A gluten-free diet doesn’t include foods that contain wheat, rye and barley or foods and products made from these grains. As a result, a person with Celiac disease should not eat most grain, pasta, cereal, and many processed foods.
Despite these restrictions, people with Celiac Disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from mainstream stores.
“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with Celiac Disease can freely eat these foods. In the past, people with Celiac Disease were advised not to eat oats. New evidence suggests that most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with Celiac Disease should work closely with their health care team when deciding whether to include oats in their diet. Examples of other foods that are safe to eat and those that are not are provided in the table below
The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with Celiac Disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they grab for a snack. Eating out can be a challenge. When in doubt about a menu item, a person with Celiac Disease should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.
Gluten is also used in some medications. People with Celiac Disease should ask a pharmacist if prescribed medications contain wheat. Because gluten is sometimes used as an additive in unexpected products—such as lipstick and play dough—reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature.
The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect on January 1, 2006, requires food labels to clearly identify wheat and other common food allergens in the list of ingredients. FALCPA also requires the U.S. Food and Drug Administration to develop and finalize rules for the use of the term “gluten free” on product labels.
The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with Celiac Disease should discuss gluten-free food choices with a dietitian or physician who specializes in Celiac Disease. People with Celiac Disease should always read food ingredient lists carefully to make sure the food does not contain gluten.
- Wild Rice
- Indian Rice Gras
- Job’s Tears
Foods to Avoid
- Including einkorn, emmer, spelt, kamut
- Wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
- Triticale (a cross between wheat and Rye
Other Wheat Products
- Bromated flour
- Graham flour
- Self-rising flour
- Durum flour
- Phosphated flour
- Enriched flour
- Plain flour
- White flour
Processed foods that may contain wheat, barley or rye
- Bouillon cubes
- French fries
- Seasoned tortilla chips
- Brown rice syrup
- Self-basting turkey
- Imitation fish
- Chips/potato chips
- Soy sauce
- Cold cuts, hot dogs, salami, sausage
- Rice mixes
- Vegetables in sauce
Points to Remember
- People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
- Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
- Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
- A person with celiac disease may or may not have symptoms.
- Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
- Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
- Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
- A dietitian can teach a person with celiac disease about food selection, label reading, and other strategies to help manage the disease.