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Keeping a strict celiac disease diet—avoiding all foods that contain wheat, rye, or barley—is essential for those with celiac disease or non-celiac gluten sensitivity. People on a gluten-free diet can eat a well-balanced menu with a wide variety of foods. Unprocessed meat, fish, rice, fruits, and vegetables do not contain gluten, plus there are plenty of gluten-free breads, pasta, and cookies that use rice flour and alternative grains. The key is to focus on what you can eat, not what you cannot.
On the other hand, the gluten-free diet requires a completely new approach to eating. People on a celiac disease diet have to be extremely careful about what they buy for lunch at school or work and what they eat at cocktail parties or order from restaurants.
Cheating (eating food containing gluten) or cross-contamination (even as small as one-eighth of a teaspoon) can cause intestinal damage. A dietitian who specializes in celiac disease can help patients learn about their new diet.
A strict gluten-free diet—one free of all forms of wheat, barley, and rye—is necessary to help prevent both short-term and long-term consequences of celiac disease. Miniscule amounts of gluten—a crumb on a shared stick of butter—can be enough to cause problems for those with celiac disease.
Don’t eat a food if you are unable to verify the ingredients or if the ingredient list is unavailable. Regardless of the amount eaten, if you have celiac disease, damage to the small intestine occurs every time gluten is consumed, whether symptoms are present or not.
Understanding these dietary requirements will enable the newly diagnosed to read labels of food products and determine whether a product is gluten-free—critical knowledge for anyone on a celiac disease diet.
- Corn (maize)
- Nut flours
Grains Not Allowed in Any Form
- Wheat (einkorn, durum, faro, graham, kamut, semolina, spelt)
Foods/Products That May Contain Gluten
- Beers, ales, lager
- Breading and coating mixes
- Brown rice syrup
- Communion wafers
- Drugs and over-the-counter medications
- Energy bars
- Flour and cereal products
- Herbal supplements
- Imitation bacon
- Imitation seafood
- Nutritional supplements
- Processed luncheon meats
- Sauces, gravies
- Self-basting poultry
- Soup bases
- Soy sauce or soy sauce solids
- Stuffings, dressings
- Thickeners (roux)
- Vitamins & minerals
Those who eat a celiac disease diet know it’s essential to prevent gluten cross-contamination. Clean or replace the items in your kitchen where gluten contamination can occur: scratched pans, the toaster, colanders, cutting boards, your food mill. Do the homework to truly understand cross-contamination, gluten-containing ingredients, and food labeling so that your kitchen becomes a safe haven.
If your kitchen is not fully gluten-free, take steps to make sure there is no cross contact with gluten before baking. Scrub your counters and put utensils, pans, bowls, cutting boards and sponges in the dishwasher before baking gluten-free. Be aware that particles of wheat flour can linger in the air for 24 to 36 hours.
If someone in your household plans to continue to eat gluten, organize your pantry and cabinets so that no gluten-containing foods, pots, or pans are mistakenly used. Use clear plastic bins in your pantry to segregate items so there are no mix-ups when unpacking the groceries or when reaching for cereals or snacks. Color-code pots, pans, utensils, and the like with fun-colored duct tape so that it’s easy to tell which are dedicated for gluten-free use.
Take out everything in the pantry, refrigerator, and freezer and check labels. Keep a permanent marker in the kitchen and write “GF” (gluten-free) on all safe foods and condiments. Use separate jars of mustard, peanut butter, and jelly and separate sticks of butter to avoid cross-contamination from wheat crumbs. Or buy squeeze bottles for condiments, which reduces the chance of cross-contamination. Don’t buy foods from bulk bins that are prone to contamination from other grains.
Buy some prepared gluten-free foods, like frozen pizza, pasta, soup, pretzels, and other favorite snacks—whatever you enjoyed eating before going gluten-free. Having these on hand will keep you from feeling deprived and help you avoid the temptation to eat gluten. Try a few different brands to figure out which you like best. The best ways to find tasty alternatives are to get connected with others by joining a support group and to attend gluten-free fairs and expos, where you can sample different items before buying.
You’ll also want to stock some gluten-free baking mixes and a reliable all-purpose gluten-free flour blend. Find an all-purpose flour blend that can be used for almost everything, from fish sticks and tempura to birthday cake and sandwich bread. Once you’ve gained confidence, you can experiment with the growing variety of alternative gluten-free flours made from whole grains and seeds. The best ones offer rich flavor, nutrients, and fiber that will enhance your culinary repertoire.
Even if you’ve never baked from scratch, consider doing it now. Despite all the new gluten-free products available, many just don’t taste like the foods you remember. That’s where you and your oven come in. Any item you enjoyed prior to your diagnosis, you’ll be able to enjoy once again, gluten-free. Bread, cookies, cake, muffins, pizza—you’re limited only by your imagination.
The sweeping legislation known as FALCPA, the Food Allergen Labeling and Consumer Protection Act of 2004, requires clear labeling of the top eight allergens (milk, eggs, tree nuts, peanuts, fish, shellfish, soy, and wheat, frequently referred to as “the great eight”). Thus, all food containing wheat must declare it on the label.
The term “gluten-free” took shape in the United States in 2013. Updating an earlier proposal, the Food & Drug Administration issued a rule on Aug. 5, 2013 defining the term “gluten-free” for voluntary use in the labeling of foods. The compliance date for manufacturers was Aug. 5, 2014. Food products bearing a “gluten-free” label on or after that date are to meet the rule’s requirements: gluten content has to be less than 20 ppm (parts per million).
“In general,” the FDA ruling stated, “foods may be labeled ‘gluten-free’ if they meet the definition and otherwise comply with the final rule’s requirements. More specifically, the final rule defines ‘gluten-free’ as meaning that the food either is inherently gluten free; or does not contain an ingredient that is: 1) a gluten-containing grain (e.g., spelt wheat); 2) derived from a gluten-containing grain that has not been processed to remove gluten (e.g., wheat flour); or 3) derived from a gluten-containing grain that has been processed to remove gluten (e.g., wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food. Also, any unavoidable presence of gluten in the food must be less than 20 ppm.”
Permissible synonyms for “gluten free” include “free of gluten,” “without gluten” and “no gluten.”
For further reading, see these University Health News posts:
- “What Is Gluten?“
- “Celiac Disease Symptoms: Get Ready For Related Conditions“
- “Celiac Disease Diagnosis? 10 Steps You Can Take Right Now“
This article was riginally published in 2016 and is regularly updated.