Dental Manifestations of Celiac Disease Reference List

dentist conference kelowna

dentist conference kelownaSeveral Canadian Celiac Association members have been volunteering at the TODS dental conference at the Delta Grand Hotel in Kelowna today (Friday) and this weekend. About 1,500 dentists and dental assistants are registered. Dr. Hardy Limeback is presenting at the conference on Celiac Disease, IBS, Crohn’s & The Role Of The Dental Team.  The CCA has a booth at the conference staffed by CCA volunteers including  Kelowna’s Jennie Johnson and Calgary’s Marie-Claude Beaulieu.

Calgary Chapter PAC Committee and Dr Trey Petty (a dentist in Calgary that specializes in Celiac) have put together this helpful reference list on the oral and dental manifestations of Celiac Disease. It meant as an aid to help all those in the dental care profession. We are publishing it here as a reference for those attending the conference and for those beyond who may benefit from it.

PDF Document (.pdf), Word Document (.docx) – Dental Manifestations of Celiac Disease Reference List
PowerPoint Presentation (.pptx) – Dental Manifestations of Celiac Disease (by Calgary Chapter’s Education Committee, April 2016)

Kismet Brand Methe Powder Recalled

By The Canadian Food Inspection Agency

A recall has been added to the CFIA’s Food Recall Report.

Class: 2
Reason for Recall: Allergen – Wheat
Product(s): Kismet brand Methe Powder (Fenugreek Powder)
Recalling Firm: New Generation Foods
Distribution: British Columbia

Product details are available at:


Don’t Depend On Safe Candies List


By Sue Newell, CCA Operations Manager

chocolate-barEvery year about this time I start to see the “where is the list of safe candies” queries. The CCA does not publish a list of safe candies and it strong discourages you from depending on one. Why? Because the information you need is on the package and that is the ONLY reliable place to find it. Lists from other people and especially lists from multiple people are risky. Is that the Canadian or US product? Is that the small, mini. micro, or treat-size package?

The information you need is right there on the package: look for wheat, rye, barley, oats.

It is frustrating when you have a mini treat with no ingredients on the bar. Now is the time to go to the grocery store and look at the ingredients for the ones you like. That way, when you are confronted with temptation at the office or at a party, you will already know what is safe.

Candy isn’t just a temptation for kids. You will find candy on offer everywhere you go for a couple of days so keep a few safe options in your pocket or purse or backpack so you have a treat too. If you prefer, promise yourself a special indulgence or maybe a speciality coffee that day.

When you are dealing with a child who is gluten-free, you need to talk out the ground rules in advance. Some parents do a 1-for-1 swap for gluten-containing treats, others do a bulk swap for something other than candy. Almost all set a “no candy until you get home” rule. Many schools have done away with the “treats at school” practice, but make sure you check it out in advance so your little one won’t feel left out.

Halloween is a challenge for everyone with a need for gluten-free food. It is almost inevitable that there will be something on offer you cannot eat and it will hurt a bit, even if you have been doing this for a lot of years. With a bit of planning, you will not only survive but enjoy the day.

Featured Gluten- Free Business:  The Original Cakerie

Inspired By Happiness Truck

Submitted by Val Vaartnou

Inspired By HappinessI recently met with Doris Bitz, Senior Vice President and Michelle Tiang, Director of Marketing of Retail Sales & Marketing for The Original Cakerie, which produces a new line of products, Inspired by Happiness. This “Better for you” product line includes decadent gluten-free cakes: Dreamin’ of Chocolate and Cravin’ for Cookies and Cream.

Founded in 1979 by two passionate entrepreneurs in British Columbia, Canada, The Original Cakerie has grown to be one of the leading commercial premium bakeries in North America. The original business philosophy still resonates today – use the very best ingredients and manufacturing processes to produce superior tasting cakes, deliver product efficiently and NEVER compromise on quality. With many employees who have been with the company over 20 years, The Original Cakerie takes pride in the quality of the products produced for the market and their families. Michelle is known as the “cake lady” when she visits her relatives.

Michelle Tiang explained that the development and testing of the gluten-free products took over 2 years. Their objective was to produce a great tasting, high-quality product that you could not tell was gluten-free. In fact, many of the focus groups included non-celiac/non-gluten sensitive individuals. Doris Bitz shared that they believe that desserts are meant to bring people together, and so with that in mind, their objective was to produce a product that everyone could enjoy – with or without celiac disease. The final product contains no artificial trans fats, no artificial colors, has natural flavors and have also been Kosher Certified, BRC Certified as well as, Gluten Free Certified by the Gluten-Free Certification Program (GFCP). I have enjoyed both the Cravin’ for Cookies & Cream and the Dreamin’ of Chocolate and found the cakes to be moist and decadent. My husband could not tell they were gluten-free.

The Dreamin’ of Chocolate cake is a chocolate lover’s dream come true with moist chocolate cake between layers of the finest Belgian chocolate mousse and finished with chocolate ganache. Cravin’ for Cookies and Cream is a family favourite as it comes with chunks of cookies (gluten-free, of course) between generous layers of vanilla cream mousse. Smothered with dark chocolate ganache, this cake is also unbelievably gluten-free as well.

Inspired By Happiness TruckIn producing these exceptional cakes, gaining certification initially was a challenging process as their internal standard is to produce a product that contains below 10 ppm of gluten (the Canadian standard is 20 ppm). The integrity of the gluten-free product is key as those of us who have tried gluten-free baking would know. However, with an AA rating for BRC certification, The Original Cakerie has managed to consistently produce quality products to meet growing demands of its gluten-free desserts.

Inspired by Happiness cakes retails between $10.99 to $12.99 and can be found in the in-store bakeries of IGA, Sobeys, Longo’s, Overwaitea, Save-On, Safeway and Thrifty Foods. As they are available in select locations, if you do not see them at your local store, ask for them. They are great when you have company as they are designed to be enjoyed by everyone! For more information, visit

Non-Celiac Gluten Sensitivity: How to Diagnose and Differentiate it from Celiac Disease

By the Canadian Celiac Association Professional Advisory Council


  • Non-Celiac Gluten Sensitivity can present with intestinal and extra-intestinal symptoms
  • There are no biomarkers for diagnosis
  • Autoantibodies (TTG, EMA, DGP) are absent
  • There is no villous atrophy
  • Diagnosis requires excluding celiac disease by serological tests
  • A gluten-free diet should not be started before ruling out celiac disease
  • The gluten-free diet is complicated and expensive
  • Patients should be referred to a dietitian with expertise in the gluten-free diet.

The spectrum of gluten-related disorders includes celiac disease, dermatitis Herpetiformis, gluten ataxia, wheat allergy and nonceliac gluten sensitivity. The term non-celiac gluten sensitivity (NCGS) is used to describe the clinical state of individuals who develop symptoms when they consume gluten containing foods and feel better on a gluten-free (GF) diet but do NOT have celiac disease.

Celiac Disease
Celiac disease is a multi-system autoimmune disorder that is triggered by ingestion of gluten (a protein in wheat, rye, and barley) in genetically susceptible individuals. A common disorder, affecting about 1% of the population, patients can present with a variety of intestinal and non-intestinal symptoms. Autoantibodies such a tissue transglutaminase antibody (TTG), endomysial antibody (EMA) and deamidated gliadin peptide (DGP) are produced in the body and form the basis of serological tests used for screening. The diagnosis of celiac disease is confirmed by a small intestinal biopsy and treatment consists of a strict GF diet for life. Adherence to the GF diet results in the resolution of symptoms and intestinal inflammation, with the autoantibodies becoming negative over time. Celiac disease is a serious disorder with patients being at risk for nutritional deficiencies and development of other autoimmune disorders and rarely malignancies such as small intestinal lymphoma.

Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity is frequently a self-diagnosis; hence the true prevalence is difficult to establish. There are currently no biomarkers for this disorder. In a survey of 1,002 people from the United Kingdom, 13% reported having gluten sensitivity, with 3.7% claiming to be on a GF diet. In a large study from Italy of 12,255 individuals, NCGS was found to be only slightly more common than celiac disease. Data from the National Health and Nutrition Examination Survey in the United States found that 0.55 to 0.63% of people followed a GF diet in the absence of celiac disease. This prevalence is similar to that of combined diagnosed and undiagnosed cases of celiac disease. The symptoms of NCGS are highly variable. These include bloating, abdominal pain and diarrhea; symptoms mimicking irritable bowel syndrome. Other intestinal manifestations include nausea, acid reflux, mouth ulcers, and constipation. Individuals may have non-intestinal symptoms such as feeling generally unwell, fatigue, headaches, foggy mind, numbness, joint pains, or skin rash. An individual may have one or more symptoms.

The clinical symptoms of NCGS and celiac disease overlap making it difficult to distinguish the two disorders on the basis of symptoms alone. In one study of adults, patients with celiac disease were more likely to have a positive family history, personal history of other autoimmune disorders and nutrient deficiencies compared to those with NCGS. It is important to note that in NCGS, the TTG, EMA, and DGP antibodies are absent and there is no villous atrophy (damage to the small intestine) on biopsy. Therefore, the diagnosis of NCGS can only be established by excluding celiac disease.

Non-celiac gluten sensitivity was first reported in the 1970’s. However, over the last decade, an increasing number of people are following a GF diet for perceived health benefits. This has renewed both interest and concern whether these individuals have a true gluten-related disorder. There is a real possibility that some of those who go on a GF diet on their own could, in fact, have celiac disease. These individuals may not get diagnosed or receive adequate nutritional counseling from a dietitian and appropriate follow-up from their physicians. As a result, this may put them at risk for long-term complications of celiac disease. Since the small intestinal damage resolves and the TTG (and other antibodies) normalize after starting a GF diet, the true diagnosis of celiac disease becomes difficult to establish.

Most clinical trials investigating the phenomenon of gluten sensitivity gave study subjects gluten-containing grains such as wheat, rye, and barley in their diet rather than pure gluten. Therefore, it has been postulated that individuals with NCGS may be reacting to another component in wheat rather than gluten. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are types of carbohydrates that some people cannot digest very well. The bacteria in the colon ferment these carbohydrates resulting in gas, bloating, abdominal pain and diarrhea.

Wheat, barley, and rye are high in FODMAP, which may be a contributing factor to these symptoms. Furthermore, wheat contains other proteins called amylase/trypsin inhibitors (ATI) that in laboratory studies have shown to cause intestinal inflammation.

The GF diet can be very challenging to follow, as it is complicated and expensive. In addition, there are concerns about the nutritional adequacy of GF products as they can be high in fat and sugar, and often low in fiber, iron and B vitamins. For these reasons, patients requiring a GF diet should be referred to a registered dietitian with expertise in this diet. Currently, a lot remains unknown about NCGS.What is its exact pathophysiology? Is the sensitivity/intolerance to gluten a dose-related phenomenon? Is it a transient or a permanent problem? Do some individuals outgrow this condition over time? Are there specific diagnostic tests that can confirm the diagnosis? Clearly, more research is needed to clarify these issues.

Take Home Message:
What is most important for the public and healthcare professionals to know is that the diagnosis of non-celiac gluten sensitivity should not be made without excluding celiac disease. A gluten-free diet should NOT be initiated without a proper clinical assessment that includes serological testing with IgA-tissue transglutaminase antibody while the individual is on a regular gluten-containing diet.

Primary author: Dr. Mohsin Rashid

(1). Lebwohl B, Ludvigsson JF, Green PHR. Celiac disease and non-celiac gluten sensitivity. BMJ 2015;351;h4347
(2). Volta U, Bardella MT, Calabro A et al. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Medicine. 2014;12:85.
(3). Kabbani TA, Vanga RR, Leffler DA et al. Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis. Am J Gastroenterol. 2014;109;(5);741-6

Gluten-Free Cheerios Not Recommended by CCA

General Mills Canada announced last week that five Cheerios flavours sold in Canada will carry a gluten- free claim. Original Cheerios, Honey Nut Cheerios, Multi-Grain Cheerios, Apple Cinnamon Cheerios and Chocolate Cheerios will be rolled out across the country in August. The Canadian Celiac Association (CCA) held a conference call with representatives of General Mills Canada and General Mills US on August 2nd 2016 to discuss our concerns with the gluten-free label on these products.


The Canadian Celiac Association (CCA) recommends that people with celiac disease or gluten sensitivity DO NOT consume the gluten-free labeled Cheerios products at this time because of concerns about the potential levels of gluten in boxes of these cereals. The CCA is receptive to evaluating any additional information that General Mills is willing to disclose.

Why is the CCA concerned?

Oats are a naturally gluten-free grain; however, it has been documented that oats are frequently cross-contaminated with gluten-containing grains, especially barley and wheat. Health Canada scientists have tested commercial oat samples and found high levels of gluten contamination. Cross-contamination can occur because oats often are grown in rotation with other crops, harvested and transported with equipment that is also used for gluten-containing grains.

We know the following:

  1. Oats are an extremely high risk grain and even “gluten-free oats” are at high risk for gluten contamination.
  2. It is very difficult to remove gluten-containing grains from oats using optical and mechanical technology alone because barley and wheat are similar in size, shape and color as oats. Broken kernels present in the grain also add to the sorting challenge.
  3. General Mills is using a cleaning system that they developed based on mechanical sorting to remove barley and wheat from regular commercial oats.
  4. Gluten contamination in oats is not distributed evenly through a batch; therefore, “hot spots” of high contamination can occur.

Based on the information provided to date, our scientific advisors are not convinced that the testing procedures described by General Mills are sufficient to detect these contamination “hot spots” in the oats and oat flour or in the boxes of cereal that may contain those contaminated oats. As a result, some boxes of cereal in the market may be safe for people with celiac disease while others contain significant gluten contamination that has not been detected using current testing protocols.

The CCA is receptive to evaluating any additional information that General Mills is willing to disclose. Until then, the CCA stands by its advice that people with celiac disease or gluten sensitivity should not consume Cheerios products in spite of the gluten-free claim.

CCA’s Position on the Safety of Oats

The CCA relies on advice from our Professional Advisory Council (PAC) and other scientific experts for recommendations on the safety of oats for people with celiac disease. The PAC “Position statement on consumption of oats by individuals with celiac disease” indicates the need for evidence-based, peer-reviewed, published data that demonstrates the levels of gluten in oats that have been cleaned using mechanical and/or optical sorting procedures.

There are three product brands currently on the market made with gluten-free oats that are manufactured in facilities certified by the CCA’s Gluten-Free Certification Program (GFCP):

  • Holy Crap Plus Gluten Free Oats
  • Quaker Oats (several types)
  • Nairn (several products)

These companies have demonstrated to independent parties, trained GFCP auditors and GFCP technical personnel, that both their processed oats and finished products meet Health Canada’s standard for gluten free and are safe for individuals with celiac disease.

What if I eat Cheerios and have a problem?

We realize that some people with celiac disease will decide to eat Cheerios. The CCA recommends that if you experience a reaction to the cereal, you should notify the Canadian Food Inspection Agency (MAPAQ in Quebec), General Mills Canada, the store that sold you the package and the CCA.

Canadian Food Inspection Agency (all provinces except Quebec)
Please keep the remainder of the cereal package and any unopened boxes purchased at the same time until it is clear whether CFIA is interested in testing the package for gluten.

MAPAQ (Quebec only)

General Mills Customer Service

Canadian Celiac Association
Email or Facebook

How do I help get the message out that “gluten free” must mean “safe for celiac disease”?

This is an issue of significant concern to the Canadian Celiac Association.

  1. Contact General Mills Canada Customer service and tell them that you would like to eat Cheerios, but not until you are sure the product is safe for people with celiac disease.
  2. Contact Health Canada (Bureau of Chemical Safety) and tell them that you want “gluten free” to mean “safe for people with celiac disease” so that you do not have figure out if the test protocols used by a particular manufacturer are adequate to detect gluten contamination.
Please copy the CCA on your messages to Health Canada.

Anne Wraggett
President, Board of Directors
Canadian Celiac Association

P.S. Has the CCA made a difference in the quality of your gluten-free life? You can help us continue to address food safety issues with a donation to the CCA at

For a PDF copy of this email visit:

Donors to Match Celiac Research Fund

by Anne Wraggett, CCA President

At our National Conference in St. John’s last month, two CCA members offered to match all the donations up to $10,000 made to the CCA’s J. A. Campbell Research Fund between June 24 and August 31, 2016. That means that if you make a donation of $50, the research fund will grow by $150.

What does the CCA’s J. A. Campbell Research Fund do? It makes two awards each year: up to $25,000 to an established researcher and up to $5,000 to a young investigator (usually a graduate student working with a mentor). The research projects have to study something related to celiac disease, gluten sensitivity or the gluten-free diet. The projects frequently have a scientific or medical focus, but they can also focus on issues that affect the life of someone who must eat gluten free.

Applications are reviewed by the members of our Professional Advisory Council and the grants are making a BIG IMPACT! The CCA provided Dr. Elena Verdú with a small grant a few years ago and now she heads a research lab investigating host-microbial and dietary interactions in the context of celiac disease and gluten sensitivity at McMaster University in Hamilton Ontario.

With your help, and thanks to our two very generous matching donors, we can add an entire year of funding to the Campbell fund in just 6 weeks!! Help us reach that goal!

There are 3 ways to make your donation:

  1. Click here to make your donation online using the secure facilities of, OR
  2. Call the office toll free at 800-363-7296 to make a credit card donation, OR
  3. Mail your cheque to the national office today.

Canadian Celiac Association
5025 Orbitor Drive, Building 1, Suite 400
Mississauga, ON L4W 4Y5

Please identify your donation for CCA’s J. A. Campbell Research Fund on your cheque.

Thank you for your generous help with this project.

Anne Wraggett
CCA Board of Directors

Beware of Barley Malt Containing Beverages

malt barley root beer

Courtesy CCA National

malt barley root beerToday is one of those hot hazy summer days when not much sounds better than sitting beside the pool and enjoying an “adult beverage”, that is, something with alcohol in it.

This year, the range of beverages that do not contain gluten is larger than ever before thanks to the popularity of ciders, hard root beer, and what the industry likes to call “one pour” or “ready-to-drinks” beverages.

The concern is that you need to determine if there is gluten in the form of barley malt in the product based on its category. Hard root beers are a good example: Crazy Uncle has no gluten ingredients; Mad Jack is a combination of a regular lager beer (containing gluten) and root beer. Nearly all of the ciders contain no gluten but a few include barley malt. Holy Crow Bruised Apple Cider Ale tells you right from its name that it contains gluten.

If you live in or near Quebec the problem gets even worse. Some beverages sold at the SAQ (Quebec liquor stores) are fine but the beverage with the same name sold at Costco has malt added to it. In Quebec, only malt beverages can be sold in alternate outlets like Costco and corner stores.

The solution is to extend the motto “read every label every time” to “read the ingredient list ON THE BOTTLE YOU ARE ABOUT TO CONSUME every time”. A bother? Yes. Worth it to keep yourself safe? Absolutely.

May 2016 Chapter Meeting Minutes

We all enjoyed Pizzas from Jim’s Place in Vernon, what a nice treat. We had a small number attend 19 in total. We also had gift certificate from Inspired by Happiness for a free cake. These are the best cakes ever I think that everyone agreed as they had samples to try.

mary-hicks-thank-youMary Hicks our dietician is retiring from her position as our dietician. The chapter presented Mary with a small token of appreciation for all the work she had done for our members. Selina deVries will be taking on the position of dietician for our chapter (Thank you Selina.)

Marilyn gave her treasures report to all the members. Our current balance is 7707.00 and 14,000 in GIC investments.

Jennie Johnson updated us on membership. We are still having problems getting correct information from National. It was suggested that if we have members that cannot afford to renew or join our chapter that we on a case by case bases maybe support them by paying half of the fee. We all agreed that National needs to look at a new business plan. It was suggested that they drop the membership fee and hope to get more donations. Our chapter is losing members as are most other chapters.
Marie sent out 100 new letters 80 e-mailed and 20 mailed it helps save money if we can e-mail the newsletters.

Our Chapter donated $300.00 to the Vancouver Chapter to help with the cost of having a booth at the Family Medicine Form later this year.
Irene will be going to the conference in Newfoundland and will bring back information to our meeting in Sept.

David Fowler has been helping with getting information up on our web page at no charge. The chapter decided to send David a small token of apparitions for all his work on behalf of our chapter. We now have advertisers on our web site.

We as members agreed to donate to National. We first need to know what the money would be used for. We do not feel we want the funds to go into general revenue.

The next meeting is September 11, 2016 a regular potluck.