CanadianCELIAC Empowering Canadians with Celiac Disease - To vaccinate or not? Sick Kids Vs. Celiac Disease Cautions for online shopping Sweet & ...
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CanadianCELIAC Empowering Canadians with Celiac Disease. PLUS To vaccinate or not? Sick Kids Vs. Celiac Disease Cautions for online shopping Sweet & Savory Recipes for February
CCA board of directors Executive Directors Janet Bolton, President Meredith Birchall-Spencer Treena Duncan, Past President Tamara Close Jennifer Stebbing, Secretary David Congram Andrew Kotys, Treasurer Jessica Danford Kathryn Djordjevic Lizbeth Wall Ravil Veli Contact us Canadian Celiac Association 1450 Meyerside Dr., Suite 503 Mississauga, ON. Canada L5T 2N5 Phone: 905.507.6208 or 800.363.7296 Fax: 905.507.4673 | Email: info@celiac.ca www.celiac.ca Canadian CELIAC A MAGAZINE FOR CANADIANS WITH CELIAC DISEASE AND GLUTEN SENSITIVITY Editorial Board Melissa Secord Janet Dalziel Caleigh McAuley Mark Ascione Contributors Janet Dalziel Dr Marcon Liz Pietrzak Inez Martincevic Lori Grein Melissa Secord Krista Evans Caleigh McAulay Dr. Walsh Rosie Fountotos DEPOSIT PHOTO Dr. Dowhaniuk COVER PHOTO BY DEPOSIT PHOTO Copyright © 2021 by the Canadian Celiac Association Publication Agreement#40787580 Canadian Celiac is published for the Canadian Celiac Association, L’Association Canadienne de la maladie coelique. Reproduction of this magazine in whole or in part is prohibited without the express written consent of the publisher. Disclaimer: The contents of Canadian Celiac are provided in good faith for information purposes only, and using the most current information available subject to amendment, and should not be used as a substitute for the advice of a qualified medical professional. The Professional Advisory Council of the Canadian Celiac Association (CCA) has not reviewed the contents of Canadian Celiac. Use of the information is at your own risk. The CCA does not endorse any product referenced in this publication. To the fullest extent permitted by law, the CCA, its local chapters and all persons involved in the compiling of this publication disclaim any responsibility for, and make no representations or warranties regarding the information provided. In no event will CCA, its Chapters or those persons involved in compiling this publication be liable for any damages of any kind resulting from the use of the information. 2 | Canadian CELIAC
A magazine for Canadians with celiac disease and gluten sensitivity WINTER 2020 COVID-19 VACCINATION AND CELIAC DISEASE 6 SICKKIDS VS CELIAC DISEASE 7 A GUIDE TO CHOCOLATES 20 MY CELIAC JOURNEY 18 ONLINE FOOD SHOPPING 25 SWEET & SAVORY RECIPES 29 TREATMENT, CURE, OR “NO THANKS” 33 2 VOLUME 4 | ISSUE 4 Canadian CELIAC | 3
From the editor’s desk A NEW YEAR BRINGS HOPE AND POSSIBILITIES. As we flip over the calendar to a new year, we are filled with hope and possibilities that we will turn the corner on the pandemic. Canadian winters can already be hard as it is with the cold and snow but with many parts of the country on their second lockdowns, it has been challenging and isolating for many. We hope in this issue we can bring a positive, hope- ful message. With thanks to our community and two significant donors, a new full-time dietitian will be soon onboarded. This new role will provide in-house expertise for our Client Support Desk to help those who call or contact the office for information and allow us to invest more time in science-based educa- tion, resources, advocacy and research. Having the additional support will allow CCA to stay on top of a quickly changing landscape such as with COVID-19. As vaccines roll out across Canada, our Professional Advisory Council has been able to offer some encouraging news and you can read the The CCA created its magazine with the goal of results of our gluten-free company survey to find out connecting the celiac community across the how they are managing through this storm. Continue country and to help empower readers to find a to watch for COIVD-19 resources on our website and better quality of life with celiac disease. Now we’d in our publications to help you keep safe. like your feedback. Help the CCA with insights on how to provide the best support, evidence-based We are thrilled to feature Hospital for SickKids Celiac information, education and advocacy for the Disease Clinic who are taking a wholistic approach Canadian gluten-free community by taking this to helping children and collaborating with other quick survey on our magazine. institutions to ensure our children get the best care https://www.surveymonkey.com/r/CDNCELIAC Continued on next page 4 | Canadian CELIAC
they deserve. We do a deeper others get diagnosed and onto a We have been truly humbled dive with Assistant Professor Dr. better path. by the support of the Canadian Walsh at SickKids and Dr. Cather- gluten-free community this past ine Dowhaniuk of McMaster Uni- But if food is your comfort and joy, year. Our year-end has generated versity who have joined forces to we are pleased to share some excitement that we will be able to research a new modality of patient sweet and savoury recipes from support individual families in more management with thanks to a JA Chef Lori of Kinnikinnick. Kinni- ways than ever before and it’s all Campbell Research grant support- kinnick is celebrating its 30th because of you. You have filled us ed by CCA’s community. birthday this year. This fami- with hope and possibility of better ly-owned company was one of things to come. We hope that you will be inspired the first to support the gluten-free by Krista Evans’ Celiac Journey. community with a wide variety of Stay healthy and stay safe, She has teamed up with her best safe snack and pre-made foods. four-legged friend and taken to We also speak with MarcAngelo the outdoors for a trek to better Foods, another GFCP partner, who health. In addition to her com- takes great pride in food safety mitting to better health, she is and conservation. Melissa Secord, CAE, CCA Nation- giving back to the CCA by doing al Executive Director a walkathon so that she can help “I only want the best for her to live better and healthier than my generation — to be strong and empowered.” Contact the CCA for more information. Legacy Giving: How charitable giving can increase what you leave for your family April 8, 2021 8 – 8:45pm EST. Click to register: DEPOSIT PHOTO https://us02web.zoom.us/webinar/register/WN_ wCmLCocIQDmcwWPntzQgBw Canadian CELIAC | 5
Vaccines and celiac TO VACCINATE OR NOT? CCA Professional Advisory Council issues statement on COVID-19 vaccinations and celiac disease Professional Advisory Council (PAC) to provide immunity against this DEPOSIT PHOTO statement on COVID 19 Vaccination virus. We recommend that peo- ple with celiac disease receive A vaccine has recently been the COVID-19 vaccine approved approved in Canada for COVID-19 according to their provincially de- and we anticipate more vaccines termined prioritization schedules. will be available in the future. Having a diagnosis of celiac dis- Celiac and Coronavirus Our celiac community is asking ease should not affect the efficacy for guidance of vaccination for of the vaccine and should not be Patients with only celiac are not COVID-19. At the beginning of the associated with any added ad- immuno-compromised, unless Covid-19 pandemic, there was a verse outcome from vaccination. they are taking medications for concern that people with celiac It is important to clarify that celi- other medical conditions which are disease might be at increased ac disease is not considered an immuno-suppressive. Like every- risk of contracting COVID-19 allergy, and therefore, there is no one, they should exercise careful and had severe outcomes from anticipated need to take any addi- infection control practices, includ- the infection, given prior studies tional precaution when proceed- ing washing hands with soap and suggesting increased risks from ing with vaccination. The CCA like water frequently, and avoid touch- pneumonia and viral infections. many other celiac societies and ing the eyes, nose and mouth. Thus far, we have learned from research groups has stated that Patients with other co-morbidities an international large study1 and this vaccine is likely safe for most such as diabetes may be at higher celiac registry that individuals with patients who have celiac disease risk of severe infection and should celiac disease are not more likely and have no immune compromise. take additional precautions. to contract COVID-19 or to have A discussion with your health pro- adverse outcomes from COVID-19 vider to consider your individual To access more resources and in- infection compared to the non-ce- health situation is recommended. formation on how the COVID-19 liac population. However, we have pandemic impacts seen the devastating effects of 1- ZhenJ et al, CGH 2020 the Canadian gluten-free COVID-19 in the Canadian and 2- International ISECURE celiac regis- community, Click here: https:// worldwide population, and there- try: https://covidceliac.org/home www.celiac.ca/news-events/ fore, mass vaccination is crucial covid19/ u 6 | Canadian CELIAC
Q&A SICKKIDS VS CELIAC DISEASE – A WHOLISTIC APPROACH Q&A with the Hospital for Sick Kids Celiac Clinic Team WRITTEN BY ROSIE FOUNTOTOS, MSC. (C), FACULTY OF MEDICINE, MCGILL UNIVERSITY How many patients do you see each The clinic was started in 2015 to help When a child is initially diagnosed year and what is your process or coordinate the care of children with with celiac disease, we begin the journey with each family and patient? celiac disease and their families. We educational process to help children Who is part of the SickKids’ Celiac receive approximately 50-200 new transition to a gluten-free lifestyle Clinic team? referrals each year and we follow which is crucial in navigating this We [Dr. Walsh and Dr. Marcon] are the roughly one thousand children with diagnosis. The children and families physician leads of the Celiac Clinic active celiac disease in our clinic. Any in our clinic receive teaching around which is part of the Division of Gastro- child who is diagnosed with celiac dis- the gluten-free diet from our amazing enterology, Hepatology and Nutrition ease is followed in the clinic until they dietitians, Inez Martincevic and Veronik at the Hospital for Sick Children (Sick- transition to adult care to help ensure Connan. Our wonderful nurse, Vikki Kids). We have a very dedicated and they are following a strict gluten-free Scaini, helps direct them to the online diverse team which includes dietitians diet and they achieve the best possi- and nurses. ble health outcomes. Continued on next page SickKids celiac clinic team (L to R): Dr. Peggy Marcon, Vikki Scaini (RN), Inez Martincevic (RD), Veronik Connan (RD), Dr. Catharine Walsh Canadian CELIAC | 7
When a child is initially diagnosed with celiac disease, we begin the educational process resources and interactive e-learning the government. modules that we have created to help Ontario is the them learn more about celiac disease only Canadian and the gluten-free diet. The modules province that can be found at AboutKidsHealth.ca does not cover when you search for ‘celiac disease.’ the cost of this important test. What generally brings children to your clinic and leads to them being in What is your your care? approach to Celiac disease can lead to a wide managing celiac variety of symptoms in children such disease in children, where the man- of our patients and their families. as growth failure, abdominal pain, agement often requires involvement diarrhea, or constipation. Symptoms of parents, caregivers, teachers, and In your experience, do you notice can happen at any time in a child’s life others to ensure a child follows a anxiety in children with celiac dis- and some children who have celiac strict gluten-free diet? ease related to the gluten-free diet? disease have no symptoms at all. With To ensure children and their families What is your approach for patients an increased awareness of celiac have accurate and up to date infor- and their families on managing these disease today, family doctors and mation, one of the big focuses of sentiments and barriers? pediatricians are screening children the SickKids clinic over the last few We know that simply removing gluten more frequently and earlier to identify years and going forward is building from the diet does not resolve all children at risk for the disease. This educational materials related to celiac issues in children with celiac disease. means children with celiac disease disease. We have developed online Chronic pain and mental health issues, are often being picked up earlier and resources, including website materials including anxiety and depression, are have fewer symptoms. When a child and e-learning modules, to help teach known to occur in some children with is found to have a positive screen- children and their families about celiac celiac disease. The social impact of ing blood test for celiac disease it is disease and the gluten-free diet. It is feeling different and eating a different important that they continue to eat also important to educate other adults diet from friends can also greatly affect gluten-containing foods until they can in a child’s life, including other care- children’s well-being. Additionally, food be seen by a pediatric gastroenter- givers, relatives, teachers, babysitters, insecurity or the lack of access to ad- ologist who will assess the child and camp counselors and friend’s parents. equate, nutritious, and safe food can consider further testing to confirm the Online resources are particularly use- be an issue for children with celiac dis- diagnosis of celiac disease. An upper ful for this as they can be accessed by ease as the diet is significantly more endoscopy, which is a procedure that anyone at any time. We have also de- expensive than a regular wheat-based allows doctors to see the upper part veloped specific resources for children diet. These findings are a large motiva- of your child’s digestive system, may with both celiac disease and type 1 dia- tion for our clinic moving forward. be used to help confirm the diagno- betes. Going forward, we are planning sis. One barrier to the diagnosis of on developing additional child-friendly In collaboration with Dr. Dowhaniuk celiac disease in Ontario is that the educational resources, the content of from McMaster, we had a recently screening blood test is not covered by which will be determined by the needs Continued on next page 8 | Canadian CELIAC
simply removing gluten from the diet does not resolve all issues in children with celiac disease received the Dr. J. A. Campbell Re- will enable us to focus on the men- This has been helpful to guide discus- search Award from the CCA to help tal health aspects of celiac disease, sions and has made appointment visits develop a Pediatric Celiac Symptom integrate improved dietetic care very engaging. With adolescents in Index which is a tool to assess symp- and provide appropriate psychology particular, we can dive into an honest toms in children with celiac disease support to build educational resources conversation to address barriers in from the perspective of the child and for the patient and families. It is our maintaining a gluten-free diet. their family (i.e., a patent reported hope that these initiatives will lead to outcome measure). This tool will help improvements not only in the physical Drs Walsh and Marcon, you both guide doctors, nurses, and registered health of children with celiac disease carry out research related to celiac dietitians as to the questions to ask but also in their overall well-being and disease and have exciting ongoing children with celiac disease about how quality of life. collaborations. Could you share with they feel, both physically and mental- us your recent and current research ly. We are hopeful this tool will help How has COVID-19 impacted the projects? us better understand patients’ and medical care at the clinic? And how We are currently working on develop- families’ needs and how we can best has the experience been using tele- ing a registry of pediatric patients with support their health journey, improve medicine for you and your patients? celiac disease that includes children patient-provider communication and Our interactions with children and their from SickKids, McMaster Children’s increase recognition of problems that families so far indicate that virtual visits Hospital, and William Osler Health Sys- were not previously detected. have been very well received. Families tem. This registry will help us gather appreciate the flexibility virtual visits information about a large multicultural Over the years we have shifted the offer. Coordinating time off from work population of children and adoles- focus in our clinic to ensure we are and school presented challenges in cents who have celiac disease that will looking at the child as a whole person regard to scheduling in-person ap- enable us to look at factors that impact and not only as someone who can- pointments in the past. the prognosis and quality of life of not eat gluten. Our clinic has been children with this disease. fortunate to receive a donation that Most children now have their blood work done Gastroenterology and endocrinology ahead of their share in the care of children with type scheduled virtu- 1 diabetes and celiac disease. There al appointment is a long history of collaboration and and complete most recently we have looked at the some question- effect of the gluten-free diet in the naires to assess management of diabetes in both chil- their ongoing dren and adults with celiac disease. symptoms, the This collaboration also led to the adap- impact of celiac tation of the celiac teaching modules disease on to those with both celiac disease and their quality of type 1 diabetes. life and dietary compliance. Continued on next page Canadian CELIAC | 9
we are aiming to build less of an illness-supporting outlook and more of a holistic approach We have carried out research to Celiac disease and type diabetes 1: develop and test the effectiveness https://www.aboutkidshealth.ca/Arti- of online educational modules for cle?contentid=2527&language=En- celiac patients as well as children glish with both celiac disease with type 1 Celiac disease: The gluten-free diet: diabetes and families. Within the next https://www.aboutkidshealth.ca/Arti- few months, the online modules will cle?contentid=956&language=English be posted on the SickKids AboutKid- Celiac disease: Tips to maintain the sHealth.ca website. This will make gluten-free diet: them freely available to individuals https://www.aboutkidshealth.ca/Arti- worldwide who have celiac disease, cle?contentid=957&language=English as well as their families and care- givers. Also, as mentioned, we are Dr. Catharine M Walsh, MD, MEd, carrying out a study to develop a pa- PhD, is a Clinician Scientist and tient reported outcome tool to assess Associate Professor in the Division of symptoms in patients and families Gastroenterology, Hepatology and with celiac disease in collaboration Nutrition at the Hospital for Sick Chil- with at the celiac team at McMasters dren (SickKids), University of Toronto, University. Canada. She is also an Educational Researcher in the SickKids Learning What’s been your greatest success Institute, a Scientist in the SickKids as a gastroenterologist practicing at Research Institute and a cross-ap- the SickKids clinic? pointed Scientist at the Wilson Centre Seeing children thrive is generally the for research in education. Dr. Walsh greatest success of being a pediatric has a research and clinical interest gastroenterologist. We enjoy seeing a holistic approach to treating children in celiac disease and co-leads with children engage in life and not let with celiac disease and their families. Celiac Clinic at SickKids. the gluten-free diet hold them back. It is important to remember to view the Following children and seeing them child with celiac disease as a whole Dr. Peggy Marcon, MD is a pediatric overcome the social and psychological person and not just as someone who gastroenterologist who has had both a impacts of their diagnosis is also very cannot eat gluten. We like to empha- research and clinical interest in Celiac rewarding. size that the child, like the rest of their Disease for twenty-five years. She co- family, should eat a healthy well-bal- leads the Celiac Clinic at SickKids with A takeaway for young readers, pa- anced diet, just that they need to not Dr. Walsh. She oversees the Motility tients and their families when they or include foods that contain gluten. Testing Unit and also has a clinical their young child is diagnosed with and research interest in Neurogastro- celiac disease? RESOURCES: enetrology. She helps runs both the In our clinic and with our research ef- Celiac disease: https://www.aboutkid- Aerodigestive Clinic and the Eosino- forts, we are aiming to build less of an shealth.ca/Article?contentid=816&lan- philic Esophagitis Clinic at SickKids. u illness-supporting outlook and more of guage=English 10 | Canadian CELIAC
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Spotlight on research Q&A WITH RESEARCHERS DR. WALSH AND DR. DOWHANIUK Donor-supported research through CCA’s James A. Campbell Grants hopes to improve outcomes for children with new management tool What is a PROM, and why is it help care providers recognize with celiac disease experience. so important when working with problems that were not previous- celiac disease? ly detected. The PROM we are What got you interested in de- Patient reported outcome mea- developing for celiac disease will veloping this tool (the PROM)? sures (PROMs) are self-complet- focus on the symptoms children A PROM that focuses on the ed questionnaires that assess well-being, health status and experiences of healthcare from the view of the child (and caregiv- er). This is without any interpre- tation from a healthcare provider. A PROM can be answered by a child and/or a caregiver to help to inform clinical care in line with a patient-centred approach to care. PROMs are developed by follow- ing research standards to make them reliable and valid to use in clinical care. Previous research has shown that PROMs can improve patient-provider commu- nication, patient satisfaction, and Dr. Walsh Dr. Dowhaniuk 12 | Canadian CELIAC
This is an important step in the care of pediatric patients symptoms and health complaints a reliable, valid and feasible tool that children with celiac disease We are both that can be used to by healthcare experience will provide health- dedicated to providers to follow children with care practitioners with a tool to celiac disease over time, help en- help guide the care of children improving the gage children and families in their with celiac disease across Cana- care and well-being care, and will identify symptoms da. It will help to capture patients’ of children with that are common and important in views of their illness experience, the long-term health of children support shared decision-mak- celiac disease. with celiac disease to improve ing, and guide future research their overall well-being. in this field. Most importantly, to ensure we capture symptoms such a PROM will help make care that are important to them and How does this research fit into providers more aware of how are aligned with their treatment the bigger picture of your work their patients with celiac disease goals. Once developed, the PCSI with celiac disease? function and feel. We decided to can be used for celiac disease We are both dedicated to improv- undertake this study as no such symptom assessment both in clin- ing the care and well-being of measures currently exists. ical practice, to capture patients’ children with celiac disease. As illness experience and support the shared medical leads of the How do you hope your research shared decision-making, and in McMaster Children’s Hospital and will impact celiac disease research. Specifically, it will help The Hospital for Sick Children management? to identify changes in the clinical pediatric celiac disease clinics, Our study aims to develop a and functional status of a child we diagnose and care for many new disease-specific PROM, the over time. A change in symptoms children with celiac disease and Pediatric Celiac Symptom In- can alert healthcare providers their families. We are passionate dex (PCSI), designed to reliably to a change in the function of a about improving the quality of assess symptoms in children with child and/or their physical, mental children with celiac disease. We celiac disease from the perspec- or social well-being. For exam- are collaborating with centres tive of patients and their families. ple, in pediatric celiac disease Canada and North America on The PCSI will be the first pediat- new symptoms could represent a number of ongoing projects ric-specific celiac disease symp- a change in how well a child is that relate to many aspects of tom-related PROM. This is an adhering to the gluten-free diet celiac disease, including edu- important step in the care of pe- or signify the development of cation around the gluten-free diatric patients given the well-es- a complication related to celi- diet, assessing adherence to the tablished differences in symp- ac disease, such as arthritis or gluten-free diet, and how to more toms between children and adults constipation. The PSCI can also effectively detect and manage with celiac disease. Engagement be used to help guide manage- potential complications of the of patients and families in the ment and interventions provided disease. u development process will help in clinical care. The PCSI will be Canadian CELIAC | 13
Food Insecurity COVID-19 PANDEMIC INSPIRES CCA TO JOIN THE FIGHT AGAINST HUNGER New initiative asks SAVE ME FOR GLUTEN FREE When COVID-19 arrived in Can- food donations and hand them to “Who knows better than the ada last winter, CCA staff and clients instead of clients select- CCA community to assemble an volunteers pivoted to support ing the food on their own. The assortment of gluten-free pantry the community with information dangers of this change are that items?” says Melissa Secord, CCA and resources. What became a people with celiac disease would National Executive Director. “We major issue across Canada was potentially have to go hungry or quickly created a simple bold the issue of food insecurity. Lay- live in pain by eating food that is graphic and a message that could offs were mounting, businesses not gluten free. accompany the food donation closing and a surge on food that would alert the food bank bank visits. CCA’s Food Security Committee volunteers that this bag has been came up with the idea of pre-as- specially curated for someone While many well-intentioned sembled gluten-free kits. While who needs gluten free.” individuals and companies in at first, we were unsuccessful in While the initiative was launched the gluten-free community were attracting attention from major in the CCA’s year-end Holiday pitching in with their GF dona- grocers, we decided to plan to Survival Guide, it is hoped that tions, we know that many of ‘disrupt’ the system by asking this program, with more indus- these food donations don’t get the gluten-free community to try and individual support, will to the people who need it. As the make our own gluten-free food become a year-round effort to pandemic worsened, food banks kits. SAVEMEFORGLUTENFREE support the most vulnerable in were forced to change their busi- was born. our community. ness models and pre-assemble Continued on next page 14 | Canadian CELIAC
Join CCA to help fight hunger one gluten-free bag at a time. To help, follow these 4 steps: Step 1: Download and print our ‘SAVE ME FOR GLUTEN FREE” decals. Get here. Step 2: Purchase non-perishable gluten-free food items from your local or online grocery retailer. Look for foods that carry the CCA Gluten-free Certification Program mark. Step 3: Put your donations in a grocery paper bag and securely tape or staple the decal onto the outside of the bag. Step 4: Take to your local food bank or put in your grocery retailer collection bin. Bonus Step! SHARE! Snap a photo of your labelled bag or purchases and share on social using hashtag #SaveMe4GlutenFree and tag @CCAceliac so we can thank you for your advocacy efforts to raise awareness. FOOD INSECURE? Check out our online resources for a list of food banks across Canada who offer gluten-free food and tips on how to self-advocate and get access to safe gluten-free food here Canadian CELIAC | 15
ARE YOU GETTING ENOUGH VITAMIN D The sunshine vitamin can help you stay healthy and fight COVID-19 Vitamin D is a both a hormone and a fat-soluble vitamin that is necessary for proper immune function and required for the regulation of calcium, which is critical for building and maintaining healthy bones. Experts have discussed that a correlation exists be- tween vitamin D levels and COVID-19 susceptibility and that vitamin D could be an essential element in DEPOSIT PHOTO decreasing the risk of COVID-19 (Razdan, K., Singh, HOW MUCH VITAMIN D DOES AN ADULT NEED? K., & Singh, D. (2020). Age IU/day, RDA UL Males 9-70 600 4000 In general, many Canadians are not meeting the minimum daily requirements for vitamin D. This is Males >70 800 4000 likely due to the fact that vitamin D is found naturally Females 9-70 600 4000 in very few foods and in Canada, we have reduced Females >70 800 4000 sunlight exposure due to our long winters. Addi- Pregnancy 600 4000 tionally, for people with celiac disease, vitamin D is a nutrient of concern due to the potential for mal- Lactation 600 4000 absorption related to intestinal damage caused by gluten exposure. This can be particularly concerning HOW MUCH VITAMIN D DO MY CHILDREN NEED? in children when bones are rapidly growing and Age IU/day, RDA UL developing. Infants 0-6mths 400 1000 As a Canadian with celiac disease, it is important to Infants 7-12mths 400 1500 consume adequate quantities of vitamin D and to Children 1-3yrs 600 2500 consider routine supplementation during the winter Children 4-8yrs 600 3000 months and during COVID-19. Continued on next page 16 | Canadian CELIAC
Taken in appropriate doses, vitamin D is generally considered safe. However, since it is fat-soluble, if too much of the vitamin is ingested, it can build up in the body to levels where it becomes toxic. The upper limit (listed above) is the highest level that is likely to pose no risk of adverse health effects for almost all individu- als in the general population. As intake increases above the UL, the risk of adverse effects increases. Note: If supplementing with Vitamin D, It is always important to talk with your healthcare provider to deter- mine a dose that is best for you. 10 Gluten-Free food sources of Vitamin D Food Vitamin D (IU) 75g Salmon 435 75g Herring, Atlantic, cooked 161 75 g Sardines, canned 70 75g Tuna, canned, light 36 1 cup GF breakfast cereal, fortified 168 1 cup Orange juice, fortified 100 1 cup Milk, fortified 115 1 cup Yogurt, fortified 88 1 Egg yolk 43 1 cup Shiitake mushrooms 53 Did you know? Vitamin D helps your body effectively absorb calcium. Calcium is necessary for building strong, healthy bones. Without vitamin D, your body can only absorb ~10-15% of calcium from your diet. Make sure you consume enough vitamin D in order for your body to absorb enough calcium. Additional tips • Spend more time outside • Consume at least 2 servings of fatty fish per week. • Eat fortified foods • Take a supplement Resources Razdan, K., Singh, K., & Singh, D. (2020). Vitamin D Levels and COVID-19 Susceptibility: Is there any Correlation?. Medicine in drug discovery, 7, 100051. https://doi.org/10.1016/j.medidd.2020.100051 u Canadian CELIAC | 17
My celiac journey BROKEN BONES BUT NOT A BROKEN SPIRIT. Krista’s journey to raise $700 for 700km and take back her life. BY KRISTA EVANS I’ve known about celiac disease since I was a little kid. My best friend’s Aunt had it. But I didn’t com- pletely understand it. Around 2004 my sister ended up being diagnosed with celiac disease (CD) due to severe stomach issues. She was actually diagnosed fairly quickly because of the acute pain she was in. There was never any mention that my brother and I, or our parents for that matter, should be tested. Fast forward to 2011 and I broke my ankle for the first time. In fact, it was the first time I had ever bro- ken a bone. I didn’t think much of it as most people break a bone in their lives. In 2017 while in South Africa I broke the ankle again. While I thought it was unusual, I didn’t really question it because again people break bones. It wasn’t until later in 2017 when I broke my other ankle that I knew something was going on. I went to my doctor and insisted he needed to help me figure out what was going on. He sent me to an endocrinologist after the bone density scan came back normal and she tested for everything she could think of in my blood that could impact my bones. Ev- I had a 1st degree relative with CD came up and she erything came back fairly normal, but my Vitamin D ordered the blood test. I never would have suspect- levels. In fact, she said she was surprised at how low ed I had CD. People with CD have stomach issues, my levels were. In discussions with her the fact that they lose weight etc. I’m definitely not underweight, 18 | Canadian CELIAC
I soon realized the impact of celiac disease on my quality of life, mental health and personal identity. PHOTOS SUPPLIED BY KRISTA EVANS and I didn’t have any stomach issues. Imagine my surprise when the blood work came back posi- tive. Six months later, in June 2019 the endoscope confirmed the re- sults of the blood work and I was diagnosed with CD. What a change to my life. I live alone so I ate a lot of conve- nience food. Who wants to cook just for themselves? With gluten free, the options for convenience were drastically reduced. Since the diagnosis and sticking to a GF diet I have actually lost quite a bit of weight (not a bad thing for me) and have definitely found I have more energy. Being on Iron and Vitamin D supplements have helped. When Covid-19 hit in 2020 and I could not go to the gym anymore I started taking my dog, Hiccup, for long walks regularly as it got me out of the house and doing something. It’s something we have both definite- ly enjoyed and we walked about 450km over the course of about 8 months. This year I wanted to set a goal and push myself and have chal- lenged myself to walk at least 700 km with Hiccup over the course of 2021. But I needed a way to and 1% of all Canadians, I decided One dollar for every kilometer I be accountable because other- to raise money to help find a cure, walk. wise it would just be something or at least a treatment that doesn’t I started and didn’t follow up on. involve the insanely expensive To support Krista’s campaign, you With celiac disease now impacting GF diet. With CanadaHelps.org I can visit her CanadaHelps fund- myself, my sister, many friends created a fundraiser to raise $700. raising page at: Click here. u Canadian CELIAC | 19
Sweets for the Sweet DEPOSIT PHOTO CCA’S GUIDE TO CHOCOLATE Ursula Kohaupt said, “chocolate is happiness that you can eat.” While chocolate is a favourite and decadent treat that often makes one smile, not all chocolates are safe to eat if you have celiac disease or a non-celiac gluten sensitivity. Chocolates are a perennial go-to favourite for many holidays like Valentine’s Day and Easter. The following is a brief guide DEPOSIT PHOTO to help one ensure chocolates are enjoyed while maintain- ing a gluten-free lifestyle. Is Chocolate Gluten Free? Pure, unsweetened chocolate is derived from roasted cacao beans, which are naturally gluten free. Howev- er, most of us do not eat pure cacao beans. Instead, we eat cacao bean-based confectioneries and baked goods that may or may not have gluten containing ingredients or be contaminated with gluten. Chocolate-based Treats: Checking for Gluten • It is important to always read the label of any packaged or processed product. If the full label is not available, for example the product is being purchased online, then the product may not be safe and should not be eaten. • Carefully read the label for any gluten-containing ingredients. Products with chocolate may have ingredients that contain gluten. • Ingredients can be obvious like added cookie dough, biscuit or pretzels. • Or ingredients may be less obvious like added malt (barley malt, malt extract, malt flavouring or malt syrup; read the following link for more information about malt: https://shelleycase.com/what- is-malt-is-it-gluten-free/), graham, wheat flour, or brewer’s yeast, as a few common examples. • Carefully read the label, even if the brand of product with chocolate is familiar. • For example, holiday-sized chocolates may be made with different ingredients. • For example, holiday-sized chocolates may be made in a different facility and cross-contaminated with gluten. • Carefully read the label for the country of manufacturing. The same brand of product with chocolate may contain gluten in one country, but not another. • Check the label for manufacturer’s contact information to get more details about the source of ingredients or manufacturing processes. u 20 | Canadian CELIAC
A Gluten-free Certified Program Partner Feature CONVENIENCE, FOOD SAFETY AND CONSERVATION ARE AT THE HEART OF MARCANGELO FOODS Serving up quality gluten-free options for nearly 30 years What do you bring to our table? We take pride in the premium products we produce. From our fully cooked proteins to our kabobs, sausages, steaks and roasts, we use only the freshest, finest cuts of meat and poultry, plus traditional herbs and spices. Our goal is to provide healthy, tasty and affordable value-added foods to people looking to save time and effort in their meal preparation, while striving towards sustainability, environmental preservation, and responsible animal welfare policies. We hear you are great at saving consumers’ valuable time. Tell us more! We offer a wide range of fresh and frozen value-added meats, most of which are ready to cook right from the package: marinated kabobs, roasts, steaks, sausages, burgers and meatballs. We also offer a full line of fully cooked ready to eat chicken strips, meatballs, kabobs and breast portions. Continued on next page Canadian CELIAC | 21
What is your most popular item? Our Souvlaki kabobs and our Italian sausages are very popular. What makes your products unique? We offer high-quality Mediterranean-inspired products that are fully prepared and ready to cook, or in some instances, already cooked and ready to eat. Are all your products gluten free and safe from cross contamination? All our products bearing the Gluten-Free logo are strictly gluten-free and safe from cross- contamination. We observe stringent HACCP protocols to ensure that GFCP standards are met with every gluten-free product we make. Why did you become certified? Why is this important for your company? Many of our products are naturally gluten free. Becoming certified was a logical step for us in offering consumers peace of mind when they buy our gluten-free products. The GFCP logo on our packaging makes shopping and meal planning easier for those with celiac disease and other gluten intolerances. Where can customers find Marcangelo products? Marcangelo products are available at all major grocery retailers across Canada. u 22 | Canadian CELIAC
Online Shopping THE GREAT BINGE: THE STORY OF COVID-19 AND GROCERY STORES COVID-19 saw a run-on grocery store shelves this past year and CCA wanted to know the impact on the gluten-free consumer This past fall as the world entered the second wave of the COVID-19 pandemic, CCA wanted to find out if gluten-free consumers would be seeing an impact on their favourite gluten-free food and companies. The spring saw a run on toilet paper, pasta and flour as Canadians hunkered down under government lockdowns. What can we expect as we move ahead? The results? Demand was up while Canadians cooked at home more. And while companies did experience pressures, they pivoted to face this demand through innovation and DEPOSIT PHOTO gave back to help support the fight against hunger. Check out the highlights from the survey. Continued on next page 24 | Canadian CELIAC
46.7% of companies are coping with the COVID-19 pandemic by increasing their online presence To what extent has your firm’s Are you providing home delivery operations/production of Gluten- for customers unable to leave free products been affected by their homes during COVID-19? the COVID-19 pandemic? • 86.7% of companies are • 40% of companies reported providing home deliveries facing small difficulties in directly to consumers maintain production/operations • 26.7% of companies reported Do you see the Canadian Celiac that they were mainly impacted Association as a viable partner to due to an increase in demand help inform the Canadian Gluten- for certain products free community with updates? Martha Henderson • 73.3% of companies see the Are andyou facing Patty any problems Massel CCA as a viable partner to with sourcing gluten-free food keep the Canadian Gluten-free ingredients/gluten-free products? community updated • 35.7% of companies reported increase in domestic demand/ Are you making any donations to sales to consumers directly food banks in Canada to improve the food security issue? What strategies are you adopting • 53.3% of companies are to cope with the crisis? making donations to food • 46.7% of companies are coping banks in Canada to improve with the COVID-19 pandemic the food security issue by increasing their online presence Did you come up with any product innovation? • 42.9% of companies came up with innovations during this pandemic Answers were not conclusive regarding how COVID-19 is impacting the business operations/ production of gluten-free products. More participants are needed for a conclusion u. Canadian CELIAC | 25
THE TRANSFORMATION OF GLUTEN-FREE BAKING AND COOKING BY LIZ PIETRZAK Gluten-free Baking DEPOSIT PHOTO Gluten is a binder, that adds elasticity, and helps to keep the ‘structure’ of baked goods. Back in 1970’s, when gluten allergies were identified, and became a mainstream concern, bakers chiefly used corn, rice and potatoes flour as gluten free flours. Eggs were commonly used to replace the gluten, and this limited what you could bake. Bakers (my sister) were making Black Forest Cakes with rice flour, and potato mini Continued on next page 26 | Canadian CELIAC
loafs with whisked egg whites. existence of soup can be traced Currently, there is much a home Her 1982 wedding cake was as far back as 20,000 BC. The cook can do to replicate the homemade three tier rice, many first soup was likely a broth made ingredients and cooking qualities fruits and nuts, and egg white from the protein hunters were able of gluten, and still make a delicious delight. to catch, and the farmer-gathers dish. added vegetables and grains Bakers then discovered the that were grown nearby. Dishes TIPS FOR THICKENING DISHES ‘gluten’ like properties of guar became ‘thicker’ with whatever gum and xanthan gum. Adding a was added that was available. • Thickening agents you can add teaspoon to a cup of gluten-free as you are making your dish flour, created the binding and rising Cooking has followed this method include tapioca and arrowroot properties of gluten. As bakers to the present day. Cook what you flour and cornstarch. They add experimented, they discovered can buy or grow and then add minimum flavour to your dish, more varieties of gluten-free more stuff. For many centuries, if and you can adjust the amount flours and options increased the eater did not like a dish, it was of thickening. tremendously. There was now likely stated “they did not like one arrowroot, bean flours, cornmeal, of the ingredients”. Perhaps it may • Vegetables can also be various rice flours, soy flour, be that they did not feel well after roasted or grilled, to reduce tapioca flour and many more. eating that ingredient and tried to their liquid content, and them avoid eating it. mashed and added to a dish. With the growth of knowledge, and exposure of a gluten-free With the acknowledgement and • Usually, a tablespoon of diet, came the availability of many practice of identifying ingredients thickener should be added to baking flours and mixes, that that some people are allergic the liquid in your dish, or to a contained all the dry ingredients. to, or react badly too, came the liquid ingredient you are about A gluten-free baker can now make discovery that people may be to add to your dish. virtually, any baked good. ‘allergic’ to bread. Further research DEPOSIT PHOTO established people were either • Let the dish cook for a while Gluten-free Cooking: intolerant to gluten or as with to activate the thickening, celiac disease, the body had an and then add more as you Soups, stew, and other ‘creamy’ autoimmune response in the small require. u dishes have been since around intestines. for a very long time; the earliest Canadian CELIAC | 27
Ask the expert BUYING GLUTEN-FREE FOODS ONLINE In an era of advanced technology, and during a world- wide pandemic, online shopping may be an option of interest. Online shopping can be convenient, fast and affordable – But is it safe to buy gluten-free foods online? We asked a Registered Dietitian. BY INEZ MARTINCEVIC Q. Why buy gluten-free foods Q. What should buyers be read the product label to make online? cautious of? sure it is safe and free from • New products not yet avail- • Not all websites have the most gluten-containing ingredients able in stores up to date nutrition informa- • More choice and variety as tion of gluten-free products, Additional tips for shopping stores are limited by shelf so check the manufacturer’s safely online: space, especially for glu- website if you are not purchas- • Research the retailer ten-free options ing direct from the food maker • Browse safely by using web- • Often more affordable includ- • Photos of gluten-free products sites that start with HTTPS and ing coupons, codes, deals, may not include all the neces- anti-virus technology free shipping sary information to find out if • Protect your accounts by cre- • You can compare products the product is safe for people ating very strong passwords and prices in a pressure-free with celiac disease, so contact and monitor your banking/ environment the manufacturer for more credit information often • There are usually reviews of information • Take other precautions like the website and/or gluten-free • Some online retailers get glu- limiting your personal informa- products from customers, like ten-free products from outside tion and using a secure Wi-Fi you, which can help with the of Canada, so be sure to do network decision to buy the product your research and check that • The Canadian Centre for Cy- • There often is live customer the product is safe for people ber Security has some helpful service or access to customer with celiac disease information: https://cyber. service to help with your shop- • Ingredients may be different gc.ca/en/guidance/how-shop- ping experience from what was listed online. online-safely-itsap00071. u Before consuming, always 28 | Canadian CELIAC
Recipes 30 YEARS OF BEING HERE FOR THE GLUTEN-FREE COMMUNITY CCA asked Chef Lori Grein at Kinnikinnick to inspire us with some sweet and savoury treats to get us through the cold winter days. Cookies and Cream 3. In a medium KinniTOO® Cookies bowl, cream butter, vanilla, Moist, soft cookies smothered and sugars in white chocolate. until light and Recipe created by Kinnikinnick fluffy. Add Corporate Chef Lori Grein eggs one at a time, beat- INGREDIENTS ing well after z 1 package Kinnikinnick Choc- each addition. olate KinniTOOS® - reserve ½ 4. Slowly add package (220 g) All Purpose z 2¼ cups Kinnikinnick All Flour Blend, Purpose Flour Blend (444 g) salt and z ½ tsp salt (2 g) baking soda fitting bowl on top). Dip the tops PHOTOS SUPPLIED BY KINIKINNICK z 1 tsp baking soda (4 g) to creamed mixture alternating of each cooled cookie in white z ½ cup granulated sugar (105 g) with water. Mix until fully chocolate. Top with broken z ¾ cup brown sugar (146 g) incorporated. Chocolate KinniTOOS®. Let z ¾ cup softened butter (144 g) 5. Fold in chocolate chips and ½ set completely before storing z 1 tsp pure vanilla extract (3 g) package crushed KinniTOOS®. in an air-tight container. Store z ⅓ cup water (80 g) Stir until combined. Drop dough with parchment paper between z 2 large eggs (112 g) onto baking tray leaving 3 layers to prevent sticking. z 1 cup white chocolate chips (180 g) inches between. Bake in pre- z 6 oz white chocolate (170 g) heated oven for 8 - 10 minutes. Yields 24 - 30 cookies Remove from oven and let cool DIRECTIONS completely. 1. Preheat oven to 375°F (190°C), FINISH lightly spray baking tray or line 1. Break reserved ½ package with parchment paper. Chocolate KinniTOOS® into 2. In a bag, crush ½ package of small pieces. Set aside. Chocolate KinniTOOS®. Set 2. Melt white chocolate on a bain aside. marie (pot of water with a snug Canadian CELIAC | 29
Chocolate KinniTOOS® Cake 6. Divide batter evenly between Crumb Coat Using Cookies ‘N cake pans. Cream Filling, spread a thin layer Explosion of everyone’s favour- 7. Bake in preheated oven for 15 - on top of cake and sides. Use a ite gluten- free sandwich crème 17 minutes. pallet knife to smooth top (don’t cookie! Recipe created by Kinni- Yields 5 (6”) cakes use too much icing). Use a large kinnick Corporate Chef Lori Grein scraper to remove excess filling Simple Syrup (optional) from sides and smooth. Finish INGREDIENTS 1. Bring sugar and water to a boil, with the top of the cake, using a Cake do not stir. Boil for 3 minutes. pallet knife to create a smooth z 1 package Kinnikinnick White Let cool completely. top. Let crumb coat set in the Cake Mix (500 g) Simple Syrup can be stored in the refrigerator for 20 minutes. z 4 large eggs (224 g) refrigerator for up to 3 weeks z 1 cup water (213 g) Vanilla Buttercream Coat Using z ¾ cup vegetable oil (115 g) Cookies ‘N Cream Vanilla Buttercream Icing, place a z ½ package Kinnikinnick Choc- Buttercream Filling dollop of icing on top and smooth olate KinniTOOS® - crush into 1. In a medium bowl, mix butter working your way to the edges small pieces (110 g) until smooth. using a pallet knife. Add a gen- 2. Slowly add sifted icing sugar 1 erous coat of icing on the side of Cookies ‘N Cream cup at a time alternating with the cake. Use a large scraper to Buttercream Filling milk. scrape off excess from sides and z 1 cup butter (222 g) 3. Mix until smooth and incorpo- create a smooth finish. Finish with z 3 cups icing sugar (480 g) rated. top of cake using a pallet knife to z ¼ cup milk 2% (50 g) 4. Fold in ½ package fine create a smooth finish working z ½ package Kinnikinnick Choco- crumbed Kinnikinnick towards centre of cake. late KinniTOOS® - crushed fine Chocolate KinniTOOS®. (110 g) Do not refrigerate. Decorate Decorate sides of cake with ½ package of crushed Kin- Vanilla Buttercream Icing Vanilla Buttercream Icing nikinnick Chocolate KinniTOOS® PHOTOS SUPPLIED BY KINIKINNICK z 1 cup butter (222 g) 1. In a medium bowl, mix butter (half way up the side of the cake). z 3 cups icing sugar (480 g) until smooth. In a small bowl mix remaining z ⅓ cup milk 2% (80 g) 2. Slowly add sifted icing sugar 1 Cookies ‘N Cream Filling with re- z 1 package Kinnikinnick Choc- cup at a time alternating with maining Vanilla Buttercream Icing. olate KinniTOOS® - crush ½ milk. Place in a piping bag with a star package/reserve remainder 3. Mix until smooth and incorpo- tip. Pipe rosettes on the top of the whole cookies (220 g) rated. Do not refrigerate. cake. Decorate with reserved Kin- nikinnick Chocolate KinniTOOS® Simple Syrup (optional) ASSEMBLY Cookies. z 1 cup granulated sugar (240 g) Cake Trim tops of each cake z 1 cup water (240 g) base using a serrated knife for a total of 5 layers. Place DIRECTIONS one cake base on a 6” cake Cake board (bottom cake side 1. Preheat oven to 350°F (176°C). down). Spray cake base 2. Lightly spray 5 shallow (6”) with Optional Simple Syrup. cake pans. Set aside. Using Cookies ‘N Cream 3. In a medium bowl combine Buttercream Filling, spread eggs, oil and water. Mix with a an even layer on cake base. whisk until combined. Place the next cake base on 4. Add Kinnikinnick White Cake top and repeat with remain- Mix and whisk until combined. ing layers. Finish top layer 5. Fold in crushed Kinnikinnick (bottom side up). Do not Chocolate KinniTOOS®. spray with Simple Syrup. 30 | Canadian CELIAC
Individual Pepperoni Pizza z ¼ cup shredded mozzarella slices each direction). PHOTOS SUPPLIED BY KINIKINNICK Pull Apart cheese (28 g) 4. Loosely press 5 slices into each z ¼ cup shredded cheddar greased muffin cup creating a Perfect snack for those late-night cheese (30 g) solid base. movie munchies. Recipe created z Optional: finish with dried orega- 5. Top with pizza sauce and by Kinnikinnick Corporate Chef no sprinkle with ½ of the cheese. Lori Grein Top with sliced pepperoni and PREPARATION DIRECTION sprinkle with remaining cheese. INGREDIENTS 1. Preheat oven to 375° (190°C). 6. Bake in preheated oven for 10 - z 1½ package Kinnikinnick Ham- Lightly grease 8 spaces of a 12 minutes until bottom crust is burger Buns (245 g) muffin pan. crisp and cheese is melted. z ½ cup pizza sauce (gluten-free) 2. In a small bowl, combine both 7. Garnish with optional oregano. (110 g) cheeses together. Set aside Serve immediately. z 8 pepperoni slices - quartered 3. Cut Kinnikinnick Hamburger Yields 10 pizza pull apart u (gluten-free) (70 g) Buns into 25 slices each (5 Canadian CELIAC | 31
Upcoming CCA Events GF101 - February Webinar Celiac Disease: Tax Credit Legacy Giving: How charitable When: Feb 18, 2021 07:00 PM When: Feb 23rd, 2021 giving can increase what you Eastern Time (US and Canada) 7:00 pm EST leave for family Topic: Gluten Free 101: Getting When: April 8, 2021 started on the gluten free diet Register in advance for this webinar: 8:00pm EST https://us02web.zoom.us/webi- Register in advance for this webinar: nar/register/WN_EMblIZArRH- Speaker: Jennifer Stebbing, Ross & https://us02web.zoom.us/we- W7H5wCr25EAQ McBride LLP Certified Specialist in binar/register/WN_vIm5xzk2S- Estates and Trusts MerHnxcs_rnkQ Is gluten a problem for you? Many people want to help their fa- When: Mar 4, 2021 vourite charity or cause by leaving GF101 - March Webinar 7:00 PM EST a legacy donation but worry it will When: Mar 13, 2021 04:00 PM take away from what they leave Eastern Time (US and Canada) Register in advance for this webinar: behind for their family or friends. Topic: Gluten Free 101: Getting https://us02web.zoom.us/webi- Learn how you can give in your will started on the gluten free diet nar/register/WN_HohyxAk4RN- or insurance and leave more for 2P4Rq1guBj5w the ones you love. We are pleased Register in advance for this webinar: to have Jennifer Stebbing, LLP who https://us02web.zoom.us/webinar/ Do you think gluten is a problem is uniquely situated to assist with register/WN_W7gJ2gqfTnibIIhho- for you? Do you get an stomach any planning needs given her des- vyTMQ upset or have bloating after eat- ignation as a Certified Professional ing pasta, bread, pizza or baked Consultant on Aging (CPCA) and in GF101 - April Webinar goods? Or maybe you experience Wills and Estates. It’s an interactive When: Apr 12, 2021 06:00 PM a headache, joint pain or fog session so bring your questions! Pacific Time (US and Canada) brain? Join the Canadian Celiac Topic: Gluten Free 101: Getting Association (CCA) and Dr. Mohsin Click here to register: https:// started on the gluten free diet Rashid for a free webinar on un- us02web.zoom.us/webinar/reg- derstanding the signs and symp- ister/WN_wCmLCocIQDmcwW- Register in advance for this webinar: toms of celiac disease and gluten PntzQgBw https://us02web.zoom.us/webi- disorders. He’ll cover some of nar/register/WN_O2JbbZNPT- the common and not so common CCA National Virtual Conference la2c6W5iRq6Bg signs of gluten-related conditions When: November 13 & 14, 2021 – and learn what next steps you can Save the Date After registering, you will receive take to feeling better. a confirmation email containing Two streams of education – information about joining the After registering, you will receive one weekend of learning webinar. a confirmation email containing • On the Cusp of Diagnosis and information about joining the Newly Diagnosed webinar. • Education for the Experienced Celiac or Healthcare Practitioner To stay updated with all CCA events. Click here: https://www.celiac.ca/news-events/events/ 32 | Canadian CELIAC
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