constipation, neurological disorders, fatigue, weight gain, migraines, autoimmune diseases, ADHD, autism and fatty liver disease are just some of the issues making up the huge base of the iceberg under the water.

Myth: It’s an allergy to wheat.

Fact: Allergies are caused when your immune system overreacts to an environmental factor most people can tolerate, producing IgE antibodies to the food. IgE antibodies then bind to the allergen causing immune mast cells to destroy it, releasing histamine in response. The histamine is responsible for the itching, swelling, redness and/or cramping that then occurs. Wheat is considered one of the top 10 allergens, along with soy, dairy, fish and eggs. Allergies lead to quick, defined responses and are something that can be outgrown.

Celiac disease, on the other hand, is an autoimmune disease and can’t be defined in such a cookie cutter fashion. Exposure to gluten causes the immune system to produce antibodies to the protein gliadin as well as auto-antibodies. These auto-antibodies mistakenly damage specific organs and tissues. Common targets of the auto-antibodies in celiac disease are the small intestine, the insulin-producing islet cells of the pancreas, and the nervous system. There are over 300 associated symptoms to celiac disease and reactions to gluten usually do not occur immediately.

Myth: It doesn’t matter if my personal products have gluten in them.

Fact: The information available to this question is completely inconclusive. It has been argued that the gluten protein is too large to be absorbed through your skin. The Mayo Clinic in fact, specifically talks about how gluten in your skin care products does not matter, and suggests that any reaction to such products is only due to an underlying allergy, such as to wheat. However, those with skin rashes like dermatitis herpetiformis have tiny micro-tears in their skin. By putting on wheat germ oil or triticale containing products, they are essentially pouring gluten directly into their blood stream.

I have seen reactions to gluten containing skin products in several of my clients, including myself, over the years. It is my opinion that living gluten free means replacing your personal products as well. Try Gluten Free Savonnerie or Desert Essence if you are interested.

Myth: Celiac disease only affects your gut.

Fact: Dermatitis herpetiformis, insulin dependent diabetes, migraine headaches, osteoporosis, depression, ADHD, rickets, hepatitis, brain atrophy, infertility, thyroid imbalance, cardiac abnormalities, lymphoma, and bronchiectasis are just some of the over 300 symptoms associated with celiac disease. Every organ and tissue in the body can be affected by gluten.

Myth: Celiac disease is common in Europe but rare in the United States.

Fact: Just because you don’t see something does not mean it doesn’t exist. Celiac disease is diagnosed much more in Europe than in the United States. The prevalence of celiac disease in both the US and Europe is currently estimated at about 1%. The Gluten Free RN suspects that this estimate will continue to increase in the next few years.

Myth: Only white people get celiac disease.

Fact: A study by Dr. Carlos Catassi found that 5.6% of Saharawi children had elevated endomysial antibodies, a common marker of celiac disease with 100% specificity. Celiac disease has been reported in Southern Asia, the Middle East, Brazil, West and East Africa, and in South American Indians in Chile. Celiac disease affects all humans, regardless of race, gender or age.

Myth: My test was negative so I don’t have celiac disease.

Fact: One negative test for celiac disease does not rule you out.  First, these tests can give a false negative (see Serological Test). Second, you must be on a gluten containing diet to have a positive test. Third, levels of antibodies in the blood can be cyclic, meaning a patient can have a negative test one month and a positive test the next. Plus, just because you don’t have celiac disease now, that does not mean you won’t get it in the future. Dr. Karin Larsson in Sweden recommends screening children with type 1 diabetes for celiac disease every year for at least 3 years. If you suspect celiac disease, Gluten Free RN suggests you do the same even if your doctor said you are “ruled out”.

Myth: Gluten free food doesn’t taste good.

Fact:It does. Just last night I had chips and salsa, lamb chops with mashed potatoes, and bananas foster over vanilla ice cream. We have been known to eat gluten free fish and chips, cupcakes and cinnamon rolls here at the Gluten Free RN office. I believe that this comment stems from ignorance of what the gluten free diet contains and misconceptions that gluten containing bread needs to be at every meal. It is true, gluten free alternatives to baked items have come a long way and to those who endured the gluten free “canned bread” days of the 1950s- I apologize. But, if you think you won’t eat well on a gluten free diet I challenge you to stop by Andina’s in Portland or Living Earth Bakery in Corvallis. Bon Appétit!

Myth: The gluten free diet is expensive.

Fact: It can be. Yes, gluten free breads do cost more than gluten containing ones, and tapioca and rice flour cost more than wheat flour. In the beginning a lot of people replace their gluten containing foods with gluten free alternatives, which usually cost more. However, there are some tricks that can help you keep these costs down. Make your own breads with a bread maker and buy the “flours” from Big River Grains. It may take awhile to find a good recipe but the warm smell of freshly baked GF bread is worth it. You may realize that you don’t need these packaged alternatives after all. Experiment with other gluten free starches as alternatives to bread at meals. Rice is low cost and easy to prepare. Quinoa is delicious. Even potatoes are versatile, cheap and familiar.

Myth: The gluten free diet is a fad diet.

Fact: True, there have been some claims lately about gluten free as a new weight loss miracle. For some it is, but for others who are underweight or average weight going gluten free have no effect, or actually lead to weight gain. Mostly, I hear this comment a lot from people who have noticed words like “celiac” and “gluten” everywhere recently. I think it is wonderful! The United States is finally recognizing one of the most common autoimmune diseases and taking note that it can actually be completely controlled by diet. This is hard for our Western medicine brains to wrap around, but until are diagnosis rates increase from 3% to 100% in the estimated 1 out of 100 Americans with celiac disease, you will continue to see this “fad diet” increase in popularity.