2018 National Conference Recap

Courtesy Calgary Chapter

The CCA’s Ottawa Chapter hosted the 2018 National Conference and it was a tremendous success! Not only did we have nearly 300 delegates (more than we’ve seen in years), but we also were able to break new ground by having a presentation on neurological issues and celiac – a rapidly developing but lesser-known area of celiac disease research.

Held at the majestic Shaw Centre in downtown Ottawa, the location was great for tourism – right by Parliament Hill, the Rideau Centre, the Byward Market and more. The conference received rave reviews from attendees and we thank the Ottawa Chapter for all the work put into this event. If you weren’t able to make it, we’re pleased to provide some of the key points from three featured speakers.

Dr. Marios Hadjivassiliou gave us a thrilling presentation on the neurological manifestations of celiac disease.

  • “Classic” celiac disease is no longer the norm. More and more we are seeing neurological issues. It’s possible to have no digestive issues, just neurological issues, and be celiac. Going gluten-free is critical to help alleviate these symptoms.
  • Early diagnosis when gluten ataxia is present can help save the patient from much hardship.
  • Balance issues and vertigo are red flags. Celiac can also interfere with speech, coordination, strength.
  • Gluten neuropathy – loss of sensation/tingling, can be numbness and pain. Accounts for 26% of all neuropathies.
  • Gluten ataxia equally common between men and women, study shows. Only 50% of them will be celiac.
  • With gluten ataxia, we can see damage to the cerebellum – damage that is often permanent.
  • Gluten ataxia in some cases linked to refractory celiac disease, which can be very difficult to treat.
  • There is a strong connection between headaches and patients with celiac disease. Some ataxia  patients get horrific headaches. You wouldn’t automatically assume that’s celiac!
  • Antibodies from gluten exposure can cross-react with neural tissue. The cerebellum is what’s primarily impacted for ataxia in these cases, but other areas of the brain can be impacted as well.
  • Some neurological patients show a poor response to the gluten-free diet. Reason most often is poor diet adherence, but there could be other issues as well.
  • Some patients say they feel like there’s a big cloud over your head, things are hazy, as if you’re just going through the motions of life.
  • Physiotherapy has been found to be able to help when there has been gluten ataxia damage to the cerebellum. Easier for younger people.
  • We know that depression and anxiety levels are higher in those with celiac disease.
  • Studies in our clinic found that half of people with ataxia showed enteropathy.
  • Ataxia patients get MR spectroscopy scans, show great improvement for celiacs once the gluten-free diet is adopted.
  • Age of diagnosis for a classical-symptomed celiac is 44, versus 53 for those with the neurological presentation.
  • Even if you’re on a strict gluten-free diet, gluten ataxia can persist. Depends on the patient and antibody profile.
  • Seizures can be associated with celiac. Specific type of epilepsy, seems to be more common in Italy and Argentina.
  • Since screening programs implemented in Finland, fewer cases of dermatitis herpetiformis have been reported.
  • If a celiac still has neurological symptoms on the gluten-free diet, he or she should repeat the blood work and the endoscopy. If everything looks healed/compliant, there may be a need to use immunosuppressants.
  • Some patients with schizophrenia showed improvement on the gluten-free diet, but we can’t say that there is a clear link. More research is needed.

 

Dr. Joseph Murray provided an overview of the latest research from the world of celiac disease.

  • There are drugs that can damage the intestine to make it appear like celiac. There are other conditions that can also mimic the damage. Beware.
  • People with celiac disease should test their thyroid function every 4-5 years, as there is a strong link between celiac disease and thyroid disease. Both are autoimmune.
  • Cannabis is soon to be legal in Canada. Cannabis is better than over-indulging in alcohol and better than smoking cigarettes, but there are still negative impacts to watch out for. There has been no research on whether cannabis could help people with celiac disease.
  • Whether global warming is impacting celiac, who knows. It may be changing how wheat grows, how it adapts, etc.
  • In northern climates, we see more multiple sclerosis, just like we see more celiac disease.
  • Perhaps related to vitamin D? More research is needed.
  • If you’re a mother who is diagnosed with celiac, test your children NOW. Before you turn your house totally or partially gluten-free.
  • Being “very positive” on the celiac tTG blood test doesn’t really impact the level/severity of symptoms. Positive is positive.
  • Celiac was considered a rare disease in the past. We found 0.2% in testing in the 1950s. Definitely far higher now  1%, or 5x what it was.

 

Dr. Justine Dowd presented her research, partially funded by the CCA, on evidence-based holistic approaches to celiac disease management.

  • Many people with celiac disease are misdiagnosed with IBS first. Or some, like me, are “lucky” enough to have both.
  • I struggled for a long time with infertility and was misdiagnosed. Getting finally diagnosed as celiac led to huge improvement.
  • Those who adhere the best to the gluten-free diet are those who were in dire straits when diagnosed, awful symptoms. They do not want to take any chances at going back to how things were.
  • We need to retrain our nerves so that we can feel well. Brings in the idea of self-compassion.
  • There is a strong connection between gut health and mental health. Lots of research in that area. More incidence of depression, anxiety and other mental health issues among those with celiac disease.
  • Research shows that people are more likely to be kind to others than to themselves. Self-compassion is needed, giving ourselves the same kindness. Mindfulness over overidentification, common humanity over isolation.
  • We’re looking at exercise and effect on microbiome. Does being active make a difference?
  • Vagus nerve is key – connects gut and brain, promotes rest and digestion. Also need to reduce stress as much as possible – and cope with it, where elimination is not possible.
  • We have over 1,000 different bacteria species in our gut. Strong link between exercise and gut health.
  • Can be higher risk of excess abdominal fat, high blood pressure, high blood sugar with celiac patients. May be due to excess consumption of processed GF foods. Can lead to metabolic syndrome.
  • The app @myhealthygut is free to get started, and has additional features available ($). The dietary tracker and journal can help to figure out why you may still have symptoms. Then you can email it to your health care provider.
  • For newly diagnosed, we need to teach them self-regulatory skills. That’s what she is researching at the University of Calgary.

In addition, the conference included presentations on nutrition, gluten-free lentils and grains, and baking GF and vegan, as well as updates from Health Canada and the CFIA.

Next year’s conference will be in the Toronto area, likely in late May. Stay tuned for more details!

If a Product Does Not Contain Gluten Ingredients, Why Isn’t It Labelled Gluten-Free?

The Canadian Celiac Association Answers the Facebook Question of the Month

Why doesn’t procduct X have a “gluten-free” claim on it? There are no gluten ingredients listed.

CCA LogoIn Canada, not having gluten ingredients is just one of three criteria for a gluten-free claim. The other requirements are that the food must meet the criteria of a food for special dietary use and it must not contain gluten from uncontrolled contamination in the ingredients or manufacturing process.

A food for special dietary use is “… a food that has been specially processed or formulated to meet the particular requirements of a person a) in whom a physical or physiological condition exists as a result of a disease, disorder or injury;”. In other words, a gluten-free food must be specifically made for someone with celiac disease.

A jar of jam may not contain any gluten ingredients but it cannot be labelled “glutenfree” unless the manufacturer takes specific steps to confirm that there is no gluten.  Because a product must meet all three of these requirements to make a “gluten-free” claim, there are many products on the market that are safe for someone with celiac disease, even though they do not carry a gluten-free claim.

Low Risk
Some of these products are essentially unprocessed including fresh fruit, vegetables, seafood, dairy, and meat. Others are products where no gluten ingredients are used in most or all of the products in the category including jams and jellies, butter, yogurt and cheese.

High Risk
There are some products that are at a higher risk for gluten contamination. The CCA recommends that you look for a “gluten-free” claim on those products. They include baked goods, breakfast cereals, flour and nuts. For lower risk products, we recommend that you make your decision based on the ingredient labelling information provided on the package.

Distilled Liquors: Are they Gluten-Free?

By  Val Vaartnou

I responded to an info line question requiring Grey Goose Vodka and whether it was glutenfree. I gave the standard response to the query that as vodka was a distilled alcoholic beverage like rye whiskey, scotch whiskey, gin and vodka they are distilled from a mash of fermented grains. Rum is distilled from sugar cane. Brandy is distilled from wine and bourbon is distilled from a grain mash including corn. Since the distillation process does not let the proteins enter the final product, distilled alcohols are gluten-free. (CCA Pocket Dictionary).

The individual asking the question said that after talking with a fellow celiac, he had been told this could not be true, as ingesting vodka causes significant celiac symptoms in his friend. I forwarded this to Sue Newell who provided this thoughtful response. I thought I would share it you as it may explain issues you may have with distilled alcohols.

I know I don’t have to tell you that not every reaction is due to gluten. Alcohol is rarely consumed in isolation from food, but somehow the alcohol always get the blame! In addition to alcohol, the other component that survives distillation is congeners. These are the flavouring agents and other components that are light enough to be carried in water vapour or that convert to gas at a lower temperature than the boiling point of water.

Most congeners are innocuous but some are rather nasty, including small amounts of chemicals such as methanol and other alcohols (known as fusel alcohols), acetone, acetaldehyde, esters, tannins, and aldehydes (e.g. furfural). If someone has a sensitivity to any of these items, they can show a variety of reactions and depending on the dose, can become quite ill. Usually, the first 5% of distillate is discarded to get rid of some of these substances. When you hear about alcohol that has been distilled multiple times, it is to
remove some of these compounds.

Different grains have different types and levels of congeners. As a result, it is possible for people to react to one brand but not another.  I can almost guarantee that this correspondent is not going to believe this information. That is common and is one of the reasons why so many rumors continue to exist.

Thanks Sue for your always knowledgeable response.

Best Foods to Stock in Your Kitchen

by Val Vaartnou

food-potluckSo you’ve been diagnosed with Celiac Disease and you worry that there will be nothing to eat because “everything” contains gluten. Yes, gluten does lurk everywhere, but there are great foods that you can enjoy and get the added benefits of reducing your inflammation in the body while eating for your health.

Keeping it simple is one of the first recommendations that I make to anyone diagnosed with Celiac Disease. Eating lots of fresh fruits and vegetables in as many colors as you can find and eating lots of lean meats is the best start. Your kitchen staples should include staples that are readily available to give you a varied diet.

Note: Grain, nuts, and seeds have the most risk of cross-contamination from gluten of all foods. In the field, during processing and packaging, the processes must be monitored to ensure gluten does not contaminate them. Ensure the manufacturer has marked grains, nuts, and seeds as gluten-free on the packaging.

Dairy products are fine unless you are also lactose intolerant. Aged cheeses and low sugar yogurts, especially greek yogurts are less problematic. Goat yogurts and cheeses are sometimes good alternatives.

Fresh fruits: In the winter, pomegranates, apples, pears, bananas, and in my freezer for smoothies, frozen berries (raspberries, blueberries, cherries and blackberries!). During the summer, visit the farmer’s market and enjoy the fresh fruits of the season.

Fresh herbs: like ginger, turmeric, chives, parsley, cilantro, rosemary, and basil. I cook with them and throw them in my salad, too. Cilantro and parsley are great as they help to detoxify the body.

Fresh veggies: Spinach, chard, kale, arugula, beets, broccoli, cauliflower and brussel sprouts. radishes, jicama, scallions, and fennel for my salad. Again the farmer’s market is great to pick up fresh local vegetables.

Healthy fats: Avocado, olives, oils (avocado, coconut, olive), ghee (check out online recipes to make your own), seeds (chia, hemp, flax, pumpkin or sunflower seed), full-fat coconut milk.

Healthy grains: Quinoa and wild rice are my favorites. Try some different grains for variety, for example, millet, teff, and sorghum. If you are very strict on your gluten-free diet and still find your symptoms continue, you may find that the elimination of all grains is required. Eliminate them all for a few weeks and then reintroduce each grain, one at a time, eating it daily for a few days. Listen to your body and your symptoms. You may find you can tolerate some grains better than others.

Healthy proteins: Turkey, chicken, salmon, sardines, mung beans, adzuki beans, lentils (again marked gluten-free by the manufacturer), hummus (chickpeas).

Healthy snacks: Whole nuts and seeds, or nut butters (cashews, almonds, Brazil, macadamia, coconut, sunflower, walnut), nori (seaweed), 70% or higher dark chocolate.

Spices and condiments: Cinnamon, cumin, curry powder, coriander, turmeric,
ginger, black pepper, sea salt and dried herbs.

Pantry staples: canned beans (chickpeas, kidney, and black), canned tuna and salmon, gluten-free minimally-processed crackers (Mary’s Gone Crackers for example), artichoke hearts, sardines.

Gluten-free processed foods are fine for treats but should not be the foundation of your diet. Unfortunately, gluten-free foods are often high in fats, sugars, and salt so reading the nutritional label is always required, not just to ensure there is no gluten, but to ensure that you are not eating empty calories.

Action Needed By Sept 14: Write Govt On New Beer Labelling Regs.

gluten-free-beer

gluten-free-beerThe Government of Canada is proposing to amend the compositional standards for beer and ale, stout, porter and malt liquor. Their aim is to modernize the Food and Drug Act to recognize the new variations of beer, flavourings and preparations.

In addition to this review, the Government is also recommending to require beer manufacturers to declare allergens including gluten on their product labels.

As the voice for people adversely affected by gluten, the Canadian Celiac Association, with assistance from the Professional Advisory Council, has submitted its response in support of the proposed amendments. View our response here.

Pour on the support by September 14.

Why do we need your help?
During amendments to the regulations in 2010, the beer lobby was very effective in influencing politicians and bureaucrats to not be included in regulations requiring declarations of allergens or gluten on their labels or products. They were exempt. Now eight years later, the government is now proposing to remove this exemption.

The Government of Canada needs to hear from concerned consumers who are impacted by these regulations. The more people and groups who submit official responses, the more likely the amendments will be implemented.

Step one: Click here to download a template letter.
Step two: Add your name and address
Step three: Submit by email to: [email protected] by September 14 using the subject line: Canada Gazette, Part I, Volume 152, Number 24: Regulations Amending the Food and Drug Regulations (Beer) – June 16, 2018
Step Four: Tell us you sent a letter by emailing us at [email protected]

BONUS STEP!
Step Five: Donate to CCA to allow us to continue to be your advocate in Ottawa and across the country for the right to safe gluten-free food. Donations can be made securely online, via CanadaHelps by clicking here.

Thank you for your help and support!

CCA Publishes Management of Bone Health Paper

The Professional Advisory Council of the CCA has written a paper on bone health. It’s now been published and will become one of our standard resources. It’s also 6 pages long, so here are the key points.

  • Celiac disease (CD) is a chronic disorder that affects bone structure. It requires strict lifelong adherence to a gluten-free diet (GFD), and long-term monitoring of patients with CD should include assessment of bone health.
  • Bone health assessment in CD with malabsorption requires bone mineral density (BMD) testing at diagnosis. Correction of malabsorption of calcium, phosphate, and vitamin D should be ensured. At the time of diagnosis, patients should receive counselling on a GFD and on the nutrition required to restore bone health. Intake of calcium and vitamin D should be optimized using dietary sources, whenever possible. Patients should be encouraged to participate in weight-bearing exercises, limit alcohol intake, and avoid cigarette smoking.
  • Evidence for management of low BMD and prevention of fractures in CD is limited. Strict adherence to a GFD seems to be the only effective treatment to improve BMD in adults with CD and decrease the risk of fractures.

If you would like to read the whole paper, you can find it at http://www.cfp.ca/content/cfp/64/6/433.full.pdf

Question: Can I get a safe food list from the CCA?

Answer:

Many people would prefer to use a list of safe products instead of reading ingredient lists.

The CCA has made a specific decision not to put out safe food lists, and we strongly urge Canadians to avoid them too. We worked very hard with Health Canada to get to the point where the information is present on the package. Because of this work, you are looking for four words: wheat, rye, barley, and oats.

gluten-free-listYour responsibility is reading every label every time you buy a product looking for those four words. Reading labels might seem like an overwhelming task, but here’s a tip – if you can’t pronounce an ingredient name, it doesn’t contain gluten. Ingredient lists use common names for gluten sources.

Some U.S. organizations produce safe lists and this is because of different regulations, barley and rye sources may be hidden in other ingredient names. It’s important to note that the U.S. lists are not correct for products sold in Canada. Just because a product has the same name in the U.S. and Canada does not mean that the ingredients are the same. If you want an example, search for “Smarties” and look at the images. You will see two completely different candies in Canada and the U.S.

If you have a question you’d like answered, email [email protected]

What Is Gluten Ataxia?

By Jane Anderson | Reviewed by Emmy Ludwig, MD

Gluten Ataxia is a Rare Autoimmune Condition That Can Damage Your Brain
Gluten ataxia, a rare neurological autoimmune condition involving your body’s reaction to the gluten protein found in wheat, barley, and rye, can irreversibly damage the part of your brain called the cerebellum, according to practitioners who first identified the condition about a decade ago. This damage potentially can cause problems with your gait and with your gross motor skills, resulting in loss of coordination and possibly leading to significant, progressive disability in some cases.

However, because gluten ataxia is so relatively new, and not all physicians agree that it exists, there’s as of yet, no accepted way to test for it or to diagnose it. But that may be changing: a group of top researchers in the field of celiac disease and non-celiac gluten sensitivity has issued a consensus statement on how practitioners can diagnose all gluten-related conditions, including gluten ataxia.

In Gluten Ataxia, Antibodies Attack the Cerebellum
When you have gluten ataxia, the antibodies your body produces in response to gluten ingestion mistakenly attack your cerebellum, the part of your brain responsible for balance, motor control, and muscle tone. The condition is autoimmune in nature, which means it involves a mistaken attack by your own disease-fighting white blood cells, spurred on by gluten ingestion, as opposed to a direct attack on the brain by the gluten protein itself. Left unchecked, this autoimmune attack usually progresses slowly, but the resulting problems in balance and motor control eventually are irreversible due to brain damage. Up to 60% of patients with gluten ataxia have evidence of cerebellar atrophy—literally, shrinkage of that part of their brains—when examined with magnetic resonance imaging (MRI) technology. In some people, an MRI also will reveal bright white spots on the brain that indicate damage.

How Many People Suffer From Gluten Ataxia?
Because gluten ataxia is such a newly-defined condition and not all physicians accept it as of yet, it’s not clear how many people might suffer from it. Dr. Marios Hadjivassiliou, a consultant neurologist at Sheffield Teaching Hospitals in the United Kingdom and the neurologist who first described gluten ataxia, says as many as 41% of all people with ataxia with no known cause might, in fact, have gluten ataxia. Other estimates have placed those figures lower — somewhere in the range of 11.5% to 36%. Since ataxia itself is a rare condition—affecting only 8.4 people out of every 100,000 in the U.S.—that means fewer still actually have gluten ataxia. Estimates are much higher for the number of people with celiac disease and gluten sensitivity who have neurological symptoms.

Gluten Ataxia: Gluten-Induced Neurological Problems
Gluten ataxia symptoms are indistinguishable from symptoms of other forms of ataxia. If you have gluten ataxia, your symptoms may start out as mild balance problems—you might be unsteady on your feet, or have trouble moving your legs. As symptoms progress, some people say they walk or even talk as if they’re drunk. As the autoimmune damage to your cerebellum progresses, your eyes likely will become involved, potentially moving back and forth rapidly and involuntarily. In addition, your fine motor skills may suffer, making it more difficult for you to work writing instruments, zip zippers, or to manipulate buttons on your clothing.

Diagnosis Not Straightforward for Gluten Ataxia
Since not all physicians accept gluten ataxia as a valid diagnosis, not all doctors will test you for the condition if you show symptoms. In addition, experts in the field of gluten-induced disease only recently have developed a consensus on how to test for gluten ataxia.

Gluten ataxia diagnosis involves the use of specific celiac disease blood tests, although not the tests that are considered the most accurate to test for celiac disease. If any of those tests shows a positive result, then the physician should prescribe a strict gluten-free diet. If ataxia symptoms stabilize or improve with the diet, then it’s considered a strong indication that the ataxia was gluten-induced, according to the consensus statement.

Gluten Ataxia Treatment Involves Strict Gluten-Free Diet
If you’re diagnosed with gluten ataxia, you need to follow a very strict gluten-free diet with absolutely no cheating, according to Dr. Hadjivassiliou. There’s a reason for this: the neurological symptoms spurred by gluten ingestion seem to take longer to improve than the gastrointestinal symptoms, and seem to be more sensitive to lower amounts of trace gluten in your diet, Dr. Hadjivassiliou says. Therefore, it’s possible that you might be doing more damage to yourself if you continue to ingest small amounts of gluten. Of course, not all physicians agree with this assessment, or even necessarily with the advice to eat gluten-free if you have otherwise unexplained ataxia and high levels of gluten antibodies. However, it does seem to be backed up by anecdotal reports from people with diagnosed gluten ataxia and from people with severe neurological problems associated with celiac disease: Those people say the neurological symptoms take much longer to resolve; while some stabilize but never improve.

Numers Are Small
The number of potential gluten ataxia sufferers is very small when compared with the numbers of people with celiac disease, and it’s also small when compared with estimates for how many people have gluten sensitivity. However, many people with celiac disease and gluten sensitivity also suffer from neurological symptoms, which often include gluten-related peripheral neuropathy and migraine. Some also complain of balance problems that do seem to resolve once they go gluten-free. It’s possible that, as more studies are conducted on gluten ataxia, researchers will find even stronger links between that condition, celiac disease, and gluten sensitivity. In the meantime, if you have symptoms similar to those of gluten ataxia, talk to your doctor. You may require testing to determine if you have another condition that can cause similar symptoms.

Article Sources
Fasano A. et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. Published: 7 February 2012
Hadjivassiliou M. et al. Dietary Treatment of Gluten Ataxia. Journal of Neurology, Neurosurgery and Psychiatry. 2003;74:1221-1224.
Hadjivassiliou M. et al. Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain. 2003 Mar;126(Pt 3):685-91.
Hadjivassiliou M. et al. Gluten Ataxia. The Cerebellum. 2008;7(3):494-8.
Rashtak S. et al. Serology of celiac disease in gluten-sensitive ataxia or neuropathy: role of deamidated gliadin antibody. Journal of Neuroimmunology. 2011 Jan;230(1-2):130-4. Epub 2010 Nov 6.

Osteoporosis and Celiac Disease

by Nicole LeBlanc, Dt.P. (Translation by Mark Johnson)

Osteoporosis is a frequent complication of celiac disease, linked to the malabsorption of calcium.

This nutrient is absorbed in the first portion of the small intestine, which is also the main area of intestinal damage in someone with untreated celiac disease. Osteoporosis is a condition that affects the skeleton and is characterized by low bone density and the deterioration of bone tissue, rendering the bones more fragile. This problem can lead to pain as well as deformities in the spine.

Prevalence

Indeed, osteoporosis is a major public health problem in Canada, and the prevalence is only increasing with the aging population. Looking at gender, women are four times more likely than men to have osteoporosis – the decline in estrogen production results in a 2-5% loss of bone density per year over the course of the first few years post-menopause. Osteoporosis is also more common in people with a new celiac diagnosis than among the general population – and with celiacs, men have the same percentage of risk as women do.

Risk factors

People are at greater risk if they present with the following factors:

  • Family history of osteoporosis (e.g. fractures in the hip, wrist or vertebrae)
  • Being a woman and over 50 years of age
  • Weakened bone structure and a weight at the lower end of the healthy range – BMI between 18.5 and 25
  • Early menopause (before the age of 45)
  • Smoking
  • Lack of physical activity
  • Low intake of dietary calcium
  • Excessive caffeine consumption (more than four cups per day)
  • Excessive alcohol consumption
  • Using certain medical drugs, including cortisone, for more than three months
  • Diseases that interfere with the absorption of nutrients (e.g. Crohn’s disease, celiac disease)

How to Prevent Osteoporosis:

To prevent osteoporosis, medical experts advise above all to have a balanced diet, heavy on plant consumption, and sufficient intake of calcium and vitamin D, and be sure to get physical exercise. In celiac patients, strict adherence to the gluten-free diet is the most important factor that will contribute to the regeneration of the intestinal mucosa, ensuring better absorption.

Get physical exercise
Physical activity, from childhood onwards, promotes the formation of strong bones. Throughout your life, exercise helps to maintain optimal bone mass and musculature, which supports your body’s weight. For example, walking, running, tennis, soccer, etc. Exercise that requires handling or pushing heavy objects is also beneficial.

Choose foods that are rich in calcium
Calcium is an important mineral. It contributes to bone metabolism, the maintenance of blood pressure levels, muscle contraction, and the activation of many enzymatic systems involved blood coagulation. Though the matter continues to be debated, currently calcium
requirements are estimated at between 700 and 1,300 mg per day, depending on age and sex. These recommendations may change in the future, depending on the findings of research that is underway.

Choose foods that are rich in vitamin D
This vitamin helps the body to better absorb calcium, no matter the source (food or supplements). It is difficult to meet your vitamin D requirements without the regular consumption of dairy products or milk substitutes that are fortified with calcium and vitamin D. Very often, one’s vitamin D requirements can only be met through food. In addition, living in the north (as we do) and aging both make it more difficult to produce vitamin D following sun exposure. It is therefore recommended that people over the age of 50 take a daily
supplement of 1,000 IU of vitamin D.

Reduce excess intake of calcium, alcohol, salt and meat
Although their influence on bone health remains unclear, it is suggested to moderate your consumption of animal protein, caffeine, alcohol and salty foods as these promote an increase in calcium loss through the urine.

Quit smoking
Stopping smoking has long been encouraged to support heart health and to help prevent lung cancer. Many studies confirm that smoking is also harmful to bone density.

Confusing May Contain Warnings Explained

By Sue Newell

A large food retailer in Canada adds “May contain wheat” warnings to virtually all of its house brand products.  Snack foods imported from some countries regularly list all 12 priority allergens on their ingredient lists. Products with a gluten-free claim also carry “may contain wheat” warnings (and this is encouraged by Health Canada and the Canadian Food Inspection Agency).  Almost all the ingredient labelling regulations in Canada are set by regulation but precautionary labels remain in the “optional” category.  No wonder people are confused about the words “May contain”.

In the last two years, products have appeared in our stores carrying both a “Gluten-free” claim and a “May contain wheat” warning. According to Health Canada, this labelling rule is acceptable in situations where the product meets the criteria for a gluten-free claim (no gluten ingredients, product made specifically to be gluten-free, and no gluten contamination at levels above 20 ppm) but may have levels of gluten contamination below 20 ppm. The “May contain” warning is provided as a service to people with a true wheat allergy. There are no maximum safe levels for allergy warnings.

So what should someone with celiac disease or non-celiac gluten sensitivity do with these products? Here are our recommendations:

  1. “Gluten-free” claims must be true so they take precedence over any precautionary “May contain wheat” claims. Go ahead and eat the product.
  2. If there is no “gluten-free” claim, but there is a “May contain” warning for any gluten grain, do not eat the product.

The fact that “May contain” labels are voluntary triggers fear for some consumers. Product manufacturers are “responsible for the safety of their products, including addressing potential risks associated with the presence of allergens”.  In other words, if the risk is significant and not controlled, they must inform consumers.

Meeting Health Canada: As the voice for people with CD and GS, CCA representatives recently met with Health Canada in June. CCA is also involved in stakeholder consultations related to prescription drugs, natural health products and new beer standards. We will continue to advocate for ways to make labelling more clear for consumers.