Q. I have  celiac disease and follow a strict gluten-free diet, but my recent lab tests show that somehow I've been eating gluten, (which explains my fatigue.)  I don’t understand how this can be, what are your thoughts?

A.  There are three key possibilities that might explain your unintentional gluten exposure—cross contamination and/or hidden sources of gluten.

First, here are some examples of cross-contamination, which can happen at home or eating out:


          • Using the same family toaster to toast gluten-free bread—-it’s possible to pick up gluten from the crumbs of regular bread.

 • Using the same utensil to stir regular pasta and gluten-free pasta.

• Cooking your gluten-free pancakes on the same griddle as regular pancakes, (without cleaning between batches)

          • Sharing jars of peanut butter, jam, mayonnaise and so forth with others.  If a person eating    regular  bread double-dips the knife, it can add regular bread crumbs (gluten), to the communal spread. 

Here are hidden sources of gluten that might be in the foods you are eating, whether at home or away from home:
           • Soy sauce (in many marinades, teriyaki sauces and salad dressings)

• Malt extract (in many cereals and packaged foods)

• Imitation bacon bits

• Brown  rice syrup

These are foods that are not obvious sources of gluten:

     • Bears, ales

     • Malt vinegar

     • Processed luncheon meats

     • Supplements, including herbs, vitamins and minerals

     • Over-the-counter medications

     • Kamut

     • Triticale

     • Graham

     • Spelt

It also could be helpful to check with a registered dietitian who specializes in celiac disease, in your geographic region, to help you identify the possible sources of gluten in your diet.