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Celiac Disease Nutrition Resources

Gluten-Free Diet Resources

What is gluten? 

Gluten is a protein found in wheat, rye and barley and can be hidden in additives and other ingredients. Gluten is the substance that forms the structure of dough, like the “glue” that holds the product together. 
The tricky part of following a gluten-free diet can be when ingredients are derived from gluten-containing grains. For example, malt is usually derived from barley, and therefore is not safe to eat on a gluten-free diet. The following lists include foods to avoid as well as safe foods to include on the gluten-free diet. 
 

Common gluten containing foods include, but aren't limited to:

Barley Mazah
Beer (even used in cooking)* Modified food starch*
Bran* Noodles/Pasta*
Bread* Oats (products which aren't labeled gluten-free)
Brewer's yeast Pizza*
Brown rice syrup Rye
Bulger Seasoning and gravy mixes*
Cereal* Seitan
Cookies and cakes* Semolina
Communion wafers* Soy sauce*
Couscous Spelt
Crackers* Sprouted wheat or barley
Cream sauces* Stuffing*
Croutons Tabbouleh/Tabouli
Durum Teriyaki Sauce*
Farina Triticale
Flour (usually from wheat)* Udon
Kamut Vinegar (if the type is not specified)
Lunch meats* Wheat
Malt (includes malt flavoring, malt extract) Worcestershire sauce*
Malt vinegar  

 *Unless labeled gluten-free

Safe foods include, but aren't limited to:

Amaranth Meat (plain)
Arrowroot Milk (unflavored)
Baking soda Millet
Beans (dried beans, lentils, most baked beans) Montina flour
Buckwheat (beware of buckwheat being combined with wheat flour) Nut flour 
Butter Oats (only if labeled gluten-free)
Canola oil Polenta
Carob flour Potato
Cellulose gum Quinoa
Cheeses (caution on processed cheeses) Rice
Chickpeas (garbanzo beans) Rice crackers, rice cakes
Corn Sago
Cream of tartar Sorghum
Eggs Sesame
Flax Soy
Fruit (plain) Tapioca
Gelatin Teff
Guar gum Vegetables (plain)
Herbs Vegetable oil, canola oil, olive oil
Manioc Vinegar (apple cider, red wine, distilled, white, balsamic)
Masa (corn) Yogurt

Food Labeling Laws

The Food Allergen Labeling and Consumer Act:

  • Requires companies to list in plain language the eight most common food allergens (milk, egg, peanuts, tree nuts, fish, shellfish, soy and wheat) that are in the product.
  • Requires allergens to be listed even if used in small amounts (for example colorings, spices, and natural or artificial flavoring). 
  • The law does not include barley, rye, or oats. 
  • The allergen can be found on food labels in one of two places:
 In the ingredient list. 
This list must state the common name, such as wheat. The common name may be in parentheses after the ingredient name.
  In the “contains” statement. 
This always lists the common name, such as wheat. 
 Celiac ingredient listing    Celiac Ingredients Label


The Gluten Free Labeling Rule:

  • Allows for the voluntary use of the term “gluten free” for the labeling of foods
  • “Gluten free” is defined as less than 20 parts per million (ppm) of gluten in foods
  • Foods may be labeled “gluten free” if the food is either 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)
  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 ppm or more gluten in the food 

Reading Food Labels

Reading labels is a way of life for those with celiac disease. Label reading will be discussed when you meet with your dietitian. Learn to read labels carefully, and try to memorize safe and unsafe ingredient names. If a product has a questionable ingredient you should avoid it. You must read labels every time you purchase food because ingredients in foods can change. Just because a product is gluten free today doesn't mean it will be the next time you buy it.

3 Key Places to Look on a Food Package

  • Label/Logo indicating that product has been certified gluten free. If a product has this, no further label reading is required.
  • Not certified, but bears “gluten free” claim. Also applies to “no gluten”, “free of gluten”, and “without gluten.” Product should be safe to consume.
  • Ingredient list. For products neither certified nor labeled gluten free, it is essential to read ingredient list.

Calling Manufacturers

If you are unable to determine whether or not a product is gluten free you can call the manufacturer using the toll free number on the food package. Ask if the product contains wheat, barley or rye. Today, most customer service representatives understand the question and have reliable information about the gluten free status of their products. If the person you talk to doesn't appear to understand the question, be sure to ask to speak with a supervisor or quality control specialist.

Cross Contamination

Another source of hidden gluten can be from cross contamination. This occurs when a gluten free product comes in contact with a gluten containing product. As a result, the gluten free food will then contain a small amount of gluten that could cause a reaction in someone who is sensitive. Some examples of cross contamination are:

  • A toaster that has been used to toast gluten containing products
  • A knife used to spread peanut butter on gluten containing bread is dipped back into the peanut butter jar
  • A deep fat fryer that has been used for breaded products such as chicken nuggets, fried fish, etc
  • A conveyor belt in a manufacturing plant that has been used for gluten containing products

How to prevent Cross Contamination

  • Teach others about cross contamination and ask appropriate questions when obtaining food outside the home
  • Foods may have manufacturer advisory statements saying the product could have accidental inclusion of wheat by using manufacturer “advisory” warnings such as: “May contain wheat” or “Processed in a facility that also processes wheat.” These foods should be avoided.

Non Food Sources of Gluten

When you think of a dietary restriction, it's obvious to examine the foods you eat. But it's important to consider whether or not a product is gluten free, even if it's not typically thought of as food. If you can ingest it, you need to check it. This applies to chapstick/lipstick, medications, vitamins and mineral supplements, toothpaste, mouthwash, Play-DohTM and other products that curious kids may be tempted to put in their mouth.

Tips for Getting started on the gluten-free diet

Even if you feel overwhelmed, frustrated, deprived or confused about the diet, it's important to jump in with both feet and try to achieve and maintain a 100 percent gluten free diet, right from the beginning. It's OK to make mistakes. You and others will make them, especially in the first six months. But forget the notion of "easing into" the gluten free lifestyle. It's best to strive for a strict, gluten free diet right off the bat.

The gluten-free diet is difficult – at first

It's easy to get caught up in the challenges of this diet. Realize that it's OK to be angry, scared, frustrated and confused. Deal with those emotions in whatever way you find most therapeutic – confide in close friends, seek counseling or find other emotional outlets. When first diagnosed, many people with celiac disease never imagine that the diet will come easily; but before they know it, studying labels and ingredients becomes second nature.

Feeling deprived?

There's no need to feel deprived on the gluten-free diet. Many commercial products, including candies and candy bars, chips, ice cream, pretzels, crackers, cookies, brownies, cakes and pudding (many of which are available at any grocery store) are gluten-free (read labels to be sure).

Talking to friends and family about celiac disease

Everyone you talk to about this condition is likely to react differently. Some will understand and put forth a lot of effort to learn about the diet; others will have a hard time accepting the diagnosis and may not be receptive to information about the condition. Loan books to people, refer them to websites, and encourage them to learn more. The better they understand it, the more support they can provide.

Frequently Asked Questions

Are oats safe for those on a gluten free diet?

The protein found in oats is safe for those with celiac disease. However, there is concern that oats may become contaminated with wheat during milling and processing. It is recommended that you only consume oats that are labeled gluten free.

Are there risks to a gluten free diet?

Yes. Studies show that gluten free diets can be deficient in fiber, iron, folate, calcium, Vitamin D, Vitamin B12, and zinc. To decrease the risk of nutrient deficiencies, everyone following a gluten free diet should take a gluten free multivitamin supplement. Additionally, many gluten free products have more fat and sugar added to them to replace the taste and texture that gluten provides. Due to the increased fat and sugar content in commercial gluten free products some people on a gluten free diet unintentionally gain weight. To prevent excess weight gain, try to encourage naturally gluten free foods over commercially prepared gluten free foods.

But it's my birthday – isn't just a little bit of cake OK?

Even if you are like some people who do not feel the symptoms from eating gluten, you shouldn't sample, even a little. Instead, treat yourself to a candy bar, ice cream, gluten free cake, or one of the other many delicious gluten free treats that are available.

Can my whole family switch to a gluten free diet if just one of my children has celiac disease?

This is a common question as many families do not want to make different meals for each family member based on their dietary restrictions. The answer is yes but you must keep in mind that the cost of many gluten free products is typically higher than their gluten containing versions. Therefore, it may be more realistic to have your main family meal of the day (e.g. dinner) be gluten free but having different options available for your family at other meals.

How do I eat when I'm away from home?

This can be difficult at first but do not stay home for fear of making a mistake on the gluten free diet. Dining out is a part of life, so with a little planning and patience you can continue to enjoy eating away from home. Here are a few basic tips that will make eating out easier:

  • Before going out, do some research on local restaurants. Many restaurants have gluten free menus posted on their websites. Check to see if there are enough options for you.
  • Call the restaurant ahead of time and talk to the manager or chef. Do not be afraid to ask how foods are prepared. Ask how they prevent cross contamination in their kitchen.
  • Dine early or late, not during peak hours.
  • Explain your dietary restrictions by using words like “severe reaction” or “allergy”.
  • Be pleasant and informative, but not demanding.

How do I know if I accidentally eat gluten and what should I do if I do?

Most people with celiac disease who eat gluten experience a reaction, whether it's gastrointestinal in nature, a headache, irritability, joint or muscle pain, or another symptom. Usually the response occurs within four to six hours after ingesting gluten. It's important to think back on the foods you've eaten to determine what you ate that may have contained gluten, so that you can avoid that product in the future. If you do ingest gluten, the most important thing to remember is that you'll be OK. Don't panic. There is no need to call 911 and no need to call or see a doctor. Most importantly, don't let a mistake derail you from sticking to a 100 percent gluten free diet. If you make a mistake, learn from it and get back on track.

How do I send my child with celiac disease to school without worrying?

There are a few strategies we recommend:

  1. Empower your child- Involve your child in his or her condition, no matter how young he or she is; read labels with him or her, encourage him or her to make food choices with your help, and allow your child to help with food preparation. Teach your child to politely decline well-meaning friends and family who offer gluten-containing foods.
  2. Educate teachers-Provide your child's teachers with as much information as they will accept about your child’s condition and the gluten free diet. Make the teacher a list of safe and unsafe ingredients/foods to have on file. If they are interested in reading books or information on the topic, offer to buy or lend them a copy of your favorite gluten free guide. Make sure they understand your child's symptoms, so that if he or she accidentally ingests gluten, the teacher will be aware of the consequences.
  3. Pack a lunch- It is possible to let your child buy lunch at school, but it takes planning, coordination and cooperation between you and your lunch provider. In the beginning, it is best to send a gluten free lunch and gluten free snacks to be safe.
  4. Provide the teacher with treats- A large bag of small candies works well to leave with the teacher, in case there are surprise birthdays or unplanned events involving snacks or treats. If you know of a party or birthday in advance, bring your child a special treat – or better yet, bring gluten free treats for the entire class.

If I don't have a reaction to a food, can I assume it's gluten-free?

No. Those with Celiac disease have a variety of responses to gluten, ranging from no symptoms whatsoever to severe distress. Gluten is harmful to all with Celiac disease, whether there are symptoms present or not. Sometimes someone will accidentally or intentionally ingest gluten and have no reaction, and may assume they have "outgrown" the condition. No one outgrows celiac disease. 

What if I have a reaction to something that is gluten free?

Some people tend to assume that when they feel badly, it must be because they've ingested gluten, yet that's not always the case. People with celiac disease also can have allergies or difficulty with absorption of some sugars. The following can cause GI symptoms that are not related to gluten: acidic foods, sorbitol, guar gum, xanthum gum, lactose, flax, and other food allergens. Symptoms related to food should be discussed with your healthcare team.

Will gluten free foods always be labeled “gluten free"

No. The gluten free labeling rule is voluntary for food manufacturers. There are many products that are not labeled gluten free that are either naturally gluten free or contain no added gluten. In order to identify these foods you must read food labels/ingredient lists to ensure there is no hidden gluten. It is also important to remember that while gluten free may mean a product is wheat free, wheat free doesn't mean a product is gluten free. 
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